Please Vote on Health Care!

[OncoCaP]

... The second step would be to simultaneously begin a plan to phase out Medicare and Medicaid over many years AND end all monopoly priveledges granted to hospitals. I'd give fair warning to charitable and religious institutions, allowing them time to develope plans to deal with those that will eventually lose coverage. I also think malpractice reform would have to come early in the process.

What do you mean by "end all monopoly priveledges [sic] granted to hospitals"?

Also, encouraging charitable organizations to take over care for the poor (perhaps there could be medicare/medicaid tax breaks for regions that have charitable organizations serving them) and implementing malpractice reforms are two points we agree on.

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[Miami_med]

What do you mean by "end all monopoly priveledges [sic] granted to hospitals"?

Well, right now it is illegal to just build a hospital. Specific hospital districts have to demonstrate "need" in order to do so. In fact, Hospitals often have to get permission from the government in order to increase the number of beds that they have. This system creates a defacto government enforced monopoly of existing hospitals.

Also, due to the requirements of JCAHO, the regulatory burden is inhibitory in terms of starting a hospitals. There is also legitimate fear on the part of anyone who tries to open anything from a specialty care hospital to an urgent care center that someone somewhere will determine that they are somehow "stealing" patients from other less efficient hospitals, and the cost to defend themselves politically makes it impossible for anyone to just enter the market for what it actually costs to run a hospital. Competition tends to drive prices down without an entitlement (yes, if the government pays for everyone, this makes care even more accessible, more people use it, and prices go up. This was actually the reason for the "need" rules in the first place. Too many people might actually use the "free" healthcare.). Thus, in order to contain the costs to government payment systems (read Medicare and Medicaid) and with a fear that new efficient hospitals might take private patients away from the Medicare/Medicaid hospitals (proof that these systems don't keep these institutions afloat without the private market), the government has consistently stood in the way of competition entering the market. These attempts to contain costs should actually drive costs up in the long run by reducing supply.

Also, encouraging charitable organizations to take over care for the poor (perhaps there could be medicare/medicaid tax breaks for regions that have charitable organizations serving them) and implementing malpractice reforms are two points we agree on.

Well, I think a tax breaks system is way too complicated and politically charged, but atleast we agree on something

 

[indo]

She didn't miss the point. You missed the point.

Comparing providing excellent medical care to furnishing customers with exclusive, high-quality houses is really kind of a messed-up analogy, I agree. If you missed my response to you earlier:



Like I said, I'm really bothered by the attitude that practicing medicine could be analogous to providing "boutique"/exclusive service. The idea skeeves me out. I do think physicians should be comfortable (and not suffering under crippling debt), but I hate the implication that medicine is just like any other business. It's fine to deny access to your custom, designer construction services or your cosmetic dentistry if people don't have the means, but I think people who want to get rich off of doctoring-- to the exclusion of people who need their services but cannot afford them-- are not really people I want as colleagues.

At the same time, while I chastize you for your sense of entitlement, I realize that many Americans have no realistic sense of what they should be financially contributing to their health care, yet feel entitled to the best care even though they make irresponsible decisions.

What can I say? The world doesn't get better if everyone thinks, "f*** the other guy, I'll do what's best for me." (Yes, huge idealist here, I know.)

It says something about you that you need to be well-paid to want to achieve. I really don't think there's going to be a brain drain from medicine. Believe me, there are plenty of bright, bleeding-hearted people that would still be committed to medicine even in a single-payer system. Just look at academics. They could be making a lot more in private practice.

Unfortunately, we need business-minded entrepeneurs and people with less "noble" motives (like getting rich) to drive/fund innovation and progress (even though this is a double edged sword), hence my original vote.

She did miss the point. She was focused on the square footage of the house! The point was that nobody is going to buy a a crappy house when they can get a better house for the same price and nobody is going to spend the time and money building a better house when they won't be able to sell it for any more than the crappy house.

The point of comparing health care to building houses wasn't to create a relationship between the products. It was to demonstrate that higher quality comes from motivation to be better than the next guy. The motivation for people to go into medicine is usually a sum of helping people, the challenge, and financial reward. Take the finacial reward out of the equation and you're better off becoming a teacher where you have less initial debt and you still get to see your actions changing lives every day. Start taking away the financial incentives for becoming a doctor and the smarter and harder working people will take their careers elsewhere. The overwhelming debt will be a huge roadblock for most people since medicine would no longer present the opportunity to overcome that debt. The only people left in medicine would be super rich kids and foriegn medical graduates.

Just applying to medical schools is an example of how competition filters for smarter and harder working people. Who is going to put forth THAT much work to make the same amount that could be made in other industries with half the effort? How many residents are willing to work the rest of their lives for the same amount they're making now? 3, the answer is 3 and those 3 put in money to buy lottery tickets and won the 300 million dollar powerball.




A single payer system would be nice if we, as providers, could collectively negotiate. In addition, we need to be able to practice only necessary medicine rather than cover-my-ass medicine. But, we're still turning healthcare over to the government and they're good at screwing things up.


side note:
In a way, the human brain functions in a "**** the other guy" fashion. However, humans are more likely to survive if they work together. Evolution is driven by propagation of genes. Your brain is built so that people who are genetically related to you take priority over everyone else. This helps ensure that your resources are not wasted on genes that don't belong to you. Modern society is totally structured based on this. Your family > other families, your friends > random people, your country > other countries, etc.

 

[def jeff]

Thanks. Yes, my goal really is not to win an argument. I want to understand the options and advocate the best solutions. I wish more people would do the same.

I'm sure there is more than one great plan for U.S. healthcare financing. The tough part is comparing and evaluating them. We are not each other's enemies (hopefully). We all stand to benefit from a great healthcare system. There are tradeoffs and these need to be understood and managed.

I realize that a great plan is only part of a solution. Excellent execution, incentives for excellence, smart political lubrication, and protection against fraud and abusers are some of the many details that can make or break just about any plan.

Well said.

 

[Jejton]

If I'm a surgeon who is the absolute best at total knee replacements in America, under a single payer system would I only be paid the same as everyone else even though my success rate is huge and the complication rate and recovery time are much lower than everyone else's? If that is the case then all of my hard work was pretty much wasted. I should have gone into construction where a better quality job gets higher reimbursement.

Would you pay the same amount for a 4000 square foot manufactured home and a 4000 square foot home that you designed? Well, you would if the home building industry was run by a single payer system. Who is going to waste the time learning how to build a quality 4000 square foot house if they know that they know that they won't be paid any more than the guy down the street who builds crappy 4000 square foot houses? Nobody. All the talent will go into other fields where their efforts will actually pay off.

A valid point but perhaps it can be argued that due to your greater skill and reputation, you would attract more patients. Furthermore, under many existing single payer systems ( i.e. Canada ), and even some socialized systems ( i.e. Israel ), customers..er I mean patients have the option of paying out of pocket, and doctors have the right to refuse the single payer salary and accept only cash paying patients, or a combination.

 

[Jejton]

What exactly is the single payer system?

I dont mean to pick on you, but this typifies most people. Ask most people, even medical students and many doctors, and they really dont know anything about the various systems, at least more than superficially. Say single payer and right away people shout " No to the damn socialists" Single payer systems is not socialized medicine. Most people, as is usually the case, engage in heated debated on healthcare systems without having the slightest idea about the facts. Thats why it is important to educated, and be educated, about this topic, or any other, before casting a vote.

I am not trying to argue in favor or against SP, but its important that at least the facts are all known.

 

[Jejton]

No, you get paid per procedure according to an established fee schedule, pretty much the same as it is now. Pro: way less bureacracy. Con: only one party to negotiate with.

But I want to know if anyone has definitive studies that show whether the money saved in cutting the beauracracy ( i.e. less health insurance paper pushers, less man hours spent negotiating/arguing over payments, etc. ) outweighs the potential cut in provider earnings.

 

[Jejton]

Those who require it are going to be the ones who took out hundreds of thousands in student loans to make it through college/med school. ....

So then perhaps a valid answer to that, rather than placing the burden on end-used ( the patient ), the burden of the cost of education should be placed on the government. Instead of offering low-interest loans ( which dont cover costs for most students anyways ), the government should heavily subsidize the cost of education. It happens often that when there is a need for something, which has a tremendous startup or market entry cost, the government subsidizes said costs in the forms of grants, tax breaks, etc. The alternative fuel industry is just one example I can think of at the moment.

 

[Jejton]

You are only saying this because you have not been pushed far enough. When you get kicked in the nutz by the system(guaranteed to happen in a socialized system), you will not think of strikes as an impossibility.

An interesting side note - during many instances of physicians' strikes in socialized countries, the death rate has actually decreased.

 

[Jejton]

It is wise to put your trust not in the government, but place it in the free-market system. Open up healthcare to the free market and you will see greater competition, which drives down costs, increases quality and makes healthcare more affordable FOR EVERYONE! Just ask yourself this... would you want the government in charge of your health... just think about how well the government handles your drivers license renewal at the DMV, and you will have your answer. Turning our healthcare over to the government is a dangerous solution to our healthcare crises.

P.J. O'Rourke said it well when he stated in 1993, "If you think health care is expensive now, wait until you see what it costs when it's free."


For those of you who think healthcare is a "right", I strongly encourage you to read this brilliant article in its entirety.

http://www.frontpagemag.com/Articles/ReadArticle.asp?ID=26465

The whole rationale behind the current healthcare system was exactly what you are stating and look where it has gotten us now. You cannot ever treat healthcare like any other commodity. People can choose which car, if any, they want to buy. People rarely, if ever, choose which illness to contract.

 

[Jejton]

Let me make it very clear... Our system needs reform. That is, by opening up our system up to the free market. A free market is CONSUMER AND DOCTOR DRIVEN CHOICES. You say our system a mostly private system? What? The largest inceases in our healthcare costs are from the government subsidized welfare programs of medicare and medicaid. Also, the vast majority of Americans have HMO's responsible for making their healthcare decisions...which means a third party is responsible. Nobody ever spends someone elses money as well as they spend their own. THat is why our system is expensive. Free market healthcare advocates that the patients and doctors are making decisions vs. our trusty government getting involved (remember Katrina?).

Our system may have the largest number of people declaring bankruptcies due to medical bills, primarily because people don't have the ability to afford good health insurance. But that only means that we must have solutions that make it more affordable. I support a single payer system, but the patient should be the single payer. If you are suggesting that turning our healthcare over to the government will make it more affordable. Think again. The government doesn't create wealth, all revenues from the government come from the people it taxes. This idea that the government can waive a magic wand and suddenly make healthcare "free", is false and morally objectionable. Watch what happens to costs when patients have a greater role in sharing the healthcare decisions they make. THe best thing the government could do is get out of the way, except for those who actually, truly NEED IT.

I ask you then... Why is it that every other sector subjected to the free market has fostered innovation, drastically improved quality, and at the same time driven down the costs of consumer products. Take the tech sector, while the quality of computers continues to get better, costs continue to decrease, and companies continue to innovate new products. This drives a perpetual cycle of better products at more affordable prices (Remember what computers or plasma TVs cost 10 years ago?). Now they are commonplace for almost all Americans.


And yes, to have "intelligent" discussions we must look at our system objectively. Opening healthcare up to the free market is not an "idealistic" point of view. Capitalism , free markets, competition and individual liberties are exactly what has made America the most successful country in the world. So why would we abandon the same principles that made this country great when it comes to healthcare?

Again and again and again. People choose which, when and if to buy a computer, car, house. People choose which, when and if to use a bank, broker, barber. People do not choose to contract childhood leukemia, genetic disorders, strokes, etc. Yes lifestyle choices play a role ( and should be rewarded or penalized just like with car insurance ) but not the only role and not for every malady.

Most people do not willingly take off days of work ( i.e. salary ) to spend the day sitting in the doctors office or the ER. Yes I know the ER is abused but that is not due to EMTALA but often to being under or noninsured. The people who cant arent offered insurance through work, and make too much to receive medicaid but cannot afford their own insurance are usually the same people who fill up the ER. Yes i know there are exceptions but most people are not hypochondriacs or junkies looking to score scripts.

 

[Jejton]

The IT infrastructure (EHR's, etc.) of the VA is signficantly more innovative that that of the average hospital. Every VA patient's records can be pulled up on a laptop and aid the physician in making fewer errors.

As well as lost and/or stolen from said laptops

http://news.com.com/Veterans+data+swiped+in+theft/2100-1029_3-6075212.html

 

[Jejton]

Unders a single payer system, I would be in favor of higher taxes or other penalties for people who smoke (in a way they already pay for it with cigarette taxes, which might be ok). Obesity is more difficult. Perhaps if a person who is obese would need to enroll in some kind of weight control program to avoid paying penalties and higher taxes. However, many Americans would probably find such penalties to be unacceptable. I'm not sure a "cheeseburger and fries" tax similar to the tax on cigarettes would get public approval. Maybe better access to healthcare and better promotion of exercise and healthy eating would make a difference.

My mother-in-law told me something interesting - that in the Soviet Union ( yes I know it did fall apart ) pregnant women were required to go to regular pre-natal checkups ( no biggie ), and also excercise classes. If they didnt show up enough times, they would lose benefits ( perhaps more in the good ol' days ). Now I am not saying we should emulate the USSR but it wouldnt be too bad an idea if, in order to maintain coverage under a single payer system, people had to fulfill certain minimal requirements such as regular excercise, meetings with a nutrionist ( perhaps in a group setting to maintain cost effectiveness ), regular physicals, etc. and credits given to those who met certain benchmarks such as quitting cigarettes, etc.

 

[Jejton]

My vote goes to any system that can help alleviate the health care disparities plaguing lower- and middle-class Americans who, despite working, can not provide adequate health care for their families. While a lot of people will agree with me, the truth about these systems is that it's going to take sacrifice in the way of lower salaries for health care professionals, reduced overhead in health plan administration, and funding from businesses and the government. From the several courses I've taken in health policy and health care, three things have become clear: our system is heading for a train wreck, one in six people is on the brink of medical or financial disaster because they are without insurance, and certain cuts need to made in order to alleviate this, whether we like it or not.

Can anyone provide an actual figure ( with a source ) to show what percentage of costs are due to provider salaries? I can't imagine that its that big a percentage. I would think things like bureacracy, infrastructre, R&D, litigation and bureacracy would be the main sources of high costs.

 

[sirus_virus]

My mother-in-law told me something interesting - that in the Soviet Union ( yes I know it did fall apart ) pregnant women were required to go to regular pre-natal checkups ( no biggie ), and also excercise classes. If they didnt show up enough times, they would lose benefits ( perhaps more in the good ol' days ). Now I am not saying we should emulate the USSR but it wouldnt be too bad an idea if, in order to maintain coverage under a single payer system, people had to fulfill certain minimal requirements such as regular excercise, meetings with a nutrionist ( perhaps in a group setting to maintain cost effectiveness ), regular physicals, etc. and credits given to those who met certain benchmarks such as quitting cigarettes, etc.

Forget credit. If you smoke you loose your benefits, simple as that. Do you want to fund someone's bad habits?

 

[Jejton]

If you need a mansion, a yacht, and a Ferrari to feel a sense of "personal benefit," then you've gotta be compensating for something.

I have yet to meet a doctor who has any of the above ( ok maybe a Ferrari ) but I have met many doctors who have a heard time meeting overhead and making a few dollars while at the same time managing to give their patients the level of care that they ( the doctors ) would like to.

 

[Jejton]

\It says something about you that you need to be well-paid to want to achieve. I really don't think there's going to be a brain drain from medicine. Believe me, there are plenty of bright, bleeding-hearted people that would still be committed to medicine even in a single-payer system. Just look at academics. They could be making a lot more in private practice.

That is a fallacy. People dont tend to work hard unless there is a reward. For some, especially students and those without families to support, intangible rewards are quite sufficient. For others, they are not. I know quite a few altruistic doctors who would see patients for free if they could but unfortunately rent is not free.

As far as a brain drain, well look at India, the Phillipines and many African countries. There were some articles recently ( I can look them up when I have time ) about problems these nations are having with their best and brightest ( Indian doctors and Phillipine nurses especially ) refusing to return to their native countries once they complete their training in the US because of the disparity in lifestyle. The Phillipine government in particular had some big complaints because the US government recently expanded a program to grant visas to thousands of nurses from the Phillipines to fill the nursing shortage in the US ( which is due more to burnout from being overworked then from an actual shortage in trained and qualified nurses but thats another thread ).

 

[Jejton]

Forget credit. If you smoke you loose your benefits, simple as that. Do you want to fund someone's bad habits?

Well there are existing examples already. For instance, even though I have a pretty good driving record ( two minor violations in the last five years ) I have to pay astronomical premiums due to the fact that there are too many crappy drivers, thefts and insurance fraud in NYC.

 

[TCIrish03]

"Mother should I trust the government?"

 

[indo]

"Mother should I trust the government?"

Why wouldn't you?

 

[monday_best]

That is a fallacy. People dont tend to work hard unless there is a reward. For some, especially students and those without families to support, intangible rewards are quite sufficient. For others, they are not. I know quite a few altruistic doctors who would see patients for free if they could but unfortunately rent is not free.

As far as a brain drain, well look at India, the Phillipines and many African countries. There were some articles recently ( I can look them up when I have time ) about problems these nations are having with their best and brightest ( Indian doctors and Phillipine nurses especially ) refusing to return to their native countries once they complete their training in the US because of the disparity in lifestyle. The Phillipine government in particular had some big complaints because the US government recently expanded a program to grant visas to thousands of nurses from the Phillipines to fill the nursing shortage in the US ( which is due more to burnout from being overworked then from an actual shortage in trained and qualified nurses but thats another thread ).

Sorry, I don't see how the significant disparity in lifestyle between the U.S. and the developing world compares to making 100k instead of 300k a year. Physicians are most highly compensated in the U.S. system anyway, so where exactly (geographically) would people interested in medicine drain to? We have already postulated that those who want to have their pay scale to the quality of their work will go into other sectors (or at least choose a field with a smaller debt load).

I think people who need financial reward to "work hard" in the generic sense are really working in the wrong field.

 

[Miami_med]

Again and again and again. People choose which, when and if to buy a computer, car, house. People choose which, when and if to use a bank, broker, barber. People do not choose to contract childhood leukemia, genetic disorders, strokes, etc. Yes lifestyle choices play a role ( and should be rewarded or penalized just like with car insurance ) but not the only role and not for every malady.

Most people do not willingly take off days of work ( i.e. salary ) to spend the day sitting in the doctors office or the ER. Yes I know the ER is abused but that is not due to EMTALA but often to being under or noninsured. The people who cant arent offered insurance through work, and make too much to receive medicaid but cannot afford their own insurance are usually the same people who fill up the ER. Yes i know there are exceptions but most people are not hypochondriacs or junkies looking to score scripts.

To the guy who wins the award for most consecutive posts ever :

People have to spend money on things that they don't plan for all the time. Dad dies, the roof leaks, the car breaks down, a hurricane hits. When the government tries to cover all of these things, you get the USSR and Cuba. Your one allusion to a single example of decent Soviet Healthcare doesn't really change the fact that it didn't really work in the long run. You are trying to make life fair. It is not. I wish that I didn't have a Hiatal Hernia or other health maladies. I'm glad that I wasn't born in Nicaragua. We all have good and bad. None of it's fair. The government doesn't make things more fair either. In the end, a small group of connected people get a lot, with the overall quality of everything going down. I'll refer you back to the USSR.

 

[Miami_med]

Sorry, I don't see how the significant disparity in lifestyle between the U.S. and the developing world compares to making 100k instead of 300k a year. Physicians are most highly compensated in the U.S. system anyway, so where exactly (geographically) would people interested in medicine drain to? We have already postulated that those who want to have their pay scale to the quality of their work will go into other sectors (or at least choose a field with a smaller debt load).

I think people who need financial reward to "work hard" in the generic sense are really working in the wrong field.

Many don't need a financial reward to work hard, but they will work hard in another field for financial reward. Work some 80 hour weeks for a couple of decades and think about this one again.

 

[Jejton]

Sorry, I don't see how the significant disparity in lifestyle between the U.S. and the developing world compares to making 100k instead of 300k a year. Physicians are most highly compensated in the U.S. system anyway, so where exactly (geographically) would people interested in medicine drain to? We have already postulated that those who want to have their pay scale to the quality of their work will go into other sectors (or at least choose a field with a smaller debt load).

I think people who need financial reward to "work hard" in the generic sense are really working in the wrong field.

They dont have to leave the US. They can just migrate to other careers. Now for people who are already committed to the field, that probably wont happen, but to potential future doctors, it is a possible scenario that would have to be considered. An example is the computer industry. In the 90's, with the high-tech and .com booms, many of the brightest and hardest working students gravitated towards those fields. Now that the busts have occured, those fields are not so attractive, and students pursue other careers. ( As an aside, the Wall Street Journal last year published a list of the professional careers with the top ten median - or was it mean - salaries and university economics professor was at the top ).

 

[Jejton]

To the guy who wins the award for most consecutive posts ever :

People have to spend money on things that they don't plan for all the time. Dad dies, the roof leaks, the car breaks down, a hurricane hits. When the government tries to cover all of these things, you get the USSR and Cuba. Your one allusion to a single example of decent Soviet Healthcare doesn't really change the fact that it didn't really work in the long run. You are trying to make life fair. It is not. I wish that I didn't have a Hiatal Hernia or other health maladies. I'm glad that I wasn't born in Nicaragua. We all have good and bad. None of it's fair. The government doesn't make things more fair either. In the end, a small group of connected people get a lot, with the overall quality of everything going down. I'll refer you back to the USSR.

Thanks for the award !

I am not arguing for emulation of the Soviet system - I was just bringing an example to support a thought. I do not support drastic wealth distribution measures, though I do believe that society should be as fair as possible - I guess its those pesky morals. I dont blindly support social programs unless they can be shown to have a benefit to society. Having healthy citizens is something that every state can only benefit from. On a microscopic level, many big companies ( think Detroit ) started offering health benefits because they realized that a healthy worker is a productive worker. A productive worker is a profitable worker. The same can be said of a state's citizens. Can you think of one example of an advanced state in which a large portion of their population is in ill health? So while I dont think that the government should provide free comprehensive health care to all, I do believe that it is to the advantage of our state if the government provides some kind of minimal, at the least, health care coverage to those who cannot afford it while at the same time promoting public health awarness. Like car insurance, there can be rewards for those who lead healthy lifestyles ( reduced premiums ) and penalties for those who lead unhealthy lifestyles ( premium increases ? ) but I dont believe that it is the interest of society for decent healthcare to be denied to anyone who cannot afford coverage, nor do I feel the present system works, so I am open to debating pros and cons of alternate systems. I have done research into different health care systems ( not exhaustive ) and so far the system that I find works the best ( or at least is the least broke ) is a single payer system.

 

[johankriek]

She didn't miss the point. You missed the point.

Comparing providing excellent medical care to furnishing customers with exclusive, high-quality houses is really kind of a messed-up analogy, I agree. If you missed my response to you earlier:



Like I said, I'm really bothered by the attitude that practicing medicine could be analogous to providing "boutique"/exclusive service. The idea skeeves me out. I do think physicians should be comfortable (and not suffering under crippling debt), but I hate the implication that medicine is just like any other business. It's fine to deny access to your custom, designer construction services or your cosmetic dentistry if people don't have the means, but I think people who want to get rich off of doctoring-- to the exclusion of people who need their services but cannot afford them-- are not really people I want as colleagues. I think you may be a typical pompous premed. I think

At the same time, while I chastize you for your sense of entitlement, I realize that many Americans have no realistic sense of what they should be financially contributing to their health care, yet feel entitled to the best care even though they make irresponsible decisions.

What can I say? The world doesn't get better if everyone thinks, "f*** the other guy, I'll do what's best for me." (Yes, huge idealist here, I know.)

It says something about you that you need to be well-paid to want to achieve. I really don't think there's going to be a brain drain from medicine. Believe me, there are plenty of bright, bleeding-hearted people that would still be committed to medicine even in a single-payer system. Just look at academics. They could be making a lot more in private practice.

Unfortunately, we need business-minded entrepeneurs and people with less "noble" motives (like getting rich) to drive/fund innovation and progress (even though this is a double edged sword), hence my original vote.

I disagree with you. I am fairly confident that you are very early in your training. For the very best surgeon to want to be well-compensated I think is reasonable. And for doctors to want the Lions share of money is not unreasonable. And for them to want to leave medicine for greener pastures if they are not adequately compensated is understandable because and only because of the environment we live in. Medicine IS a business Period. YOu can argue all you want. It is. And it is a HUGE HUGE business. IF you are not making the money(you hold the product) someone else is taking it from you. you just have to realize who is taking it from you becuase most of the time it is very difficult to discern. And if it is not WORTH the sacrifice at the end less and less people are going to go into it. People and physicians are human beings. Why suffer needlessly in your life. No matter how much you LOVE helping people and how much you want to make a difference.no matter how bleeding heart you are. Your well being will always come first.. And I do believe the quality of medicine will suffer the more and more we squeeze the profession and continue to make it more and more un attractive..

 

[Miami_med]

Thanks for the award !

I am not arguing for emulation of the Soviet system - I was just bringing an example to support a thought. I do not support drastic wealth distribution measures, though I do believe that society should be as fair as possible - I guess its those pesky morals. I dont blindly support social programs unless they can be shown to have a benefit to society. Having healthy citizens is something that every state can only benefit from. On a microscopic level, many big companies ( think Detroit ) started offering health benefits because they realized that a healthy worker is a productive worker. A productive worker is a profitable worker. The same can be said of a state's citizens. Can you think of one example of an advanced state in which a large portion of their population is in ill health? So while I dont think that the government should provide free comprehensive health care to all, I do believe that it is to the advantage of our state if the government provides some kind of minimal, at the least, health care coverage to those who cannot afford it while at the same time promoting public health awarness. Like car insurance, there can be rewards for those who lead healthy lifestyles ( reduced premiums ) and penalties for those who lead unhealthy lifestyles ( premium increases ? ) but I dont believe that it is the interest of society for decent healthcare to be denied to anyone who cannot afford coverage, nor do I feel the present system works, so I am open to debating pros and cons of alternate systems. I have done research into different health care systems ( not exhaustive ) and so far the system that I find works the best ( or at least is the least broke ) is a single payer system.

Ah, but you see, I don't believe that we exist to be productive for the state. All of that being said, we are probably not as far apart as you might think. I've always maintained that the ONE role of government in healthcare is the control of infectious disease. This is sort of a police function, preventing the guy with TB from infecting everyone. I have no problem with that. Outside of infectious disease, there has to be a balance, and this balance is best determined by the free market. A more productive person can afford more healthcare, as higher productivity leads to more money in a free market. Beyond that, the argument that it benefits society just isn't true, as the person being helped is now draining more than he contributes. In this case, charity can take over, with people choosing to help. The argument that they should be forced to in the name of social good however falls apart at this point.

 

[45408]

A valid point but perhaps it can be argued that due to your greater skill and reputation, you would attract more patients.

That would still mean that he would have to work much longer hours to make any more money, even if he was the better surgeon.

 

[monday_best]

I disagree with you. I am fairly confident that you are very early in your training. For the very best surgeon to want to be well-compensated I think is reasonable. And for doctors to want the Lions share of money is not unreasonable. And for them to want to leave medicine for greener pastures if they are not adequately compensated is understandable because and only because of the environment we live in. Medicine IS a business Period. YOu can argue all you want. It is. And it is a HUGE HUGE business. IF you are not making the money(you hold the product) someone else is taking it from you. you just have to realize who is taking it from you becuase most of the time it is very difficult to discern. And if it is not WORTH the sacrifice at the end less and less people are going to go into it. People and physicians are human beings. Why suffer needlessly in your life. No matter how much you LOVE helping people and how much you want to make a difference.no matter how bleeding heart you are. Your well being will always come first.. And I do believe the quality of medicine will suffer the more and more we squeeze the profession and continue to make it more and more un attractive..

Was it really necessary to call me a "typical pompous pre-med"? Or was that putting words in my mouth?

Eh, can we agree to disagree? You're not going to convince me that I'm just naive and inexperienced, because I have been working in the real world for a while (even meeting that 80 hour week benchmark that one seems to need to have experienced to qualify for speaking on this subject) and I know what motivates me (and how much my paycheck influences my personal happiness). I really don't think I'm that special, i.e. there are lots of people like me. If we manage to reduce some of the barrier to entry in the profession (i.e., huge amounts of debt), then I'm sure a lot of people wouldn't mind taking a pay cut to still keep practicing medicine as long as they (and the families the have to support) were comfortable. Can anybody find me some statistics on doctor satisfaction and employment trends in countries with socialized health care?

(If you pay me a lot, I'll look for the statistics myself. )

Wasn't there some sociology study that claimed once you take care of people's basic needs and give them some modest amount of disposable income a year (I think it could have been as low as 20k), more money does not equal more happiness? I'm young, but I have some empirical evidence to support that.

Anyway, I was arguing about the unlikelihood of a brain drain to other professions. I acknowledge that our health care system is currently run like a business. Obviously, that's not really working out for us.

 

[def jeff]

Please read this story:

http://www.editorandpublisher.com/eandp/columns/shoptalk_display.jsp?vnu_content_id=1003548374


The worst part of the story is how the Walter Reed hospital is being inudated with patients from Iraq, while politicians were previously planning to shut the hospital down by 2011 (just to cut the cost!). This is really a sad story about some of the government provided healthcare veterans are getting. And to think that people applaud the VA system for its "efficiency" and lack of overhead.

 

[OncoCaP]

Please read this story:

http://www.editorandpublisher.com/eandp/columns/shoptalk_display.jsp?vnu_content_id=1003548374

The worst part of the story is how the Walter Reed hospital is being inudated with patients from Iraq, while politicians were previously planning to shut the hospital down by 2011 (just to cut the cost!). This is really a sad story about some of the government provided healthcare veterans are getting. And to think that people applaud the VA system for its "efficiency" and lack of overhead.

The sad thing is that these conditions are not limited to the VA, and as bad as the VA is, the private system has areas of poor care as well. Here is one article that outlines one area with problems (in public & private systems):

http://abcnews.go.com/US/story?id=2367511&page=1

I'm not sure which is worse: having little or no access at all vs getting bad care. If the same thing that happened at Walter Reed's outpatient clinics happened at a private hospital to private patients, I'm not sure we would have heard anything about it. The fact that it was at a VA hospital and was happening to vets struck a nerve. Let's hope that at the VA the problem will lead to improvements. Let's also hope that our private healthcare system will be reformed to eliminate such problems for ordinary citizens as well as vets. CNN recently had a story about a woman who didn't want to be released from jail because in jail she received care for her cancer, whereas in "freedom" she would not ... imagine that ... wanting to go to jail so that you can get cancer treatment! There are similar stories about people stealing so that they can go to jail and get dialysis treatment. It's a bad situation all the way around.

 

[def jeff]

The sad thing is that these conditions are not limited to the VA, and as bad as the VA is, the private system has areas of poor care as well. Here is one article that outlines one area with problems (in public & private systems):

http://abcnews.go.com/US/story?id=2367511&page=1

I'm not sure which is worse: having little or no access at all vs getting bad care. If the same thing that happened at Walter Reed's outpatient clinics happened at a private hospital to private patients, I'm not sure we would have heard anything about it. The fact that it was at a VA hospital and was happening to vets struck a nerve. Let's hope that at the VA the problem will lead to improvements. Let's also hope that our private healthcare system will be reformed to eliminate such problems for ordinary citizens as well as vets. CNN recently had a story about a woman who didn't want to be released from jail because in jail she received care for her cancer, whereas in "freedom" she would not ... imagine that ... wanting to go to jail so that you can get cancer treatment! There are similar stories about people stealing so that they can go to jail and get dialysis treatment. It's a bad situation all the way around.

Yeah, well in all honesty I regreted posting that soon after. I didn't really know enough about the story to make a comment. I'm learning a little more about the situation now and maybe we could talk about that story more in general in the future. With that said, I think the horror stories of people going without any health care whatsoever are the rarest of the rare. We have Medicare. We have Medicaid. If people are missing the cutoff point for Medicaid based on income, then there is a good chance that they could pay for a health insurance plan. If not, there are many charitable foundations that can step in and help out. If all else fails, I know of student run clinics (free) at both of the medical schools I just interviewed at. If people are really missing the cut off point for federal aid and don't have enough money to pay for insurance, then maybe we need to take another look at the way we allocate Medicare. But other than that, I don't see the massive problems with insurance coverage that are oft mentioned.

Take my personal experience. I worked last summer at a hospital in surgery as an operating room assistant (we prepped rooms and cleaned up after surgery, bringing surgical trash bags to waste rooms, etc). I worked a very low level job for relatively low wages (8 bucks an hour). I think only a high school diploma was required for the job, but then I'm not even sure about that. The people I worked with were not college graduates, but they worked very hard, made a dollar or two more than me an hour, and I have the utmost respect for each one of them. If I wasn't going to school or a dependent of my parents and needed to work at that job full time, I would have been able to receive full health benefits. I know this isn't the case for every hosptial or workplace in the country, my point is this. Health insurance is availible for those who search for it with few exceptions. We need to find ways to reach the exceptions. Please don't quote 45 million as the exceptions. There are many reports that these figures are severly inflated (one coming from the congressional report itself that is almost always ingnored). Whatever the true numbers are, we need to find ways to reach these uninsured and help them get insurance. Some people voluntarily choose to not take out insurance that could very well afford it. I have no problem with this since I believe in the freedom of choice. For those who want insurance but can't afford it, we should look for ways to do this. And we don't need to overhaul the system necessarily to accomplish it. But changes need to be made, we almost all agree on that. It is important to note that I am not necessarily a fan of insurance companies. I know that they are not always in the best interest of doctors and I think that things need to be done to limit the power of insurance companies and give it back to physicians. But here I want to focus on ways to provide coverage to those who do not have insurance. I think its interesting (and I made the poll by the way) but our system is already referred to by some as a two-tier because we have our combination of private and public insurance. I think we can tweak the system to get optimal results and not settle for "bad care." I genuinely hope no one wants to settle for "bad care" and actually that makes me sad to think that could be the goal of anyone.

What are the reasons why people don't have health insurance? This is an honest question, by the way.

1. Miss cut off for Medicaid and truly cannot afford it.
2. Voluntarily do not take out insurance.
3. ???

And Oncocap, no offense and I am the first to side with you that this shoudl be a relaxed discussion, not a debate. With that said, it sounds absolutely terrible for you to say that we should settle for "bad care" and really doesn't help any platform for public funded healthcare.

 

[OncoCaP]

... I think we can tweak the system to get optimal results and not settle for "bad care." I genuinely hope no one wants to settle for "bad care" and actually that makes me sad to think that could be the goal of anyone.

What are the reasons why people don't have health insurance? This is an honest question, by the way.

1. Miss cut off for Medicaid and truly cannot afford it.
2. Voluntarily do not take out insurance.
3. ???

And Oncocap, no offense and I am the first to side with you that this shoudl be a relaxed discussion, not a debate. With that said, it sounds absolutely terrible for you to say that we should settle for "bad care" and really doesn't help any platform for public funded healthcare.

Agreed. We should not settle for bad care. This issue needs more study and I'm concerned that it will be difficult to get objective data. Some of the data I have is that ~14,000/yr in the U.S. die because they are unable to get the care they need for lack of insurance. This isn't a big number in the grand scheme of things (~40,000/yr die from traffic accidents per year), but it's something worth looking at more closely. From what I read and have heard, it's simply a matter that if you get sick, you could lose your job, lose your health insurance, and be unable to pay for the care you want.

http://www.amsa.org/uhc/CaseForUHC.pdf
* The uninsured are less likely to be able to fill prescriptions and more likely to pay much more of their money out-of-pocket for prescriptions.
* The uninsured are 3-4 times more likely than those with insurance to report problems getting needed medical care, even for serious conditions.
* The uninsured are more likely to be forced to delay medical services, affecting the timeline of diagnosis and thus the prognosis of the disease process. In one study, the time to diagnosis of late-stage cancer was compared between uninsured and privately insured patients. The uninsured patients were 1.7, 2.6, 1.4, and 1.5 times more likely to be diagnosed late for colorectal cancer, melanoma, breast cancer, and prostate cancer, respectively.
* The uninsured are more likely to receive poor care for chronic diseases.

I recently went through the process of purchasing individual health insurance. In my opinion, for a family, individual private health insurance is a disaster of a system. My family is in great health, and I'm really unsure if we will be able to get coverage for my children beyond a very minimal amount. This is totally unlike purchasing any other insurance, such as life, auto, or home insurance. It's a very complicated system where, if you get sick, they can raise your rates to anything they want or simply non-renew your policy after a month or whatever, at which point, you'll be paying those $20K medical bills out of your pocket. There are plenty of opportunities to improve the system we have. I'm in favor of a two-tier system as you suggest. Maybe there is a way of reworking what we have. Once everyone has at least basic healthcare coverage (even if it has long wait times), that would be a start. Ideally, I would like us to have the most efficient and effective healthcare system in the world. We have a long way to go.

Here is a recent story in the NYTimes that illustrates some of issues with individual coverage and why some people don't have it. I would guess that people in this category are in a minority (people who cannot easily buy the insurance), but it can be difficult for anyone to get coverage for a family. If you want to buy insurance, there are plenty of ways the process can get stalled. Unlike the usual auto, home, and life insurance companies, health insurance companies are mostly concerned to exclude you from coverage for any existing health conditions. Basically, if you have a prior health problem (cancer, obesity, diabetes, a cyst, etc.), individual coverage insurance will at times not cover you for that issue (or at all) or require you to pay large premiums like $27,000+/year for coverage:

http://www.nytimes.com/2007/03/05/us/05uninsured.html?_r=1&hp&oref=slogin
Without Health Benefits, a Good Life Turns Fragile
Vicki Readling, a real estate agent, cannot afford health insurance.
By ROBERT PEAR
Published: March 5, 2007
"SALISBURY, N.C. — Vicki H. Readling vividly remembers the start of 2006.

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The Uninsured
Middle Class Not Exempt
Articles in this series will explore the growing ranks of Americans without health insurance.
"Everybody was saying, ‘Happy new year,' " Ms. Readling recalled. "But I remember going straight to bed and lying down scared to death because I knew that at that very minute, after midnight, I was without insurance. I was kissing away a bad year of cancer. But I was getting ready to open up to a door of hell."

Ms. Readling, a 50-year-old real estate agent, is one of nearly 47 million people in America with no health insurance.

Increasingly, the problem affects middle-class people like Ms. Readling, who said she made about $60,000 last year. As an independent contractor, like many real estate agents, Ms. Readling does not receive health benefits from an employer. She tried to buy a policy in the individual insurance market, but — having had cancer — could not obtain coverage, except at a price exceeding $27,000 a year, which was more than she could pay.

...

But the surprise is that the uninsured are not necessarily the poor, the unemployed and the undocumented. Solidly middle-class people like Ms. Readling are one of the fastest growing subgroups.

And that is one reason, according to a recent New York Times/CBS News poll, that the problems of the uninsured have jumped to the top of the domestic political agenda in Washington and on the campaign trail.

Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker.

Ms. Readling's experience is typical; people who have had serious illnesses often have difficulty obtaining insurance. If coverage is available, the premiums are often more than they can afford.

While the government does not have an official definition of "middle class," one commonly used point of reference is the median household income, which was $46,326 in 2005.

Katherine Swartz, a professor of health policy and economics at Harvard, said the soaring cost of health care was a major reason for the increase in the number of uninsured. She said it also reflected long-term changes in the economy, like the decline in manufacturing jobs and the growth in the share of workers in service industries and small businesses, which are less likely to provide health benefits.

Moreover, Ms. Swartz said, "Companies have become more aggressive in hiring people as temporary or contract workers with no fringe benefits."

The National Association of Realtors says 28 percent of its 1.3 million members are without health insurance.

"Because real estate agents are independent contractors, they are forced into the individual insurance market, where there is no negotiating or leverage," said Pat V. Combs, president of the association.

...