Is universal healthcare inevitable?

[Miami_med]

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we do ration based on finance. Coming through the ER, is hardly even close to the same concept as getting comprehensive care. For example. If you have a 45 year old male come through the ED with painless hematochezia, he doesn't get a colonoscopy in the ED. He gets his hgb checked, and a referral is made. Problem is, if his finanical credentials, ie: insurance isn't adequate, he won't get the test. This happens daily across this country. To try and equate ED care with the best possible care, is not only disingenuous, it is flat out misleading. But thanks for parroting the Sean Hannity talking points.

I can honestly say to this day that I have watched Sean Hannity exactly once, and it was because I was visiting a colleague who was a fan. I personally don't care much for political talk TV. I have no idea what you are talking about with regards to not being able to get a colonoscopy. Maybe that's how it is at Mayo, but I can tell you that we give colonoscopies to people who can't afford them down here at Jackson Memorial Hospital all the time. The way we do it is stupid, because you end up going through the ED to get access to these things (thus the barriers to which I previously alluded). Perhaps the issue to which you are referring is that Mayo doesn't want to treat these patients charitably. I understand that perfectly, but it is certainly not an example of the way any other place works.

I agree with you on some potential constitutional problems, which is why I would like to see an amendment to clarify things permanently.

Speaking of rights. Isn't it strange that a man who is arrested for a crime, will get a lawyer appointed to him FREE of charge if needed, as a right.

The difference here, is that being tried for a crime is essentially the government actively attempting to remove your freedom, and the lawyer for the defendant is really there more to make sure that the legal system works to prevent false convictions. In other words, you only get a lawyer when the system goes after you. The government doesn't give you a lawyer for any other reason, including seeking redress for wrongs.

Yet, a man who becomes ill, and is trapped between making too much money to qualify for any government assistance, and too poor to pay for insurance with his now defined illness, and has no money, will get no care.

I personally find that odd.

Societies are judged by how they treat their sickest and oldest. I believe this to my core.

This doesn't address the fundamental issue at all. Your reference to the dysfunction of the current system has nothing to do with whether a federal takeover of the medical system would be good. We both already agreed that the current system is ridiculous.

Your last statement there is one with which I agree on some levels, but I disagree with it as a premise for the point you are trying to make. It's sort of like when many of our European friends turn up their noses at the US for the lack of "international aid." Our government may or may not be giving less money, but the individual gifts from individual Americans usually supercede all personal giving from the rest of the world combined in virtually every crisis. The government is not a substitute for you deciding to be a good person. We are not a better society because we give a bunch of power mongers in Washington a bunch of power to give things to poor people. This is at best, a reflection on a lazy citizenry that would rather turn all of those poor unfortunate souls over to someone else. It's cheering about how good we are while simultaneously giving the problem away. In my personal life, I have participated greatly in charitable giving, and it has nothing to do with who made what law. The government only has the power to make people do things with force. It is not a benevolent being. The whole system would only work because the government would jail people who failed to pay into whatever system they concocted. That's not benevolence. How great a society are we when we threaten force and jail against anyone who doesn't want to meet our definition of charity du jour? That's government healthcare.

As far as the VAT tax, I'm not inherently crazy about the value added portion, as I learned in all my econ classes eons ago, that they were structurally not great for some of the reasons you alluded too. To be honest, I would rather see a flat consumption tax.

That would be a more visible (and yet equally damaging) tax. It doesn't solve the underlying problem. Higher taxes impair the ability of business to compete. It drives up the price of goods. It makes the average family unable to afford as much. This in turn reduces demand, which reduces demand for workers. A giant new tax on consumption would be a really good way to continue the recession longer.

AS pertains to your federalist argument, there are certain duties that are, and need to be the purvey of the federal government.

Yes, and they are clearly enumerated in the US constitution.

We have the FDA, to ensure that all of our food, and medication supply is hopefully safe, and while they make errors from time to time. Could you really imagine every state having their own laws and rules?

We have the EPA, for many of the same reasons.

I have no problems with states getting together and agreeing to a uniform code. I do have a problem with making enforcement federal unless it crosses state lines. When it crosses state lines, it falls under the purview of regulating interstate trade, which is an enumerated right of the federal government in the US constitution.

We have National Defense, really the FIRST national organization, present even before the ratification.

This is also an enumerated right of the federal government in the consitution.

Personally, I would argue, that the government not only has a duty to protect our citizens from external invaders, but it has an equal duty to protect it's citizens when possible from illness.

You don't have to agree, I know you won't.

Why does it have the duty to protect citizens from illness? The only really valid argument for why we have governments is to protect the citizenry from external threats, and perhaps to deal with issues that impact the population as a whole. This doesn't mean every crisis that is a combination of individual bad luck or bad choices.

Is there a reason to have a CDC and prevent epidemic disease? Yes. Infectious disease is a problem that affects all people, and the spread of an epidemic impacts the entire citizenry personally. I can walk down the street and be infected by someone else through no fault of my own, so the spread must be stopped. On the flip side, if I get cancer, it's terrible, but it is certainly not a national threat. I am not contagious. If I eat too many steaks and smoke too many cigarettes and have a heart attack, it sucks, but it isn't a national threat. The provision of a road is a common good, because everyone uses the same road. The same is not true for healthcare, where treatment is not in-common.

It goes down to the core of political theory (which is really what most of us end up disagreeing on) and how you perceive the government. I view the government as the least of all evils. A power vacuum is bad. A tyranny is also bad. In a sense, we give individuals some priveledge to oversee certain common necessities and common defense. They are certainly not the solution to all social ills. Is there any real reason to believe that a motley crew of people who spend every 2-6 years winning popularity contests by promising things to people with other people's money are the most qualified to solve social problems? If you were looking at it objectively, would any of the people involved in the final healthcare decision making even be at the table if you were trying to come up with the most qualified to make these types of decisions?

 

[Miami_med]

we do ration based on finance. Coming through the ER, is hardly even close to the same concept as getting comprehensive care. For example. If you have a 45 year old male come through the ED with painless hematochezia, he doesn't get a colonoscopy in the ED. He gets his hgb checked, and a referral is made. Problem is, if his finanical credentials, ie: insurance isn't adequate, he won't get the test. This happens daily across this country. To try and equate ED care with the best possible care, is not only disingenuous, it is flat out misleading. But thanks for parroting the Sean Hannity talking points.

I can honestly say to this day that I have watched Sean Hannity exactly once, and it was because I was visiting a colleague who was a fan. I personally don't care much for political talk TV. I have no idea what you are talking about with regards to not being able to get a colonoscopy. Maybe that's how it is at Mayo, but I can tell you that we give colonoscopies to people who can't afford them down here at Jackson Memorial Hospital all the time. The way we do it is stupid, because you end up going through the ED to get access to these things (thus the barriers to which I previously alluded). Perhaps the issue to which you are referring is that Mayo doesn't want to treat these patients charitably. I understand that perfectly, but it is certainly not an example of the way any other place works.

I agree with you on some potential constitutional problems, which is why I would like to see an amendment to clarify things permanently.

Speaking of rights. Isn't it strange that a man who is arrested for a crime, will get a lawyer appointed to him FREE of charge if needed, as a right.

The difference here, is that being tried for a crime is essentially the government actively attempting to remove your freedom, and the lawyer for the defendant is really there more to make sure that the legal system works to prevent false convictions. In other words, you only get a lawyer when the system goes after you. The government doesn't give you a lawyer for any other reason, including seeking redress for wrongs.

Yet, a man who becomes ill, and is trapped between making too much money to qualify for any government assistance, and too poor to pay for insurance with his now defined illness, and has no money, will get no care.

I personally find that odd.

Societies are judged by how they treat their sickest and oldest. I believe this to my core.

This doesn't address the fundamental issue at all. Your reference to the dysfunction of the current system has nothing to do with whether a federal takeover of the medical system would be good. We both already agreed that the current system is ridiculous.

Your last statement there is one with which I agree on some levels, but I disagree with it as a premise for the point you are trying to make. It's sort of like when many of our European friends turn up their noses at the US for the lack of "international aid." Our government may or may not be giving less money, but the individual gifts from individual Americans usually supercede all personal giving from the rest of the world combined in virtually every crisis. The government is not a substitute for you deciding to be a good person. We are not a better society because we give a bunch of power mongers in Washington a bunch of power to give things to poor people. This is at best, a reflection on a lazy citizenry that would rather turn all of those poor unfortunate souls over to someone else. It's cheering about how good we are while simultaneously giving the problem away. In my personal life, I have participated greatly in charitable giving, and it has nothing to do with who made what law. The government only has the power to make people do things with force. It is not a benevolent being. The whole system would only work because the government would jail people who failed to pay into whatever system they concocted. That's not benevolence. How great a society are we when we threaten force and jail against anyone who doesn't want to meet our definition of charity du jour? That's government healthcare.

As far as the VAT tax, I'm not inherently crazy about the value added portion, as I learned in all my econ classes eons ago, that they were structurally not great for some of the reasons you alluded too. To be honest, I would rather see a flat consumption tax.

That would be a more visible (and yet equally damaging) tax. It doesn't solve the underlying problem. Higher taxes impair the ability of business to compete. It drives up the price of goods. It makes the average family unable to afford as much. This in turn reduces demand, which reduces demand for workers. A giant new tax on consumption would be a really good way to continue the recession longer.

AS pertains to your federalist argument, there are certain duties that are, and need to be the purvey of the federal government.

Yes, and they are clearly enumerated in the US constitution.

We have the FDA, to ensure that all of our food, and medication supply is hopefully safe, and while they make errors from time to time. Could you really imagine every state having their own laws and rules?

We have the EPA, for many of the same reasons.

I have no problems with states getting together and agreeing to a uniform code. I do have a problem with making enforcement federal unless it crosses state lines. When it crosses state lines, it falls under the purview of regulating interstate trade, which is an enumerated right of the federal government in the US constitution.

We have National Defense, really the FIRST national organization, present even before the ratification.

This is also an enumerated right of the federal government in the consitution.

Personally, I would argue, that the government not only has a duty to protect our citizens from external invaders, but it has an equal duty to protect it's citizens when possible from illness.

You don't have to agree, I know you won't.

Why does it have the duty to protect citizens from illness? The only really valid argument for why we have governments is to protect the citizenry from external threats, and perhaps to deal with issues that impact the population as a whole. This doesn't mean every crisis that is a combination of individual bad luck or bad choices.

Is there a reason to have a CDC and prevent epidemic disease? Yes. Infectious disease is a problem that affects all people, and the spread of an epidemic impacts the entire citizenry personally. I can walk down the street and be infected by someone else through no fault of my own, so the spread must be stopped. On the flip side, if I get cancer, it's terrible, but it is certainly not a national threat. I am not contagious. If I eat too many steaks and smoke too many cigarettes and have a heart attack, it sucks, but it isn't a national threat. The provision of a road is a common good, because everyone uses the same road. The same is not true for healthcare, where treatment is not in-common.

It goes down to the core of political theory (which is really what most of us end up disagreeing on) and how you perceive the government. I view the government as the least of all evils. A power vacuum is bad. A tyranny is also bad. In a sense, we give individuals some priveledge to oversee certain common necessities and common defense. They are certainly not the solution to all social ills. Is there any real reason to believe that a motley crew of people who spend every 2-6 years winning popularity contests by promising things to people with other people's money are the most qualified to solve social problems? If you were looking at it objectively, would any of the people involved in the final healthcare decision making even be at the table if you were trying to come up with the most qualified to make these types of decisions?

 

[physasst]

I can honestly say to this day that I have watched Sean Hannity exactly once, and it was because I was visiting a colleague who was a fan. I personally don't care much for political talk TV. I have no idea what you are talking about with regards to not being able to get a colonoscopy. Maybe that's how it is at Mayo, but I can tell you that we give colonoscopies to people who can't afford them down here at Jackson Memorial Hospital all the time. The way we do it is stupid, because you end up going through the ED to get access to these things (thus the barriers to which I previously alluded). Perhaps the issue to which you are referring is that Mayo doesn't want to treat these patients charitably. I understand that perfectly, but it is certainly not an example of the way any other place works.


The difference here, is that being tried for a crime is essentially the government actively attempting to remove your freedom, and the lawyer for the defendant is really there more to make sure that the legal system works to prevent false convictions. In other words, you only get a lawyer when the system goes after you. The government doesn't give you a lawyer for any other reason, including seeking redress for wrongs.


This doesn't address the fundamental issue at all. Your reference to the dysfunction of the current system has nothing to do with whether a federal takeover of the medical system would be good. We both already agreed that the current system is ridiculous.

Your last statement there is one with which I agree on some levels, but I disagree with it as a premise for the point you are trying to make. It's sort of like when many of our European friends turn up their noses at the US for the lack of "international aid." Our government may or may not be giving less money, but the individual gifts from individual Americans usually supercede all personal giving from the rest of the world combined in virtually every crisis. The government is not a substitute for you deciding to be a good person. We are not a better society because we give a bunch of power mongers in Washington a bunch of power to give things to poor people. This is at best, a reflection on a lazy citizenry that would rather turn all of those poor unfortunate souls over to someone else. It's cheering about how good we are while simultaneously giving the problem away. In my personal life, I have participated greatly in charitable giving, and it has nothing to do with who made what law. The government only has the power to make people do things with force. It is not a benevolent being. The whole system would only work because the government would jail people who failed to pay into whatever system they concocted. That's not benevolence. How great a society are we when we threaten force and jail against anyone who doesn't want to meet our definition of charity du jour? That's government healthcare.


That would be a more visible (and yet equally damaging) tax. It doesn't solve the underlying problem. Higher taxes impair the ability of business to compete. It drives up the price of goods. It makes the average family unable to afford as much. This in turn reduces demand, which reduces demand for workers. A giant new tax on consumption would be a really good way to continue the recession longer.


Yes, and they are clearly enumerated in the US constitution.


I have no problems with states getting together and agreeing to a uniform code. I do have a problem with making enforcement federal unless it crosses state lines. When it crosses state lines, it falls under the purview of regulating interstate trade, which is an enumerated right of the federal government in the US constitution.

This is also an enumerated right of the federal government in the consitution.


Why does it have the duty to protect citizens from illness? The only really valid argument for why we have governments is to protect the citizenry from external threats, and perhaps to deal with issues that impact the population as a whole. This doesn't mean every crisis that is a combination of individual bad luck or bad choices.

Is there a reason to have a CDC and prevent epidemic disease? Yes. Infectious disease is a problem that affects all people, and the spread of an epidemic impacts the entire citizenry personally. I can walk down the street and be infected by someone else through no fault of my own, so the spread must be stopped. On the flip side, if I get cancer, it's terrible, but it is certainly not a national threat. I am not contagious. If I eat too many steaks and smoke too many cigarettes and have a heart attack, it sucks, but it isn't a national threat. The provision of a road is a common good, because everyone uses the same road. The same is not true for healthcare, where treatment is not in-common.

It goes down to the core of political theory (which is really what most of us end up disagreeing on) and how you perceive the government. I view the government as the least of all evils. A power vacuum is bad. A tyranny is also bad. In a sense, we give individuals some priveledge to oversee certain common necessities and common defense. They are certainly not the solution to all social ills. Is there any real reason to believe that a motley crew of people who spend every 2-6 years winning popularity contests by promising things to people with other people's money are the most qualified to solve social problems? If you were looking at it objectively, would any of the people involved in the final healthcare decision making even be at the table if you were trying to come up with the most qualified to make these types of decisions?

Not likely, and I have no love for the government, and having spent too much time visiting with congressional types, I have no faith in them to ever do the right thing.

Which is why I support the Fuchs/Emanuel plan. It is governed by a separate US health board, which is not under congressional control, and is administered by private plans with the infrastructure already in place.

As far as taxes, yes it is an increase, but not as much as you might think. Although his proposal calls for a 10% VAT national sales tax, it also calls for the elimination of the Medicare tax, because Medicare is no longer necessary. NOW, seniors will be contributing any time they purchase something. Your state income tax should fall, although it is difficult to say by how much, as Medicaid and SCHIP are not only funded by the states, but also by the fed. Your paycheck should also increase, as IF your employer is providing health benefits, than they will no longer need to do so, and therefore your pay should increase, again difficult to say by how much, as each company has different cost structures and financial matrixes.

I believe that the federal government has a reponsibility beyond infectious disease concerns.

The NIH is concerned with research and many other things, and yet they are funded by the fed.

 

[GeraldMonroe]

Like uh, THE UNITED STATES (PRE-MEDICARE.) Ask your parents what they thought of the healthcare system back then, compared to now.

Rose colored glasses. No one does it this way now for a reason.
I could write a wall of text like the massive brick walls above this post explaining why we can't go back to that golden era, but I'm an M0, so I know nothing, by definition. However, out of 25 countries in the world that you might voluntarily live in, precisely 0 of them do it that way. That's a far more damning indictment against 'let the poor die but for charity' than any argument I could cook up.

 

[dragonfly99]

physassist,
I've never been impressed with either these "managed competition" and/or "let's govern medical spending and health care resource allocation by a national board" type of health care reform plans. I just don't think there is any evidence this would work better than our current (albeit imperfect) system. I think if you are going to have another national tax (the VAT) and use it to fund health care, then just be honest and make it a completely socialized, single payer thing. It will be like the VA, where I often moonlight. It will not be as good as the care that many people get at the better private hospitals today, but it will be better than no care. There will be rationing according to cost of treatments, just like there is at the VA and other gov't run health care entities today. There will be longer wait times for procedures, surgeries, etc. and some health care providers will not work as hard as others (since some people need money, and/or the threat of being fired/losing a job to work hard).

Personally, for now I would just reimburse primary care docs a bit better (at the expense of some of the higher paid specialists if need be, even though I'm about to be one!), try to strip away some of the unnecessary and time consuming gov't regulations and insurance company paperwork, stop trying to mandate insurance companies to cover treatments like IVF that are not really necessary to life, and try to institute some sort of liability reform (not just medical liability reform, but throughout society). We need to have a good safety net in place in every state for the working poor, so that they can get access to affordable insurance for catastrophic care. However, I disagree with your premise that charity care and/or discounted care won't work for most outpatient problems. I am an IM doc, and I volunteer to work for free several times/month at a sliding scale clinic, and we actually could see even more patients than we do. There are also federally funded CHC's and there is a free clinic run my medical students, residents and faculty of the major U. teaching hospital nearby. There is access to primary care, at least in our community, for those who want it and realize how to access it.

By the way, I voted for Obama and I'm basically a Democrat. I just think that we as a community of health care providers are not being honest about what has to happen with health care. You can't give people everything they want, in terms of health care, and have it be cheap or free. We have rationing now, and we'll have rationing if/when we have socialized medicine. I haven't seen any data that convinces me that a socialized medicine "cure" won't be worse than the "disease" of escalating costs that we have now. Socialized medicine might cost even MORE money...

 

[Miami_med]

Rose colored glasses. No one does it this way now for a reason.
I could write a wall of text like the massive brick walls above this post explaining why we can't go back to that golden era, but I'm an M0, so I know nothing, by definition. However, out of 25 countries in the world that you might voluntarily live in, precisely 0 of them do it that way. That's a far more damning indictment against 'let the poor die but for charity' than any argument I could cook up.

Why does how other people do things have to factor into how we do them at all? Didn't your mom ever give you that whole speach about if all of your friends jumped off a bridge, would you do it too?😉 We act as though the whole world is some sort of healthcare panacea outside of the US. We spend more on healthcare, but we are by no means alone in being driven to bankruptcy by rising healthcare costs. If you want to make the mob rule argument, you might want to look at the fact that every other nation on earth is currently moving back towards market incentives and privatization in their health systems. We are the ONLY country in which healthcare is moving more left.

It would also be hard to take your explanation of how we can't go back seriously at this point because as you've pointed out, you haven't yet attended medical school and don't understand the modern system well enough to make a comparison.

 

[GeraldMonroe]

Why does how other people do things have to factor into how we do them at all? Didn't your mom ever give you that whole speach about if all of your friends jumped off a bridge, would you do it too?😉 We act as though the whole world is some sort of healthcare panacea outside of the US. We spend more on healthcare, but we are by no means alone in being driven to bankruptcy by rising healthcare costs. If you want to make the mob rule argument, you might want to look at the fact that every other nation on earth is currently moving back towards market incentives and privatization in their health systems. We are the ONLY country in which healthcare is moving more left.

It would also be hard to take your explanation of how we can't go back seriously at this point because as you've pointed out, you haven't yet attended medical school and don't understand the modern system well enough to make a comparison.

1. Reality : the majority of American voters have put democrats in charge. The chance of this country going to a system considerably more conservative than it is today is 0.0%. So, whether your ideas would work or not is irrelevant : the government is going to be heavily involved in paying for healthcare (like it already is) for the rest of our lifetimes.

2. I'm attending a Master's program at a medical school right now due to crappy undergrad grades that I thought would prevent me from being accepted. So I've seen firsthand what is taught : and about 0.1% of the material covers how healthcare is actually financed and run behind the scenes. Thus, I'd believe an economist who has studied the medical system as a whole over a physician who's only seen the front end of it. Perhaps you know a faculty, degreed economist who is supporting what you're proposing?
Or are you going to tell me that academics (such as medical school professors who taught you half what you know) don't know what they are talking about, as a rule.

 

[Miami_med]

Not likely, and I have no love for the government, and having spent too much time visiting with congressional types, I have no faith in them to ever do the right thing.

Which is why I support the Fuchs/Emanuel plan. It is governed by a separate US health board, which is not under congressional control, and is administered by private plans with the infrastructure already in place.

Is this the same infrastructure that is being used to run the train wreck we have now? Who selects who is on the board? Why is the person selected going to do a good job? Why is the person selected more qualified to make decisions for individual patients better than the physicians who know those patients? These magic boards a diversion. It's sort of like the Fed. It may be "not under federal control," but it generally ends up being run by *****s (or those with alternative motives), and we all know that the moment they stray from the policy espoused by the party in power, their own control is on the chopping block.

As far as taxes, yes it is an increase, but not as much as you might think. Although his proposal calls for a 10% VAT national sales tax, it also calls for the elimination of the Medicare tax, because Medicare is no longer necessary. NOW, seniors will be contributing any time they purchase something. Your state income tax should fall, although it is difficult to say by how much, as Medicaid and SCHIP are not only funded by the states, but also by the fed. Your paycheck should also increase, as IF your employer is providing health benefits, than they will no longer need to do so, and therefore your pay should increase, again difficult to say by how much, as each company has different cost structures and financial matrixes.

My local government won't cut taxes. They will say they need the money, and we will all pay more. We will end up with consumption taxes at both the state and federal level, which will both continue to rise into perpetuity. My personal paycheck won't rise, because the cost of attempting to comply with the rising prices imposed by the VAT won't free up any more money. If anything, the ~2% of salary impacted by current Medicare tax would pale in comparison to a 10% VAT.

I believe that the federal government has a reponsibility beyond infectious disease concerns.

The NIH is concerned with research and many other things, and yet they are funded by the fed.

Yeah, I guess we'll just pretty much have to disagree on this.

 

[Miami_med]

1. Reality : the majority of American voters have put democrats in charge. The chance of this country going to a system considerably more conservative than it is today is 0.0%. So, whether your ideas would work or not is irrelevant : the government is going to be heavily involved in paying for healthcare (like it already is) for the rest of our lifetimes.

Since I was discussing what I thought should happen, this entire statement is irrelevant. I agree that it is likely that the government will become more heavily involved. The degree of concern amongst many of those who are actually involved in the healthcare system now might lead you to think that this could be a problem, though we've already pointed out that this in and of itself doesn't make or break the idea.

2. I'm attending a Master's program at a medical school right now due to crappy undergrad grades that I thought would prevent me from being accepted. So I've seen firsthand what is taught : and about 0.1% of the material covers how healthcare is actually financed and run behind the scenes. Thus, I'd believe an economist who has studied the medical system as a whole over a physician who's only seen the front end of it. Perhaps you know a faculty, degreed economist who is supporting what you're proposing?
Or are you going to tell me that academics (such as medical school professors who taught you half what you know) don't know what they are talking about, as a rule.

I learned nothing valuable about healthcare financing in my first two years of medical school. I learned little about healthcare financing in medical school at all. I learned a heck of a lot about the healthcare system in my 3rd and 4th years of medical school. I am not a degreed economist, though if you want to read a number of papers on this very subject from my perspective from those who are, you can search for healthcare articles over at this website:

http://www.mises.org

It is a home base for a free market think tank that subscribes to the ideas of classical liberal economic thinking.

If you need further proof that there are plenty of people in mainstream acadamia that have beliefs in that direction, you could probably get tickets to this conference:

http://www.cato.org/events/healthcarereform/

This is sponsored by Cato, which is primarily a libertarian think tank. They have speakers from Harvard, Stanford, The Whorton School of Business at Penn, and others.

As far as proof, I'm not sure what you would want. I could construct a fictional economic model that isn't as good as the paper that it's written on. I could also point you to the successes of the free market in providing virtually every other service to which you are privy today better than the government is doing with their portion of the healthcare system.

I don't believe that academic physicians are as a rule anything. They are generally partially insulated from healthcare financing, and they are the beneficiaries of department grants and other financing that muddies the waters with regards to their own understanding of healthcare finance. Most physicians are terrible with money even outside of academia. I can tell you that medical school professors taught me half of what I know about medicine, but they taught me very little of what I know about finance and economics.

I will also say one more thing, the views amongs school professors are EXTRAORDINARILY slanted to the left compared to others in their fields of expertise as a rule regarding most subjects, and medicine is no exception. While I generally disagree with both major political parties on most everything, you will find the ratios of political opinion probably inverted D/R vs. R/D when comparing academic physicians to their community practicing counterparts. This makes sense on two levels. One, people who are attracted to left-leaning philosophy are generally more comfortable with others who think that way in the University systems. Two, academics get lots of money from the government while private physicians get lots of money taken away by the government while often having to bear the brunt of government healthcare regulation out of pocket. The Universities can spread this cost around.

I'm not going to keep debating it with you, so you can ultimately decide whether you care about what I have to say or not. I hope at some point in your training, you get some real down and dirty contact with the underserved, preferably at a county facility in a big city. It may not change your mind, but it will certainly change your perspective over time.

 

[GeraldMonroe]

Miami_MD : I think a less regulated 'free-er' market healthcare system is a good idea. Honestly.

However, I also think that through some mechanism, every last American should be required to purchase catastrophic health insurance. It is just like being a car : breathing is a risk. Except, when you drive your car without collision coverage, you can always total your car and take the bus if you wreck it and do more damage than you can afford to repair.

With your body, if you wreck it or it gets wrecked due to bad luck, society can't let you just die. For one thing, most hurt people are begging to live...even if they don't have any way of ever repaying the money it will cost to save their life.

So mandated health insurance is obviously the MINIMUM level of government intervention in healthcare that is even practical. Just being alive makes you liable.

Personally, here's the most conservative mechanism for doing mandated health insurance I could think of.

1. At a certain date, you must have enough insurance coverage to pay for any and all cost-effective medical treatments that prolong life or limb. (aka the insurance coverage must cover a medical treatment if it costs less than $100,000 per year of quality life gained on average, or a similar formula for "limb-years")

2. If you don't buy coverage, or can't afford it, the government automatically pays for it...and makes a note in your IRS file.

3. You now owe the money that was spent by the government on your healthcare. If, in the future, your income rises, you'll be charged extra taxes to pay down this debt.

4. Health insurance companies are allowed to vary their premium based upon factors WITHIN THE CONTROL OF THE COVERED PERSON. So, they can't adjust it for age or gender or genetics, but they CAN adjust it for BMI and smoking history and criminal history.

 

[MOHS_01]

Gerald,

I can see that you are still working through this like the rest of us. The conclusions that one leans toward often is a reflection of their personal experiences with the system; when these experiences are lacking, they fall back on the information and thoughts gained through the educational process. There is absolutely no guarantee that what I, or anyone else, believe today will be our same beliefs in years to come with the benefit of more experience or more information.

A government mandated, one size fits all solution where the government assumes control over the production (I and eventually you) is not too palatable in my world (and should not be in yours, either). This is not likely to happen, as there is not enough political capital in DC to pull off total socialization. What is more likely, however, through regulatory creep and progressive control of financing (and, ultimately, decision making) we will have a fascist system whereby the production is privately held but "guided" by the central government. Not a pretty picture if you rely on this as your livelihood, if you can connect the dots....

One last thing -- listen to, and learn from Miami. Read his blog if you get the chance. He has one of the most rounded educations on the forum and affords great insight on multiple topics.

 

[Miami_med]

Gerald,

I can see that you are still working through this like the rest of us. The conclusions that one leans toward often is a reflection of their personal experiences with the system; when these experiences are lacking, they fall back on the information and thoughts gained through the educational process. There is absolutely no guarantee that what I, or anyone else, believe today will be our same beliefs in years to come with the benefit of more experience or more information.

A government mandated, one size fits all solution where the government assumes control over the production (I and eventually you) is not too palatable in my world (and should not be in yours, either). This is not likely to happen, as there is not enough political capital in DC to pull off total socialization. What is more likely, however, through regulatory creep and progressive control of financing (and, ultimately, decision making) we will have a fascist system whereby the production is privately held but "guided" by the central government. Not a pretty picture if you rely on this as your livelihood, if you can connect the dots....

One last thing -- listen to, and learn from Miami. Read his blog if you get the chance. He has one of the most rounded educations on the forum and affords great insight on multiple topics.

I appreciate all of the complements MOHS, but if you keep talking me up, I'm bound to disappoint everyone 😉

 

[MOHS_01]

I appreciate all of the complements MOHS, but if you keep talking me up, I'm bound to disappoint everyone 😉

yeah, you're probably right... scratch that... you suck😀

 

[physasst]

Is this the same infrastructure that is being used to run the train wreck we have now? Who selects who is on the board? Why is the person selected going to do a good job? Why is the person selected more qualified to make decisions for individual patients better than the physicians who know those patients? These magic boards a diversion. It's sort of like the Fed. It may be "not under federal control," but it generally ends up being run by *****s (or those with alternative motives), and we all know that the moment they stray from the policy espoused by the party in power, their own control is on the chopping block.


My local government won't cut taxes. They will say they need the money, and we will all pay more. We will end up with consumption taxes at both the state and federal level, which will both continue to rise into perpetuity. My personal paycheck won't rise, because the cost of attempting to comply with the rising prices imposed by the VAT won't free up any more money. If anything, the ~2% of salary impacted by current Medicare tax would pale in comparison to a 10% VAT.



Yeah, I guess we'll just pretty much have to disagree on this.

It is, the problem is, the time, and funds needed to create an entire new infrastructure, are from my readings, somewhat prohibitive.

I'll have to confess, a US Health Board is one of the cornerstones of the Mayo Clinic Health Policy Center, but to be honest, it is one that I am very leery of. The libertarian in me is screaming about the entire concept, and I am reminded of Thomas Jeffersons absolute disdain of the creation of a federal banking system. Unfortunately, costs have risen to the point that I believe the only entity capable of absolute provision of medical financing for the population is the federal government. As a quasi-federalist in my own beliefs, I have struggled with this concept for years. It was only within the last two years that my opinion finally swayed.

If I accept therefore, that the government must be involved with healthcare, than I suggest that congress have absolutely no control over the provision, but even more importantly, the financing. I have almost no faith at all in our congressional leaders ability to lead anyone to a bathroom, let alone something as important as healthcare.

I also have concerns that state governments won't really return any tax item, or decrease taxation, as they will simply divert the funds. It will require separate legislature, and is likely to vary considerably by state.
The Medicare tax savings however, would be real. I like the fact that EVERYONE contributes, it is not regressive.

At any rate, Miami, it has been an interesting discussion, and I have nothing but respect. Intelligent debate over ideas is the foundation of our society.

If anyone is interested, there is a bunch more at my blog.

http://physasst.blogspot.com

 

[MOHS_01]

physasst,

See my post to Gerald above; I fall in the camp with those who have little faith in the government mechanism for control. I'm not convinced that they do much other than running a military and waging war well, but that is another topic for another day altogether. Just look at the two largest entitlement programs (and let's call this universal push what it is, an entitlement program): SS and MC. Who here would argue that either are glaring successes? They have been woefully underfunded for the coming demographic changes and neither party has been willing to address meaningful reform to speak of since Reagan raised the retirement age in the early 80's. Past performance can yield clues to future performance in this instance -- they won't get it right, at least not with any of the plans proposed.

Jefferson's fears were much broader than a centralized bank; both he and his contemporaries rightfully feared government intrusion into their lives (and livelihoods). It has often been said (virtually always as a way to discredit the founding fathers positions on matters) that they were limited by their times; true enough, as are we all -- but the same perils of large, intrusive government that were present in their day persist to our own.

Everyone agrees that costs are high and the rate of increase is unsustainable. What I cannot endorse, however, is the implementation of a fascist model where we, as providers, become indentured servants to the state. "Allowing" us to maintain a private enterprise, when services are restricted and there is only one payer, is nothing more than that.

 

[GeraldMonroe]

Jefferson's fears were much broader than a centralized bank; both he and his contemporaries rightfully feared government intrusion into their lives (and livelihoods). It has often been said (virtually always as a way to discredit the founding fathers positions on matters) that they were limited by their times; true enough, as are we all -- but the same perils of large, intrusive government that were present in their day persist to our own.

I agree with you in principle, but I have to call out this bit. Without computers or even copy machines, how intrusive could the government really be in Jefferson's time? It's hard to conceive of an over-reaching bureaucracy controlling everyone's lives in 1780...the technology for it didn't exist.

It does now : mandatory electronic health records will mean that everything a doctor does for a patient will finally be available in a standardized, accessible form. Government bureaucrats could write (at the cost of millions of dollars) inefficient scripts that would parse doctor's EHRs for each patient and make sure everything the government deemed necessary had been done. I think a limited form of this already exists.

A surgeon I talked to once told me that there can never be another Michael DeBakey, not because further breakthroughs in surgery aren't possible (robots and stem cell organs will make possible things DeBakey could only dream about) but because the government will start controlling individual doctor's every move.

 

[Miami_med]

I agree with you in principle, but I have to call out this bit. Without computers or even copy machines, how intrusive could the government really be in Jefferson's time? It's hard to conceive of an over-reaching bureaucracy controlling everyone's lives in 1780...the technology for it didn't exist.

It does now : mandatory electronic health records will mean that everything a doctor does for a patient will finally be available in a standardized, accessible form. Government bureaucrats could write (at the cost of millions of dollars) inefficient scripts that would parse doctor's EHRs for each patient and make sure everything the government deemed necessary had been done. I think a limited form of this already exists.

A surgeon I talked to once told me that there can never be another Michael DeBakey, not because further breakthroughs in surgery aren't possible (robots and stem cell organs will make possible things DeBakey could only dream about) but because the government will start controlling individual doctor's every move.

The first 10 amendments to the constitution (The Bill of Rights) reads like a laundry list of ways to prevent the government from being intrusive in the ways that it was. There was prohibition of assembly, speach, the press, the bearing of arms. There was legal double jeapordy, unfair trial practices, searches and seizures of property, etc... What we do today is often equally bad and is symptomatic of the fact that we let the government get out of control again.

 

[Miami_med]

It is, the problem is, the time, and funds needed to create an entire new infrastructure, are from my readings, somewhat prohibitive.

I'll have to confess, a US Health Board is one of the cornerstones of the Mayo Clinic Health Policy Center, but to be honest, it is one that I am very leery of. The libertarian in me is screaming about the entire concept, and I am reminded of Thomas Jeffersons absolute disdain of the creation of a federal banking system. Unfortunately, costs have risen to the point that I believe the only entity capable of absolute provision of medical financing for the population is the federal government. As a quasi-federalist in my own beliefs, I have struggled with this concept for years. It was only within the last two years that my opinion finally swayed.

If I accept therefore, that the government must be involved with healthcare, than I suggest that congress have absolutely no control over the provision, but even more importantly, the financing. I have almost no faith at all in our congressional leaders ability to lead anyone to a bathroom, let alone something as important as healthcare.

I also have concerns that state governments won't really return any tax item, or decrease taxation, as they will simply divert the funds. It will require separate legislature, and is likely to vary considerably by state.
The Medicare tax savings however, would be real. I like the fact that EVERYONE contributes, it is not regressive.

At any rate, Miami, it has been an interesting discussion, and I have nothing but respect. Intelligent debate over ideas is the foundation of our society.

If anyone is interested, there is a bunch more at my blog.

http://physasst.blogspot.com

I agree, it's been interesting to speak with someone intimately involved.

I'd submit one more idea for you to mull over. Let's pretend that this did come into play. I'm not sure when you're playing with this much money that you should have a board with no congressional oversight. They screw things up, but the alternative is defacto taxation without any representation at the distribution of the funds. This must end badly. The fact that no one can fund it but the federal government is not really true (why couldn't tax money go to individual states if you wanted a government plan). It also should make us look more closely at the real problem, which is cost. I understand your frustration, and we all know that it has to change. I hope that you listen to that feeling in your gut for both our sakes. If you ever want to talk about it more, I'd love to.

 

[cpants]

Thought some of you might be interested in this article from last week's NY Times Magazine. It's about life in the Dutch socialist state. They talk some about healthcare, but I thought the discussion of the cultural differences that make this type of society difficult in the US was particularly interesting.

http://www.nytimes.com/2009/05/03/magazine/03european-t.html?_r=1&em

 

[MegaProjectile]

Thought some of you might be interested in this article from last week's NY Times Magazine. It's about life in the Dutch socialist state. They talk some about healthcare, but I thought the discussion of the cultural differences that make this type of society difficult in the US was particularly interesting.

http://www.nytimes.com/2009/05/03/magazine/03european-t.html?_r=1&em

The author seems to denounce the "socialist" term when applied to the Dutch system. Interesting article though. How much are Dutch doctors paid? They don't seem to pay much in malpractice insurance .

 

[physasst]

searches and seizures of property, etc...

That small town in Texas....Tenaman is it? Well, they should read this.

 

[physasst]

searches and seizures of property, etc...

That small town in Texas....Tenaman is it? Well, they should read this.