"Socialized medicine"? Democratic president? Educate me on the future of medicine.

[NerdBoy]

Look, there are plenty of people in the world that have it worse than we do. A homeless person in NYC affects me the same way a starving child in ethiopia...not at all. Its sad, but i don't lose sleep. There is too much in the world for me to fix it all, so i'd rather not sacrifice a lot just to throw a few starfish back in the sea.

I agree. The hell with the starving children of the world. Such "people" are beneath us. I for one am tired of all these idiots who can't buy food, housing, or healthcare all on their own. "People" like that are such an inconvenience.

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[Ross434]

I agree. The hell with the starving children of the world. Such "people" are beneath us. I for one am tired of all these idiots who can't buy food, housing, or healthcare all on their own. "People" like that are such an inconvenience.

They are. It means they havent contributed anything to our society. (ie: earned money through production)

 

[El Duderino]

ook, i am not going to read 50 pages written by the WHO, but I can assure you that the healthcare situation in this country is alot better than in any other country. When you have a serious health problem, would you rather be in malta? I don't care what their criteria is, because simply we have a better healthcare system.

First off: Is there ANY statistic that would make you change your mind on this? If not, further discussion is pointless.

There is no doubt that the US is home to the world's best hospitals. Noone is contesting that. However, having the best hospitals and having the best healthcare system is not the same thing. The inequal distribution of healthcare resources means that the US comes out looking pretty crappy when you look at measures such as infant mortality etc. Of course, you could argue that you don't give a flying **** about babies surviving, and that you define "best healthcare system" by the "best healthcare system for me" but then we should make that clear from the outset.

Besides if you look at the chart, we have the highest LEVEL of healthcare. The overall ranking of our system is lower, because of inefficiencies...but i dunno, insuring a country as diverse as ours and at 300 million strong probably will be a bit harder than a country full of starving kids that only need antibiotics.

Newsflash: The world doesn't consist of the US and countries "full of starving kids that only need antibiotics".

Everyone who reads this site has healthcare, for instance.

I'm currently uninsured.

Of the 44 million who are uninsured, i think ilike 35% make over 75k...

It's roughly 15%, but your point is well taken.

Mostly, though, they are "between jobs" or self-employed. You are correct in pointing out that not all uninsured people are hurtin', though. Only about half of them are uninsured for more than a year. On the other hand, there are just as many underinsured as there are uninsured.

they choose not to pay for it to save money. The people who don't have healthcare are basically those who choose not to buy it.

15% is basically 100%, that's what you are saying?

BTW, i know what socialized medicine is and how it differs from universal healthcare.

Yes, when you want to scare people with inane rhetoric, you have to know one from the other.

The fact is, universal healthcare can only exist with it in this country, as private companies are not going to insure 18 year old crack mothers with 3 kids. In any case, my company wouldn't.

In principle, I think you are correct in saying that universal coverage is unlikely. I think the priority would be to reform Medicare and Medicaid (i.e. make the coverage less comprehensive but make more people eligible).

But the fact is, i think we need to be able to start turning people away from the ER in order to make changes.

You really don't see many people advocating the wallet biopsy these days. In a way, it is refreshing that you're not hypocritical about it.

People abuse welfare, people abuse healthcare. I never got anything I didn't pay for, so I don't feel like anyone else should either.

Oh come on. Noone's buying.

What can i say? I am an american and a capitalist. Most people who think i shouldn't be in med school aren't smart enough to get in.

If you assume that people who don't get into medical school are necessarily not as smart as you just because you did, you're obviously not familiar with the admission statistics...

I want to do good work and get paid accordingly for it. If everyone in society was like that, we wouldn't have that problem.

In principle, I agree. The question is what we do when we realize that there are dífferences between the map and reality.

 

[typeB-md]

i don't have time to respond to all the rest of these idiotic counter arguments. but here is one thing i noticed and will say.

the WHO judging criteria may work in a world filled with fluffy bunnies and cute little candy-cane avenues, but the reality is that American physicians and hospitals are by FAR the best bet for anyone if you can AFFORD it. the WHO criteria is inherently socialistic and baseless as it assumes that healtchare is right.

the WHO is the same group giving condoms out to the africans like these individuals really have the want to use a piece of rubber to stop the spread of disease. and what happens when the condoms run out?

healtcare is nature's last ditch effort in weeding out those useless members of society and the socialists are fighting tooth and nail to undermine these principles that have ruled the world since the beginning of time.

 

[dopaminophile]

i don't have time to respond to all the rest of these idiotic counter arguments. but here is one thing i noticed and will say.

the WHO judging criteria may work in a world filled with fluffy bunnies and cute little candy-cane avenues, but the reality is that American physicians and hospitals are by FAR the best bet for anyone if you can AFFORD it. the WHO criteria is inherently socialistic and baseless as it assumes that healtchare is right.

the WHO is the same group giving condoms out to the africans like these individuals really have the want to use a piece of rubber to stop the spread of disease. and what happens when the condoms run out?

healtcare is nature's last ditch effort in weeding out those useless members of society and the socialists are fighting tooth and nail to undermine these principles that have ruled the world since the beginning of time.

I still haven't been able to figure out whether you're trolling and baiting people or whether you've actually fallen pray to the naive ideology that you're pushing. My feeling is that the former is the case because you bypassed most hard-line pure capitalists a long time ago. In any case... here's something for you to flame:

John Locke, the founder of modern democracy and American-style capitalism, from whom Thomas Jefferson forged parts of countless documents including the Declaration of Independence, argued that the most fundamental right a person has is to their own body. This means a person has a right to not be killed either by another person, by a bear in the woods, or by other things in his/her environment. Socondary to that and as an extension to that most fundamental right then is the right to own property and to not have that property destroyed by another person or by nature. Locke argues that property is an extension of one's body and is therefore fundamental as well. These two arguments are the basis for our government and our economic system.

We have fire departments, police departments, forestry services, environmental protection agencies, and countless more, all of which are dedicated to protecting everyone from the macro-scale threats to our bodies and our property. Both threats from other people and from nature are protected against. We protect against fire, but you don't want to be protected against disease? Your house is protected against nature's destruction, but your body isn't? According to the roots of American politics, quality health care is a more fundamental right than your right to your property.

I'm willing to put that aside for just a second though. You want to leave the happy candy filled streets with fluffy bunnies, okay. The cold, hard truth of the matter is that Americans will not tolerate poor children dying in the street. People will not sit by and watch plagues sweep tent cities twenty miles down the road. We did not do it before and we sure as hell aren't going to sit back and watch it when every suffering face is plastered across CNN. As much as you want it, there's no way the American public going to turn people away from emergency rooms and watch them bleed to death. This is where you cannot avoid the fact that health care early is a whole heck of a lot cheaper than end-stage care in the E.R. The government (paid for by you and me) will foot the bill either way. Right now we're taking the far more expensive option, I'm more than happy to change and give everyone good primary care. Away from candy streets, the reality is that there are two options: (1) continue paying the 100 & some billion dollar high price tag now or (2) provide some basic level of universal care. In the end, even if it's not a fundamental right, it's better for you if there's universal coverage. That, and you get the benefit of not killing babies.

 

[Gut Shot]

the WHO judging criteria may work in a world filled with fluffy bunnies and cute little candy-cane avenues, but the reality is that American physicians and hospitals are by FAR the best bet for anyone if you can AFFORD it. the WHO criteria is inherently socialistic and baseless as it assumes that healtchare is right.

Oh, yeah, all those fluffy bunny filled statistics like "life expectancy at birth" and "probability of dying (per 1000)". And I always get visions of candy-cane avenues when perusing infant mortality numbers.

Out of curiosity, how old are you? Have you started med school yet?

the WHO is the same group giving condoms out to the africans like these individuals really have the want to use a piece of rubber to stop the spread of disease. and what happens when the condoms run out?

Many groups are trying to stem HIV in Africa, not just the WHO. I'm sure Trojan would be happy to crank out as many Gym Hats as needed. This is digression, but I'll bite (emphasis added):

"However, much of the progress is still occurring in localised settings. One new study in Zambia has shown success in prevention efforts. The study reported that urban men and women are less sexually active, that fewer had multiple partners and that condoms were used more consistently. This is in line with findings that HIV prevalence has declined significantly among 15-29 year-old urban women (down to 24.1% in 1999 from 28.3% in 1996), as well as amongst rural women aged 15-24 (down from 16.1% to 12.2% in the same period). Although these rates are still unacceptably high, this drop has prompted a hope that, if Zambia continues this response, it could become the second African country (after Uganda) to reverse a devastating epidemic. However, many hurdles still separate the country from such a milestone. For example, condom use amongst rural men remains very low (reported as 15% in 2001 compared to 68% for urban men when they last had sex with a casual or paid partner)."

http://www.avert.org/aafrica.htm

healtcare is nature's last ditch effort in weeding out those useless members of society and the socialists are fighting tooth and nail to undermine these principles that have ruled the world since the beginning of time.

The precise attitude of an empire that is on the decline.

 

[Gut Shot]

I still haven't been able to figure out whether you're trolling and baiting people or whether you've actually fallen pray to the naive ideology that you're pushing.

I'm voting for troll. At least this gives me something to do during the last of my brutal M4 electives.

The question is: what is medstyle up to? It would be rather embarassing come out swinging in defense of a troll, dontcha think?

 

[Gut Shot]

but I can assure you that the healthcare situation in this country is alot better than in any other country.

Before we continue, your qualifications to issue assurance are...?

In this country, everyone gets a chance to live, whereas in most places if you're a sick baby, you're a dead baby.

(Okay, this one thing) Most places, yes, but apples to apples, my friend.

Infant mortality per 1000 live births

USA - 7.2
Britain - 5.7
Canada - 5.5
Netherlands - 5.2
Spain - 5.0
Australia - 5.0
Germany - 4.7
France - 4.7
Japan - 3.6

 

[DrMojorisin]

Its fascinating how impertinent personal principles have derailed an otherwise insightful discussion. What any individual thinks should happen to U.S. healthcare is of very little relevance. In fact, the opinions of the U.S. population as a whole are disturbingly irrelevant. The opinions that count are those of our legislature (mostly rich conservatives) and special interests (the powerful ones are strongly against socialized medicine). So, to address the OP's concerns about whether physicians are gonna get bent over and given fast food pay over the next 20 years, the answer is that it almost definitely will not happen (although general practitioners might take big pay cuts due to increased competition). Social unrest regarding health care will continue to rise as social stratification continues to polarize the haves and have-nots. The disintegration of the middle class will lead to a revolution that will restructure American society as we know it - but I think that will come when social security collapses, not medicare. At that point, we might manage to convert to systemwide socialism (not just health care) before anarchy destroys us. This is my view of the course we are on. I don't believe people are just going to die in the streets, as typeBmd would have them do. Rather, they will revolt and kill people like typeBmd if it ever comes to this. You'd be surprised at how lethal a person with end stage renal disease can be (Osama Bin Laden, for example). But I don't think we'll see major problems like this occurring anywhere in the next 20 years.

Of course, I'm only guessing as to what will happen, but I think most would agree that the American system cannot go on as it is without change, and that no meaningful change is likely to occur within the current political structure. I think we are headed towards either socialism or anarchy as a nation. As I see it, the problems facing health care are mostly a symptom of the disease of social stratification - a disease that won't be cured by socializing medicine alone.

 

[typeB-md]

Oh, yeah, all those fluffy bunny filled statistics like "life expectancy at birth" and "probability of dying (per 1000)". And I always get visions of candy-cane avenues when perusing infant mortality numbers.

Out of curiosity, how old are you? Have you started med school yet?




The precise attitude of an empire that is on the decline.

i just turned 24 and have probably traveled more extensively throughout the world than many individuals. i also am probably more intellectually capable than most of the other pseudo-intellects that medicine attracts (i.e. little boys and girls that mommy said needed to be studying all the time so that they could become the american doctor).

and life expectancy is a result of many americans being fat, lazy, underproductive pieces of crap. exercise? accountability for productivity? we don't want to hear those things!!!

and our birth mortality is likely more a case of poor decision making during pregnancy and VERY likely a result of the heterogeneous make-up of our population. All those other countries that you listed have a very homogenous population. it is apples to oranges and to deny this fact is evidence that people are ******ed and inately ignorant.

you want better numbers for the WHO? tell the american people to stop being such unaccountable hand-me-outers and to start finding internal motivations for activity and production.

and empires fall because of complacency with stupid ideas (illogical tolerances) and too great division of power. read your history books, folks.

 

[Gut Shot]

i also am probably more intellectually capable than most of the other pseudo-intellects that medicine attracts

Anyone else notice that the moment someone refers to himself as "intellectual" you realize he's just a loud, opinionated sack of foul-smelling wind?

and life expectancy is a result of many americans being fat, lazy, underproductive pieces of crap. exercise? accountability for productivity? we don't want to hear those things!!!...

...you want better numbers for the WHO? tell the american people to stop being such unaccountable hand-me-outers and to start finding internal motivations for activity and production.

I'm sure the American workers would be fascinated to know how lazy and unproductive they are.

http://archives.cnn.com/2001/CAREER/trends/08/30/ilo.study/
http://www.forbes.com/feeds/ap/2005/03/03/ap1860502.html

and our birth mortality is likely more a case of poor decision making during pregnancy and VERY likely a result of the heterogeneous make-up of our population.

Reference? Maybe I'm crazy, but I believe it has been demonstrated that when a segment of society with lousy infant mortality stats is given access to simple, free prenatal healthcare (the kind that is available in every other industrialized nation), the mortality numbers improve dramatically.

Look, perhaps you're loaded with principles and your own brand of rationalized morality, but let's be pragmatic. And this is coming from someone who has spent the last two years of clinical training in an urban medical center, with high crime, that serves 98% of the state's indigent care needs. I've seen more idiots, more crack and FAS babies, more drug seekers, more apathy, more GSW's, and more general ******ation from the underbelly of our "heterogenous" society that I ever cared to.

For every social parasite, however, there are ten working stiffs who just want to earn a living, see the doctor periodically, be able to afford their medications, and have coverage in the event of something drastic. If you preach capitalism then this is the consumer. The only problem is that unlike every other capitalistic venture, which seeks to make its products more affordable (think Henry Ford or Sam Walton), healthcare makes itself less affordable. Then people like you come along and say that it's not up to the healthcare system to become more efficient, cut costs, reduce bloated bureacracies. Oh no, for some reason it's the fault of the consumers that they have to move to Canada, eat Alpo or declare bankruptcy in the face of our insane system.

One thing I really can't figure out is why corporate America hasn't led the charge for universal, single-payer healthcare (two-tiered or otherwise). I would have thought that they'd be desperate to throw off the yoke of covering employee's skyrocketing healthcare premiums. Oh wait, they just cancel coverage. Nevermind.

In the end, my opinion is that a two-tiered system would be better for our country. Not perfect, but a sight better than what we have now. So if you're born in Crackton with a serious heart defect you're screwed, but if it's just some strabismus then you can have that fixed and proceed on to America's great socio-economic ladder.

 

[Ross434]

The only problem is that unlike every other capitalistic venture, which seeks to make its products more affordable (think Henry Ford or Sam Walton), healthcare makes itself less affordable.

huh, maybe its because doctors are restricting entry into their profession? Haha, market forces will prevail. Look at NP's.

 

[medstyle]

Anyone else notice that the moment someone refers to himself as "intellectual" you realize he's just a loud, opinionated sack of foul-smelling wind?



I'm sure the American workers would be fascinated to know how lazy and unproductive they are.

http://archives.cnn.com/2001/CAREER/trends/08/30/ilo.study/
http://www.forbes.com/feeds/ap/2005/03/03/ap1860502.html



Reference? Maybe I'm crazy, but I believe it has been demonstrated that when a segment of society with lousy infant mortality stats is given access to simple, free prenatal healthcare (the kind that is available in every other industrialized nation), the mortality numbers improve dramatically.

Look, perhaps you're loaded with principles and your own brand of rationalized morality, but let's be pragmatic. And this is coming from someone who has spent the last two years of clinical training in an urban medical center, with high crime, that serves 98% of the state's indigent care needs. I've seen more idiots, more crack and FAS babies, more drug seekers, more apathy, more GSW's, and more general ******ation from the underbelly of our "heterogenous" society that I ever cared to.

For every social parasite, however, there are ten working stiffs who just want to earn a living, see the doctor periodically, be able to afford their medications, and have coverage in the event of something drastic. If you preach capitalism then this is the consumer. The only problem is that unlike every other capitalistic venture, which seeks to make its products more affordable (think Henry Ford or Sam Walton), healthcare makes itself less affordable. Then people like you come along and say that it's not up to the healthcare system to become more efficient, cut costs, reduce bloated bureacracies. Oh no, for some reason it's the fault of the consumers that they have to move to Canada, eat Alpo or declare bankruptcy in the face of our insane system.

One thing I really can't figure out is why corporate America hasn't led the charge for universal, single-payer healthcare (two-tiered or otherwise). I would have thought that they'd be desperate to throw off the yoke of covering employee's skyrocketing healthcare premiums. Oh wait, they just cancel coverage. Nevermind.

In the end, my opinion is that a two-tiered system would be better for our country. Not perfect, but a sight better than what we have now. So if you're born in Crackton with a serious heart defect you're screwed, but if it's just some strabismus then you can have that fixed and proceed on to America's great socio-economic ladder.

i agree with you completely. I don't want to live in a nation where our ER's are only for the rich, but I don't think we can provide top notch healthcare for everyone who doesn't pay either.

I think the part of the problem wiht "sky rocketing" healthcare costs is that there is more healthcare available here then in anywhere else. We have treatments for everything, including antivirals for the flu, which are unheard of elsewhere. Its hard to make healthcare more efficient when more and more treatments are available every day. In addition, we need to have more preventative care and measures to prevent problems that can be easily avoided, like heart disease and diabetes from obesity.

For the guy who is talking about the evaporation of the middle class and upcoming anarchy, i would suggest you just study and get a job. the middle class in this country is over 200 million strong and they aren't going anywhere. This nation is built on the labor of the middle class, from engineers to teachers or whatever. There is no revolution.

BTW, the WHO is just like the UN or any other world organization. Their "objectivity" does not apply to our diverse nation or our unique position as a country that is 300 million strong, as well as the military and economic leader of the world. If our infant mortality rate is higher than that of italy, there is a good reason.

 

[Booyakasha]

i AM telling you that you ARE wrong. canada's healthcare works by stealing money from one person to give it to another... this is not cool by American capitalism, you anti-American socialist.

You stupid American. People like you make others believe that we are arrogant, unintelligent, and ignorant. Canadians democratically chose to have such a system. And it works quite well, I might add. Although pure socialism has its ills, and for that reason I tend to stick more to capitalism, every society has socialistic mechanisms in place, even your beloved United States. Funding an army through public funds so they can march around the globe and kill "enemies" is socialistic. So is a public education system; which you, most likely, are a product of. Go think a little (if you are capable of doing that) before you make bold statements such as this one.

 

[Ross434]

You stupid American. People like you make others believe that we are arrogant, unintelligent, and ignorant. Canadians democratically chose to have such a system. And it works quite well, I might add. Although pure socialism has its ills, and for that reason I tend to stick more to capitalism, every society has socialistic mechanisms in place, even your beloved United States. Funding an army through public funds so they can march around the globe and kill "enemies" is socialistic. So is a public education system; which you, most likely, are a product of. Go think a little (if you are capable of doing that) before you make bold statements such as this one.

\

There are some institutions where socialism is the only way.. Ie: the army. how would it be if there were private armies that were hired by the government to get things done?? I bet they'd be real accountable! Same thing with education. If there were 1000 different companies running schools, everybody would be learning differently. Inefficient. You notice power companies are regulated monopolies. Its because economics has proven that they are cheaper for everyone this way. Is socialism always right? No, its not usually the best way, but sometimes it is. We need to carefully compare the cost and benefits (economically) before making hasty decisions based on ideology.

Healthcare might not be the same way as these other services like police or fire departments. They are relatively cheap. Healthcare is vast and complex.

 

[LabMonster]

This healthcare crisis and the death of social security are not single variable problems to be solved by any one particular idealogy or nationality.

Medicare is in part to blame for outrageous private insurance premiums now. It used to be, healthcare could gouge Medicare for all it wanted and nobody thought twice. Doctors I know talk about times of low patient census in their hospitals - so they went and rounded the nursing homes. They would admit UTI's, angina, blah blah blah - pay the hospital and here's my fee. Everyone is making money except the taxpayer. Government starts cutting funding, so hospitals start billing differently. The more you can afford, the more you can pay and now private health insurance gouges businesses to cover their billing losses.

SS is similar. Generations grew up expecting SS to supplement their "pensions" (anyone familiar with that word anymore?) and for Medicare to completely cover their medical expenses (or supplement a pension.) Now we have an entire generation of baby boomers who expect what their parents had and are really pi$$ed they aren't getting it.

I'm really frustrated at how people can afford cable/TIVO/satellite, a myriad of electronic gadgets, spinners on their tires, sneakers with springs in them, and pre-ripped clothes, but express the grandest of disdain when you suggest people actually start picking up more of the tab on their healthcare. Imagine that, me, taking responsibility for... myself!? Is there anything more important than your health when you boil it down?

This is not a partisan issue, nor is it a country vs country issue. Healthcare is a dynamic issue, but most of the developed world has treated it as static. Unfortunately, we only start worrying about things when they go haywire instead of using some form of preventative maintenance, or a system of checks and balances to assess and control individual beaurocracies.

Socialized healthcare is not the answer, and neither is privatized healthcare - but there is a solution out there. This country is centered on capitalism, but we simply do not have the time to let the market work. Similarly, we don't need government butting in and screwing things up more - they're part of the problem.

I know this isn't a unified essay where I've tied all three tasks neatly together - this is a rant and it's a bit choppy with missing literary citations - but I hope you see what I'm getting at.

The next generation of physicians will help set the tone (in my opinion) so collectively, we can arrive at a solution to this problem instead of complaining about it.

Let the barbecue roar.

 

[matthew45]

Okay, so as a current med student and a recovering right winger I think I should weigh in here...

I'm going to aim this at Type-B although I'm sure there are others out there who think like him, and I don't mean it as any sort of personal attack...

When people come to a doctor they are sick and scared. We have an incredible opportunity to help them. We are at the top of the intellectual food chain and most of the people we see could not possibly understand their pathology in the way that we can.

I used to think of medicine as a service like any other, if you can pay for it you can have it. But man, the first time you walk into a room to talk to some poor old grandma of 12 who just found out she had advanced ovarian cancer, I hope something goes through your head other than "can this lady pay me?"

We don't really need to debate about whether or not healthcare is a right or it isnt. We as future doctors need to recognize that millions of people across this country and around the world are sick and scared and NEED US.

If you're going into medicine for the science, you're going into the wrong field. This is why we have PhDs.

If you're going into medicine for the money, you're going to be sorry. This is why we have MBAs and JDs.

Please, please, please, I beseech you applicants and matriculants. Do not fall into this mentality of medicine as a service like being a mechanic. Much has been given to us and much is expected. I wish that all Americans could realize that we could turn this entire messed up world aroud if we as a people and a nation would make a decision to try.

Good luck to all the future M1s.

 

[Gut Shot]

huh, maybe its because doctors are restricting entry into their profession? Haha, market forces will prevail. Look at NP's.

Nah, it's way more complicated than that. Patients get sick, doctors overbill in order to get maximum reimbursement, insurance companies counteract by under-reimbursing in order to maximize profits. Hospitals that do a lot of indigent care periodically have to ask their state's for more tax money to offset how much free care they've had to write off. The HMO's take their cut, the lawyers take their share. NP's and PA's are going to enjoy a honeymoon until there is a single huge lawsuit against one of them. Then their malpractice insurance is going to skyrocket and the lawyers will be laughing all the way to the Mercedes dealership.

Standards of care that involve expensive new medicines/techniques, and the general inability of hospitals to refuse acute lifesaving care to anyone really throw a wrench into things. Some of the capitalists on these forums really seem content with the unbelievably wasteful HMO/insurance bureacracies. In his book "As Sick As It Gets", Dr. Rudolph Mueller calculated that about 1.5 million Americans (1 in every 200) are employed in some capacity related to processing the gigantic labyrinth of paperwork associated with this beheamoth.

 

[typeB-md]

You stupid American. People like you make others believe that we are arrogant, unintelligent, and ignorant. Canadians democratically chose to have such a system. And it works quite well, I might add. Although pure socialism has its ills, and for that reason I tend to stick more to capitalism, every society has socialistic mechanisms in place, even your beloved United States. Funding an army through public funds so they can march around the globe and kill "enemies" is socialistic. So is a public education system; which you, most likely, are a product of. Go think a little (if you are capable of doing that) before you make bold statements such as this one.

economic socialism has nothing to do with a government funded military.

and our public education system is only one part of our total education with many private schools turning out the more productive students. so yes, public schooling is a form of government regulation and you can judge for yourself the caliber of student coming out these days.

and no, i am not a product of our public school system. i was trained and schooled at a very reputable private school which i would rather not mention.

and canadians democratically chose to have it, so what? just because your society's mentality is socialistic doesn't make it any better. i have been to canada, i have friends who lived in canada... if you like waiting a long amount of time for sub-standard healthcare, then go ahead and pay your taxes.

and let me also add that canada has roughly 10% of america's population. so if you think the lines are bad in canada, i can only imagine how the **** would hit the fan here in the states (and here's the link for you nay-sayers http://www.geohive.com/global/pop_data2.php )

also, since you canadians are so set on being such unselfish do-gooders, why don't you tell me what good you've done for the world lately. it seems to me that canada produces no good electronics, no good automobiles, no good drugs, etc. everything is raw materials that we could just as easily take form you as we are currently buying. canda has no place to speak in any matters of economy as you are useless without our goods. your military is a joke. your scientific contributions are laughable since many of the brightest come to american universities. maybe if you rewarded individualism you might progress to something more than just our largest export market. do some reading http://en.wikipedia.org/wiki/Economy_of_Canada

 

[winstonm]

Please excuse Booyakasha for the "stupid American" comment. I hate when these health policiy threads dissolve to US/Canada bashing.

The "skyrocketing" costs aren't due to the US having treatments for everything; most industrial countries have treatments for everything the US does. A study a few years ago (I think it was in NEJM) attributed the high cost of the US system (relative to the Canadian one) to higher physician fees and the ridiculous increase in administrative costs due to your various financing mechanisms and insurers. Regarding physician incomes, there are some idiots on this board who think neurosurgeons in Canada make $50000. That's just stupid so disregard any post that contains nonsense like that.

Now, I understand that maybe most Americans can get care if their life was in danger, but what about all those people who will develop chronic conditions that will later become expensive simply because they don't get ongoing care? Look at the obesity problem in both of our countries. You don't think that there will be literally millions of people who will develop diabetes, heart disease etc. later on whose conditions could have at least been controlled if they had coverage for ongoing care?

Lastly, can you guys let me know if women in the US are guaranteed care while they are pregnant and also for their kids immediately after (i.e. well-baby visits)?

 

[winstonm]

if you like waiting a long amount of time for sub-standard healthcare, then go ahead and pay your taxes.

it seems to me that canada produces no good electronics, no good automobiles, no good drugs, etc. your scientific contributions are laughable since many of the brightest come to american universities.

You might try doing some reading other than a free online encyclopedia based on contributions from the general public.

Ontario is the largest maker of vehicles in N. America, having passed Mich. last year. Why? Because car manufacturers don't have to pay for their workers health care. You should know that GM is being hit by health care premiums.

Sub-standard care? Yeah, OK. Are there waitlists, yes. Have been shown to affect care? No, at least not for cardiac surgery since it's triaged appropriately. Look at your own health indicators and tell me we have substandard care. Guess what, Americans, from NY, have come to Sick Kids for care.

Scientific contributions laughable? Yeah, I guess so. Much of modern immunology is based on the discovery of the T cell receptor by Tak Mak, in Toronto. The CFTR gene? Discovered here, as was the gene responsible for the most severe form of Alzheimer's. Insulin? Ditto. Islet cell transplantation? Albera. ABO-incompatible heart transplantation? Toronto. The first double-lung transplant? Toronto. One of the worlds 10 most cited medical researchers is here. The world's most advanced centre for research, development and implementation of surgical robotics is in London, Ont. The world's first robotic, closed-chest beating CABG was done here. The first cyclosporin trials were done here. How about the development of the pacemaker, hypothermia in heart surgery, nerve transplant, heart valve transplant, single and double-lung transplant, liver-bowel transplant. The largest hospital-based peds research institute in the world, after Harvard, is in Toronto. The Scientist voted UofT as the world's best centre for scientific research outside the US. Your US Air Force pilots and astronauts can credit the G-Suit and space suit to Canadian researchers. That's a sample. Sure you have more, but as you said, your population is 10x higher and your economy is larger.

By the way, waitlists aren't the product of nationalized health systems. France has no waitlists.

 

[Gut Shot]

i agree with you completely. I don't want to live in a nation where our ER's are only for the rich, but I don't think we can provide top notch healthcare for everyone who doesn't pay either.

I disagree, but I don't have any numbers to back myself up. Not for lack of searching, but it's incredibly difficult to make accurate estimations of such things. Nevertheless, the perceived trade-off seems to be "average healthcare for all" vs. "high-end healthcare for few and piss-poor/zero healthcare for many." I reject this simply because I think extending a basic level of care to everyone without out-of-pocket expense is cost-effective in the long run. As such, with a streamlined system we could cover more people for the same or less money, and not touch the funds that go to high-end care.

It's not too difficult to see that the biggest bang-for-buck is going to be in preventative care and through relatively inexpensive treatments of common complaints. I once treated a woman who was a seamstress. She had lost her job and couldn't afford meds to control her diabetes. Her diabetes was gradually making her blind, thus destroying her chances of becoming re-employed. Once she became blind enough she would qualify for disability, and could then finally be "on the dole" and get looked after appropriately. Makes sense, eh?

Heck, the biggest health-related advances ever developed by civilzation were 1. hand washing, 2. public sanitation, 3. vaccination and 4. antibiotics. You'll note that only one of these originated within the last 100 years.

So yeah, with an intelligently-designed two-tier system I think we could have it all, especially for 14% of our GDP. The citizenry could rest easier, doctors could practice at whatever level they choose, and the health administration bureacrats could start turning tricks or working the front door at Wal-Mart. Oh, and I love the idea of universal catastrophic insurance funded by Uncle Sam. If you put everyone in the country in the same risk pool, and take the heat off the HMO's and private insurers for such coverage, there might be significant savings for all.

BTW, the WHO is just like the UN or any other world organization. Their "objectivity" does not apply to our diverse nation or our unique position as a country that is 300 million strong, as well as the military and economic leader of the world. If our infant mortality rate is higher than that of italy, there is a good reason.

I'm not sure why our diversity and unique position disqualifies us from data collection and/or statistical analysis, but okay.

 

[medstyle]

I disagree, but I don't have any numbers to back myself up. Not for lack of searching, but it's incredibly difficult to make accurate estimations of such things. Nevertheless, the perceived trade-off seems to be "average healthcare for all" vs. "high-end healthcare for few and piss-poor/zero healthcare for many." I reject this simply because I think extending a basic level of care to everyone without out-of-pocket expense is cost-effective in the long run. As such, with a streamlined system we could cover more people for the same or less money, and not touch the funds that go to high-end care.

It's not too difficult to see that the biggest bang-for-buck is going to be in preventative care and through relatively inexpensive treatments of common complaints. I once treated a woman who was a seamstress. She had lost her job and couldn't afford meds to control her diabetes. Her diabetes was gradually making her blind, thus destroying her chances of becoming re-employed. Once she became blind enough she would qualify for disability, and could then finally be "on the dole" and get looked after appropriately. Makes sense, eh?

Heck, the biggest health-related advances ever developed by civilzation were 1. hand washing, 2. public sanitation, 3. vaccination and 4. antibiotics. You'll note that only one of these originated within the last 100 years.

So yeah, with an intelligently-designed two-tier system I think we could have it all, especially for 14% of our GDP. The citizenry could rest easier, doctors could practice at whatever level they choose, and the health administration bureacrats could start turning tricks or working the front door at Wal-Mart. Oh, and I love the idea of universal catastrophic insurance funded by Uncle Sam. If you put everyone in the country in the same risk pool, and take the heat off the HMO's and private insurers for such coverage, there might be significant savings for all.



I'm not sure why our diversity and unique position disqualifies us from data collection and/or statistical analysis, but okay.

i believe in a two tier system.

as far as my WHO comment, its like those things i hear about "American students rank 14 in the world, behind, japan and germany". stuff like that. Statistics presented without context are worthless and manipulative. They Malta look better than the US.

Like the whole educational thing, in Japan kids go to cram school to get into a cheap public university. Private school over there is for suckers. Once they go to college, they don't do anything. When they graduate, they are just as imcompetant as us. In fact, they don't learn much in all that cramming, unless you count worthless rote memorization which is forgotten instantly. The japanese kids i live with think i am freaking genius, but the fact is i learned how to think throughout my life, which is something they apparently can't do.

In germany, schools limit what fields you can pursue from your middle school and high school performance. Great job guys! They don't need AA, because only the kids from good backgrounds can even think about a good job.

I want to see pictures of the hospitals. I want to see what kind of illnesses they are dealing with. When someone has tumor the size of golfball in their head in the USA, they still have options. In Malta, they are already dead. When you have a 24 week old baby, we call it a preemie here and it gets a chance to live. In malta, they have a funeral. If our infant mortality is worse, it HAS to mean that we are giving more babies a chance to fight it out. Who knows what or what isn't included inthere?

All i know is, some private hospitals cater to rich foreign nationals coming for treatment. They often are coming from those rich arab nations that are ranked so highly. The reason? We're the best.

That's my point. The WHO and the UN are all about these "hey, USA is not that great after all" presentations. The fact is, we have the best health care available and we run the world. Nothing the WHO or UN says counters that. I mean, the only thing the WHO does for us is determine what strains of flu to watch out from, and i am sure the drug companies would have no problem footing the bill for that either. The UN told us they don't support our war...what are they doing now? Whatever we say, as usual.

And for canada, you're not even good enough to be the 51st state. You contribute nothing to the world. Thats fine, you exist, but thats it. You don't hurt nobody, but you're not helping anybody either. The USA basically has kick started everything in the modern world. We made japan modernized, and europe was in ruins after WWII. We are the leader of the new world. You eat american foods, you wear american brands, you listen to american music, use american medicine develped by american scientiests, drive cars made with american technology, using computers designed by americans, your countries army uses american weapons...etc.

The only thing i get from canada are 3 dollar pot pies. Thanks guys. And you can keep sum 41.

 

[MJB]

As a 28 year old Cancer survivor and self described hater of insurance companies and what they stand for all intents and purposes...and someone that has travelled and lived in countries that have what I consider to be the worst kind of healthcare (government run), I am extremely torn on this issue...

I'm quite sure that universal healthcare would be a good thing, IF people took advantage of it....but I'm not convinced that a high % would use it to their advantage...

I can only say that I am ever thankful that 3 years ago when I was diagnosed I am glad I had just gone to work for a company that pays healthcare on their own and has a rather large insurance company manage the program for them.

I have had WELL into the 6 figures in medical care over the last 3.5 years, and I don't think we have broken the 500 dollar out of pocket mark as of yet.

I have seen young people just like myself die of the same Cancer I had (my wife works at the clinic where I was treated)...I'm not sure if they had the best care, like myself, and I would never wish for someone to die just because they are less fortunate than me through no doing of their own.

I'm a lucky person, and I will not bring myself to believe that I'm alive because I'm "better" than those other people...Sure, I may have worked harder than them to get the job I have, but I can't hold them accountable for contracting a disease that, even with our "best healthcare in the world", we have NO CLUE what causes it.

This is a VERY difficult issue...I hope we can get it fixed...there are too many smart individuals in our country to not get this figured out....The one thing I can say is that I don't think a totally government run system is the answer from what I have seen in other countries.

An emphasis on individual responsibility for one's health is the most important and most difficult step in my opinion. Until we fix that, the problems will only mount.

 

[jrae]

First, I think both sides make valid points. A tip for Type-B med, if you want to make your point more effective, which you do have some very valid, thought out stances on healthcare, try not to be so mean..... . It really makes people think you're an arrogant individual and argue with you out of spite.

That said, it's true that there is a large group of uninsured people who abuse healthcare, causing society to develop an attitude much like that of Type-B. However I do not agree that we should allow these individuals to die in the street. A basic level of heathcare, and healthcare education should be available to all citizens. To me this means access to basic treatment for preventative care, infections, broken bones, etc. I do not feel this includes treatment for late stages of cancer, cardiovascular disease, or other chronic illnesses that are a product of one's lifestyle choices, or could have been prevented through early detection via preventative treatment, unless that individual is a minor. If you can afford the health insurance to cover such costly treatment then you deserve to have the best.

If you chose to state that any form of healthcare should only be available to those who can pay, you are a large threat to society. Have you take the time to consider the increasing public health risks, and cost, if we refuse to treat people for infectious diseases, vaccinate children, and provide a basic level of care to all citizens? Also, is it fair to deny care to a child who had no choice what family they were born into? Just because they were born into a poor or abusive home is no reason to deny them care. Before you call me a socailist, or idealistic intelectual, realize that I know what it is like to grow up poor and without healthcare, and not as a student. No individual in this country should have to suffer from basic treatable disease. Enough said.....

 

[medstyle]

First, I think both sides make valid points. A tip for Type-B med, if you want to make your point more effective, which you do have some very valid, thought out stances on healthcare, try not to be so mean..... . It really makes people think you're an arrogant individual and argue with you out of spite.

That said, it's true that there is a large group of uninsured people who abuse healthcare, causing society to develop an attitude much like that of Type-B. However I do not agree that we should allow these individuals to die in the street. A basic level of heathcare, and healthcare education should be available to all citizens. To me this means access to basic treatment for preventative care, infections, broken bones, etc. I do not feel this includes treatment for late stages of cancer, cardiovascular disease, or other chronic illnesses that are a product of one's lifestyle choices, or could have been prevented through early detection via preventative treatment, unless that individual is a minor. If you can afford the health insurance to cover such costly treatment then you deserve to have the best.

If you chose to state that any form of healthcare should only be available to those who can pay, you are a large threat to society. Have you take the time to consider the increasing public health risks, and cost, if we refuse to treat people for infectious diseases, vaccinate children, and provide a basic level of care to all citizens? Also, is it fair to deny care to a child who had no choice what family they were born into? Just because they were born into a poor or abusive home is no reason to deny them care. Before you call me a socailist, or idealistic intelectual, realize that I know what it is like to grow up poor and without healthcare, and not as a student. No individual in this country should have to suffer from basic treatable disease. Enough said.....

no one is saying deny basic healthcare to people. but 6 figure cancer treatments are not for people who are uninsured and not covered by medicare or medicaid.

 

[medstyle]

As a 28 year old Cancer survivor and self described hater of insurance companies and what they stand for all intents and purposes...and someone that has travelled and lived in countries that have what I consider to be the worst kind of healthcare (government run), I am extremely torn on this issue...

I'm quite sure that universal healthcare would be a good thing, IF people took advantage of it....but I'm not convinced that a high % would use it to their advantage...

I can only say that I am ever thankful that 3 years ago when I was diagnosed I am glad I had just gone to work for a company that pays healthcare on their own and has a rather large insurance company manage the program for them.

I have had WELL into the 6 figures in medical care over the last 3.5 years, and I don't think we have broken the 500 dollar out of pocket mark as of yet.

I have seen young people just like myself die of the same Cancer I had (my wife works at the clinic where I was treated)...I'm not sure if they had the best care, like myself, and I would never wish for someone to die just because they are less fortunate than me through no doing of their own.

I'm a lucky person, and I will not bring myself to believe that I'm alive because I'm "better" than those other people...Sure, I may have worked harder than them to get the job I have, but I can't hold them accountable for contracting a disease that, even with our "best healthcare in the world", we have NO CLUE what causes it.

This is a VERY difficult issue...I hope we can get it fixed...there are too many smart individuals in our country to not get this figured out....The one thing I can say is that I don't think a totally government run system is the answer from what I have seen in other countries.

An emphasis on individual responsibility for one's health is the most important and most difficult step in my opinion. Until we fix that, the problems will only mount.

how can you hate insurance? didn't they save your life? i can't even get a suit for 500 bucks, they spent more than a 100g's on you.

show some appreciation. you or your employer paid for a service and you got it.

 

[MJB]

Insurance in today's society is a necessary evil in my opinion.

My company paid the bulk of it...I pay relatively low premiums and extemely low out of pocket costs...for now.

I didn't mention that the original Doc I saw pretty much disregarded the lump on my neck...didn't even do a mono screen or even a needle biopsy.

I even went to an ENT that reluctantly did a needle biopsy at the request of the original doc...turned up nothing.

It was not until the Onc my wife works highly suggested I see an IM specialist here in town that I got correctly diagnosed.

Luckily, I live in a country and have a plan that allows me to see pretty much any doc I want, specialist or not, or I might not have been so lucky.

Where would I have been under a different system? The current one worked for me, but I'm lucky.

Just illustrating what a tough question this is for our country.

 

[clc8503]

let me also add that healthcare is a not a right, not even in it's most basic form. if you can't pay to save yourself, do us all a favor and die... because if you can't make money, you aren't productive and we don't need lazy/unproductive individuals overpopulating American anymore.

And you need to realize that being a physician is about more than putting money in your own pocket. Some people do not have the same opportunities in life as the doctors that serve them did. I once heard an Internal Medicine physician say something about how he did not make a dime off patients with Medicaid Insurance. I said to him, "it must be a bummer to be examining a patient and know you’re not getting paid for it". Let me tell you, he then set may A$$ straight. He told me that he made plenty of money and that seeing a few patients a day that had Medicaid did not hurt anything and that being a doctor was not about one person (the physician) striking it rich. You sound like Hitler with your morbid views on healthcare. I realize you’re probably just kidding, but that posts really hit close to home with me. My grandmother is currently in a nursing home with Alzheimer’s disease. I guess she should just die because she's not making money and she's not productive, even though she worked her entire life and raised four children on her own. People like you make me sick!

Yours,
Caraway

 

[DrMojorisin]

There is extensive evidence that the middle class is disintegrating and that social mobility has been greatly diminished in the US. I'm shocked that so many people still believe that this is "the land of opportunity" or that "the middle class is going strong." Please visit the following websites and enlighten yourselves:

http://www.faireconomy.org/research/Economic_Apartheid_Data.html
http://www.inequality.org/
http://www.trinity.edu/mkearl/strat.html

There are a lot of good links from that last one.

Globalization is only hastening this process of wealth transfer, and it is probably irreversible. Doom on you, I say!!!

But don't worry, there is a silver lining for us SDN'rs. Physicians are gonna make a FORTUNE from all the upcoming terrorist attacks and the anarchy that ensues after the middle class disintegrates. There is nothing to worry about in terms of future compensation!! We're guaranteed an indispensable place in society after the coming apocalypse.

 

[Gut Shot]

I want to see pictures of the hospitals. I want to see what kind of illnesses they are dealing with. When someone has tumor the size of golfball in their head in the USA, they still have options. In Malta, they are already dead.

Hmmm, golfball sized tumor in the head. Sounds pretty dead in both countries. The difference is that in Malta they will say "you have a golfball sized tumor in your head, we can give you chemo and then morphine to comfort you until you die."

In America they say "you have a golfball sized tumor in you head, we can resect most if it, give radiation treatment and chemo, then start you on a regiment of experimental therapies that have approximately zero percent chance of working. You'll die, but about 3 weeks later than you would on that godforsaken island of Malta. Oh, and your 21 extra days of life will only cost about $420,000, so enjoy them. F***k those Maltese!!!"

 

[riceman04]

I cannot imagine that anybody who would realistically be elected president would push for purely socialized medicine. Not a single one of the pre-primary democratic candidates advocated a complete changeover or even a major transformation. The major reform that John Kerry advocated was to completely cover health care costs for children who were uninsured. To tout socialized medicine seriously would be political suicide because the health care industry constitutes roughly well over 10% of the US's GNP. It will grow to as much as 25% of the GNP in the coming decades. A money monster like that simply will not hand over the reigns.

I don't really think that a two tiered system will work well either. The reason being, that if you were to draw a line in the income scale, then it would behoove people with health care problems or children to make less money so that they can be covered. You would have very few people that fall just above that line, which creates a separation of classes even worse than we have now. You'd have the poor that are unproductive and are supported by the state, and you have the rich that support the state. I believe that the good compromise might be a sliding scale. That is, the state subsidizes an increasing portion of health insurance premiums with the less you make. You could even do this for children only health insurance policies if you don't want to take the entire plunge. That is, if a family is poor, a portion of the insurance premiums for their kids is covered. The more poor the family, the more their kids are covered. That way, you don't get a big pay-off past a certain income level.

More at the heart of the problem though with decreasing physician salaries, increasing dependence on PAs, NPs, etc, and stratospheric health insurance and malpractice insurance costs is the cost of providing care. More expensive technology treats fewer problems than ever before. The drugs are expensive to research, to make, and profit margins for drug companies are mind-boggling. With the exception of profit margins, the cost of technology is inevitable. When a patient goes to get treated for an infection, the doctor has to make money, the insurance company has to make money, the government has to tax every level along the way, the pro-bono patients that the hospital treats have to be covered, the malpractice insurance has to be covered with it's profit margin, the pharmacist that sells the antibiotic adds a percentage, the drug company has to make a percentage, and the list goes on and on and on with levels of people that have to make money on a simple infection. The key, I believe is regulation of this massive money shuffling machine. The federal government makes California-style insurance reforms (which work very well) to keep health care and malpractice insurance at bay. The federal government regulates drug company profits either through anti-trust prosecution or direct taxation. The pharmaceutical industry has been the most profitable industry on the planet for the past 20 years, don't let them tell you that there'll be no money for research or incentive for investment. Doctors need to get smarter. The days of small private practices and HMOs aren't compatible. Large group practices are the answer. Doctors' organization like the AMA have been castrated by anti-trust regulations and massive insurance conglomorates can walk all over them. Group practices like Mayo and Cleveland Clinic carry enough might to realistically fight the insurance companies. Large group practices also offer a realistic alternative to traditional insurance and the abysmal failure of HMOs. They eliminate all of the multi-tiered profit making that I talked about before and replace it with a single profit margin. Doctors work on salary, are payed consistently, and are payed very well. One umbrella policy covers a large group practice against malpractice and they can even be self-insured if large enough.

Once the cost of conducting health care in our technology driven industry is controlled, then we can realistically expect to get everyone in the country covered with our well-tuned capitalist system.

Now, who's going to do it? In the last election, democrats were so hell-bent on making George Bush out to be a bozo who took our country to war for nothing that they missed a great opportunity to talk about what their policies are on these things. The only issue that got any attention was Canadian drugs, which is rediculous because either way we'll be stuck in the same situation. George Bush believes so strongly that big corporations work themselves out and it's ultimately better for the people that he's absolutely refused to do anything. He won't touch the insurance companies, the pharmaceutical industry, HMOs, anything. There's merit to that philosophy in other industries, but health care is unique in that if people don't get the services, they die. My feeling is that democrats will want a Hillary/Obama, Obama/Hillary ticket, but I can't imagine that they would beat someone like Frist, who is the leading GOP contender in my humble opinion. Unless the Tom Delay scandal eats away at the GOP's underbelly, I feel that it'll be a Republican White House and congress in 2008. I think that means not a lot will change for the health care industry. Even if the dems upset the whole government and got into complete power, I can't imagine much will change. It may require a catastrophic failure of the health care industry to instigate real reform whoever is in office.

whew...

-dope-

Omg, you are soooooooooooooooooooooooooooooooooooooo right! My father is a private practice physician practicing in a socially and economically disadvantaged community. On top of that, the majority of his patients are now elderly. So, yes his opperating costs have increased significantly over the past 10 years. This past year alone he lost 15,000 in profits. But in the end, it is not the profits he is most concerned with. He is troubled by the fact that his ability to make care-based, rather than economically based decisions for his patients is extremely limited. Furthermore, his insurance keeps increasing, but the patient insurance checks get smaller, and his patients are paying more and more for smaller prescriptions.

My sister used to work as an OBGYN under an HMO's in Houston (1st: Magregor, 2nd: Kelsey Sebold) until she realized that once she reached a certain payscale she would be fired (it happened both times). Now, after coercion from our father, she too has decided to go into private practice. Unforutnately, she is quickly finding out that private practice is now for the pits.

I do not disagree with you at all but I think that the fact that physicians are innately stubborn makes it is difficult to get them to see eye to eye on many health care related issues. Yes, large grp practices are the answer, but the reason there are so few is b/c of what is stated directly b4 this sentence. It is amazing that I frequently witness heated arguments between fellow physicians on how to tackle this problem. Yes, this just an argument, but it lets you know where people stand. In many cases, I think they would rather have a private practice or be controlled like puppets under HMO's than work with each other to find a common solution that will help rectify this problem.

But I do agree with you!!!