Interesting article: Is free market health care possible?

[SunsFun]

Funny, even these guys think that a system like the ACA is "the most expensive model of reform" while still "fall[ing] short on universality and equity."
http://www.pnhp.org/facts/single-payer-faq#young-adults

I am not the biggest fan of ACA and to be honest with you I wanted something entirely different. But I am willing to give it a shot and wait 5-10 years to see what happens. I know it initially was created in some form by Heritage Foundation and I do think it was the only plan that the government was able to pass. I doubt people who vigorously opposed ACA on Capital hill had any other plans in mind anyway that they honestly would try to implement.

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[SunsFun]

I'm confused, because Taiwan doesn't seem to have the type of system you're claiming to support. Do you know the difference between a VA-for-all type system and a Medicare-for-all type system? This is a sincere question, I'm really not trying to be an ass.

Yes I do. Look, I am not saying that Taiwan is exactly going to reflect what I want but it was the closest I could find put of the countries I looked at.

 

[ruralsurg4now]

Either way, no one in this thread mentioned Cuba until you brought it up.

I like how every time you look foolish your response is that nobody was talking about it until I brought it up.

 

[rain4venus]

Yes I do. Look, I am not saying that Taiwan is exactly going to reflect what I want but it was the closest I could find put of the countries I looked at.

Like I said, I'm just confused because Taiwan has socialized insurance, but providers are primarily private. (admittedly according to Wikipedia)
But you said that you support socialized medicine, so I would expect the closest system to what you support to be one that is primarily or completely socialized, especially since there are several such examples.
Do you just mean that the public sector of the Taiwanese system is the closest to what you support?

 

[Trek19]

Insurance companies, or "sickness funds" as they are known in Germany, are also required by law to be non-profit entities. Same as in Switzerland and Japan, two other countries following the Bismarck Model.

I'm glad you brought up the Bismarck Model. If I recall correctly private industries (steel I think) in Germany were losing workers to the American Dream. The private industry then pressured Bismarck to create a healthcare system using public funds to try to keep workers in Germany. This was the first time resources were tied together in this manner. A short while later relatively speaking the German economy tanked and people who were not contributing to the system were viewed as burdens. I encourage everyone to look up the results of this in the form of 1920s-1930s propaganda. I am opposed to a system that would make people view their sick as an unacceptable burden.

That being said, it seems to be working now in homogenous countries with great economies, low fertility rates (too low to sustain long term entitlement services: pyramid schemes need new workerss!) and low behavior-induced healthcare system burden (WHO says 9 out of the top 10 healthcare system burdens are behavior related e.g. smoking, drinking, obesity).

 

[Reckoner]

"ruralsurg4now", do you honestly believe anyone here is debating you? This isn't debate, it's Crossfire. I'm hoping you're trolling - well, my secret hope is that you're LizzyM in a mischievous mood - because someone with real views like yours is in for a life of misery and impotent rage. I'm not one of those pesky internet kids who won't get off your lawn. I'm probably older than you. And I've made decisions in the kind of conditions you're advocating.

I've spent a lot of time working to defend our nation in ****ty little places you've never even heard of. As part of that job, I've had to make decisions about who lives and who dies. Not just our people, but wounded civilians who needed healthcare, and still-healthy allies of ours who needed our training and equipment to stay alive against our common foes. Unlike you, I have actually placed a dollar amount on what people's lives are worth - often in the three figures for patients who would quickly die without the care they needed for their chronic conditions. I was their only option, and I put a price on their lives. When their budget was exceeded, these people died. I didn't do this because I'm some fuddy-duddy tree hugger. I didn't do this because I believe healthcare is a right. I did it because I was helping advance our nation's cold, calculated interests and had limited resources to do so.

What I can take away from that experience, unequivocally, is that anyone who wants to institute a system that's even remotely similar in our country is a person worthy of pity more than anger. I wouldn't wish the decisions I had to make upon anyone and you wish them upon our entire nation. Who even cares if healthcare is a right? It's a damn duty. We are all responsible to each other to be as healthy as possible. If we want to maximize our wealth, as individuals and as a nation, we need healthy people. We need people and companies who have money to invest and grow, instead of keeping up on healthcare bills. We need people who can afford to see a doctor when they're sick, instead of having to go to work and infecting a dozen other people. Now, you can counter and go on and on about how you think the magical free market can deliver all these things. But that's not really what you want to say, so there's no point in making counterpoints. What you really want to do is find an excuse to say, "**** everyone but me".

At some point, you came to a moral crossroads. You were stressed, tired of idiots, and you made a judgment call. Trust me, I've been there, too. But you made the wrong call. You were at that moment when you doubted whether what you were doing was worth it, and you decided that your problems were all caused by others and that you are better than them because you are better off. You decided that life is an easily manageable sequence of predictable events that only lazy or stupid people couldn't keep under control (not surprising considering the privileged, faux-darwinist environment most doctors traditionally spring from). It's all their fault. They're trying to drag you down because they hate you for your success.

Now you're pissed off that all the pansies and the homos and the negros are coming to steal your money. You've become another messiah of the truth that the sheeple masses can't see: some mystical conspiracy by the lazy-yet-incredibly-good-at-intricate-conspiracies moochers to steal your money and your precious bodily fluids or whatnot. And now that you've found that zeal, that One True Faith, there's nothing any of us can do to take you off this path. If we agree with you, we've come to the faith. If we disagree, we're apostates who will burn in eternal fire. That's all we are, just binary inputs into a rigid view that, somewhat fittingly, can only held by those so well off that they are insulated from the consequences of their own opinions. There's no nuance or open-mindedness to your views and, like the rest of your demographically shrinking cohort, you're only becoming more irrelevant as you fulminate from the sidelines, while the rest of us weigh all the options and come to a reluctant conclusion that one option might be better than the other - no guarantees, of course, since certainty is for fools and teenager. To put it another way...

If it makes you feel better. Won't change anything, though.

And remember: we're here to destroy your way of life and force your kids to have premarital sex.

This entire miserable thread was worth it for this gem.

 

[TheRobin]

I'm glad you brought up the Bismarck Model. If I recall correctly private industries (steel I think) in Germany were losing workers to the American Dream. The private industry then pressured Bismarck to create a healthcare system using public funds to try to keep workers in Germany. This was the first time resources were tied together in this manner. A short while later relatively speaking the German economy tanked and people who were not contributing to the system were viewed as burdens. I encourage everyone to look up the results of this in the form of 1920s-1930s propaganda. I am opposed to a system that would make people view their sick as an unacceptable burden.

Hitler and the Nazis looked at anyone who did not fit into their conception of the volksgemeinschaft (roughly translated as "national community") as an unacceptable burden. I don't think you can fault the Bismarck Model for late 1920s through 1930s propaganda.

*Edited to Add*

As to private industry losing German workers because they immigrated to the U.S. for the American Dream, I cannot answer that. I will say that Bismarck was somewhat iron-fisted, so maybe people left because of political repression. As to Bismarck's motivation to provide social programs, some historians believe that he did so to appease Germans, i.e. he gave them social rights and programs because he didn't want to grant them political rights.

 

[Trek19]

Hitler and the Nazis looked at anyone who did not fit into their conception of the volksgemeinschaft (roughly translated as "national community") as an unacceptable burden. I don't think you can fault the Bismarck Model for late 1920s through 1930s propaganda.

I agree the Bismarck Model may be viable, I am justifiably wary of tying resources of a majority to the burden of a vulnerable minority. This relationship creates economic incentive to make populations more homogenous, and we don't want that.

Edit: I don't think that will happen again, I think that what we will see is an abundance of laws being passed that try to make people behave in ways that are viewed as less burdensome.

 

[rain4venus]

I am opposed to a system that would make people view their sick as an unacceptable burden.

well our current system largely does that, not that I think anyone is advocating our current system as any kind of ideal

 

[SunsFun]

Like I said, I'm just confused because Taiwan has socialized insurance, but providers are primarily private. (admittedly according to Wikipedia)
But you said that you support socialized medicine, so I would expect the closest system to what you support to be one that is primarily or completely socialized, especially since there are several such examples.
Do you just mean that the public sector of the Taiwanese system is the closest to what you support?

Even though the providers are private the entire industry is highly standardized with each citizen carrying a card that has his complete healthcare history that is accessed and modified by each provider. There is no billing nightmare like the US. This works for me even though the providers are private.

 

[Trek19]

well our current system largely does that, not that I think anyone is advocating our current system as any kind of ideal

True, but not to the point of forced sterilizations (atleast not since the 1960s in this country, with a recent exception in CA) and eradication. And I agree our current system is not the ideal, we want something better.

 

[Trek19]

Hitler and the Nazis looked at anyone who did not fit into their conception of the volksgemeinschaft (roughly translated as "national community") as an unacceptable burden. I don't think you can fault the Bismarck Model for late 1920s through 1930s propaganda.

*Edited to Add*

As to private industry losing German workers because they immigrated to the U.S. for the American Dream, I cannot answer that. I will say that Bismarck was somewhat iron-fisted, so maybe people left because of political repression. As to Bismarck's motivation to provide social programs, some historians believe that he did so to appease Germans, i.e. he gave them social rights and programs because he didn't want to grant them political rights.

Yeah on second look my idea that the workers were moving to the U.S. seems like a bias from receiving the U.S. version of world history.

 

[SunsFun]

I agree the Bismarck Model may be viable, I am justifiably wary of tying resources of a majority to the burden of a vulnerable minority. This relationship creates economic incentive to make populations more homogenous, and we don't want that.

Edit: I don't think that will happen again, I think that what we will see is an abundance of laws being passed that try to make people behave in ways that are viewed as less burdensome.

This is slightly off topic but I think the problem is that the environment majority of Americans live in makes unhealthy living a default easy lifestyle choice. Once I have more time I am going to create a thread on how poor urban planning (the great suburbia) and bad agricultural policies along with monopolization of food industry ruined community and facilitated the spread of various health problems.

 

[TheRobin]

Even though the providers are private the entire industry is highly standardized with each citizen carrying a card that has his complete healthcare history that is accessed and modified by each provider. There is no billing nightmare like the US. This works for me even though the providers are private.

You are referring to something similar to the carte vitale in France. Taiwanese health care reformers borrowed this from the French. From T.R. Reid's book, this electronic card system coupled with Taiwan's adaptation of the Canadian/Medicare-for-all Model keeps administrative costs around 2-3% of total health care costs.

 

[Trek19]

This is slightly off topic but I think the problem is that the environment majority of Americans live in makes unhealthy living a default easy lifestyle choice. Once I have more time I am going to create a thread on how poor urban planning (the great suburbia) and bad agricultural policies along with monopolization of food industry ruined community and facilitated the spread of various health problems.

Good point. Also, what kind of effect do you think the War on Drugs and Zero-Tolerance school policies had on the health of urban areas? I think both factors contribute to the problem at least as much as a monopolized food industry.

Edit: *Considering lack of education probably has downstream consequences.

 

[rain4venus]

Even though the providers are private the entire industry is highly standardized with each citizen carrying a card that has his complete healthcare history that is accessed and modified by each provider. There is no billing nightmare like the US. This works for me even though the providers are private.

That does seem very convenient and efficient, albeit very frightening to me as far as privacy goes.
But that only requires socialized insurance (medicare-for-all), not socialized medicine, right?

 

[TheRobin]

That does seem very convenient and efficient, albeit very frightening to me as far as privacy goes.
But that only requires socialized insurance (medicare-for-all), not socialized medicine, right?

Just to be clear on terminology, when you say "socialized insurance," can I substitute in single-payer? When you say socialized medicine, do you mean that the government is the provider of health care, such as in Britain and the U.S.'s VA hospitals?

 

[Trek19]

Just to be clear on terminology, when you say "socialized insurance," can I substitute in single-payer? When you say socialized medicine, do you mean that the government is the provider of health care, such as in Britain and the U.S.'s VA hospitals?

I'm curious, in the U.S. the VA can refer a patient to a private specialist if needed, is this also possible in the UK?

Edit: the point being if we decide to call both by one name we should have another category to address the private sector support

 

[rain4venus]

Just to be clear on terminology, when you say "socialized insurance," can I substitute in single-payer? When you say socialized medicine, do you mean that the government is the provider of health care, such as in Britain and the U.S.'s VA hospitals?

yup, I'm using the terms from that physicians for a national health program (or whatever it was) link, as well as the wikipedia articles on various healthcare systems.
"Socialized insurance" means the government pays for insurance for everyone aka "Medicare-for-all" or single-payer
"Socialized medicine" in this case means the government employs all the doctors aka "VA-for-all"

I just think it's very important to note the difference between these two cases, because a lot of people don't have a clue. Hopefully it's different among pre-meds or at least doctors, though I sadly doubt it... :/

(Technically, medicare and the VA are already socialized insurance and socialized medicine, respectively, even without being applied to everyone, so I'm using an overly simplistic examples above as it's obviously possible to have both socialized and privatized elements in one system. I think it just depends on how much of the system is public versus private.)

 

[Trek19]

yup, I'm using the terms from that physicians for a national health program (or whatever it was) link, as well as the wikipedia articles on various healthcare systems. "Socialized insurance" means the government pays for insurance for everyone aka "Medicare-for-all" or single-payer
"Socialized medicine" in this case means the government employs all the doctors aka "VA-for-all"

I think this is a good way to describe it. However it is, in my opinion, important to note that when the VA is unable to provide timely or reasonable access to care it can send people to the private sector. This is admirable, and is one reason the shortcomings of the VA are greatly alleviated. Also, I'm going to have to review payment schedules but I have a feeling they are similar to Medicare, meaning it is likely the private sector is eating some of the cost to help support veterans and their families.

Also VA care isn't always free: there are enrollment fees and co-payments.

Edit: http://www.va.gov/healthbenefits/cost/copays.asp

 

[rain4venus]

I think this is a good way to describe it. However it is, in my opinion, important to note that when the VA is unable to provide timely or reasonable access to care it can send people to the private sector. This is admirable, and is one reason the shortcomings of the VA are greatly alleviated. Also, I'm going to have to review payment schedules but I have a feeling they are similar to Medicare, meaning it is likely the private sector is eating some of the cost to help support veterans and their families.

Also VA care isn't always free: there are enrollment fees and co-payments.

Several single-payer systems require co-payments to prevent overutilization of the system. It's weird to me since co-payments are clearly regressive. A $20 copay won't stop someone making $500k from going to the doctor to check out a papercut while it will keep someone working minimum wage from going in for the flu.

 

[Trek19]

Several single-payer systems require co-payments to prevent overutilization of the system. It's weird to me since co-payments are clearly regressive. A $20 copay won't stop someone making $500k from going to the doctor to check out a papercut while it will keep someone working minimum wage from going in for the flu.

I see, that is interesting. I just watched the PBS documentary on healthcare Sun posted above, and in it they ask UK people if they ever had a bill for healthcare and they said no.

 

[Womb Raider]

God this thread is great, +1 Blue

And thank you rural - people like you remind me that this country isn't completely overrun by left-winged fools. Great posts, I love watching liberals get destroyed.

 

[ruralsurg4now]

"ruralsurg4now", do you honestly believe anyone here is debating you? This isn't debate, it's Crossfire. I'm hoping you're trolling - well, my secret hope is that you're LizzyM in a mischievous mood - because someone with real views like yours is in for a life of misery and impotent rage. I'm not one of those pesky internet kids who won't get off your lawn. I'm probably older than you. And I've made decisions in the kind of conditions you're advocating.

I've spent a lot of time working to defend our nation in ****ty little places you've never even heard of. As part of that job, I've had to make decisions about who lives and who dies. Not just our people, but wounded civilians who needed healthcare, and still-healthy allies of ours who needed our training and equipment to stay alive against our common foes. Unlike you, I have actually placed a dollar amount on what people's lives are worth - often in the three figures for patients who would quickly die without the care they needed for their chronic conditions. I was their only option, and I put a price on their lives. When their budget was exceeded, these people died. I didn't do this because I'm some fuddy-duddy tree hugger. I didn't do this because I believe healthcare is a right. I did it because I was helping advance our nation's cold, calculated interests and had limited resources to do so.

What I can take away from that experience, unequivocally, is that anyone who wants to institute a system that's even remotely similar in our country is a person worthy of pity more than anger. I wouldn't wish the decisions I had to make upon anyone and you wish them upon our entire nation. Who even cares if healthcare is a right? It's a damn duty. We are all responsible to each other to be as healthy as possible. If we want to maximize our wealth, as individuals and as a nation, we need healthy people. We need people and companies who have money to invest and grow, instead of keeping up on healthcare bills. We need people who can afford to see a doctor when they're sick, instead of having to go to work and infecting a dozen other people. Now, you can counter and go on and on about how you think the magical free market can deliver all these things. But that's not really what you want to say, so there's no point in making counterpoints. What you really want to do is find an excuse to say, "**** everyone but me".

At some point, you came to a moral crossroads. You were stressed, tired of idiots, and you made a judgment call. Trust me, I've been there, too. But you made the wrong call. You were at that moment when you doubted whether what you were doing was worth it, and you decided that your problems were all caused by others and that you are better than them because you are better off. You decided that life is an easily manageable sequence of predictable events that only lazy or stupid people couldn't keep under control (not surprising considering the privileged, faux-darwinist environment most doctors traditionally spring from). It's all their fault. They're trying to drag you down because they hate you for your success.

Now you're pissed off that all the pansies and the homos and the negros are coming to steal your money. You've become another messiah of the truth that the sheeple masses can't see: some mystical conspiracy by the lazy-yet-incredibly-good-at-intricate-conspiracies moochers to steal your money and your precious bodily fluids or whatnot. And now that you've found that zeal, that One True Faith, there's nothing any of us can do to take you off this path. If we agree with you, we've come to the faith. If we disagree, we're apostates who will burn in eternal fire. That's all we are, just binary inputs into a rigid view that, somewhat fittingly, can only held by those so well off that they are insulated from the consequences of their own opinions. There's no nuance or open-mindedness to your views and, like the rest of your demographically shrinking cohort, you're only becoming more irrelevant as you fulminate from the sidelines, while the rest of us weigh all the options and come to a reluctant conclusion that one option might be better than the other - no guarantees, of course, since certainty is for fools and teenager. To put it another way...

If it makes you feel better. Won't change anything, though.

And remember: we're here to destroy your way of life and force your kids to have premarital sex.

So, basically, once he manages to write something instead of using Internet GIFs, the summary is:

"I was in the military and for some reason didn't understand that people would die. Now that I'm not in the military, that experience tells me that I don't care if healthcare is a right, nor do I care about justifying it. All I care about is that I want it, so I'll call it a duty, which is much easier for me because now I don't have to explain it. Then some socialist stuff about how we are 'all responsible to each other to be healthy,' which doesn't even make sense. Also, then something about 'pansies, homos, and negros' because I'm liberal and, hey, what the heck, that's my best argument. Finally, broken image link ftw."

This guy means business. Good thing he'll never be a doctor.

 

[ruralsurg4now]

God this thread is great, +1 Blue

And thank you rural - people like you remind me that this country isn't completely overrun by left-winged fools. Great posts, I love watching liberals get destroyed.

My pleasure!

 

[KnuxNole]

Yeah, but I'm healthy ...I have a statistically better chance of living longer than the Obama voters. Then I'll get to laugh as they're denied care.

for now

 

[ruralsurg4now]

for now

Lol, yeah, but by the time I get sick we'll either have instituted a two-tiered system or there will be a healthy medical black market.

 

[ScarcelyMedical]

Lol, yeah, but by the time I get sick we'll either have instituted a two-tiered system or there will be a healthy medical black market.

Elaborately done. I'm not bound to this career and plan to work at a Denny's and start getting those cadillac entitlements ASAP. Life shall be cush. Join us on the other side, ruralsurg. Join us and forget the searing pain of obligation.

I'm my own man and so are you. Break the manacles. Break free.

C'est la vie.

 

[beyondhuman]

setting all the political issues aside and addressing the role of the internet mentioned... thanks to the internet I have found that I generally am more informed about my unique/rare disorders than most physicians, definitely more than PCPers and perhaps more than or at least rivaling specialists in the field (of course I have also been trained to critically evaluate relevant research data and most "worried moms" haven't been).

Additionally, I have had at least two infections/illnesses where I went to the doctor after doing the online research and knew what I had and what prescription I needed only to leave feeling like I had spent $50 for them to clear the red tape of prescription drug access limitations. BTW most basic antibiotics, etc. are available online or in stores (for pets) without a prescription I wonder what the effect of this will be the general population grows to be more internet savvy.

 

[ruralsurg4now]

thanks to the internet I have found that I generally am more informed about my unique/rare disorders than most physicians

Yeah, but so what? If your disorder is that rare, then most physicians probably never encounter it and instead focus on things they do. Whereas, that's basically the only disorder you need to know about. Also, your statement that you "knew what prescription I needed" is laughable. I hope you become a physician and are plagued with patients such as yourself.

 

[Goucher2013]

So, basically, once he manages to write something instead of using Internet GIFs, the summary is:

"I was in the military and for some reason didn't understand that people would die. Now that I'm not in the military, that experience tells me that I don't care if healthcare is a right, nor do I care about justifying it. All I care about is that I want it, so I'll call it a duty, which is much easier for me because now I don't have to explain it. Then some socialist stuff about how we are 'all responsible to each other to be healthy,' which doesn't even make sense. Also, then something about 'pansies, homos, and negros' because I'm liberal and, hey, what the heck, that's my best argument. Finally, broken image link ftw."

This guy means business. Good thing he'll never be a doctor.

I'm never going to be a doctor, that's the best ad-hominem comeback you've got? Well, your mother was a hamster and your father smelled of elderberries!

 

[ruralsurg4now]

I'm never going to be a doctor, that's the best ad-hominem comeback you've got? Well, your mother was a hamster and your father smelled of elderberries!

It wasn't a comeback, it was a prediction based on the level of your current discourse. I'm sure your personal statement will have fine passages about homos and negroes, however.

 

[Goucher2013]

It wasn't a comeback, it was a prediction based on the level of your current discourse. I'm sure your personal statement will have fine passages about homos and negroes, however.

Alright, I'll continue what's turning into the lamest 'zing' thread ever:

Prediction? Well, since you guys had such great success with unskewing all the polls, I'm not too worried.

Oh, I get it, that's what you meant about the personal statement...because I forgot update my status from "pre-med"? Already 0-for-1 on predictions, I'm afraid. Of course, you could still make your prediction come true by reporting me to my dean for failing to support Freedom.

I hope you don't make these kinds of predictions with your patients.

"Well, your WBC count is up, but I think the sample was skewed by the liberal Coulter counter."

PS: by the time we're done with this thread, both of us will probably look like this.

 

[rain4venus]

"Well, your WBC count is up, but I think the sample was skewed by the liberal Coulter counter."

Everyone knows Coulter is an extreme conservative

P.S. if it isn't clear, this is a joke.

 

[BlueLabel]

 

[ruralsurg4now]

Oh, I get it, that's what you meant about the personal statement...because I forgot update my status from "pre-med"? Already 0-for-1 on predictions, I'm afraid. Of course, you could still make your prediction come true by reporting me to my dean for failing to support Freedom.

Uh oh, this guy is in med school! He's FOR REAL.

 

[ruralsurg4now]

By the way, here's another prediction: Goucher isn't going to go into any primary care field where he has to take care of all these people he has a "duty" to take care of. Prove me wrong, buddy!

 

[Jabbed]

It's devolving into a flame thread again. Let's just admit that ruralsurg has extensive and comprehensive knowledge about healthcare administration, health economics, healthcare policy, public health, insurance business models, actuarial statistics, as well an unparalleled understanding of the human condition. Also by extension all of us are idiots. I wasted so much money on my degree in economics/public health, I could've learned more by memorizing: 'free market is da best, poor people don't deserve healthcare.' Darn

 

[KnuxNole]

I know for a fact ruralsurg doesn't hate on poor patients. After all, he'll go out of business in his rural practice if he discriminates against all poor people haha

 

[ruralsurg4now]

Let's just admit that ruralsurg has extensive and comprehensive knowledge about healthcare administration, health economics, healthcare policy, public health, insurance business models, actuarial statistics, as well an unparalleled understanding of the human condition. Also by extension all of us are idiots.

That's actually the best advice you've given thus far. Perhaps there's some hope for you after all!

 

[ruralsurg4now]

I know for a fact ruralsurg doesn't hate on poor patients. After all, he'll go out of business in his rural practice if he discriminates against all poor people haha

That's actually not how it works.

 

[BlueLabel]

Maybe some of you wizards can weigh in on the initial topic I really wanted to discuss: resources like WebMD make healthcare info more accessible to patients; does this translate into patients often or sometimes being better informed than their doctors, and if so, is this good or bad? I have opinions on these points but I was hoping to generate some discussion on them from SDN at large.

In particular, input from attendings/residents/fellows would be interesting because you folks no doubt see patients/families informed through WebMD periodically. Does this make your job harder or easier? How deferent should patients be to the opinion of professionals when they (seemingly) have access to droves of medical knowledges online? Doesn't increasing patient awareness have to be a positive in the long run? Why or why not? There are so many interesting questions here to discuss but unfortunately we're getting bogged down in a puerile political dispute.

 

[hubriz]

That was a very lengthy way of admitting you can't explain your data. As predicted.

Within the yellow column of the chart is a number representing what can be considered an economical burden: (federal funding received / federal taxes spent). Obviously, any state with an amount higher than $1.00 indicates that this state (and its residents) is receiving more federal funding than they are contributing; i.e. a positive economical burden (gross receivers). On the other hand, any amount less than $1.00 implies a negative economic burden (gross contributors).

Overall, the results of this rudimentary calculation demonstrate that blue state residents and corporations are, on average, not only contributing more money in the form of federal taxes, but that they are receiving less money. In other words, they are the major funders of America through taxes.

With that said, it is worth discussing that the majority of State funding comes from taxes, fees, penalties and not earmarked federal funds. So, what this chart mostly represents is the burden it's residents are placing on the federal fund, which is paid into by residents and corporations of all states.

More importantly, a huge caveat to this study is the omission of income disparities. Blue states have a significantly higher average income, which, of course, leads to higher federal tax contributions. Since the relationship between income and federal aid is inversely proportional, one would expect lower income states to have higher federal funding received and to also pay lower taxes. This, in turn, results in lower income states having a positive economical burden.

What this study demonstrates is that red states are lower income states, on average. This finding is unsurprising and unexciting, until it is put in the form "Blue states are the major funders of America". Both findings are the same.

Boom.

 

[Trek19]

Within the yellow column of the chart is a number representing what can be considered an economical burden: (federal funding received / federal taxes spent). Obviously, any state with an amount higher than $1.00 indicates that this state (and its residents) is receiving more federal funding than they are contributing; i.e. a positive economical burden (gross receivers). On the other hand, any amount less than $1.00 implies a negative economic burden (gross contributors).

Overall, the results of this rudimentary calculation demonstrate that blue state residents and corporations are, on average, not only contributing more money in the form of federal taxes, but that they are receiving less money. In other words, they are the major funders of America through taxes.

With that said, it is worth discussing that the majority of State funding comes from taxes, fees, penalties and not earmarked federal funds. So, what this chart mostly represents is the burden it's residents are placing on the federal fund, which is paid into by residents and corporations of all states.

More importantly, a huge caveat to this study is the omission of income disparities. Blue states have a significantly higher average income, which, of course, leads to higher federal tax contributions. Since the relationship between income and federal aid is inversely proportional, one would expect lower income states to have higher federal funding received and to also pay lower taxes. This, in turn, results in lower income states having a positive economical burden.

What this study demonstrates is that red states are lower income states, on average. This finding is unsurprising and unexciting, until it is put in the form "Blue states are the major funders of America". Both findings are the same.

Boom.

Thank you for the contribution, however there is some information about that analysis that isn't immediately apparent but is very important:

"Federal Aid" includes Military Bases, Military Funding, Native American Reservations, Federal Research Labs, Disaster Relief, and Public Servant Retirement/VA benefits.

Many low population states with low tax yields are dotted with very expensive military bases and other programs. Retired public servants may also move to places like Virginia or Florida as well. These things skew the data in a very significant way.

Bottom line: things are complicated and attempts to simplify them are often misleading.

 

[SunsFun]

Maybe some of you wizards can weigh in on the initial topic I really wanted to discuss: resources like WebMD make healthcare info more accessible to patients; does this translate into patients often or sometimes being better informed than their doctors, and if so, is this good or bad? I have opinions on these points but I was hoping to generate some discussion on them from SDN at large.

In particular, input from attendings/residents/fellows would be interesting because you folks no doubt see patients/families informed through WebMD periodically. Does this make your job harder or easier? How deferent should patients be to the opinion of professionals when they (seemingly) have access to droves of medical knowledges online? Doesn't increasing patient awareness have to be a positive in the long run? Why or why not? There are so many interesting questions here to discuss but unfortunately we're getting bogged down in a puerile political dispute.

Just knowing a lot about a medical condition does not solve the information asymmetry problem. The patient are still not aware of all of the treatment options and certainly are not aware of a fair market value of those services. Most people do not shop around for medical care. If a hospital is overcharging or a doctor is going with the most expensive options (or basing his plan on insurance coverage), it is highly unlikely that the patient will object especially when insurance is footing the bill. In this sense the hospitals are like monopolies. Even if they allocate resources inefficiently or charge more than just and fair price, they will not see a drop in a customer base.

 

[Jabbed]

I think this is a good way to describe it. However it is, in my opinion, important to note that when the VA is unable to provide timely or reasonable access to care it can send people to the private sector. This is admirable, and is one reason the shortcomings of the VA are greatly alleviated. Also, I'm going to have to review payment schedules but I have a feeling they are similar to Medicare, meaning it is likely the private sector is eating some of the cost to help support veterans and their families.

Also VA care isn't always free: there are enrollment fees and co-payments.

Edit: http://www.va.gov/healthbenefits/cost/copays.asp

Not sure if you're advocating a VA-like national healthcare system. If so...

 

[Jabbed]

In particular, input from attendings/residents/fellows would be interesting because you folks no doubt see patients/families informed through WebMD periodically.

Dead serious and not trying to be offensive, but I feel like they have better things to do than hang around pre-allo forums. There's probably a better sub-forum if you're serious about getting their opinions though.

 

[BlueLabel]

Dead serious and not trying to be offensive, but I feel like they have better things to do than hang around pre-allo forums. There's probably a better sub-forum if you're serious about getting their opinions though.

Questions from pre-meds stay in pre-allo, period. Also do you not remember the attending who filled this thread with hundreds of posts over the past couple days?

 

[Jabbed]

Questions from pre-meds stay in pre-allo, period.

Well, I meant that there is probably a thread in another forum that discusses this topic from the experience of an attending. You might have better success reading those threads.

Also do you not remember the attending who filled this thread with hundreds of posts over the past couple days?

This should be a bit of a red flag.

 

[Jabbed]

Just knowing a lot about a medical condition does not solve the information asymmetry problem. The patient are still not aware of all of the treatment options and certainly are not aware of a fair market value of those services. Most people do not shop around for medical care. If a hospital is overcharging or a doctor is going with the most expensive options (or basing his plan on insurance coverage), it is highly unlikely that the patient will object especially when insurance is footing the bill. In this sense the hospitals are like monopolies. Even if they allocate resources inefficiently or charge more than just and fair price, they will not see a drop in a customer base.

Hospitals are very much like monopolies. An issue about elevated pricing points was brought up earlier and another article was linked that showed evidence of this. Technically: A perfectly competitive market prices goods/services at the intersection of marginal cost and demand (ie the equilibrium at which the cost of producing an additional unit equals the market demand). Hospitals tend to set their prices at the market demand level corresponding to the quantity of production where marginal cost equals marginal revenue. This price setting behavior maximizes profit and is known as monpolistic competition. The quantity of goods/services that exists between the two price points is known as deadweight loss.

If anyone's actually interested: http://economicsonline.co.uk/Business_economics/Monopolistic_competition.html

Essentially, hospitals charge higher prices and provide fewer services than a free market equilibrium would suggest in order to maximize profit, which is all possible because they have market power.

I don't want to make it seem like I'm pinning the blame on hospitals though. There is a lot to be said about medical tort reform, insurance incentives, public health education, and expansion of primary care.