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Jasminegab

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One would think that if someone spends undergraduate and graduate then a residency passing board exams and perhaps becoming a board certified MD that you have gained the right to call yourself a Medical Doctor. However, this is not the case. The state declares being a Medical Dcotor a previledge.

Sadly, the state does this with your driving license also. You drive because it's a previledge. It can be taken away and denied. But why is this? Can someone explain to me what the previledge is? What exacatly is the definition of being given a previledge to do something? Does this mean that if I shadow a MD and study every action the MD does, I'll someday be granted the previledge of doing it on my own someday? If my previledge can be taken away, does that mean that I lose all that I've learned? Is it like when we were children and our parents said that we've earned the previledge to stay up late at night and watch scary movies but if we did something bad then we lost the right to stay up late?:confused: :confused: :confused: :idea:
 

exmike

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first its PRIVILEDGE

Of course practicing medicine is priviledge. If you don't practice up to the high standards expected of doctors, then they dont deserve to practice. If you drive below the standards expected, then you lose your priviledge to drive. I don't see the problem here.

Of course, you could lose your priviledge to practice medicine, but you'll still have your MD degree, and thus still be a Doctor.
 

Gleevec

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I believe practicing medicine is a privilege.

But receiving quality and affordable medical care is definitely a fundamental human right in a my book.
 
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Jasminegab

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Originally posted by exmike
first its PRIVILEDGE

Of course practicing medicine is priviledge. If you don't practice up to the high standards expected of doctors, then they dont deserve to practice. If you drive below the standards expected, then you lose your priviledge to drive. I don't see the problem here.

Of course, you could lose your priviledge to practice medicine, but you'll still have your MD degree, and thus still be a Doctor.

I knew there would be someone who would point out the mis-spelling first. Not that I had any clue as to the proper way of spelling the term.

Anywho, it was not my intention of pointing out the problems. The whole purpose of the post is to get people to think and respond upon the issue. I want to know how other people think and feel about having the right to practice medicine. Not so much is it right or wrong.

Nevertheless, thanks for pointing out my grammer mis-stacks though. :hardy:
 

exmike

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Originally posted by Gleevec
I believe practicing medicine is a priviledge.

But receiving quality and affordable medical care is definitely a fundamental human right in a my book.

Unfortunately health care is not a right under the constitution.
 

DrBodacious

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privilege: A special advantage, immunity, permission, right, or benefit granted to or enjoyed by an individual, class, or caste.

Anything you need a licence for is a privilege, medicine would be included. To say practicing medicine is a "right" in the "privelege or right" sense of the word right would be to say that anyone on the street can open up a doctor's office. No way.

You can be granted the privilege to practice medicine in some states, have that privilege revoked, and then practice in other states. If you can't practice in the US, then I suppose you could use your knowledge in other countries. Knowledge cannot be take away from you, of course. But you have to do something inexcusable (i.e. break laws) to have your privileges revoked, so I don't see that as being a problem.
 

exmike

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Originally posted by idq1i
May I suggest a good dictionary?

LOL *blush* <remove foot from mouth>

privilege

heehee notice how some after me spelled it the same way :laugh:
 

Gleevec

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Originally posted by exmike
Unfortunately health care is not a right under the constitution.

Most things aren't a right in the constitution. Black people not being 3/5 a person wasnt in the original constitution. Womens and nonwhite suffrage werent a part of the constitution.

Lots of things arent part of the constitution, but are added as amendments or become so socially prevalent that the courts change the interpretation of the laws/constitution to reflect these new norms.

Thus, even if health care isnt a right stated explicitly in the constitution, most people agree that it is a right, and not a privilege. And people who dont believe that access to medical care is a right really have no business practicing medicine IMHO.
 
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G_Eagle

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My question is, just how much medicine do people have a right to? Every procedure available? The best surgeries out there? The most expensive drugs? Are those a right? What about other needs like the need for housing? Government provides that, but I would certainly argue that government provided housing is the bare minimum and not the best out there. It is the same way with food....

No, don't yell at me, I am not tipping my cards on what I think, rather posing questions that plague me about this issue. Where do you draw the line between right and what you can afford? Because if the government should be providing the best to cover our necessities, they certainly are failing in more areas than healthcare. I still see homeless, and I still see hungry...and I even saw those people when I visited socialist countries like the Netherlands....

Great, I probably just pushed this thread into the everyone forum...
 

Spitting Camel

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Lets see here... how do you guys feel about this:

When someone goes to prison, do you believe they forfeit their "right" to medical treatments? I personally don't believe that someone who commits a certain crime is entitled to the same rights as law-abiding citizens. For example: a murderer needs a heart and is the next on the transplant list. He is currently in prison for life, but wants the heart. The next person on the list is a 35 year old father of 2 who has a clean record. Would you still say that the murderer has the right to be treated over the 35 year old man?

Am I unethical for thinking that criminals forfeit that right?
 

NonTradMed

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I agree with most here that practicing medicine is a privilege. The ability to treat sick people should be regulated. The whole point of "allowing" someone to practice medicine is to protect the public from unscrupulous doctors who would do harm. Not much of a debate here about the privilege to practice medicine.

As for the right to have access to health care.....well, I feel it is like education...everyone deserves the basic, for the frills, buy private insurance. The basics should include anything that would endanger public health or become a cost to society and one which is reasonably preventable. This means prenatal checkups for women, immunizations (which for the most part are subsidized already) and basic checkups and exams, and some other things as well, like simple surgeries. People shoudl be given the option to buy better deals through private insurance if they so choose.

I also believe it is in our national interest to provide basic health care to all under the age of 18. It is not children's fault that their parents have crappy jobs, and society will save money if children are given proper health care.

This does not mean spending a million on preemies, or experimental drugs, which I think are many people's fears. No, we as a society must maximize our dollars to provide the most bang for our bucks. :)
 

Gleevec

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Originally posted by G_Eagle
My question is, just how much medicine do people have a right to? Every procedure available? The best surgeries out there? The most expensive drugs? Are those a right? What about other needs like the need for housing? Government provides that, but I would certainly argue that government provided housing is the bare minimum and not the best out there. It is the same way with food....

I dont know how you can be asking this question. Doctors simply repair what is broken in the best way possible (best defined as combination of solving the problem, least complications, lower cost, etc).

The bare minimum for health care, defined as simply treating people with most common treatment in that area to cure the ailment, is a different story than housing projects.

Indeed, for housing projects, no theyre not pretty or in great areas, but it provides a place to live. In terms of health care as a right, all that needs to be done is cure the disease. The fundamental threshold of housing projects is providing a home, the fundamental threshold of providing medical care is curing the ailment with whatever is available at the time.
 

G_Eagle

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I think this is probably the best approach, public health. Anything that one could argue would benefit the public health might be supported by the government. Immunizations decrease illness expenses and should promote a larger workforce as well as more consumers. Preventative care is good for society as it promotes a healthier, more viable one. But if you take this utilitarian approach, then expense procedures for one person that could be better spent as preventative care for many others, the one is sacrificed for the others. Why? I am not sure that society can afford spending top dollar for each person. We already devote 15% of our GDP to healthcare, higher than any nation I know of. Much more feasible is providing basic healthcare and protecting the young...
 

Gleevec

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Originally posted by AlreadyInDebt
Lets see here... how do you guys feel about this:

When someone goes to prison, do you believe they forfeit their "right" to medical treatments? I personally don't believe that someone who commits a certain crime is entitled to the same rights as law-abiding citizens. For example: a murderer needs a heart and is the next on the transplant list. He is currently in prison for life, but wants the heart. The next person on the list is a 35 year old father of 2 who has a clean record. Would you still say that the murderer has the right to be treated over the 35 year old man?

Am I unethical for thinking that criminals forfeit that right?

I dont think you can EVER be unethical for thinking something. Debating something as highly controversial as this within in your mind is perhaps the most ethical thing you can do in itself.

That said, you raise an interesting point, and I think I am about to give a very unpopular answer, but Im willing to defend it since I believe my premise to be sound, and if I were to go the other way on this issue, I think it would establish a horrible precedent.

My most fundamental belief regarding this issue is that doctors ought not be in a position to judge people in order to grant life or death. Furthermore, I abhor the notion that one's life can be judged as "more worthy" on any criteria. If two 18 year olds need a transplant, and one is a bully and the other is an honor student, I dont feel its fair at all to have to "judge" one's life as superior. Your question regarding prison inmates is simply an extension of that. In fact, I believe if we were to start sorting waitlists for organs BASED on what one has accomplished in life and how much one's life is worth, that would be the most heinous and abusive system. So to answer your question, no, I wouldnt bypass the prisoner for a family man in terms of getting an organ for fear of people starting to judge individual's worth and whether they live or not.

That said, I think a system of organ matching based on likelihood of the transplant taking hold successfully, time on wait list, and possibly age is solid.

Age is a tricky issue for me, and though I would feel bad giving preference to a 14 year old over an 18 year old, I would feel even worse giving a fresh organ to an 80 year old instead of a 16 year old.
 

G_Eagle

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Originally posted by Gleevec
the fundamental threshold of providing medical care is curing the ailment with whatever is available at the time.

Let me put it like this...do you give all out treatments for everyone? Quadruple bypass and experimental, expensive drugs? Such procedures can cost up to hundreds of thousands of dollars...can society truly bear such a cost? If treating illness were a matter of prescribing penicillin, then this might be feasible, but there are many more options than that. Healthcare has unpredictable costs.

Also, doctors don't look for the lowest cost. Especially with defensive medicine to battle malpractice risks, doctors tend to order tests so that they cannot be questioned in court. This defensive approach drives up costs.
 

Gleevec

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Originally posted by G_Eagle
Let me put it like this...do you give all out treatments for everyone? Quadruple bypass and experimental, expensive drugs? Such procedures can cost up to hundreds of thousands of dollars...can society truly bear such a cost? If treating illness were a matter of prescribing penicillin, then this might be feasible, but there are many more options than that. Healthcare has unpredictable costs.

Yes. And of course society can bear the cost, it's a question of whether society is WILLING to bear the cost.

For example, if simply the top 1% of taxpayers resumed paying taxes at the 1990s level, that's about 90 billion dollars. A quadruple bypass procedure costs about 40k (not hundreds of thousands of dollars, there are very few of those types of surgeries, namely twin seperations come to mind, but those are generally done for FREE by awesome academic doctors). Thats 2.25 million procedures. So for even the most exaggerated example of a surgery people would need that you have provided, it would be quite easy from a social standpoint to fund this endeavor. Society can most definitely bear the costs, it just needs to be willing to.

I mean, seriously, if some poor guy in need of an expensive procedure comes up to you, without insurance, are you just going to say "no, get the heck out of my office."?

So if a quadruple bypass is what someone needs to live, then, I guess society ought to cough up the money for it. Of course, if society had been paying smaller amounts for this person to go to the doctor more oftern at a younger age, preventative medicine would have probably recouped all of those expensives.

So the short answer is yes, I believe.
 

G_Eagle

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Then this is where we will have to disagree. Although I would like to believe that healthcare is an expense that can meet everyone's needs, I do believe that it becomes too expensive at a certain point. I think that provision of preventative care for society is good...but past provision for public goods that benefit everyone, I cannot see society paying for everyone. Would I want to turn anyone away? Of course not! But the issue remains, who pays for that procedure? Certainly you can't ask yourself to absorb the cost of every person who walks into your door and cannot pay, and society won't want their taxes raised as high as in Europe (70 and 80% for all levels of income).

Here is another issue, our society is built upon capitalism, the harder you work and better your skill, the more you make. It is the market system. What if you took that away? What if doctors were government employees, paid similar rates? What would be the incentive to specialize and put in the extra years? Goodness of people's heart and altruism only go so far... Example...look at police officers, they certainly are public servants who are way underpaid and underappreciated...I know very few people who jump at the chance to be a beat cop. Do you know anyone who would jump to put in the years to be a neurosurgeon without large compensation? Ask a neurosurgeon if they would perform for a low salary...

I am not trying to be mean here, just realistic. Currently, I am taking an economics of healthcare class, and it is proving to me that socialized healthcare has problems too. It isn't the fix that people think it is. It just changes the issues.
 

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1) Practicing medicine is somewhat murky. Current laws make it a privilege. Philosophically, one may make the case that practing acts of medical benefit is one's human right.

2) Receiving medical care, however slight or substantial, is not a right. It is a privilege, although most dictionaries would distort the concept to unfair proportions. Medicine is a highly complex service, and no one has a human right to a service in a free society. On the other hand, I believe it is legitimate to have a government help provide health care services by picking up the tab from the private sector, in the name of public health or whatever. Just don't use it as an excuse to "roll back tax cuts for the wealthy." Use the damn money you have more efficiently.

3) Don't kid yourselves. Prisoners have atrocious medical care, with waiting lists that would make some of the worst socialist health care operations in Europe look pleasing. The issue is brought up here and there when we hear of them receiving some operation while a non-prisoner is denied for whatever reason, but these are rare and not characteristic of the system.
 
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Gleevec

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Originally posted by G_Eagle
Then this is where we will have to disagree. Although I would like to believe that healthcare is an expense that can meet everyone's needs, I do believe that it becomes too expensive at a certain point. I think that provision of preventative care for society is good...but past provision for public goods that benefit everyone, I cannot see society paying for everyone. Would I want to turn anyone away? Of course not! But the issue remains, who pays for that procedure? Certainly you can't ask yourself to absorb the cost of every person who walks into your door and cannot pay, and society won't want their taxes raised as high as in Europe (70 and 80% for all levels of income).

Here is another issue, our society is built upon capitalism, the harder you work and better your skill, the more you make. It is the market system. What if you took that away? What if doctors were government employees, payed similar rates? What would be the incentive to specialize and put in the extra years? Goodness of people's heart and altruism only go so far... Example...look at police officers, they certainly are public servants who are way underpaid and underappreciated...I know very few people who jump at the chance to be a beat cop. Do you know anyone who would jump to put in the years to be a neurosurgeon without large compensation? Ask a neurosurgeon if they would perform for a low salary...

I am not trying to be mean here, just realistic. Currently, I am taking an economics of healthcare class, and it is proving to me that socialized healthcare has problems too. It isn't the fix that people think it is. It just changes the issues.

So what you're saying is, you think people should be turned away from life-saving procedures because they are poor, and sentenced to die because they are of a lower economic class?

I think some people find it easy to point to economic textbooks and abstract meta-analysis and say, oh, its just being realistic.

No, I think being realistic is turning away some poor guy who is going to die because YOU (general you, not you in particular, g_eagle) know he can't pay for the procedure. I don't know how anybody could do that.

On a related note, I think the bottom 33% of students should be kicked out of school. They obviously can't cut it, society can't afford to educate them, and they are taking away money, time, and resources from us gifted avante-garde (sarcasm).

So can I take it you think that healthcare is a privilege then, g_eagle? Because that is what your arguments seem to me. I just want to make sure I understand you here.
 

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Originally posted by Gleevec
So what you're saying is, you think people should be turned away from life-saving procedures because they are poor, and sentenced to die because they are of a lower economic class?
That's an unfair attack. Those of us who would prefer a freer market in medicine believe that those who are not able to pay or are poor should be taken care of in other ways. Charity, government pool, etc. There are ways to pay without making medicine a right accorded to anyone who demands it -- that's just unfair to the providers of it.
 

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I think that it is a privilege. I think that it is up to charitable aspects of the private sphere to cover those who are not able to pay for their healthcare. With government health insurance, I think we bring in a third-party who will dictate what procedures can and cannot be done, restricting physician autonomy.

I am not sure what you mean about kicking out the bottom 33% of students, since they are paying for their education either through taxes or tuition. Yes, those who fail to perform in a capitalist society do not get the same outcomes. Economically, the US is built to create a pyramid in society through competition.

Therefore, it is up to the private sector to help those in need. This is why we have hospitals like Scottish Rite that does charitable cases. What would I do if someone in need came to me for help? That is a situation that I will have to continue to ponder. Would I automatically turn someone away? No. Do I realize that not everyone can get a heart transplant. Yes.

And remember, managed care wasn't created to get healthcare to everyone but to lower costs. Ultimately, that also lowers what is performed. I would like to believe that it pushes efficiency, but I think that in reality it pushes misdiagnosis and patient dumping.
 

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How about we seperate doctors into 2 catagories -

Those that feel it's a right

and

Those that feel it's a privilege.

For the first group, they are required to donate all earnings over $50k / year to charitible organizations and must work entirely in underserved areas.


For the second group, they get to keep what they earn, donate what they wish, provide care where they want, and donate their time/abilities as they want.

Everyone always wants something for free - and get it easy... never understood that.

In my town, doctors, dentists, and nurses sacrifice 2 nights per week (Tues and Thurs) until 11pm giving F R E E patient care to those who are the "working poor". Last year, that same clinic donated something like $140k in drugs to the elderly. Surgeons perform needed procedures for some of these patients if it's needed and can't pay.

Did some government agency order them to do it? Nope - They did it out of the basic goodness of their heart and thru donations of money and time from the community.

I don't think we need some law forcing anyone to pay for other peoples problems - that's basically slavery and stupid. I just don't believe that there are people out there who get turned away from medical care if they need it (at least not in the US).

Of course, they have to be willing to look for it - the clinic doesn't advertise in the paper (why spend the money for that?) but a quick call to any local health professional or local churches should reveal sources of free or low-cost medical care in the area.

Maybe I'm just lucky, in my city the doctors care about people and do what needs doing.... They sure as heck don't need someone who's never volunteered (truly volunteered, not just "getting ECs") telling them they aren't doing enough for free.
 

exmike

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Originally posted by Gleevec
Yes. And of course society can bear the cost, it's a question of whether society is WILLING to bear the cost.

For example, if simply the top 1% of taxpayers resumed paying taxes at the 1990s level, that's about 90 billion dollars. A quadruple bypass procedure costs about 40k (not hundreds of thousands of dollars, there are very few of those types of surgeries, namely twin seperations come to mind, but those are generally done for FREE by awesome academic doctors). Thats 2.25 million procedures. So for even the most exaggerated example of a surgery people would need that you have provided, it would be quite easy from a social standpoint to fund this endeavor. Society can most definitely bear the costs, it just needs to be willing to.
That has to be one of the most untrue statments I've ever heard.



Contrary to what some may think, society's demand for health care is insatiable. It is fiscally and socially irresponsible to provide as much health care to everyone that needs it. The fact is that is a limited supply of resources that needs to be distributed to a mass of unlimited demand. I find it quite naive that people suggest that simply increasing taxes is a simple way to pay for the national demand for health care.

NO, everyone should NOT be given EVERY life saving treatment out there, and this has nothing to do with socioeconomic status. The question is when you have limited resources, how are you going to distribute those resources. Would you rather provide one bypass surgery to an overweight illegal immigrant or preventative health care for dozens of illegals. Those two cost the same, yet the latter is probably more effective in terms of YLL's (year's life lost).

Gleevec, our country spends 14% of our GDP on health care with 40 million are uninsured, and countless others are underinsured. Do you still mean to suggest that we could possibly afford the best possible health care for every single citizen? It is absolutely impossible because for any given condition there is invariably another possible treatment or another regimen that compounds the costs non-linearly every time you add another consumer.

Quality health care for every american is as much of a right as equal protection. Sure, we all deserve it, but it doesnt mean we'll get it.
 

bigbaubdi

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Originally posted by exmike
Contrary to what some may think, society's demand for health care is insatiable. It is fiscally and socially irresponsible to provide as much health care to everyone that needs it. The fact is that is a limited supply of resources that needs to be distributed to a mass of unlimited demand.

If a doctor posted a sign on his office advertising free amputations, would that make you any more likely to visit him/her for an amputation? By in large, people don't go in for medical procedures until they really need them.

Which brings up an important point - the market for health care is completely different from the market for typical consumer goods. Health care demand is largely driven by real needs, not by changing consumer preferences in response to different prices.
 

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The United states spends far more per capita on healthcare than any other country in the world. Yet there is something like 40 million people without any kind of healthcare, why is that?
 

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Originally posted by bigbaubdi
If a doctor posted a sign on his office advertising free amputations, would that make you any more likely to visit him/her for an amputation? By in large, people don't go in for medical procedures until they really need them.

Which brings up an important point - the market for health care is completely different from the market for typical consumer goods. Health care demand is largely driven by real needs, not by changing consumer preferences in response to different prices.

I think there's evidence for more price-sensitivity on the part of health care consumers than we would believe. Check out work by David Wennberg and Elliot Fisher on regional disparities in health care spending. They find that high-spending areas are not necessarily (and in some cases, negatively) correlated with higher quality health care. In later work, they find a relationship between factors like number of specialists in an area to the amount of health care spending (and inversely related to quality). Doctors can and do induce demand by increasing and promoting supply. In some cases it is good, but it can be unnecessary.

In the case of drugs, it's even better documented that advertising and price can affect demand. Again, good in some cases, and bad in others.
 

exmike

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Originally posted by bigbaubdi
If a doctor posted a sign on his office advertising free amputations, would that make you any more likely to visit him/her for an amputation? By in large, people don't go in for medical procedures until they really need them.

Which brings up an important point - the market for health care is completely different from the market for typical consumer goods. Health care demand is largely driven by real needs, not by changing consumer preferences in response to different prices.

The appetite for health care has to do with insurance coverage. The "in" thing to talk about nowadays is a national health insurance plan. It has been proven time and time again that consumer demand for health care is inversely proportional to the out of pocket costs for that consumer. If you suddenly insured another 40 million, imagine how much demand would increase.

What if you simply reduced the huge deductibles that others have to pay before coverage begins (i.e. catastrophic coverage), dont you think that those people would utilize health insurance more as well?

As another poster pointed out, consumers ARE very price sensitive. That is why it is not feasible to provide comprehensive coverage the way we would all LIKE. The problem is that the only way to curb demand is to introduce price considerations for the consumer. Insurance plans such as MSAs are a move in the right direction because it places price considerations into the consumers health care choices.

Placing price considerations into health care reintroduces wealth into the health care equation, which is bound to apall those in favor of socialist medicine (gleevec).

As you can see there really isn't a way to provide equal health care to every american in an affordable way. Not now at least.

As an aside, I am all for universal coverage, but only in a socially and fiscally responsible way. Comments like increasing taxes on the top 1% to fun universal coverage is simply an irresponsible thing to say because it will never happen. It is politically sensitive. What we need to do is to better allocate what we currently spend on health care to impart the greatest benefit to the greatest number of people.
 
?

....

Gleevec how on earth can health care be a basic human right?

Do you know what a right is?

Can I vilote your rights without acting?

Are not rights timeless? I think BASIC HUMAN rights are.

But how can someone have a right to chemotherapy before it was invented? How can someone have a right to antibiotics before they were discovered?

Regarding health care as a basic human right is insane. It simply doesnt fit.

Alone on an island you die of something trivial. You didnt get proper heath care. your basic human rights were viloated.....by whom?

doesnt there need to be an agent to violate a right?
 
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jlee9531

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Originally posted by Tas

I don't think we need some law forcing anyone to pay for other peoples problems - that's basically slavery and stupid. I just don't believe that there are people out there who get turned away from medical care if they need it (at least not in the US).


ahh so i guess my family and others i have met live in another country.

for the most part...if its costly...they will not provide...simple as that unfortunately.
 

Celestron2000

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The Planned Parenthood that I volunteered at provides their services on a sliding fee scale depending on income. Everyone pays something, those with more money pay more. Those with less money still feel the financial pinch, but not in a way that is impossible to cover. Just a thought.
 
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....

Originally posted by medic8m
Not according to the constitution

what does that have to do with anything. The constitution does give us BASIC HUMAN rights. the are....BASIC and INTRINSIC
 

gdk

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not to get off topic, but keep in mind this was in the constitution for the purpose of the census, which sets representation in congress. the founders didn't want slave holders to have more power in government, so they inserted the 3/5th of "other people" part. i think if you study it you'd find that many of the authors were against slavery, they just didn't want to risk spelling it out as right or wrong. i mean, that might start a civil war.
oh, nevermind.
 

medic8m

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Originally posted by hightrump
what does that have to do with anything. The constitution does give us BASIC HUMAN rights. the are....BASIC and INTRINSIC

You are right health care is not a basic human right

neither is voting, employment, etc.

That doesn't mean everyone shouldn't have the opportunity for all of them, especially in the richest country in the world.
 

shawred

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Originally posted by Gleevec
My most fundamental belief regarding this issue is that doctors ought not be in a position to judge people in order to grant life or death. Furthermore, I abhor the notion that one's life can be judged as "more worthy" on any criteria. If two 18 year olds need a transplant, and one is a bully and the other is an honor student, I dont feel its fair at all to have to "judge" one's life as superior. Your question regarding prison inmates is simply an extension of that. In fact, I believe if we were to start sorting waitlists for organs BASED on what one has accomplished in life and how much one's life is worth, that would be the most heinous and abusive system. So to answer your question, no, I wouldnt bypass the prisoner for a family man in terms of getting an organ for fear of people starting to judge individual's worth and whether they live or not.

That said, I think a system of organ matching based on likelihood of the transplant taking hold successfully, time on wait list, and possibly age is solid.

Age is a tricky issue for me, and though I would feel bad giving preference to a 14 year old over an 18 year old, I would feel even worse giving a fresh organ to an 80 year old instead of a 16 year old.


Thank goodness you didn't get this question in an interview. If you did, you must not have said this. I particularly have a problem with the age distinction. It is COMPLETELY WRONG. Lets say you have a 16 year old and an 80 year old in a car wreck. They are both in need of a liver, and you have one to give out. Who gets it? According to you, you would make the hasty decision to give it to the 16 year old. But actually, assume that after the transplant, the 80 year old has a high probability to live an extra 10 years, but the 16 year old will only live 5 years with that liver? Seems clear cut now. You shouldnt make decisions based purely on age. There is more to it. You claim that physicians should not judge worth, but you contradict that with the ageism.

Now time for me to get roasted for claiming something that most will say is COMPLETELY WRONG. They only true, fair system for handing out organs is one that involves auctioning them off to the highest bidder. You don't have to make decisions that are political and arbitrary.
 

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Very interesting debate...

I'd like to chime in agin and say I believe health care is definately a privilege.
Life isn't fair people! The number of people with inadequate health care is astounding in the US, and even more so on a global level. You could work every waking moment trying to treat all these people, but I don't think that any of you will. If I were ever severly ill, I would be thankfull to have the privilege of access to treatment, and I hope that I am privileged enough to be able to afford the best treatment possible.


It would be nice if we could taxes to pay for health, either by reprioritizing or increaseing taxes a bit. But I don't see that happening with a budget deficit of $500 billion. If Bush gets reelected, don't count on tax increases for the rich either.
 

bigbaubdi

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Originally posted by periodic
In later work, they find a relationship between factors like number of specialists in an area to the amount of health care spending (and inversely related to quality). Doctors can and do induce demand by increasing and promoting supply. In some cases it is good, but it can be unnecessary.

In the case of drugs, it's even better documented that advertising and price can affect demand. Again, good in some cases, and bad in others.

Does the number of specialists influence the amount of health care spending or do certain areas that can afford to spend more on health care attract more specialists?

Even if the former explanation is correct, how many of these procedures and drugs are elective and how many of them are absolutely necessary? For example, I can easily see the relationship between botox injections or viagra pills with slick PR campaigns but what about triple bypass surgeries or protease inhibitors? In any case, most of the proposals for universal health insurance do not cover elective procedures.

Originally posted by exmike
It has been proven time and time again that consumer demand for health care is inversely proportional to the out of pocket costs for that consumer.

But what does this reflect? Does this mean that people will unnecessarily take powerful drugs if they have free access to them or does it mean that in today's situation, many people are priced out of the market for needed drugs/procedures?
Originally posted by exmike
Insurance plans such as MSAs are a move in the right direction because it places price considerations into the consumers health care choices. Placing price considerations into health care reintroduces wealth into the health care equation, which is bound to apall those in favor of socialist medicine (gleevec). .

MSAs are extremely problematic because the vast majority of people in this country could not possibly deal with the astronomical out of pocket costs associated with catastrophic injuries.

I don't have the statistics readily on hand, but if I recall correctly, the VAST majority of health expenditures are caused by a small fraction of the population - typically people with chronic illnesses.

An MSA system would disproportionately benefit people who are already in excellent health. This problem is similar to the problem associated with private insurers, who try to enroll healthy, low cost patients and exclude patients with histories of illnesses. In both situations, we have an extreme perversion of the basic purpose of the health care - to take care of the sick.

Originally posted by exmike
As you can see there really isn't a way to provide equal health care to every american in an affordable way. Not now at least.

Our PUBLIC per capita spending alone is much higher than the total per capita spending of many nations with universal health insurance, including Japan and the United Kingdom. Our total per capita spending is WAY higher than any other nation. These two facts suggest that universal health care is actually cheaper, than our current amalgamation of private and public insurers.
 

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The arguments I have read so far are indeed interesting. Let me add my thoughts, more with the sentiment of a non-American.

The issue of healthcare and its deservingness are complicated because of diverging interests in the field. How? First you have the business guys (add economists here and financially-oriented medical practitioners), quasi-altruists and the altruists.

In the first class you have people such as the HMOs, hospital directors and the like who see the healthcare industry as an avenue to profit. They then come up with agitprop-like insurance programs that have as their sole purpose the garnering of wealth. Consequently they discriminate on who can be insured and who can't be based on medical/genetic records as insuring a potentially "diseased" person will cost them. At the end of the day, these business people make a good note that year with incomes in the million-dollar range.

In the second class you have the quasi-altruists. These people seek that individuals receive good healthcare at the best price possible. They, of course, seek profit, but not as avidly as the medico-economist business individual. At certain times they would call upon insurance for the insured, more government spending in healthcare for the poor, and involve themselves in actions that fit the philosophy they espouse, but that is it.

Then the third class really has no tangible impact on the healthcare cost problem, but you know them as those who work in underserved communities, etc.

300 million people live in America; 31 million people live in Canada. Canada practises subsidized medicine, America does so in a sense but with profit at its general goal. But, as someone said before, America spends the most amount of money on healthcare relative to other countries in the world, however there are lots of uninsured individuals. I simply blame those people I placed in the first class--the economists and business individuals.

To add another point, the constitution still has a problem with the definition of basic human rights. At first it was a right to representative government, but as time unfolds society keeps tinkering with what we MEAN by basic rights. What does Abraham Maslow's hierarchy of needs say? This might help. Again I believe everyone should have access to basic healthcare, but with PREMIUM healthcare, just blame the capitalist nature of society.

RP.
 

Gleevec

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OK, there are way too many illogical posts made on this thread, and I think its DISGUSTING how many people think healthcare is a privilege. I hope you all made your beliefs that health care is a privilege quite clear during your interviews as well.

beastmaster: no, my response is not an "attack" the fact that you view what happens in reality to real people as an "attack" should indicate to you how egregious denying healthcare to people is. Its hilarious how so many people on this thread have their heads stuck in some economics book, yet don't realize that what they're saying boils down to DENYING PEOPLE HEALTHCARE BECAUSE OF THEIR CLASS. That is what is implied by making health care a privilege, and if you support telling people "no, we can't perform that procedure since your income isn't high enough," well, you're the one that is going to have to sleep at night.

g_Eagle: most poor people are paying taxes as well, supporting the hospital system. Unfortunately, simply paying taxes doesn't entitle you to medical care. Furthermore, most procedures cost WAY more than the proportion of taxes paid that people give towards health care. Also, Im not really sure what to make of "What would I do if someone in need came to me for help? That is a situation that I will have to continue to ponder. Would I automatically turn someone away? No. Do I realize that not everyone can get a heart transplant. Yes." I dont know what there is to ponder. If you dont feel an immediate obligation to help someone who is painfully ill until you find out their annual income and insurance status, well, I think we are in completely different worlds then, which would explain why I dont understand your premises at all.

Tas: Your post is founded in very poor logic, much akin to when people say "oh, you want higher taxes to pay for education, health care, etc, well why dont YOU just pay higher taxes and Ill keep my money" The reason that argument is idiotic is because its a tragedy of commons problem. And also, volunteering in a free clinic is really good, and its something I plan on doing, but oftentimes those doctors are limited by the funding at hand.

Exmike: Im really not quite sure what you're smoking here. People dont just ask for bone marrow transplants or invasive surgery because they "feel like it." And lest you forgot, DOCTORS are the ones that make the call on what procedures are the ideal mix of success, cost, and lack of complications. And no, Im not in favor of socialist medicine, I am in favor of universal health insurance for the uninsured though.

Im really surprised, and quite apalled, by a lot of the people on this thread. If you want to turn away some poor guy for having a disease that is expensive to treat, then that's your choice I guess. Though Im surprised a medical school would want someone who STARTS OUT with that attitude. But, I mean, if you can sleep at night declining health care to people just because of how much money they make, well, then none of this really matters.

Im really disgusted by this thread, and I dont want to deal with it anymore. Too many people I thought were different are willing to deny healthcare to people, effectively sentencing them to pain and death indefinitely, without remorse, and frankly, I dont want to learn which other SDNers are willing to do this.

Peace out.
 

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For the last time, it's PRIHVELEHDJGE not privilege. People always forget the silent letters.
 

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Pardon me Gleeve, but what are YOU smoking? You too bigbadaudi.

Gleevec maybe you're socialist agenda is clouding your objectivity.

I'm not saying universal care will drive up demand for outrageous procedures like heart transplants and what not.

Thats just plain ridiculous. Most health economists acknowledge that the demand for invasive (and thus costly) services will NOT increase even if they are universally covered because there is no incentive to use those services! That is NOT at all what I am arguing.

The question lies in more routine treatments. Lets say you have a minor cold. If you had to pay, say, $60 for an office visit, you might decide to let the cold pass rather than fork over the $60. But lets say you have comprehensive coverage and it only costs you a $5 dollar copay, then the decision really isnt about the money, but rather about taking time out to go see the doctor. You see, it is the demand for the more basic services that will ultimately drive up costs if there is universal coverage.

So stop with the examples about transplants and amputations, thats obviously not the point. Who the hell says "oh crap, bone marrow transplants are free. let me go out and get one". Noone. Please stop confusing the issue.

BigBadAudi - There is NO WAY you can compare per capita spending on health care and health outcomes with the US and other countries. The US has a heterogenous patient population that presents a tremendous barrier to the effective delivery of health care that neither japan nor great britan could ever appreciate. The US spends the most on technology and R&D, adding to the costs. There is the reason why we have the best hospitals in the world. It is far to simplistic to compare per capita spending and mortality ratios among countries. Beyond that, the comparison would be cross-sectional and is thus statistically irrelevant!

Gleevec, I dont understand your disbelief in what people are saying. I'm not saying I'm an expert on the field, but I think I'm pretty accurate in my viewpoint after two years in public health school. Nearly all of us that have pursued public health feel strongly about the need for health care coverage for all, but we have to acknowledge that there are tremendous political and social issues that prevent that from becoming reality.

Secondly I'm actually disgusted in how you are judging the character and integrity other posters on this board. I'm talking about coverage from a public health population based persepctive. That has little to do with whether or not I would treat a poor man that came in off the street in dire need of health care. Without a doubt I would, and I believe many others here would as well. You should look into how much of our hospital budgets are appropraited for uncompenstated care for the unisured before you go off saying we're casting the uninsured off on the streets.
I highly recommend everyone participating in this discussion to take a few courses in health care and delivery and health economics before discrediting what others are saying.
 

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Gleevac, I understand your wanting to offer the best health care to everyone on the planet. But the fact is the resources just are not there to do so. All I (and I think most of the privilege crowd) am saying is that certain people are privileged to be able to afford $1000/month perscription bills, and since the government doen't allocate the resources for everyone to get that kind of $ for care, poor people w/o insurance are not privileged to get that. Are you honestly saying that as a physician you will pay for the care of everyone and their brother to get free drugs and treatments out of your own pocket?? I doubt you will! There are definately trade-offs with having a market driven health care system here in the U.S.

There are significant negatives to having socialized health care that you may be overlooking. For example, if we were to provide health care to everyone then we would have to provide health care to illegal immigrants as well. This would mean we'd end up locking down the US/mexico border, more animosity would be directed towards mexican-americans etc. This is just one example. It is much easier for a small ethnically homogenous country to have universal health care than a large diverse country such as our own. This is just one example I'm throwing out for the sake of argument. I'm not particullarly against universal health care, I'm just saying that implementing such a plan would be difficult in the US.

To add to my argument, just by considering the difficulties involved with implementing universal health care, it obviously becomes a privilege. A privilege is something that one has to work towards, such as a drivers or medical license. A right is something that everyone deserves, and when people are not granted a right, it impicitly means that the group in power (i.e. govt) is oppressing the people who don't have that right. No right = oppression. I think our government is working to grant people the best possible health care plan, while respecting the wishes of the public, and that since we--as a country--have decided not to grant universal health care, we have also decided that health care is not a right, but a privilege.

I sincerly wish that everyone could get health care, and when I practice medicine in the future, I plan to do everything in my power to help sick people find the means to get treatment. Whether that be at a free clinic, thru private donor support (i.e. cancer or AIDS treatement funding groups), through loans, or by spending twenty minutes doing a free exam if I can. There are definately going to be people that I can't help for one reason or another, that is unfortunate, but it will probaly be the case. I will do what I can, and I'm sure you will too. Just wait until you start practicing before you judge me or anyone else with this point of view.
 

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Originally posted by Gleevec

Tas: Your post is founded in very poor logic, much akin to when people say "oh, you want higher taxes to pay for education, health care, etc, well why dont YOU just pay higher taxes and Ill keep my money" The reason that argument is idiotic is because its a tragedy of commons problem. And also, volunteering in a free clinic is really good, and its something I plan on doing, but oftentimes those doctors are limited by the funding at hand.


The logic of the commons breaks down when resources decline and/or population grows too large. -http://members.aol.com/trajcom/private/commons.htm

Perhaps I'm reading the wrong thing, I don't see much corollation between tragedy of commons and our discussion unless you are actually secretly supporting my standpoint. Which is, large population, limited resources.

I'm only suggesting that you live your life the way you are trying to force us to live. I'd be far more impressed by your arguement if you did that. There are lots of people just like you that try to force us to live their way, even when they themselves don't live what they are espousing.

You "plan" on volunteering at a free clinic? Why aren't you doing that now? Most clinics I know of would LOVE to have extra volunteers to help, even if you don't have an MD.
 

bigbaubdi

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Originally posted by exmike
The question lies in more routine treatments. Lets say you have a minor cold. If you had to pay, say, $60 for an office visit, you might decide to let the cold pass rather than fork over the $60. But lets say you have comprehensive coverage and it only costs you a $5 dollar copay, then the decision really isnt about the money, but rather about taking time out to go see the doctor. You see, it is the demand for the more basic services that will ultimately drive up costs if there is universal coverage.

You could go to a PCP to get your cold treated, or you could go to an emergency room, which will cost the system way more than the PCP. Or even worse, that cold may actually be a symptom of something worse, which could get much more serious (and expensive to treat).

Originally posted by exmike
So stop with the examples about transplants and amputations, thats obviously not the point. Who the hell says "oh crap, bone marrow transplants are free. let me go out and get one". Noone. Please stop confusing the issue.

The issue here is that many medical treatments do not operate according to conventional economics.

Originally posted by exmike
The US has a heterogenous patient population that presents a tremendous barrier to the effective delivery of health care that neither japan nor great britan could ever appreciate.

Of course, the existence of significant disparities in health outcomes between different groups is itself an indictment of the health care system.

Here are the life expectancy and infant mortality statistics for different groups -

Life Expectancy -

White - 77.7
Black - 72.2

Infant Mortality -
White - 5.7
Black - 14.0

http://www.cdc.gov/nchs/fastats/Default.htm

But that said, even if the US were 100% white, the US would still be ranked 41st in infant mortality and 41st in life expectancy.

Originally posted by exmike
The US spends the most on technology and R&D, adding to the costs. There is the reason why we have the best hospitals in the world.

And the ridiculously high administrative costs of HMOs also contribute quite a bit to the costs of US health care. Compare this with Medicare, which only consumes about 3% of its budget in overhead.
 
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