socialized medicine

[naegleria brain]

I know we're not supposed to be in it for the money, but I wanted to hear your thoughts on this...

Considering most of us are residents and some (including me) medical students, several won't be in practice for another 5-10 years, or longer.

Because of the sad state of Republicans currently, it is very conceivable for Hillary Clinton to take it (tho I pray not). In '93 and '94 she had her nationalized plan shot down pitifully; since then, however, it has gained a lot of support. She stated in an Iowa campaign that the first step would be to have a national plan for children, and then expand it till it reaches the whole nation.

It pains me to say this, but her approach seems logical, and though she is a terrible politician, I think she has enough Democrats who do play politics well on her side to make it happen. So, if it does, what do you think will happen to surgical salaries?

I'll be graudating with nearly, if not more, than 200 grand debt, and don't want to be paying it off for a decade when, if I were practicing now, I could manage it in about five years.

Also, does it seem that plastics would be the only immune field - as they don't necessarily take insurance for all their elective procedures.

Of interest, the average doctor makes about five times the median, clocking in over 140 grand (can't remember the site I found this on). Most other nations, it's barely 2-3 times the median, with the second highest doctor salary occuring in Canada at less than 100 grand (i think somewhere between 90-95).

I know it's wrong to be in it for the money, but with a debt as big as mine, and I'm sure as high as some of you share too, a paycut THIS big poses a real conundrum.

Your thoughts?

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[Miami_med]

Yeah,

There is nothing wrong with wanting to be reimbursed for hard work with money. Money is the medium of exchange that we use to determine the relative value of goods. It is not intrinsically evil. Someone who provides a valuable and/or scarce good or service shouldn't feel guilty for wanting to receive a relatively larger share of income for that good or service. Why is everyone so apologetic for wanting a good income for a highly specialized, well trained position? Even compared to some other people in medicine, surgeons should receive a good income, and they would have no problem earning it in the absence of the Washington political machine.

 

[random-dude]

Don't be apologetic for wanting a big income for a valuable service and never call either Clinton logical. No plan that takes earned money from one person and gives it to someone who has not earned it in exchange for nothing is never logical.

 

[isurus22]

I work designing medical devices and socialized medicine would kill the industry. I don't think it will happen, the US has the highest quality medical treatment in the world, why would anyone want to copy Europe and others who aren't as good. All the Europeans I know buy their own insurance b/c the state run plans are really bad.
-Here is the problem: Government run insurance cares only about cost. Want that expensive high tech new product...think again...Lets just amputate. Cheaper...faster...that is what would happen. Quality would be second to price. The American medical products industry (one of the only big american technologies left) would outsource to China, etc.

Im getting out of this industry though and going to Dental School class of '11.
Insurance has less of an impact on dentists.

 

[Smoke This]

Hillary Clinton is a deplorable person, and in almost every way imaginable it would be a crying shame if she is elected president.

However, I am convinced that the medical system in this country is irretrievably broken and is only getting worse. Socialized medicine could be the best thing to happen to health care in this country in a long time. It is an absolute outrage that third parties, HMO execs, etc. are siphoning huge amounts of money out of medicine and into their collective pockets. That alone is strikingly unacceptable and deserves to be rapidly stopped. What is more, if you think about anyone important to you personally and what may be the very real possibility that they can't get health care they need simply because of cost issues, that situation is fundamentally unfair and profoundly wrong. That's intolerable, and this country shouldn't stand for that.

I am strongly in favor of socialized medicine. I have no idea what will happen to doctors' salaries but a safe assumption is they would almost surely go down some. However, there was a very interesting editorial in JAMA a few years ago (2004?) that I remember being around election time which said that eliminating the enormous beaurocracy of health care reimbursement and the third parties with their hands out by instituting a nationwide, centralized goverment payer for health care would actually cause an increase in doctors' income. What may be more likely is that Medicare would be expanded to cover everyone but for-profit, private medicine will still exist and contribute to a tiered system of health care access. If the government were smart about it and used a restrictive drug formulary (i.e. no Zofran instead of compazine, etc.) and cut back on unnecessary imaging I'm sure they could save a substantial amount that they could use to improve access and quality. One thing is for sure though: we can't go on like this, and I really think something will have to be done soon out of necessity.

 

[naegleria brain]

i actually think that there is plenty of evidence that the United States has the best system of medicine; europe has better access, but the quality of treatment the patients actually receive is not nearly at par with the minimum of American standards, given our aggressive nature to image and treat.

this would be severely halted.

In terms of money - couple hundred thousands of people a year on dialysis being paid by medicair/medicaid. each dialysis costs a couple hundred thousand a year. clearly there's not enough money, and we're just talking dialysis alone.

so salaries undoubtedly would go down a lot. but do you think plastics will stay immune?

i can't stand the clintonian view of socialized healthcare, and hillary clinton i can't stand period. but i think the democrats would send a woman over an African-American to the ticket. However, Obama is clearly the more national candidate, but whether the west and south would vote for an African American still remains to be seen.

Regardless of the politics, socialized medicine has gotten much acceptance over time, and i'm fearing that it'll become a reality in our lifetimes. that'll be a sad day for medicine. how do i stay immune?
all i can think is plastics, but i'm not sure if i'll be satisfied with reconstructing breasts all day.

 

[Ballz]

i actually think that there is plenty of evidence that the United States has the best system of medicine; europe has better access, but the quality of treatment the patients actually receive is not nearly at par with the minimum of American standards, given our aggressive nature to image and treat.

this would be severely halted.

In terms of money - couple hundred thousands of people a year on dialysis being paid by medicair/medicaid. each dialysis costs a couple hundred thousand a year. clearly there's not enough money, and we're just talking dialysis alone.

so salaries undoubtedly would go down a lot. but do you think plastics will stay immune?

i can't stand the clintonian view of socialized healthcare, and hillary clinton i can't stand period. but i think the democrats would send a woman over an African-American to the ticket. However, Obama is clearly the more national candidate, but whether the west and south would vote for an African American still remains to be seen.

Regardless of the politics, socialized medicine has gotten much acceptance over time, and i'm fearing that it'll become a reality in our lifetimes. that'll be a sad day for medicine. how do i stay immune?
all i can think is plastics, but i'm not sure if i'll be satisfied with reconstructing breasts all day.

Actually, there is plenty of evidence to the contrary... Even though we pay more for our medical care, we actually are in the 20s in the rank list of patient outcome/health. So we actually aren't doing a very good job for the huge amount of money we put in the system. Also, it is pretty damn likely that cosmetic/boutique type plastics would be immune because that is out of pocket not insurance.

 

[iwantneurosurg]

Actually, there is plenty of evidence to the contrary... Even though we pay more for our medical care, we actually are in the 20s in the rank list of patient outcome/health. So we actually aren't doing a very good job for the huge amount of money we put in the system. Also, it is pretty damn likely that cosmetic/boutique type plastics would be immune because that is out of pocket not insurance.

i believe the people who study healthcare come from a nation of socialized healthcare. at any rate, their methodology shows a very clear bias.

i like to look at things first hand:

you get a kidney stone in USA, and you have insurance, which is more than 80% of the population i believe, you get imaging, and then a lithotripsy to blast it.

you go to canada, 100% of the population is sent home with a bottle of water. they usually pay for the water at a local vending machine.

In Tales of Neurosurgery, Dr. Vertosick recounts his six-month neurology rotation in England during his residency there after spending a few years as a neurosurgeon at the Mayo Clinic. The differences are clear. It tells me one thing for sure: I'd hate to have an aneurysm, period. But given a choice, I'd have it here over England any day.

 

[Miami_med]

Most healthcare "quality" studies don't take into account quality of life. Asking "are you satisfied?" is so culturally biased, as to be useless. So many factors go into life expectancy, that the 2 year difference between the top 30 countries (or something like that) is probably insignificant. Most "quality studies" also heavily weigh access, which is a useless variable when comparing universal vs. non-universal systems. If 80% of the US has "access" and superior care, while 20% don't have easy access, they will still fall short in the "access" department, even though the average quality of care is much higher. There aren't even across the board definitions of things like "infant mortality." The rankings, while interesting, are pretty useless in evaluating overall quality.

 

[andros]

i believe the people who study healthcare come from a nation of socialized healthcare. at any rate, their methodology shows a very clear bias.

i like to look at things first hand:

you get a kidney stone in USA, and you have insurance, which is more than 80% of the population i believe, you get imaging, and then a lithotripsy to blast it.

you go to canada, 100% of the population is sent home with a bottle of water. they usually pay for the water at a local vending machine.

In Tales of Neurosurgery, Dr. Vertosick recounts his six-month neurology rotation in England during his residency there after spending a few years as a neurosurgeon at the Mayo Clinic. The differences are clear. It tells me one thing for sure: I'd hate to have an aneurysm, period. But given a choice, I'd have it here over England any day.

... you really know what you're talking about, don't you ... Don't you know that in Canada, we don't have bottled water? Litho-whatsy?

 

[powermd]

Corporate greed and capitalism will keep this country sick and health care expensive for a long time. People are sick because they eat ****, smoke, drink, don't exercise, and don't cooperate with preventive health measures. The problem is that people have virtually no incentive to do the opposite of the above. Our weakness for a convenient lifestyle propels us further into the abyss. Corporations profit from us on the way down by helping us kill ourselves. Politicians profit from corporate funding of their campaigns. The rules of the game never change. People aren't penalized for making bad lifestyle choices- on the contrary, we're trying to give everybody health insurance so they don't have to pay the exorbitant costs of treating end-stage heart, lung, liver, and kidney diseases.

Fix the incentives, and we have a shot at fixing the problem socialized medicine aims to solve.

 

[mtoto]

Hey guys, I studied medicine in Canada and also did some electives in the US...

First my mom had a kidney stone and was operated on. I believe that this is std procedure.

I agree that quality of care is probably better in the US for those with insurance.

I think that tertiary care is "generally" better in the US due to greater availability of expensive technologies. Nothing beats a universal system of health care however for primary care... so Canada is better at primary/preventive care.

Working conditions for doctors however are better in Canada dispite the lower pay (and only family doctors average 100k/a... surgeons make way more and as far as I can tell, they are rich). The single payer system means way less paperwork. Public hospitals means way less litigation--> less confirmatory imaging--> more autonomy for residents/interns/med students--> attendings who hardly ever have to write a note (not for billing purposes or litigation).

Think of the VA... but not just for veterans... for everyone.

Training for Surgery in Canada is better... this is info from every surgeon I know... residents coming from the US are blown away by Canadian surgical training. You operate more, you work fewer hrs. You round for like 45 mins in the AM... then you operate. Your typical note/pt is "All Vital Signs Stable". That's all you need to write (unless of course there's actually a real issue)! Your med student takes care of the floor while you operate. Canadians are much more lifestyle oriented and work hours/week has never even come up as an issue (thus, there are no work hour limits in Canada).

I don't think that basic healthcare can be left to the market. We don't choose to inject ourselves with insullin the same way that we choose to buy a diamond tennis bracelet.

Certainly it is reasonable as a US grad to worry about your salary when you graduate with so much debt. But I don't think that this is a reason not to support universal health care. And universal care and socialized care are different things. Universal just means that everyone should have some form of care (some form of primary care at least). Perhaps the government can be pursuaded to forgive all debts incurred by medical school. Instead of spending all that money on HMOs maybe the govt should start paying to train doctors.

My 2 cents... open to objection of course!

 

[naegleria brain]

general rule number 1: when the government does anything, they suck at it.

history has shown us this time and again. two examples off the top of my head include the post office, and that time the government tried to complete the human genome project. it was actually a private researcher and his team that automated it and got it done years ahead before the government projected to get it done. they were so busy with manually figuring it out, had they not faced competition, we'd still be tryna crack it today.

I don't know about your experiences, but veterans hospitals are the absolute worst. They don't come even close to the standard of private hospitals. I rotated at the VA; simple UTI's are left hospitalized for weeks, patients with diabetes don't get their diagnosis until days later, and, at this particular one, they give out "free passes" for the patients to go home since theyre in the hospital so long.
Compared to the private hospitals, their system is so hopelessly lackluster, ineffecient, with terribe resources (they carry their own sphygmomanometers, not wall attached in every room as an example), and a complete mockery of healthcare.

I didn't think about it - but if a national healthcare plan meant all hospitals would be like that - forget it. Healthcare will go down the tube. If that's how dentistry is done in England, then I can understad why those protestors sieged and rocked their dentist offices for not getting their fillings and root canals. Laughable? yes; but sadly, it's true.

The sheer volume of equipment, diagnostics, and tests the United States has is remarkable; when adjusted for population, i think it's something like five or six times that of Canada in terms of CT and MRI units. When there's an emergency, we jump on right away. My uncle who had pain in his chest couldn't get imaging in England for another whole month. He came here, went to the ER, had the tests done immediately. These statistics are universal: although healthcare isn't universal here, the vast majority that do have it enjoy much better healthcare.

In Germany, a friend of mine visited a car factory (probably mercedes) and noticed that >90% of them smoked. (In case you didn't know, Europe smokes way worse than Americans). After talking to their on-site physician, he stated it saves them money to let them smoke and die, rather than stop them from smoking, extend their life, and pay for all the care. Theyve effectively killed the incentive to keep people alive.

Immoral? yes. But again, it happens, and will as long as humans consistently maintain their ability to separate morality from emotion and pragmatism.

While a great theory, in practice, government-run healthcare would turn out like the rest of their programs: expensive, ineffecient, and terrible. governments worldwide have a track record of doing this. and when funds run short, where's the best part to cut salaries?

Think about it - 100 grand yearly for dialysis for about a couple hundred thousand people on it in the US. $20,000,000,000 right there alone. Governments can't handle dollar amounts that big - look at their trillion dollar budget and how terrible they are with managing that. I'm not letting them add this to the plate on top of that.

And I'm certainly not taking a 50% paycut that'll double my period of indebtedness.

 

[Chinnychin]

Just so you know and I hate hilary and all but her plan is really a lot different than socialized medicine in canada and europe. I have lived in both and also know hilary's plan and much different.

In canada and europe-you basically have to go through you PCP to get anywhere and then the next step is an apointment with a surgeon, specialist whatever (kinda like HMO's here)-however everything is run through the govt healthcare system and no docs can take private insurance. Other than cash pay fields like plastics, no other docs canmake money any other way with their services other than getting paid by the health care system. This ends up in ridiculous waits for procedures, scans etc. To get a knee replacement or something elective is probably about a year. An MRI can easily be 6 months-its crazy.

Hilary's plan kind of combines the best of both systems. A nationlized system will be in place and offer a health plan that covers all types of care however it has a network of providers to choose from. This works almost identical to how an HMO works. However the difference is that the plan still allows people to see which ever doctor they want and pay for it-If you look at reimbursments today for procedures, office visits or whatever with insurance-they are pitiful and probably will not be much higher than what the national system will offer. But docs cash pay fee will be pretty reasonable because it will be a compromise between accepting the national health plan and how it is now. Poeple that want to go through the national plan will have to wait long waits and go through the appropriate channels like HMO's. Like PPO's however people can see whoever they want and doctors are allowed to do this-this is the difference, in Canada you cannot go to any doc you want and pay cash pay and get in any faster-In america you will be able to get pretty much anything you want done if you want to pay for it-and I reiterate if you think about how much we pay in insurance-paying cash pay for things that you would want speed treatment for is not that much. Things like long hospital stays etc would be covered so there will never really be any unaffordable out of pocket fees to the middle upper class who is the groups who will pay for speedier services from docs they want.

 

[morpheus md]

Hey guys, I studied medicine in Canada and also did some electives in the US...

First my mom had a kidney stone and was operated on. I believe that this is std procedure.

I agree that quality of care is probably better in the US for those with insurance.

I think that tertiary care is "generally" better in the US due to greater availability of expensive technologies. Nothing beats a universal system of health care however for primary care... so Canada is better at primary/preventive care.

Working conditions for doctors however are better in Canada dispite the lower pay (and only family doctors average 100k/a... surgeons make way more and as far as I can tell, they are rich). The single payer system means way less paperwork. Public hospitals means way less litigation--> less confirmatory imaging--> more autonomy for residents/interns/med students--> attendings who hardly ever have to write a note (not for billing purposes or litigation).

Think of the VA... but not just for veterans... for everyone.

Training for Surgery in Canada is better... this is info from every surgeon I know... residents coming from the US are blown away by Canadian surgical training. You operate more, you work fewer hrs. You round for like 45 mins in the AM... then you operate. Your typical note/pt is "All Vital Signs Stable". That's all you need to write (unless of course there's actually a real issue)! Your med student takes care of the floor while you operate. Canadians are much more lifestyle oriented and work hours/week has never even come up as an issue (thus, there are no work hour limits in Canada).

I don't think that basic healthcare can be left to the market. We don't choose to inject ourselves with insullin the same way that we choose to buy a diamond tennis bracelet.

Certainly it is reasonable as a US grad to worry about your salary when you graduate with so much debt. But I don't think that this is a reason not to support universal health care. And universal care and socialized care are different things. Universal just means that everyone should have some form of care (some form of primary care at least). Perhaps the government can be pursuaded to forgive all debts incurred by medical school. Instead of spending all that money on HMOs maybe the govt should start paying to train doctors.

My 2 cents... open to objection of course!

One major difference between Canada/Europe and the US: they don't have the same out of control legal climate as the US. Cover your ass paperwork and procedure takes up 3/4 of the day of the typical American physician, and amplifies the cost of health care exponentially with the practice of defensive medicine in ordering unnecessary tests, etc.

 

[Miami_med]

general rule number 1: when the government does anything, they suck at it.

I'm not sure that I've ever put it THAT bluntly.

 

[Miami_med]

One major difference between Canada/Europe and the US: they don't have the same out of control legal climate as the US. Cover your ass paperwork and procedure takes up 3/4 of the day of the typical American physician, and amplifies the cost of health care exponentially with the practice of defensive medicine in ordering unnecessary tests, etc.

I wonder how many people would be able to afford healthcare without the general malpractice climate in the US. Malpractice is nothing but an arbitrary market intervention by the judicial system in which some physician is determined to owe someone a "duty" and then fails to live up to an arbitrary standard. The paperwork in the US is egregious, but its use is so tilted towards preventing litigation that the removal of the malpractice threat would probably solve much of the problem. Doctors who practiced in the largely free market medical economy of the early 60s had no such paperwork burden. In other words, while the Canadians implemented a system of market intervention that doesn't have as much paperwork but lowers salaries, the US implemented a system of market intervention that kept salaries higher but created more paperwork. The ideal would seem to be to reduce the overall intervention to create less paperwork AND higher salaries.

 

[Chinnychin]

Yes seriously I worked with a few canadian docs and they were explaining their malpractice stuff and every doc pays a VERY small fee each year into the national malpractice fund that covers all types of docs-and it is like a thousand bucks a year or something. I was surprised but than found out that there has only been ONE successful case of someone sueing a doctor for malpractice in canada in the last 10 years or something. Being a letigious soceity has hurt our health care more than anyone realizes. That is why nobody can afford insurance-it actually is not our system.

The other thing that is funny is if you read hilarys 93 health plan-it talks about how her system "unleashes the power of the market on health care" which is crap since anythin with govt s limits the effect of the market. But a private system is by far the best system-if you took out the lawsuits and insurance was normally priced and affordable-everyone would win except the lawyers and their clients-who could be reasonably compensated but not those extreme amounts. If insurance was low-most could afford it, doctors would be reimbursed more since insurance would not pay out as much-everyone would win.

 

[mtoto]

general rule number 1: when the government does anything, they suck at it.

history has shown us this time and again. two examples off the top of my head include the post office, and that time the government tried to complete the human genome project. it was actually a private researcher and his team that automated it and got it done years ahead before the government projected to get it done. they were so busy with manually figuring it out, had they not faced competition, we'd still be tryna crack it today.

I don't know about your experiences, but veterans hospitals are the absolute worst. They don't come even close to the standard of private hospitals. I rotated at the VA; simple UTI's are left hospitalized for weeks, patients with diabetes don't get their diagnosis until days later, and, at this particular one, they give out "free passes" for the patients to go home since theyre in the hospital so long.
Compared to the private hospitals, their system is so hopelessly lackluster, ineffecient, with terribe resources (they carry their own sphygmomanometers, not wall attached in every room as an example), and a complete mockery of healthcare.

I didn't think about it - but if a national healthcare plan meant all hospitals would be like that - forget it. Healthcare will go down the tube. If that's how dentistry is done in England, then I can understad why those protestors sieged and rocked their dentist offices for not getting their fillings and root canals. Laughable? yes; but sadly, it's true.

The sheer volume of equipment, diagnostics, and tests the United States has is remarkable; when adjusted for population, i think it's something like five or six times that of Canada in terms of CT and MRI units. When there's an emergency, we jump on right away. My uncle who had pain in his chest couldn't get imaging in England for another whole month. He came here, went to the ER, had the tests done immediately. These statistics are universal: although healthcare isn't universal here, the vast majority that do have it enjoy much better healthcare.

In Germany, a friend of mine visited a car factory (probably mercedes) and noticed that >90% of them smoked. (In case you didn't know, Europe smokes way worse than Americans). After talking to their on-site physician, he stated it saves them money to let them smoke and die, rather than stop them from smoking, extend their life, and pay for all the care. Theyve effectively killed the incentive to keep people alive.

Immoral? yes. But again, it happens, and will as long as humans consistently maintain their ability to separate morality from emotion and pragmatism.

While a great theory, in practice, government-run healthcare would turn out like the rest of their programs: expensive, ineffecient, and terrible. governments worldwide have a track record of doing this. and when funds run short, where's the best part to cut salaries?

Think about it - 100 grand yearly for dialysis for about a couple hundred thousand people on it in the US. $20,000,000,000 right there alone. Governments can't handle dollar amounts that big - look at their trillion dollar budget and how terrible they are with managing that. I'm not letting them add this to the plate on top of that.

And I'm certainly not taking a 50% paycut that'll double my period of indebtedness.

Just in response to Brain's earlier post... and to clarify my earlier post. I agree that Americans with insurance generally enjoy better healthcare than Canadians. If we must talk about "morals" however, I would say that leaving 40 million people uninsured in the richest country in the world undermines the "morality" of the US system.

Litigation climate aside... and even putting aside the public/private debate... I think that one of the true beasts that have contributed to spiraling health costs is the PhRMA. Drug costs in Canada are way less than in the US. Generic drugs in Canada are available sooner. It boogles my mind that there is legislation in place in the US that prohibits Medicare and Medicaid from negotiating with drug companies... that's not a free market!

Last I'm not an advocate of introducing a "Canadian style" healthcare system in the US. These are after all different countries, with unique histories and even different values. I can not imagine an entirely public system in the US... but I don't see why there can not be a public/private mix that will still offer basic primary care to everyone- even if it is VA std care.

 

[Miami_med]

Just in response to Brain's earlier post... and to clarify my earlier post. I agree that Americans with insurance generally enjoy better healthcare than Canadians. If we must talk about "morals" however, I would say that leaving 40 million people uninsured in the richest country in the world undermines the "morality" of the US system.

Why is this immoral? Undermining the care and raising the tax rate on 260 million insured Americans to improve care for 40 million uninsured seems like the oppposite of that in almost any system of morality.
.

Litigation climate aside... and even putting aside the public/private debate... I think that one of the true beasts that have contributed to spiraling health costs is the PhRMA. Drug costs in Canada are way less than in the US. Generic drugs in Canada are available sooner. It boogles my mind that there is legislation in place in the US that prohibits Medicare and Medicaid from negotiating with drug companies... that's not a free market!

Medicare and Medicaid's presence in the market by definition makes it not free. Negotiation just makes it not free in a different way, with an artificial market heavyweight holding the gun of regulation negotiating prices.

Last I'm not an advocate of introducing a "Canadian style" healthcare system in the US. These are after all different countries, with unique histories and even different values. I can not imagine an entirely public system in the US... but I don't see why there can not be a public/private mix that will still offer basic primary care to everyone- even if it is VA std care.

Why again, should the government take money from people who earn it in order to pay for the care of people who did not? That doesn't sound particularly moral at all.

 

[mtoto]

Now how can I possibly argue with Miami Med. And heaven help us if we start talking about "morals".

I guess everyone thinks differently. 40 million seems like a tragedy to me but I guess compared to 260 million insured it seems like peanuts to you. To some people even 1 person fallen through the cracks is tragic... to others someone must be sacrificed.

I suppose I would like to think that everyone should be able to get care without compromising the care of anyone. That by virtue of being human people should have basic rights that includes a right to basic healthcare.

 

[dynx]

Now how can I possibly argue with Miami Med. And heaven help us if we start talking about "morals".

I guess everyone thinks differently. 40 million seems like a tragedy to me but I guess compared to 260 million insured it seems like peanuts to you. To some people even 1 person fallen through the cracks is tragic... to others someone must be sacrificed.

I suppose I would like to think that everyone should be able to get care without compromising the care of anyone. That by virtue of being human people should have basic rights that includes a right to basic healthcare.

I would like to think that every man should have a ferarri and every woman a pair of double D's but it just aint in the cards you know?

 

[Miami_med]

Now how can I possibly argue with Miami Med. And heaven help us if we start talking about "morals".

I guess everyone thinks differently. 40 million seems like a tragedy to me but I guess compared to 260 million insured it seems like peanuts to you. To some people even 1 person fallen through the cracks is tragic... to others someone must be sacrificed.

I suppose I would like to think that everyone should be able to get care without compromising the care of anyone. That by virtue of being human people should have basic rights that includes a right to basic healthcare.

Your world leaves out scarcity and the basic economic condition. By diverting resources into treating more people, they have to be taken from somewhere else. They also have to exist. 40 million is not peanuts. One is not peanuts. I just like to live in economic reality, and I believe that stealing is always wrong. I believe that deceiving people while stealing under the guise of vague moral principles in not only wrong, but hypocritical. The person with the moral high ground shouldn't need guns in order to placate the people actively involved in carrying out his moral mission.

I have no problem with people who promote universal healthcare donating both time and money to do exactly that. What I have a big problem with is taking my time and money by force. All of these big government plans demand forced resource redistribution, taking continually from a sucker who keeps working harder in order to supply the insatiable appetite of the masses. As I've said to others, come talk to me again about universal care when you've given every penny and minute you have to the cause. I really am not sure why people think that they should come after my money before they've spent their own. Just because the government plays middle man, doesn't change the basic condition of the socialized principle.

 

[Miami_med]

Now how can I possibly argue with Miami Med.

And feel free to argue with me.

 

[naegleria brain]

Miami med - my thought processes mirror yours almost exactly; it's uncanny

logic, morality, everything.

just wanted to say that...i've yet to meet someone in real life who thinks like us (not since high school anyway).

 

[random-dude]

Your world leaves out scarcity and the basic economic condition. By diverting resources into treating more people, they have to be taken from somewhere else. They also have to exist. 40 million is not peanuts. One is not peanuts. I just like to live in economic reality, and I believe that stealing is always wrong. I believe that deceiving people while stealing under the guise of vague moral principles in not only wrong, but hypocritical. The person with the moral high ground shouldn't need guns in order to placate the people actively involved in carrying out his moral mission.

I have no problem with people who promote universal healthcare donating both time and money to do exactly that. What I have a big problem with is taking my time and money by force. All of these big government plans demand forced resource redistribution, taking continually from a sucker who keeps working harder in order to supply the insatiable appetite of the masses. As I've said to others, come talk to me again about universal care when you've given every penny and minute you have to the cause. I really am not sure why people think that they should come after my money before they've spent their own. Just because the government plays middle man, doesn't change the basic condition of the socialized principle.

I know a Rand fan when I smell one.....we can smell our own kind.

 

[mtoto]

But I live in the real world too! I do!

Last year I did an HIV elective in Baltimore. There I met a woman in her 40s who had recently been diagnosed with HIV. She had had 2 lifetime sexual partners and contracted the disease from her second partner. She had worked her whole life... never been on govt. assistence. She was a secretary or book-keeper or something like this. She had always been able to get by on with this job... but she didn't have health insurance. 3 months after her diagnosis she was bankrupt and 30 000 in debt. At the clinic she was still getting care... we were accessing charities and such to pay for her meds and tests... and I guess at this point she became eligible for Medicare. To me however, it seems unfair, someone who had always worked to all of a sudden not even be able to pay their doctor, all of a sudden this person is a charity case. It's demoralizing and depressing.

This is what hits me as strange about the US system... the dirt poor actually have care- Medicaid... it's the working poor that take the biggest hit.

I find Miami's arguments also depressing. It's like saying that for me to be fullfilled someone else must be kept down.

You ask where the resources should come from... look at the kazillion dollars being spent bombing Iraq, the incredible profits of PhRMA (making them the most profitable industry in the world) as they churn out me too drugs... it's like going into the bowels of this horribly inefficient company (called the US healthcare system) that spends millions of dollars a day rubber stamping documents and sueing eachother and saying that nothing can be done, that the system can not be more efficient.

Again, I don't think that everyone should have a porsche or that the "insatiable appetite of the masses" should be served. But just as there is a right to free speech and freedom from torture and if you are a child to grow up in a healthy and nurturing environment... there should be provisions for basic healthcare. Healthcare is not a commidity the way a diamond tennis bracelet is...

And consider that Canada, just north DOES provide univeral care... spends 30% less per capita doing it AND has comparable (and by some indicators such as life expectency, child mortality better) care. AND no one is being held at gunpoint to have their money stolen from them... don't forget, we have gun control.

I grew up in Canada and fortunately for many years now my parents have been proud owners of a small business. We pay our taxes and undoubtably have subsidized the healthcare of somebody somewhere. We wouldn't have it any other way. Many Canadians would not have it any other way!

When we first imigrated to Canada 30 yrs ago, and were in fact a part of the working poor (you name it my mom and dad did it- window washer, vacuum salesman, bank night janitor, shoe factory worker...) we appreciated that someone else somewhere was paying their taxes so that we could have healthcare. But trust me we were not living in the lap of luxury... we taped our windows with garbage bags in the winters to keep out the cold... we walked in the snow whenever possible to save the 25 cents busfare...

 

[mtoto]

And my next Q is this... so Miami, if I were to show you all my bank statements etc basically everything I owned and then sign it all away to the as yet uncreated charity for "Universal Health Care in the US" and promised you that from this day foward I would spend every waking/dreaming minute I had on working towards getting universal care up and running in the US without "socializing" everything and without compromising the care of others... would you at least consider... working with me?

 

[TX_Longhorn]

But I live in the real world too! I do!

Last year I did an HIV elective in Baltimore. There I met a woman in her 40s who had recently been diagnosed with HIV. She had had 2 lifetime sexual partners and contracted the disease from her second partner. She had worked her whole life... never been on govt. assistence. She was a secretary or book-keeper or something like this. She had always been able to get by on with this job... but she didn't have health insurance. 3 months after her diagnosis she was bankrupt and 30 000 in debt. At the clinic she was still getting care... we were accessing charities and such to pay for her meds and tests... and I guess at this point she became eligible for Medicare. To me however, it seems unfair, someone who had always worked to all of a sudden not even be able to pay their doctor, all of a sudden this person is a charity case. It's demoralizing and depressing.

This is what hits me as strange about the US system... the dirt poor actually have care- Medicare... it's the working poor that take the biggest hit.

I find Miami's arguments also depressing. It's like saying that for me to be fullfilled someone else must be kept down.

You ask where the resources should come from... look at the kazillion dollars being spent bombing Iraq, the incredible profits of PhRMA (making them the most profitable industry in the world) as they churn out me too drugs... it's like going into the bowels of this horribly inefficient company (called the US healthcare system) that spends millions of dollars a day rubber stamping documents and sueing eachother and saying that nothing can be done, that the system can not be more efficient.

Again, I don't think that everyone should have a porsche or that the "insatiable appetite of the masses" should be served. But just as there is a right to free speech and freedom from torture and if you are a child to grow up in a healthy and nurturing environment... there should be provisions for basic healthcare. Healthcare is not a commidity the way a diamond tennis bracelet is...

And consider that Canada, just north DOES provide univeral care... spends 30% less per capita doing it AND has comparable (and by some indicators such as life expectency, child mortality better) care. AND no one is being held at gunpoint to have their money stolen from them... don't forget, we have gun control.

I grew up in Canada and fortunately for many years now my parents have been proud owners of a small business. We pay our taxes and undoubtably have subsidized the healthcare of somebody somewhere. We wouldn't have it any other way. Many Canadians would not have it any other way!

When we first imigrated to Canada 30 yrs ago, and were in fact a part of the working poor (you name it my mom and dad did it- window washer, vacuum salesman, bank night janitor, shoe factory worker...) we appreciated that someone else somewhere was paying their taxes so that we could have healthcare. But trust me we were not living in the lap of luxury... we taped our windows with garbage bags in the winters to keep out the cold... we walked in the snow whenever possible to save the 25 cents busfare...

well, maybe you should be having fun in canada then.
btw, its never the working poor (quite an oxymoron) that are most screwed.

first off, if you make a mistake/are foolish enough to not use protection and come down with an STD, why should the society be liable for it?

second, US is way more litigatious society than canada.

third, US med students accumulate a considerable amount of debt relative to canadian med students.

fourth, life expectancy in US is a function of the excellent McDonald's diet and lifestyle that we lead. We are the worse when it comes to living healthy lives compared to any other developed nation. It does not reflect on the kind of health care we deliver.

fifth, we in america face the problem of illegal immigration. there has been enough said on this topic and so i feel its enough to say that a socialized/cover all - form of healthcare would be an open invitation for more illegal immigration.


finally, i have an aunt living in canada who was diagnosed with uterine cancer. but they scheduled a complete removal of the uterus 6 FRIGGIN months later. (she wound up going to india and got the surgery done there).

so lets be a little bit more realistic now shall we.

 

[Gunny]

What I have a big problem with is taking my time and money by force.

This happens already. It's called taxation.

 

[Miami_med]

But I live in the real world too! I do!

Last year I did an HIV elective in Baltimore. There I met a woman in her 40s who had recently been diagnosed with HIV. She had had 2 lifetime sexual partners and contracted the disease from her second partner. She had worked her whole life... never been on govt. assistence. She was a secretary or book-keeper or something like this. She had always been able to get by on with this job... but she didn't have health insurance. 3 months after her diagnosis she was bankrupt and 30 000 in debt. At the clinic she was still getting care... we were accessing charities and such to pay for her meds and tests... and I guess at this point she became eligible for Medicare. To me however, it seems unfair, someone who had always worked to all of a sudden not even be able to pay their doctor, all of a sudden this person is a charity case. It's demoralizing and depressing.

It is depressing. However, they are still a charity case whether the money is given voluntarily or taken by force. It is unfortunate that she was struck with such severe side effects from relatively mild lapses in judgement. However, that doesn't make anyone else responsible for taking care of her. Many people have it worse of than her in fact. I have a number of medical problems, and mine are primarily the results of my genes. I'm thankfully quite functional, but plenty of people are not. This fact however, doesn't make anyone responsible for me or anyone else. If the you or the woman feel bad about accepting charity, you should ask yourself why a universal system (with money taken by force from unwilling participants) should make you feel better.

This is what hits me as strange about the US system... the dirt poor actually have care- Medicare... it's the working poor that take the biggest hit.

#1. You mean Medicaid. #2. I don't agree that it should exist either. Feel free to read my blog for my reasons why.

I find Miami's arguments also depressing. It's like saying that for me to be fullfilled someone else must be kept down.

Quite the contrary, my argument is that we should all do our best to pull ourselves up without pulling anyone else down. You are the one saying that the only way for a person to be fullfilled is for the government to pull someone else down. AIDS treatment is expensive. You know what's more expensive, not getting AIDS treatment. Your above individual has been receiving an incredible gift of life that she would not have, were it not for the effort of the individuals treating her. That is uplifting to everyone involved. It only becomes tainted when the money is taken by force from someone else.

You ask where the resources should come from... look at the kazillion dollars being spent bombing Iraq, the incredible profits of PhRMA (making them the most profitable industry in the world) as they churn out me too drugs... it's like going into the bowels of this horribly inefficient company (called the US healthcare system) that spends millions of dollars a day rubber stamping documents and sueing eachother and saying that nothing can be done, that the system can not be more efficient.

When has the government EVER made anything more efficient. The government is the reason that we are bombing Iraq. Anyone who knows me, will tell you that I have always opposed Iraq. With regards to PhRMA, those are the guys making the drugs that you expect to be paid for by the government. The profit motive is a powerful reason for these companies to keep doing that. Read my blog for more on that.

Again, I don't think that everyone should have a porsche or that the "insatiable appetite of the masses" should be served. But just as there is a right to free speech and freedom from torture and if you are a child to grow up in a healthy and nurturing environment... there should be provisions for basic healthcare. Healthcare is not a commidity the way a diamond tennis bracelet is..

Freedom of speach doesn't equal free healthcare. One is a negative right, and one is a positive right. I hate to keep referring you, but my blog has an entire section on this exact point. Healthcare IS a commodity, just like a tennis bracelet. It has to be paid for somehow. It is has to be performed by trained individuals. It doesn't exist in a vacuum. It isn't magic. The science of medicine is just like the science of tennis bracelet making. Both are skills passed along by teachers, and continuously improved by human ingenuity. There is no other way for free individuals to engage in healthcare activities than by trade. Any other way necessarily enslaves someone to someone else.

And consider that Canada, just north DOES provide univeral care... spends 30% less per capita doing it AND has comparable (and by some indicators such as life expectency, child mortality better) care. AND no one is being held at gunpoint to have their money stolen from them... don't forget, we have gun control.[/QUOTE
#1. I've often heard this argument from everyone in both the US and Canada that has never been sick in Canada.
#2. Gun control doesn't apply to the tax man, to whom I'm referring. Of course the forced reallocation of resources implied in socialized medicine will be called a tax.

I grew up in Canada and fortunately for many years now my parents have been proud owners of a small business. We pay our taxes and undoubtably have subsidized the healthcare of somebody somewhere. We wouldn't have it any other way. Many Canadians would not have it any other way!

I'm not trying to get involved in Canadian social policy. My best friend growing up was Canadian, and his family disagreed, so I won't say that it is universal. I don't intend to practice in Canada. I am worried about policy in the US, because I intend to practice here.

When we first imigrated to Canada 30 yrs ago, and were in fact a part of the working poor (you name it my mom and dad did it- window washer, vacuum salesman, bank night janitor, shoe factory worker...) we appreciated that someone else somewhere was paying their taxes so that we could have healthcare. But trust me we were not living in the lap of luxury... we taped our windows with garbage bags in the winters to keep out the cold... we walked in the snow whenever possible to save the 25 cents busfare...

And look at how far your family has come. That is quite a success story. It is also not particularly relevant. Most of my family still is the working poor.

With regards to giving money if you spend every cent you have on universal care, I'll tell you it depends. If you create a private charity and devote your life to it, I will help you. I will, because I am in medicine to help people who are sick, and I will achieve my own desire to help them by supporting your charity. If you promote universal socialized medicine with your money, I will not support it, because I believe that the system will be worse for everyone, and I have a right to control the degree to which I choose to help other people.

 

[Miami_med]

I know a Rand fan when I smell one.....we can smell our own kind.

I'm not a true objectavist, though I must admit a particular fondness for Atlas Shrugged

 

[naegleria brain]

unfortunately i didnt discover rand till med school; and pathology is an even longer, and more boring read.

it's important to remember why US pharma produces the most drugs and is actively involved in the most research worldwide - the profits are here.

you cut them down, you cut their incentive, they won't research new drugs, and medical therapy comes to a standstill. so you can't take money from them.

it's wrong to steal. you can't take your neighbors money to pay for your own treatment because you weren't wise enough to use a condom. that's immoral, hypocritical, and just plain wrong. so you can't tax your neighbor.


and canadians who say they like their own system had never had the impending sense of doom that is clasically (and textbook-ically) categorized in imminent heart attacks. neither have they had strokes or questionable nontender masses in their RUQ. once that manifests, let's see how long it takes for them to get treated.
chances are, they die first. no cost involved with imaging and curing a dead guy. hence, their costs are artificially low - people die and no one treats dead people.

in terms of quality of care, life expectancy is certainly not a measure of healthcare. u can't go ten miles without seeing a McDonald's. In other war-torn asian and african countries, life expectancy pushes to the upper 70s. yet, the people are so poor, healthcare is certainly not a priority. does that mean no care is better than America's care? simply doesn't hold.

infant mortality rate indicates prenatal care and congenital disorders, which can reflect varations in the gene pool, etc.

Most common scenario - you are a 60 y/o man with L chest pain and dyspnea. you have consistently cold feet and progressively worsening hemoptysis.
Which country would you rather be in? England? Canada? you won't get imaging/diagnosis for weeks to months, and you can't get treated until they know what's wrong.
America? same-day imaging, maybe next day consult, day after diagnosis, treatment in a week.

I'll take America any day.

 

[Playmakur42]

.

 

[mtoto]

Life expectency in "war torn" Africa is certainly NOT pushing 70 years... chk out these stats:

157 190 Mauritania 52.73 2006 est.
158 191 Benin 52.66 2006 est.
159 192 Republic of the Congo 52.26 2006 est.
160 193 Uganda 51.59 2006 est.
161 194 Democratic Republic of the Congo 51.10 2006 est.
162 195 Cameroon 50.89 2006 est.
163 196 Burundi 50.29 2006 est.
164 197 Equatorial Guinea 49.70 2006 est.
165 198 Guinea 49.36 2006 est.
166 199 Ethiopia 48.83 2006 est.
167 200 Mali 48.64 2006 est.
168 201 Côte d'Ivoire 48.62 2006 est.
169 202 Burkina Faso 48.45 2006 est.
170 203 Somalia 48.09 2006 est.
171 204 Kenya 47.99 2006 est.
172 205 Chad 47.18 2006 est.
173 206 Rwanda 46.96 2006 est.
174 207 Nigeria 46.74 2006 est.
175 208 Guinea-Bissau 46.61 2006 est.
176 209 Tanzania 45.24 2006 est.
177 210 Namibia 43.93 2006 est.
178 211 Niger 43.50 2006 est.
179 212 Central African Republic 43.39 2006 est.
180 213 South Africa 43.27 2006 est.
181 214 Djibouti 43.10 2006 est.
182 215 Afghanistan 42.90 2006 est.
183 216 Malawi 41.43 2006 est.
184 217 Mozambique 40.32 2006 est.
185 218 Sierra Leone 39.87 2006 est.
186 219 Zambia 39.70 2006 est.
188 220 Liberia 38.89 2006 est.
189 221 Angola 38.43 2006 est.
187 222 Zimbabwe 37.82 2006 est.
190 223 Lesotho 34.47 2006 est.
191 224 Botswana 33.87 2006 est.
192 225 Swaziland 33.22 2006 est.

Much of this of course is 2ndary to the HIV/AIDS pandemic.

Certainly one poor country that has always stood out for it's high life expectancy is China (72 yrs)... but I would hardly say that just b/c they are poor healthcare is not a priority for the Chinese.

And I thought that the Fountainhead was weird and poorly written.

 

[naegleria brain]

Sri Lanka - civil war for the past ~20 years, ranking the highest for "unexplained disappearances among civilians"

Life expectancy...72.89 years

vs. India...64 years

hmm

 

[Miami_med]

And I thought that the Fountainhead was weird and poorly written.

Yeah, I'd have to say that Atlas Shrugged is the best read of the Rand Novels. I still can't figure out what the heck Dominique was supposed to stand for in The Fountainhead If you want a good Randish perspective on libertarianism and medicine, there is a speach from the mid 80s that makes its way around the internet in various forms from a Dr. Leonard Peikoff. It is called Socialized Medicine: The Death of a Profession. It manages to effectively convey how a socialized medical system harms those that it claims to protect. I am not as eloquent as Dr. Peikoff. On top of addressing all of the problems in medicine in the 80s, he effectively predicts many of the problems we have today. We are all entitled to our own opinions, though mine is obviously less prevalent in the normal media. This speach is an excellent way to educate yourself on libertarianism perspectives in medicine. There are also a number of interesting articles on the subject buried in the website of mises.org, which is a libertarian academic think tank. I think that comparing life expectancy in Sri Lanka vs. The United States misses the bigger picture entirely, and there is more to life than comparing who gets to live the most years.

 

[mtoto]

Yeah, I'd have to say that Atlas Shrugged is the best read of the Rand Novels. I still can't figure out what the heck Dominique was supposed to stand for in The Fountainhead If you want a good Randish perspective on libertarianism and medicine, there is a speach from the mid 80s that makes its way around the internet in various forms from a Dr. Leonard Peikoff. It is called Socialized Medicine: The Death of a Profession. It manages to effectively convey how a socialized medical system harms those that it claims to protect. I am not as eloquent as Dr. Peikoff. On top of addressing all of the problems in medicine in the 80s, he effectively predicts many of the problems we have today. We are all entitled to our own opinions, though mine is obviously less prevalent in the normal media. This speach is an excellent way to educate yourself on libertarianism perspectives in medicine. There are also a number of interesting articles on the subject buried in the website of mises.org, which is a libertarian academic think tank. I think that comparing life expectancy in Sri Lanka vs. The United States misses the bigger picture entirely, and there is more to life than comparing who gets to live the most years.

Quoting an article by Dr. Peikoff:

The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle: self- preservation.

To each his own... though certainly this is not my morals!

Truthfully, my main interest is international health. I'm sure y'all on this thread will have a heart attack. Miami, you said that you are not concerned with social policy in Canada since you plan on practicing in the US. I consider myself a citizen of the world and am concerned about the social policies of all countries. And I suppose it doesn't bother me as much if a 75 yo isn't able to extend his/her life by 1 year for lack of the most advanced technological services (even if he/she is rich and "earned" it). It does bother me that 5 yo in Asian/African countries die of malaria in the hoards every year for lack of meds and mosquito nets (even if they are poor and "deserve" it).

Incidentally according to your logic why are Vetarans an exception to the rule... why should they have their healthcare subsidized by the govt?

 

[mtoto]

Cool quotes from Wikipedia:

While Canada's health system is cheaper, some have claimed that it compares well with the American one based on the fact that Canadians are, overall, statistically healthier than Americans. Life expectancy in 2005 was about two and a half years lower in the United States than in Canada, with Canadians living to an average of 80.1 years and Americans 77.7 (US Census Bureau). Infant and child mortality rates are also higher in the United States. This may be due in part to the different way agencies compile their statistics, although Canada's healthcare performance is regularly as good as or better than that of the US system in major comprehensive comparisons (WHO study, Johns Hopkins study, independent study).

There are a number of ancillary costs that are much higher in the United States. One of the most important of these is marketing both by insurance companies and health care providers. These costs, that are very low in Canada, are eventually borne by the consumer. Administrative costs are also higher in the United States - the diversity of insurers and plans means more administrative effort. There are also more players involved in health care, with the patient, insurer, physician, HMO, and hospital all involved in most transactions. Administrative costs in the United States are roughly double what they are in Canada (reference: http://content.nejm.org/cgi/content/abstract/349/8/768).

A major difference between the Canadian and American health spending is on investment in technology. For example, in terms of medical equipment such as MRI scanners per million people, America ranks first in the world with 19.5 per million people; Canada ranked 13th, with 4.6 MRI scanners per million people. In terms of CT scanners per million, America ranked third in the world with 29.5 per million while Canada was ranked 16th, with 10.3 per million [8].

Another much higher cost in the United States is that of prescription drugs and medicines. The US has explicit laws that prohibit Medicare or Medicaid from negotiating drug prices. Canada has laws that impose medical patents less rigorously[citation needed]. Generic drugs are thus available on Canadian shelves sooner[citation needed]. The Canadian system also takes advantage of centralized buying by the provincial governments that have more market heft and buy in bulk, lowering prices. This typically delays the introduction of new medications into the Canadian market[citation needed]. In addition, price negotiations by Canadian health insurers are based on evaluations of the clinical effectiveness of prescription drugs[7], allowing the relative prices of therapeutically-similar drugs to be considered in context.

Higher pay in the United States lures skilled doctors and nurses, trained in Canada partially at the taxpayer's expense, to emigrate to the United States to pursue higher salaries. This partly contributes to Canada having fewer doctors per capita than the United States. In the United States there were 2.8 doctors per 1000 people in 1998 while in Canada only 2.1. New statistics, however, compiled by the Canadian Institute for Health Information (CIHI) show that for the first time since 1969 (the period for which data are available) more physicians have returned to Canada than moved abroad. [6].

Health care is one of the most expensive items of both nations' budgets. The United States spends more per capita on health care than the government does in Canada. In 2003, the government of Canada spent $1886 (in US dollars) per person on health care, while the United States government spent $2548.[11]

Despite the American government paying more per capita, private sources also pay far more for health care in the United States. In Canada an average of $630 dollars is spent annually by individuals or private insurance companies for health care, including dental, eye care, and drugs. In the United States this number is $2719. In 2001 the United States spent in total 13.6% of its annual GDP on health care. In Canada only 9.5% of the GDP was spent on health care. This difference is a relatively recent development. In 1971 the nations were much closer with Canada spending 7.1% of GDP on health while the U.S. spent 7.6%.

 

[Miami_med]

Quoting an article by Dr. Peikoff:

The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle: self- preservation.

To each his own... though certainly this is not my morals!

Truthfully, my main interest is international health. I'm sure y'all on this thread will have a heart attack. Miami, you said that you are not concerned with social policy in Canada since you plan on practicing in the US. I consider myself a citizen of the world and am concerned about the social policies of all countries. And I suppose it doesn't bother me as much if a 75 yo isn't able to extend his/her life by 1 year for lack of the most advanced technological services (even if he/she is rich and "earned" it). It does bother me that 5 yo in Asian/African countries die of malaria in the hoards every year for lack of meds and mosquito nets (even if they are poor and "deserve" it).

Incidentally according to your logic why are Vetarans an exception to the rule... why should they have their healthcare subsidized by the govt?

You are probably correct that we are so idealogically different, that we'll never get to agree. Just remember that your morality can only exist by conscripting me by force. I want nothing more than to be left alone and allowed to practice medicine for individuals who want my services by choice. You are looking to draft me into your service through taxation with the force of the government. I don't believe that the poor deserve to die, but they have no right to force me to make them live.

In my system, the poor are individuals who are offered pity and charity. Your system desires to turn them into parasites in order to give them the illusion of not being charity cases. In medicine, we consider an organism that forcibly survives by living off of another organism a parasite. My dog isn't a parasite, because I want to take care of him. A person whom I choose to treat at a free clinic isn't a parasite, because I treat him by choice. If he comes into my office with a gun and demands my services, he is then a parasite. Using the government as a middle man doesn't change the premise, just the perpatrator. Hosts have a tendency to grow a distaste for the parasites, and the enslaved doctor of a socialist system is likewise not a person whom I want to treat anyone. This IS primarily because I want people to have good care.

As a final note, I'll give a little background on how the economy works. When the evil, rich corporations make a lot of money, they pay it out in the form of salaries and dividends. The dividends go to the shareholders, which include middle class americans, pension funds, and insurance entities. Even the wealthy heads of these companies will use their large salaries. They will invest, allowing new innovations from safer cars to new medical devices. They will buy yachts, which are built by working class men and sold by middle class people. They will buy expensive cars, that are built by working class workers. Everyone from the assembly line worker to the CEO benefits. This method of distributing wealth is doubly beneficial. #1: Each individual spreads the money with all sorts of variation throughout the economy. #2: High income allows each individual to be rewarded for their money making contributions. If they choose to use this reward for expensive medical treatment, so be it.

When epidemics spread through the US in the 1800s and early 1900s, we didn't solve them by demanding vaccines from other countries. Sending vaccines or cloroquine to Africa does nothing if they have no infrastructure to support it. The day the supply lines slip, they are back at zero. Those countries need an economy. An economy is the thing that happens when many individuals looking out for their own self-interest manage to create lots of wealth and make life better for everyone. Without private enterprise and the hard work of many individuals, you would have nothing to socialize. The socialist schemes that keep taking over in Africa and S. America are exactly why these countries haven't managed to develope, even in the face of extreme natural resources.

As a side note, I never said anything about the VA. I never said it should exist. However, I'll point out that I believe that the ONE legitimate role of government is defense, and if the government wants to offer medical care as a job perk, I am not diametrically opposed to it. In this case, it is not a handout. They have to go to work (usually with people shooting at them) to qualify.

 

[Miami_med]

Cool quotes from Wikipedia:

While Canada's health system is cheaper, some have claimed that it compares well with the American one based on the fact that Canadians are, overall, statistically healthier than Americans. Life expectancy in 2005 was about two and a half years lower in the United States than in Canada, with Canadians living to an average of 80.1 years and Americans 77.7 (US Census Bureau). Infant and child mortality rates are also higher in the United States. This may be due in part to the different way agencies compile their statistics, although Canada's healthcare performance is regularly as good as or better than that of the US system in major comprehensive comparisons (WHO study, Johns Hopkins study, independent study).

There are a number of ancillary costs that are much higher in the United States. One of the most important of these is marketing both by insurance companies and health care providers. These costs, that are very low in Canada, are eventually borne by the consumer. Administrative costs are also higher in the United States - the diversity of insurers and plans means more administrative effort. There are also more players involved in health care, with the patient, insurer, physician, HMO, and hospital all involved in most transactions. Administrative costs in the United States are roughly double what they are in Canada (reference: http://content.nejm.org/cgi/content/abstract/349/8/768).

A major difference between the Canadian and American health spending is on investment in technology. For example, in terms of medical equipment such as MRI scanners per million people, America ranks first in the world with 19.5 per million people; Canada ranked 13th, with 4.6 MRI scanners per million people. In terms of CT scanners per million, America ranked third in the world with 29.5 per million while Canada was ranked 16th, with 10.3 per million [8].

Another much higher cost in the United States is that of prescription drugs and medicines. The US has explicit laws that prohibit Medicare or Medicaid from negotiating drug prices. Canada has laws that impose medical patents less rigorously[citation needed]. Generic drugs are thus available on Canadian shelves sooner[citation needed]. The Canadian system also takes advantage of centralized buying by the provincial governments that have more market heft and buy in bulk, lowering prices. This typically delays the introduction of new medications into the Canadian market[citation needed]. In addition, price negotiations by Canadian health insurers are based on evaluations of the clinical effectiveness of prescription drugs[7], allowing the relative prices of therapeutically-similar drugs to be considered in context.

Higher pay in the United States lures skilled doctors and nurses, trained in Canada partially at the taxpayer's expense, to emigrate to the United States to pursue higher salaries. This partly contributes to Canada having fewer doctors per capita than the United States. In the United States there were 2.8 doctors per 1000 people in 1998 while in Canada only 2.1. New statistics, however, compiled by the Canadian Institute for Health Information (CIHI) show that for the first time since 1969 (the period for which data are available) more physicians have returned to Canada than moved abroad. [6].

Health care is one of the most expensive items of both nations' budgets. The United States spends more per capita on health care than the government does in Canada. In 2003, the government of Canada spent $1886 (in US dollars) per person on health care, while the United States government spent $2548.[11]

Despite the American government paying more per capita, private sources also pay far more for health care in the United States. In Canada an average of $630 dollars is spent annually by individuals or private insurance companies for health care, including dental, eye care, and drugs. In the United States this number is $2719. In 2001 the United States spent in total 13.6% of its annual GDP on health care. In Canada only 9.5% of the GDP was spent on health care. This difference is a relatively recent development. In 1971 the nations were much closer with Canada spending 7.1% of GDP on health while the U.S. spent 7.6%.

Doctors are only 10% of health. We've already been over why Canadians live longer. I'd still rather be sick here. These differences in your last paragraph developed AFTER the government got involved in medicine. I am against Medicare and Medicaid. Before that, we had a very high life expectancy compared to the rest of the world, and we didn't spend that much on medical care. Our large costs are ALREADY the result of government meddling. As Mark Twain said, "there are lies d*mn lies, and statistics." The word on the ground doesn't match what they say. All your article proves is that the US government is even WORSE than the Canadian government in healthcare distribution (which makes sense in a country with 10x the population). It doesn't prove that the Canadian government is doing a good job.

 

[dynx]

Cool quotes from Wikipedia:

Here's an interesting read as well. Good points to counter some of your's, if not a bit long. I don't think the wikipedia summary is a good way to form an opinion by the way.

http://www.cato.org/pubs/pas/pa532.pdf

 

[naegleria brain]

I think that comparing life expectancy in Sri Lanka vs. The United States misses the bigger picture entirely, and there is more to life than comparing who gets to live the most years.

that's what i was trying to get at

...also, the pitiful state of VA hospitals and nation-wide agreement on its sub-standard conditions are a pretty good indication that the government is usually inept at providing healthcare.

 

[johankriek]

Im getting out of this industry though and going to Dental School class of '11.
Insurance has less of an impact on dentists.

That is the smartest thing said by a premed ever.. and im serious about that. Medicine is the pits... its a MESS for doctors.. It may still be good for administrators and insurance agents..

 

[johankriek]

I don't know about your experiences, but veterans hospitals are the absolute worst. .

i think there was a big study recently that proved the opposite. VA healthcare is the best in the nation. ANd im not being facetious.. Does anyone remember this study?

 

[Miami_med]

i think there was a big study recently that proved the opposite. VA healthcare is the best in the nation. ANd im not being facetious.. Does anyone remember this study?

I think that the study you are referring to showed that the amount spent on "administration" was less at the VA. Considering that VA hospitals have worse outcomes on almost every level, have a generally less healthy patient base, and are often understaffed, I doubt that any legitimate study could prove such a thing. Of course, they do use EMR, and according to the government, all medical problems in the whole universe will be solved if we just implement a universal EMR. Down here at Jackson Memorial in Miami, we have a number of surgeons who operate here and at the VA. The SAME surgeons have worse outcomes at the VA than here at a community hospital that primarily cares for impoverished immigrants. That's the anecdotal evidence anyway, as reported by agents of the University themselves.

 

[LuckyMD2b]

The old timers used to say: an ounce of prevention is worth a pound of cure. Simply stated but nonetheless very true.

Uninsured patients actually cost the healthcare system more becuase they present late with chronic illness and have much more severe consequences of these diseases. [It's cheaper to keep diabetes or hypertension undercontrol with PO meds than to pay for the longterm complications of those illnesses -- in acute care (amputations, MI, CABGs, Caths) and disabilities (CHF, dialysis, blindness)]. But we all know that... or so I'd hope.

Fact of the matter is that Europeans have better healthcare than Americans do. And thats not based on subjective BS or anecdotal "evidence" but hard data and objective outcomes

Check this article from JAMA: disease and disadvantage in the US
http://jama.ama-assn.org/cgi/content/short/295/17/2037

Measuring biological outcomes of health shows that Americans are sicker. -- And the authors actually ACCOUNTED FOR SOCIOECONOMIC STATUS, and only included WHITE englishmen to WHITE americans; and found that
"behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences."

 

[LuckyMD2b]

I feel that central to the arguement is whether you think that healthcare is a basic human right.

I, being a future physician, believe that everyone -- immigrant, citizen, rich, or poor -- deserves healthcare.

No matter how conservative you are you have to agree that there are some things that the government can do better for us than we can each do individually: such as building roads, enforcing a justice system, national defense, and running the CDC and NIH.

And ensuring that every American has the basic human right of adequate primary health care, and affordable prescription meds is a perfect job for the government. Why? becuase the Europeans have shown us that it actually leads to better outcomes and COSTS less than what we are doing now.

In my opinion, if making money is more important to you than helping patients then maybe medicine isn't the place for you.

 

[Miami_med]

I feel that central to the arguement is whether you think that healthcare is a basic human right.

I, being a future physician, believe that everyone -- immigrant, citizen, rich, or poor -- deserves healthcare.

No matter how conservative you are you have to agree that there are some things that the government can do better for us than we can each do individually: such as building roads, enforcing a justice system, national defense, and running the CDC and NIH.

And ensuring that every American has the basic human right of adequate primary health care, and affordable prescription meds is a perfect job for the government. Why? becuase the Europeans have shown us that it actually leads to better outcomes and COSTS less than what we are doing now.

In my opinion, if making money is more important to you than helping patients then maybe medicine isn't the place for you.

Oh boy, here's another one with that argument. Wanting to make money and help patients are NOT mutually exclusive. Please read the well cited link from the CATO institute about 8 posts up that refutes everything you just said with data from the socialist governments in question. Healthcare is NOT a basic human right, because it requires the work of another human to give it to you. Please read my blog for further arguments. I, being a future physician, believe that people deserve what they earn and that everything else is charitable. I don't think that this makes me evil at all. On the contrary, it makes me an autonomous person who believes that individuals have a right to take care of themselves without someone else trying to make them a sacrificial lamb.

 

[Miami_med]

The old timers used to say: an ounce of prevention is worth a pound of cure. Simply stated but nonetheless very true.

I guess you won't be wanting any of the preventative imaging (like mammograms) that are hard to come by in the land of our neighbors to the north. If your goal is to tell people to exercise and lose weight, hire a personal trainer for $15/hr. If you want to practice medicine, well, there are some problems.