Is Socialist Medicine Really that bad?

[NHL Fever]

There is also a racial gap, which different people will attribute to different things, but it can be noted that infant mortality amongst caucasian babies in the US is as good as it is anywhere:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5127a1.htm

You link doesn't support your point. It only talks about neonatal outcomes by race in the US, no other countries. You can't say its as good as anywhere unless you're comparing it to anywhere.

Also, 12% of US infants are premature:
http://www.emedicine.com/PED/topic1889.htm

Are you saying that's better or worse than other nations?

I can't find any rates for Canada anywhere, but you could enlighten me if you know. I know that this rate has gone up 30% in the US over the last decade, probably in part due to redefining prematurity vs. stillbirth and the increase in multiple gestations due to IVF and other fertility treatment.

Canada's rate went up with a similar redefinition problem in 1993. Like yourself I've had a hard time coming up with Canadian data. But one of my favorite links is nationmaster.com. Choose health and then you can choose parameters.

Also, according to the WHO: Under-5 mortality in Canada is 6 vs. 8 in the US (VERY MINOR DIFFERENCE). A full 45% can be attributed to prematurity in the US, vs. 38% in Canada.

Whether you consider the difference minor or major is all relative. If a 2 point difference is very minor, then the US has a very minor difference in infant mortality than south korean, lithuania and estonia, which are likewise around 2 points lower than the US. Going the other direction, Canada is only 2 points behind the very best country in the world estimated to be Japan unless you count Hong Kong which is even better. Of course that doesn't account for all the factors we've discussed but the point is that yes all western and some eastern countries are in the general grouping of 'less than 8'. If you want to group and say it doesn't matter then fine, but you're flip-flopping from a minute ago when you posted about the infant mortality in >24 and 500g babies being relevant for comparison. You'll need to decide then if you do, or do not, believe a few points difference is significant. If you do not, then you can't claim any advantages of the US system in any area over other western countries, since they're all relatively close. If you do, then you have to accept that improved rates in non-US countries may mean something as well.

This is a difference of less than one. You can call this "worse" if you want, but it probably makes no real difference in the real world. The main point is that these numbers don't get better by socializing.

But that's not what its about. The argument rarely starts with someone trying to prove Canada is better. It starts when an American makes the claim that for sure those numbers would get way worse by socializing. The evidence suggests they improve, or using your most recent number-grouping perspective, at least stay the same.

And according to Blueprints Pediatrics (Yes, I'm on that clerkship now), Gestational Age Adjusted Infant Mortality is one of the best in the world in the US (how a baby born at a particular gestational age fairs), I can't find statistics comparing rates of gestational age prematurity, probably because they don't exist. I wouldn't hedge an entire healthcare system on a difference in mortality of 0.7.

You're kind of stealing from Peter to pay Paul here. If a baby at a given gestational age fares better in the US, but infant mortality overall is better in Canada even accounting for stillbirth vs mortality discrepancies, then the conclusion must be that more infants are born pre-mature in the states, disproportionately skewing the numbers. If so, that's another condemnation of the US system, would apparently does not optimize the pre-birth status of its pregnant mothers as well as the Canadian system does.

But anyway there are other health indicators that are better in Canada. For example Canada has a higher rate of measles immunization in infants, more acute care beds per capita, more hospital beds overall per capita, lower percentage of life lived with ill health, lower maternal mortality and lower probability of dying before 60. Some of those are stats about health outcomes, some about access to care. What's more important to the person asking the question will determine where they believe the best for health is. If you believe that access to a same-day MRI on an elective basis is important, the US if for you. If you believe your likelihood to have chronic disease or die in childbirth is more important, then statistically Canada is a safer bet.

You can't only look at health care from the point of view of a single individual in a single situation. You have to consider the whole population as the beneficiary of a health system, and how that system's entire program or approach addresses the health needs of its population. Consider that your neighbor's health is your health, because a sick neighbor is going to be a poor neighbor, and thus a neighbor more likely to be unsuccessful and tending to steal or resort to a life of crime. The increasing crime affects your financial status because you need more money for more security, more police etc.

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[methadonian]

My overall point is that there are many many differences with our culture and our government that make these comparisons between us and Canada (or England, Australia, Cuba, whatever) like comparing apples and oranges. Aside from all the other things already mentioned, our tax dollars go to many other things different than Canada. For example, I dont know the exact figures, but I am willing to bet we spend just a little bit more on our military budget than our neighbors up north. My point is you cant just look at salaries up north and cost per patient, etc, and say that it will work down here. It's not a direct comparison. What you have to do is look at our current system and what would realistically happen, given our elected officials, our medicolegal climate, our tax base, our economy, etc, if they tried to socialize medicine. And I am saying it would be a disaster.

Litigation is not untouchable. The fact that the medical legal system is junk can be changed,should not be a reason to simply rule out a universal system.

I wasnt saying it cant be changed, I was saying it WONT. Not until the damage is done. And that is a HUGE difference between here and Canada.

Why would subsidizing med school, or politicians opinions of that, have anything to do with losing doctors?

My point was that doctors will retire earlier with the cut in salaries, as well as the other problems with the system, and fewer and fewer will want to go into the field. Because why go through all these years of struggle and building up massive debt without a financial reward at the end. There has not been ANY talk of subsidizing medical school or changing the medical education system to be like most of the world. And there wont be because that would mean even more tax dollars which would be a tough sell politically.

 

[Miami_med]

By the way, this is actually an interesting debate with someone who actually works with the Canadian Healthcare System.

You link doesn't support your point. It only talks about neonatal outcomes by race in the US, no other countries. You can't say its as good as anywhere unless you're comparing it to anywhere.

As I pointed out, infant mortality in the US is 8. Compare that to the rates within the US in the article above. This puts the US at very good if you happen to be white.

Are you saying that's better or worse than other nations?

Neither, because I can't find the statistic. It's all anecdotal on both of our parts.

Canada's rate went up with a similar redefinition problem in 1993. Like yourself I've had a hard time coming up with Canadian data. But one of my favorite links is nationmaster.com. Choose health and then you can choose parameters.

Same as above. No data. I'll have to keep looking.

Whether you consider the difference minor or major is all relative. If a 2 point difference is very minor, then the US has a very minor difference in infant mortality than south korean, lithuania and estonia, which are likewise around 2 points lower than the US. Going the other direction, Canada is only 2 points behind the very best country in the world estimated to be Japan unless you count Hong Kong which is even better. Of course that doesn't account for all the factors we've discussed but the point is that yes all western and some eastern countries are in the general grouping of 'less than 8'. If you want to group and say it doesn't matter then fine, but you're flip-flopping from a minute ago when you posted about the infant mortality in >24 and 500g babies being relevant for comparison. You'll need to decide then if you do, or do not, believe a few points difference is significant. If you do not, then you can't claim any advantages of the US system in any area over other western countries, since they're all relatively close. If you do, then you have to accept that improved rates in non-US countries may mean something as well.

These differences are not enough to prove anything that a million other factors can't prove. In other words, when you have a mortality of about 140 like Afghanistan, it proves deficient healthcare. When you compare 4-6-8-10, you're really splitting hairs on a public health level. Those differences are too small to attribute to only the healthcare system.

But that's not what its about. The argument rarely starts with someone trying to prove Canada is better. It starts when an American makes the claim that for sure those numbers would get way worse by socializing. The evidence suggests they improve, or using your most recent number-grouping perspective, at least stay the same.

Well, some of us don't think the US would ever do as well as Canada do to a whole host of social issues that are just worse here. I still think that those numbers would get worse. Frankly though, that's not really my reason for not wanting socialized medicine here. I oppose it in the traditional cowboy American libertarian sense of finding redistributing wealth to pay for other people's poor choices as revolting. I just wanted to point out before that the US "deficiencies" as "proven" by these statistics didn't really exist.

You're kind of stealing from Peter to pay Paul here. If a baby at a given gestational age fares better in the US, but infant mortality overall is better in Canada even accounting for stillbirth vs mortality discrepancies, then the conclusion must be that more infants are born pre-mature in the states, disproportionately skewing the numbers. If so, that's another condemnation of the US system, would apparently does not optimize the pre-birth status of its pregnant mothers as well as the Canadian system does.

There are a lot of reasons for higher prematurity rates. I'm sure that this is part of it. That's not all the systems fault. At my hospital, we give free prenatal care to a whole bunch of people who don't show up to appointments and then show up in pre-term labor after an abruption due to a recent crack binge. We essentially have "socialized medicine" in my hospital (no one turned away. Free care to the poor, etc...). I've never seen a better example of why we should not have it. Somewhere between the call to DCF and withdrawl, these women will usually threaten to sue.

But anyway there are other health indicators that are better in Canada. For example Canada has a higher rate of measles immunization in infants, more acute care beds per capita, more hospital beds overall per capita, lower percentage of life lived with ill health, lower maternal mortality and lower probability of dying before 60. Some of those are stats about health outcomes, some about access to care. What's more important to the person asking the question will determine where they believe the best for health is. If you believe that access to a same-day MRI on an elective basis is important, the US if for you. If you believe your likelihood to have chronic disease or die in childbirth is more important, then statistically Canada is a safer bet.

Vaccines are free in the US at many clinics. They cost if you want the convenience of a private physician. I belive that controlling infecion is an actual legitimate role of government. Lower rates of vaccination in the US are a result of people choosing not to go get them, not a lack of access. Increased death before 60 can almost all be attributed to higher rates of violent crime. None of these things would be better in socialized medicine.

You can't only look at health care from the point of view of a single individual in a single situation. You have to consider the whole population as the beneficiary of a health system, and how that system's entire program or approach addresses the health needs of its population. Consider that your neighbor's health is your health, because a sick neighbor is going to be a poor neighbor, and thus a neighbor more likely to be unsuccessful and tending to steal or resort to a life of crime. The increasing crime affects your financial status because you need more money for more security, more police etc.

I do look at healthcare from the point of view of a single individual. That's the type of medicine I practice. When I work with one person, I work with that person. I do not believe in utalitarian philosophy. My sick neighbor is either too sick to rob me or well enough to get a job. He can't be well enough to resort to crime but too sick to work.

Lastly, I think that US healthcare now has many flaws. I just don't think that we fix them by being socialized. All comparisons are to the current system, not the way that atleast I think it should be.

 

[NHL Fever]

Frankly though, that's not really my reason for not wanting socialized medicine here. I oppose it in the traditional cowboy American libertarian sense of finding redistributing wealth to pay for other people's poor choices as revolting. I just wanted to point out before that the US "deficiencies" as "proven" by these statistics didn't really exist.

You are however ok (I think, correct me if I'm wrong) with the wealth redistribution schemes of police and fire services, roads, and military for example. In each, regardless of local realities in this or that place, you are lawfully equally represented or served regardless of financial input or merit.

There are a lot of reasons for higher prematurity rates. I'm sure that this is part of it. That's not all the systems fault. At my hospital, we give free prenatal care to a whole bunch of people who don't show up to appointments and then show up in pre-term labor after an abruption due to a recent crack binge. We essentially have "socialized medicine" in my hospital (no one turned away. Free care to the poor, etc...). I've never seen a better example of why we should not have it. Somewhere between the call to DCF and withdrawl, these women will usually threaten to sue.

The way a society treats its weakest and least capable is definitive of that nation's character. These women's babies have no choice in their mothers actions, they have no way to be guilty of anything. Should they not have a chance to live to their fullest potential. The mother will not get the child, it will be apprehended by child services, but can be put up for adoption, for which there is a huge waiting list. Who will sue is irrelevant, they have to meet certain criteria to sue successfully. No crack head will have enough competence to get a lawyer much less be viewed the legal victor.

Vaccines are free in the US at many clinics. They cost if you want the convenience of a private physician. I belive that controlling infecion is an actual legitimate role of government. Lower rates of vaccination in the US are a result of people choosing not to go get them, not a lack of access.

Its foolish to not vaccinate children. The risk of contracting the illness is far greater than the risk of serious side effects. I think its the governments job to educate people about this, it can fail or succeed. People can also choose to not be vaccinated in Canada, its not mandated. Perhaps the government has been more successful in talking sense into people. I'm excluding the HPV vaccine from that statement since its expensive, rarely covered, and since it has the added dimension of some people believing it makes the recipient less afraid of being promiscuous and thus not immunizing their daughters out of moral objection.

Increased death before 60 can almost all be attributed to higher rates of violent crime. None of these things would be better in socialized medicine.

I do look at healthcare from the point of view of a single individual. That's the type of medicine I practice. When I work with one person, I work with that person. I do not believe in utalitarian philosophy. My sick neighbor is either too sick to rob me or well enough to get a job. He can't be well enough to resort to crime but too sick to work.

If you don't consider the health on the community as something you promote then you are putting your individual patients at disadvantage and increased likehood of poor outcomes. The patient who's been seen for preventative treatment will be a better operative candidate, will be more compliant with the therapy you put them on. Considering the patient from the time they walk into your doors from when they leave is very short-sighted, and massively increases the chance they walk right back through your doors. Public health programs, good affordable public facilitation of physiotherapy, rehab, social work, and home care facilities is critical to your patient's outcome. If you either actually care about the patient, or even only care about the patient's outcome and thus your reputation, you will want to promote community services that supplement your efforts in that way.

What stage are you at in your education or practice?

 

[docB]

You are however ok (I think, correct me if I'm wrong) with the wealth redistribution schemes of police and fire services, roads, and military for example. In each, regardless of local realities in this or that place, you are lawfully equally represented or served regardless of financial input or merit.

There are libertarians who disagree with all forms of government action including fire, police, etc. I accept these socialist institutions because they can not be done by private industry and they already exist and function reasonably well. We started out with private fire companies back in the days of Ben Franklin and it led to many abuses so a socialist system rose up and has been successful. If healthcare could be run as efficiently as the fire service by the government I might accept it. I don't believe they would do anywhere near as well.

The way a society treats its weakest and least capable is definitive of that nation's character. These women's babies have no choice in their mothers actions, they have no way to be guilty of anything. Should they not have a chance to live to their fullest potential. The mother will not get the child, it will be apprehended by child services, but can be put up for adoption, for which there is a huge waiting list. Who will sue is irrelevant, they have to meet certain criteria to sue successfully. No crack head will have enough competence to get a lawyer much less be viewed the legal victor.

Is it a question of character? We provide tons of social services to the poor but many either won't avail themselves of them or are addicted and will not get off the dope.

As for getting sued by a crackhead it happens frequently. They don't have to meet any criteria to sue. If they can get a lawyer to file the suit we have to defend against it. It costs us money and time. If we win the plaintiff loses nothing. If we lose the lawyer and to a lesser extent the plaintiff get a big payday. They often sue just hoping that we'll settle to avoid the hassle. I can assure you that in American medicine the threat of a lawsuit is never "irrelevant."

 

[Miami_med]

You are however ok (I think, correct me if I'm wrong) with the wealth redistribution schemes of police and fire services, roads, and military for example. In each, regardless of local realities in this or that place, you are lawfully equally represented or served regardless of financial input or merit.

I believe that the one legitimate role of a federal government is defense. Police and Military are included. Infectious disease control is also included. Society can't exist without defense. This is not the case regarding whether someone can treat his CHF or diabetes.

The way a society treats its weakest and least capable is definitive of that nation's character. These women's babies have no choice in their mothers actions, they have no way to be guilty of anything. Should they not have a chance to live to their fullest potential. The mother will not get the child, it will be apprehended by child services, but can be put up for adoption, for which there is a huge waiting list. Who will sue is irrelevant, they have to meet certain criteria to sue successfully. No crack head will have enough competence to get a lawyer much less be viewed the legal victor.

I just disagree with the first statement, and it is that fundamental difference that probably underlies our philosophies. If you think that no crackhead will get a lawyer and sue, then you've never practiced in the US. I know a number of physicians that have had this happen. You don't need to lose a case to create a disaster. Most of these kids are not adopted. They bounce between DCF services and their parents.

Its foolish to not vaccinate children. The risk of contracting the illness is far greater than the risk of serious side effects. I think its the governments job to educate people about this, it can fail or succeed. People can also choose to not be vaccinated in Canada, its not mandated. Perhaps the government has been more successful in talking sense into people. I'm excluding the HPV vaccine from that statement since its expensive, rarely covered, and since it has the added dimension of some people believing it makes the recipient less afraid of being promiscuous and thus not immunizing their daughters out of moral objection.

This is probably all true. However, since vaccines are free now, and the people don't use them, it's irrelevant. There is just a different population of people.

If you don't consider the health on the community as something you promote then you are putting your individual patients at disadvantage and increased likehood of poor outcomes. The patient who's been seen for preventative treatment will be a better operative candidate, will be more compliant with the therapy you put them on. Considering the patient from the time they walk into your doors from when they leave is very short-sighted, and massively increases the chance they walk right back through your doors. Public health programs, good affordable public facilitation of physiotherapy, rehab, social work, and home care facilities is critical to your patient's outcome. If you either actually care about the patient, or even only care about the patient's outcome and thus your reputation, you will want to promote community services that supplement your efforts in that way.

Again, these things don't need socialized medicine to exist. We have them all now. We had most of them before Medicare. They don't need to be public or government funded. The fact that something is valuable doesn't mean it must be funded by the government. I can both care about my patient and not believe that widescale wealth redistribution is the best way to help him.

What stage are you at in your education or practice?

I'm a medical student on clinical rotations at a public hospital that generally caters to a poor immigrant population.

Sorry for the hijack everyone.

 

[Hausdaddy24]

All that I have to say is... Private sector>>>>>>>Public sector (= government)

 

[bartleby]

If healthcare could be run as efficiently as the fire service by the government I might accept it.

Healthcare run by the government (3% administrative cost in Medicare) is actually more efficient than that funded by private insurance (15-20% administrative cost). The way doctors and hospitals are compensated (by doing stuff rather than by obtaining results and providing evidence-based care) is equally wrong-headed in our system regardless of the payor.

People being able to sue for bad outcomes not related to faulty or negligent care is a wholly separate issue. The medical malpractice lottery is a problem which requires a fundamental re-thinking of how people who are harmed by the healthcare system are compensated. This doesn't involve a unskilled jury and (or judge) who don't have any understanding of the basics of medicine or healthcare and thus make decisions based on which heart strings get pulled by the lawyers. This reform is something that is not going to happen anytime soon (it's not just "the damned liberals"...didn't happen when the Republicans controlled both Congress and the White House).

So if all things "socialistic" are bad, we shouldn't have insurance at all, private or otherwise. This is just another parasitic method of wealth transfer (the healthy/strong financing the care of the weak/ill). Why not just go back to straight fee-for-service? Pay in cash or hit the road!

I don't have all the answers to these problems. Nobody does. I do know that i went into medicine to do the best by as many people as possible with the resources I have at my disposal. Not to ensure the bottom line of insurance company profits or the right of our colleagues who choose to be businessmen first and physicians second.

 

[docB]

So if all things "socialistic" are bad, we shouldn't have insurance at all, private or otherwise. This is just another parasitic method of wealth transfer (the healthy/strong financing the care of the weak/ill). Why not just go back to straight fee-for-service? Pay in cash or hit the road!

Not true. Insureance as a concept is OK. The idea is that if you are willing to pay to limit your risk you can. Then the cost of the insurance depends on the risk characteristics of the group who has volunteered to pay for the coverage. It becomes socialist when the government requires you to have insurance. Then the risk pool is everyone. At that point there's no difference between a having private insurers getting paid by the people who are mandated to buy the insurance and just taxing everyone and having the government run the system or contract it out. To be insurance it needs to be exclusive by definition.

 

[bartleby]

The premise of insurance being non-mandatory is false because healthcare costs have been rising at many multiples of inflation and real wage increases for so long that it is no longer realistic to pay your own medical unless you're Bill Gates. Hence the joke about the chart label "self pay" really meaning "no pay". Having 20-50% of your patient care being non-reimbursible disproportionately increases the cost to those with medicare/insurance.

Plumbers are not motivated by an intrinsic professional or legal motivation to plumb for you. If you don't pay your bill, you're going to have to use duct tape and chewing gum on the next leaky pipe. Or if you're lucky, perhaps you'll never need a plumber. In the world of healthcare, everybody's pipes leak at some point.

 

[docB]

The premise of insurance being non-mandatory is false because healthcare costs have been rising at many multiples of inflation and real wage increases for so long that it is no longer realistic to pay your own medical unless you're Bill Gates. Hence the joke about the chart label "self pay" really meaning "no pay". Having 20-50% of your patient care being non-reimbursible disproportionately increases the cost to those with medicare/insurance.

Plumbers are not motivated by an intrinsic professional or legal motivation to plumb for you. If you don't pay your bill, you're going to have to use duct tape and chewing gum on the next leaky pipe. Or if you're lucky, perhaps you'll never need a plumber. In the world of healthcare, everybody's pipes leak at some point.

I agree. But my preferred solution would be to get the govt. out of the health insurance biz altogether rather than continuing in this situation where self pay does = no pay.

 

[bartleby]

I don't see how any reform to system is going to come from anywhere but the government. I believe in free speech, free markets, (and free love) but there is too much incentive to keep things the way they are for individuals and corporations who are still having a good time of it at the trough.

See the recent example of the company that manages all these dialysis centers (http://www.nytimes.com/2007/09/16/business/16dial.html?_r=1&oref=slogin) where patients magically wind up getting a high profit off but potentially harmful drug called Epogen (a synthetic erytropoietic to replace a hormone not made by the kidneys in end-stage renal disease) at a rate way above the average. They're taking the fight to the lobbyists to avoid changing their ways despite the increasing evidence that their care is substandard in regard to their use of this drug.

Companies are supposed to make profits. If you need wickets made, I believe that the free market will find the most elegant way to do it. But if you need to provide something for the entire population in a standards-based fashion where the most profitable means are not always the best way to do things when lives are at stake, there needs to be another way.

 

[8744]

...Healthcare run by the government (3% administrative cost in Medicare) is actually more efficient than that funded by private insurance (15-20% administrative cost)....

Whoa. The adminstrative cost of medicare is thrust upon the physician in the form of paperwork and other bureacratic exercises. THere is no way to accurately determine administrative costs because physicians do not report the opportunity cost of compliance.

 

[ForbiddenComma]

In my area, HCA recently closed down two community hospitals in order to consolidate operations into one shiny new hospital that looks more like an upscale shopping mall.

Now 'consolidation' is taught in Chapter 1 of any MBA text, so I'm sure it makes good sense financially. But in reality, a bunch of people living in the boonies at the edge of town just lost their hospital, and now have to drive at least half an hour to get to the nearest one. With that kind of ambulence time... hope they don't have an acute coronary event in their trailer home anytime soon.

It's just one more example of what happens when the greedheads are calling the shots in healthcare. As we get more and more for-profit hospital chains, predatory pricing, direct-to-consumer pharm marketing, shocking claim denials, ever-stricter protocols dictating what the doctor can and cannot do... the dam will burst, the politicians will cave, and we'll have socialized medical care.

Of course, the only difference with socialized medical care is that instead of a corporate weasel denying your claim, you get a monotonous bureaucrat denying your claim. You're still paying out the wazoo (increased payroll deductions to Medicare instead of your company healthcare plan, same difference), doctors are still shackled by rules made by non-doctors, ERs are still overflowing with people using them as their primary care clinic... and predators like Big Pharma are still running amok because just like with Part D, you just know that Pfizer's lobbyists will ensure them a continued place at the trough.

So either way, we're screwed. Hooray!

Medicine wasn't a paradise before managed care took over... but it's hard not to wish for the "good ol' days."

 

[Jeff698]

Whoa. The adminstrative cost of medicare is thrust upon the physician in the form of paperwork and other bureacratic exercises. THere is no way to accurately determine administrative costs because physicians do not report the opportunity cost of compliance.

Howdy Panda,

Let's not kid ourselves into thinking that private insurance companies don't thrust paperwork expenses onto physicians as well.

In fact, based on the large number of different insurance companies, all with their own forms, contracts and ridiculous reasons to deny claims, I'd argue that the paperwork expenses from all private firms combined way exceed that from Medicare. And, at the end of the day, overhead is still less with Medicare than with for profits even with the increased cost shifting the privates do.

Take care,
Jeff

 

[Seaglass]

I agree. But my preferred solution would be to get the govt. out of the health insurance biz altogether rather than continuing in this situation where self pay does = no pay.

I don't see how you can have it both ways.

 

[Seaglass]

Whoa. The adminstrative cost of medicare is thrust upon the physician in the form of paperwork and other bureacratic exercises. THere is no way to accurately determine administrative costs because physicians do not report the opportunity cost of compliance.

As most insurance tie their requirements to medicare so in reality the compliance costs are the same. I know I never see the costs related to billing.

 

[docB]

I don't see how you can have it both ways.

Have what both ways?

 

[Seaglass]

You cannot have gov't out of the picture AND get rid of the self pay = no pay. Unless we can just stop seeing the uninsured.

 

[docB]

You cannot have gov't out of the picture AND get rid of the self pay = no pay. Unless we can just stop seeing the uninsured.

If we got the govt. out of the picture and changed the model back to a consumer driven fee for service system health care would be more affordable. You'd have to get med mal under control. If people could decide how much they really want to stay and pay for a chest pain rule out we'd save a ton.

I like the HSA/catastrophic insurance idea where people pay for their care unless they incur some really huge bill (like a CABG).

 

[Miami_med]

If we got the govt. out of the picture and changed the model back to a consumer driven fee for service system health care would be more affordable. You'd have to get med mal under control. If people could decide how much they really want to stay and pay for a chest pain rule out we'd save a ton.

I like the HSA/catastrophic insurance idea where people pay for their care unless they incur some really huge bill (like a CABG).

I always thought that this was a good idea too, with an attached caveat that forced individuals to obtain some minimal amount of preventative care (basic screenings, vaccines, and such) on their own dime to keep the insurance and not destroy the risk pool with uncontrolled illness.

 

[GeneralVeers]

I always thought that this was a good idea too, with an attached caveat that forced individuals to obtain some minimal amount of preventative care (basic screenings, vaccines, and such) on their own dime to keep the insurance and not destroy the risk pool with uncontrolled illness.

Any system that forces people to take responsibility for their own health will ultimately fail, as it would be unpopular with both the public and the politicians. Hence the move towards comprehensive, government-sponsored health insurance, with no obligations or conditions placed on the beneficiaries. We don't kick people out of Medicare because they refuse to be compliant with their meds, or lose weight. Likewise getting people to show up for screenings or to get vaccines as a condition of insurance would also not be possible.

 

[RxnMan]

I always thought that this was a good idea too, with an attached caveat that forced individuals to obtain some minimal amount of preventative care (basic screenings, vaccines, and such) on their own dime to keep the insurance and not destroy the risk pool with uncontrolled illness.

Any system that forces people to take responsibility for their own health will ultimately fail, as it would be unpopular with both the public and the politicians. Hence the move towards comprehensive, government-sponsored health insurance, with no obligations or conditions placed on the beneficiaries. We don't kick people out of Medicare because they refuse to be compliant with their meds, or lose weight. Likewise getting people to show up for screenings or to get vaccines as a condition of insurance would also not be possible.

I don't know how you could enforce people seeing preventative care. Edwards is proposing something similar in his universal care plan. If you went to a fee-for-service model, when faced with the cost of poor body habits, market forces would make preventative care attractive.

 

[deleted77919]

But once you factor the insurance costs, which are indeed a fraction in Canada of the US costs, who knows where the net salaries are most lucrative?

The first link wouldn't work for me, so I couldn't check out the data you presented. What I can say is most physician salary surveys and data in the US are reported after all overhead including malpractice insurance, but before tax. Therefore malpractice insurance has already been accounted for.