'Obamacare' to the rescue

[eHombre]

---

Members do not see this ad.

An op-ed by a breast cancer patient in today's LA Times that encapsulates what's wrong with employer-based health insurance. The PPACA might be making life uncomfortable for some physicians and no product of legislative wrangling is perfect, but it's a step in the right direction and it's already saving lives.

http://www.latimes.com/news/opinion...-praise-of-obamacare-20111206,0,6794828.story

"If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn't mean that you're better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn't depend on luck."

 

[Ormm]

Thanks for sharing this! 🙂

 

[NickNaylor]

Interesting read, but feel-good stories from patients is hardly evidence that the ACA is "working."

By the way, I think some of the things the ACA does is great. I'm not a wholesale opponent of it. However, I disagree with your implication that it demonstrates that a single-payer model is the way to go. At least I'm assuming that's what you're hinting at.

 

[Ebola4Breakfast]

Not a popular opinion around these parts, but I agree with this article. ObamaCare is far from perfect, but it does stop some of the more deplorable acts of the health insurance industry.

As a cancer survivor, I was dropped from my parents' health insurance at age 22. I was rejected from every private health insurance company I applied to for a "pre-existing health condition"... namely the fact that the chemotherapy I had makes me more likely to develop a secondary cancer later in life. I enrolled in the costly COBRA option which my parents graciously paid to tide me over until graduate school. Had I let my health insurance coverage lapse at any time, all pre-existing condition would not have been covered for a year when I started my grad school health insurance. No one is asking for an advantage. We're simply asking for an even playing field.

 

[TXKnight]

An op-ed by a breast cancer patient in today's LA Times that encapsulates what's wrong with employer-based health insurance. The PPACA might be making life uncomfortable for some physicians and no product of legislative wrangling is perfect, but it's a step in the right direction and it's already saving lives.

http://www.latimes.com/news/opinion...-praise-of-obamacare-20111206,0,6794828.story

"If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn't mean that you're better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn't depend on luck."

👍 I believe PPACA is a first step in the right direction too.

 

[IMSingular]

Well the story exemplifies selfishness. She only realised it when she directly benefited from it. Reminds me of Ronald Reagan. When his pop got a job under WPA he was a Democrat. When his time came to pay taxes he became a Republican. Then when he was having alzheimers all of his family was rooting for funding NIH and reseach on alzheimers.

 

[Ebola4Breakfast]

Well the story exemplifies selfishness. She only realised it when she directly benefited from it. Reminds me of Ronald Reagan. When his pop got a job under WPA he was a Democrat. When his time came to pay taxes he became a Republican. Then when he was having alzheimers all of his family was rooting for funding NIH and reseach on alzheimers.

I disagree. I think this story exemplifies the fact that the average person doesn't know jack about their health insurance coverage or the positive changes that have been enacted under ObamaCare until they end up on the receiving end of a medical disaster.

 

[RogueUnicorn]

one day this country may be civilized enough to accept healthcare as a right of most and not a privilege of the few.

 

[gettheleadout]

one day this country may be civilized enough to accept healthcare as a right of most and not a privilege of the few.

The only problem with this is that are we then obligated as providers to render services to everyone? If so, what happens when (as is the case now) there aren't enough of us to go around?

 

[Bartemius]

The real issue I have with Obamacare is the lack of spending control. 17.6% of the GDP went to health care in 2010; by 2020, it's expected to approach 20%, or almost $4.5 trillion.

Obamacare isn't addressing the real issues undermining health care. The 85/15 rule states that 15% of a nation's health can be attributed to it's health care system, while the other 85% comes down to social factors. Obamacare's trying to push more and more money into that 15%, with grossly diminishing returns.

Obama's got the right idea, though. Real health reform is social reform, and maybe after several decades and seven Presidents pushing for health reform to no avail, Obama might actually be the first to spin the wheel. I just think there needs to be a bigger focus on obesity education and overall "downward-spiral" prevention, since the vast majority of health care costs are related to chronic disease management, end-of-life and emergency room care.

My $0.02

 

[FoxyMD30]

Read the book "The Healing of America" by T.R. Reid.

100% great information and a reasonably quick, entertaining read about universal healthcare systems worldwide, the US system, and PPACA.

 

[FoxyMD30]

Getheleadout-

It shouldn't be a "problem" for doctors to treat patients. If you're a uro, or other specialist, you're not "obligated" to see cardiac patients or others you aren't trained to treat. In most universal systems, the GPs don't feel "obligated" to see everyone, they are HAPPY they get the chance to treat everyone who needs their help, equally. They make less money than US docs, but they don't have to deal with billing nightmares like in the US, don't have the threat of malpractice (yes they pay mal. ins., but tiny premiums and they are rarely sued), and they get to do what they are trained to do- HEAL- without all the bull***t.

Everyone gets seen (by GPs in most systems) for basic healthcare, but NOT everything is covered. Some systems cover dental, physio, massage, acupuncture, etc, and some don't. It's culture dependent. Most countries still allow physicians to perform elective procedures if they choose (cosmetic, etc) that can be covered by supplemental insurance policies pts can buy. Also, some GPs get incentives to keep their patients away (Britain) and healthy. If you have a base of 1000 patients you have to see when they get sick, you are going to be a lot more likely to practice the preventative medicine that will keep them from diabetes, hypertension, obesity, etc. and out of your office. Universal coverage can lead to fewer visits, if it is done intelligently.

In Japan you can walk right in to an ortho with no appointment and be seen straightaway and schedule a covered surgery in a week. In other countries the GPs are gatekeepers to cut down on that- GP can refer pt to a specialist, who sometimes have waiting lists, sometimes not. In Canada it might take a year for a consult and another year for covered surgery. In Britain, you can get the consult but the surgery won't be paid for.

When there aren't enough GPs to go around, the govt needs to provide more incentives for the specialty, but supply will eventually get much closer to fulfilling demand, IF the public and politicians make it a priority.

 

[IMSingular]

I disagree. I think this story exemplifies the fact that the average person doesn't know jack about their health insurance coverage or the positive changes that have been enacted under ObamaCare until they end up on the receiving end of a medical disaster.

That's what I mean by selfishness: you don't care or care to understand until it hits you personally. Democracy to function people should care about others and not just their own pocketbook. More egrigeous selfishness is once one gets his benifits from the government one doesn't care about others. Well woman seems to be flip-flopper.

 

[Gut Shot]

The real issue I have with Obamacare is the lack of spending control. 17.6% of the GDP went to health care in 2010; by 2020, it's expected to approach 20%, or almost $4.5 trillion.

Reform actually funds many projects to experiment with various cost control measures. The problem is that we don't know which, if any of them, will pay off. Should I be surprised that almost nobody knows this?

 

[sirenomelia]

one day this country may be civilized enough to accept healthcare as a right of most and not a privilege of the few.

Medical care is a service that has to be paid for not a right anyone is entitled to.

 

[Schizotypy]

Reform actually funds many projects to experiment with various cost control measures. The problem is that we don't know which, if any of them, will pay off. Should I be surprised that almost nobody knows this?

I've done a lot of reading on the ACA and didn't know this until I read Remedy & Reaction (http://yalepress.yale.edu/book.asp?isbn=9780300171099). I'd say you shouldn't be surprised because it's somewhat difficult to find a lot of clear, yet detailed information on the reform efforts.

 

[theseeker4]

Medical care is a service that has to be paid for not a right anyone is entitled to.

Don't you get it? Everything is a right now a days. Which makes each and every health care worker a slave to anyone who wants to exercise their "right" to as much health care as they want.🙄 After all, if you decline to see someone, anyone, you are violating their rights by not providing them health care.👎

 

[Ebola4Breakfast]

I've done a lot of reading on the ACA and didn't know this until I read Remedy & Reaction (http://yalepress.yale.edu/book.asp?isbn=9780300171099). I'd say you shouldn't be surprised because it's somewhat difficult to find a lot of clear, yet detailed information on the reform efforts.

+1; I've tried to educate myself, but it has been really difficult to differentiate the facts from the abundance of political rhetoric.

 

[candav]

The only problem with this is that are we then obligated as providers to render services to everyone? If so, what happens when (as is the case now) there aren't enough of us to go around?

Then you ration, as you point out is already happening in the US anyway, but you ration on the basis of need, not financial or employment status. That's a more just system.

 

[NickNaylor]

Then you ration, as you point out is already happening in the US anyway, but you ration on the basis of need, not financial or employment status. That's a more just system.

You mean like in the UK? Where if treatments cost more than $50k per year, your insurance (HMS) simply won't pay for it? Keep in mind that $50k limit is easily surpassed in many cancer treatments, which is why cancer morbidity in the UK is worse than it is in the US.

That doesn't sound like rationing on the basis of need to me.

 

[theseeker4]

Then you ration, as you point out is already happening in the US anyway, but you ration on the basis of need, not financial or employment status. That's a more just system.

Forcing people to pay for others' health care is more just? Thanks, but I prefer to live in a free country, not a nanny-state that is some leftist's ideal of "more just."

 

[NickNaylor]

You mean like in the UK? Where if treatments cost more than $50k per year, your insurance (HMS) simply won't pay for it? Keep in mind that $50k limit is easily surpassed in many cancer treatments, which is why cancer morbidity in the UK is worse than it is in the US.

That doesn't sound like rationing on the basis of need to me.

By the way, I'm sure I'll be attacked on the truthfulness of this at some point, so I'll be happy to provide a source when I'm at home and not on my phone.

 

[RogueUnicorn]

The only problem with this is that are we then obligated as providers to render services to everyone? If so, what happens when (as is the case now) there aren't enough of us to go around?

you personally? no. the system as a whole? yea. that's kind of the point. as mentioned, the result will be rationing, which is already happening anyway. it will hopefully just be more rational.

Medical care is a service that has to be paid for not a right anyone is entitled to.

the services of a criminal defense attorney is something that is both paid for and a right i am entitled to.

Forcing people to pay for others' health care is more just? Thanks, but I prefer to live in a free country, not a nanny-state that is some leftist's ideal of "more just."

you and i are forced to pay for a lot of things that we may disagree with. my property taxes pay for schools i have never and will never attend. i don't enjoy my federal taxes being used to pay for bombs who may land on questionable targets. it's too bad you find a more equitable and just society to be a partisan ideal.

 

[Ebola4Breakfast]

Medical care is a service that has to be paid for not a right anyone is entitled to.

Don't you get it? Everything is a right now a days. Which makes each and every health care worker a slave to anyone who wants to exercise their "right" to as much health care as they want.🙄 After all, if you decline to see someone, anyone, you are violating their rights by not providing them health care.👎

I'm curious about these two statements. Judging by your reactions, neither of you are proponents of a socialized, government option. Correct? So then do either of you think that everyone should have access to affordable healthcare, regardless of health history, employment, pre-existing condition, etc? Or do you think the existing system prior to ObamaCare is sufficient? I don't want to argue points. I'm not trying to bait either of you into an argument. I'm just curious and want to see your views.

 

[Bartemius]

Reform actually funds many projects to experiment with various cost control measures. The problem is that we don't know which, if any of them, will pay off. Should I be surprised that almost nobody knows this?

My point wasn't that reform isn't going to try to reduce costs. I was more using standard predictions to get to my point: that some of the current efforts are tending in the wrong directions, and that the American lifestyle and mindset won't sustain lower costs without a significant impact on health.

 

[candav]

You mean like in the UK? Where if treatments cost more than $50k per year, your insurance (HMS) simply won't pay for it? Keep in mind that $50k limit is easily surpassed in many cancer treatments, which is why cancer morbidity in the UK is worse than it is in the US.

That doesn't sound like rationing on the basis of need to me.

I am not too familiar with the UK system; when you say “HMS”, do you mean the NHS - National Health Service? This is the first I’ve heard of the $50,000 cap, and a quick Google search didn’t turn up any results. Could you provide the reference for this statement? I’d appreciate it.

Also, regarding your statement: “$50k limit is easily surpassed in many cancer treatments, which is why cancer morbidity in the UK is worse than it is in the US” -- is this something you inferred yourself, or have there been studies to test this? I find it difficult to believe any study could isolate the effects of the health care system on the incidence of cancer, absent any cultural/social/psychological confounds. For instance, the US has reduced life expectancy compared to most high-income countries, but I’m not going to go ahead and say that this is due to the healthcare system.

What I get from your argument is that if universal healthcare is not perfect, it isn’t worth anyone’s time. Certainly, no one believes a universal system will fix everything; notice I said such a system would be “more just”, rather than simply “just”. But many would argue that even the $50,000/year would be invaluable to many uninsured people in the US.

I am interested to hear what you think should be done to improve the healthcare system, or if you think anything should be done at all.

 

[theseeker4]

I'm curious about these two statements. Judging by your reactions, neither of you are proponents of a socialized, government option. Correct? So then do either of you think that everyone should have access to affordable healthcare, regardless of health history, employment, pre-existing condition, etc? Or do you think the existing system prior to ObamaCare is sufficient? I don't want to argue points. I'm not trying to bait either of you into an argument. I'm just curious and want to see your views.

Correct, regarding my opposition to a socialized, government "option" (which really isn't optional if people not interested in it still have to pay for it). Exactly how to fix the system, I don't claim to know. Reducing the liability doctors have could significantly reduce the overall cost, as the practice of defensive medicine would no longer be such a huge issue (ordering tests and scans to catch the 1 in 10,000 condition because you are afraid of beings sued, etc.) If everyone had to pay something out of pocket for their medical care, that would be a huge incentive to avoid pointless and wasteful use of medical care (a la patients who show up to the ER because their arm fell asleep, but it's ok that it is a $400 visit, cause they are on disability and don't have to pay anything). Removal of the near-monopoly many insurance companies have in many states by allowing insurance companies to sell insurance across state lines would help quite a bit to bring down prices, and open up options to purchase medical care. I know these won't completely solve the spending issues, but they could help and make it affordable for more people.

For me, it basically comes down to the fact that you cannot say one person has a "right" to the work of another. Calling health care a right is doing just that. Either money will be stolen from some people to pay for the health care of others, or health care workers will have to be turned into de-facto slaves of other people's "rights". Or the "health care is a right" claim is just dishonest rhetoric. I would love it if everyone had access to quality health care, but it is not the government's responsibility, nor is it mine, to provide it for them. Health care is a service, which has to be paid for. What would the ideal system look like? I am not sure, but I am certain it doesn't involve more government control over the system. This is especially true when you consider the vast majority of health problems are the product of people knowing what they should be doing, but not doing it (eating right, exercising, smoking, managing previously diagnosed conditions, etc.) and not a basic lack of health care access. The remainder are the product of people just getting old or just having bad luck re their health. The first will certainly not be solved with government-guaranteed health coverage, and the latter will soon overwhelm our ability to pay even with extreme income taxes and significant slashing of reimbursements, as our population continues to age and we continue to be able to keep very sick, very old people breathing longer.

So in answer to the question, no, despite certain aspects of the law that may or may not be beneficial (for example, I think the provision requiring restaurant chains to post the nutrition information of their food is both a good law, and within the bounds of the interstate commerce clause of the Constitution), I do not support mandated health insurance, increased government-run health care, or an increase to the government controlling this aspect of our economy. In addition to my philosophical objection to the government running more aspects of our lives, simply try to find anything the government does well and efficiently.....

 

[NickNaylor]

I am not too familiar with the UK system; when you say "HMS", do you mean the NHS - National Health Service? This is the first I've heard of the $50,000 cap, and a quick Google search didn't turn up any results. Could you provide the reference for this statement? I'd appreciate it.

Also, regarding your statement: "$50k limit is easily surpassed in many cancer treatments, which is why cancer morbidity in the UK is worse than it is in the US" -- is this something you inferred yourself, or have there been studies to test this? I find it difficult to believe any study could isolate the effects of the health care system on the incidence of cancer, absent any cultural/social/psychological confounds. For instance, the US has reduced life expectancy compared to most high-income countries, but I'm not going to go ahead and say that this is due to the healthcare system.

What I get from your argument is that if universal healthcare is not perfect, it isn't worth anyone's time. Certainly, no one believes a universal system will fix everything; notice I said such a system would be "more just", rather than simply "just". But many would argue that even the $50,000/year would be invaluable to many uninsured people in the US.

I am interested to hear what you think should be done to improve the healthcare system, or if you think anything should be done at all.

Sorry - brain fart. I meant the NHS. Somehow Harvard got in my head instead.

Well there are obviously no studies that specifically link spending to morbidity. That would essentially be impossible due to the multifactorial causes of cancer morbidity, treatment availability being one. I don't need something to be proven in a journal to accept that it's reasonable. When faced with the proposition that the US doesn't have limits on spending on cancer treatment (or any treatment) while the UK does, and, at the same time, US cancer mortality is less than that of the UK, is it such a large logical leap to think that the two are correlated?

As far as limits on NHS treatment benefits, here you go: http://virtualmentor.ama-assn.org/2011/04/ccas3-1104.html. That article provides a good explanation of how NICE (essentially the organization that dictates what will and won't be covered under the NHS) determines what will be paid for with respect to cost-effectiveness and includes NICE's financial threshold for treatments. (30,000 pounds - roughly $50k - to extend life by one year). I was unable to find something directly from NICE disclosing how they come about their approval decisions; I'm sure it's out there, but I couldn't navigate the NHS/NICE websites to find it.

Here's an article from the BBC that discusses the difficulties of funding expensive treatments, specifically cancer treatments, under the NHS: http://news.bbc.co.uk/2/hi/health/6652183.stm

This is also an interesting story that provides one problem when the government is effectively the sole provider of healthcare and is under constant pressure to cut costs: http://www.telegraph.co.uk/news/uknews/1572683/NHS-U-turn-on-prostate-cancer-treatment.html.

Universal healthcare doesn't equate to single-payer, government-run healthcare. I'm all for universal healthcare and opening access to healthcare to as many people as possible, especially those who don't currently have access to it. I'm not for the government running that system.

I really don't want to get into a discussion on what I think should be done to reform the system - partially because I'm not all that educated on the topic and partially because it's a pointless discussion to have. I'm simply challenging your assertion that a single-payer system results in rationing "based on need." In reality it's still rationing based on financial well-being, just with a bunch of smoke and mirrors to attempt to hide that. If we're going to be rationing based on financial resources (WHICH ALL SYSTEMS DO - there is no mythical rationing "based on need"), I would much rather have the ability to choose insurance providers that provide the services I'm looking for rather than be told that these are the services I'll receive.

 

[Ebola4Breakfast]

Correct, regarding my opposition to a socialized, government "option" (which really isn't optional if people not interested in it still have to pay for it). Exactly how to fix the system, I don't claim to know. Reducing the liability doctors have could significantly reduce the overall cost, as the practice of defensive medicine would no longer be such a huge issue (ordering tests and scans to catch the 1 in 10,000 condition because you are afraid of beings sued, etc.) If everyone had to pay something out of pocket for their medical care, that would be a huge incentive to avoid pointless and wasteful use of medical care (a la patients who show up to the ER because their arm fell asleep, but it's ok that it is a $400 visit, cause they are on disability and don't have to pay anything). Removal of the near-monopoly many insurance companies have in many states by allowing insurance companies to sell insurance across state lines would help quite a bit to bring down prices, and open up options to purchase medical care. I know these won't completely solve the spending issues, but they could help and make it affordable for more people.

For me, it basically comes down to the fact that you cannot say one person has a "right" to the work of another. Calling health care a right is doing just that. Either money will be stolen from some people to pay for the health care of others, or health care workers will have to be turned into de-facto slaves of other people's "rights". Or the "health care is a right" claim is just dishonest rhetoric. I would love it if everyone had access to quality health care, but it is not the government's responsibility, nor is it mine, to provide it for them. Health care is a service, which has to be paid for. What would the ideal system look like? I am not sure, but I am certain it doesn't involve more government control over the system. This is especially true when you consider the vast majority of health problems are the product of people knowing what they should be doing, but not doing it (eating right, exercising, smoking, managing previously diagnosed conditions, etc.) and not a basic lack of health care access. The remainder are the product of people just getting old or just having bad luck re their health. The first will certainly not be solved with government-guaranteed health coverage, and the latter will soon overwhelm our ability to pay even with extreme income taxes and significant slashing of reimbursements, as our population continues to age and we continue to be able to keep very sick, very old people breathing longer.

So in answer to the question, no, despite certain aspects of the law that may or may not be beneficial (for example, I think the provision requiring restaurant chains to post the nutrition information of their food is both a good law, and within the bounds of the interstate commerce clause of the Constitution), I do not support mandated health insurance, increased government-run health care, or an increase to the government controlling this aspect of our economy. In addition to my philosophical objection to the government running more aspects of our lives, simply try to find anything the government does well and efficiently.....

Wow. I really wasn't expecting such a calloused view. It makes me a little sad to think this view might be widespread.

So where do you see the health insurance companies fitting into all of this? Correct me if I'm wrong, but we're the only developed country to solely use for-profit health insurance companies. Do you see them shouldering any of the blame in this healthcare mess? Is there any major reason why we can't shift to non-profit health insurance to cover basic needs and for-profit for "luxury" health insurance needs? Again, just curious. I'm not just targeting you but anyone who cares to answer.

 

[candav]

Universal healthcare doesn't equate to single-payer, government-run healthcare. I'm all for universal healthcare and opening access to healthcare to as many people as possible, especially those who don't currently have access to it. I'm not for the government running that system.

I really don't want to get into a discussion on what I think should be done to reform the system - partially because I'm not all that educated on the topic and partially because it's a pointless discussion to have. I'm simply challenging your assertion that a single-payer system results in rationing "based on need." In reality it's still rationing based on financial well-being, just with a bunch of smoke and mirrors to attempt to hide that. If we're going to be rationing based on financial resources (WHICH ALL SYSTEMS DO - there is no mythical rationing "based on need"), I would much rather have the ability to choose insurance providers that provide the services I'm looking for rather than be told that these are the services I'll receive.

Thank you! I’ll read over this stuff and think on it a bit. Also, thanks for clarifying your position on universal healthcare. I agree that a properly-run government (read: a government not run by corporate interests) is prerequisite to the single-payer system. I understand we’re coming from two very different perspectives, and we really don’t hear much intelligent anti-single payer discourse in Canada, so it’s good to hear the other side of the argument.

To clarify my position re: rationing -- Again, it is a matter of degree. You enter the ED at a Canadian hospital and are assigned a number based on the severity of your condition. Those with the most severe, critical conditions are seen first. You might encounter a similar situation in the US, but that neglects the entire population of people outside the ED doors who don’t have the insurance to be treated. The single most significant way in which the US health care system rations its services is by excluding the uninsured or underinsured. This is rationing by financial/social status.

A universal system reduces (but perhaps does not eliminate) this type of rationing, which is why I consider such a system “more just”.

 

[LockDoc]

Wow. I really wasn't expecting such a calloused view. It makes me a little sad to think this view might be widespread.

So where do you see the health insurance companies fitting into all of this? Correct me if I'm wrong, but we're the only developed country to solely use for-profit health insurance companies. Do you see them shouldering any of the blame in this healthcare mess? Is there any major reason why we can't shift to non-profit health insurance to cover basic needs and for-profit for "luxury" health insurance needs? Again, just curious. I'm not just targeting you but anyone who cares to answer.

IMO opinion, the problem with the insurance companies is that there is so little competition because of the inability to go outside of state lines. With little to no competition, there is no reason for costs to be forced to go down to maintain competitiveness. Additionally, I am curious as to what exactly limits people from getting coverage from insurance companies in different states/why it can't be sold across state lines?

As for your your non-profit health insurance, I would be very ok with it if it arose as a charity organization that was not tied to the the government or supported with tax dollars. Not sure why this can't already be done.

 

[kduck]

To clarify my position re: rationing -- Again, it is a matter of degree. You enter the ED at a Canadian hospital and are assigned a number based on the severity of your condition. Those with the most severe, critical conditions are seen first. You might encounter a similar situation in the US, but that neglects the entire population of people outside the ED doors who don’t have the insurance to be treated. The single most significant way in which the US health care system rations its services is by excluding the uninsured or underinsured. This is rationing by financial/social status.

A universal system reduces (but perhaps does not eliminate) this type of rationing, which is why I consider such a system “more just”.

You seem to be missing a key component of the US system, which is that everyone who needs a emergency treatment must be treated in the ED regardless of ability to pay, under EMTALA. Rather than the ED excluding the uninsured and underinsured, it is one of the places that people without insurance rely on the most.

 

[autotroph]

Reform actually funds many projects to experiment with various cost control measures. The problem is that we don't know which, if any of them, will pay off. Should I be surprised that almost nobody knows this?

Was going to mention this. It's really an important part of the reform, and really shows you that this is not meant as a final solution. It's clearly a stepping stone that does improve health care in certain areas, and probably hurts it in others. Ultimately if cost is a concern though, US healthcare is going to need a pretty fundamental overhaul.

 

[autotroph]

You seem to be missing a key component of the US system, which is that everyone who needs a emergency treatment must be treated in the ED regardless of ability to pay, under EMTALA. Rather than the ED excluding the uninsured and underinsured, it is one of the places that people without insurance rely on the most.

But what about people who are not quite emergency yet, that will over the course of weeks or months need that emergency care? EMTALA is good to have, but its effect on public health is backwards from what we should be aiming for. Instead of seeking medical care earlier when conditions are for more treatable, patients must wait until it is considered an emergency at which point treatment is difficult, and often times far more expensive.

 

[RogueUnicorn]

For me, it basically comes down to the fact that you cannot say one person has a "right" to the work of another. Calling health care a right is doing just that. Either money will be stolen from some people to pay for the health care of others, or health care workers will have to be turned into de-facto slaves of other people's "rights". Or the "health care is a right" claim is just dishonest rhetoric. I would love it if everyone had access to quality health care, but it is not the government's responsibility, nor is it mine, to provide it for them.

as i mentioned before, a right to a defense attorney is a constitutionally protected right to the work of another.

it's interesting to me that you say you want everyone to have access to quality healthcare but seem completely uninterested, if not outright opposed to doing anything about it. is this dishonest rhetoric on your part?

Universal healthcare doesn't equate to single-payer, government-run healthcare. I'm all for universal healthcare and opening access to healthcare to as many people as possible, especially those who don't currently have access to it. I'm not for the government running that system.

i too agree with this. i think to believe that the government will be an effective single payer is at best naive, especially considering recent events where congress drove us to the brink of insolvency over partisan bickering. i also want to point out that it's possible to present arguments, as cole does, and hopefully i do on occasion, without resorting to catchphrase name-calling and use of deliberately biased, sensationalized and editorialized words like "slaves."

 

[Ebola4Breakfast]

...
Universal healthcare doesn't equate to single-payer, government-run healthcare. I'm all for universal healthcare and opening access to healthcare to as many people as possible, especially those who don't currently have access to it. I'm not for the government running that system.
...

...
i too agree with this. i think to believe that the government will be an effective single payer is at best naive, especially considering recent events where congress drove us to the brink of insolvency over partisan bickering.
...

I'm still new to educating myself to the healthcare systems in other countries. Are there other developed countries which have universal healthcare options that are not government-run? Most of the systems I've read about seem to have heavy government influence... at least at the basic care level.

 

[NickNaylor]

I'm still new to educating myself to the healthcare systems in other countries. Are there other developed countries which have universal healthcare options that are not government-run? Most of the systems I've read about seem to have heavy government influence... at least at the basic care level.

Switzerland is actually a pretty prime example of a heavily regulated, universal, but private system. Some of the things they've implemented there are actually similar to what was included in the ACA (e.g., individual mandate). All insurers must essentially be licensed to operate by the government and cannot make a profit on the "barebones" plan the government requires insurers to offer (and which fulfills the individual mandate requirements), though they're free to make a profit on supplementary insurance that they offer to extend the benefits of the barebones plan.

 

[Ebola4Breakfast]

Switzerland is actually a pretty prime example of a heavily regulated, universal, but private system. Some of the things they've implemented there are actually similar to what was included in the ACA (e.g., individual mandate). All insurers must essentially be licensed to operate by the government and cannot make a profit on the "barebones" plan the government requires insurers to offer (and which fulfills the individual mandate requirements), though they're free to make a profit on supplementary insurance that they offer to extend the benefits of the barebones plan.

So there is some government involvement without it being government run. Interesting. Thanks for the info.

 

[gettheleadout]

Getheleadout-

It shouldn't be a "problem" for doctors to treat patients. If you're a uro, or other specialist, you're not "obligated" to see cardiac patients or others you aren't trained to treat. In most universal systems, the GPs don't feel "obligated" to see everyone, they are HAPPY they get the chance to treat everyone who needs their help, equally. They make less money than US docs, but they don't have to deal with billing nightmares like in the US, don't have the threat of malpractice (yes they pay mal. ins., but tiny premiums and they are rarely sued), and they get to do what they are trained to do- HEAL- without all the bull***t.

Everyone gets seen (by GPs in most systems) for basic healthcare, but NOT everything is covered. Some systems cover dental, physio, massage, acupuncture, etc, and some don't. It's culture dependent. Most countries still allow physicians to perform elective procedures if they choose (cosmetic, etc) that can be covered by supplemental insurance policies pts can buy. Also, some GPs get incentives to keep their patients away (Britain) and healthy. If you have a base of 1000 patients you have to see when they get sick, you are going to be a lot more likely to practice the preventative medicine that will keep them from diabetes, hypertension, obesity, etc. and out of your office. Universal coverage can lead to fewer visits, if it is done intelligently.

In Japan you can walk right in to an ortho with no appointment and be seen straightaway and schedule a covered surgery in a week. In other countries the GPs are gatekeepers to cut down on that- GP can refer pt to a specialist, who sometimes have waiting lists, sometimes not. In Canada it might take a year for a consult and another year for covered surgery. In Britain, you can get the consult but the surgery won't be paid for.

When there aren't enough GPs to go around, the govt needs to provide more incentives for the specialty, but supply will eventually get much closer to fulfilling demand, IF the public and politicians make it a priority.

Your view seems idealistic to me. The problem is not that doctors don't like to see patients (really?) the problem is that doctors then lose independence in choosing clients.

Then you ration, as you point out is already happening in the US anyway, but you ration on the basis of need, not financial or employment status. That's a more just system.

you personally? no. the system as a whole? yea. that's kind of the point. as mentioned, the result will be rationing, which is already happening anyway. it will hopefully just be more rational.


the services of a criminal defense attorney is something that is both paid for and a right i am entitled to.

As far as the rationing is concerned, will some entity not have to oversee this rationing? As it stands private practice physicians can choose who they see without a governing body telling them they must accept patients of type X. This could be a dangerous power to delegate, even to the government.

Rogue, the defense attorney point is really interesting. However, there is a surplus of lawyers, so the idea that there would be no willing candidates to take the position of a public defender is unrealistic. However, with a shortage of physicians, how do we presume to employ enough physicians in public service of this sort? (if this were the way we achieved provision of such services?) If physicians were not employed to be the ones to provide this equal-opportunity care of sorts, how would we achieve coverage of the populace without mandating how physicians provide their services? And if we do that, who will pay? I may be missing something.

 

[Bartemius]

Something to ponder: "How Doctors Die" (came across it in the allo forum)

 

[Gut Shot]

My point wasn't that reform isn't going to try to reduce costs.

So when you said "The real issue I have with Obamacare is the lack of spending control." you meant to say "The real issue I have with Obamacare is that it will try to control costs but those controls will fail." Would that be about right?

I was more using standard predictions to get to my point: that some of the current efforts are tending in the wrong directions, and that the American lifestyle and mindset won't sustain lower costs without a significant impact on health.

So what are you saying? Abandon the healthcare system entirely and it won't significantly impact health? Do you think that, in the long run, longer lifespans from improved health cut costs or contribute to them?

 

[anthrovagabond]

Medical care is a service that has to be paid for not a right anyone is entitled to.

Guess you're not familiar with any of the treaties the United States is a signatory for regarding health...like the international ones...doesn't mean we shouldn't pay, but we signed agreeing that healthcare is a human right. You do know about these, right?

 

[Bartemius]

So when you said "The real issue I have with Obamacare is the lack of spending control." you meant to say "The real issue I have with Obamacare is that it will try to control costs but those controls will fail." Would that be about right?

Yes

So what are you saying? Abandon the healthcare system entirely and it won't significantly impact health? Do you think that, in the long run, longer lifespans from improved health cut costs or contribute to them?

No, just place a much stronger emphasis on nutrition, affordable housing, youth education, etc. (i.e. minimize poverty and obesity) and health care costs will go down. Improved general health and well-being will always cut costs.

 

[IMSingular]

Something to ponder: "How Doctors Die" (came across it in the allo forum)

👍 That is the way!

Cancer was, however, taking its toll. In 1988, 15th February, after fighting with cancer for a decade, he finally lost. He came out of his coma, said “I don’t want to die twice. Dying is boring”. That was the last of his discoveries.

The above is about Richard P Feynman.

 

[Gut Shot]

Yes

A rather sweeping indictment. Got anything to back it up?

No, just place a much stronger emphasis on nutrition, affordable housing, youth education, etc. (i.e. minimize poverty and obesity) and health care costs will go down. Improved general health and well-being will always cut costs.

In the short term. How do you feel about this seminal 1997 NEJM paper which modeled the long term costs of smoking cessation?

 

[FoxyMD30]

Gettheleadout-

I may be idealistic, but the people who are actually going to make a difference in this mess to make life better for others who can't help themselves need to be. Your statements really disturb me, and I honestly am scared about the physician you might be. If physicians want to cherry pick their patients (but I am not getting your reasoning why they need to) in most systems they can practice private medicine to people who want services not covered by the basic system. If you don't want to treat anyone, then don't. What exactly are YOUR criteria for telling someone you don't want to treat them, by the way, especially if you know you will be paid the same for treating them as the next patient??

 

[Bacchus]

Gettheleadout-

I may be idealistic, but the people who are actually going to make a difference in this mess to make life better for others who can't help themselves need to be. Your statements really disturb me, and I honestly am scared about the physician you might be. If physicians want to cherry pick their patients (but I am not getting your reasoning why they need to) in most systems they can practice private medicine to people who want services not covered by the basic system. If you don't want to treat anyone, then don't. What exactly are YOUR criteria for telling someone you don't want to treat them, by the way, especially if you know you will be paid the same for treating them as the next patient??

I see no point in involving myself with Medicaid patients if I'm not part of a larger corporation. Its unfortunate they're on Medicaid, but when you have a family to feed and are a private practice physician, you will consider cherry picking patients and also refuse certain groups of people. I'm not the Messiah, and I genuinely want to help folks, but not at the expense of my family and friends.

 

[FoxyMD30]

You seem to be missing a key component of the US system, which is that everyone who needs a emergency treatment must be treated in the ED regardless of ability to pay, under EMTALA. Rather than the ED excluding the uninsured and underinsured, it is one of the places that people without insurance rely on the most.[/QUOTE

EMTALA does no part in getting the consistent maintenance treatment needed for chronic illnesses like lupus, cancer, etc. You can't go to the ED for your drugs and continuity imaging to see if you have liver damage from your meds or if your tumors are shrinking or growing. Here are the people who need coverage.

 

[STAT EKG]

You seem to be missing a key component of the US system, which is that everyone who needs a emergency treatment must be treated in the ED regardless of ability to pay, under EMTALA. Rather than the ED excluding the uninsured and underinsured, it is one of the places that people without insurance rely on the most.

So, in the current climate, we have uninsured people flocking to the ERs as their primary care physician (many if not most of whom never end up paying their bill). The price of ER visits and procedures rises so that the money attained from those who do pay covers the cost of those who don't. The cost of insurance premiums rise accordingly to maintain record (and ridiculous) profits and cover the rising procedural costs.

For ideological purists who are all up in arms about potentially being mandated to pay for others

You're already doing it, yo.... (and in that yummy for-profit system nonetheless)

 

[gettheleadout]

Gettheleadout-

I may be idealistic, but the people who are actually going to make a difference in this mess to make life better for others who can't help themselves need to be. Your statements really disturb me, and I honestly am scared about the physician you might be. If physicians want to cherry pick their patients (but I am not getting your reasoning why they need to) in most systems they can practice private medicine to people who want services not covered by the basic system. If you don't want to treat anyone, then don't. What exactly are YOUR criteria for telling someone you don't want to treat them, by the way, especially if you know you will be paid the same for treating them as the next patient??

In the system we function in now, reimbursement for services is not equal across all patients, as privately insured patients are more profitable to treat. Patients currently covered under government insurance plans such as medicare/medicaid potentially cause private practice providers to take a loss when providing care. My criteria for choosing patients were I in private practice would consist of those that enable me to continue treating others and employing my staff. Again, in this hypothetical situation where everybody is due care, and somehow everybody is paid for, unless something significantly changed in the ways patients not covered on private plans have their providers reimbursed, lack of physician autonomy in choosing patients could have detrimental effects on the viability of small practices. This would not a problem in some perfect plan where all reimbursements exceed cost, however I find this an unnecessary infringement on physician independence merely in principle.

Edit: Also, LOL @ your implication about my fitness to be a physician. Passing judgment is not an admirable quality.