cbrons

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Go start this up in the sociopolitical forum before this one gets outta hand Johnson. All I will say is that the USA is a very dumb and bankrupt country who'd like nothing more than to disappear off the face of the earth. We are like a space ship with fat drunks piloting us towards a black hole and no one with the power to turn it around has any desire to do so. Any more questions plz?
 

CunningCaregivr

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From almost every media source, the healthcare discussion is on hot-button issues that fuel political arguments. The big picture is rarely addressed, and where are the medical experts? Our political system is so polarized (a true disgrace), so unfortunately we're getting our healthcare reform messages through that prism.

I think somewhere like SDN is a great place to have REAL discussion, without a fear of being called a socialist or a selfish physician to-be.

Some issues that cause me to rub my chin and ponder:

  • Tort Reform: It is a shame that this got nowhere in our legislation. This is a fundamental reason why costs are out of control. Physicians have to cover their bases excessively to avoid lawsuits. Professional insurance has also become a large burden. Couldn't we at least have capped lawsuits categorically? I have heard that Democrats run from this issue b/c lawyers are HUGE supporters of the party... and the ones who benefit from lawsuits.
  • Single-Payer = smart, not socialist: This is a large debate in itself. I saw very smart proposals with this in mind: Instituting a government health insurance company makes it an OPTION, and wouldn't have forced anyone to break from their policies. The major benefit would have been competition, via potentially lower premiums and standards for higher quality care. Increasing consumer demand would cause the rest of the insurance industry to follow-suit (optimistic I know, but this competition is capitalism at its finest right? ;) )
  • Preventive Incentives: I really like how preventive procedures were one of the first regulations placed on the insurance industry (many are now free of charge to patients). Prevention and primary care in beg for the most improvement, so bravo for a start. I have one big problem with this however: physicians do not get much incentive to offer these preventive services. INCENTIVES to the patient, insurer & physician are the key to all of these issues IMO.
  • Other topics !! :clap:
 

cbrons

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Wait wiatw ait wait wait you thought with that piece of garbage scum that we have for president, he would make the low life trial lawyers make any concessions whatsoever? :laugh:
 

Helen Wheels

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[YOUTUBE]VCokRbdDvgg[/YOUTUBE]

I loved the line where he sings, "I hope you don't mind if a nurse operates on you." :laugh:

I was referring to NPs and CRNPs as "mid-level providers" in a conversation with my sister who is an NP. She retorted in an irritated voice that they are "physician extenders"! :rolleyes:
 

cbrons

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Cmon docbuzzard, we've had this discussion ad nauseam on these boards. Single payer/socialized anything sucks. Why should anyone be forced to pay for someone else? Don't answer its rhetorical.
 

DuxburyPembroke

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As a Canadian, I read about health care reform all the time online and in the paper as well as watch discussions on health care reform in the news. No matter the scenario, I have noticed one thing: The extreme biased view in either direction.

I was wondering if you would mind discussing whether you are for or against it and why. I read about health care reform, and you guys actually EXPERIENCE the American Health Care System. I think this would be a beneficial thread in the Pre-DO forum because most future applicants and current applicants will be asked this in interviews. I figured it could act as a resource.

I would love to hear anyones input. If people think this thread is a bad idea, I apologize as im not trying to stir up some huge debate...just an informal discussion.

Thanks
As I'm sure you have already gathered from CBron's comments, SDN is not a good place to have a real discussion about health care.
 
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drctother

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Cmon docbuzzard, we've had this discussion ad nauseam on these boards. Single payer/socialized anything sucks. Why should anyone be forced to pay for someone else? Don't answer its rhetorical.
Really cuz ive only found it on MD forums. What is your reason for it sucking? Anyway whatever clearly this thread wont work I was putting hope that people on SDN would be mature and intelligent when getting political, clearly thats not the case. Cbrons: Ya you are right, I would rather pay 10 times what I pay for health care only to know that it helps myself and only myself, pssh forget about other people. How stupid is that? Hint, dont answer its rhetorical

"docbuzzard" what are you like 6 years old? Didnt you say on the other thread that you are a grad student? What kind of grad student gets drunk on friday nights only to come onto SDN for several hours? You are just way too cool for me, so I will show myself the door:laugh:
 

cliquesh

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Since no one really knows the outcome of the bill it is kind of pointless to discuss the issue. For one, only a handful of people have actually read it, and I'm sure no one here has read it. Additionally, there are hundreds of sections of the bill that say, "to be determined by the Secretary of Health Care at a future date." So, even though the bill has been passed, it is not complete. Moreover, a lot of the provisions go into effect in 2014 and beyond, and it is likely that those provisions will not receive any funding from congress. So why talk about something we don't understand and will likely be changed drastically in the future?
 
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drctother

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Since no one really knows the outcome of the bill it is kind of pointless to discuss the issue. For one, only a handful of people have actually read it, and I'm sure no one here has read it. Additionally, there are hundreds of sections of the bill that say, "to be determined by the Secretary of Health Care at a future date." So, even though the bill has been passed, it is not complete. Moreover, a lot of the provisions go into effect in 2014 and beyond, and it is likely that those provisions will not receive any funding from congress. So why talk about something we don't understand and will likely be changed drastically in the future?
Good point. I didnt really take that into account. Well hopefully this thread will fade away:)
 

painmd87

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My question: Why wouldnt the US benefit from such a system? Essentially it would be Medicare for EVERYONE. With the huge number of hospitals and money already invested in medical technology, I really think you guys would

Thoughts?
Because Medicare is a subpar system compared to private insurance. Medicare has the highest rescission rates of all insurers. Only Aetna comes close, and they just revamped their system to pre-auth most procedures rather than just deny them later.

Medicare also overpays for a lot of stuff, such as DME. They will pay a DME provider $800 for a wheelchair that costs $399. Compare that to reimbursement rates for office visits, which are well below market rates. Additionally, they have very screwy rules on paying for equipment. I work in sleep lab; the Medicare rules on getting a patient a CPAP are very complicated and wasteful.

Medicare is also not sufficient for most people; that's why retirees have supplemental insurance either through their old company, or a private, for-profit company that can actually cover their needs.

It's an easy-to-scam system (how often do you hear about people scamming CIGNA out of billions?) that is simply a social safety net. To answer your original question, Medicare for everyone would be an insufficient, expensive, wasteful program.

And don't even get me started on the people who say it would be like the VA for everyone. That's a disaster orders of magnitude higher than Medicare.
 

SFO-IST

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The problem is that they are looking at the issue from the wrong end. It doesn't matter if it's government or private, both can work.

I hold Canadian citizenship and American citizenship. I've had the (mis)fortune of experiencing both healthcare systems and I know that -anecdotally- Canadian healthcare is awesome. I have no complaints. Also, I was born when both my parents were unemployed. In the USA, they would have gone bankrupt. Nowdays they more than pay back in one year's worth of taxes what it cost the Canadian govt. to pay for my birth.

Japan has a healthcare system that is mostly private. However, they have regulatory mechanisms that prevent cost from growing the way it does in the USA. It doesen't matter whether it's private or public, what is needed is regulatory incentives to keep costs low.
 
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drctother

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Thank you both of your feedback, believe it or not I couldnt find an explanation simplified like that anywhere on the internet. Now I have a better idea about medicare, i did not realize it overpays for a lot of stuff.

I will keep that in mind about the benefits of increasing regulatory incentives to keep prices low and I will try to research that. Thanks
 
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Upon first learning about Obamas Health Care Reform, I was all for it. I thought it was genius and sounded amazing. But then I realized its more like a "band-aid" in that it temporarily fixes a few problems. However, it doesnt really address the main problem with American Health Care: The Insurance and Pharmaceutical companies have way too much power and only care about making money. Thus even with the reform, they are able to jack up premiums

I am personally for a single-payer health care system upon learning more and more about the US health care system. I have spent my whole life in this kind of system (being Canadian) and the US could REALLY benefit from it. The one thing that sucks about Canadian Health Care (waiting lists) would not exist in the states because of the way your system is currently designed. Imagine not having to worry about a hospital bill. Imagine not needing a visa or mastercard to show up at a hospital. Imagine leaving a hospital after X surgery and not paying a dime. Thats what I experience everyday. How do I suffer? Well say I sprain my ankle...and need a CT or X-Ray.... I need to wait up to 6 weeks to get it, IF and ONLY IF they misdiagnose me the first time in the ER but this rarely happens. But let me ask you this: Is that really SO bad when its free? The waiting is nearly as bad as people portray it on TV, but there is still waiting. Its based off prioritizing. If I walk into an Emergency Room and I broke my wrist...and a woman who just had a heart attack comes in..you can best believe she is gonna get treated first, and why shouldnt she? Thats why there is waiting. Also we dont have as many fancy machines as America has. Thus it adds to waiting

My question: Why wouldnt the US benefit from such a system? Essentially it would be Medicare for EVERYONE. With the huge number of hospitals and money already invested in medical technology, I really think you guys would

Thoughts?

You are very liberal with that "free" word. When it comes time to pick up your check, you will find that you only earn 40 cent dollars, because your government helps themselves to the other 60 cents to give you all that "free" stuff. Now imagine you don't want to wait or your are in an area that doesn't have enough PCP's to go around so they need to start raffling off the PCP's for the year. Would you be as happy paying that 60 cents for every dollar you make? This is your system. No real incentives for novel treatments or new discoveries in medicine with the government overworking your hospital staff and limiting what they are and are not able to treat. So, do you really feel comfortable with a bureaucrat deciding what kind of treatment you are going to get? I know I don't.

There are two fundamental problems with the US system:

1) Malpractice costs/litigation
2) The third party payer system. This removes financial responsibility away from the individual and allows for cost inflation behind the scenes which the insurance companies and hospitals all partake in.

If you really want to fix the problem, the US needs to move beyond this and get down and dirty with a pay for service model. If you want a check-up, YOU pay for it. The only thing insurance companies should be in business for is catastrophic coverage (i.e., cancer, trauma, etc.). This is a model that will soon self regulate itself. Costs will be managed by competition for business, and technological advances will be made in an effort to lure more patients and compete for the market share. This would do two things, it would bring the individual back into the picture where s/he would need to make decisions about his/her medical care, and it would remove the insurance companies from the day to day aspects of medicine.

I'm dreaming though... this will never happen, because people are too challenged to see that it would work, so they would never fight for it, and the insurance companies and hospitals are making too much money to allow it to happen.

If you want a clean cut example of how costs are reduced by competition and technology, look at any elective medical procedure (plastic surgery, Lasik, etc.).
 

FSUchess99

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can anyone recommend a quality book on health care reform that offers multiple perspectives? Im premed and should know much more about these issues than I do. I plan on looking for a course on the matter before I graduate.

generally speaking, I think the government brings inefficiency to everything they touch (sometimes inefficiency needs to be balanced with what is fair in the business world), and any given process can be made much more effective/efficient when there is a financial incentive to operate the process as such.
 

cbrons

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can anyone recommend a quality book on health care reform that offers multiple perspectives? Im premed and should know much more about these issues than I do. I plan on looking for a course on the matter before I graduate.

generally speaking, I think the government brings inefficiency to everything they touch (sometimes inefficiency needs to be balanced with what is fair in the business world), and any given process can be made much more effective/efficient when there is a financial incentive to operate the process as such.
http://www.amazon.com/How-Economy-Grows-Why-Crashes/dp/047052670X/ref=sr_1_1?ie=UTF8&s=books&qid=1291589740&sr=1-1
 

gatorfann14

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You are very liberal with that "free" word. When it comes time to pick up your check, you will find that you only earn 40 cent dollars, because your government helps themselves to the other 60 cents to give you all that "free" stuff. Now imagine you don't want to wait or your are in an area that doesn't have enough PCP's to go around so they need to start raffling off the PCP's for the year. Would you be as happy paying that 60 cents for every dollar you make? This is your system. No real incentives for novel treatments or new discoveries in medicine with the government overworking your hospital staff and limiting what they are and are not able to treat. So, do you really feel comfortable with a bureaucrat deciding what kind of treatment you are going to get? I know I don't.

There are two fundamental problems with the US system:

1) Malpractice costs/litigation
2) The third party payer system. This removes financial responsibility away from the individual and allows for cost inflation behind the scenes which the insurance companies and hospitals all partake in.

If you really want to fix the problem, the US needs to move beyond this and get down and dirty with a pay for service model. If you want a check-up, YOU pay for it. The only thing insurance companies should be in business for is catastrophic coverage (i.e., cancer, trauma, etc.). This is a model that will soon self regulate itself. Costs will be managed by competition for business, and technological advances will be made in an effort to lure more patients and compete for the market share. This would do two things, it would bring the individual back into the picture where s/he would need to make decisions about his/her medical care, and it would remove the insurance companies from the day to day aspects of medicine.

I'm dreaming though... this will never happen, because people are too challenged to see that it would work, so they would never fight for it, and the insurance companies and hospitals are making too much money to allow it to happen.

If you want a clean cut example of how costs are reduced by competition and technology, look at any elective medical procedure (plastic surgery, Lasik, etc.).
Did you steal this out of my head? I could not agree more with everything you said as an economist and logical person.
 
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drctother

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Did you steal this out of my head? I could not agree more with everything you said as an economist and logical person.
He proves some very good points except making the Canadian health care system sound horrible, I dont appreciate that. Maybe I misunderstood his tone, who knows. I should have avoided the word "free", yes we pay via taxes. I also dont like when you use the terms "Socialist" because as Americans it has been drilled into your heads that anything socialist is the end of the world, especially regarding health care. The biggest flaw in our system is the waiting lists and even those are not bad. Yes we can wait up to a few hours in the Emergency Room, but only if you have a non-life threatening injury. With regards to this whole "cents to the dollar" approach: Why would you want to pay $5000 for a visit to the ER when it is covered, no matter the reason you are in the ER? Suddenly when someone you know dies because they cant afford an MRI or surgical procedure, maybe the whole cents to the dollar wont sound as bad. It is also incorrect to say our doctors dont have incentives. Fine, you may not like the idea of paying for someone else's health coverage (as someone else mentioned).....but that kind of scares me that pre-meds would be thinking in that way. Seems kind of selfish? Anyway before this seems like im trying to make this a US Vs Canadian health care debate, which im not, I was merely trying to take the pros of the Canadian health care system and apply them to the US health care system as it is. Obviously I am leaving my country to come practice medicine in yours, so obviously I see a lot of potential in your health care system and I was hoping to learn more about it. It was just an idea to take some of the pros of the Canadian system, thats all.

Would you mind explaining more about malpractice problems? I didnt realize it was such a big deal:(. Are doctors being sued that frequently???
 
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TallScrubs

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You are very liberal with that "free" word. When it comes time to pick up your check, you will find that you only earn 40 cent dollars, because your government helps themselves to the other 60 cents to give you all that "free" stuff. Now imagine you don't want to wait or your are in an area that doesn't have enough PCP's to go around so they need to start raffling off the PCP's for the year. Would you be as happy paying that 60 cents for every dollar you make? This is your system. No real incentives for novel treatments or new discoveries in medicine with the government overworking your hospital staff and limiting what they are and are not able to treat. So, do you really feel comfortable with a bureaucrat deciding what kind of treatment you are going to get? I know I don't.

There are two fundamental problems with the US system:

1) Malpractice costs/litigation
2) The third party payer system. This removes financial responsibility away from the individual and allows for cost inflation behind the scenes which the insurance companies and hospitals all partake in.

If you really want to fix the problem, the US needs to move beyond this and get down and dirty with a pay for service model. If you want a check-up, YOU pay for it. The only thing insurance companies should be in business for is catastrophic coverage (i.e., cancer, trauma, etc.). This is a model that will soon self regulate itself. Costs will be managed by competition for business, and technological advances will be made in an effort to lure more patients and compete for the market share. This would do two things, it would bring the individual back into the picture where s/he would need to make decisions about his/her medical care, and it would remove the insurance companies from the day to day aspects of medicine.

I'm dreaming though... this will never happen, because people are too challenged to see that it would work, so they would never fight for it, and the insurance companies and hospitals are making too much money to allow it to happen.

If you want a clean cut example of how costs are reduced by competition and technology, look at any elective medical procedure (plastic surgery, Lasik, etc.).
I like it in theory, but I foresee a major problem--you would throw primary care under the bus

The problem is that people, especially the working class, would rather forgo that $90 check-up for that little breathing problem they've been having so that they can eat for the week or buy their kids school supplies. Then, down the line, a small medical problem that could have been treated, again, in theory, escalates into an expensive problem. As a result, insurance companies have to jack up premiums and we're back where we started.
 

gatorfann14

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I like it in theory, but I foresee a major problem--you would throw primary care under the bus

The problem is that people, especially the working class, would rather forgo that $90 check-up for that little breathing problem they've been having so that they can eat for the week or buy their kids school supplies. Then, down the line, a small medical problem that could have been treated, again, in theory, escalates into an expensive problem. As a result, insurance companies have to jack up premiums and we're back where we started.
The point of covering catastrophic events only is that it would lower the cost of insurance significantly, which would free up funds to be used by patients to pay the full cost of things such as check-ups. This would serve the purpose of lowering the overall expenditures by making people understand the cost of care better(no more visits because a child sneezed).
 

cliquesh

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With regards to this whole "cents to the dollar" approach: Why would you want to pay $5000 for a visit to the ER when it is covered, no matter the reason you are in the ER?
If you switched to a service for fee model, healthcare providers (Docs/hospitals) would be forced to compete for patients, and would therefore be forced to lower prices to attract patients. So, instead of paying $5k for an ER visit, it would be significantly less. The price would be something the average person could afford. This is how medicine was in the 1940-1970's, and this is when doctors made a lot of money, lol. And, in our med law class, the professor said, "everyone in this room will be listed as a defendant at least once." So, yea, you are going to be sued.
 

fiznat

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I think the current picture of our "healthcare crisis" would change quite a bit if patients were brought in closer relation to the actual cost of their care. So much is wasted on needless medicine, I'm having trouble even imagining what the world would look like if that were to change.

Oftentimes I find this discussion tends to boil down to a few key points, the most important of which is usually "do patients have an intrinsic right to medical care?" I'm not sure that they do....
 

gatorfann14

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I think the current picture of our "healthcare crisis" would change quite a bit if patients were brought in closer relation to the actual cost of their care. So much is wasted on needless medicine, I'm having trouble even imagining what the world would look like if that were to change.

Oftentimes I find this discussion tends to boil down to a few key points, the most important of which is usually "do patients have an intrinsic right to medical care?" I'm not sure that they do....
I can't think of anything else that is considered a "right" that must provided and paid for by someone else's hard work and money. Healthcare is not a right anymore than owning a mansion is a right. While there are many instances of rights being protected(such as the military fighting our enemies and protecting all rights americans enjoy) healthcare is very different than a right such as speech in that it is not free. It does not cost anyone anything for a citizen to be able to criticize anyone or whatever.

You are only owed what you can kill and drag home. :beat: