Health Care Reform

[boggvir]

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America can't afford it, the way it's currently structured. Raising taxes is ludicrous, because we have so many low-hanging fruits of budgetary excesses as it is.

In my opinion, America can't afford a trillion dollar war budget. It can afford a hundred billion healthcare bill. Even if it runs to two hundred billion.

I think you can do all that in conjunction with raising taxes to close the deficit. At least that what I'd do, and the people who support it are the ones I usually vote for.

 

[IvyHopeful20]

Obamacare FTW.

 

[wristbandMD]

 

[Sesom]

You all are false!

 

[NickNaylor]

Agree with HCR in principle, don't agree with the way it's funded. American government spending is a house of cards, and it's going to come falling down at some point. If people want HCR, that's fine, but they should raise taxes in order to fund it. Of course that's never going to happen, because people are utterly ******ed and ZOMG I DONT WANT TO GIVE AWAY MORE OF MONEY!!1111

 

[boggvir]

Yes I'd agree with that.

 

[VikingLegacy]

baleeted

 

[Charles_Carmichael]

I don't know how much I like about the new legislation. In my opinion, there are several things that could be changed in order to reduce the costs associated with the delivery of medical care before doing something that has the potential to drastically affect patients.

First of all, there's a lot of excess fat in terms of the administrative layers present in the health care system. By getting rid of administrative positions/hassles that do not affect patient care, we'd be able to save a significant amount of money. Do we really need to have physicians justify their clinical judgment to insurance administrators? Do we really need to have a ridiculous amount of paperwork to fill out for each patient? Why do we need so many administrators in the delivery of medical care? Do these administrative hassles really improve patient care? Or do they have no meaningful impact other than increase the costs associated with the health care system?

The second area where I think a lot of money could be saved is with end-of-life care. The cultural mindset in America is that death is something unnatural and that we should do everything in our power to avoid it. There are a lot of things that medicine can offer to prolong life, but many of them do not offer any improvement in quality of life and some even reduce it. Around 30% of Medicare's budget is spent on people in their last year of life. A lot of money could be saved by changing the cultural mindset that death should be avoided at all costs, even if it means very little to no quality of life. Should patients be able to demand treatments that offer no tangible medical benefit while carrying a significant risk of side-effects, etc? Is it a wise idea to provide all heroic measures to keep people alive not matter what the adverse effects of such measures are? By utilizing hospice care rather than providing futile (and expensive) end-of-life care, not only will a lot of money be saved, but also, families will be more satisfied (as several studies have shown).

Lastly, we need to address the area of defensive medicine. Unfortunately, this mentality seems to be so engrained into the minds of current students and physicians that even if plans are set in motion to curb this practice, it might easily be several generations before any real results are seen. I think that by enacting malpractice reform (not tort reform...I'm not suggesting that caps should be placed awards paid to patients) that would compensate patients truly damaged due to negligence in a no-fault manner would be ideal. Not only will this reduce frivolous lawsuits as well as the costs associated with such lawsuits, but it will also allow physicians to be more open about mistakes (because of the no-fault approach) and the open discussion of medical errors would likely help avoid future mistakes. That would be beneficial to both patients and physicians.

So, rather than drastically overhauling the system, I really think that targeting things that won't negatively affect patient care should be the first thing to do. And I really think that the things I mentioned have the potential to save a lot of money. After cutting this excess fat, if there's still a need for cost cutting, then we can start thinking about changing things that would have a significant impact on patient care.

 

[LuciusVorenus]

My health insurance through one of my parent's employers had agreed not to terminate young adults back in April ahead of schedule..but my mom's employer still kicked me off the family health insurance when I graduated at the end of May. I think there is still a small problem when people can just opt out of things.

I got a job with benefits and insurance a few months later so no big deal but that sucked. When my mom confronted HR about it all they said was "oh no that doesn't apply to us, we opted out of that"

"The employer would continue to cover all or part, but employers may choose to opt out of the early implementation. This extends coverage to age 26 only for currently enrolled dependents. Employers could choose not to support the early start to this implementation by sending Providence Health Plan an updated termination list of covered members. However, by federal reform law, the employers must comply with the under 26 rule at their next health plan contract renewal after Sept. 23, 2010."

Sounds like they opted out of early implementation, they have no choice now as of the 23rd. You could call them back if you wanted, probably.

Who said I support insurance? We don't have insurance. Insurance is meant to cover catastrophic costs, i.e. home burns down, car is totaled etc. We should go to a system of high deductible i.e. 5 or 10k deductible insurance plus HSAs. Plus medicare sucks I plan to refuse it when I practice. If you're afraid of the costs of cancer then don't seek treatment.

We should totally implement that when it comes to the fire/police department too! It would be pretty cool if we made all roads toll roads too! If you're afraid of how much it would cost to drive/keep your house/family safe then don't pay for it. Easy stuff! 🙄

I'm so sick of hearing about Libertarianism. There's no such thing as total individual liberty when you live in a country. You have to pay taxes, it's as simple as that. Don't pay taxes and you can watch your country slowly crash and burn around you. Then you can move somewhere else!

Next time you enjoy your weekend/holiday/child labor laws/lack of indentured servitude/education/minimum wage/product that isn't ridiculously expensive because it didn't come from a monopoly, make sure you thank some sort of deity the majority of the country doesn't share your beliefs.

 

[BBender716]

My friend's dad went to the doctor with back pain. He prescribed him some physical therapy. In the next month he switched health insurance providers because he lost his job and went back in to the doctor when he had a bad cough that month. He was diagnosed with a rare form of lung cancer and his insurance company refused to cover any treatment citing it as a "pre-existing condition".

Things like that always help me "reality check" myself when talking about things that can quickly get theoretical instead of practical.

 

[NickNaylor]

"The employer would continue to cover all or part, but employers may choose to opt out of the early implementation. This extends coverage to age 26 only for currently enrolled dependents. Employers could choose not to support the early start to this implementation by sending Providence Health Plan an updated termination list of covered members. However, by federal reform law, the employers must comply with the under 26 rule at their next health plan contract renewal after Sept. 23, 2010."

Sounds like they opted out of early implementation, they have no choice now as of the 23rd. You could call them back if you wanted, probably.



We should totally implement that when it comes to the fire/police department too! It would be pretty cool if we made all roads toll roads too! If you're afraid of how much it would cost to drive/keep your house/family safe then don't pay for it. Easy stuff! 🙄

I'm so sick of hearing about Libertarianism. There's no such thing as total individual liberty when you live in a country. You have to pay taxes, it's as simple as that. Don't pay taxes and you can watch your country slowly crash and burn around you. Then you can move somewhere else!

Next time you enjoy your weekend/holiday/child labor laws/lack of indentured servitude/education/minimum wage/product that isn't ridiculously expensive because it didn't come from a monopoly, make sure you thank some sort of deity the majority of the country doesn't share your beliefs.

Obvious hyperbole is obvious. People need to see the costs of healthcare. They need to be responsible for bearing a good chunk of the cost. Without those things, people want to use every service they can because it's essentially an all-you-can-eat type of system, and it's this kind of use that, at least partially, drives up costs. If people directly see the costs of the healthcare services they're using, I think they'll take the lifestyle choices that affect their health and the medical services they decide to use more seriously. To account for people that genuinely can't afford $5-10k annual deductibles, a system that determines your deductible based on income - maybe setting your deductible at 10-15% of your net income, for example - could help make the system a little more "fair."

Regardless, the problem (which I think is what Future was pointing at) still remains: how do we pay for it? The "people" want unlimited healthcare and don't want to pay anything more for it. So, what gives? At least one of the following must happen: taxes must be increased (for the liberal route), more private income must be devoted to healthcare spending (for the conservative route), or the quantity and/or quality of services must be reduced. We can't have our cake and eat it too.

 

[IvyHopeful20]

Yea, my preference would be to increase taxes and also to decide on priorities as a society, e.g, not spend the vast majority of money on end of life, much of which is just futile.

 

[wanderer]

My friend's dad went to the doctor with back pain. He prescribed him some physical therapy. In the next month he switched health insurance providers because he lost his job and went back in to the doctor when he had a bad cough that month. He was diagnosed with a rare form of lung cancer and his insurance company refused to cover any treatment citing it as a "pre-existing condition".

Things like that always help me "reality check" myself when talking about things that can quickly get theoretical instead of practical.

Reminds me of the time my insurer tried to not pay for screening of recessive genetic disorders, because I was seeking treatment due to an "injury" caused by a third-party.

 

[LuciusVorenus]

Obvious hyperbole is obvious. People need to see the costs of healthcare. They need to be responsible for bearing a good chunk of the cost. Without those things, people want to use every service they can because it's essentially an all-you-can-eat type of system, and it's this kind of use that, at least partially, drives up costs. If people directly see the costs of the healthcare services they're using, I think they'll take the lifestyle choices that affect their health and the medical services they decide to use more seriously. To account for people that genuinely can't afford $5-10k annual deductibles, a system that determines your deductible based on income - maybe setting your deductible at 10-15% of your net income, for example - could help make the system a little more "fair."

Regardless, the problem (which I think is what Future was pointing at) still remains: how do we pay for it? The "people" want unlimited healthcare and don't want to pay anything more for it. So, what gives? At least one of the following must happen: taxes must be increased (for the liberal route), more private income must be devoted to healthcare spending (for the conservative route), or the quantity and/or quality of services must be reduced. We can't have our cake and eat it too.

Not a hyperbole. We pay for the fire department through taxes for the same reasons we should pay for cancer treatment; it could happen to any one of us and the incurred costs would be disastrous, so we've decided that pooling our money to pay for a public service when it comes to fire/crime is a smart move. Why is cancer any different?

I think we can agree that people don't pursue cancer treatment because they feel they're at a buffet of free services. If he had replaced cancer treatment with ER/obesity clinic visits it would be a hyperbole, and I'd also agree with both of you.

 

[morning]

Try way too high. The rich are forced to pay for the failures, including but not limited to: welfare queens, prisoners, social security and medicaid. Social security is a ponzi scheme, that I should be able to opt out of. I shouldn't be forced to support the poor. If I want to give to them I will, I just spent 5 hours last night in the ghetto of Miami working with the homeless. However the government shouldn't force me to pay for an interventionist foreign policy, a welfare state and an overzealous war on drugs I oppose. America should have a flat tax. Just because the wealthy have more is not a justification to steal it.

Welfare was reformed in the 1990s.

Agree with HCR in principle, don't agree with the way it's funded. American government spending is a house of cards, and it's going to come falling down at some point. If people want HCR, that's fine, but they should raise taxes in order to fund it. Of course that's never going to happen, because people are utterly ******ed and ZOMG I DONT WANT TO GIVE AWAY MORE OF MONEY!!1111

I'm surprised to be agreeing with one of your posts, but here we are.

It's the same situation as 2002/2003: The people wanted war, but they also wanted tax cuts.

 

[FutureCTDoc]

In my opinion, America can't afford a trillion dollar war budget. It can afford a hundred billion healthcare bill. Even if it runs to two hundred billion.

I think you can do all that in conjunction with raising taxes to close the deficit. At least that what I'd do, and the people who support it are the ones I usually vote for.

I disagree with spending more of my money on both foreign intervention and on health care. We need to end health care reform and these ridiculous unfunded/underfunded mandates and entitlements. America used to spend 6.3% of GDP in 1903 in 2009 it was 42.32 as per USgovernmentspending.com. This is unsustainable. We can't afford any of this.

Where do you want to get taxes from? The truly "rich" don't get hit up nearly as bad. Also what's rich? 250,000 is nothing in NYC, it's middle class, the same is true for most major cities, and much of the decent 'burbs in CT, NY and NJ etc.

What we need is to truly trim all spending, Medicare, Medicaid etc. are prime for cuts. Physicians should collectively refuse governmental dollars.

 

[VikingLegacy]

baleeted

 

[FutureCTDoc]

Not a hyperbole. We pay for the fire department through taxes for the same reasons we should pay for cancer treatment; it could happen to any one of us and the incurred costs would be disastrous, so we've decided that pooling our money to pay for a public service when it comes to fire/crime is a smart move. Why is cancer any different?

I think we can agree that people don't pursue cancer treatment because they feel they're at a buffet of free services. If he had replaced cancer treatment with ER/obesity clinic visits it would be a hyperbole, and I'd also agree with both of you.

Actually the FD in my home town is volunteer. No one is forced to join and there is no town funding. Private donations fund it. When it comes to crime there is a valid and separate issue as Nozick posits in Anarchy, State and Utopia, there is a role, however small for government. They should administer the judiciary, military and the police. That's it.

 

[LuciusVorenus]

Actually the FD in my home town is volunteer. No one is forced to join and there is no town funding. Private donations fund it. When it comes to crime there is a valid and separate issue as Nozick posits in Anarchy, State and Utopia, there is a role, however small for government. They should administer the judiciary, military and the police. That's it.

Sounds like you came from a really small home town. That kind of system would not work in a major urban, or even suburban, area.

Saying that the government should just fund the judiciary, military, and police systems is easy enough, but actually doing so is something completely different. Funding those 3 systems effectively means funding a ridiculously large number of other things. If we're going to fund the judiciary we need to fund public education, otherwise you're going to get a criminal justice system run by a select few, or a pack of uneducated vigilantes. Funding the police department means funding the prison system, highways, and setting traffic laws. Funding the military means pouring money not just into the military itself, but also the entire industrial complex that holds the military up. How useful would a military be if the government didn't provide large amounts of money in the form of grants to companies like Boeing and Lockheed? (as a side note, I wonder how many universities - private included - and small business would exist in a world devoid of government grants)

All that aside, we already know an unregulated form of capitalism doesn't work. Did we forget about all the Robber Barons? Didn't seem like "competition" kept those people in check. Remember how effective Hoover's "volunteerism" was when it came to stopping the Great Depression? The insurance system right now (and the banking crisis) shows why unregulated capitalism doesn't work. Nozick wrote about a species of humanity, and an economy, that doesn't exist.

 

[IvyHopeful20]

What we need is to truly trim all spending, Medicare, Medicaid etc. are prime for cuts. Physicians should collectively refuse governmental dollars.

That's the biggest pipe dream of all time. Seniors vote. A lot. And they won't vote to rid themselves of medicare. And physicians won't refuse the 46% of healthcare spending that's from the government.

Not seeing old people in medicine = not really an option in many specialties.

 

[FutureCTDoc]

I abhor the term robber Barron, however when capitalism was at its most ruthless we got the telegraph, mass production, the rise of a middle class, infrastructure. Railroads are a product of raw capitalism. It was done so well back then that the rails Amtrak uses are products of it. Medicine is an oligopoly, supply is restricted by the government. The number of residency spots is limited and you need a residency to practice. In real capitalism, physicians would compete on expertise, competence, likability and price. People would seek the best value rather than assuming Doctor X=Doctor Y because they are both licentiate.

 

[trailking]

Single payer systems are prevalent in Europe and even Taiwan. There is not one
country where the cost of health care exceeds the percentage of GDP as experienced
in the U.S.A. We are the highest in the world WITHOUT a single payer system. Therefore the single payer system does not contribute to an increase in healthcare
costs. The value added tax in Europe is used to fund such a system. The salaries of physicians in Europe are reflective of an
upper middle-class life-style so this system does not force Docs to moonlight as custodians. Also prior to Medicare dollar being used for Residency
salary, the payment for this on the job training was peanuts It's called
Residency because the training Docs had a bed in the hospital because they couldn't
afford an apartment of their own. You become Docs because you like the work
and the salaries wii always be at a level to attract competent practitioners. Remember if you pay peanuts you attract monkeysl There
is no guaranteed salary or job prospects for lawyers, but thousands graduate every
year and try to practice law. Some make big bucks and many end up chasing
ambulances. Law school enrollment has not dropped off. The cap on medical school admission and restrictive residency opportunities creates shortages in the profession and therefore the demand for
service exceeds the supply of practitioners. This means guaranteed work and higher
than average salaries. Posters should be more cognizant of "reality" and facts rather
than hearsay and massive amounts of B.S.

 

[FutureCTDoc]

That's the biggest pipe dream of all time. Seniors vote. A lot. And they won't vote to rid themselves of medicare. And physicians won't refuse the 46% of healthcare spending that's from the government.

Not seeing old people in medicine = not really an option in many specialties.

Ever heard of psych? They're cash and carry. Most specialties i.e. IM, Geriatrics, Neurology, Cards (Non procedural) and ophtho could go and do concierge or cash and carry.

 

[LuciusVorenus]

I abhor the term robber Barron, however when capitalism was at its most ruthless we got the telegraph, mass production, the rise of a middle class, infrastructure. Railroads are a product of raw capitalism. It was done so well back then that the rails Amtrak uses are products of it. Medicine is an oligopoly, supply is restricted by the government. The number of residency spots is limited and you need a residency to practice. In real capitalism, physicians would compete on expertise, competence, likability and price. People would seek the best value rather than assuming Doctor X=Doctor Y because they are both licentiate.

Naming innovations that came about" because" of unregulated capitalism makes no sense. You think if the government regulated monopolies and large businesses in the way that it does today we wouldn't have gotten those things? Hey, after the 1950s we also saw a huge increase in the size of the middle class, the increased prevalence of automobiles, computers, the internet, etc. So what? Science tends to innovate no matter what system it's placed under. If anything (and like I said above) the government grants available today drive innovation much more effectively than unregulated capitalism.

 

[IvyHopeful20]

Ever heard of psych? They're cash and carry. Most specialties i.e. IM, Geriatrics, Neurology, Cards (Non procedural) and ophtho could go and do concierge or cash and carry.

Note that I didn't say that there isn't a specialty that you could work without taking older people...I said in most you'd have to.

There aren't enough patients for a large number of doctors to go cash only. As long as it's a small segment of the population, it works.

 

[IvyHopeful20]

Would love to see any progress in basic science without the NIH and other government bodies....not going to happen.

 

[morning]

Ever heard of psych? They're cash and carry. Most specialties i.e. IM, Geriatrics, Neurology, Cards (Non procedural) and ophtho could go and do concierge or cash and carry.

Psych is the specialty the general public would probably benefit the most from. Certainly, being in a good state of mental health would prevent fewer health problems elsewhere just by promoting a healthy lifestyle...and less child abuse.

Naming innovations that came about" because" of unregulated capitalism makes no sense. You think if the government regulated monopolies and large businesses in the way that it does today we wouldn't have gotten those things? Hey, after the 1950s we also saw a huge increase in the size of the middle class, the increased prevalence of automobiles, computers, the internet, etc. So what? Science tends to innovate no matter what system it's placed under. If anything (and like I said above) the government grants available today drive innovation much more effectively than unregulated capitalism.

Real capitalism would, of course, drive DOWN doctor salaries.

 

[FutureCTDoc]

Psych is the specialty the general public would probably benefit the most from. Certainly, being in a good state of mental health would prevent fewer health problems elsewhere just by promoting a healthy lifestyle...and less child abuse.



Real capitalism would, of course, drive DOWN doctor salaries.

Real capitalism might or might not drive down salaries. PRS has arguably the best remuneration of any specialty and the aesthetic side is cash and carry, exposed to the machination of the market. Some specialties i.e. FP, IM, Peds might do better if they could bill at $100 a visit, plus procedures.

 

[Astarael]

Not a hyperbole. We pay for the fire department through taxes for the same reasons we should pay for cancer treatment; it could happen to any one of us and the incurred costs would be disastrous, so we've decided that pooling our money to pay for a public service when it comes to fire/crime is a smart move. Why is cancer any different?

I think we can agree that people don't pursue cancer treatment because they feel they're at a buffet of free services. If he had replaced cancer treatment with ER/obesity clinic visits it would be a hyperbole, and I'd also agree with both of you.

Your comparison there is a bit lacking in one respect. While I agree that pooling resources to lighten the load on the individual that gets unlucky is probably a good thing, that argument doesn't reflect the fact that a huge number of people get cancer because of their own choices. I'm talking about lung cancer for people who smoke, and similar situations.

Single payer systems are prevalent in Europe and even Taiwan. There is not one
country where the cost of health care exceeds the percentage of GDP as experienced
in the U.S.A. We are the highest in the world WITHOUT a single payer system. Therefore the single payer system does not contribute to an increase in healthcare
costs.

Your argument is flawed. Just because other countries spend less of their GDP on healthcare and have a single payer doesn't mean that the two are related: that's a correlation fallacy. What I think you might not be realizing is that our healthcare system is built in a certain way and if we went to a single payer system, the only thing that would change immediately would be where the money is coming from, not how much money is being used. I doubt that our government could shoulder such an immediate increase in spending. A more useful endeavor would be to figure out why we are using so much more money, and then try to fix it.

 

[morning]

Real capitalism might or might not drive down salaries. PRS has arguably the best remuneration of any specialty and the aesthetic side is cash and carry, exposed to the machination of the market. Some specialties i.e. FP, IM, Peds might do better if they could bill at $100 a visit, plus procedures.

You're wrong about that; in the deregulated world you envision, doctors will be fighting NPs every single step of the way. If anyone get into the game and undercut anyone else, you're going to see lower prices - period. Imagine the fury when every single (legal) IMG is able to hang a shingle minus residency, and is perfectly willing to work for dirt cheap.

Also: history is your friend. It's not just your lack of understanding about how welfare has changed, but you also don't get how the government DID step in and regulate monopolies. http://en.wikipedia.org/wiki/Sherman_Act

 

[trailking]

Single payer like expanding Medicare is a mechanism to provide universal health
care in the United States. One method to pay for an expansive health care system
is a value added tax. The high cost of medical care is reportedly the result of costly
medical procedures because we have a propensity to utilize the latest technology and
drugs on the market. Apparently this doesn't prolong or improve the quality of
life compared to other first-world countries. We spend more, but this doesn't
translate to better results. This has nothing to do with developing a health delivery
system that provide access to ALL our citizens. Interestingly, 40% of the Medicare
dollar is spent in the last year of a patients life. Maybe we should pay closer attention how medical care is delivered in France, Germany, Sweden among others.
Granted universal health care is an expensive proposition but we willingly spend a
trillion dollars on a bogus war and charge it on the Federal Visa card. The folks
in Europe view access to health care for all its citizens a right and not a privilege.
It's interesting to note that 40 million citizens have access to good medical care
(age 65 and older)through Medicare and millions more who are younger helps pay
for this largess and are denied the same level of coverage. Fairness is also
a factor in the equation.

 

[FutureCTDoc]

You're wrong about that; in the deregulated world you envision, doctors will be fighting NPs every single step of the way. If anyone get into the game and undercut anyone else, you're going to see lower prices - period. Imagine the fury when every single (legal) IMG is able to hang a shingle minus residency, and is perfectly willing to work for dirt cheap.

Also: history is your friend. It's not just your lack of understanding about how welfare has changed, but you also don't get how the government DID step in and regulate monopolies. http://en.wikipedia.org/wiki/Sherman_Act

Some will be able to make more, some will make less, you failed to note how I said might or might not. When you're paying out of pocket and the choice is between MD and NP at roughly the same price point what would you choose? The same is true in less tightly controlled environments take law for example. Admission to law school is easier than medical school whereas getting into the T-14 is much more difficult. The fact that some grads are lesser trained or less skillful, is noted in their reputation and is then largely reflected in the price point they charge. A Cravath partner may charge $1,000 an hour whereas a TTT grad crim law attorney will charge $150 per hour. This isn't pure competition, however, it is closer than medicine. Do some people lose? Yes, TTT grads do, however the cream always rises to the top.

I am cognizant of the Sherman Anti-trust act I feel it was vile especially as it served to criminalize what was previously lawful behaviour. Monopolies aren't evil. If you jack the price of a commodity too high no one will pay for it. In a free market, monopolies don't tend to form. However with governmental involvement, they do. Take power, by increasing the difficulty of licensure of power plants, the price is increased especially as gaining licensure for a nuclear plant is near impossible. The government has created a monopoly by regulation. The same is true of oligopoly in chemicals and pharma, smaller outfits can't comply with the onerous regulations which have been put into place by the government.

Don't lecture me on econ, I understand just fine thanks.

 

[LuciusVorenus]

Some will be able to make more, some will make less, you failed to note how I said might or might not. When you're paying out of pocket and the choice is between MD and NP at roughly the same price point what would you choose? The same is true in less tightly controlled environments take law for example. Admission to law school is easier than medical school whereas getting into the T-14 is much more difficult. The fact that some grads are lesser trained or less skillful, is noted in their reputation and is then largely reflected in the price point they charge. A Cravath partner may charge $1,000 an hour whereas a TTT grad crim law attorney will charge $150 per hour. This isn't pure competition, however, it is closer than medicine. Do some people lose? Yes, TTT grads do, however the cream always rises to the top.

I am cognizant of the Sherman Anti-trust act I feel it was vile especially as it served to criminalize what was previously lawful behaviour. Monopolies aren't evil. If you jack the price of a commodity too high no one will pay for it. In a free market, monopolies don't tend to form. However with governmental involvement, they do. Take power, by increasing the difficulty of licensure of power plants, the price is increased especially as gaining licensure for a nuclear plant is near impossible. The government has created a monopoly by regulation. The same is true of oligopoly in chemicals and pharma, smaller outfits can't comply with the onerous regulations which have been put into place by the government.

Don't lecture me on econ, I understand just fine thanks.

I hate it when people compare Law and Medicine. It's two completely different fields and customers approach them with completely different mindsets. It's not nearly as expensive training a lawyer as it is a board certified doctor. Who's going to fund the schools? Charity? Then enjoy your shortage. Private interests? Enjoy your for-profit medical education. Also, it wouldn't be an NP and an MD at the "same price", NPs would be able to and would be willing to charge much less than doctors. As for power plants and pharma, I'd rather have a few regulated companies making safe power and FDA approved drugs than any "entrepreneur" deciding it's a good idea to set up a nuclear reactor in my backyard and mail snake oil to my house. In a perfect society costumers would pick the "correct" option. In real life they don't.

True capitalism is just as viable as a utopia. Yes, in a true capitalism competition drives prices down and more money=more innovation=a happier population. In the real world companies collude, merge and form monopolies, and spend a ridiculous amount of wealth making sure they crush competing small businesses. No competition would exist.

In "raw" capitalism what you get is an extremely rich and powerful minority that controls all production and revenue and a large class of poor, underpaid, unhappy workers. Does this system promote innovation? Who cares. What matters is people are going to get royally pissed off and whatever government decides to foolishly support such an economy wouldn't even last long enough to see the fruits.

I'm guessing you've read The Jungle.

 

[trailking]

I hate it when people compare Law and Medicine. It's two completely different fields and customers approach them with completely different mindsets. It's not nearly as expensive training a lawyer as it is a board certified doctor. Who's going to fund the schools? Charity? Then enjoy your shortage. Private interests? Enjoy your for-profit medical education. Also, it wouldn't be an NP and an MD at the "same price", NPs would be able to and would be willing to charge much less than doctors. As for power plants and pharma, I'd rather have a few regulated companies making safe power and FDA approved drugs than any "entrepreneur" deciding it's a good idea to set up a nuclear reactor in my backyard and mail snake oil to my house. In a perfect society costumers would pick the "correct" option. In real life they don't.

True capitalism is just as viable as a utopia. Yes, in a true capitalism competition drives prices down and more money=more innovation=a happier population. In the real world companies collude, merge and form monopolies, and spend a ridiculous amount of wealth making sure they crush competing small businesses. No competition would exist.

In "raw" capitalism what you get is an extremely rich and powerful minority that controls all production and revenue and a large class of poor, underpaid, unhappy workers. Does this system promote innovation? Who cares. What matters is people are going to get royally pissed off and whatever government decides to foolishly support such an economy wouldn't even last long enough to see the fruits.

I'm guessing you've read The Jungle.

Lucious old chap no criticism intended. Just curious because you apparently are
an economic theorist applying to med school. What happens in the MD/DO world with a focus on compensation if NP, DC, PharmD, PA, OD,ND can legally treat patients and write prescriptions absent major surgery. The MD/DO supply/ demand ratio
would be disrupted and I assume health care specials would be advertised on the web
and billboards and 7 year trained MD would compete for business with the 2 year
trained PA. What are your views?

 

[dillydally]

Single payer like expanding Medicare is a mechanism to provide universal health
care in the United States. One method to pay for an expansive health care system
is a value added tax. The high cost of medical care is reportedly the result of costly
medical procedures because we have a propensity to utilize the latest technology and
drugs on the market. Apparently this doesn't prolong or improve the quality of
life compared to other first-world countries. We spend more, but this doesn't
translate to better results. This has nothing to do with developing a health delivery
system that provide access to ALL our citizens. Interestingly, 40% of the Medicare
dollar is spent in the last year of a patients life. Maybe we should pay closer attention how medical care is delivered in France, Germany, Sweden among others.

+1

I don't know how much I like about the new legislation. In my opinion, there are several things that could be changed in order to reduce the costs associated with the delivery of medical care before doing something that has the potential to drastically affect patients.

First of all, there's a lot of excess fat in terms of the administrative layers present in the health care system. By getting rid of administrative positions/hassles that do not affect patient care, we'd be able to save a significant amount of money. Do we really need to have physicians justify their clinical judgment to insurance administrators? Do we really need to have a ridiculous amount of paperwork to fill out for each patient? Why do we need so many administrators in the delivery of medical care? Do these administrative hassles really improve patient care? Or do they have no meaningful impact other than increase the costs associated with the health care system?

The second area where I think a lot of money could be saved is with end-of-life care. The cultural mindset in America is that death is something unnatural and that we should do everything in our power to avoid it. There are a lot of things that medicine can offer to prolong life, but many of them do not offer any improvement in quality of life and some even reduce it. Around 30% of Medicare's budget is spent on people in their last year of life. A lot of money could be saved by changing the cultural mindset that death should be avoided at all costs, even if it means very little to no quality of life. Should patients be able to demand treatments that offer no tangible medical benefit while carrying a significant risk of side-effects, etc? Is it a wise idea to provide all heroic measures to keep people alive not matter what the adverse effects of such measures are? By utilizing hospice care rather than providing futile (and expensive) end-of-life care, not only will a lot of money be saved, but also, families will be more satisfied (as several studies have shown).

Lastly, we need to address the area of defensive medicine. Unfortunately, this mentality seems to be so engrained into the minds of current students and physicians that even if plans are set in motion to curb this practice, it might easily be several generations before any real results are seen. I think that by enacting malpractice reform (not tort reform...I'm not suggesting that caps should be placed awards paid to patients) that would compensate patients truly damaged due to negligence in a no-fault manner would be ideal. Not only will this reduce frivolous lawsuits as well as the costs associated with such lawsuits, but it will also allow physicians to be more open about mistakes (because of the no-fault approach) and the open discussion of medical errors would likely help avoid future mistakes. That would be beneficial to both patients and physicians.

So, rather than drastically overhauling the system, I really think that targeting things that won't negatively affect patient care should be the first thing to do. And I really think that the things I mentioned have the potential to save a lot of money. After cutting this excess fat, if there's still a need for cost cutting, then we can start thinking about changing things that would have a significant impact on patient care.

+1


Anyone know why what I quoted from these two posts had very little/nothing in the way of replies? Because there was a lot of truth in there, and truth is hard to argue with.

 

[LuciusVorenus]

Lucious old chap no criticism intended. Just curious because you apparently are
an economic theorist applying to med school. What happens in the MD/DO world with a focus on compensation if NP, DC, PharmD, PA, OD,ND can legally treat patients and write prescriptions absent major surgery. The MD/DO supply/ demand ratio
would be disrupted and I assume health care specials would be advertised on the web
and billboards and 7 year trained MD would compete for business with the 2 year
trained PA. What are your views?

We don't really need to assume/predict anything. It also has nothing to do with me thinking I'm an economist. I'm speaking from past experiences we as a country have already HAD. Take the comparison between law and medicine for example, people said the same thing about engineering. Train more engineers and competition will make sure that MIT grads will keep their high salaries while Cal State grads will fill the gap but be unable to compete with MIT grads because of their "lower level" education. It didn't work. Engineering salaries fell for EVERYONE and engineering is a shadow of the profession it used to be when it comes to compensation/independence.

Guess what else? For the first time in a long time Ivy league law grads have been unable to land a firm after graduation, after decades of being used to having firms fight over them. Maybe it has something to do with the excess supply of lawyers? If this is a future you want to risk for medicine, then go ahead. I doubt a for-profit educated doctor forced to compete with NPs over patients will improve anything though.

The truth is that most people don't know the difference between an MIT grad and a Cal State grad, or a Harvard law grad and a lower tier grad, or a Mayo grad and a Ross grad, or even that just because an NP wears a white coat they aren't really a doctor. They really don't. Keep this in mind.

 

[trailking]

We don't really need to assume/predict anything. It also has nothing to do with me thinking I'm an economist. I'm speaking from past experiences we as a country have already HAD. Take the comparison between law and medicine for example, people said the same thing about engineering. Train more engineers and competition will make sure that MIT grads will keep their high salaries while Cal State grads will fill the gap but be unable to compete with MIT grads because of their "lower level" education. It didn't work. Engineering salaries fell for EVERYONE and engineering is a shadow of the profession it used to be when it comes to compensation/independence.

Guess what else? For the first time in a long time Ivy league law grads have been unable to land a firm after graduation, after decades of being used to having firms fight over them. Maybe it has something to do with the excess supply of lawyers? If this is a future you want to risk for medicine, then go ahead. I doubt a for-profit educated doctor forced to compete with NPs over patients will improve anything though.

The truth is that most people don't know the difference between an MIT grad and a Cal State grad, or a Harvard law grad and a lower tier grad, or a Mayo grad and a Ross grad, or even that just because an NP wears a white coat they aren't really a doctor. They really don't. Keep this in mind.

No I'm merely responding to your advocacy of de-regulation and a mania for the
free market. Top law firms just discovered they could get Ivy league grads for
100k rather than 150k because the demand for lawyering merely decreased and there were more candidates than jobs. If they de-regulated and allowed para-legals
to practice then a whole new compensation scene would be on the horizon. In your view the same approach should apply to the medical biz. Expand the number of mid-level practitioners and let the market place through competition of DC, NP, ND, PA's etc. set the compensation level for those folks who treat patients and write prescriptions. Remember that through
caps on medical school enrollment and limited residencies we've created a greater
demand than supply of practitioners. If you allowed the mid-levels to practice and
gave free reign to the thousands graduating from Indian medical schools who want
to work in the U.S. then the compensation level for MD's would change radically.
We could also allow the 15,000 grads of Cuban medical schools to join the ranks.
Under the theory that you advocate are you sure with a whole new compensation equation based on free market and non-regulatory principles you still want to practice medicine. Who says anything about improvement I merely saying let
the unfettered market place dictate terms and conditions. I believe this is
the point that you've proposed. Correct me if I'm wrong.

 

[Astarael]

Single payer like expanding Medicare is a mechanism to provide universal health
care in the United States. One method to pay for an expansive health care system
is a value added tax. The high cost of medical care is reportedly the result of costly
medical procedures because we have a propensity to utilize the latest technology and
drugs on the market. Apparently this doesn't prolong or improve the quality of
life compared to other first-world countries. We spend more, but this doesn't
translate to better results. This has nothing to do with developing a health delivery
system that provide access to ALL our citizens. Interestingly, 40% of the Medicare
dollar is spent in the last year of a patients life. Maybe we should pay closer attention how medical care is delivered in France, Germany, Sweden among others.
Granted universal health care is an expensive proposition but we willingly spend a
trillion dollars on a bogus war and charge it on the Federal Visa card. The folks
in Europe view access to health care for all its citizens a right and not a privilege.
It's interesting to note that 40 million citizens have access to good medical care
(age 65 and older)through Medicare and millions more who are younger helps pay
for this largess and are denied the same level of coverage. Fairness is also
a factor in the equation.

Just because other countries have higher life expectancies does not mean that their health care systems are better. Correlation is not causation, and there are many other places to potentially put the blame in the U.S. other than health care. For instance, we are often called the fattest country, and we all know that obesity is a risk factor for quite a number of different diseases, but obesity is not a failure of our health care system. For all you know, instituting a single payer system here would lower our average life expectancy because people would take even less ownership in their own health. I just think that boiling it down to single payer being a magical fix is looking at the world through rose colored glasses and ignoring the fact there are other more serious issues than where the money comes from that need to be dealt with.

 

[trailking]

+1




+1


Anyone know why what I quoted from these two posts had very little/nothing in the way of replies? Because there was a lot of truth in there, and truth is hard to argue with.

Cutting he fat is one thing and we can tinker to our hearts content. The big issue
is access. Obamacare is a step in the right direction, but it's cobbled together to
please various interest groups. How about a fresh start with the simple proposition
that every citizen will be covered from the womb to the tomb by Medicare. It's
the perks of being a legal resident in the U.S. A right and not a privilege

 

[Charles_Carmichael]

Expand the number of mid-level practitioners and let the market place through competition of DC, NP, ND, PA's etc. set the compensation level for those folks who treat patients and write prescriptions. Remember that through
caps on medical school enrollment and limited residencies we've created a greater
demand than supply of practitioners. If you allowed the mid-levels to practice and
gave free reign to the thousands graduating from Indian medical schools who want
to work in the U.S. then the compensation level for MD's would change radically.
We could also allow the 15,000 grads of Cuban medical schools to join the ranks.

They can practice. After they go through med school and residency (in the case of non-physicians) or just residency (in the case of IMGs).

I do not support the idea of a completely free market in the delivery of medical care. It's only through regulation that you can ensure that patients are exposed to competent providers. By removing that regulation, you're allowing every single voodoo magic practitioner, along with well trained physicians, to practice independently. Not only will this result in significant harm to patients but an even bigger impact would be a complete erosion of public trust in the medical field.

You're probably thinking that the problems will only be in the short term? That the voodoo practitioners will get weeded out due to malpractice lawsuits, etc? Unfortunately, by that point, there's a good chance that a significant amount of damage has already been done. Why play with people's health and lives by taking away an important regulation that would ensure that only competent providers (for the most part) are allowed to practice independently?

PS. trailking, could you please type your posts just like everyone else? They're showing up truncated on my screen (like you've been copying and pasting from a text file or something) and it's a little distracting. Thanks!

Edit: Looks like you made that post with sarcasm in mind. My fault. It's hard to recognize sarcasm over the internet.

 

[LuciusVorenus]

No I'm merely responding to your advocacy of de-regulation and a mania for the
free market. Top law firms just discovered they could get Ivy league grads for
100k rather than 150k because the demand for lawyering merely decreased and there were more candidates than jobs. If they de-regulated and allowed para-legals
to practice then a whole new compensation scene would be on the horizon. In your view the same approach should apply to the medical biz. Expand the number of mid-level practitioners and let the market place through competition of DC, NP, ND, PA's etc. set the compensation level for those folks who treat patients and write prescriptions. Remember that through
caps on medical school enrollment and limited residencies we've created a greater
demand than supply of practitioners. If you allowed the mid-levels to practice and
gave free reign to the thousands graduating from Indian medical schools who want
to work in the U.S. then the compensation level for MD's would change radically.
We could also allow the 15,000 grads of Cuban medical schools to join the ranks.
Under the theory that you advocate are you sure with a whole new compensation equation based on free market and non-regulatory principles you still want to practice medicine. Who says anything about improvement I merely saying let
the unfettered market place dictate terms and conditions. I believe this is
the point that you've proposed. Correct me if I'm wrong.

Actually I agree with you? I think you may have mis-read my posts or read Furture's instead. I'm completely against de-regulation.

Now I'm confused.

 

[trailking]

Just because other countries have higher life expectancies does not mean that their health care systems are better. Correlation is not causation, and there are many other places to potentially put the blame in the U.S. other than health care. For instance, we are often called the fattest country, and we all know that obesity is a risk factor for quite a number of different diseases, but obesity is not a failure of our health care system. For all you know, instituting a single payer system here would lower our average life expectancy because people would take even less ownership in their own health. I just think that boiling it down to single payer being a magical fix is looking at the world through rose colored glasses and ignoring the fact there are other more serious issues than where the money comes from that need to be dealt with.

Our health issues are not radically different from our brother and sisters across
the Atlantic. The experts contend that the French, Swiss and German health
system is the best in the world. Everybody is covered and these countries also have
fat people and so on. You pay by raising taxes plain and simple. If you buy a
5,000 dollar Rolex you pay $500 value added tax. If it's a $50 Timex then the
tax is five bucks. The money generated is added to the pot to pay for the health
care system just like we should have imposed a war tax to pay for the fiasco in Iraq
and Afghanistan. No free lunches allowed.

 

[trailking]

Actually I agree with you? I think you may have mis-read my posts or read Furture's instead. I'm completely against de-regulation.

Now I'm confused.

Great. Certain activities have to be regulated for the common good.

 

[Charles_Carmichael]

Cutting he fat is one thing and we can tinker to our hearts content. The big issue
is access. Obamacare is a step in the right direction, but it's cobbled together to
please various interest groups. How about a fresh start with the simple proposition
that every citizen will be covered from the womb to the tomb by Medicare. It's
the perks of being a legal resident in the U.S. A right and not a privilege

Technically, everyone does have access to healthcare (EMTALA). Just not the appropriate access in many cases (ie. you shouldn't be using the ER as a primary care visit).

I don't think that every citizen should be covered from "womb to tomb" by Medicare. Medicare is becoming insolvent faster than you can say uncle. Adding more people to it is not going to help. What will happen if you add millions of new people to Medicare is that Medicare will start cutting payment for even more services than it already does. The gaps in coverage will increase even further, with the result being that people will pretty much be required to get secondary insurance to plug those holes.

Where will the money come from to support the millions of new people to Medicare? Throughout Medicare's history, it has underestimated the costs it will incur. Why will this time be any different?

The topic of whether health care is a right or a privilege shouldn't necessarily be argued in this thread. That merits its own thread and, if you do a search, you'll see that some heated debates have taken place in the past regarding that issue.

 

[trailking]

They can practice. After they go through med school and residency (in the case of non-physicians) or just residency (in the case of IMGs).

I do not support the idea of a completely free market in the delivery of medical care. It's only through regulation that you can ensure that patients are exposed to competent providers. By removing that regulation, you're allowing every single voodoo magic practitioner, along with well trained physicians, to practice independently. Not only will this result in significant harm to patients but an even bigger impact would be a complete erosion of public trust in the medical field.

You're probably thinking that the problems will only be in the short term? That the voodoo practitioners will get weeded out due to malpractice lawsuits, etc? Unfortunately, by that point, there's a good chance that a significant amount of damage has already been done. Why play with people's health and lives by taking away an important regulation that would ensure that only competent providers (for the most part) are allowed to practice independently?

PS. trailking, could you please type your posts just like everyone else? They're showing up truncated on my screen (like you've been copying and pasting from a text file or something) and it's a little distracting. Thanks!

I'm not a blogger and I'm trying to learn the requisite computer skills...sorry

 

[LuciusVorenus]

Great. Certain activities have to be regulated for the common good.

Then why were we arguing :/

 

[Astarael]

Our health issues are not radically different from our brother and sisters across
the Atlantic. The experts contend that the French, Swiss and German health
system is the best in the world. Everybody is covered and these countries also have
fat people and so on. You pay by raising taxes plain and simple. If you buy a
5,000 dollar Rolex you pay $500 value added tax. If it's a $50 Timex then the
tax is five bucks. The money generated is added to the pot to pay for the health
care system just like we should have imposed a war tax to pay for the fiasco in Iraq
and Afghanistan. No free lunches allowed.

I understand the concept of using tax to pay for government service. The fact of the matter is that, in general, people are completely unwilling to pay additional tax for any service the government would provide, no matter how necessary. And comparing the U.S. to other countries is confounded by several factors, not the least of which is the fact that we have a much more heterogeneous population than all of the countries that you listed as having better health care than ours. There is one fact that we can agree on - our average life expectancy is shorter than that of people in several other countries. Pinning that on the health care system is a great way to gloss over the fact that we have other, severe problems that should be addressed that health care cannot be a band-aid for. Yes, it could be access to health care that is causing problems. But it could be other things, and unless you show me some literature stating that it is, in fact, a deficit of health care that causes our problems, you are speaking meaningless words. The fact of the matter is that you don't know what is causing problems in the U.S. and blindly stating that it is the health care system is dangerous in that it keeps us from actually stating what the real cause is. If we were to find out that our health care system is empirically worse than others, I'd be all for the switch. However, just blindly moving to a single payer system is not going to be the magical fix you seem to think it will be.

 

[IvyHopeful20]

Real capitalism might or might not drive down salaries. PRS has arguably the best remuneration of any specialty and the aesthetic side is cash and carry, exposed to the machination of the market. Some specialties i.e. FP, IM, Peds might do better if they could bill at $100 a visit, plus procedures.

Actually it would. There'd be no cap on who can set up a shingle and practice. Hello, 10,000 IMGs next year, who are fully qualified.

I don't think that every citizen should be covered from "womb to tomb" by Medicare. Medicare is becoming insolvent faster than you can say uncle. Adding more people to it is not going to help. What will happen if you add millions of new people to Medicare is that Medicare will start cutting payment for even more services than it already does.

It's insolvent because we don't commit to funding it like a true health insurance provider. Of course you need to fund it like one to have it provide services like one....

The only long term sustainable solution out of bankruptcy is a single payor like medicare for all. Or we'll continue spending twice as much on health insurance while still leaving 50 million without any insurance.

Where will the money come from to support the millions of new people to Medicare? Throughout Medicare's history, it has underestimated the costs it will incur. Why will this time be any different?

Increase in taxes, cut in bloat like military spending. Actually even if you don't raise taxes and you just cut military spending by 30%, America would still spend more on the military than the next 10 countries combined, and we could offer every citizen that needs it, a top notch insurance plan with reimbursements equal or better than private insurance. The money is there, people just don't want to do it.

What you can't do is "I'm not going to raise taxes, I'm not going to cut services, and I'm going to expand this program." Politically, that's the easiest thing to do since no one is 'hurt' by raised taxes or cuts of services and yet new people get more programs. But it's the worst in terms of the well being. If we would just commit to a national single payor, a lot of this would be solved.

 

[morning]

Technically, everyone does have access to healthcare (EMTALA). Just not the appropriate access in many cases (ie. you shouldn't be using the ER as a primary care visit).

I don't think that every citizen should be covered from "womb to tomb" by Medicare. Medicare is becoming insolvent faster than you can say uncle. Adding more people to it is not going to help. What will happen if you add millions of new people to Medicare is that Medicare will start cutting payment for even more services than it already does. The gaps in coverage will increase even further, with the result being that people will pretty much be required to get secondary insurance to plug those holes.

Where will the money come from to support the millions of new people to Medicare? Throughout Medicare's history, it has underestimated the costs it will incur. Why will this time be any different?

The topic of whether health care is a right or a privilege shouldn't necessarily be argued in this thread. That merits its own thread and, if you do a search, you'll see that some heated debates have taken place in the past regarding that issue.

I've said in another thread, several months ago, that I don't care HOW we get to more accessible, less expensive healthcare, as long as we get there. I don't have a sacred cow in this debate. So I don't necessarily believe that expanding Medicare for all is THE ideal situation. But if we were to do so, we should follow Australia's lead. Australia's medical system is also known as Medicare, it covers most things, and it is a 1.5% tax levy on every single citizen below $75,000 in income -- 2.5% for those above 75,000 IF they don't have private insurance as well. There's a system of private insurance to cover things that Medicare doesn't cover or to get quicker care at private hospitals. About 50% of the population has private insurance.

 

[trailking]

I understand the concept of using tax to pay for government service. The fact of the matter is that, in general, people are completely unwilling to pay additional tax for any service the government would provide, no matter how necessary. And comparing the U.S. to other countries is confounded by several factors, not the least of which is the fact that we have a much more heterogeneous population than all of the countries that you listed as having better health care than ours. There is one fact that we can agree on - our average life expectancy is shorter than that of people in several other countries. Pinning that on the health care system is a great way to gloss over the fact that we have other, severe problems that should be addressed that health care cannot be a band-aid for. Yes, it could be access to health care that is causing problems. But it could be other things, and unless you show me some literature stating that it is, in fact, a deficit of health care that causes our problems, you are speaking meaningless words. The fact of the matter is that you don't know what is causing problems in the U.S. and blindly stating that it is the health care system is dangerous in that it keeps us from actually stating what the real cause is. If we were to find out that our health care system is empirically worse than others, I'd be all for the switch. However, just blindly moving to a single payer system is not going to be the magical fix you seem to think it will be.

Granted that single payer is not magic bullet that solves the problem.
Obamacare is one approach that unfortunately was patched together to
appeal to various constituencies for the sake of passage. The run-away
cost of health care is predicated on a health care consumer market that
demands more and better, but an unwillingness to pay for it through
taxation or other funding sources. Single payer is the system we use
for Medicare so its been tested since 1965 for better or worse. Obviously,
there is waste in the Medicare system and maybe that's the major
problem which needs to be confronted. We now cover 40 million citizens (age 65 and over) under a single payer system. The VA system could also arguably be considered a single payer operation There is still three hundred million out there that should have access. The NHS in England
is the equivalent of the VA with government owned hospitals etc., which
may not be the best approach for a nation-wide health care system. But,
the Brits also have access to private health insurance so many employers
offer a private plan besides all Brits having access to the comprehensive
government system. You have suspenders and a belt to hold up your pants.