How close are we to Universal Health Care?

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Originally posted by NineSixteen
Two different programs, medicaid is inefficient and underfunded. Medicare is not inefficient, see my above post :)

Yes, they are two different programs, yet if you've ever actually worked in physician billing, you would know exactly what I am talking about. It's incredibly frustrating.

I've just finished reading through this whole thread, and I have to say you write some excellent and well thought-out posts. :)

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Originally posted by Ripley
Yes, they are two different programs, yet if you've ever actually worked in physician billing, you would know exactly what I am talking about. It's incredibly frustrating.

I've just finished reading through this whole thread, and I have to say you write some excellent and well thought-out posts. :)
Thanks, Ripley :) I try!

I would argue that Medicare is frustrating because it is one of many billing options. If Medicare were the only billing option, it would not be frustrating nor confusing.
 
For those of you that are advocating the implementation of a single payer system, I can only assume that your position is based on naivete' of the current healthcare crises and the belief that being a bleeding heart liberal is somehow morally superior. When you grow up, a basic fact of life is that all systems operate with limited resources and universal coverage is a huge misnomer. Universal coverage still means that the when-where-which-how of medical coverage will be set in stone by politicians who neither have medical expertise nor care for the people which they serve more than getting enough votes to be re-elected.

Why isn't anyone suggesting other solutions like caps on malpractice lawsuits, government paid malpractice insurance, federally guaranteed forgiveable loans for service in an underserved area (for all of you trying to find a way to pay for med school, you know that very few of these loans exist). The US has the most progressive medical system in the world and for those of you willing to ditch it for socialized medicine, maybe you should consider moving to another country if you like their system so well.
 
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Originally posted by spanky
For those of you that are advocating the implementation of a single payer system, I can only assume that your position is based on naivete' of the current healthcare crises and the belief that being a bleeding heart liberal is somehow morally superior. When you grow up, a basic fact of life is that all systems operate with limited resources and universal coverage is a huge misnomer. Universal coverage still means that the when-where-which-how of medical coverage will be set in stone by politicians who neither have medical expertise nor care for the people which they serve more than getting enough votes to be re-elected.

I will never understand why well-thought our plans that happen to be suggested by progressive thinkers are dismissed as bleeding heart liberal plans that will not work. In none of my posts do I claim moral superiority, nor do I resort to cheap personal attacks to prove a point. My thoughts are backed up by research. I am a grown up, and I know what I am talking about. The plan set forth by physicians will not be set in stone by politicians. The plan creates a group of physicians and health care workers whose sole job is to determine what will be covered under the NHI and what will not be covered. As it is now, this is determined on a case by case basis by insurance administrators. Under NHI, a liver transplant will be covered for everyone, under the current system some business exec decides if someones bilirubin is high enough and if they are encephalopathic enough to get a liver transplant. Under NHI, breat augmentation won't be covered, those who want elective surgeries that are not medically necessary will have to find another way to pay. Under no circumstances will decisions about medical necessity be made by non-medical persons, and case-by-case decisions will be eliminated. The reason resources are limited under the current system is because insurance CEOs and executives are millionaires.

Originally posted by spanky
The US has the most progressive medical system in the world and for those of you willing to ditch it for socialized medicine, maybe you should consider moving to another country if you like their system so well.

I just have to say

:rolleyes: :rolleyes: :rolleyes:

Again, NHI is not socialized medicine. And I honestly have nothing to say about the moving to another country comment except that I can't believe that a person named "spanky" who ends an argument by suggesting the people who disagree should pack up and leave are telling ME to grow up. Honestly. I am glad to engage in lively debate with people who have other opinions about how to fix health care, but your words here certainly don't make me want to debate anything further with you.
 
Single payer hasn't worked for Canada, and it wouldn't work for the USA. Why f*ck up the medical care of 240 million people because the system isn't working for 40 million? Fix the system for those 40 million, but leave the rest of us alone.
 
"Health Care is a Human Right " only in the Marxist mind.
 
Originally posted by Diogenes
Single payer hasn't worked for Canada, and it wouldn't work for the USA. Why f*ck up the medical care of 240 million people because the system isn't working for 40 million? Fix the system for those 40 million, but leave the rest of us alone.

If you define "hasn't worked" as costs less, increased access, similar if not shorter waits for non urgent care, and high satisfaction rates then yes the single payer system in Canada "hasn't worked".

There are numerous posts pointing out the problems with the status quo as well as the likelihood that a single payer system would cost less than our system, if it can be called that. What is wrong with that? By your own admission the system doesn't work for 1 out of 6 people; if you have an idea to "fix the system" for those 40 million without effecting the other 240 million then let's hear it.

Same source as NIneSixteen (www.pnhp.org)
 
Originally posted by vivekap2007
If you define "hasn't worked" as costs less, increased access, similar if not shorter waits for non urgent care, and high satisfaction rates then yes the single payer system in Canada "hasn't worked".

There are numerous posts pointing out the problems with the status quo as well as the likelihood that a single payer system would cost less than our system, if it can be called that. What is wrong with that? By your own admission the system doesn't work for 1 out of 6 people; if you have an idea to "fix the system" for those 40 million without effecting the other 240 million then let's hear it.

Same source as NIneSixteen (www.pnhp.org)

Quality is down in Canada. Hospitals are stuck using obsolete equipment because there is no money for modernization. Patients have to wait longer and longer for treatments. Many cancer patients don't start their chemo for an average of 6 weeks after diagnosis, whereas the average is less than 2 weeks in the USA. Hip replacements take 6 months to schedule -- meanwhile you are stuck in a bed. Wealthy Canadians are coming to the USA for treatment so they don't have to wait.

Of the 40 million uninsured in the USA, 20 million could be covered by a) setting the "poverty" level that defines Medicaid eligibility to a realistic poverty level, and not at the laughably low levels that most states use to minimize expenditures and b) signing up all eligible children for programs that provide coverage for children with working parents. Of the remaining 20 million, 10 million are healthy, working young people who could afford to buy into a medical insurance program but choose not to because they are young and don't have medical insurance as a priority. That leaves 10 million uninsured -- so the system would be working for all but 1 in 28 if state programs were funded at levels that would allow them to cover all the people that the programs were designed to cover. Pretty damn good.
 
Yes, prescription drugs are cheaper in Canada because there are restrictions placed on trial lawyers and the filing of frivilous law suits. But who hasn't heard of stories of cancer patients in Canada who wait in line so long for surgery, only to find out that their tumors are no longer operable.

I apologize for offending anyone, but passion exists on both sides of this issue. We can agree that most of us would love to ensure that everyone is taken care of to the best of our abilities. But I don't see any great medical breakthroughs coming from Canada. And even the most zealous advocate of single pay must acknowledge that this is not a progressive or innovative idea.

My final thought: for any system to be implemented, it will be better for some and not for others. Some benefits will come only at the sacrifice of others. When the patient is your child, parent or spouse what are willing to sacrifice??? Are you going to take them to Canada???
 
Originally posted by Diogenes
Of the 40 million uninsured in the USA, 20 million could be covered by a) setting the "poverty" level that defines Medicaid eligibility to a realistic poverty level, and not at the laughably low levels that most states use to minimize expenditures and b) signing up all eligible children for programs that provide coverage for children with working parents. Of the remaining 20 million, 10 million are healthy, working young people who could afford to buy into a medical insurance program but choose not to because they are young and don't have medical insurance as a priority. That leaves 10 million uninsured -- so the system would be working for all but 1 in 28 if state programs were funded at levels that would allow them to cover all the people that the programs were designed to cover. Pretty damn good.

I like your ideas...but how will they be funded (i feel like i'm in CX debate again). Many states are already facing budget shortfalls so the money just isn't there. CHIPs is a great program that provides matching federal dollars and it would be wonderful if every child were enrolled. However some states (Texas for instance) only recently started encouraging and publicizing CHIPs presumably 'cause they didn't want to pony the 1 dollar for 3 matching federal dollars. Good point about the 10 million people who just don't want health insurance.
 
Originally posted by NineSixteen
Two different programs, medicaid is inefficient and underfunded. Medicare is not inefficient, see my above post :)

I worked for three years billing Medicaid and Medicare in a mental health facility. I've got a bad back from jumping through too many hoops!

In any case, because payments by these programs are done on the state or regional level, there's a lot of latitude in how the beauracracy works. But if you're fed up with pencil pushers in HMOs making medical decisions, just wait until the government socailizes medicine.
 
Originally posted by vivekap2007
If you define "hasn't worked" as costs less, increased access, similar if not shorter waits for non urgent care, and high satisfaction rates then yes the single payer system in Canada "hasn't worked".

There are numerous posts pointing out the problems with the status quo as well as the likelihood that a single payer system would cost less than our system, if it can be called that. What is wrong with that? By your own admission the system doesn't work for 1 out of 6 people; if you have an idea to "fix the system" for those 40 million without effecting the other 240 million then let's hear it.

Same source as NIneSixteen (www.pnhp.org)

1. I don't know what country you're talking about, but that isn't Canada.

2. I think we can all agree that single payer has some possible benefits. But it's equally clear that a lot of questions and criticisms need to be resolved before it ever happens. Unfotunately, if there were an easy answer to all of these problems, it would have been found a long time ago (and NOT on an Internet message board :) ).
 
WOW! Awesome thread! I've been looking for a great discussion on this, and of COURSE I find it on good 'ol SDN... Have I told you (guys) lately that I love you? (thanx to Rod Stewart for that line) :love:

This is a forward I got in my inbox today from the politically active 'health-economics dude' in the second year. I already signed it and hope that you and many of your and your classmates will too!:)

--------------------
Please visit http://www.physiciansproposal.org and ENDORSE THIS PLAN, which can realistically provide quality health insurance for every man, woman, and child in America. PNHP wants MEDICAL STUDENTS as well as doctors to endorse this plan. It has already been endoresed by two former US Surgeon Generals, 3 past editors of the New England Journal of Medicine, and many past presidents of the American Public Health Association, American Medical Student Assoc., American Medical Assoc and the list goes on...

Not only that, please tell EVERY DOCTOR YOU KNOW to endorse it as well.

This is an entirely grassroots effort, but support is growing quickly. Your efforts can really help. With significant numbers of doctors (already over 10,000) this plan cannot be ignored.

That is it! If you want to know more about single-payor, there is a short summary below, a lot more info in the proposal, and more still at www.pnhp.org

Thanks,

Sam Seiden, MS2
 
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Canada is the "cheap bastard" of countries with socialized medicine. Please don't cite their problems as shortcomings of a socialized system. Their problems come from poor funding and have nothing to do with thier system. Our problems, on the other hand are directly the result of a bad system, and not poor funding.

What people need to understand is that the market system fails healthcare in this country b/c it's run through employers and not individuals. Many of you die-hard capitalists need to realized that the market system is only functional when people have the ability to choose what they want to pay for. In our system, it goes through employers which F'@#Ks everything up. The facts show that the goverment has been much more efficient when it comes to healthcare than the market system has, and the facts don't lie.

I'm with the socialists on this one.
 
I'm gonna agree with Wazupshah on this one...

For all you free market idealogues, just think about what combining profit incentive with healthcare will do... A free market system will inevitably fail to achieve universal coverage because it seeks to achieve the most profitable result. An insurance company which seeks to maximize its profit is going to: 1. raise the premiums on 'high-risk' people 2. deny coverage to other 'high-risk' people 3. waste money on advertising, overhead, etc. In this case, the only people who are covered are people who really don't need to be covered in the first place. Thats just a simple example of the failure of free market economics... There are a whole lot of other inefficiencies built into the system, but we could get to those later...

The United States Healthcare system, is inequitable and inefficient. I was taking a look at some stats the other day, and we spend 14.5% of our GDP on healthcare, 5% more than the next nearest country, Sweden. The sad thing is that Sweden, and other socialized healthcare countries, have achieved universal coverage, even though they spend less. On top of that, if you analyzed their life expectancy and infant mortality, it is actually better than here in the US. So, not only does Sweden, and a host of other countries by the way, run a far more efficient healthcare system, but, by most accounts, the average Swede (or any other European for that matter, and maybe even Cubans) is in better shape than the average American healthwise.

Why is there such a knee-jerk rejection of socialized health care? We have a socialized education system (Which really sucks, by the way, because we don't put enough money into it). All you StateU people owe your cheap (in price,not quality) educations to public subsidization of your educations. Don't be idealogues either way, its good to consider each case on its own. And, in my humble opinion, socialized healthcare is the more equitable and cheaper way to go.
 
Well said, pAkhtmAn and wazupshah. The big misconception is that people will be more restricted with a socialized system rather than in the market system we have now. But right now your employer basically picks your doctor for you.

This may sound very third gradish, but it's true: one of the underlying foundations of the capitalist system is the opportunity to succeed. Implicit in this is the possibility of failure. I think the logic makes sense from a business standpoint, but why allow the possibility for failure when human health and wellness is concerned? This is also the logic for having a government-funded public education system--why should some kids have to "fail" at the expense of those that win? Then again, with the current administration this may also be on the way out . . .

Anyways, let the flaming begin.

As for this:

Originally posted by spanky
The US has the most progressive medical system in the world and for those of you willing to ditch it for socialized medicine, maybe you should consider moving to another country if you like their system so well.

I can only say :rolleyes: :rolleyes: :rolleyes:

I love how this comment implies that nothing is wrong with the current system, and that the correct reaction to something that one doesn't like is just to run away from it instead of trying to improve it. Would you have said the same thing to civil rights activists and the suffragists earlier this century?
 
Thanks so much everyone for a great discussion! This is exactly what we need--education and respectful conversation--to spread the single-payer idea.

(In case you missed it, Al Gore just came out in support of single-payer . It's a big step in the movement, getting the words "single-payer" to the national dialog at that level.)

I work for PNHP, and manage our website, so if you have any questions, want any resources about single-payer, why incremental reforms people have suggested won't work, the problem with the current system, the pharmaceutical industry... we've got tons.

Just one note on waiting times, since that seems to be the current point in discussion: there are no waits for emergency services in Canada. People, in 99% of cases, get the care they need in Canada. There will always be small numbers of cases where the system fails. We invest (and have over-invested) in technology and services here in the US. In our current system, maintaining a high level of health care spending, there would be very little waiting time for services.
 
Originally posted by gramcracker
(In case you missed it, Al Gore just came out in support of single-payer . It's a big step in the movement, getting the words "single-payer" to the national dialog at that level.)


And I suppose he took credit for inventing the notion of a single payer system? :)

No matter what you believe, I'm amazed that such a thread has gone largely without needless flaming and hostility. Good work everyone.
 
Since Al Gore has been brought up, I feel it's only fair to mention that Rush Limbaugh is at this moment linking the hold-up of passage of the homeland security thing to the liberals' pursuit of universal health care.

When people discuss the efficiency of government run medicare, I wonder what they think of the efficiency of government run military medical care? The military are treated by Tricare, which is a huge HMO, and there are many many critics of the system who say it is worse than the worse HMO possibly imaginable. Medicnas has some links for info on this on the "military pay" thread. If the government wants a trial run at universal health care, why don't they set up the military system (tricare) as a type of test, then document efficiency and patient satisfaction, etc., then sell it to the public.

I also want to say that I am impressed at the little amount of flaming type of stuff. Now that Rush Limbaugh's name was mentioned by me, will you all be able to resist????
 
What is the major difference between "universal health care" and a "single payer system" -- ISn't the idea that everyone has coverage the main idea of both things.

I guess my question is how is the so called "universal health care plan" that Gore is lambasting as inefficient different from the "single payer system" he is advocating??
 
Originally posted by ShortStuff
What is the major difference between "universal health care" and a "single payer system" -- ISn't the idea that everyone has coverage the main idea of both things.

I guess my question is how is the so called "universal health care plan" that Gore is lambasting as inefficient different from the "single payer system" he is advocating??

ShortStuff--
Universal health care is just the general concept--providing health care to everyone. A single-payer system is one way of providing national health insurance. Universal health care exists in Canada, Germany, and the UK (as well as all other developed nations), but they each have a different way of doing it.

Canada has a single-payer system. All health care dollars go to one central fund, and are then distributed among the provinces. Germany has a multiple-payer system--similar to Canada's, except there are more payers (I believe 5 or 10? I'm not sure). The UK truly has socialized medicine. Doctors are employed by the state, and the health system is run by the government. (In Canada and Germany, health care is still provided privately.)

I missed where Gore is lambasting universal health care? Where are you getting that?
 
Thanks.I got it from a CNN article talking about Gore favoring a single payer system and I guess that why it didn't make sense.
** ok my bad as i am re-reading it a little more closely it says he was attacking the idea of "universal health care" in 2000. - And of course as we know he supports it now.

Just my 2cents but I think we need to build a better system than the Canadian. Healthcare is still provided privately in Canada but no insurance plans are private -- you cannot buy private insurance to cover basic care. I think that we should have "socialized medicine" but I think we need to keep competition in the equation so we dont' see that problems that Canada has (and trust me after living there even though the idea is great it can definitly be improved upon) that are a result from lack of competition/incentive/etc..
 
Originally posted by ShortStuff
Thanks.I got it from a CNN article talking about Gore favoring a single payer system and I guess that why it didn't make sense.
** ok my bad as i am re-reading it a little more closely it says he was attacking the idea of "universal health care" in 2000. - And of course as we know he supports it now.

Just my 2cents but I think we need to build a better system than the Canadian. Healthcare is still provided privately in Canada but no insurance plans are private -- you cannot buy private insurance to cover basic care. I think that we should have "socialized medicine" but I think we need to keep competition in the equation so we dont' see that problems that Canada has (and trust me after living there even though the idea is great it can definitly be improved upon) that are a result from lack of competition/incentive/etc..

The system we're proposing is better than the Canadian one, SS, but it still doesn't introduce a private system. The single-payer proposal would include prescription drugs and long-term care (two major things the Canadian system didn't predict to be important, but are very important today). The problem with introducing competition into the health care system is that a two-tiered system will inevitably lead to a difference in quality of care, support of doctors, etc. Part of the reason many Canadians like their system so much is that it really shows the country's dedication to equality. The rich and the poor use the same system. If you start making a system that is *just* for people who can pay for it, they're going to get better services, leaving those who can't pay for it behind. Whereas in Canada, if some rich or powerful person is dissatisfied about their local hospital's waiting times or technology, when they complain and get changes through, it helps the entire community, not just them.

I'm not sold (and don't think I'll ever be) on competition in healthcare. I agree it's a great principle in other markets, but it doesn't work in health care. Goals clash. A health care system's goal is to provide health care for its members. A corporation's goal is to make money. How have some HMOs, in part, been making money? By dumping the sick people off their enrollments, and trying to only enroll healthy ones.

Canadians are, for the most part, very happy with their system. And when compared to the US system, they hands down support their medicare program.

(Many businesses--including the Canadian auto industry (pdf)--support their medicare system, because it keeps costs down (and would be similarly effective for businesses in the US). More cars are now being made in Ontario than MICHIGAN, because it's much cheaper for car manufacturers to pay workers in Canada--since health care costs are so much lower.)
 
Healthcare is not always chosen by employers. In many large companies (and union shops - listen up democrats), healthcare benefits are used as a bargaining chip in negotiating new contracts with employees. By eliminating private healthcare benefits, you may also succeed in taking away dental, eyecare, short-term disability, and long-term disability benefits which are usually available to employees at a lower cost and offered as a package deal.

Many employers do ask for the employees input when switching plans and ensure that doctors that are being seen will be covered under the new plan.

The idea of a single payer system is overly simplified and have yet to cover what will happen to people who count on their existing plans to cover eyeglasses and braces for their children.

PS. Glad to know there is another dittohead out there!!!
 
People have been lauding the maturity of this post, the absence of flaming and hostility. Well, the disgusting decency with which you have all conducted yourselves cannot go without mention. I think you are all stupidheads. Clearly my way is the best solution for this dilemma.
 
gramcracker

how's it going? I just read your posts on this thread and noticed you work at PNHP here in Chicago. How's that going for you? What type of campaigns, talks, brochures do you guys have available?

The reason I write is that we just started a student-PNHP @ U of Chicago and I literally just made the e-mail list yesterday. Our HUGE first event will be a debate between Quentin Young and Dr. Epstein (also mentioned on this thread) in Feb. They had a televised debate on C-SPAN ~3 years ago and we're thinking about making it just as big here @ the U of C. The demand will definitely be there now that the discussion of a single-payor plan has reached national media. Both have already voiced lots of enthusiasm to go head-head again.
You got any advice/input on helping to orchestrate such an event?

Finally, I wanted to say that you seem to be a great fit for our school and since you've been accepted I am hereby actively recruting you. Look for PM's in your inbox. ;)
 
For sometime now I've been evolving and developing my 'flame-resistant' theory. This is my idea of what types of threads tend to be flamed more than others.

Flamed: religious discussions, affirmative-action, israel-palestine, homosexual etc.

What these all have in common to me is that they involved deep-seated (or is it seeded?) opinions where people tend to judge easier- or to use a more apt word with its proper definition, threads that people go into holding a prejudice with the issue at hand.

I'm willing to wager the majority of those that clicked on this thread did so with a GENUINE interest to learn more. They didn't click on it with the intention to immediately defend their belief prior to reading the very first post. The reason? Simply the infancy of this topic. It's one that is being developed and we generally do not have a lot of info on. As time passes and more get involved in the coming years on this crucial issue, we'll solidify which 'camp' we are in, and the first torches will begin to light ;)
 
I have a few questions for you smarties out there that know what you're talking about.

What exactly is the difference between "universal healthcare" and "single payer system." I am assuming universal healthcare is an umbrella and a single payer system is just one way of achieving that reform.

For example--a single payer system implies that the government )(or a any other private/public sector) pays for the ENTIRE populatin as a whole, where as Universal healthcare is just the government paying for healthcare for all??

Furthermore, what's "incremental reform." That phrase has been thrown out a few times and I have yet to understand it. Does it mean increasing taxes slowly to cover the deficit?
 
I think that the real crux of the issue is that there are two different visions of what healthcare is/should be.

The first says that health care is something that people either have access to or do not. Thus a universal health care system seems effective.

The second (which admittedly, I hold) says that it is most important to have care of the highest quality then comes the availability of such care.

I admit that a universal system of some sort could initialy provide care of similar quality to that of a free market system. However, such a system must eventualy degenerate, or stagnate at best. This must happen under a universal payer system as such a system eliminates the element of competition. Why would anyone do anything different if there was no benifit for doing so? For example...why offer some new procedure that may work a little better, if you get paid the same to do the old one? What compensation would one get for learning and implementing the new one? None.

Another thing that I simply don't understand is how one can argue that universal health care is more equitable. It is inherently unfair, essentialy it requires those who create the great majority of production to pay for the care of both those who do not produce significantly. Further, it requires those that are healthy to pay for the care of those that are sick...as their costs are likely to be greater than those of a healthy person. I don't see what the problem with insurance companies requireing greater premiums from those who will require greater expenditure. This redistribution of wealth is inherently unfair.

The alternative that I would suggest is a free market system, but one where the individual would have the absolute control over their own health care. A simple fee-for-service system. Health care in the US was fine until HMOs started showing up. HMOs create problems similar to those that would be experienced under a government conroled system. The only way to really let the individual have complete control over their own care is to let them pay for their own care.

As for comparing life expectancy in different countries, this isnt a very valid comparison as there are a huge number of differences more likely to cause these descrepancies. (ie. diet, number of smokers, genetic differences, location...ie prevelant pathogens, climate, etc. etc.) Correlation does not prove causation.

Oh yeah....and someone asked how fee-for-service would reduce the cost of health care (esp. for the lower middle class(working poor...if you prefer:rolleyes: )) I'll try to explain again:

Ok...imagine a doctor provides a service.

He bills patient A's insurance company $100 (knowing that they will never pay him this much). The insurance company then proceeds to pay the physician $25 (this is called the UCR--the "usual customary and reasonable" amount-as determined by the HMO). If physician A has a contract with the company then he must accept this amount as complete payment. If he has no contract then he has the option of either accepting the amount as full payment or billing the patient for the $60. Most likely he has a contract. If he does not, most likely he will just accept the amount.

Now, patient B goes to see the same physician and recieves the exact same service. Patient B, who has no insurance, is then billed $100. Patient B then takes out his check book and pays $100, because he has no contract with the doctor or an ability to just offer to pay what he feels is the "UCR".

Now....do you see it? The doctor just used patient B to make up for not making much from patient A. More likely than not patient B is the patient with the lower income. The were both billed the same...but because one is paying through a proxy (he pays the HMO, the HMO pays the doctor) he pays less to the doctor.

Hope this helps...I can see why it is hard to grasp...most people just don't see this...all they see is that it is impossible to afford health care without insurance.

or you can look at it another way....as a closed system....
Money In = Health Care Out
so if your insurance takes a big chunk out of your $$ before it goes in, and the same amount of Health Care comes out...then someone else must be putting in more and getting less out.

Oh...and here is a website with some good info:
http://www.afcm.org/
 
Originally posted by Tweetie_bird
I have a few questions for you smarties out there that know what you're talking about.

What exactly is the difference between "universal healthcare" and "single payer system." I am assuming universal healthcare is an umbrella and a single payer system is just one way of achieving that reform.

For example--a single payer system implies that the government )(or a any other private/public sector) pays for the ENTIRE populatin as a whole, where as Universal healthcare is just the government paying for healthcare for all??

Furthermore, what's "incremental reform." That phrase has been thrown out a few times and I have yet to understand it. Does it mean increasing taxes slowly to cover the deficit?

Tweetie--see my reply to ShortStuff on the differences between single-payer and universal health care. (You've got it right anyway.)

Incremental reform refers to expanding existing programs to cover more people, and eventually, everyone would, theoretically be covered. So, for example, you could expand CHIP (Children's Health Insurance Program) to not just cover kids, but their mothers. Or you could raise the income levels to allow more people to be covered under Medicaid. Or you could lower the age limit from 65 to 55 for Medicare. You get the picture.

There are several reasons incremental reforms just won't fix the problem. One big dual-problem: cost and coverage. The minute you lower the age from 65 to 55, many employers will drop coverage for their over-54 employees. This will bloat the system, and, increase costs. We're already struggling with 14.5%-15% GDP spending on health care costs; Canada is the next highest with only 12%. So, we'd increase spending, and only cover a small fraction of the people that still need coverage. Incrementalism, in the words of Marcia Angell, former EiC of NEJM, said in 2000, "incremental reform plans as proposed by Bush or Gore are still piecemeal and would likely backfire. They exacerbate the fragmentation, make the system even less efficient, and depress access to affordable, high-quality care. They both rely on the private sector (Bush's more than Gore's)."
 
There is something that I agree with 100% introducing universal health care by increments would be even worse than just intoducting universal health care....however...i think it is the only way that universal health care could squeak by without anyone noticing.....
 
Originally posted by logos

Gotta get to bed soon here, but I'll try to respond as thoroughly as possible:

However, such a system must eventualy degenerate, or stagnate at best. This must happen under a universal payer system as such a system eliminates the element of competition. Why would anyone do anything different if there was no benifit for doing so?

I disagree. Europe, several developed Asian countries, Canada--even Cuba--have some sort of universal coverage programs, and they're not dying under lack of competition. Sure, many are facing new challenges (all systems have challenges!) due to long-term care issues and prescription drug costs, but they cost less and work better than the US system. Why would anyone do anything different if there was no benifit for doing so? If there's no benefit, you're probably right, no one would do anything different. But if a new procedure benefits a patient--there are better outcomes--I think doctors will do them. I definitely would. Wouldn't you? Also, I think doctors like challenges. People don't want a stagnant practice. They want to learn new things, try new approaches--to help their patients the best they can. Maybe I?m missing understanding something here? A great deal of the research and trials of new drugs and procedures is paid for by the NIH, and done by university researchers, so I don?t think there?s any motivation-for-innovation loss under NHI (national health insurance).

Another thing that I simply don't understand is how one can argue that universal health care is more equitable. It is inherently unfair, essentialy it requires those who create the great majority of production to pay for the care of both those who do not produce significantly.

I guess by ?equitable,? I mean, uh, fair? I don?t think it?s right that just because a person has to work at McDonald?s because there are no other jobs in their area, or they don?t have enough education to qualify for others means they should suffer and receive poorer care, or no care at all. That seems unfair to me more than anything. Also, please note: something around 80% of those who are uninsured work. They give greatly to this economy, but their work is not appreciated. They clean our streets, serve us our meals, care for our children, hell, they even http://www.pnhp.org/news/archives/001524.php]take care of us when we?re sick[/URL].

Further, it requires those that are healthy to pay for the care of those that are sick...as their costs are likely to be greater than those of a healthy person.

Uh, that?s how all insurance works, logos. 5-10% of the population accounts for 80% of health expenditures here in the US. And disease isn?t always selective. You can be a Nobel Prize winner and have cancer, or you can live in rural Kentucky, or you can live in the inner-city. There are a lot of ways that redistributions of wealth might be unfair, but you probably don?t complain about them: government-funded immunization clinics for babies, income tax credits, or tax breaks for corporations who reap billions in profits (but that?s a redistribution from the wealthy to the wealthiest).

The only way to really let the individual have complete control over their own care is to let them pay for their own care.

That?s fine and dandy, but as I was taught, free markets and economics depend on consumers to be informed decision-makers. And until more of the population gets some sort of medical training, or knows the basics about how to spend a health care dollar efficiently and effectively, I think a free-market system would just create a different type of inequality: those who know how to research their health care money, have the time to research it, or can pay to have someone research it for them.
HMOs create problems similar to those that would be experienced under a government conroled system.

Which problems under a government system would those be? Medicare is at least three times more efficient that the average HMO, and has been as effective at controlling costs as HMOs have. (Single-payer systems, however, do a much better job at controlling costs.)

As for comparing life expectancy in different countries, this isnt a very valid comparison

Any suggestions for better ones? Infant mortality? The US still stinks. (And infant mortality is highly related to prenatal care.) Also, of the examples you give?diet, smoking, etc.?those are all related to a country?s public health education and infrastructure. If everyone in the US had a primary care doc they could see regularly, and had little not to see one, one could argue that those doctors could educate more people more effectively about diet, smoking, etc.

Yeah, I?m not following your free-market example. Maybe it?s too late. Not sure.

Post-submit:
i think it is the only way that universal health care could squeak by without anyone noticing...

People are noticing. Something's going to cave. Businesses are starting to realize a single-payer system would save them billions in health care costs. The middle-class is starting to get upset. Doctors are increasingly unhappy with medicine.
 
Hi, I'm a Canadian applying to US schools and I need some pointers to get to know the US health care system better. If anyone knows whether I can get a book or other resources so I can get myself informed, please let me know.

Thanks!
 
I was about to respond, but seems taken care of... excellent job gramcracker!;)

I specifically want to address the fee-for-service argument, since, in my humble opinion, fee-for-service seems to be the source of the problem for the practice of medicine here in the US.

In fee for service, a physician gets money for service rendered to the patient (duh!). Because of this, a physician has a financial incentive to see that his patients are sick and to perform procedures on that patient. Now, before anybody accuses me of anything let me explain. I'm not saying doctors are inherently greedy or evil, I'm just saying that people respond to signals in their environment. Let me draw an analogy: If we paid judges $500 for every guilty ruling and $5 for every innocent ruling, I would imagine there would be an increase in the number of guilty people. Likewise, a physician has a financial incentive to rule every patient as somehow 'sick', even though there is probably nothing seriously wrong with them. On top of that, fee-for-service, allows for some wreckless and disgusting profiteering from truly greedy doctors.

What else does fee-for-service do? Well, it provides a financial incentive for potential doctors to continue to specialize, because specialists can sell their services for higher fees. It also encourages the use of High-Tech treatment, when other treatments would be perfectly fine, again because you can charge more for the high-tech treatment. Our strictly fee-for-service system has generated a lot of inefficiencies.

Now, I'm not saying that capitation is ok either. Doctors who make money from capitation (from HMOs) and from fee-for-service (everything else) actually have a financial incentive to get rid of their HMO patients as quickly as possible, since they are paid the same by the HMO regardless of how many patients they actually see.

There are a whole lot of other issues surrounding fee-for-service, and right now, their just not coming to mind so I'll end this post right about here.

thE pAkht
 
BTW, I was responding to logos' argument...
 
logos, some points;

The second (which admittedly, I hold) says that it is most important to have care of the highest quality then comes the availability of such care.

This is the classic Bourgeoisie v. Proletarian argument. Lets say that the upper class decided that they liked a type of bread that was very high quality, a delicacy of sorts. Now, this bread required allot more time and resources to produce, so it obviously would cost more, but that is O.K. because they can afford it. So the people with the resources demand that they have this fancy bread, and the bread maker bows to their pressure and produces it. Now this is some really high quality stuff, the only problem is that the proletarian population can't afford it. This is all right though because the lower class says that the regular bread is fine and they don't need the expensive stuff. So now there is a demand for the regular bread and the bread maker responds by producing some more affordable bread. There is only one problem, the high quality bread required twice as much flour to make, so there is only enough left to make half of the affordable bread that is needed to sustain the lower class. Result, famine strikes the proletarian population and many of the weaker citizens, such as children and the elderly, perish. All the while, the upper class citizens were enjoying the quality of the fancy bread and the lower class citizens were suffering the consequences of its production. Do we see some similarities here???

I admit that a universal system of some sort could initially provide care of similar quality to that of a free market system. However, such a system must eventually degenerate, or stagnate at best. This must happen under a universal payer system as such a system eliminates the element of competition. Why would anyone do anything different if there was no benefit for doing so? For example...why offer some new procedure that may work a little better, if you get paid the same to do the old one? What compensation would one get for learning and implementing the new one? None.

Supply equals demand. Just because the payment for a new service may be the same as a current one doesn't mean that the demand for that service will not increase, especially if it is an improved product/service. For example, early next year a new generation of coronary stents that elute anti-angiogenic drugs will begin to hit the market. These stents are naturally more expensive than the current ones being used, but insurance companies and Medicare will only cover a marginal increase in the cost. The profit margin that the hospital makes upon each implanted stent will suffer, but the competition for the patients to have the procedure done at one place over another outweighs this lower profit margin. Therefore, the hospitals decide to "eat" the difference in cost to maintain the patient volume. This is also the reason for these UCRs that you seem to despise. The physician decides that they want the higher volume of patients, rather than the higher charge for the service. The innovation of new services and equipment in the medical field will always remain high because people will use and request the "better" treatments, thus causing a demand for those treatments, thus giving a reason for their development. This will occur despite the lack of an increased profit margin.

It is inherently unfair, essentially it requires those who create the great majority of production to pay for the care of both those who do not produce significantly. Further, it requires those that are healthy to pay for the care of those that are sick...as their costs are likely to be greater than those of a healthy person. I don't see what the problem with insurance companies requiring greater premiums from those who will require greater expenditure. This redistribution of wealth is inherently unfair.

All I have to say about this is that I sure hope you included these sentiments in your personal statement.:rolleyes: And people wonder why medical schools desire students with strong humanitarian activities, maturity, and humility.:confused:

Now....do you see it? The doctor just used patient B to make up for not making much from patient A. More likely than not patient B is the patient with the lower income. The were both billed the same...but because one is paying through a proxy (he pays the HMO, the HMO pays the doctor) he pays less to the doctor.

You should rethink your logic here. If patient B can't afford health insurance, how in the hell can he afford to write a check for a $100? These patients are the ones who cut into the bottom line of a physicians profit. Most often, physicians will not even see someone that doesn't have insurance unless they pay by cash or charge up front. Too often, hospitals and physician have to spend an incredible amount of money and time trying to recoup funds from people w/o insurance. Often times, not only will the physician get stuck for the bill, but also the collection agency bill and any legal costs that might have been accrued. Imagine the savings in this realm! I for one would rather have the lower, but guaranteed money over the time and resources spent chasing after a patient who needed services that they couldn't afford in the first place (couldn't afford does not equal didn't deserve or require). You should check out the amount of money spent each year on the uninsured, it is quite staggering. These people don't want the best care, they just need ANY care that they can get.

Respectfully,

DALA
 
There seems to be strong support for Universal Healthcare. Is this support illusory? Are these sentiments shared by the vast majority of the American people? Or do we, as Americans, prefer the current system? And if if there is vast support, well, How come we don't have Universal Healthcare...
 
Originally posted by pAkhtmAn
There seems to be strong support for Universal Healthcare. Is this support illusory? Are these sentiments shared by the vast majority of the American people? Or do we, as Americans, prefer the current system? And if if there is vast support, well, How come we don't have Universal Healthcare...

Insurance companies have a VERY strong lobby.:mad:
 
Originally posted by pAkhtmAn
There seems to be strong support for Universal Healthcare. Is this support illusory? Are these sentiments shared by the vast majority of the American people? Or do we, as Americans, prefer the current system? And if if there is vast support, well, How come we don't have Universal Healthcare...

It's not illusory, and it's growing. PNHP has over 10,000 physician members and medical students that support single-payer, and our physiciansproposal is growing every day. Public support is growing, too, and business support is starting to grow as well.

And yes, Dalabroka's right. The healthcare industry was the largest lobbyist group last year, giving the most money to campaigns. Hell, if you were making several billion dollars a year, wouldn't you throw your monetary muscle around to protect it?
 
I don't really think that a majority of Americans are all that interested in changing the health care system. People would much rather have an expensive, inefficient system that they fund directly than an expensive, inefficient system they fund indirectly through taxation. Such common American notions like individualism and capitalism will long hinder any prospects for universal health coverage.
 
Well said, gramcracker, pahkthman and DALABROKA. I also wanted to make an additional comment on the following:

Originally posted by logos
Health care in the US was fine until HMOs started showing up. HMOs create problems similar to those that would be experienced under a government conroled system. The only way to really let the individual have complete control over their own care is to let them pay for their own care.

Health care was NOT fine until HMOs started showing up. HMOS only became a big player in the last couple of decades, however the recognition for the need innovation in health care delivery goes back many, many decades. I think that the HMO was an inevitable step in the evolution of health care in the US, but I also firmly believe that the shortcomings of this system will eventually do it in and we'll make it to universal coverage.

Plickfu, I have to disagree with you when you say the majority of Americans aren't that concerned with changing healthcare. 40 million uninsured + seniors who have no drug or long term care coverage + people who are insured but unhappy with their coverage= a LOT of people, and if current trends continue this number is just going to skyrocket in the next decade or so. But I do agree with you that the capitalist philosophy that is so ingrained in this country will really hinder any change.

Great discussion, everyone.
 
Originally posted by TroutBum
Well said, gramcracker, pahkthman and DALABROKA. I also wanted to make an additional comment on the following:



Health care was NOT fine until HMOs started showing up. HMOS only became a big player in the last couple of decades, however the recognition for the need innovation in health care delivery goes back many, many decades. I think that the HMO was an inevitable step in the evolution of health care in the US, but I also firmly believe that the shortcomings of this system will eventually do it in and we'll make it to universal coverage.

Plickfu, I have to disagree with you when you say the majority of Americans aren't that concerned with changing healthcare. 40 million uninsured + seniors who have no drug or long term care coverage + people who are insured but unhappy with their coverage= a LOT of people, and if current trends continue this number is just going to skyrocket in the next decade or so. But I do agree with you that the capitalist philosophy that is so ingrained in this country will really hinder any change.

Great discussion, everyone.

HMOs were a great idea in the beginning. They just have become overrun with business/corporation types who jacked patients to make money. it goes to show how an idea in concept may have positives, and yet doesn't work well in the real world. A good reminder to those wanting universal health care completely financed by the gov't.

About the large numbers of under- or uninsured, if capatailist history tells us anything, growing markets inherently create modalities of delivering those services. The growing resentment of health care as it is provided will quickly force change for the better. Rather than be pessimistic about the state of health care, I tend to be optimistic, and feel that the future will definately hold exciting changes.

That attitude being a far cry from the fear that swept through medicine in 94 prior to Hillary botching the universal health care drive.
 
Hey All,
I was just wondering: How would Medical Malpractice costs be contained in a single-payer universal healthcare system? How is it contained in other systems in other countries of the world?

thE pAkht
 
Originally posted by pAkhtmAn
Hey All,
I was just wondering: How would Medical Malpractice costs be contained in a single-payer universal healthcare system? How is it contained in other systems in other countries of the world?

thE pAkht

ok, I'm shooting from the hip here but perhaps through what they call "tort reform??"

If the govn. is going to be the centralized payer, it is likely that they would want to put some sort of cap on how much patients can get paid through lawsuits.

I have heard of states/countries that actually are compensating people MORE when they don't go into legal stuff but only decide to settle. This way, lawyers fees, court fee etc is kept to a minimal and the patient him/herself gets a larger sum of money through some sort of settlement. They have to sign a waiver though, ahead of time, that they will not sue the doc if anything wrong happens but will instead decide to settle it out of court. Anybody hear of something similar to that?? I think this might be a good idea (but only to curb the malpractise problem, not cure it).

Another question I had about single payer was--how is it going to control for immigration/population trends? And how long would it take for change to occur if population/immigration trends continue to happen. For example, Florida may have many more elderly people than say...Colorado. What would the state/federal gov. officials decide then?

I am learning a lot from you guys!! Keep it coming.
 
Great questions, Tweetie. I'm not actually that familiar with malpractice stuff. Partially, I believe Canada's judicial system doesn't allow some certain type of damages. Punitive? Pain and suffering? Law isn't my strong suit, either. (Any Canadians or JDs able to help me out here?)

I do, however, know that Canadian malpractice costs are literally FRACTIONS of what some doctors are paying today in certain states. Here's the fee schedule (PDF): http://www.cmpa.org/cmpaweb/public/english/pdf/2003cal-e.pdf You'll notice that OB-GYN and Neurosurgery (typically two of the most expensive malpractice specialties, where it's not uncommon for docs in the US to pay $150,000 or more a YEAR) have lower rates. It ranges greatly (leftmost column is Quebec, which has the lowest HC costs, and middle is Ontario, the most expensive), but they're, for the most part, much lower than US costs.

For your other question about population trends: this is taken into consideration when deciding global budgets. (In Canada, each province receives a global budget for the year; this dollar amount is calculated by taking into consideration the population demographics, population size, etc., with data on how much it "should" cost per person in the province. This could be done regionally in the US--NE, SE, Midwest, etc--or could be done state-by-state). So, using census data, if we know that Florida has a much higher population of people over 65, they'll be figured in that way when calculating their annual global budget: ie: more money for prescription drugs and long-term care, and maybe less for, to use your example, mountain-climbing accidents, like in Colorado.
 
If our government continues to push us into a single payer system, which seems inevitable to be honest, don't they need to control immigration first? Someone mentioned Sweden as a panacea of universal health care, and said they would move there if they could get in... Well, we have a huge problem of illegals who don't pay at all for their health care as is, and will not later because they don't pay taxes, and even if they did their marginal rate would be so low that they wouldn't pay taxes. Our family of 5 lives now on 40K a year, and we pay $500 a month on healthcare, and our employer kicks in the other $500. And, it seems the healthcare premiums will continue to increase until we absolutely can't afford it. We are way beyond a fee for service scenario, much closer to single payer. But if Sweden has a tax of about 70% overall (this is what I've heard before), and excellent control of immigration, how much would our overall tax increase to here? Can we really model our health care after that of a small completely socialized country?

We do have huge problems in health care now. But rather than rush into something, I think it should be tested first. And also someone mentioned that under universal health care a docotor's salary may decrease to about 40K a year! Wow. Good luck getting people to endure 4 years of med school then residency etc. The compensation just isn't there. I am past the completely idealistic stage because I have a family and other responisbilities. That's not to say that I'm going into medicine just for the money (of course not- I'm after all going the military route), I'm just saying that it's important to be able to provide for your family, and if you can't do that in a career of medicine (at 40K a year), people will start to go to other sectors where they can.

But then again, I can see the sentiments of capitalism is evil all over this thread, and so I guess that in the ideal country, everyone's salaries would be controlled by a guru in the government, and then we wouldn't have to worry about anyone being obsenely wealthy.

AAAAAAHHH! BTW, how many doctors, real, current, practicing docs, are against universal/single payer/whatever you want to call it???

The government *completely* runs the military health care system, and irony of ironies, that that is where I am going, there are serious problems with it because whenever the government gets involved the paperwork increases and administrators are the ones who end up getting the "big bucks". Why would doctors in a universal/single payer/whatever you want to call it system have less paperwork and be able to practice medicine just how they want it???

One thing I do not get at all- Trial lawyers are against universal/single payer because it would require a capping of those lucious punitive damage multimillion dollar malpractice lawsuits. But democrats tend to do whatever they can to keep their trial lawyer buddies happy. So how are the libs gonna pull off universal health care and keep the trial lawyers sending them the big checks?
 
Originally posted by republicandr
...don't they need to control immigration first? ... someone mentioned Sweden as a panacea of universal health care, and said they would move there if they could get in... Well, we have a huge problem of illegals who don't pay at all for their health care as is, and will not later because they don't pay taxes, and even if they did their marginal rate would be so low that they wouldn't pay taxes.

We do have huge problems in health care now. But rather than rush into something, I think it should be tested first. And also someone mentioned that under universal health care a docotor's salary may decrease to about 40K a year!

But then again, I can see the sentiments of capitalism is evil all over this thread, and so I guess that in the ideal country, everyone's salaries would be controlled by a guru in the government, and then we wouldn't have to worry about anyone being obsenely wealthy.

there are serious problems with it because whenever the government gets involved the paperwork increases and administrators are the ones who end up getting the "big bucks".

1) I don't know much about immigration effects, but my first reaction would be this: if, as you say, we're already paying for immigrants' care with emergency visits, it'd be much cheaper to pay for primary care visits, *and* it would improve their health. One ER visit can easily be $1,500; one outpatient visit is what, $100-$200?

2) Single-payer has been tested. Canada, Denmark, Norway, Sweden... they've all had NHI programs since the mid 1960s. Single-payer is effective at controlling costs, insuring the entire population, but keeps the system private. (Not sure if those are your major reservations against it.) Canada's health costs were beginning to spiral out of control just the US's, up until they passed their medicare program in 1963 (I think?). After that, their cost increases declined sharply, while the US's continued to rise.

3) Do you have any data, evidence, or, uh, anything showing a doctor's salary at $40,000 per year? I've never seen anything remotely near that estimate; there's lots of misinformation out there. In fact, in Canada, when medicare was passed, physicians' salaries went UP by 35%. (Universal Health Care, by Pat and Hugh Armstrong.) Most estimates state that general pratice/IM/FP doc salaries would stay mostly the same, but specialists salaries would decrease. And plus, doctors would have it easier: fewer billing clerks, no hassle from HMOs about getting procedures covered, etc.

4) I don't think capitalism is evil. It works great in some situations, but not all of them. When people are making money off of people's health, denying treatments, performing unnecessary treatments, however, yeah, I've got a big problem with that. All of that $400 million Tenet has paid its CEO over the past 15 years could have gone toward patient care, could have saved lived, and eased suffering. I don't think that's right.

5) I'm not sure if you've read single-payer proposals--it really doesn't seem like you have, republicandr. http://www.physiciansproposal.org. There are three major ways doctors can work in a single-payer system. They can work in a private practice. They can be employed for salary. They can be part of a collective health maintenance oragnization. If you work for a government-run hospital, then, yes, your salary is set by the government. Otherwise, it's not. Physician groups collectively bargain with the government for reimbursement rates. The government doesn't just set them. Negotiation is involved, and doctors are represented by doctors.

6) In a random survey of academic doctors, when asked if they'd support a single-payer national health insurance program, 57% said yes. When a randomized sample of Massachusetts doctors (including surgeons!) were asked if they'd support single-payer, 63% said yes. Hell, when small business owners, possibly the most conservative group of people in the US were asked 5 years ago, "Would you support a national health program financed by tax payers covering all Americans in a single government plan,? 40% supported, 9% were unsure, 50% were against it. And that was 5 years ago.

7) There is paperwork in every system. You have to accept that. But I don't care if you think it's a lot of paperwork in the military--it's all relative. HMOs spend 15%-30% of their health care dollars on administrators and paperpushers. Medicare spends 3%. Private insurers do worse than Medicare, and are just as unable to control medical costs as Medicare is.

8) Why would there be less paperwork? BECAUSE THERE'S ONE PAYER. Case in point: in a mental health study in Seattle, done for other reasons than health insurance, over 750 different health insurance plans were found among the study's 2700 participants. Imagine the sheer volume of paperwork, phone calls, billing software, forms, faxes, database managers, and confusion go into just one doctor's office in Seattle, even if they had a FRACTION of that number of health insurance plans in their office. It's a mess. With one payer, everyone has the same forms, the same database, the same contacts. It saves time and money--over $150 billion--from cutting administrative waste alone.

9) This isn't just a Democrat/Republican Liberal/Conservative idea. As I've posted before, Canada's Auto Association (that would be Ford, Chrysler, among others--big business, and therefore, usually pretty conservative) supports their health care system--their SINGLE-PAYER system--because it saves so much money.

Employer's costs of health insurance in the US on average: 8% of an employee's salary. In Canada: .6%. Again, you do the math, and please, read a *little* bit on single-payer before you make assumptions about it. I'm happy to answer questions and to try to explain it, but rash generalizations about what you heard someone say aren't gonna cut it if we're going to have a true, informed discussion.
 
wow,
excellent points, Repub. Anybody wanna take that??

Edit: nevermind, Gram was quick to the punch. :clap:
 
I was the one who posted about Sweden (actually, I said Scandinavian countries, but nevermind), and said I would like to move there if I could. It is true that these countries have immigration policies that are much more restrictive than the US, I agree with republicandr that this is an issue that would need to be resolved since unchecked immigration would be difficult in a single payer system, socialized system, what have you (isn't single payer a form of socialization, since ultimately under such a system the nation's medical care would be payed for out of our collective tax dollars? I truly don't know much about economics, so please explain to me the difference if I'm wrong).

Anywho, when I was interning at the NIH a couple of summers ago, I worked with a very nice doctor from Denmark who explained their system to me. She told me that doctors in Denmark make about as much as high school teachers, but the government pays entirely for their medical education- tuition, books, living expenses, everything- and THAT is why people are willing to go through medical school there to only make a fraction of what a US doc would make. I think it makes perfect sense and would absolutely agree to a similar system here. People who become physicians in Denmark do so because of a true interest in and dedication to medicine, since there is obviously not the same financial motivation as exists here, and on the flip side, there is also not the financial barrier to becoming a doctor there as here. Denmark, however, is a relatively small and wealthy country with a long history of socialization and progressive policies and I would not expect the US to model our system after their's, although steps in that direction- such as perhaps the single payer system gramcracker and others have been discussing- would be a refreshing change from our current bloated and ineffective medical system.
 
Originally posted by Mistress S
People who become physicians in Denmark do so because of a true interest in and dedication to medicine, since there is obviously not the same financial motivation as exists here, and on the flip side, there is also not the financial barrier to becoming a doctor there as here.

I doubt that many people in the US excel at 4 years of undergrad work, survive 4 years of med school, complete a residency, and work hard to pay the bills without a sense of dedication.

Also, if you don't have some sort of financial incentive to reimburse and attract people to medicine, many of those talented people will go elsewhere into other professions. Paying doctors what high school teachers make isn't going to make anything better, and it won't make better doctors. In any case, doctors salaries aren't the problem with delivering healthcare.
 
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