Liberal Medical Schools

[pwrpfgrl]

I know, i know, I'm a bad SDNer for not spending my Sun. afternoon posting... my boyfriend would probably break my laptop if I hung out here instead of with him!

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[Jalby]

K, I didn't read any of the flaming, but I would say my school, Keck, is prolly one of the most liberal. No real super duper conservative students.

 

[chypes]

Calling that a contract is a somewhat tenuous line of thought...dont you think? This all basically comes down to how one defines a right. As I think of it, a right is something that exists in its own right, ie a NATURAL right. That is to say that rights simply exist, whether we awknowledge them or not is a different story. The founders of our country never believed that by listing rights in the constitution they were creating rights, they were merely making their existance painfully clear. They were just saying "Here are some of the natural rights of man as provided by God (or nature or whatever)......" I dont think they had any intention of limiting rights to those they listed. In this sense healthcare cannot be a right....however there is some aspect of human decency that says healthcare should be made generally available when possible. Mostly just definition differences....

But what really dissapoints me is that so many potential physicians can even espouse the slightest support for a system of socialized medicine. If you just look at countries that do have such systems you will quickly realize that what is provided is not quality medical care, but the minimum tolerable medical care. Places on the canadian border do a huge buisness doing surgery for canadian citizens who can afford to pay, so that they can recieve quality care in a reasonable amount of time. You know all those jokes about Brits having bad teeth....well its generaly true, and for what reason....well british dentistry is socialized too. Socialized medicine just makes no logical sense....and im very dissapointed that so many people who want to become doctors cannot see the fallacie inherent to it....

 

[cabruen]

chypes --

You use far too broad a brush about socialized health care. One example of a remarkably well run socialized health care system is Costa Rica. It is universal, completely funded, and provides an outstanding level of care. Socialized health care does not inherently mean poor care.

 

[chypes]

While you are correct in saying that Costa Rica has a relatively successful system of socailized health care, it is the exception and not the rule. Look at nations more analagous to the US like Canada and England. They are a mess, health care in the US is far superior(although WHO would probably disagree....thats another story). The fundamental problem is this, patients have no direct means to hold their healthcare providers responsable, as they are not paying for their health care(not directly anyway). Any system set up like this is bound for failure....there is no drive to innovate, to provide the highest quality care, only to maintain the status quo. If I am a physician, I could put in a little extra effort to take care of a patient, but not doing so can not be construed as negligence. So, why should I bother? The law cant bind me too put in extra effort, Im providing a reasonable standard of care. I get paid the same either way. Why not go home earlyer? It is a competitive capitalist nature that drives people to achieve. Socialized medicine does not provide this. While it has numerous other flaws, this one is the fundamental reason that socialized medicine can NEVER provide health care of the best quality.....It can provide care that is "good enough" or "a reasonable standard of care" but if I'm sick, thats not what I want. I want the best and only the best. Likewise, as a physician, I will want to provide only the highest quality of care.

 

[cabruen]

Originally posted by chypes
...Likewise, as a physician, I will want to provide only the highest quality of care.

...that you get paid for. Our capitalist system provides remarkably good health care for those that have money to pay for it. If you do not have the money however (approx 50 million the last count I heard), it provides a remarkably low level of care (acute care at ERs only).

Another example...in last five years 6 new drugs have been introduced and marketed that deal with depression. In the last 15 years no new drugs have been introduced to treat Malaria, Chagas, Sleeping Sickness, and Leshmanias. This summer I spent 10 weeks in Central America taking Chloroquine as a malaria prophlaxis, which was first introduced during WW2. Why are these diseases being neglected, simply because the massive populations that suffer from them, do not have money to buy the drugs.

 

[Random Access]

Originally posted by cabruen
Another example...in last five years 6 new drugs have been introduced and marketed that deal with depression. In the last 15 years no new drugs have been introduced to treat Malaria, Chagas, Sleeping Sickness, and Leshmanias. This summer I spent 10 weeks in Central America taking Chloroquine as a malaria prophlaxis, which was first introduced during WW2. Why are these diseases being neglected, simply because the massive populations that suffer from them, do not have money to buy the drugs.

R&D costs money, yo. Someone's gotta pay for it...

-RA

 

[cabruen]

I agree. I wasn't trying to imply that people have a right to these drugs. I was just pointing out that there are failings of a capitalistic system (assuming by defiinition we mean providing the highest level of care to the most people).

I am in favor of engineering of universal health care plan for this country. I do no think that involves complete socialized health care, but rather an expansion of our medicare/medicaid system of basic coverage.

People with money will always have better health than everyone else, but I do want to get atleast basic coverage for everybody.

 

[Random Access]

Originally posted by cabruen
I agree. I wasn't trying to imply that people have a right to these drugs. I was just pointing out that there are failings of a capitalistic system (assuming by defiinition we mean providing the highest level of care to the most people).

I am in favor of engineering of universal health care plan for this country. I do no think that involves complete socialized health care, but rather an expansion of our medicare/medicaid system of basic coverage.

People with money will always have better health than everyone else, but I do want to get atleast basic coverage for everybody.

Agreed. It might not be a right. But it can't hurt.

Hehe...according to the stuff I've been reading, those 6 drugs for depression probably aren't big improvements over older drugs.

 

[owen_osh]

Originally posted by cabruen
I agree. I wasn't trying to imply that people have a right to these drugs. I was just pointing out that there are failings of a capitalistic system (assuming by defiinition we mean providing the highest level of care to the most people).

I am in favor of engineering of universal health care plan for this country. I do no think that involves complete socialized health care, but rather an expansion of our medicare/medicaid system of basic coverage.

People with money will always have better health than everyone else, but I do want to get atleast basic coverage for everybody.

Are you aware that many physicians hate medicare/medicaid and try to limit the number of medicare/medicaid patients that they treat. In many parts of the country, doctors will not accept any new medicare/medicaid patients. Are the doctors heartless? Not really; they understand that medicare/medicaid does not reimburse them at a rate that is sufficient to cover the costs of providing care. Thus, if they see too many medicare/medicaid patients, they will go out of business. Even worse, President Bush has pushed for and gotten further cuts in medicare payment rates.

 

[cabruen]

Yes owen_osh. There are major problems with these systems that require fixing. I don't have all of the answers, but lets try to work on them together.

PS, I am glad you can only take one of thos spots. Congrats on your success in the admission process so far. Hopefully I can have one of those spots you don't take.

 

[Random Access]

Originally posted by owen_osh
Are you aware that many physicians hate medicare/medicaid and try to limit the number of medicare/medicaid patients that they treat. In many parts of the country, doctors will not accept any new medicare/medicaid patients. Are the doctors heartless? Not really; they understand that medicare/medicaid does not reimburse them at a rate that is sufficient to cover the costs of providing care. Thus, if they see too many medicare/medicaid patients, they will go out of business. Even worse, President Bush has pushed for and gotten further cuts in medicare payment rates.

Yeah, the fact that Medicare won't cover costs really sucks. You honestly have to limit the number you can take, or else it's down the drain you go. It sucks, but what other choice is there?

And of course, there's the whole rural medicine thing. Malpractice costs are too high (particularly for OB/GYN Kenobis), so people are leaving for the city where they can get more patients.

 

[Ryo-Ohki]

Medicaid sucks.

Medicare drives the industry standard.

 

[chypes]

"This summer I spent 10 weeks in Central America taking Chloroquine as a malaria prophlaxis"

I have to applaud that.

and I dont have nearly as much of an objection to expanding medicare/medicaide......except to say that they would be largely unnecessary if it were not for the cost of them.....Ie. medicare and social security are a viscious circle.....now we can never hope to eliminate them....as whole generations have gone on the assumption that they will always exist..... if the government didnt take so much out in taxes.....more people would be able to pay for health care through private means.....

although certainly reasonable standards of care should exist in a compassionate society......and the people dependant on them should be very thankful for them....

 

[Jet915]

Just my thoughts. I think that a nationalized healthcare system would be a horrible idea. Not only would it be ineffective but also very costly to the american people. First of all, it's the government that would be running it and most of us know how terribly wasteful the government is. Also, nationalized healthcare would put unimagineable constraints on our healthcare system. People would be coming to the hospital for minor injuries etc.................just look at Canada. I talked to a nurse who use to work in Canada and she was telling me how horrible it was there and how long it was to schedule appointments/surgeries. I know not everyone here has the access to healthcare, but because we have little government constraint on our system, we have the ability to make great advancements in medical technology that other nations cannot match. I know this might sound "mean" or "cold-hearted" but not everyone has the right to healthcare. In America, everyone has the right to pursue life, liberty and happiness but dont expect someone to hand that to you on a platter. If you work hard, you can live the american dream cause in america, you dont get anything for free, you have to work for it. Some solutions?? Well, it would be nice to get a patients bill of rights to make sure insurance companies arent screwing us and I think it would be nice to set up medical savings accounts in which people who work (earn it) can use them to choose the best medical plan for them. Not only would this drive competition between insurance companies, it would keep the government out of healthcare and make healthcare cheaper and more affordable. .

Jetson

 

[Cerberus]

Originally posted by Jet915
In America, everyone has the right to pursue life, liberty and happiness but dont expect someone to hand that to you on a platter. If you work hard, you can live the american dream cause in america, you dont get anything for free, you have to work for it.

Jetson

Unless of course you come from a wealthy family like the majority of rich Americans. I don't think that the capitalist approach to health care will work until the American wealth is more fairly distributed. 50% of the wealth in this country lies in the hands of 1% of the population. If this economic disparity were reduced then there would be no need to socialize the system because the majority of people would be able to pay for health care (or recieve it through their job). I think it is sad when the richest country in the world cannot provide health care to its citizens or a wage fair enough to provide it for themselves.

 

[gbv]

this entire debate of whether or not healthcare is a "right" or not really depends on one's conception of what constitutes a "right." Many people here have argued that because healthcare is not a "negative" right, that it therefore is not a right at all. However, there are many examples in our society which specifically tag "positive" standards as rights; examples that I can immediately think of are right to legal counsel and rights against cruel and unusual punishment--under the latter are included provisions for shelter and adequate food and healthcare for prison inmates. At this point, it becomes clear that while there may be such thing as a "negative" right, what this country really considers to be rights are things that the society decides is a "good idea", whether they be positive or negative.

perhaps a better way to conceptualize what should constitute a right is what is considered necessary to even strive for "life, liberty, and property,"--a right can be thought of as something that is basic to such pursuits...under this latter framing, it certainly seems that basic healthcare should qualify. Arguing about the logistics of such a system, what a system would entail, and the pros and cons of universal healthcare are really secondary to the question of whether or not it is a right..and keeping in line with many other examples seen in society, it certainly seems that basic healthcare should be a right...if it is a right for prison inmates, it seems ludicrous and sad that it shouldn't be a right for the rest of society.

Ultimately, society decides what a "right" is; rights don't exist independent of society because, without a society, the very concept of a "right" doesn't even make sense.

thanks for reading--have a good day!

 

[Jet915]

"50% of the wealth in this country lies in the hands of 1% of the population."

I'm sure that you also know that the top 5% of the population pays 50% of the taxes. I dont consider my family linked to wealth handed down from my ancestors. My parents came here on a boat 25 years ago with nothing. Now they've made something out of themselves and I consider myself very lucky to have such parents. They worked hard and they are now able to live the American dream and I hope to do the same.

Jetson

 

[SMW]

Originally posted by cabruen A person's right can not be morally justified if it makes a demand on another person to perform an action.

A person has a right to a lawyer if charged with a crime, even if they can't afford to pay for one. Society provides one -- not individual lawyers donating their time. The same should be true for healthcare. I see no difference between the right to a lawyer and the right to a physician. In most cases, the right to a physician is more vital.

Originally posted by Random Access Ummm...SMW... we do charge people for clean water and for how much they contribute to sewers. At least, that's what my water bill says.

Yes, but we don't deny people too poor to pay taxes access to clean water, sewage systems, and public schools.

Originally posted by chypes I dont think they had any intention of limiting rights to those they listed. In this sense healthcare cannot be a right.....

If they didn't have any intention of limiting the rights to those listed, then rights can be added to the list (for example, the right not to be enslaved, which should have been obvious pursuant to the right to liberty, but wasn't at the time. I think in time it will be as obvious to everyone that the right to the pursuit of happiness includes the right to be as free as possible from illness and disease as it is now that the right to liberty includes the right not to be enslaved).

Originally posted by banannie
i think the major source of this argument was a misstatement on my part. what I should have written is "health care SHOULD BE a right, not a privelege" is does not equal ought. as it currently stands, healthcare is not a right in our country. however, it should be, and can easily be made so by legislation. after all, doesn't every individual have a right to a public defender? i would argue that under the same logic, every individual should have a right to decent health care when they are sick.

Well, I would say if something SHOULD be a right (i.e. it's the right thing to do to make it a right), then it IS a right, just one of those not enumerated by the Founding Fathers. Good point about the public defenders.

Originally posted by pwrpfgrl While I don't really want to get involved in this discussion, I think it should be pointed out that basic healthcare is a right according to the UN declaration of human rights

THANK YOU, pwrpfgrl!!!

Originally posted by chypes But what really dissapoints me is that so many potential physicians can even espouse the slightest support for a system of socialized medicine. If you just look at countries that do have such systems you will quickly realize that what is provided is not quality medical care, but the minimum tolerable medical care.

Hello, did you (or anyone else besides SP) read the NYTimes articles I posted the link to earlier? The Forgotten Domestic Crisis, by Marcia Angell, former editor-in-chief of the New England Journal of Medicine and a senior lecturer at Harvard Medical School. She clearly shows why the assumption you make is not justified. With the money we now spend on healthcare in this nation, (approximately twice per person what the so-called socialized systems spend), we can guarantee decent medical care with no waiting to all.

Originally posted by Street Philosopher
Life, liberty, and the pursuit of happiness ALL exhibit negative rights, namely in the right NOT to be murdered, to have liberties taken away, and the liberty to choose what is best for one's own life. Perhaps if you take "right to healthcare" to mean that one has a right to treat themselves without others preventing them to do so, you might have a point. However, if you interpret the right to healthcare as "i have the right to be treated by someone else" (which is without a doubt what you have in mind), then I say there is no such right.

You seemed to have a little trouble finding the negative right asociated with the right to the pursuit of happiness. I guess I have a little trouble with the whole negative rights concept. But I think that the right to the pursuit of happiness includes the right NOT to be riddled with preventable and/or treatable disease.

Originally posted by Random Access So you're saying that doctors must treat everyone no matter what???? Because they are in a position to help people, regardless of whether those people can afford it? I don't see how this obligation should be the burden of doctors.

Originally posted by finney a physician in a world where every person has the "right" of health care would become a slave to society's medical needs.

I think everyone arguing against healthcare as a right is a little too (selfishly) insisting on their rights as an individual doctor NOT to provide care to those who can't afford to pay.

But because someone has a right to healthcare (as we've now confirmed they do, by virtue of the United Nations language) does not mean doctors have to toil ceaselessly treating endless lines of people too poor to pay. That seems to be the fear. I think it's enough if we all just work for the improved access to care that everyone (or almost everyone) claims to be in favor of. And the best way to do that is to ensure that the money we're now throwing away on profit for insurance companies and their minions who ceaselessly toil to limit coverage goes to doctors who treat the poor along with everyone else.

Originally posted by Jet915 Just my thoughts. I think that a nationalized healthcare system would be a horrible idea. Not only would it be ineffective but also very costly to the american people. Well, it would be nice to get a patients bill of rights to make sure insurance companies arent screwing us and I think it would be nice to set up medical savings accounts in which people who work (earn it) can use them to choose the best medical plan for them. Not only would this drive competition between insurance companies, it would keep the government out of healthcare and make healthcare cheaper and more affordable. .

Read this article! The Forgotten Domestic Crisis.
And what about the people who can't work or can't find work with your medical savings accounts idea?

Originally posted by Cerberus I think it is sad when the richest country in the world cannot provide health care to its citizens or a wage fair enough to provide it for themselves.

Originally posted by gbv
perhaps a better way to conceptualize what should constitute a right is what is considered necessary to even strive for "life, liberty, and property,"--a right can be thought of as something that is basic to such pursuits...under this latter framing, it certainly seems that basic healthcare should qualify. Arguing about the logistics of such a system, what a system would entail, and the pros and cons of universal healthcare are really secondary to the question of whether or not it is a right..and keeping in line with many other examples seen in society, it certainly seems that basic healthcare should be a right...if it is a right for prison inmates, it seems ludicrous and sad that it shouldn't be a right for the rest of society.

Ultimately, society decides what a "right" is; rights don't exist independent of society because, without a society, the very concept of a "right" doesn't even make sense.

Cerberus and gbv, Amen!

cabruen and SP, no hard feelings!
saiyagirl, thanks for hanging in there and being the voice of rational debate!
SP, you certainly caved quickly when the UN declaration was brought up!

 

[Jet915]

Hi SMW,
My thoughts are why can't people work and can't find work?? Unemployment is only at 5% right now so I dont think people are having problem finding jobs. We arent in the same situation as the 1930s yet so I dont see that as a problem. As for people who cant work, to me, the only people who cant work are those who are mentally disabled or physically disabled. I believe those people should have some type of basic healthcare coverage. As for those who can work but do not choose to work, I am sorry, but I have no sympathy for them. If they want handouts, they can go to Canada.

Jetson

 

[Doc Holliday]

Maybe we can all agree that there are trade-offs involved in adopting capitalist vs. socialist models, which is what most of the posts dealing with "solutions" come down to. Each system offers benefits at some cost. Most discussions of the "details" result in hypocritical hyperbole and misunderstood intentions. So let's go beyond that if possible.

Most of us agree that the United States is the wealthiest country on the map. I would argue that the capitalist model has enabled the advancement of technologies that range across the spectrum of modern living far beyond any other model. Clearly in history there is no socialist equivalent to the US in terms of advancement in technology and quality medical care.

The trade-off is inherent in the nature of freedom, which allows for entrepreneurship and individual choice, especially in terms of investment in resources. The danger of socialism therefore is its centralization of power, which ultimately (and historically) proves too tempting and corruptive to even the most well intentioned altruist, and its stiffling effect on competition. But I digress...

I think the free-market healthcare model can work, but will continue to suffer from escalating costs and a myriad of additional problems under current economic and political conditions. For example, tort law needs to be reformed to reduce and control malicious lawsuits in order to help control skyrocketing malpractice and consumer health insurance premiums. The only problem is that a very wealthy segment of legal experts (who are also tenacious lobbysits) will need to detach themselves from the insured and taxpayer's teats. I never said capitalist pigs couldn't be greedy! Where would we be if more of our children were taught moral clarity?

Additionally, we need to consider stricter control of access to our borders. Immigration is growing more and more rapidly and unchecked could strain healthcare resources to a breaking point. A sizeable proportion of the "uninsured" are also "non-citizens". Many of you argue for healthcare benifiting all citizens, but don't address how non-citizens skew the system. Those that do cite billions of starving and malnourished people across the globe without the faintest idea of what the cost would be to make significant progress, which includes prevention and education in otherwise incompatible cultures that do not share our values. Treat 'n release is not a solution. Our democracy is built on freedoms and fueled by supply and demand. If demand for health care exceeds supply, we could ultimately be introducing more than "economic" competition.

This topic is a lot more complex than any of us has time to reason completely through. If there were easy solutions, great minds would have already solved the problems we face. My point ultimately is that we make trade-offs, and yes, those trade-offs influence the quality of life one group potentially enjoys over another. Freedom bears awesome responsibility. If we were all guided by moral clarity and empowered to philanthropic inclinations the world would be a better place. Each of us can make a difference.

Until then, set your alarm because you don't want to be late for work. Someone has to pay for your internet connection and computer. Otherwise, how would we get our SDN fix? On the dole? -dh

 

[SMW]

Originally posted by Jet915
Hi SMW,
My thoughts are why can't people work and can't find work?? Unemployment is only at 5% right now so I dont think people are having problem finding jobs. We arent in the same situation as the 1930s yet so I dont see that as a problem. As for people who cant work, to me, the only people who cant work are those who are mentally disabled or physically disabled. I believe those people should have some type of basic healthcare coverage. As for those who can work but do not choose to work, I am sorry, but I have no sympathy for them. If they want handouts, they can go to Canada.

Jetson

Jetson,
It can't have escaped your notice that we are heading into a recession! It could be a bad one. But even at the height of the dot-com/Enron Bubble, huge numbers of the working poor could not (and still can't) afford health insurance or even one visit to the doctor (particularly scandalous when you consider what those CEOs responsible for the mess got away with. You can bet they all still have health insurance). It is impossible to afford health care on the minimum wage in this country, even with two wage earners.
Many of our elderly cannot afford their prescription medicines, or have to choose between going hungry or buying their medicine. Those are the lucky ones who have a doctor who accepts Medicare. As owen_osh pointed out, many doctors do not. Here in Anchorage there is a crisis because no new doctors will accept new Medicare patients, and many of the ones who would are retiring. Heard of the Medicare prescription drugs benefits controversy? Seems to have faded from our consciousness lately. But my parents are worried, and my Dad is a successful attorney. That means he pays for the health insurance for all the people in his office as well as our family's. And guess what? He's not going to be able to afford to pay for it for much longer, becasue health care costs are rising so rapidly (10% on average yearly for the past several years, and projected to be 23% next year). And he's worried about how in the world he will be able to afford it for him and my mother once he retires. And relying on Medicare is not a good option, because they might not find a doctor who takes it (understandably enough, given the government reimbursement schedule). Welcome to the real world.
P.S. I don't really think there are a lot of slackers out there looking for a hand-out. I'm glad to hear you think those uanble to work should be guaranteed health care -- that's Medicaid, right? Just hope they can find a doctor who will take it. I think it's a problem here in Anchorage.

 

[Doc Holliday]

Originally posted by pwrpfgrl
... I think it should be pointed out that basic healthcare is a right according to the UN declaration of human rights.

I call "BS" on this one. Since when did the UN become an authority on human rights? Several of the countries that sit on the UN are in direct violation of their own charter. It's all a bunch of political double talkin' jive! Koffi Anan's own country is one of the worst offenders. Please!!

I really worry about the lack of thought that goes into considering the UN's scope of authority and credibility. Many nations are represented by unelected officials working as mouth-pieces for morally bankrupt dictatorships. I'm not saying that we are perfect, but the US at least has a track record of opposing oppressive governments that gave no concern whatsoever for human rights. I'm not saying that the UN serves no purpose, but let's please not fool ourselves into thinking that they have any kind of moral authority regarding human rights. - dh

 

[SMW]

Originally posted by Doc Holliday

I think the free-market healthcare model can work, but will continue to suffer from escalating costs and a myriad of additional problems under current economic and political conditions. For example, tort law needs to be reformed to reduce and control malicious lawsuits in order to help control skyrocketing malpractice and consumer health insurance premiums. The only problem is that a very wealthy segment of legal experts (who are also tenacious lobbysits) will need to detach themselves from the insured and taxpayer's teats. I never said capitalist pigs couldn't be greedy! Where would we be if more of our children were taught moral clarity?

Additionally, we need to consider stricter control of access to our borders. Immigration is growing more and more rapidly and unchecked could strain healthcare resources to a breaking point. A sizeable proportion of the "uninsured" are also "non-citizens". Many of you argue for healthcare benifiting all citizens, but don't address how non-citizens skew the system. Those that do cite billions of starving and malnourished people across the globe without the faintest idea of what the cost would be to make significant progress, which includes prevention and education in otherwise incompatible cultures that do not share our values. Treat 'n release is not a solution. Our democracy is built on freedoms and fueled by supply and demand. If demand for health care exceeds supply, we could ultimately be introducing more than "economic" competition.

Will have to take these issues up another day, doc. I'll just close by saying it's a good thing we have the lawyers to help us stand up to the insurance companies and HMOs in the absence of a Patients' Bill of Rights.

 

[Street Philosopher]

Originally posted by SMW

SP, you certainly caved quickly when the UN declaration was brought up!

Well I still don't think healthcare is a natural right. But when there is a law, it implies some sort of contract between the people and the state. In that case, the notion of "rights" becomes a matter of fact, rather than a matter of principle. i.e. the right to healthcare is established de facto rather than de jure.

I could still argue away about the example of legal counsel, since that protects the right to happiness by making sure justice is carried out and one's innocence is vigorously defended. This is sort of a de jure right based upon a de facto system. The fact that we agree to the legal/punitive system (the de facto part) creates a de jure right to legal counsel. This serves to clear up the two notions of "rights" but there's no further need to beat a dead horse.

 

[Nefertari]

Originally posted by Doc Holliday

I'm not saying that we are perfect, but the US at least has a track record of opposing oppressive governments that gave no concern whatsoever for human rights. - dh

Doc Holliday,

The US also has a "track record" of overthrowing progressive governments (i.e. Sandinistas in Nicaragua) & instituting oppressive "US puppet military regimes" in their place (i.e. in Guatemala, Honduras & El Salvador). I lived in Nicaragua for a year, travelled to El Salvador and Guatemala, saw first-hand the results of the US's track record in Central America, and worked with organizations trying to undo the political and economic of impact of decades of US interference. Look @ Indonesia and East Timor. Human Rights Watch's list of the US-backed abuses (whether overtly or discreetly through CIA/State Dept) in these countries is

The US has opposed oppressive governments mostly when it has been politically and economically expedient to do so (i.e. Iraq). The UN is practically paralyzed in carrying out its global mission because guess who is its most powerful member?

 

[MacGyver]

If the UN says healthcare is a right and yet dont provide for it, they are in violation of their own directives.

the UN is denying everyone on this world a basic and fundamental right to healthcare....

At least thats the natural conclusion that one reaches if the UN declares this as a right

 

[MacGyver]

If healthcare is a right, then that means the government has the power to FORCE YOU to provide for them.

Think about it. Luckily there are many lawyers right now who volunteer to do pro bono work in criminal court.... HOWEVER if suddenly lawyers decided they didnt want to do that anymore then the fed govt could FORCE them to do so for free.

 

[SMW]

Originally posted by MacGyver Think about it. Luckily there are many lawyers right now who volunteer to do pro bono work in criminal court.... HOWEVER if suddenly lawyers decided they didnt want to do that anymore then the fed govt could FORCE them to do so for free.

Nobody does pro bono work in criminal court. Well, maybe a few lawyers do, but the vast majority of legal counsel for indigent defendants is provided at taxpayer expense i.e. the lawyers get paid by the government. Just like doctors would get paid if there were universal health coverage.

 

[MacGyver]

I just read that article...

I must be missing something here. She talks about how we should spend the same amount of money now for healthcare but put it into a universal single payer model.

I thought the whole point of single payer was to bring DOWN the costs we are currently spending on healthcare?

She also assumes that government single payer model operates at 100% efficiency with no overhead. I'm not convinced that the overhead in the system now is worse than it would be under single payer system.

 

[chypes]

I'm not convinced that the overhead in the system now is worse than it would be under single payer system.

Does the govenment ever accomplish anything in an effiecient manner?

It dosent have to, because it does not have the financial constraints of a buisness. It can spend and spend, and the competition will never take away its buisness despite phenominal waste and inefficiency....because there is no competition.....competition drives everything....without competition the quality of any product drops....

 

[SMW]

Originally posted by MacGyver
II thought the whole point of single payer was to bring DOWN the costs we are currently spending on healthcare?

No, the point is to get everybody covered! Sheesh! We accomplish that by diverting the money now wasted on profits and people trying to deny care to providing care to the currently the uninsured.

 

[DW]

Originally posted by SMW
No, the point is to get everybody covered! Sheesh!

not mutually exclusive points. Gotta bring down the costs before you can start extending coverage to more people

 

[SMW]

Originally posted by DW
not mutually exclusive points. Gotta bring down the costs before you can start extending coverage to more people

No, you don't. Read the article!

 

[SMW]

Originally posted by chypes
Does the govenment ever accomplish anything in an effiecient manner?

It dosent have to, because it does not have the financial constraints of a buisness. It can spend and spend, and the competition will never take away its buisness despite phenominal waste and inefficiency....because there is no competition.....competition drives everything....without competition the quality of any product drops....

Your assumption that free-market competition is getting us the best possible system is erroneous. It's getting some people the best health care money can buy, but for the same aount of total dollars we could get everyone the best health care in the world. As it stands now, the real competition in the marketplace is not between doctors, with the quality of care driving the system. The real competition is to see who can provide the least amount of care to the healthiest people. The competition as it stands now is actually lowering the quality of care as HMOs and insurance companies attempt to maximize profit by avoiding the sickest patients.

A single payer system does not necessitate that the government actually get into the business of health care. Just like the fact that the government funds road construction does not mean that the government actually builds the roads. Last I checked construction companies were still in business and doing well.

 

[DW]

as a federal employee, i have an extremely hard time buying a government finacned system is going to be implicitly more economically efficient with less overhead. thats just me though

and, even if the ideas in the article are viable, i doubt any political force could push this one on tax paying, already insured americans. it has roughly the same chances of being instituted as a one legged man in an @ss kicking contest during our lifetimes.

i think a push towards a defined contribution, consumer driven model instead of managed care cost gatekeeping could reduce costs and partly alleviate the problem of the uninsured, without some of the political difficulty.

 

[SMW]

Well, I think the article is pushing a consumer-driven, defined contribution model (she suggests a payroll tax earmarked for healthcare, like the Medicare tax). So I don't see what your argument with it is. And don't you think we should aim for completely, not partly, eliminating the problem with the uninsured?

 

[DW]

Originally posted by SMW
consumer-driven, defined contribution model=Medicare

And don't you think we should aim for completely, not partly, eliminating the problem with the uninsured? [/B]

Well, in my heart, of course for all working americans. But, once again, do you really, REALLY think a single payer system will happen anytime soon in the states. i would like to completely, not partly, get rid of poverty and homelessness, but again, i realize at some point compassion has to meet fiscal reality

so anyways, GW seemed pretty liberal when i interviewed there

 

[MacGyver]

SMW,

i dont understand why you think that a single payer system is going to magically erode the difference between rich and poor regarding healthcare.

take a look at the socialized/universal/single payer health systems. IN all of these countries the rich people STILL get better medical care than the poor

 

[SMW]

Originally posted by MacGyver
SMW,

i dont understand why you think that a single payer system is going to magically erode the difference between rich and poor regarding healthcare.

take a look at the socialized/universal/single payer health systems. IN all of these countries the rich people STILL get better medical care than the poor

Well, I'm not sure we need to totally do away with the difference between medical care the rich can afford and medical care that should be available to everyone, rich or poor, as a matter of human rights (as the UN Declaration on Human Rights states). I think if the rich want to pay for their cosmetic surgery and botox injections outside the system, that should be fine. The point is that considering all the money we're now wasting, if we were to continue to spend the amount of money we're now spending on health care (about twice as much per person as the more developed countries that have universal health care) under a single payer system, then we ccould afford a very high level of care for everyone. The problem with the universal systems in other countries is that they are not well funded, thus the waits, rationing, etc.

 

[owen_osh]

A few points:

a) Regarding the NYT article, the Times editorial positions have been a little sketch ever since Raines took over. Basically, everything boils down to "We hate Bush." In the case of this example, the author claims that an expanded medicare system could solve healthcare problems, but for months, the Times has been pointing out the problems with medicare, namely that reimbursement is too low and therefore many physicians don't want to participate.

b) SMW has written several times that healthcare could be fixed if money was not "wasted" on profits. I'm not so sure that profits are wasteful. Profit is what motivates people to do work.

c) I agree with MacGyver that a universal system will not provide equal care for everyone. For example, I studied in Spain this summer and talked to some Spanish people about their socialized healthcare system. Basically, they told me that there are public clinics that most doctors work at in the morning. At the public clinics the doctors rush to see as many patients as quickly as possible, and they leave as soon as they can. The doctors leave early so that they can go to their private clinics. Only poor people go to the public clinics, and people with any money try to see private doctors. This is a good example of the power of profit: doctors in Spain don't make much profit at the public clinics, so they don't want to work at them.

d) We already have a socialized system in the US. It's called the VA. I'm not a veteran, so I've never been treated at a VA hospital, but from researching medical careers and medical education I've come to understand that the VA is usually the worst hospital in town.

e) Finally, I think a lot of the problems of medicare and the VA are systemically caused by the political control to which they are subject. Historically, politicians have chosen to cut spending on these programs in order to fund other priorities. Based on this reality, I think the analysis in the NYT article is flawed. Perhaps in the first year of a national health care program all of the money currently spent on privately and publicly funded healthcare including coorporate profits, insurance company overheard, etc would be spent on healthcare. But by the second or third year, much of that money would be diverted to other policy initiatives such as military spending, tax cuts, etc, etc.

Also, I don't think there would be much political opposition to cuts in a hypothetical national health care program because the only people who really care about health care spending are people who are very sick, and at any one time a majority of Americans are not very sick.

 

[Doc Holliday]

Owen, You are right on the money. Well said. Of course, all due respect to those that disagree.

An additional issue we haven't addressed regarding socialized medicine is the nature of the employee-employer relationship. As physicians we will be employed by the federal government. Don't expect politicians to balk at the opportunity to regulate healthcare decisions, including how many physicians are trained and what specialty they will practice.

Socialist solutions errode freedoms. I applaud everyone's good intentions, but you will not get my vote. I am willing to give of my time, energy, and resources to help others, but not because someone tells me I have to. -dh

 

[SMW]

Originally posted by owen_osh
A few points:

the Times has been pointing out the problems with medicare, namely that reimbursement is too low and therefore many physicians don't want to participate.

That could be fixed by funding the system well.

SMW has written several times that healthcare could be fixed if money was not "wasted" on profits. I'm not so sure that profits are wasteful. Profit is what motivates people to do work.

Not everyone is motivated by profit. Most people are just motivated by getting paid their salaries. It is only large corporations (insurance, HMOs, etc.) that are trying to squeeze excess profits out of healthcare. Doctors could still charge enough to make very good salaries, hospitals could charge just enough to cover costs, and the government could agree to reimburse at prevailing rates.

I agree with MacGyver that a universal system will not provide equal care for everyone. For example, I studied in Spain this summer and talked to some Spanish people about their socialized healthcare system. Basically, they told me that there are public clinics that most doctors work at in the morning. At the public clinics the doctors rush to see as many patients as quickly as possible, and they leave as soon as they can. The doctors leave early so that they can go to their private clinics. Only poor people go to the public clinics, and people with any money try to see private doctors. This is a good example of the power of profit: doctors in Spain don't make much profit at the public clinics, so they don't want to work at them.

We don't have to repeat the mistakes of the Spanish program. And we can certainly afford to fund it better, so that doctors have an economic incentive to see all the patients that need seeing.

I think a lot of the problems of medicare and the VA are systemically caused by the political control to which they are subject. Historically, politicians have chosen to cut spending on these programs in order to fund other priorities.Based on this reality, I think the analysis in the NYT article is flawed. Perhaps in the first year of a national health care program all of the money currently spent on privately and publicly funded healthcare including coorporate profits, insurance company overheard, etc would be spent on healthcare. But by the second or third year, much of that money would be diverted to other policy initiatives such as military spending, tax cuts, etc, etc.

It seems the program could be structured so that this is not possible. By having payroll deductions go into a dedicated fund, Inflation proofing the fund, etc.

Also, I don't think there would be much political opposition to cuts in a hypothetical national health care program because the only people who really care about health care spending are people who are very sick, and at any one time a majority of Americans are not very sick.

I think once everyone was on the program, and saw that it was working out there would be huge support for it. Everyone could get a yearly annual exam, kids could get vaccinated. Plus, the Baby Boomers are heading into retirement, and will have all those age related ailments. The children of the BabyBoomers who are starting their families could rest assured that they could afford to take their kids to the doctor (and go themselves) even if they're laid off their job. No one would have to worry about whether their employer provides "benefits" (code words for being able to afford doctor visits and medicine). Small businesses could stop agonizing over whether and how to afford health care coverage for their employees. We could stop the viscious cycle we're in right now in which we all pay for everyone anyway, just in a very convluted, round-about way in which a lot of the money goes to not providing care, instead of providing it.

 

[SMW]

Originally posted by Doc Holliday

An additional issue we haven't addressed regarding socialized medicine is the nature of the employee-employer relationship. As physicians we will be employed by the federal government. Don't expect politicians to balk at the opportunity to regulate healthcare decisions, including how many physicians are trained and what specialty they will practice.

There is no reason the government would have to employ physicians in a single-payer system. And someone has to make healthcare policy decisions -- you'd rather the HMOs make the decision of what test your mother's doctor is allowed to order?

Socialist solutions errode freedoms. I applaud everyone's good intentions, but you will not get my vote. I am willing to give of my time, energy, and resources to help others, but not because someone tells me I have to. -dh

Apparently there aren't enough like you to take care of the problem.

 

[cabruen]

It is important to look at the reality of the system, and not what we wish were true. Employer sponsored health care for most of the working age persons (private) and medicare/medicaid for our elderly and destitute (government) constitutes how we currently finance health care. It has left a gap of about 55 million uninsured. Many of those are immigrants, self-employed, temporarily unemployed, and twenty somethings. This sysem has failed to keep costs in check, and Employers are generally shifting their health care benefits programs to defined contribution plans. This will shift more burden onto consumers (as the capitalism proponents would favor). Unfortunately my prediciation is that the consumers will also be unable/unwilling to bear this extra costs and the government will step in with larger coverage programs. This will almost assuredly be a single payer system.

For those advocates of the capitalism system I would point out that our current health care system deviates significantly from a free market system beacuse the supply of doctors is limited.

My goal is universal coverage, but I am unsure of the best way to accomplish this.

 

[MacGyver]

SMW,

even if it were possible to provide doctors with a reasonable salary, say 120k per year, its irrelevant.

doctors, just like ordinary people, will seek the HIGHEST salary they can get. They dont just sit back and say 'yeah 120k is good enough for me'

Instead they say 'yeah 120k is OK but i could be making 150k by working at this private clinic'

so you see there is always an incentive away from the single payer model.

the only way to get rid of it is to outright ban all private clinics, but then you have people screaming that they dont have the option of paying for more expensive care.

Also, you mistakenly assume that in a single payer model that the only difference between rich and poor is cosmetic surgery, botox, etc. this is not true, the difference between rich and poor will be every bit as pervasive as it is now. The rich will get the best oncologists, access to better technology, faster MRI/CT service, new nuclear medicine techniques, etc. The poor will get some base level of healthcare but to imply that the only difference between rich and poor in a single payer model is cosmetic stuff is just laughable