New Universal Health Care Thread

[DenaliView]

I completly realize thier are quite a few threads out there that discuss opinions on Universal health care. Almost all of which are very out dated. Wanted to know what everyone thought of it as we are seeing this topic being discussed in the news and people are gaining more and more insight as to how this could play out in our system. Is it discouraging anyone from wanted to become a doctor to any extent? Or for those that are practicing now do you believe it would change the kind of care you would be able to provide for your patients???

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[admitER]

"You thought healthcare was expensive, wait till it's free."

 

[DenaliView]

This is probably true, but will it benefit society as a whole enough to make it worth a little less money... and will we be able to provide a good of care as we do now?

 

[bawer234]

This is probably true, but will it benefit society as a whole enough to make it worth a little less money

Not "probably", definitely.

... and will we be able to provide a good of care as we do now?

Not even close.

There are some good threads with similar questions that aren't too old. Check em out and if your questions still aren't answered, ask away.

http://forums.studentdoctor.net/showthread.php?t=516200&highlight=bawer234

 

[bcat85]

The only problem that exists is the presence of for-profit insurance companies whose tactic to make money is to pay for and provide as little care as possible. Clearly a bit of a conflict of interest. Non-profit insurance companies would suffice to change this, but only to an extent. The problem rests with the fact that individuals choose to

a. Not use their insurance as insurance should be used. YOU should pay for your $120 primary care visit, but your insurance should pay for your 15k knee replacement if and when you need it. Somewhat like asking your homeowners insurance to pay for your lawn to get cut.

b. Use care needlessly. There is nothing quite like going to the ER at 3 a.m. because you have a cold. Imagine how much care will be sucked up by people who know they have NO chance of having to pay for it. This is partially, I suppose, contributed to by the media's almost obsessive urge to turn every American into a hypochondriac by telling them a common sign of cancer is "a headache," which of course causes everyone who doesn't function on all eight to come storming into the ER (the uninsured, on account of their lack of ability to maintain a steady job or "stop eating")

c. Continue on their merry way towards comorbidity and early mortality. In our current system, you can't tell me that insuring a 500 pound man is a sound business investment. For an interesting perspective, see my blog.

The fact that the government cannot do anything without turning it into a bureaucratic clusterf*** will only compound the problem and hurt everyone. You can only take the Robin Hood approach for so long before the haves wise up and mount a shotgun in their doorway. UHC will never work in our country.

 

[DenaliView]

So any ideas in how to fix it. If the power to manage healthcare was in your hands what would you do to make it better?

 

[Hyperstudyosis]

I'm very opposed to it for a number of reasons, perhaps most important of which is the fact that it doesn't work. Maybe a nice idea, but completely unworkable. We had an ethics and character luncheon at our school and the speakers addressed this as the main topic. Overcrowded ERs is one issue. People are already terribly impatient having to wait a few hours at the ER to be seen; I witnessed this as a volunteer. Can you imagine if they had to wait a few DAYS to be seen? I've also heard of people having to wait so long to have surgery that women in need of a mastectomy had their cancer metastasize unnecessarily and people needing orthopedic surgery had to wait for a year or more to have it. With our population what it is and growing at that, supply could NOT meet demand if we had a universal health care system.

Now I will admit that the current health care system is terrible; however socialized medicine is not the way to remedy it. I don't have all the answers, but I can foresee a huge mess if the system were changed to a universal system.

Plus, I am by all means very far from being a socialist. I believe in a capitalistic society, even with regards to medicine.

 

[DenaliView]

I am still a little uncertain how it works. If someone comes in and has the diagnosis of cancer and will need surgery/chemo lots of time as an inpatient, (highly expensive/specialized care) all this is covered. Is their any point in which this stops being covered under the universal canopy or that certain types of medications or procedures is unavailable. Can I just go in and as long as my doctor signs off on it can have anything I want done? What about things like bariatric surgery and or comsmetic recostructive surgery after a bad burn (would this also be covered). Where are the checks and balances???

 

[Hyperstudyosis]

Good questions and I'm not sure of all the answers, especially regarding more cosmetic procedures. I mean, could everyone have a facelift for free? I'd like to learn about that aspect of the plan and how far it goes. Obviously, medical necessities would be covered, but what about the "extras" and who decides what are medical necessities and what are extras?

 

[DenaliView]

completely see where you are going with this but where does the enforcement come from that makes the insurance companies pay up when they should be covering a service.
As far as patients being stacked a mile high in the ER, is their anyway to improve access to primary care so that patients are not being seen in the ED for a cold. Why can't people see their regular doc for these kind of problems.... because they don't have any insurance and this lands the in the ER (its free there). What about having a pseudo universal health care system where patients are allotted a certain amount of $ every year for office visits, and if you are given a more complicated diagnosis such as heart failure or cancer you are then put into a new bracket where you stop needing to pay. Must meet certain criteria verified by your doctor to qualify. That way everyone can have some level of primary care, people can stay out of the ED and see their primary provider for their cold/flu and those who need higher acuity care will receive it. And if you run out of money for office visits then you need to pay out of pocket unless you meet the criteria for the higher acuity care.......

 

[TheRealMD]

The main problem with universal care is lack of order - who receives care when, where, and why.

Pricing allows society to determine how resources should be allocated. The US does not have enough resources to give everyone an MRI, CT scan, or even a doctor's visit whenever they feel like it.

There will never be an equal level of care that many are pushing for. The best way to determine who gets what is to let people know what the costs are for each procedure/visit. This will reduce the moral hazard problem.

http://en.wikipedia.org/wiki/Moral_hazard

Insurance should be used to pool risk together and not used to determine what care people receive. Insurance companies should very clearly provide insurance for specific high-risk events such as cancer or heart-attacks. This will reduce the BS that the insurance companies can use to say "oh, it's not covered in the plan."

Low-level stuff should not be included in the insurance package. Forcing people to open their pocketbook when they go to the doctors will incentivize people to take care of themselves.

Well, you ask, what about the people that can't afford insurance... well they have to get in the back of the line. If they come to ER with bullet wound without insurance, ok we treat that, but maybe we garnish % of your wages until some of it is paid off.

"Ignore your health until it's bad enough that someone else will pay for it." That's why it's not as simple as you believe.

In fact, I dare say that universal health care won't work until you FORCE people to get regular check-ups and tell them that they will die in X years if they don't straighten up. Cruel, but that's pretty much the truth. Anything else is trying to spare the patient's feelings for what a doctor knows is coming anyway.

 

[DenaliView]

That is one of the real difficulties of being in medicine. Patients come in with a problem they want you to fix i.e. emphysema but they will not help themselves. I realize I need to be less judgmental but in so many instances the solution to the problem is so easy and right their in front of the patients face and they will not reach out and take it.

 

[harposnarpo]

More people with insurance != more people seeking care
Universal insurance != price ceilings

Universal health insurance could mean higher taxes.

 

[p30doc]

All you have to know is "pay is going down".

"You thought healthcare was expensive, wait till it's free."

Per capita we pay twice as much towards healthcare compared to any other country. Meanwhile overall we are ranked ~#40 in the world by the WHO. Every other developed country has some form of universal healthcare. Our current insurance based system is !@#$ up, I read that 40-60% of cost of healthcare is to deal with the insurance administration cost, how ridiculous! Every citizens health should be taken care of, if people we free to visit PCPs regularly many illnesses could be caught early and before they become a massive financial burden on the system. We need universal healthcare and we need it now, along with more PCPs. /end minirant


edit: to the guy that said people pushing universal healthcare have not taken econ 101, well my 1st BA was in economics, so =P

 

[Gut Shot]

Oh yes, let everyone be free to visit PCPs whenever. Have you stepped out of the country and visited a doctor overseas? The PCPs and even the specialists there have to see over 50 patients a day, often up to 100, and patients only get 5 minutes with their doc. Have you had to wait 4 hours to see someone even though you had made an appointment already? This is not the ER, these are their normal clinics. Their doctors are tremendously overworked - even much worse than the PCPs here.

This is universal healthcare - universally bad for doctor and patient.

There are approximately 195 countries in the world, and thus approximately 195 distinct systems for delivering healthcare. Of the ones that provide universal coverage (i.e. every other first world nation), their responsiveness and level of care ranges from abysmal to excellent. Attempting to paint them all with the same brush, particularly while trying to sound worldly, is a gross generalization.

 

[AmoryBlaine]

There are approximately 195 countries in the world, and thus 195 distinct systems for delivering healthcare. Of the ones the provide universal coverage (i.e. every other first world nation), their responsiveness and level of care ranges from abysmal to excellent. Attempting to paint them all with the same brush, particularly while trying to sound worldly, is a gross generalization.

Excellent!

AB's top 3 reasons why universal health care in the US is fraught with peril. FWIW I'm in favor of universal health care, but I'm really only in favor of an extremely rational one.

1. The forces against it are massive and rich. People throw around terms about how our current system is at the absolute breaking point but I have never seen convincing data on this. Hospitals make tons of money. Insurance companies make tons of money. My home institution prides itself on doing tons of uncompensated care and they still manage to have plenty of scratch to throw around on building improvements. Small sample I know. Those arguing for UHC are essentially the poor and those who care about them. Those arguing against it are wealthy executives with deep pockets. The presidential candidates can make nice-talk all they want but in the end even the most idealistic politician lives and breathes money.

2. When American's say they want UHC, they want as much free health care as they can consume whenever they want to consume it. A rational approach to this problem is going to be extremely difficult to push. One extremely rational way to save billions in health care dollars is to stop rescucitating/sustaining the lives of demented octagenarian amputees in multisystem organ failure. You pull the plug on one person with zero quality of life, save a week in the ICU, and you can pay for primary care for probably 10 people for a year. But this is not how Americans think. "Grandma knows we're here and we want everything done," they will say, "we are praying for a miracle." For those of you that are still pre-med or M1/2 wait until you see the average MICU, sometimes you end up having to laugh so you won't cry for the poor suffering souls being horribly tortured to the tune of $3k/day. For a much more eloquent and learned view on this topic visit Panda's blog.

3. The "soap opera factor." Kind of an extension of #2. Any time the system fails (even in fairly minor ways) it is likely to cause a huge outcry/outrage. New system doesn't want to pay for expensive treatments for your kid with Neverheardofit-Extremelyrare Disease? Go on 20/20 with an admittedly compelling sob story until a politician picks up on the outrage, makes a speech about it, and pushes a rider through Congress to have the system pay in full for NED. New system decides that it can't afford to pay for a full-on assault on your demented great-uncle's prostate cancer? Repeat above strategy. For evidence that this is a likelihood, observe the average person's understanding of health insurance. They think that for a nominal annual fee the health insurance corporation should agree to pay in full for whatever might happen to them over the course of the year. If the insurance company tries to dodge paying for something it is because the company is evil and irresponsilbe.

 

[Gut Shot]

I need to update this list, but I'll post it (again) anyways:

Dr. Thomas Bodenheimer wrote a four part series on various aspects of the health care system. If you read those you’ll know more than 99.8% of premeds (and about 80% of practicing physicians). The first three are here:

http://www.annals.org/cgi/content/full/142/10/847
http://www.annals.org/cgi/content/full/142/11/932
http://www.annals.org/cgi/content/fu.../12_Part_1/996

The birth of Medicare (many parts):
http://www.medicarerights.org/maincontenthistory.html

The system explained (many parts):
http://www.yourdoctorinthefamily.com...ory/index.html

Slate has some interesting left-leaning pieces:
http://www.slate.com/id/2161736/
http://www.slate.com/id/2114554/
http://www.slate.com/id/2099036/

For the free marketeeers:
http://www.marketmed.org/fmm.asp?fmmfont=fontsml

You can search all manner of health policy topics in the scientific literature with PubMed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
The journal Health Affairs has a lot of free content:
http://www.healthaffairs.org/

 

[Argonaut8]

I'm very opposed to it for a number of reasons, perhaps most important of which is the fact that it doesn't work. Maybe a nice idea, but completely unworkable. We had an ethics and character luncheon at our school and the speakers addressed this as the main topic. Overcrowded ERs is one issue. People are already terribly impatient having to wait a few hours at the ER to be seen; I witnessed this as a volunteer. Can you imagine if they had to wait a few DAYS to be seen?

This isn't what would happen. You think people like to go to the ER for their primary care just because it's fun to have to wait multiple hours to be seen? When people have access to primary and urgent care, they use it. This is not a bad thing. Many more people would get proper preventative care, and that can only be a good thing.

I've also heard of people having to wait so long to have surgery that women in need of a mastectomy had their cancer metastasize unnecessarily and people needing orthopedic surgery had to wait for a year or more to have it. With our population what it is and growing at that, supply could NOT meet demand if we had a universal health care system.

Here's what I don't understand about this argument. Are you saying that if we had universal healthcare, we would suddenly have more people needing surgery and thus there would be more wait times for the same amount of physicians, or are you saying that the people who need life-saving surgery but have no insurance should just have to die because they lack access to care, so that the people who CAN afford it can get their elective surgeries with no delay?

My husband is Canadian, and I've personally seen how their health system works. Sure, my mother-in-law did have to wait a week to get surgery for her uterine prolapse, but she thought that was a small price to pay to be sure that everyone in her country who needs surgery will have access to it, and to be sure that if she needed a more emergent surgery, it would be prioritized ahead of other people's uterine prolapses. If she had been in need of a mastectomy, it would not have been allowed to metastasize, because that's clearly a high priority.

 

[bcat85]

The advocates of UHC seem to think that providing free primary care to everyone will in some way improve the health of the country. This is NOT true. The fat will get fatter, the smokers will continue to smoke. Regardless of whether you arm yourself with the thousands of dollars of pharmacological firepower, the fact is that you cannot change individuals behavior. We are not 40th in the world because we have a bad healthcare system, we are 40th in the world because we have one of the highest rates of obesity, heart disease, and diabetes in the developed world. This, mind you, is in no way a physician's fault. And thanks to EMTALA, everyone gets free urgent medical care anyway. You cannot legislate personal responsibility. People either develop it, or they don't.

 

[Gut Shot]

The advocates of UHC seem to think that providing free primary care to everyone will in some way improve the health of the country. This is NOT true.

Then how do you explain the higher morbidity and mortality risks associated with being uninsured? A good summary was published by the Institute of Medicine back in 2002.

 

[Trismegistus4]

Per capita we pay twice as much towards healthcare compared to any other country. Meanwhile overall we are ranked ~#40 in the world by the WHO.

To hell with the WHO. One of their criteria is how "fairly" health care is "distributed;" therefore, their rankings carry an inherent bias toward more socialistic systems. Not to mention their reliance on life expectancy, which is affected by things like murders and auto accidents which a universal health care system would do nothing to prevent.

 

[ManualEvac]

I need to update this list, but I'll post it (again) anyways:

Interesting reading, Gut Shot, although some links were not working for me. I especially liked the VA piece at:

http://www.slate.com/id/2114554/

Detractors of UHC should take a look because it highlights the free market failures of our current private system. As we move to higher and more expensive technology, infrastructure in hospitals has been sluggish to keep up, e.g. the EXTREMELY clumsy move toward electronic records systems in the U.S. Strict free marketeers need to review the section on public goods in the macroeconomics text they're pounding. If the cost of building a viable health information network outweighs the short-term benefit, stockholders are not going to jump on it, even though 25 years down the road, errors may be significantly reduced and efficiency may be exponentially improved. That's why we need government capital and long-term infrastructure to stabilize health care delivery.

Sorry, young entrepreneurs, but the large-scale public health economy doesn't work like a mom-and-pop fruit stand. The stakes and costs are much higher than can be managed by 3rd party brokers, and for all its problems, the government is better equipped to manage it, IMO as a seasoned and fairly successful private businessman in the health field.

 

[bcat85]

Then how do you explain the higher morbidity and mortality risks associated with being uninsured? A good summary was published by the Institute of Medicine back in 2002.

The uninsured tend to have other problems complicating their health. Specifically, they have a tendency to be the most overweight.

Compare the poorest states in the union:
http://money.cnn.com/2007/08/28/real_estate/wealthiest_states/index.htm

And then look at the list of the most obese:
http://calorielab.com/news/2007/08/06/fattest-states-2007/

Remarkably similar. This is probably moreso due to a lack of nutritional information, rather then a lack of healthcare access.

 

[167649]

Interesting reading, Gut Shot, although some links were not working for me. I especially liked the VA piece at:

http://www.slate.com/id/2114554/

Detractors of UHC should take a look because it highlights the free market failures of our current private system.

Our current system is far from a true free market. And don't forget that the status quo was even created by government intervention, the HMO act of 1973 being the prime example.

I am not a detractor of UHC, but I am certainly against socialized medicine. The two terms are not synonymous. I am all for achieving UHC by moving towards a free market with limited government intervention.

 

[Ahmed786]

Did anyone see the movie "Sicko"? Even though I found it quite entertaining, I know I probably should be taking it with a grain of salt. What about is completely wrong as to why we should have UH.

Personally, I do not know enough about the issue but I know that Obama plans to not start universal healthcare but instead make sure that EVERY American in the U.S. has insurance which is extremely important since the number of uninsured Americans is in the tens of millions.

 

[VPDcurt]

A cousin of mine lives in Canada and tore his ACL 11 months ago. He's literally limping around and his knee buckles when we walks because it's so unstable. They continue to push him aside for other "emergencies" as they put it. As far as the knee goes, a torn ACL is pretty bad so I'm not sure what these other people have. On top of it all, for the "free" healthcare, he pays 52% income tax and 14% or so in sales tax. That's insane. People should decide how they spend their own money - not be forced to give 60% away to a system that is so inefficient and wasteful it's disgusting. Anyway, it's such a disaster. Our government can't even run the DMV or Amtrak in an efficient manner so I sure as hell don't trust them with our healthcare. It's also not feasible with our current tax system. Taxes would have to skyrocket to cover that - so if you're complaining about gas being expensive, that's nothing compared to what you'd be paying in taxes with a socialized system.

 

[167649]

Did anyone see the movie "Sicko"? Even though I found it quite entertaining, I know I probably should be taking it with a grain of salt. What about is completely wrong as to why we should have UH.

Entertaining is the right word. Informative, no. He makes opinion films, not documentaries.

 

[bcat85]

A cousin of mine lives in Canada and tore his ACL 11 months ago. He's literally limping around and his knee buckles when we walks because it's so unstable. They continue to push him aside for other "emergencies" as they put it. As far as the knee goes, a torn ACL is pretty bad so I'm not sure what these other people have. On top of it all, for the "free" healthcare, he pays 52% income tax and 14% or so in sales tax. That's insane. People should decide how they spend their own money - not be forced to give 60% away to a system that is so inefficient and wasteful it's disgusting. Anyway, it's such a disaster. Our government can't even run the DMV or Amtrak in an efficient manner so I sure as hell don't trust them with our healthcare. It's also not feasible with our current tax system. Taxes would have to skyrocket to cover that - so if you're complaining about gas being expensive, that's nothing compared to what you'd be paying in taxes with a socialized system.

This was exactly the point I was going to make. I also like your signature

Entertaining is the right word. Informative, no. He makes opinion films, not documentaries.

Sure. You can find support for almost any opinion on anything. Look at the 9/11 truth movement.

 

[bawer234]

The uninsured tend to have other problems complicating their health. Specifically, they have a tendency to be the most overweight.

Compare the poorest states in the union:
http://money.cnn.com/2007/08/28/real_estate/wealthiest_states/index.htm

And then look at the list of the most obese:
http://calorielab.com/news/2007/08/06/fattest-states-2007/

Remarkably similar. This is probably moreso due to a lack of nutritional information, rather then a lack of healthcare access.

Very interesting find, thanks bcat85.

 

[Gut Shot]

The uninsured tend to have other problems complicating their health. Specifically, they have a tendency to be the most overweight.

Compare the poorest states in the union:
http://money.cnn.com/2007/08/28/real_estate/wealthiest_states/index.htm

And then look at the list of the most obese:
http://calorielab.com/news/2007/08/06/fattest-states-2007/

Remarkably similar. This is probably moreso due to a lack of nutritional information, rather then a lack of healthcare access.

I admire your glorious leap in logic, but it doesn't hold much water. It has been well documented that those who lack health insurance are less likely to obtain needed care than their insured counterparts, and this results in poorer health outcomes. You'll see it many, many times before 2012. Here, I'll refer you to this seminal 1993 report, which controlled for a number of confounding factors and still identified a significant, independent connection between insurance status and mortality risk:

Health insurance and mortality. Evidence from a national cohort.
Franks P, Clancy CM, Gold MR.
Department of Family Medicine, University of Rochester, NY.
JAMA. 1993 Aug 11;270(6):737-41.

OBJECTIVE--To examine the relationship between lacking health insurance and the risk of subsequent mortality. DESIGN--Adults older than 25 years who reported they were uninsured or privately insured in the first National Health and Nutrition Examination Survey, a representative cohort of the US population, were followed prospectively from initial interview in 1971 through 1975 until 1987. PARTICIPANTS--Complete baseline and follow-up information was obtained on 4694 (91%) persons of the 5161 who reported not receiving publicly funded insurance at baseline. MAIN OUTCOME MEASURE--The relationship between insurance status and subsequent mortality was examined using Cox proportional hazards survival analysis. The analysis adjusted for gender, race, and baseline age, education, income, employment status, the presence of morbidity on examination, self-rated health, smoking status, leisure exercise, alcohol consumption, and obesity. The effects of interactions between insurance and all other baseline variables were also examined. RESULTS--By the end of the follow-up period, 9.6% of the insured and 18.4% of the uninsured had died. After adjustment for all other baseline variables, the hazard ratio for lacking insurance was 1.25 (95% confidence interval [CI], 1.00 to 1.55). The effect of insurance on mortality was comparable to that of education, income, and self-rated health. There were no statistically significant (P < .05) interactions. CONCLUSIONS--Lacking health insurance is associated with an increased risk of subsequent mortality, an effect that is evident in all sociodemographic health insurance and mortality groups examined.

 

[45408]

Per capita we pay twice as much towards healthcare compared to any other country. Meanwhile overall we are ranked ~#40 in the world by the WHO. Every other developed country has some form of universal healthcare. Our current insurance based system is !@#$ up, I read that 40-60% of cost of healthcare is to deal with the insurance administration cost, how ridiculous!

It's ridiculous because it's not true. Insurance overhead isn't insignificant, but the highest estimates I've seen are about half of what you're suggesting, and even then, the suggestion that Medicare is better because its overhead is only a few percent reveals a lack of understanding of the system.

Your comments that seem to allude that our costs would decrease if we switched to universal health care have no foundation in reality. Other countries spend less, but that doesn't mean that if we adopted their system, we would also spend less. Lots of confounders...

 

[VneZonyDostupa]

Hey, how about instead of rehashing the same boring, flame-tastic, ad hominem-filled argument on an internet messageboard, we all go out and vote in Novermber (rather than not, as our age group tends to do). Everyone vote for the candidate who you think supports the best healthcare option, and if your side wins, great! If your side loses, then suck it up, as that would mean America has spoken. Your opinion is not more valuable than the majority's, regardless of how loud or how many times you state it.

 

[bcat85]

I'm not arguing that people should be kept uninsured, because I do not believe that. I just have very little faith in the government to run this program effectively (SEE: Medicare, Medicaid, or VA Hospitals). There is no reason to create more inefficient bureaucracy then is already present in American society. Additionally, the idea of drawing a parallel to other European countries is ludicrous because of the demographics of our people. There is no Old Country Buffet in London. Overeating and living a sedentary lifestyle crush any hope of keeping our healthcare costs under control. The solution is in the use of preventative medicine and giving more control over patient care back to physicians (though this presents it's own set of problems). The duty to say "We have done all that we can, so we will not be continuing medical care" will be forced upon physicians because of the limits to care put on by UHC policies. This, in theory, could be good because it would prevent doctors from being forced by a family to torture a dying patient for weeks, but it will not gel well with the public.

The perception seems to be that "new is better." The reality is that, even with the advent of "socialized medicine," which seems to be the way it will eventually end up, there will be a new set of problems. 25% of the country can not financially afford to support the other 75% of the country.

In response to a previous criticism, I was merely pointing to the fact that obesity is correlated with poverty (which is counterintuitive). And it is:

A review published in the January 2004 issue of the American Journal of Clinical Nutrition provides an important analysis of poverty and obesity and supports the notion that addressing obesity more effectively requires confronting it as a societal and public health problem.[4] Dr. Adam Drewnowski, Director of the Center for Public Health Nutrition in the University of Washington School of Public Health and Community Medicine, and Dr. SE Specter, United States Department of Agriculture Human Nutrition Research Center, Davis, California, analyze the rising trend of obesity in the United States in terms of dietary energy density and energy costs. They review a substantial body of literature showing that low income and low education levels are associated with obesity in the United States; this is especially the case for women.

http://www.medscape.com/viewarticle/469027

 

[45408]

Your opinion is not more valuable than the majority's, regardless of how loud or how many times you state it.

It is more valuable if the Constitution is on your side, and it's not on the side of the opposing view. A federally-run single payer health care system is not constitutional.

 

[VneZonyDostupa]

It is more valuable if the Constitution is on your side, and it's not on the side of the opposing view. A federally-run single payer health care system is not constitutional.

Hmm, well, it's your opinion that the Constitution is on your side, and it's also your opinion that such a program is unconstitutional. I don't recall any clauses in the document expressly stating that such a program is not to be allowed...source please?

 

[Gut Shot]

I'm not arguing that people should be kept uninsured, because I do not believe that. I just have very little faith in the government to run this program effectively (SEE: Medicare, Medicaid, or VA Hospitals). There is no reason to create more inefficient bureaucracy then is already present in American society. Additionally, the idea of drawing a parallel to other European countries is ludicrous because of the demographics of our people. There is no Old Country Buffet in London. Overeating and living a sedentary lifestyle crush any hope of keeping our healthcare costs under control. The solution is in the use of preventative medicine and giving more control over patient care back to physicians (though this presents it's own set of problems). The duty to say "We have done all that we can, so we will not be continuing medical care" will be forced upon physicians because of the limits to care put on by UHC policies. This, in theory, could be good because it would prevent doctors from being forced by a family to torture a dying patient for weeks, but it will not gel well with the public.

The perception seems to be that "new is better." The reality is that, even with the advent of "socialized medicine," which seems to be the way it will eventually end up, there will be a new set of problems. 25% of the country can not financially afford to support the other 75% of the country.

You're a bright kid, but as Alexander Pope said, a little knowledge is a dangerous thing. This is an enormously complex topic, and while I've read extensively for a number of years, I have barely grasped the tip of the proverbial iceberg.

In response to a previous criticism, I was merely pointing to the fact that obesity is correlated with poverty (which is counterintuitive). And it is:

No, it's not counterintuitive in a country that has easy access to inexpensive, calorie rich, nutrient poor food. And the only reason for you to bring it up was as a confounder to the link between insurance status and morbidity/mortality risk. You're correct, it is associated with both poverty and poor health, but that's not the issue here. Your earlier proclamation was that universal primary care would not improve health in the country, and I believe that's demonstrably false.

 

[Gut Shot]

A cousin of mine lives in Canada and tore his ACL 11 months ago. He's literally limping around and his knee buckles when we walks because it's so unstable. They continue to push him aside for other "emergencies" as they put it. As far as the knee goes, a torn ACL is pretty bad so I'm not sure what these other people have.

Stories like this would always be more persuasive to me if I couldn't think of a dozen worse counterexamples here in the US... off the top of my head. I know a guy right now who fought with his insurance company for a year to cover an abdominal CT that was ordered on three separate occasions by three separate doctors. When he finally got it (after changing insurance plans) he finds out that he has (now) inoperable, malignant cancer in his abdominal wall. Oh, and he's 25 years old. USA! USA!

Would this have happened in Canada? Probably. France, Germany or Japan? Hell no.

On top of it all, for the "free" healthcare, he pays 52% income tax and 14% or so in sales tax. That's insane.

That is insane, especially considering that 52% is impossible under the standard 2008 Federal and Provincial tax rates. The sales taxes are pretty steep, though... ouch!

Oh well, it could be worse.

 

[AmoryBlaine]

Stories like this would always be more persuasive to me if I couldn't think of a dozen worse counterexamples here in the US... off the top of my head. I know a guy right now who fought with his insurance company for a year to cover an abdominal CT that was ordered on three separate occasions by three separate doctors. When he finally got it (after changing insurance plans) he finds out that he has (now) inoperable, malignant cancer in his abdominal wall. Oh, and he's 25 years old. USA! USA!

Would this have happened in Canada? Probably. France, Germany or Japan? Hell no.

That is insane, especially considering that 52% is impossible under the standard 2008 Federal and Provincial tax rates. The sales taxes are pretty steep, though... ouch!

Oh well, it could be worse.

So these "horror stories" tend to be fairly compelling on the surface but I think we should avoid them in a serious discussion of a serious issue.

Why? Because you're going to find these things on both sides of the aisle and they don't contribute much to the argument unless you are trying to a Michael Moore bit of rubbish which does nothing but identify problems.

Just to pick on GutShot because I quoted his post: this story obviously sucks but it raises as many questions as it answers. What are the indications for an outpatient abdominal CT in a 25 year old? The only things I could come up with would be to investigate some sort of palpable mass. If the guy is in the ER with 10/10 belly pain the story gets a little different but I'd like to hear more history on this dude.

An earlier poster mentioned how someone hobbled around Canada with a torn ACL. Also sucks, no question about that. But if we keep trading these pointless barbs all were going to end up with is...

-stories from countries with universal systems about people who had to wait "outrageous" times for care
-stores from the US about "outrageous" failure of the system to render care at all

It's pretty hard to see who will win this particular p***ing contest.

 

[167649]

Hmm, well, it's your opinion that the Constitution is on your side, and it's also your opinion that such a program is unconstitutional. I don't recall any clauses in the document expressly stating that such a program is not to be allowed...source please?

The 10th amendment:

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

AKA anything not delegated to the federal government in the constitution is outside it's legal authority. So you don't need an amendment banning a national single payer system run at the federal tier.

There is, however, nothing stopping a state or locality from doing this, so long as their own constitutions and laws permit it. Which is why (among other reasons) if there is to be any govt involvement in any attempt to acheive UH, it needs to be at a state or local level.

 

[Gut Shot]

What are the indications for an outpatient abdominal CT in a 25 year old?

It began as intermittent pain that increased with duration, intensity and frequency until eventually the area developed a palpable mass. It was bad enough for him to making rounds to specialists when it was still just pain. A CT was grasping at straws, to be sure, but in this case there was a straw... a rare and awful straw.

 

[Chizwheel]

Lots of interesting thoughts and theories here.

One things for sure is that there is no easy solution to this health care crisis. Anyone who thinks it's an easy fix is a fool.

One thing everyone must understand, especially the general public, is that healthcare is a limited resource. It is not limitless. And healthcare has 3 parts to it. Cost, Acess to Care, and Quality. Because healthcare is a limited resource, any change to one will adversely affect the others.

Increased access to care under UHC will either result in increased costs or decreased quality.

Increased quality results in either increased costs or decreased access to care (much like boutique or concierge medicine).

And decreasing costs will either result in decreased access to care or decreased quality (similar to cutting funding for medicare/medicaid).

What many Americans expect is improvement in all 3 simultaneously. This is what the country demands and what they will not get. Politicians pander to the public's skewed perception of this and make promises without explaining implications and the public eats it up. They never think past the next step or what will that result in for my taxes or in certain scenarios. Essentially, the public lacks the ability to make an informed decision. They just cheer for whatever they are spoon fed like a child eating ice cream.

Under UHC, it is true that the uninsured will gain insurance, and will increase their health status as a population. At the individual level, there will still be multiple problems and concerns that will not be addressed. The results of UHC will never meet the expectations of the public resulting in a social failure of the system and continued high costs and poor quality of care.

 

[Gut Shot]

GutShot, a couple simple questions...

They're anything but simple, but I'll play along until I get bored.

1. Please define exactly what you mean by "universal healthcare" . (Hint: Identify which services will be provided and by whom, how people will be covered, etc.)

The term "universal health care" simply means that some level of health care is extended to all citizens. It says nothing about the nature of the system used to achieve universal care. It's a goal, not a plan.

Bearing that in mind, also a useful way to tell who knows what they're talking about in one of these debates. For instance, on top of reiterating that tired P. J. O'Rourke quote in post #2, in post #5 you came out swinging with "Universal = Lowest Common denominator. People pushing it haven't taken econ 101. If you've taken econ, and don't understand this concept, PM me. If you haven't, take some basic econ please. We need some basis at least for rational discussion."

This is always very satisfying because here I know you've got a razor thin understanding of health policy, but you've already chosen to be a condescending knowitall cornhole. You could be discussing the nuances of socialized vs. consumer driven vs. hybrid systems, of employer mandates, etc. But Europe is not a country, and universal health care is not a single, monochromatic entity. Hint: you should spend less time bragging about your vast knowledge of economics and more time learning the basics of this topic.

2. After you've defined your version of "universal healthcare", discuss who will be paying for it and how. (Give real #s with supporting references if you want credit on this question.)

Extra Credit. Describe how your plan is both politically feasible and supported by a majority of healthcare workers (i.e., physicians).

Thank you.

No, thank you for providing a target rich environment in my war to exterminate health policy ignorance.

 

[45408]

Hmm, well, it's your opinion that the Constitution is on your side, and it's also your opinion that such a program is unconstitutional. I don't recall any clauses in the document expressly stating that such a program is not to be allowed...source please?

Tenth Amendment

 

[bcat85]

You're a bright kid, but as Alexander Pope said, a little knowledge is a dangerous thing. This is an enormously complex topic, and while I've read extensively for a number of years, I have barely grasped the tip of the proverbial iceberg.



No, it's not counterintuitive in a country that has easy access to inexpensive, calorie rich, nutrient poor food. And the only reason for you to bring it up was as a confounder to the link between insurance status and morbidity/mortality risk. You're correct, it is associated with both poverty and poor health, but that's not the issue here. Your earlier proclamation was that universal primary care would not improve health in the country, and I believe that's demonstrably false.

I did not effectively research the effects of universal access to primary care, so I retract that statement. However, economically, It seems that providing universal primary care would result in diminished returns. There are too many other confounding factors that negatively influence an individual's health for access to primary care to be effective. Additionally, the patient would then be forced to pay for his/her pharmaceuticals. If they cannot pay for a $60-100 visit to a medical clinic, how are they going to pay for monthly supplies of blood pressure medication, cholesterol medication, insulin, etc. A more effective initiative would be a more public-health oriented approach that focused on educating the impoverished about nutritional options, sexual health, the dangers of drug use, etc. Now, I do not argue that catastrophic medical coverage should be available to all individuals (I'm talking 3-5k deductible type coverage), but I should not have to pay for someone's $100 primary care visit because they would rather have a new pair of shoes or watch digital cable for a month. Most of the extremely impoverished are already covered by medicaid, and children are covered by SCHIP in many states.

 

[45408]

The 10th amendment:

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

AKA anything not delegated to the federal government in the constitution is outside it's legal authority. So you don't need an amendment banning a national single payer system run at the federal tier.

There is, however, nothing stopping a state or locality from doing this, so long as their own constitutions and laws permit it. Which is why (among other reasons) if there is to be any govt involvement in any attempt to acheive UH, it needs to be at a state or local level.

Ah, you beat me to it. I would very much like to see a state or city attempt a universal health care program, because I think it has the potential to work on a smaller level than a nation-wide clusterfawk. One state can learn from another, and it would be much easier to adapt a new program in a new state than it would be to jam one huge square peg into one huge round hole. Most of the developed nations with single-payer systems have a much smaller population, a much more homogeneous population or both.

I am against a federally run system. If it is up to the states, that's fine. One state f's up, move to another.

Exactly. Want a different program? Move to a state that suits your needs.

 

[167649]

Ah, you beat me to it. I would very much like to see a state or city attempt a universal health care program, because I think it has the potential to work on a smaller level than a nation-wide clusterfawk. One state can learn from another, and it would be much easier to adapt a new program in a new state than it would be to jam one huge square peg into one huge round hole. Most of the developed nations with single-payer systems have a much smaller population, a much more homogeneous population or both.

Exactly. Want a different program? Move to a state that suits your needs.

It's almost like a geographic free market. Sure, it's more complicated than that, but the key word is choice; I can choose where to live but with a national system I have no choice.

Plus, an issue I think a lot of people overlook is that states and local govts are going to be much more sensitive/accountable to needs of individuals and local communities. This is pretty important in regards to preventative medicine and public health, which would be key if we want to cover everyone without going broke. I just don't see how we could address the different ph and preventative needs of 50 states, 3,000 counties, and 300,000,000 people who together compose the most diverse population in the world with one, giant monster of a single payer system.

 

[pianola]

Doesn't Obama have a plan to cover all children? How does that sound? Would that be something anyone feels like agreeing on?

(Probably not, but worth a shot, I suppose, right?)

 

[VneZonyDostupa]

Tenth Amendment

Well, that's your interpretation and opinion of the Constitution and it's stipulations. In my opinion, as well as the opinion of many Congressmen/women and Justices, the "general welfare" clause in the Preamble implies the welfare of the people is a federal issue, delegated to the federal government.

Like I said, however, this is just my opinion, which is no more valid or correct than your opinion, the only difference being that your are arrogant enough to not recognize yours is an opinion, not a fact.

 

[Gut Shot]

Precisely why I asked what exactly YOU mean by "universal healthcare".

I told you the definition of universal health care. It's not up for debate or personal interpretation. If every citizen is extended some level of coverage then health care is universal. Do you want to know what system I would prefer? Would you like me to expand on their pros and cons?

Tell us please what will be included in your definition of "universal healthcare". And if you are going to stick by your notion of it's some level of access of healthcare for everyone, well then we already have "universal healthcare".

I do stick by my "notion," but clearly we do not have universal health care in the US. Every other industrialized nation does. Access does not equal coverage. The level of coverage, and the mechanisms by which it is administered, vary greatly from country to country, but being guaranteed stabilization in an ER does not UHC make. If it does, then we have the most expensive and least effective UHC system in the world. Should that make us proud?

No one said Europe was a country... do you?

Do I what? I was simply making a comparison. Sorry if it was lost on you.

Please don't get a jackass attitude just because you can't answer some questions. Define what you are talking about and then back it up.

What's to back up? I haven't offered anything. I find your questions inane and puerile, and frankly I've taken enough tests in my life. Google is your friend.

As it stands now, it's best to let the states come up with some stuff that might work than trying to roll out another failure like medicare and social security.

Wow, now that's a detailed, comprehensive plan to salvage health care! FWIW, to date social security and Medicare have both been enormously popular and successful programs. Ask anyone over the age of 65. If you can think of a better way to get seniors their health care, I recommend you try it on you folks. Contrary to what many think, the architects of both programs knew full well that they would face financial challenges through the decades. What they didn't know was that we'd be in a semi-permanent partisan logjam in Washington.

 

[Gut Shot]

I did not effectively research the effects of universal access to primary care, so I retract that statement. However, economically, It seems that providing universal primary care would result in diminished returns. There are too many other confounding factors that negatively influence an individual's health for access to primary care to be effective.

No, access to primary care is well known to improve health outcomes, and this is good for society on many levels, including economically. There is a more recent report, but for starters I'll link you another IOM report (in a 2004 issue of Health Affairs, which is a great journal for this discussion): Covering The Uninsured: What Is It Worth?

One out of six Americans under age sixty-five lacks health insurance, a situation that imposes sizable hidden costs upon society. The poorer health and shorter lives of those without coverage account for most of these costs. Other impacts are manifested by Medicare and disability support payments, demands on the public health infrastructure, and losses of local health service capacity. We conclude that the estimated value of health forgone each year because of uninsurance ($65–$130 billion) constitutes a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally.

Additionally, the patient would then be forced to pay for his/her pharmaceuticals. If they cannot pay for a $60-100 visit to a medical clinic, how are they going to pay for monthly supplies of blood pressure medication, cholesterol medication, insulin, etc.

Same way they do now: Medicare Part D, $4 generics at Walmart, and giving up the filet mignon for Alpo.

A more effective initiative would be a more public-health oriented approach that focused on educating the impoverished about nutritional options, sexual health, the dangers of drug use, etc. Now, I do not argue that catastrophic medical coverage should be available to all individuals (I'm talking 3-5k deductible type coverage), but I should not have to pay for someone's $100 primary care visit because they would rather have a new pair of shoes or watch digital cable for a month.

Primary care is cheap, dude. It's secondary and tertiary care that's expensive. Here, let me give you an example from my M3 year. I had a patient who was a laid off seamstress with diabetes. She couldn't afford the medication to control her blood pressure, so she was going blind and thus less and less able to get work. She was essentially waiting until she was legally blind, at which point she could file for disability and receive treatment. Oh, and she didn't qualify for Medicaid because her family had too much money (they lived in some single wides).

You can pay a little now or a lot later. Your choice.