Dismiss Notice

Interview Feedback: Visit Interview Feedback to view and submit interview information.

Interviewing Masterclass: Free masterclass on interviewing from SDN and Medical College of Georgia

Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

How close are we to Universal Health Care?

Discussion in 'Pre-Medical - MD' started by republicandr, Nov 15, 2002.

  1. republicandr

    republicandr Senior Member
    7+ Year Member

    Joined:
    Oct 23, 2002
    Messages:
    114
    Likes Received:
    0
    Hi- I've read posts about projected salaries of MDs, but one thing that I haven't read about is the impact of a universal health care system on salaries, lifestyle, etc. I'm from WA state, and here we seem to be heading toward a single payer system soon. The state hired some guy to help "fix" the health care "crisis" here in this state, and his solution is to allow insurance premiums to continue to skyrocket until they are totally unaffordable to average people, and then everyone will be forced to "demand" a single-payer option from the government. Here, insurance is a total mess, and each year our premiums go up by at least 25%. And insurance companies are pulling out of WA b/c it's still too expensive for them, since we have so many medicaid types.

    Many Doctors here think that a single-payer system isn't far off. This is a primary reason I am at this point choosing the military option as my first. In a single payer system, I won't have the financial incentive to take out loans, etc.

    I do think that universal health care would be awful, and that it's an unpopular idea right now for patients, doctors, and lawyers alike, but I am afraid that it may happen within my lifetime at least.

    Any thought?
     
  2. Note: SDN Members do not see this ad.

  3. vivekap2007

    vivekap2007 cowtown indo hornet
    7+ Year Member

    Joined:
    Sep 4, 2002
    Messages:
    116
    Likes Received:
    0
    IMO Universal Health Care makes sense because we will spend less money on health care than we do now while at the same time maintaining quality and increasing availability. As it stands now, those without any coverage besides medicaid (which many doctors won't take) must go to the ER or urgent care clinics(UCC). These lose so much money many hospitals find it hard to keep them open. A single payer system would eliminate this and other problems which I don't have time to post here but an excellent proposal is available at: http://www.pnhp.org/publications/archives/000016.php
     
  4. Jet915

    Jet915 Shi*ter's Rule
    10+ Year Member

    Joined:
    Sep 23, 2002
    Messages:
    556
    Likes Received:
    1
    I do not think universal healthcare is a good thing. First of all, patient care will go down because there will be a glut of people wanting treatment for all sorts of ailments not to mention how inefficent government bureaucracy is. I talked to an interviewer extensively about this issue at MCO and he told me it was probably going to happen eventually. He was not necessarily for it but he said it's going to happen. Hey republicandr, i am really interested in the military too and I saw you got accepted to USUHS. I interviewed there on Oct. 10 and am still waiting on them. I called them up and they gave me the generic answer saying that no decision has been made yet without even looking up my file. I know other people who interviewed that same day and after me got accepted so I will probably call again hoping for someone else to pick up. Just wondering, what did the snail mail come in? A thin envelope or a packet?

    Jetson
     
  5. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    I can't remember where I heard this, but it bears repeating: "If you think health care is expensive now, just wait to see what it costs when the government makes it free."

    Unfortunately, we are all going to be paying for healthcare, whether it be in our taxes or out of our pocketbooks. I'd much rather pay out of my pocketbook, as I figure that market forces will provider cheaper, better care faster than the government will.

    But, I still am concerned about the 40 million Americans w/o insurance. Those people should have access to care somehow, but I don't have the answers on how to do it. :(
     
  6. Tweetie_bird

    7+ Year Member

    Joined:
    Nov 20, 2001
    Messages:
    2,193
    Likes Received:
    2
    Hey there,
    could you share where you got this info from? I want to read more about single payer systems and I can't seem to find it.
     
  7. Jet915

    Jet915 Shi*ter's Rule
    10+ Year Member

    Joined:
    Sep 23, 2002
    Messages:
    556
    Likes Received:
    1
    One way to get more people insured is to give tax credits/breaks for small businesses to enourage them to provide insurance for their employers. A large amount of those who are uninsured are those who work for small businesses. Another way to insure more people is tort reform. People are sueing hmo's for 100's of millions of dollars...............I am sorry, but I dont think a number that high is really justifiable. Also, reforming the patent laws is another good way to lower medicine coasts. Many drug companies are doing frivolous lawsuits just in order to allow their drug patent to continue or they just slightly modify the drug and obtain a new patent for it. Of course, one needs to make sure that patent laws are not too short or there will not be any incentive for R&D.

    Jetson
     
  8. cabruen

    7+ Year Member

    Joined:
    May 23, 2002
    Messages:
    645
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Understanding Health Policy by Thomas S. Bodenheimer

    I will again make the pitch for THE BEST primer on the way our health care system is structured, financed, and issues involved with it. It is objective, non-partisan, short, easy to understand, and geared towards physiciancs in training.

    From the back cover...The title doesn't do the book justice. It's not only about health care policy and its implications, it's about the health care system, applied to highly clinical relevant sitations. It provides an unobstructed view of the complication health care system.

    Also from the back cover...Goes a long way towards helping readers understand how the health care system worked in the past, how it is changing, and how it might work under different scenarios in the future.

    I contend that until you have read this book, you are not taking the issue of becoming a doctor seriously.
     
  9. brownman24

    brownman24 Member
    7+ Year Member

    Joined:
    Oct 6, 2002
    Messages:
    59
    Likes Received:
    0
    I think the idea of universal healthcare has advantages and disadvantages. Obviously it helps the 44 million uninsured americans. However, implicit in choosing to insure all people will be a decrease in the quality and quantity (percapita) of care that can be bought, because you are spreading the money over more people. Also, because it will be a single payer system, all the purchasing power will be in the hands of the one player, the government, who will set their payment rates as they please.

    Result: Decrease in physician income, decrease in prestige of medical profession, with same time and emotional dedication. If we, as a society choose to go down this road, many intelligent and capable candidates will be dissuaded from the medical profession. I have spoken to people from other countries where socialized medicine is in place, and they have always told me that you don't have to be that smart to be a doctor. While I know that other qualities are very important in being a physican, i am comforted by how difficult it is to get into medical school in this country.

    Also, the AMA will do everything that it can, and it has tremendous lobbying power, to try and make sure that universal healthcare will not succeed at the federal level. This includes painting those supporters of universal healthcare as communists.
     
  10. Tweetie_bird

    7+ Year Member

    Joined:
    Nov 20, 2001
    Messages:
    2,193
    Likes Received:
    2
    will check it out today, charles. was it an easy read?? I need something to read for my vacation anyway.
     
  11. cabruen

    7+ Year Member

    Joined:
    May 23, 2002
    Messages:
    645
    Likes Received:
    0
    Status:
    Resident [Any Field]
    It is an easy and quick read. Sure it is about health care policy and financing, so it doesn't read like a Robin Cook or Danielle Steel book. But it is a small lightweight book, that is emminently readable. Another plus for vacations, is that you can pick it up and read a section or two, and put it down. You can skip around the chapters and sections easily. So the book can be read in small chunks.

    Have fun on vacation.
     
  12. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    But tax credits are opposed by those who want to keep other programs, and are upset that out tax surplus is gone. We either have to cut spending or raise taxes.

    Fortunately, in every industry where there is a lack of affordable services, new methods for delivering those servies at a profit are found. The growing number of uninsured will simply be seen a a growing untapped market for those willing to test ingenuity with the possibility of a profit. Rather than be discouraged by the financial state of medicine and physicians, I tend to be optimisitc, and beleive that the future will work itself out nicely.

    National health care will never happen in the near future. It's just way too complex to manage, and the popular will supports the current sysytem more. but things do need to change, and like you mentioned, tort reform is a great place to start.

    When tort reform happens, insurance companies will be without one more crutch they use to deny services and payment, with the somewhat booogeyman-ed excuse of litigation out of the way.
     
  13. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    Unfortunately, human nature asserts that people won't seek healthcare until they have too. Preventative healthcare is great, but the vast majority of people don't live that way.

    Universal health care is a noble idea, but it has many, many problems, as our frinds in Canada, England, and Sweden can attest.
     
  14. lola

    lola Bovine Member
    7+ Year Member

    Joined:
    Mar 22, 2002
    Messages:
    3,848
    Likes Received:
    3
    what's wrong w/ the system in sweden?
     
  15. ny skindoc

    ny skindoc Senior Member
    15+ Year Member

    Joined:
    Jul 30, 2002
    Messages:
    639
    Likes Received:
    11
    Universal health care run by the government is NOT coming soon IMHO.Why? Because it is in the interest of the president and congress to have others take the heat..HMOs and Insurance companies for the difficult cost cutting decisions which need to be made in delivering healthcare.Both political parties wont tell anyone the truth... that the only way to provide health care to the masses is to ration it.Limit procedures..no more coronary bypass surgey, dialysis and heroic measures for the elderly. Limit the use of expensive technology.Limitations which are currently practiced in many countries.In the USA no one will stand for this but few are willing to pay the taxes necessary to pay for the alternatives.Congress has no interest in telling you that your Grandma cant get the best that money has to offer.So dont worry yourself about universal govt run healthcare anytime soon!
     
  16. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    Nothing, if you like incredibly high taxes, mediocre doctors, and waiting for months for certain procedures.

    My buddy is a Swede, studying medicine in the US because he didn't want to learn in Sweden, because of the reasons above.
     
  17. TroutBum

    TroutBum Senior Member
    7+ Year Member

    Joined:
    Jun 15, 2002
    Messages:
    316
    Likes Received:
    2
    I'm not sure I agree with the folks who think that the cost of healthcare will increase more under a single payer system. As it stands now, the US pays more for health care than pretty much every other industrialized country (the majority of which have singel-payer systems), with more uninsured people.

    As for people demanding more treatment because of "free" health care, I think this argument is backward. A single payer system will require more careful budgeting of health care resources, which will eliminate many services deemed to be unnecessary but which my be provided now in a market-based system.

    I think patent law reform is a good idea, but it can't be too excessive, or as somebody mentioned, the incentive to research and develop new drugs will be gone.

    As far as not having to be "smart to be a doctor," in single-payer systems, I would disagree in some respects. In these systems there are lots of primary care physicians and fewer specialists, because that is mandated by the government health care system --here we have the opposite problem. So, there is less competition to be a primary care doc which may result in more the perception that it's not as tough to be a doctor, but there would actually be increased competition for the specialist positions, which would probably result in high selectivity.

    I think that, in all honesty, the biggest barrier to a single-payer system in this country is the loss of income for physicians and hospitals. There is no denying that a single-payer will really shred doctor's salaries, and I'm also pretty sure that the AMA will fight this tooth and nail. But, I've always said that I'm not in this for the money anyways. . .

    What it comes down to for me is sacrificing salaries and possibly enduring a slowdown in the pace of technological and scientific advancement for the sake of increased access to healthcare. I for one am for it.

    These are just my opinions--if I've said anything incorrect or if anyone disagrees, I would love to hear your thoughts.
     
  18. lola

    lola Bovine Member
    7+ Year Member

    Joined:
    Mar 22, 2002
    Messages:
    3,848
    Likes Received:
    3
    while i don't like those things too much, i might be willing to accept them if it meant no starving or homeless people. i could be wrong of course, but i doubt the doctors in sweden are that bad. sweden is one of the healthiest countries in the world and is home to the karolinska institute.
     
  19. AegisZero

    AegisZero Senior Member
    7+ Year Member

    Joined:
    Oct 27, 2002
    Messages:
    250
    Likes Received:
    0
    The problem with public medicine is that you lose specialists like crazy. With the costs of education and lack of pay afterwards, most doctors enter general practice. Few people are willing to put up with 7 years of residency for a surgical specialty if the pay is so low. That is why most Canadians with very specific health problems are oftentimes force to seek care in the US, because of the greater number of specialists over here.
     
  20. vivekap2007

    vivekap2007 cowtown indo hornet
    7+ Year Member

    Joined:
    Sep 4, 2002
    Messages:
    116
    Likes Received:
    0
    I don't see where the notion of a single payer system being inefficient comes from.

    It takes as many to run Blue Cross in Mass (covering 2.5 million people) "than are employed in all of Canada to administer single payer coverage for 27 million Canadians"

    "The average office-based American doctor employs 1.5 clerical and managerial staff, spends 44% of gross income on overhead, and devotes 134 hours of his/her own time annually to billing2. Canadian physicians employ 0.7 clerical/administrative staff, spend 34% of their gross income for overhead, and trivial amounts of time on billing"

    "According to U.S. Congress' General Accounting Office, administrative savings from a single payer reform would total about 10% of overall health spending. These administrative savings, about $100 billion annually, are enough to cover all of the uninsured, and virtually eliminate co-payments, deductibles and exclusions for those who now have inadequate plans - without any increase in total health spending."

    The article i'm citing goes on to refute (attempt to) some of the other common arguments against a Canada's single payer system including long waits and quality of care. It's available at
    http://www.pnhp.org/basicinfo/single.html
     
  21. logos

    logos 100% Organic
    10+ Year Member

    Joined:
    Nov 15, 2002
    Messages:
    1,231
    Likes Received:
    1
    Status:
    Resident [Any Field]
    I think the answer to the exact same problems is not to go to socialized medicine. But, instead to go in the other direction: Fee-for-service. The way it was back in the old days where while many people were uninsured, it didnt matter cuz when you left the doctors office/hospital you payed for what you recieved (and the prices were affordable!..still expensive but affordable)

    A system like this has many benifits, first is that your physician can be held directly responsable by you, as you are his employer. Second, this engenders a sense of responsability to the patient in the doctor. Third, it allows decisions to be made by doctors and their patients as to what is best for the patient both in terms of highest quality care and finances, something now largly dictated to both doctor and patient.

    Its a win-win doctors get better pay, patients get much better and (more importantly) more genuine and caring health care.

    Now implementing a change like this would be a mess. I think the first and best step would be to prohibit insurance companies from owning/running hospitals...a major root of the problems with managed care.

    As far as the cost to the patients being unaffordable as would appear to be the case currently. The number you see the doctor billing the insurance corp. is not what they are actually being paid, they bill an amount then the insurance pays what they want to pay of that amount (UCR). So how do doctors and hospitals make up for what there not paid by insurance companies? simple....charge the people that are paying cash more....cuz they cant resort to paying the piddely "UCR" they dont have the choice.....


    Anyway....its real simple....you take the free market (natural law...remember...what our country was founded on) out of the system and you MUST eventualy get low quality super expensive health care....we are getting some of this at the moment with HMOs which are similar to socialized medicine in that they pool resources, and squander them, then return whats left to those who paid in.....(in the form of health care)

    another obvious necessity of fee for service is the implementation of private insurance for any major costs such as hospitalization. However a private company could easily make a profit selling insurance in this manner. Unlike HMS it wouldnt waste huge volumes of $$ by encouraging people to seek treatment when it is unnecessary. People would be forced to make a choice...is this bad enough that I need to go to the doctor?....the beauty of which is that it is inherently efficient, when the financial trade off comes in line with the value of the services rendered people will take advantage of it, not untill. ie. people get their moneys worth out of medicine.....
     
  22. drumming207

    drumming207 Sucka Foo
    7+ Year Member

    Joined:
    Aug 18, 2002
    Messages:
    192
    Likes Received:
    0
    Well, I was just at an interview and we discussed Universal Healthcare. I think it is a good thing, but apparently my interviewer did not-- he said "it's a dumb idea." We debated a little bit about it in the interview. I think Universal Healthcare is a great thing-- I just don't know how we are going to pay for 40 million people that are without healtcare right now--even if we consolidate Medicare, Medicaid, Workers Comp, etc. into one lump sum of money for a single payer system. Anyway, this is a great discussion...:)
     
  23. NineSixteen

    NineSixteen Senior Member
    7+ Year Member

    Joined:
    Dec 13, 2001
    Messages:
    360
    Likes Received:
    0
    Status:
    Resident [Any Field]
    AH! Fee for service is a horrible option! Health care is a basic human right, not a right for those who can pay for it. We don't have fee for service for any other social service - when your house catches on fire the fire department doesn't check your bank account to see if you can afford their services. Schools educate all children (though not very well, but that's a whole other topic), police protect all citizens, health care should be available for all. Market forces and for-profit companies should have nothing to do with health care.

    Can we afford a national health care system? Absolutely. You think all that you pay for health care is your insurance premium? So very wrong. Out of each paycheck come taxes for medicare, medicaid and social security - but that's not all. Did you know that the US governmnet now gives over 100 Billion dollars a year in tax-payer funded subsidies to private insurance companies? Yep, the same private insurance companies that we (the insured) pay money to so that we get such quality care. The same insurance companies that the CEO's make 100X more than any of us will ever make as doctors. In fact, 60% of the total health care costs in this country comes from the government (read: your taxes) The other 40% comes from the money we pay out-of-pocket, in addition to our taxes.

    A National health care plan will cut out the fat. Doctors spend at least 8 hours a week these days doing paperwork, most of which is figuring out which patient has which insurance and what can or cannot be done for that patient based on that insurance. Doctors employ 1.66 administrative assistants per physician to help with all that paperwork, and it's still not enough. A one payer system would virtually eliminate that mess.

    There are so many misconceptions about what a one-payer system will look like and if it will be feasable. Most of the arguments listed here thus far are things that are told to us all, directly or indirectly, by the insurance industry that is currently making out like bandits. Private insurers keep 14-30% of total revenues on administrative costs and profits. PROFITS! What business does anyone have making profits on health care?! It's absurd when you really think about it.

    Please go to www.pnhp.org and read up on the plan proposed by physicians and medical students. Get the facts before you believe that a national health care plan will cut doctors salaries, limit care, add bureaucracy, limit choices or any of the other lies fed to the public. The plan we propose will do exactly the opposite of those I listed, and most importantly it will provide access to everyone, regardless of ability to pay.
     
  24. TroutBum

    TroutBum Senior Member
    7+ Year Member

    Joined:
    Jun 15, 2002
    Messages:
    316
    Likes Received:
    2
    I agree, fee-for-service would be the worst possible option. Can you really imagine telling somebody that he/she is going to have to pay for a triple-bypass surgery purely out of pocket? Who can afford to do that? Even a simple outpatient surgery is too much. I had a one-hour foot operation a few years back and the total bill came to $7,000. And I'm supposed to come up with the cash for this how?

    The reason that health insurance came about in the first place is that fee-for-service was prohibitively expensive for pretty much everybody.
     
  25. logos

    logos 100% Organic
    10+ Year Member

    Joined:
    Nov 15, 2002
    Messages:
    1,231
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Well...you see...something to the effect of a CABG would definately have to be covered under private insurance. Something to the effect of a plan that pays solely for costs greater than XXX dollars and hospitalization for more than X days...

    What you have to realize is that under such a system you would pay less than what things are currently said to "cost"...this is just a number that is billed, no one expects to recieve even half of what they bill....they know that its simply the way that HMOs operate..... under a fee for service sys. everyone would pay about what the corperations actualy pay in exchange for services recieved ( a number called "UCR" by the insurance company...the "usual customary and reasonable") What few people pay in the fee for service manner now must pay this billed fee....its partialy a way to make up for losses to the HMOs...so currently the fee for service patients (poorer patients) are taken advantage of...but in a fee for service system this would not occur...everyone would be charged the same ammount for the same services....

    not to mention that fee for service arrangements would give physicians the ability to be compassionate....you could charge less if you felt the need....or not charge the patient at all.....

    But the major benefit remains in the restoration of the patient-doctor relationship....paying for something/being paid for something forces both parties to strive togeather for the highest quality care....
     
  26. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    All I'm saying is what my Swedish friend tells me.
     
  27. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]

    Now we're getting to the philosophical meat and potatoes of the argument. :)

    The idea that healthcare is a right is ridiculous. It's a service (albeit a very valuable one). In all of the cases you cited above, it has been proven time and again that private companies/organizations are much more effiecient AND effective at providing services. Of course, not all private organizations work well, but the market selects out those that don't cut it very quickly.

    Now, I don't think that fee-for-service is the way to go either. It basically eliminates the possibility of health care for the very poor. Some type of assistance in needed to provide this most desireable of services.
     
  28. Ryo-Ohki

    7+ Year Member

    Joined:
    Apr 29, 2002
    Messages:
    3,575
    Likes Received:
    1
    but..but...it makes me feel good to say that health care is a basic human right!

    Heh, liberals are funny.
     
  29. bruinkid

    bruinkid Senior Member
    10+ Year Member

    Joined:
    May 31, 2002
    Messages:
    334
    Likes Received:
    1
    so,
    should healthcare be a right or a privilege?
     
  30. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    IMO, neither a right nor a privilege describes what health care is, or should be. It's much closer to a service/public work hybrid.

    Just because it isn't a right, doesn't mean we can't highly value it.
     
  31. logos

    logos 100% Organic
    10+ Year Member

    Joined:
    Nov 15, 2002
    Messages:
    1,231
    Likes Received:
    1
    Status:
    Resident [Any Field]

    Well, from one perspective it either IS a right or isnt.....we can not decide whether it should be or not....rights exist just by nature of being human....not something we can make or elliminate...they simply exist...

    I would argue that healthcare is a critical service and not a right. It is very important that health care be available to as many people as possible, however it is not a right. It just isnt along the same lines as the right to free speech or to a just trial.

    Also....rights usualy speek to actions and not to "things" such as health care...


    As for fee for service providing nothing to the poor. I dont oppose the idea of reasonable government medical coverage of the poor...medicaid....nor would i suggest that people should be denied care for emergent medical issues (ie...an ER cannot refuse to treat if you can not pay). Further, a fee for service system would allow physicians to be much more lenient in not charging patients, giving care to indigent patients has always been something that doctors have done....if anything I would say that a fee for service type system would be bennificial to the poor. Also many of the people who currently cannot afford healthcare...but are working (ie have some access to finances) would be able to afford their own health care. In the current system prices for these people (who cannot pay high insurance premiums for managed care) are rediculus because they are expected to pay the billed amount.....thus the people who can least afford to pay are charged the most....
     
  32. San_Juan_Sun

    San_Juan_Sun Professor of Life
    7+ Year Member

    Joined:
    Aug 9, 2002
    Messages:
    715
    Likes Received:
    2
    Status:
    Resident [Any Field]
    I really feel confident that leaving 40 million uninsured is simply creating a huge market for new ways of delivering health care. Just as HMO's multiplied like crazy when they began to make money, so will the next wave of entrepenuers.
     
  33. LoveDoc

    LoveDoc Respect the Rhesus Monkey
    7+ Year Member

    Joined:
    Aug 17, 2002
    Messages:
    555
    Likes Received:
    0
  34. bruinkid

    bruinkid Senior Member
    10+ Year Member

    Joined:
    May 31, 2002
    Messages:
    334
    Likes Received:
    1
    how do you provide quality care in an hmo environment
     
  35. republicandr

    republicandr Senior Member
    7+ Year Member

    Joined:
    Oct 23, 2002
    Messages:
    114
    Likes Received:
    0
    Hey Jetson- I interviewed Oct 3 and received a *thin* envelop on Oct 22 by snail mail. I thought it had to be a rejection, since they said at the interview that it would take about 4-6 weeks for them to make a decision... But, it was a "conditional" acceptance and who knows how long it will take for a "unconditional" acceptance. Anyway, good luck with all that! I think it's a great school and a great opportunity!
     
  36. republicandr

    republicandr Senior Member
    7+ Year Member

    Joined:
    Oct 23, 2002
    Messages:
    114
    Likes Received:
    0
    Back to the original discussion- does anyone know anything about individuals setting up funds (mutual fund types) that they can withdraw from as needed for health care costs, but if they happen to have a healthy life they would end up with a lot of extra money when they retire... I think this plays off of the fee for service idea. Of course, one would still have to have catastrophe insurance (deductible of 10000 or something!)

    Before you all start typing, we all realize that this is something that can't realistically be implemented because this entails saving money in an orderly fashion, and after all how are the unemployed and uninsured going to save money to put in a health fund...

    I was wondering about the experiences of people from less-liberal states than Washington. Are insurance premiums skyrocketing everywhere? Here it's bad, but my impression is that what threw our state into total debt is an influx of illegal immigrants who go to the ER but can't afford to pay at all, which of course gets passed along to everyone who has insurance. But even before the influx of illegals, in the 80s our state had a very open policy of allowing people onto insurance plans with pre-existing conditions and they were to receive full health care benefits without any waiting period. So, when AIDS struck we had a huge influx of AIDS victims who got right on our insurance plans, which at the time were affordable, and racked up costs exceeding 10K per year (at least) while paying 1K perhaps. Not to mention all the people who decided to sign on for insurance when they were 8.5 months pregnant... Anyway, I was wondering if this chaos is everywhere!

    Also, I wouldn't be so quick to discard the idea of a single-payer-system coming within our careers as doctors because there are people in power actively doing nothing to help the insurance problems in an effort to make the insured unable to afford their premiums any longer... When you can't afford to pay more than 1K a month on health insurance, what are your options??? To become uninsured and hope that no one gets sick (cause if you do, the hospital will come after you and take your assets until you have none left). When enough people have been wiped out financially by hospitals' bill-collectors, there will be an outcry and a demand for a single-payer-system. I think that those in power who are there to "fix" the health care system are hoping for this end, and to them, the ends justify the means. At least in Washington...
     
  37. logos

    logos 100% Organic
    10+ Year Member

    Joined:
    Nov 15, 2002
    Messages:
    1,231
    Likes Received:
    1
    Status:
    Resident [Any Field]

    This is interesting....Ive heard of some Docs in big cities (who have weathy patients )that require patients to pay beyond what their insurance pays. In exchange, these docs spend time actualy diagnosing, treating, but most of all explaining things to the patient.....essentialy they get to be traditional doctors.....

    As for the medical fund thing....there is a thing (at least in ohio) that is like that....i dont know all of the details but the gist is that you put a max of XXX dollars in an account from each of your pay checks TAX FREE. Then you can withdraw funds from the account to pay for medical need for your family (ie. copays, and any other expenses) at the end of the year the money that remains is taken out of the account and given back......but its taxed.....i think maybe even at a higher rate....
    Sort of like what you were talking about.....but its a program that employers must implement....and its used as another benifit usualy with health insurance....
     
  38. mpp

    mpp SDN Moderator
    Moderator Emeritus 10+ Year Member

    Joined:
    Jan 17, 2001
    Messages:
    3,398
    Likes Received:
    16
    Status:
    Resident [Any Field]
    These things you speak of have existed for quite a while on the federal level (I'm not sure how old...maybe 10 years...I think they came about when the Roth IRA legislation went through). They are called Medical Savings Accounts (MSAs). They aren't the most popular things in the world but some people are using them. They are tax free investment accounts that you use to pay for medical expenses.
     
  39. I've heard of this too:

    Well to do people in NYC will pay an FP 5k/yr for unlimited access (sometimes in their home). I wouldn't call this a trend, but it's an interesting idea: subscribing to a physician.

    I'd venture to say that most docs I know write off the portion beyond what insurance or Medicare/Medicaid pays. Some don't even bother to submit Medicaid claims and do that work for free because that system doesn't pay much and doesn't pay anytime this lifetime.
     
  40. DALABROKA

    DALABROKA Raider Hater
    7+ Year Member

    Joined:
    Jun 13, 2002
    Messages:
    204
    Likes Received:
    0
    Status:
    Resident [Any Field]
    (The Universal Decleration of Human Rights, The Office of the High Commissioner for Human Rights, United Nations Department of Public Information) http://www.unhchr.ch/udhr/lang/eng.htm


    The rights issue mentioned earlier is one of HUMAN RIGHTS, not constitutional rights. The only thing that I have to add to the discussion is that, in my opinion, our current system will eventually fail. It will take great efforts by all parties involved to rectify the problems facing health care in our country. It seems that the solution that will best address the problems will be a hybrid of the private vs. public health insurance stances.

    In my state, there is a public health insurance program for families that is based on a slide rule for premiums. This insurance is primarily for children, but low income parents can also access the services. It has come to be one of the best plans because all providers accept the coverage. There is none of this searching for who takes this type, or that type of insurance. This has alleviated allot of the issues surrounding uninsured children, but has not caused problems for private health insurance because it is an opt-in coverage for those that have problems affording other plans.

    To reiterate, it will take everyone working together to solve the health care crisis in the US, so lets work together toward the ultimate goal; providing affordable and quality health care to ALL of our fellow Americans.

    DALA
     
  41. NineSixteen

    NineSixteen Senior Member
    7+ Year Member

    Joined:
    Dec 13, 2001
    Messages:
    360
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I would love to see some of those "Proofs" that private companies are more efficient and effective at providing services. Do you know what the most efficient and effective system in this country is today? Medicare. Government funded medicare. Except that it doesn't provide Rx drugs. Medicare spends 2-4% on administrative costs, private insurance spends 14-30%. Efficiency? Really.

    "A study of nine options for covering California's seven million uninsured by the conservative DC-based firm of Lewin, Inc. finds that a single payer system of government financing of health care in California would actually reduce health spending while protecting the doctor patient relationship." (From a PNHP press release)

    I'm curious why it is that future physicians do not see health care as a human right. Human Right = "The right to the fulfillment of such vital needs as food, shelter, health care, and education..." This is a direct quote from the HELSINKI AGREEMENT released by the US State Department and urged on all nations, 1978. The doctor-patient relationship is at the core of good care. When we treat health care as a commodity that can be bought and sold we necessarily disrupt that relationship AND drive up costs. Private insurance tells us who we can and cannot go see for a doctor, they tell us when we are and when we are not "sick enough" to go see the doctor. Then they even tell the doctor what procedures are necessary or not for our treatment. 35 years ago, when health care costs were rising, doctors threw up their hands and said "Oh no, I just want to take care of patients, I don't want to deal with this money stuff" Business people were only too happy to step in and "take care" of the problem for us. Now we are spending way more than any other country in the world for health care that is mediocre at best. We have lower life expentancy and higher infant mortality than most other developed nations. This to me is proof that private insurance companies are NOT more efficient or effective in providing care.

    Here's a great commentary by two Harvard Profs about medical savings accounts, tax reforms, vouchers and other incremental reforms ineffectiveness

    Wollhandlet, S, Himmelstein, D; Arch Intern Med; 162, May 13 2002, 973-5.

    Great discussion y'all :) It's really important to start talking about this again and force politicians to make changes. It's an issue we all have to deal with for the rest of our lives.
     
  42. TroutBum

    TroutBum Senior Member
    7+ Year Member

    Joined:
    Jun 15, 2002
    Messages:
    316
    Likes Received:
    2
    As far as fee-for-service being good for the poor, let me just ask: "WHAT?" What is the rational behind the argument that those least able to pay for services will benefit the most from the most expensive method of health care finance? If you're speaking of doctors being able to not charge some of the patients under a fee-for-service option, my question for you would then be, "Who pays the bill?" If it's just a matter of an office visit with no tests or procedures, I can understand, but it's not these types of visits that are the driving force here. If anything, doctors won't treat ANY people unable to pay, because they'll be able to find people who will always pay, for whatever tests or procedures are done--if you're talking about a market system, this will end up cutting out all but the rich. Maybe you guys have more faith in doctors, thinking that their primary goal is to save mankind even at the expense of their own financial stability, but I'm not that optimistic.

    I believe that some forms of health care are a right, if it's available. Would anybody argue that food and water are a privilege, rather than a right? Everybody, simply by virtue of being a member of the human community, should have access to food, water, shelther, and the basic necessities of human living. Just because everyone doesn't is no proof that this is not a human right. In the same way, basic health care should also be included in this category. I'm not talking about the right to have a doctor remove an ingrown toenail, I'm talking about the right to recieve a life-saving antibiotic if it's available.

    Here's a question for everybody: how do you define a human right?
     
  43. republicandr

    republicandr Senior Member
    7+ Year Member

    Joined:
    Oct 23, 2002
    Messages:
    114
    Likes Received:
    0


    In this state, at least for ER docs and pediatrician/family practice docs, the docs actually pay about $6 to treat each medicaid patient (after subtracting the malpractice insurance cost to see each patient, the administrative/nursing staff per patient, etc.). But I've never heard of them taking this as a write-off... This is a problem in Washington state, but I'm not sure the Medicaid reimbursements are so low in other states.
     
  44. logos

    logos 100% Organic
    10+ Year Member

    Joined:
    Nov 15, 2002
    Messages:
    1,231
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Fee for service is not good for the extreme poor (read bums or people with no $$) ....but is good for the "working poor" (this term is a bit of a falacie...and i greatly dislike it....but i wont go into that) The reason it is good is that it would decrease the cost of health care to the point that they would be much more able to afford it (now...it wouldnt be cheap....but it never has been)

    It would essentialy be like the old days when nearly everyone could afford to go to the doctor when necessary.

    Why is this the case?
    Basicly...when you see your doctors bill that is to be paid by the HMO you see the BILLED amount. This is not what the doctor actualy recieves. The doctor has a contract (which he is nearly forced into) with the HMO that says he will accept less. So he bills a certain amount knowing that he will never recieve it. Thus the person with an HMO even with the added overhead of the HMO does not pay as much for service as is billed by the doc. However in the case of non-insured patients the amount billed is the amount they have to pay. This is where docs make up part of what they have lost to HMOs ....by charging more to the private patient. If HMOs were eliminated then every patient would pay the same ammount for each service an ammount currently less than the "billed" ammount currently....

    Further, as stated above....a fee for service system creates a greater responsability of the physician to the patient and improves the doctor patient relationship. The physician has to look the patient in the eye and say...."thatll be XX dollars"(usualy not so literaly but in effect...) Thus the physician has less of a tendency to get gready ....

    It is just a better system.

    If you want something to compare it to...then compare it to dentistry.....people pay (largely) for their own dental care....as a result they get high quality care that they are very satisfied with at an excellent price....why? cuz the dentist cares what the patient pays for a service....dentists present both sides of a medical issue when one exists....well you could get XX procedure done for $$$$ which is the best fix......but XXX procedure would also work and it only costs $$....if the dentist ****s up then they fix it free.....patients love and respect their dentist......and who do you know that cant afford to go to the dentist??? (not talking about cleanings here....but when they are in pain)

    Fee for service is just a better system for the patient and is much more fair. It relies on the forces of natural law to effect the market and invariably must produce a better result...

    It would, quite simply produce the simplest system with the least overhead and administrative costs. It puts the decision making into the hands of those who should be making the decisions(doctors and patients)...not those who stand to benifit financialy (HMOs)....


    Not only is it benificial to those with lower incomes but it would be benificial to all....by providing better care....
     
  45. galen

    galen Senior Member
    7+ Year Member

    Joined:
    Sep 11, 2002
    Messages:
    226
    Likes Received:
    0
    quote:I would love to see some of those "Proofs" that private companies are more efficient and effective at providing services. Do you know what the most efficient and effective system in this country is today? Medicare. Government funded medicare. Except that it doesn't provide Rx drugs. Medicare spends 2-4% on administrative costs, private insurance spends 14-30%. Efficiency? Really.
    ------------------------------------------------
    This is very interesting...One fear of single payer system is the long waits for service in Great Britain and Canada. Many Canadians have to have the govt pay their fees to have radiation tmts done in USA.
    I talked to a group of Canadian cancer pts who were in Detroit Mich for radiation tx. They say they have the machinery in thier city but noone(drs or RNs) there to do the txs. Interestingly though, they all said they were very satisfied with their system because they know if they lose their job they would still have free coverage--these were mostly older middle aged and elderly people who didnt mind making the trip every wk since the govt paid travel expenses too.
    Id be interested in what Canadian &GB premeds think about their system.
     
  46. Mistress S

    Mistress S Don't mess with the S
    10+ Year Member

    Joined:
    Apr 15, 2000
    Messages:
    996
    Likes Received:
    3
    Status:
    Resident [Any Field]
    Ninesixteen, thank you for your voice of clarity in this interesting debate. I too am surprised to see so many future physicians opposed to socialized medicine (which is essentially what we are talking about here). It is not really necessary to debate whether or not socialization would improve medicine, as we need only look at any other developed nation in the world, almost all of whom employ some form of socialization in their medical systems, to compare. These countries enjoy medical care for ALL their citizens, not just a privileged group, pay far less for it than we do, and have longer life spans, lower infant mortality rates, etc. I guess it's a matter of priorities- these systems are not perfect, as no humanly designed system ever will be, but at least nobody living within them dies for lack of a readily available antibiotic or routine operation, or has their home repossesed because they couldn't pay their hospital bill. What's more important- that every person has access to at least basic and necessary medical care, or that the relatively rich can get an MRI every time they snap their fingers? While it is true that you may wait longer for certain health care procedures in a socialized system, at least you would have the guarantee of getting those services if you need them, whether you have a job and money or not.

    The strong concept of individualism drilled into us in this country from infancy on teaches that if you work hard, you will succeed- so by implication, those who are not successful must be lazy. But this is such an obvious fallacy, as the hardest-working people in this country are often the least successful monetarily. Still, we view poverty and the poor as "their" problem, and this attitude is clearly reflected in the lack of concern for the well-being of those 40 million people in this country who cannot afford health insurance, and the ridiculous suggestion that a fee-for-service arrangement will solve this country's health care woes. As for the issue of choice, how much choice do any of us have now? Do you decide which doctor to see, what tests to order, which medicines to take? No- your insurance or HMO decides for you (assuming you are lucky enough to have health insurance), based not on what is necessarily best for you but on what is most cost-effective for them. It is disgusting that the same profit driven logic that is used in car insurance is applied to human life, and that companies are making money- huge, vomit-inducing amounts of money- off of our illness. At least in a government run system, you would have some marginal say in how the system was run through your vote. How much say do you have in how your medical insurance works now?

    I work at a non-profit clinic now, which receives government funds for low-income patients to receive reproductive health care services. Almost none of our patients have insurance, and without this funding- which the Bush administration will almost certainly not renew when it comes up for review in two years- they would go without these services. The $200 the government pays for these women to receive annual pelvic exams and birth control for a year saves thousands in costs that would otherwise result from unwanted pregnancies, which would in many cases add both the mother and child not only to medicare but also welfare and other social programs and cost the state tens of times more than the cost of simply providing them with effective birth control in the first place. The $15 pap smear and the $10 chlamydia test they receive screen for problems that, if caught early, are relatively easy and inexpensive to treat, but if left undetected and untreated could lead to cervical cancer and pelvic inflammatory disease and cost thousands to treat, as well as cause life-threatening health complications for these patients. If they could not get these services for free through my clinic, then they would not get them- for many of them, the choice is between paying rent and buying groceries or paying for health care, which is not really much of a choice at all. If everyone had health insurance, no one would need to make such a choice. I dread the day when I will have to work within the private system and watch people make decisions like that all day long. It is such a wonderful thing as a health care provider to be in an environment where neither I nor my patients have to have money be the primary deciding factor in whether or not they get the health care that they need.

    I agree that socialized medicine poses a problem in terms of doctor's salaries- as long as medical education remains prohibitively expensive, no one will be able to afford to go tens of thousands of dollars into debt only to make $40,000 a year. The solution? Socialize higher education as well- I believe the two must go hand in hand in order for such a system to work. Of course, I highly doubt any of this will happen in my lifetime, but what a wonderful thing it would be if we looked at society as a team effort where nobody is winning if the team is losing, rather than the each man for himself attitude we currently seem to espouse. It's not as if this is all some wild idea- many countries have succesfully socialized both their educational and medical systems. But I doubt with America's overall inability to see the big picture and our almost complete brainwashing by the corporations who profit from our ignorance, we will implement any similar programs here in the near future. The financial interests are too deeply entrenched to make such a thing feasible.

    And before I get some patriotic idiot telling me if I don't like it here, why don't I move- believe me, I would if I could, but highly socialized nations, such as many of the Scandanavian countries, have very restrictive immigration policies (a major but necessary drawback to such a system), and wouldn't want me until I have a useful skill, by which time I will be so deeply in debt here that I will have to work at least for several years in the private sector just to pay off my debt. Oh well, maybe I'll retire in Denmark.:D
     
  47. DALABROKA

    DALABROKA Raider Hater
    7+ Year Member

    Joined:
    Jun 13, 2002
    Messages:
    204
    Likes Received:
    0
    Status:
    Resident [Any Field]

    This is quite possible the most ignorant post I have ever read. It is obvious that logos has never tried to live the life of the average American. Dentistry is one of the most overpriced health services available. It is for this matter that most families, children, and elderly people go WITHOUT ADEQUATE DENTAL CARE!!! I hope to hell that the medical field never does anything as stupid as adapting the practices that the dental field uses...we would all be screwed then (at least those of us that were not born with a silver spoon in our mouths). My father recently found out that he has to have is teeth pulled and get dentures. Shortly after finding out that he need $2000+ in dental work, he found out that the dental insurance doesn't cover dentures. SO, he has to pay the entire $2000+ out of his own salary, which is only about $25000/year. How in the world can you say that this is an effective way of providing "low cost, quality dental care".

    Believe me when I say that lack of dental care is a major problem in our country, especially for the elderly. Most dentists could care less if your teeth were rotting away, NO PAY=NO SERVICE, pain or not (before the pre-dental people flame me I said MOST, and in MOST cases this applies to physicians as well; except in the ER for life threatening injuries). My wife is a social worker and has told me about some of the problems she has had trying to get dentists to work with low income people, even for items that Medicare will cover. The Medicare won't authorize an extraction with out the patient being seen by a dental surgeon first, but the dental surgeons refuse to see the patient until payment is made up front. If this is the future of medicine in our country, I think I'll take my chance in Canada.

    DALA
     
  48. TroutBum

    TroutBum Senior Member
    7+ Year Member

    Joined:
    Jun 15, 2002
    Messages:
    316
    Likes Received:
    2
    Dalabroka, you beat me to it but my sentiments exactly.

    Logos, you mentioned that an HMO patient never pays the full billed amount. I'm not sure I completely understand what you're saying here. Are you referring to the the total price of the medical bill, of which the patient pays only a fraction (if at all) out-of-pocket? If that's the case, you're correct, the patient only pays a little. But where does the difference come from? The difference is payed by the HMO. What do you think premiums and employer contributions are for? The flaw in your argument is that you think that health care costs will magically decrease if the HMO is taken out of the picture. That might very well be the case, but never down to the amount of a standard copay! And without premiums and employer contributions, the patient is left to make up the difference, which you seem to think will just disappear with the HMO. Lemme know if I've misunderstood what you said, but as it stands now I can't find any logic in your argument.

    I think this is a really good thread, and we should keep the discussion going--this is an issue that we'll all have to fight about, whether for or against, and I definitely think that a pretty big change is going to be made without our careers. Medicaid has just been around since the 1960's (if I'm mistaken), and that was a pretty significant development, one that more than a few doctors currently working witnessed within their working careers.

    Just my thoughts.
     
  49. NineSixteen

    NineSixteen Senior Member
    7+ Year Member

    Joined:
    Dec 13, 2001
    Messages:
    360
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Hey all-

    Quick correction, DALA - that post was logos, not galen :) Just wanted to make sure no one gets pi$$ed off ;)

    Just wanted to post some clarifications to the most recent posts. The Physicians Plan for National Health Care is not really socialized medicine. It is a one-payer system, but the plan does not call for physicians to be government employees. Physicians would continue to work in hospitals, universities and private practice, they simply would have one form to fill out for billing instead of one form for each insurance company. Hospitals would not have to bill for individual patients, they would simply be paid a global annual budget to cover all costs(including physician salaries), negotiated each year between the hospital and government, and based on the hospitals past years needs and projected increase for the coming year. The state governments would be in charge of these negotiations, even though the funds would be federal funds allocated to the states.

    I have heard a lot of people complain that we would have to wait in line in this type of system. Surveys done in the past year indicate that Canadians and Americans with insurance responded exactly the same to questions like, "How long do you have to wait for a non-urgent appointment? Urgent appointment? Specialty appointment?" The wait times were the same. Galen, I used to live in Michigan, and I do know that lots of Canadians do come to Michigan for specialty treatments. Canada's national health care is currently underfunded, the American plan will not have the same problems as the Canadian system - we have been watching that system for years and can improve upon it. But, by the same token, my grandparents have been going to Canada for years to purchase their Rx drugs. So, there are just as many Americans going to Canada as there are Canadians coming to America.

    Also, just want to make sure people know that there is a difference between Medicare and Medicaid. Medicare is a system run by the government to provide care for people over 65, and this system works very well. It is directly funded by us (taxpayers) - you can see the deduction on each paycheck. Medicare does not provide Rx drugs, and has some of the same problems as the Canadian system, but it works well - better, in fact, than most private insurance. Less wait times, etc. on recent surveys. Medicaid, on the other hand, is a chronically underfunded program for people who have no health care, unemployed, welfare, recipients, etc. Having medicaid is NOT having insurance, it's a horrible system. Someone quoted that doctors actually pay 6 bucks to see a medicaid patient, I've heard the number as high as $40 in some states. Doctors limit the number of medicaid patients that they will see simply because they cannot afford it. This program makes it really difficult for uninsured to get any kind of preventative medicine, and the costs of expensive ER visits get shifted to all of us when the bill is not covered by medicaid. Medicaid is NOT an illustration of what a national health care plan will look like. Medicare is a better example, but the NHI will be better funded and more comprehensive.

    Innovations. A lot of people think that NHI will decrease the famous innovative medicine we have in this country. We have more MRI machines per capita than any other country. We have over 10,000 mammagrophy machinges, while studies have shown that only half that amount would be more than sufficient to do all the recommended mammograms each year. These would not disappear under a one-payer system. The efficiency would improve. If each state gets a budget each year, they must decide how to spend that budget. Money will be given to each state for purchase of the latest technology. Each state will have to figure out the best way to spend that money, and we will end up with better distribution of the technology that we need.

    Finally, that was an EXCELLENT point about socializing medical education. That point was brought up at the most recent PNHP conference, and I hope that it will be addressed soon. I think the first step is working on the health plan, though, and I feel confident that somehow I'll be able to make my debt go away. There are already many options for those of us who stay in academic medicine - NIH loan repayment grants and the like. Maybe those programs can be expanded, maybe physicians should be required to serve in under-served areas (like the National Health Service Corps) in return for free medical education. I don't kow the solution for the high cost of medical education, but I completely agree that it needs to be addressed.
     
  50. Ripley

    Ripley Dr. Wannabe
    7+ Year Member

    Joined:
    Feb 17, 2002
    Messages:
    222
    Likes Received:
    0
    LOL, clearly you've never had to work with medicare and medicaid, the two most inefficient carriers out there!
     
  51. NineSixteen

    NineSixteen Senior Member
    7+ Year Member

    Joined:
    Dec 13, 2001
    Messages:
    360
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Two different programs, medicaid is inefficient and underfunded. Medicare is not inefficient, see my above post :)
     

Share This Page