How close are we to Universal Health Care?

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I did not mean to imply that all or even most US doctors lack dedication, I was only pointing out that the financial incentive that is the primary motivation for some people to become physicians here (and sometimes corrupts even those who start off with good intentions) does not exist to anywhere near the same level in a country where doctors do not make as much (obviously). Denmark and other countries seem to be producing perfectly competent doctors without necessarily paying them huge sums of money, so I don't think the only way to attract intelligent people to a field is to pay them a lot. For instance, I have a huge brain, and would be happy to pursue a career in medicine for the pittance of $40,000 or $50,000 a year if I wouldn't have to graduate with the equivalent of a house mortgage hanging over my head. Nor did I anywhere even remotely suggest that we should simply cut doctor's salaries to the level of high school teachers and this would solve America's medical problems. I do, however, strongly advocate socialized medical and educational systems, as I feel that the benefits to society outweigh the literal and figurative costs. I am open to hearing well thought out arguments to the contrary. I do not think systems such as those in Denmark, Canada, and basically every other developed nation in the world are perfect, or that they would necessarily work the same way here, only that they seem to be doing a better job than we are at substantially less cost, so maybe we should swallow our pride and learn something from them.

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Originally posted by gramcracker
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?


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.


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.


8) Why would there be less paperwork? BECAUSE THERE'S ONE PAYER.


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- Thanks for "clearing things up". How could a single-payer system that has so many options for billing decrease paperwork so much? Why would it be so much easier to get permission to do an expensive procedure than it would be in the current system? I don't know- but there are many experts on this thread who are able to educate me. I did not profess to be an expert on the single payer system. My point was that it is complex and it boils down to universal health care and the government runs it, essentially. The "private" doctors still negotiate with the government, right? So the government is paying them, right??? Why would the government pay the "private" docs so much more than the other government docs? Don't feel like you have to answer this though, because I understand it's tedious to explain the system to someone who won't just read the proposal!

As far as the immigration comments go, I am no expert on immigration, but I doubt that under any system the illegals will go to the doctor offices on a regular schedule for preventive care. They are scared of being deported, at least here in Washington state. If, as you claim, a single payer system would decrease the overall cost of health care to the average person then it would be a better deal, because the cost of ER visits by the illegals would be less. Especially from the decreased paperwork, right? BUt I'm not convinced that the single-payer system would decrease the cost of health care, at least to the average taxpaying citizen.

BTW, I have no data, evidence or anything to show that Dr's salaries would decrease to 40K per year. That was stolen from someone else's thread. (I think Mistress S who knows the Danes).

Thanks for the stats on the docs in support of universal health care. In spite of your patronizing tone you have educated me. But I hold by my opinion that we should not jump in to a single payer system.

BTW, you have no opinion on the trial lawyers' influence on this decision? I can't reconcile why they would go along with a single-payer. Wouldn't it take out their ability to sue via malpractice? Everyone knows, you can't sue the government, right?
 
Originally posted by republicandr
Wow- Thanks for "clearing things up". How could a single-payer system that has so many options for billing decrease paperwork so much? Why would it be so much easier to get permission to do an expensive procedure than it would be in the current system? I don't know- but there are many experts on this thread who are able to educate me. I did not profess to be an expert on the single payer system. My point was that it is complex and it boils down to universal health care and the government runs it, essentially. The "private" doctors still negotiate with the government, right? So the government is paying them, right??? Why would the government pay the "private" docs so much more than the other government docs? Don't feel like you have to answer this though, because I understand it's tedious to explain the system to someone who won't just read the proposal!

BTW, you have no opinion on the trial lawyers' influence on this decision? I can't reconcile why they would go along with a single-payer. Wouldn't it take out their ability to sue via malpractice? Everyone knows, you can't sue the government, right?

Yeah, actually, it is really tedious if we're trying to have a discussion about a topic, there's clear, well-written information on the topic and hand, and people would rather argue uninformed than learn about how the system would work, and then ask questions or raise points about their concern with it. (If you don't have the time to read a 10 page document, try these two factsheets. They're less in-depth, and don't explain things as specifically as the proposal, but they'll at least help you understand it: http://www.pnhp.org/hcinfo/?go=single_payer and http://www.pnhp.org/hcinfo/?go=financing_policy

I don't know where you're getting the idea that the SP system has "so many options for billing." Let me try to explain it again: it would be similar to a Medicare-for-all system (just take that at face value, ignore any problems you have with Medicare). Or, a one-insurance-company-for-all program, if that suits you better. Since there's ONE insurance company, every doctor or other health care provider bills the SAME entity. And the SAME entity pays them. So instead of having to fill out one form for Aetna, one for Tenet, one for BCBS, etc., you bill ONE payer.

Also: care is based on need, not ability to pay. You don't have to get permission. That's one major reason why docs support this plan. You don't have to call an HMO administrator who has no medical training to argue over a patient getting a certain test run, or a certain procedure. It's based on need, and evidence-based medicine. If a procedure is shown to improve outcomes and be effective, then it's covered. If it's worthless and doesn't give you any information or help the patient, it's not covered.

The government administers it, and pays for it, yes. They don't run it. It's still privately run, with private doctors, private facilities, etc. The government will pay private doctors for their services based on the procedures they do, and the reimbursement for the doctor's services are negotiated by the doctors. You seem to be under the impression that in this system doctors are, for the most part, employed by the state, and that's not the case. Private practicing doctors tend to make more in a single-payer system than salaried ones, yes. Why would salaried doctors take a lower-paying job, then? Maybe they want to help an underserved population. Maybe they love the hospital where they work. Maybe they want a scheduled work shift, and don't want to feel the pressure of running an office and being a small business as well.

Nope. Don't have any opinion on the trial lawyers, because I don't feel I have enough information to make an informed opinion. If I don't know something, I do my best to read up on it, learn about it, and then form an opinion; it does me nor anyone else any good to just come to a conclusion when I don't know the facts. (Read Marakah2's above post, there's a strong correlation between the doctor-patient relationship and malpractice suits. If you know your doctor, feel comfortable with her/him, you're much less likely to sue.) I'll just say this: laywers may not like it, no, but if the rest of the populous does--or enough of the populous--health care reform will happen.

Look, slavery took a long time to change, so did getting women the right to vote. But those were reforms that I would argue were fundamentally positive and progressive reforms to our country; I think national health insurance is the same. OSHA and the EPA were formed when Nixon was president, even though he was strongly against them. Why? Because people supported them.
 
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Originally posted by republicandr
Thanks for the stats on the docs in support of universal health care. In spite of your patronizing tone you have educated me. But I hold by my opinion that we should not jump in to a single payer system.

Republicandr, thanks for starting this thread, I think it is a great way for all of us to start educating ourselves on an issue that promises to be one that we certainly cannot ignore for much longer. I would hate to see it degenerate to patronizing tones, so the teacher in me is sending you and gramcracker to your respective corners for a time out :) I think 3 days is enough, so I'll BUMP this thread back to the first page now!

Anyway, as progressive and liberal as I fancy myself to be, I don't think I have been advocating jumping into anything. A one payer system is a HUGE change - our health care system will look nothing like the current one. The first step is going to have to be individual states trying this out before we can even think about taking it to a national level. That said, I read an article titled, "You can't jump a chasm in two leaps." Hits home for me - the problem is so sweeping and vast that small little reforms won't fix anything. There must be a fundamental change, but even us bleeding heart liberals don't think it can be done over night. I belive strongly that we need a single payer system, but I am not jumping ;) That would be unwise. But that doesn't mean we should scrap the idea, it is a good one!
 
Living in Canada here is my view of the system.

The financial "reward" in our system may not be as much as could be made in the states, but a GP here gets 119,000 a year from which they have to pay some admin fees. This is still quite a bit above the average Canadian wage. Med students here know what they're getting into when they apply for med school. Some argue that a lower paid doctor won't do thier job. What if they knew what they were getting into before hand (as we all do). Maybe they are interested in medicine because they would like to help people (the old if all jobs paid equal would you still go into medicine routine).

You might think that smarter people would tend to shy away from medicine if they won't be getting the financial reward, but the average GPA for admission in Canada to medical schools is around 3.82/4 for 4 point scale and 8.5/9 for nine point scale. Thats still awfully high. It's not like there is a lack of qualified people waiting to take the job.

If I knew that I was going to have to pay for a visit to the hospital, I would go less. I have had several trips to the emergency room that I didn't HAVE to go, but it was best to be treated right away and prevent any more damage/ secondary infection. Ie corneal abrasions & metal grindings in eye, I severed the tip of a finger, rusty nail/ tetanus shot, giardia when I was 3 etc.

As a student, it's great to go the the pharmacy and pay only a dispencing fee (8-12 bucks per perscription).

As for the wait, if i go to emergency with a problem that really isn't an emergency, I wait ten minutes to half and hour, and I don't do any paperwork. If I phone at least an hour or so ahead, I can usually get in within 10 minutes, still no paper work.

I don't know how bad it is in the States, but alot of problems being exprienced right now in Canada are a result of the baby boomers reaching an age where they are more susceptable to disease, and the doctors among them are retiring. Things will be a little tight untill they start kicking the bucket, but once the population bulge is cleared things should be alot smoother.

And I know Canada is cheap, but it's hard to make money when we are strictly bound to NAFTA, and other countries choose to disobey the rules. But universal health care keeps moving along

With the financial resources available to the States and the much denser (and therefor more efficient) infrastructure the states could make universal health care work. Look at the money used (wasted) in the army. How much does a cruise missile or a tomahawk missle cost? Although these are neat peices of technology, a 800 pound bomb is dirt cheap and will do much more damage. These high tech, high price tag weapons are a show of might and thier cost isn't really justified. I'm sure every country is aware that the states have enought nuclear weapons and a big enough army to wipe the globe clean. It's funny how the government is willing to spend billions to make sure a war can be fought without losing one soldier, but won't spend that kind of money to make sure their own citizens in their own country don't die. This isn't anti army, I'm just trying to say the money is definitely there. God knows our army it lame, and we've lost more soldiers this year than the states (I think the eight from the "accident" plus one more) but many more people are saved by access to health care.

What do the people in the US want? Are thier wants being represented by the government? Or is national policy being sold to the general population?

I'm not in the states, so I don't know the situation or the answers to these questions. Hopefully whatever the citizens feel is best for them is made to happen

Rampart
 
"free market (natural law...remember...what our country was founded on"

show me the constituional amendment that say we have to be capitalist?
 
1st--this is a very interesting thread
2nd--the uninsured, working poor--McDonalds flippers, babysitters, nurses aids etc are not the ONLY ones dissatisfied w our present system. Above them is a huge population that is just one pink slip away from a no- insurance job.
Besides downsizing, there is a huge increase in "contracting out" so employers can avoid paying high health ins fees. This means that your job is eliminated and and you (or someone else) is rehired by a private contractor w no ins benefits. Example recently our city schools decided to
fire all the bus drivers and contract out to a small private company. The drivers were then w/o any health insurance. The same was nearly done to the janitors this fall. As the insurance costs skyrocket this phenomenon will only increase. Maybe this is why the Canadians I spoke with, even tho they were having to cross to US for cancer tx, were still overwhelmingly happy with their single payer (with govt the only ins company) system
BTW-Some one of them mentioned that the oncs could make no more than $400,000 per annum there in Canada. Dont know if this is true.:confused:
 
Originally posted by Rampart

What do the people in the US want? Are thier wants being represented by the government? Or is national policy being sold to the general population?

I'm not in the states, so I don't know the situation or the answers to these questions. Hopefully whatever the citizens feel is best for them is made to happen

Rampart

The people in the US don't know what they want. They listen to alarmist pundits tell them that Universal Healthcare will limit "choice." And that we'll all be screwed and the world will come apart. Its really sick. Add to that the incredible influence of industry lobbying groups and a voter turnout of some 40% and you have the ingredients for a democracy being hijacked by special interest groups who screw us all so that they can make some money.
 
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