socialized medicine

[kronickm]

In every other first world country, doctors make about half of what they make in the U.S.

They also probably pay 1/400th of what U.S. doctors pay for med school (not to mention undergrad). Most of them don't pay anything at all.

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[Miami_med]

In every other first world country, doctors make about half of what they make in the U.S.

That's generally not true. There is a huge variation between first world countries and between specialties. The difference are smaller in primary care vs. specialists. On the extreme, I believe that the average physician is about 1/3 of US in Sweden, and it is about on par for primary care to Britain, though the specialists make less.

 

[apoptosisisfun]

You still have not challenged me on the concept that Medicare is essentially socialized medicine and so is Tri-Care which covers federal gov employees and retirees.

Go hop in the milmed forums and see how happy they (a lot) are.

They also probably pay 1/400th of what U.S. doctors pay for med school (not to mention undergrad). Most of them don't pay anything at all.

That's my thoughts exactly. If we socialize, who would be reimbursed for tuition expenses that students in socialized countries don't have to incur?

 

[LearningAlways]

1. Unless you own stock in a pharmaceutical company or manufacturer of medical equipment, or you're an established medical doctor, "free market" medicine is harmful to the economy, it is not a help. Legalized theivery (by the companies more than the doctors) does not improve the economy.

2. Until their patents expire, most medicines are already monopolized.

3. Socialism is an economic perspective, it has nothing to do with politics. Socialism can exist in the absence of formal government, just the same as capitalism can. If you have an immediate family, chances are you practice a form of socialism without formal government.

4. Our healthcare system needs serious reform. I believe deregulation has had and continues to have the opposite effect it was intended to have. Actually, I think it is having the opposite effect it is promised to have, not necessarily opposite of what is intended by those doing the deregulating.

5. If we converted to socialist medicine school would get a lot cheaper and so would setting up a practice. Maybe the specialists wouldn't make as much as they do now - perhaps they'd have to settle for one ferarri per household instead of 6 or 7 - but physicians would have to go into less debt in general in order to get their careers off the ground.

6. Whether the percentage of Japanese who get sick is less than the percentage of Americans who get sick or not, the fact is that social medicine demonstrably works in Japan. As far as Canadians coming down to the US for medical care; I think there are far more Americans who go to Canada seeking health care. I think if you proposed the thought of going to Canada for healthcare to an average American, they might take you seriously - whether they supported the idea or not. I think if you asked the average Canadian why not go down to the US for healthcare they would laugh in your face.

For patients, health care sucks in America. Even if they do get good treatment (which isn't a given), that treatment costs a fortune. I've seen no evidence at all that socialized medicine leads to outrageous (or even significantly increased) wait times. And if you're partial towards quality care, an appointment with a good specialist can take months in the US; though it is true that doctors often make time for other doctors.

As for cost, it's much cheaper to pay as a community for people to have minor procedures/visits/checkups done on a regular/as needed basis than it is to wait until those minor conditions develop into conditions requiring emergency care (sometimes over and over again) and then saddle the community with the bill anyway. Unless you consider hospitals losing money to not be a drain on the resources of the community, then letting the hospital take the hit on unpaid emergency room bills is taxing the community.

And, just as an aside; Michael Moore is a con-artist who is interested in very little other than the manipulation of people and their emotions and making money. The fact that anything he says is truthful must be understood to be incidental to the fact that it helps him manipulate people's emotions and make money. Just look at the guy. How concerned about health care could he really be?

 

[LearningAlways]

Also, I just wanted to add that the "universal healthcare" that most of the democrats are offering will not solve or even significantly reduce the problems we are having now. Most of them wants to keep the insurance companies involved, which obviously is unnecessary; it's just an extra drain of money where there should be none. If healthcare is universal, there is no place for insurance companies. Corporate interests are tugging at both sides of this issue on the mainstream, and none of the corporate solutions are going to work for anyone but the corporations who designed those solutions. If the system stays the way it is, pharmy and medical manufacturing companies continue scoring big time. If we go "universal" the way hillary and barack suggest, it's the insurance companies and other companies providing useless services who will be draining the public coffers and scoring big. people do not run this government so much as companies do, and unless we reform the government it's going to be very hard to make any economic system work.

Does anybody know what Benito Mussolini's definition of fascism was?

 

[Miami_med]

1. Unless you own stock in a pharmaceutical company or manufacturer of medical equipment, or you're an established medical doctor, "free market" medicine is harmful to the economy, it is not a help. Legalized theivery (by the companies more than the doctors) does not improve the economy.

WHo is exactly is stealing? If you don't like the product, don't buy it. If it saves your life, it's hard to claim that having to pay a fraction of the cost of creating the thing that saved your life is stealing.

2. Until their patents expire, most medicines are already monopolized.

This falls back on physicians. I had to buy my wife Cipro for a simple infection yesterday. It was not covered by any of our insurances. It cost $3. The new abx are not always necessary, and in this case, we continue to drive up the price by overprescribing high cost antibiotics.

3. Socialism is an economic perspective, it has nothing to do with politics. Socialism can exist in the absence of formal government, just the same as capitalism can. If you have an immediate family, chances are you practice a form of socialism without formal government.

Yes and no. I share economic resources with my family, and I even supply a disproportionate amount of those resources. No one forces me to however. The government uses force, and that has everything to do with politics. If Bill Gates said that he de didn't want to help support the rest of Americans and just wanted to pay for his family, they'd haul him off to jail for tax evasion.

4. Our healthcare system needs serious reform. I believe deregulation has had and continues to have the opposite effect it was intended to have. Actually, I think it is having the opposite effect it is promised to have, not necessarily opposite of what is intended by those doing the deregulating.

How would you know? The healthcare system has become progressively MORE regulated since the 1960s and the advent of Medicare. At that time it was 5% of the economy, run by physicians, there was no healthcare crisis, and being uninsured wasn't that big a deal, because many people were uninsured and physicians took reasonable cash payments.

Today, hospitals and insurance companies run the show, physicians are losing ground in every respect, and the regulation is larger than it has ever been.

5. If we converted to socialist medicine school would get a lot cheaper and so would setting up a practice. Maybe the specialists wouldn't make as much as they do now - perhaps they'd have to settle for one ferarri per household instead of 6 or 7 - but physicians would have to go into less debt in general in order to get their careers off the ground.

Do you live in a delusional universe? How much money do you think physicians make? How does socialized medicine make medical school cheaper? Cheap tuition and socialized medicine often go together in a socialized society, but one doesn't breed the other. You are confusing an association with causation.

6. Whether the percentage of Japanese who get sick is less than the percentage of Americans who get sick or not, the fact is that social medicine demonstrably works in Japan. As far as Canadians coming down to the US for medical care; I think there are far more Americans who go to Canada seeking health care. I think if you proposed the thought of going to Canada for healthcare to an average American, they might take you seriously - whether they supported the idea or not. I think if you asked the average Canadian why not go down to the US for healthcare they would laugh in your face.

I'm not sure how you can begin to compare Japan to the US in any respect. A homogenous society, where half the people live in one urban area, and the entire population is set on a few small island.

I don't know any Americans who have gone to Canada for healthcare, with the exception of prescription drugs. Canadians come here for MRIs and Surgery, we want cheaper ARBs.

For patients, health care sucks in America. Even if they do get good treatment (which isn't a given), that treatment costs a fortune. I've seen no evidence at all that socialized medicine leads to outrageous (or even significantly increased) wait times. And if you're partial towards quality care, an appointment with a good specialist can take months in the US; though it is true that doctors often make time for other doctors.

Any bum off the street can waltz into the ER at my local county hospital and have access to the top specialists in the state within the week and the most modern evidence based treatment begun that very day.

As for cost, it's much cheaper to pay as a community for people to have minor procedures/visits/checkups done on a regular/as needed basis than it is to wait until those minor conditions develop into conditions requiring emergency care (sometimes over and over again) and then saddle the community with the bill anyway. Unless you consider hospitals losing money to not be a drain on the resources of the community, then letting the hospital take the hit on unpaid emergency room bills is taxing the community.

Tat is because the system is half socialized already. The half that is, is the half that isn't working right. People showing up and not having to pay the bill, having no one else to pay the bill, and not beginning to feel an obligation to deal with the bill is a symptom of a nanny state already.

And, just as an aside; Michael Moore is a con-artist who is interested in very little other than the manipulation of people and their emotions and making money. The fact that anything he says is truthful must be understood to be incidental to the fact that it helps him manipulate people's emotions and make money. Just look at the guy. How concerned about health care could he really be?

No argument here.

 

[oldManDO2009]

I have worked in the ER for years and socialized medicine exist and it is abused. Most state insurance for the poor and undocumented results in ER visits for colds (entire family in ER), minor wounds, and a huge list of unnecessary care. Since they are not responsible for the bill (I am via taxes) I see the same people day in and out abusing the system.

I have to call my doctor and get an appointment - why? I would have to pay a penalty (larger co pay) for unnecessary care. So I choose to call and make an appointment for the cough of 2 days. And guess what, I get right in and do not have to debate going to Canada for health care.

"Free care" is a pathway to abuse and skyrocketing taxes.

My plan --> Remove the responsibility of health insurance from the employer. Every AMERICAN is part of a group plan. There are no individual plans which cost far to much to be affordable because ins co can rate and charge individuals differently then the group...The rates would be set by the government and 20 million dollar pay checks with outrageous bonuses would be harder to justify (rates are currently set by the government for Medicare just extended to the entire population)

Rate setting would happen out side the legislative process - it take them years to close loop holes and they have other interest in mind as they accept huge donation for re-election from the same companies selling $26 band aides

The money for this insurance can be paid by your employer to the plan fund as a benefit or you would pay it. The poor receive state aid in the form of premium payments. State health plans such as Medicaid (in CA) are immediately closed...

The fund is only managed by the government as a method of efficient payment

The single fund then pays the insurance company of your choice and the company can offer additional service but everyone get a basic plan.

Ins co would have incentives to compete for persons and rates would be kept down

You would accept that life is risky and nothing is guaranteed. Bad outcomes in the absence of gross negligence (drunk surgeon) would be just part of assuming the risk (of life) and lawsuits would not be possible.

A fund (re-insurance) could be developed to pay reasonable expenses for certain disabilities due to bad outcomes. But that bikini line scar a 1/2 inch above you bikini is not worth 5 million dollars.

Drugs are a risky proposition - not all drugs work the same in all people. An adverse reaction does not necessarily mean negligence on the drug companies part. If you CHOOSE to take a drug to save you life then you assume the risk. Disability would qualify you for benefits.

In other words Mr. Dirt bag lawyer got me 5 million dollars because I smoked crack and boozed during my pregnancy and my kid has CP TV ads would no longer be necessary.

Medical equipment would not cost 10 times the amount just because Medicare has a few loop holes and the 5K wheelchair would cost 5K and not 30K...no more we will get you a wheelchair ad.....

The money saved by insuring the uninsured and reducing the cost of health care would go into modernizing the electronic medical records into a central repository so lab values could be accessed instead of repeated.

Manufactures would still have incentives to develop new technology because hospitals would still be buying and more safety could be built in to the system to reduce errors --> scanning patients prior to med administration, automated med dispensors that follow the nurse and give only the ordered med (no more wrong doses wrong med)

The governments role would be the central payor and rate setter - otherwise it would be a total disaster since government fixes money blunders by just taking more money

My long 2 cents

 

[oldManDO2009]

I have worked in the ER for years and socialized medicine exist and it is abused. Most state insurance for the poor and undocumented results in ER visits for colds (entire family in ER), minor wounds, and a huge list of unnecessary care. Since they are not responsible for the bill (I am via taxes) I see the same people day in and out abusing the system.

I have to call my doctor and get an appointment - why? I would have to pay a penalty (larger co pay) for unnecessary care. So I choose to call and make an appointment for the cough of 2 days. And guess what, I get right in and do not have to debate going to Canada for health care.

"Free care" is a pathway to abuse and skyrocketing taxes.

My plan --> Remove the responsibility of health insurance from the employer. Every AMERICAN is part of a group plan. There are no individual plans which cost far to much to be affordable because ins co can rate and charge individuals differently then the group...The rates would be set by the government and 20 million dollar pay checks with outrageous bonuses would be harder to justify (rates are currently set by the government for Medicare just extended to the entire population)

Rate setting would happen put side the legislative process - it take them years to close loop holes and they have other interest in mind as they accept huge donation for re-election from the same companies selling $26 band aides

The money for this insurance can be paid by your employer to the plan fund as a benefit or you would pay it. The poor receive state aid in the form of premium payments. State health plans such as Medicaid (in CA) are immediately closed...

The fund is only managed by the government as a method of efficient payment

The single fund then pays the insurance company of your choice and the company can offer additional service but everyone get a basic plan.

Ins co would have incentives to compete for persons and rates would be kept down

You would accept that life is risky and nothing is guaranteed. Bad outcomes in the absence of gross negligence (drunk surgeon) would be just part of assuming the risk (of life) and lawsuits would not be possible.

A fund (re-insurance) could be developed to pay reasonable expenses for certain disabilities due to bad outcomes. But that bikini line scar a 1/2 inch above you bikini is not worth 5 million dollars.

Drugs are a risky proposition - not all drugs work the same in all people. An adverse reaction does not necessarily mean negligence of the drug companies part. If you CHOOSE to take a drug to save you life then you assume the risk. Disability would qualify you for benefits.

In other words Mr. Dirt bag lawyer got me 5 million dollars because I smoked crack and boozed during my pregnancy and my kid has CP TV ads would no longer be necessary.

Medical equipment would not cost 10 times the amount just because Medicare has a few loop hole the 5K wheelchair would cost 5K and not 30K...no more we will get you a wheelchair ad.....

The money saved by insuring the uninsured and reducing the cost of health care would go into modernizing the electronic medical records into a central repository so lab values could be accessed instead of repeated.

Manufactures would still have incentives to develop new technology because hospitals would still be buying and more safety could be built in to the system to reduce errors --> scanning patients prior to med administration, automated med dispenses that follow the nurse and give only the ordered med (no more wrong doses wrong med)

The governments role would be the central payor and rate setter - otherwise it would be a total disaster since government fixes money blunders by just taking more money

My long 2 cents

 

[LearningAlways]

WHo is exactly is stealing? If you don't like the product, don't buy it. If it saves your life, it's hard to claim that having to pay a fraction of the cost of creating the thing that saved your life is stealing.

The pharmaceutical companies are stealing, IMHO. Please, let's not pretend that pharmy companies lose money on their products; healthcare has constistently been the most profitable sector of the US economy for years. I believe pharmy companies are engaged in price-fixing; and I consider that stealing. I will concede that the term stealing is used loosely here.

This falls back on physicians. I had to buy my wife Cipro for a simple infection yesterday. It was not covered by any of our insurances. It cost $3. The new abx are not always necessary, and in this case, we continue to drive up the price by overprescribing high cost antibiotics.

It also has to do with the fact that the FDA will not allow any unpatentable product to be sold as a treatment, cure or prevention of any disease; and it has a lot to do with the fact that physicians get all sorts of exciting perks from pharmy companies who are pushing their products. Once a week there's a rep from a pharmy company in every hospital ward taking doctors out to lunch and handing out fancy pens and other exciting goodies. But most of all it has to do with the fact that lack of competition in the absence of pricing regulation consistently leads to higher prices.

Yes and no. I share economic resources with my family, and I even supply a disproportionate amount of those resources. No one forces me to however. The government uses force, and that has everything to do with politics. If Bill Gates said that he de didn't want to help support the rest of Americans and just wanted to pay for his family, they'd haul him off to jail for tax evasion.

I don't have an issue with anything you said there, but I do take issue with an unstated premise of yours, which is that socialism depends on tyrannical government. Socialism is not defined by the lack of democracy, or the presence of tyranny, or the presence or absence of any other form of government. It can function under either. Socialism is a function of economics, like capitalism. Both can function under a variety of regimes, or lacking a formal regime at all; as demonstrated by your depiction of how your family works. How well they function has to do with what type of political body governs them, but socialism is an economic characteristic of a society. Here it is you who is confusing association with causation. OUR government uses force, as all governments do - and in the context of our government socialist medicine might indeed be very difficult to pull off; but I attribute that to the setting up of a socialist economic system within a larger capitalist economic system - which is of course contradictory.

How would you know? The healthcare system has become progressively MORE regulated since the 1960s and the advent of Medicare. At that time it was 5% of the economy, run by physicians, there was no healthcare crisis, and being uninsured wasn't that big a deal, because many people were uninsured and physicians took reasonable cash payments.

I will concede these points. I meant deregulation mostly in terms of established pharmy companies. I am well aware that the FDA requires so much money be spent on testing new pharmaceuticals that it is damn near impossible for non-established companies to begin producing medicine. But you're right, except for as applies to a few dozen huge companies who can effectively do whatever they want, the healthcare industry in general is over-regulated.

Do you live in a delusional universe? How much money do you think physicians make? How does socialized medicine make medical school cheaper? Cheap tuition and socialized medicine often go together in a socialized society, but one doesn't breed the other. You are confusing an association with causation.

Fine, once again I'll concede this point. In the context of our existing government it is entirely possible that the state would not cover tuition and other expenses. In fact, it's probably likely that they wouldn't; though after a few years of socialized medicine and all the new practices going out of business the govt would have to do something. Perhaps I am confusing association with causation; it wouldn't be 100% guaranteed that the govt would cover tuition or the cost of setting up a new practice, but the odds of that happening would certainly be greater. I would argue that they are not totally coincidental observations.

I'm not sure how you can begin to compare Japan to the US in any respect. A homogenous society, where half the people live in one urban area, and the entire population is set on a few small island.

I don't know any Americans who have gone to Canada for healthcare, with the exception of prescription drugs. Canadians come here for MRIs and Surgery, we want cheaper ARBs.

Perscription drugs, or procedures that they could never afford in the US and their insurance companies won't pay for. Many patients are unwilling to wait until they meet the insurance company's criteria for a procedure that they and their doctors know they need. Insurance companies also bully doctors into refraining from recommending patients for treatment that the doctors would otherwise find to be beneficial.

I don't want to stir up any more controversey than we already have here, but many doctors believe in the efficacy of various controversial treatments which insurance companies won't pay for. Insurance companies, in some cases will actually try and get a doctor's license revoked for recommending or administering treatment that does not adhere to the CDC guidelines. Do we really want homogenous care? Do we want doctors restricted in what their beliefs and practices can be? I'm sure some of us do, and I'm sure that there are others still who will claim that we don't want that and would get that with socialized medicine; but that's not true. Socialized medicine wouldn't cause that, government would; and the two can be separated. I am defending socialized medicine, even though I do not believe it would work without a massive overhaul of the government; which I don't think is possible anyway.

Any bum off the street can waltz into the ER at my local county hospital and have access to the top specialists in the state within the week and the most modern evidence based treatment begun that very day.

A bum can have those things if A) he is able and willing to pay for them, or B) if his situation is immediately life-threatening. Otherwise, he can and will be denied care by the top specialists in the state, and everyone else - including the worst specialists in the state. So is your arguement that these people have too much access to medical care already? If it is, are you advocating that we let these people die in immediately life-threatening situations; just as we let them die long miserable deaths over time if they have eventually life-threatening situations, like we do with bums with cancer?

Tat is because the system is half socialized already. The half that is, is the half that isn't working right. People showing up and not having to pay the bill, having no one else to pay the bill, and not beginning to feel an obligation to deal with the bill is a symptom of a nanny state already.

You're right, the problem is the half-socialization of the system and the half capitalism of it. In either situation the system would run better if it were one or the other; but a socialized system would be, in my opinion, more patient and doctor friendly than a fully capitalist one. In a fully capitalist system you'd have to watch people die of something you could have stopped - or personally foot the bill for caring for them. Only the cold-hearted doctors would survive financially. I wonder if they would have good bedside manner?

 

[Miami_med]

The pharmaceutical companies are stealing, IMHO. Please, let's not pretend that pharmy companies lose money on their products; healthcare has constistently been the most profitable sector of the US economy for years. I believe pharmy companies are engaged in price-fixing; and I consider that stealing. I will concede that the term stealing is used loosely here.

There is no price fixing outside of the monopoly period. The US produces the VAST majority of new pharmeceuticals used throughout the world. We in a sense prop up other health systems, and our people are bearing the brunt of the cost of the world's R&D. Remember, if these companies didn't make the drugs, they wouldn't exist. We wouldn't be upset that they were "fixing their prices" because there would be no product upon which to fix the price.

It also has to do with the fact that the FDA will not allow any unpatentable product to be sold as a treatment, cure or prevention of any disease; and it has a lot to do with the fact that physicians get all sorts of exciting perks from pharmy companies who are pushing their products. Once a week there's a rep from a pharmy company in every hospital ward taking doctors out to lunch and handing out fancy pens and other exciting goodies. But most of all it has to do with the fact that lack of competition in the absence of pricing regulation consistently leads to higher prices.

If the FDA (aka government) already prevents this practice now, why would we think that they would stop if we give them even more control over the system? What you really want is a system in which individuals actually pay for their own care, and are allowed to make informed decisions with their physicians to buy what they feel is best for them.

Competition is best bread through deregulation. The FDA currently stomps out most competitors with the regulatory process, and there has been atleast one instance of the founder of an upstart drug company landing in jail. Dangerous. Of course, this is really a government problem. The pharmacy companies can only stomp out competition with government compliance. Price fixing ALWAYS creates shortages unless the fixed prices are above the market price, in which case the government is actually driving the price UP.


[QUOTE}
I don't have an issue with anything you said there, but I do take issue with an unstated premise of yours, which is that socialism depends on tyrannical government. Socialism is not defined by the lack of democracy, or the presence of tyranny, or the presence or absence of any other form of government. It can function under either. Socialism is a function of economics, like capitalism. Both can function under a variety of regimes, or lacking a formal regime at all; as demonstrated by your depiction of how your family works. How well they function has to do with what type of political body governs them, but socialism is an economic characteristic of a society. Here it is you who is confusing association with causation. OUR government uses force, as all governments do - and in the context of our government socialist medicine might indeed be very difficult to pull off; but I attribute that to the setting up of a socialist economic system within a larger capitalist economic system - which is of course contradictory.[/QUOTE]
I'd love an example of any economy of scale in which socialism is practiced outside of government coercion. I doubt that you can get much bigger than some tribe with an informal economy.

I will concede these points. I meant deregulation mostly in terms of established pharmy companies. I am well aware that the FDA requires so much money be spent on testing new pharmaceuticals that it is damn near impossible for non-established companies to begin producing medicine. But you're right, except for as applies to a few dozen huge companies who can effectively do whatever they want, the healthcare industry in general is over-regulated.

And as you just pointed out, even those companies are over-regulated. The trick is to de-regulate the process universally, so that it doesn't favor the establishment over the upstarts.

Fine, once again I'll concede this point. In the context of our existing government it is entirely possible that the state would not cover tuition and other expenses. In fact, it's probably likely that they wouldn't; though after a few years of socialized medicine and all the new practices going out of business the govt would have to do something. Perhaps I am confusing association with causation; it wouldn't be 100% guaranteed that the govt would cover tuition or the cost of setting up a new practice, but the odds of that happening would certainly be greater. I would argue that they are not totally coincidental observations.

I have yet to see anything about covering these things in any plan proposed by anyone in this country. In many other countries, the price is rising, and the socialist governments of the world are actually covering these things to a lesser degree than before.

Perscription drugs, or procedures that they could never afford in the US and their insurance companies won't pay for. Many patients are unwilling to wait until they meet the insurance company's criteria for a procedure that they and their doctors know they need. Insurance companies also bully doctors into refraining from recommending patients for treatment that the doctors would otherwise find to be beneficial.

Which is why competition is good. The insurance industry is also heavily regulated, favoring the old established companies and keeping the upstarts out. You should always be allowed to pay out of pocket for something uncovered, though that is illegal in places like Canada.

I don't want to stir up any more controversey than we already have here, but many doctors believe in the efficacy of various controversial treatments which insurance companies won't pay for. Insurance companies, in some cases will actually try and get a doctor's license revoked for recommending or administering treatment that does not adhere to the CDC guidelines. Do we really want homogenous care? Do we want doctors restricted in what their beliefs and practices can be? I'm sure some of us do, and I'm sure that there are others still who will claim that we don't want that and would get that with socialized medicine; but that's not true. Socialized medicine wouldn't cause that, government would; and the two can be separated. I am defending socialized medicine, even though I do not believe it would work without a massive overhaul of the government; which I don't think is possible anyway.

One payer who chooses what to pay for ALWAYS creates more homogenous care. Using the license as a tool to control practice is an example of abuse of regulatory power. You blame the insurance companies. I blame the government that would let such a thing happen. No license can be revoked without government action.

A bum can have those things if A) he is able and willing to pay for them, or B) if his situation is immediately life-threatening. Otherwise, he can and will be denied care by the top specialists in the state, and everyone else - including the worst specialists in the state. So is your arguement that these people have too much access to medical care already? If it is, are you advocating that we let these people die in immediately life-threatening situations; just as we let them die long miserable deaths over time if they have eventually life-threatening situations, like we do with bums with cancer?

If you walk into Jackson Memorial Hospital in Miami with any problem, you may have some pretty mean experiences, but you will be treated appropriately.

You're right, the problem is the half-socialization of the system and the half capitalism of it. In either situation the system would run better if it were one or the other; but a socialized system would be, in my opinion, more patient and doctor friendly than a fully capitalist one. In a fully capitalist system you'd have to watch people die of something you could have stopped - or personally foot the bill for caring for them. Only the cold-hearted doctors would survive financially. I wonder if they would have good bedside manner?

The warm hearted doctors didn't all die before the government began the great takeover with Medicare in the 60s. Wanting to get paid for hard complicated work is not cold hearted.

 

[LearningAlways]

There is no price fixing outside of the monopoly period. The US produces the VAST majority of new pharmeceuticals used throughout the world. We in a sense prop up other health systems, and our people are bearing the brunt of the cost of the world's R&D. Remember, if these companies didn't make the drugs, they wouldn't exist. We wouldn't be upset that they were "fixing their prices" because there would be no product upon which to fix the price.

Are the US and the US-based multinational pharmy companies the same thing? If so, I will agree that the US produces the vast majority of new pharmaceuticals produced throughout the world. To some degree "we" (by which I mean the doctors and patients who use these drugs after they have been approved) "bear the brunt of r&d." I don't see seller-funded research as proper r&d, nor do I see paying huge multi-million dollar application fees to the FDA (which is where a lot of the money labeled as "R&D" goes). I feel that way too many dangerous medications slip through the cracks only to be recalled later after they've killed thousands of patients for me to say that we have a proper procedure for premarket research and development. In reality, the way I see it, most of the effective r&d is done by doctors and patients after a drug has been approved and is being sold. Obviously this is a separate issue, and whether or not you see the process as being as fallable as I do I'm sure you'll agree it is an issue. I also want to point out that in a lot of cases the rest of the world doesn't want the expensive products our American based pharmy companies generate - see India and Africa, where the populations are fighting tooth and nail against the American pharmy companies who are making it illegal in easily influenced (and capitalist) African nations for HIV/AIDS patients to purchase the cheaper generic HIV/AIDS drugs from India. In many cases the ideas are purchased by American pharmy companies from elsewhere in the world, those ideas are put through our r&d process and then our companies sell drugs (sometimes less effective newer ones because the monopoly period on the older more effective drugs has run out and profit potential has deflated) to Americans and the rest of the world, and do their best to influence our governments and those of other countries, not to increase choices, but to decrease them. That is the true nature of free market capitalism. True free market capitalism as the Bush crew and many others push involves pulling out all the stops for the most powerful companies to squash the little guys. That's true deregulation.

If the FDA (aka government) already prevents this practice now, why would we think that they would stop if we give them even more control over the system? What you really want is a system in which individuals actually pay for their own care, and are allowed to make informed decisions with their physicians to buy what they feel is best for them.

Unfortunately, outside of the circles of Beverly Hills and the Hamptons, patients far more often end up making informed decisions with their physicians to buy what they feel they can afford. Honestly, how much does the average year of cancer treatment cost? I know there are lots of treatments, but my point is that everything is way too expensive. 1 in 2 American males will get cancer in their lifetimes and 1 in 3 American females will. I don't think it's unreasonable for us to look at cancer treatment as an indicator of whether or not people are really making informed decisions about what's best or what's not. I know many have insurance, or govt pensions etc etc, but there is also a rapidly growing percentage of Americans who don't. Personally, I don't see how the price of treatment could possibly go any higher; unless and except we were to allow our policies to remain unchanged.

Competition is best bread through deregulation. The FDA currently stomps out most competitors with the regulatory process, and there has been atleast one instance of the founder of an upstart drug company landing in jail. Dangerous. Of course, this is really a government problem. The pharmacy companies can only stomp out competition with government compliance. Price fixing ALWAYS creates shortages unless the fixed prices are above the market price, in which case the government is actually driving the price UP.

I agree with the first half of what you said, but it's not as if larger companies can only stomp out competition with government compliance. Perhaps they can only get the owners of the competition arrested with government compliance, and I agree, that has to stop - but just look at the situation with any other type of company from grocers to hardware stores - you'll see the larger companies stomping out the competition in every type of business, especially retail business. Mom and pop shops have about a one year lifespan once Starbucks or Dunkin Donuts or ACE Hardware or Stop & Shop move in. The presence of the Mom and pop shops drives the price down of course, since the larger companies come in and undercut them - but that's only temporary until the local mom and pops are put out of business, at which point the prices are jacked up and the company gains a stranglehold over the community - employing too many people for the local govt not to be accomodating to their every whim, including making it impossible for new mom and pop competition to get started up.

I'd love an example of any economy of scale in which socialism is practiced outside of government coercion. I doubt that you can get much bigger than some tribe with an informal economy.

I'll admit it's not of huge success in large scale societies because large scale societies often require a centralized government (otherwise it's not considered one society, but many - like could be considered of the Native Americans as they were before the arrival of Europeans), but I believe that the Spanish working class rebelled in 1936 when their country was taken over by fascists. They effectively took over everything, kept the economy running well, simply showing up for their jobs and doing the things that needed to be done in the society while simultaneously fighting what eventually became the Hitler-backed fascists until the fascists regained control in 1937. There were no famines or food shortages during that period, as would be expected from an economic collapse. There was no centralized rebel government. It would be interesting to see how that would have played out if the country was not facing invasion by multiple foreign powers.

And as you just pointed out, even those companies are over-regulated. The trick is to de-regulate the process universally, so that it doesn't favor the establishment over the upstarts.

I think the trick is to regulate in such a way that competition is favored over lack of competition - or not to regulate at all (by that I mean total anarchy; not regulating anyone - I don't mean simply deregulating business). We both know my second proposition could never happen so I guess I will have to keep my support behind the first.

I have yet to see anything about covering these things in any plan proposed by anyone in this country. In many other countries, the price is rising, and the socialist governments of the world are actually covering these things to a lesser degree than before.

There are many in this country who are proposing all sorts of changes; but they are not politicians or if they are they are ineffective. None of the presidential candidates could possibly support anything that would be remotely effective, because of the way our political process is set up. Since private campaign contributions are allowed only those with money or with the support of those who have money can run for anything and get any exposure. As for socialist governments, I understand that you mean governments which support socialism; but as we have established, I think the problem is with government, not socialism. Not that government could never be refined in such a way that socialism would work - I'm not saying that it could either. I don't know. But I do know that socialism is an economic charasteristic of a society and can exist under a variety of governments from totalitarian to a complete lack of government.

Which is why competition is good. The insurance industry is also heavily regulated, favoring the old established companies and keeping the upstarts out. You should always be allowed to pay out of pocket for something uncovered, though that is illegal in places like Canada.

Agreed, you should be able to pay out of pocket for something that's not covered. If it's illegal in Canada it may be because the government will cover anything that isn't otherwise against the law - i.e. if they were covering everything except euthenasia. Give me a specific example of something not covered in Canada that's illegal, and we'll discuss maybe why that is - also, is it illegal to pay for anything in Canada that's not covered? Is the cost of food covered? Technically, that could be broken down as a medical expense, right? Is it then illegal to buy food? Or is Canada just regulating the things that are also regulated here in the US, like prescription drugs? If they are, are you arguing we should deregulate prescription drugs? If you are I'm not necessarily against that, just asking for clarification.

One payer who chooses what to pay for ALWAYS creates more homogenous care. Using the license as a tool to control practice is an example of abuse of regulatory power. You blame the insurance companies. I blame the government that would let such a thing happen. No license can be revoked without government action.

Of course this is correct, the government issues the licenses in the first place. No argument here; I blame insurance companies, and I also blame government for the licenses in the first place. That's already establishing a precedent for homogenized care - just by issuing the licenses; so long as there is a criteria those applying for a license must meet. It has the same effect as a one-payer system. In both systems we are at the mercy of the govt to allow or not allow our more diverse treatments.

If you walk into Jackson Memorial Hospital in Miami with any problem, you may have some pretty mean experiences, but you will be treated appropriately.

I'm glad to see that this is true in Miami. I am from Connecticut, and I can't say with any confidence that this is the case here. I applaud JMH for this - but you were saying that this is because the system is half-socialized. So you are against this or what? What if anything is your solution for those who truly cannot afford to pay for treatment if we totally desocialize?

The warm hearted doctors didn't all die before the government began the great takeover with Medicare in the 60s. Wanting to get paid for hard complicated work is not cold hearted.

[/quote]

Agreed, the good doctors didn't die before the government began the great takeover in the 60's, and they didn't go out of business either as far as I'm aware - which is what I was talking about; not dying. I think that's more because 1) treatment cost much less back then and 2) the infrastructure was so much less developed (one or two doctors per small town kind of thing). What that means is back then closer-knit communities and the doctor could do whatever needed to be done even for those who could not afford to pay him for it. If a doctor was in financial distress he was unlikely to lose his home, and other members of the community who recognized the importance of having a competent and compassionate doctor around would invite the doctor to dinner and lunch and in general the members within a community would ensure that a doctor's needs were being met. In some ways you could say that medicine was somewhat socialized in small American towns before the 60's.

As for big city doctors, I'm sure it was fairly dog-eat-dog, even with the lower treatment costs. If you study much history of American cities in general, you'll find that the entirety of the population was fairly dog-eat-dog; with firefighters setting buildings on fire (back when the fire services were privatized and firefighters would be paid money for putting out fires) and in the hospitals people were dying by the hundreds of thousands of tuberculosis, or before that polio. They used to have enormous body-chutes in some of the hospitals where there were too many tuberculosis victims; because of the problem of disposing of so many bodies. In such circumstances I don't know if it is possible to separate the cold-hearted from the warm-hearted doctors; as technical of a term as that is.

My point was not that it's cold-hearted to want to get paid for complicated or labor-intensive treatment (or even any treatment at all really), but I think it is cold-hearted to withhold treatment that one knows would be effective and that one knows one has the capacity to administer. To be aware of the capability to ease another's suffering and to choose not to is ethically questionable to me. Also, I would point out that in a socialized healthcare system everyone would be guaranteed pay for every treatment they performed, so the issue as it stands would be a non-issue.

 

[Miami_med]

Are the US and the US-based multinational pharmy companies the same thing? If so, I will agree that the US produces the vast majority of new pharmaceuticals produced throughout the world. To some degree "we......"

This is just getting a little too big for me.

I applaud some of your points, unfortunately, family duties and an MS-3 surgery rotation prevent me from openly disagreeing with the others.

All the best.

 

[LearningAlways]

Well thanks for the civil discussion, I enjoyed it and you brought some new aspects of the issue to light for me that I had not thought about. I hope I was able to do the same.

Good friendly exchange of ideas, thanks.

 

[rgarrig]

This is just getting a little too big for me.

I applaud some of your points, unfortunately, family duties and an MS-3 surgery rotation prevent me from openly disagreeing with the others.

All the best.

Too bad, I enjoyed reading your insightful posts (and applaud LearningAlways for not being belligerent, even though s/he is wrong

 

[asuhdds]

The answer is not to demand that mommy and daddy government pay for it. You think healthcare is expensive now? Imagine how expensive it will be when its free! Most realistic analysts calculate a figure around $200+ Billion dollars a year!

WOW, that's even more efficient than the current $440 BILLION we spend on MEDICARE alone (fiscal year 2007). Who in their right mind would ever want UHC?

 

[doc sam]

I think that if the US ever went universal (note, I dont think it ever will...ie I hope we're not stupid enough to try that...) there will be a movement of some doctors to try to skirt the universal system which will produce "off system" healthcare options. This can already be seen today by physicians who refuse to take insurance. Their patients (whom they have no shortage of) pay cash and everybody wins. The doc doesnt get screwed by the insurance company and make much more money, the patient gets great care (b/c the physicians who can get away with this are usually incredibly skilled and thus in high demand) and the evil for-profit insurance company makes less money (the CEO of Aetna made $20 Million last year...not a bad salary for screwing doctors huh?)

These docs will set up their own clinics and hopitals and provide great healthcare for people who will pay cash. As the system gets worse, more docs will be drawn away from the universal system and the only docs left will be the really bad ones.

Free market system always wins because it incentivises good practice and quality products.

We need to reform the healthcare system and keep it privatized.

You're making the huge assumption that the government would allow docs to work outside the system.

Currently, it is possible to work outside of medicare, but quite frankly it is rather difficult and their are quite a few hurdles in the way.

There are many people, primarily advocates of universal healthcare, who would like to make it impossible to work outside of medicare.

If these same folks manage to get govt healthcare forced upon us all, one of the necessary hallmarks of the system will be a total prohibition on folks working outside the system (for the very reasons you mention). I predict there will be very draconian laws put in place with strict punishments for any docs (and likely for patients too) who dare to try and work outside the system.

Likely, these laws won't be put in place initially. Initially, the system will be sold to us as giving us freedom of choice. You can still choose your doctor, blah, blah, blah.

Once they have their hooks firmly in place however, they will start to tighten the screws, increase the bureaucracy, etc.

In the end, they will ultimately make it illegal for any form of private practice outside of their system.

 

[asuhdds]

Universal healthcare smacks of socialism? I hope you never called the police, sent mail, or went to public school because man, those commie programs would sure make your blood boil.

There's so much misinformation regarding UHC, and I'm getting sick of the same old tired rhetoric.

Just a few quips:

- Morally outraged about paying for someone else's health insurance? Too bad you already do, and you actually probably pay more now then if you had universal healthcare. When the uninsured seek primary care or any kind of medical care in ER, hospitals treat them even if they don't have money. Then our government subsidizes the costs, paying orders of magnitude higher in the ER then if the patient had been covered and treated at a primary care center. 40% of all healthcare spending in the US is from the government. Americans pay more than twice as much in total, than any other country with Universal healthcare.

- Overhead is significantly reduced under UHC, at an estimated 3% in current UHC using countries, as opposed to 15-20% for our private health insurance.

- The VA (our SOCIALIST veterans' medicare) gets a 60% discount on pharmaceuticals because of bulk spending, just like Canada.

- Every first world country that has had privatized care, now has UHC. It's proven and effective. Whether it's socialist or not, is irrelevent. If you want to protest socialism or progressive taxation, reject any FAFSA aid, government funded loans, IRAs, public schools, your local police department and fire station, library, community center, to name a few. You know we used to have privatized law enforcement, but then people realized there's a time and a place for public programs.

- Here's a free market conundrum for you BOOTSTRAP/CAPTAINS OF INDUSTRY types: A recent study published showed that the obese and smokers actually cost less in total care spending than healthy citizens, because they live shorter lives.

 

[LADoc00]

and before calling me a communist please know that i was enlisted for 8 years, as an infantry medic

Does somehow having served in the military make you immune to having communist and therefore traitorous thoughts?

And yes before your respond, a broad based redistribution of wealth is the motive a pure traitor AND a communist. Literally evil personified IMO.

 

[genesis09]

With the VA, to get those great deals on prescription drugs, they have an extremely limited formulary. Their formulary is similar to an in-patient hospital setting. They limit the number of SSRIs to two preferred agents, and so on. Some of the VA MDs hate the fact they are so limited in their prescribing behavior.

 

[southerndoc]

With the VA, to get those great deals on prescription drugs, they have an extremely limited formulary. Their formulary is similar to an in-patient hospital setting. They limit the number of SSRIs to two preferred agents, and so on. Some of the VA MDs hate the fact they are so limited in their prescribing behavior.

My HMO has a limited formulary. They only cover one PPI. If you must use another PPI, you must either petition the HMO (which is often denied) or you must pay out of pocket (which almost always happens).

Some people seem to think that the advocation of a single payer system is advocation of eliminating all corporations, making everything government controlled, and giving every American a government salary. Nobody is adovcating that, and the governments of the UK, Canada, France, Italy, etc. have certainly not become socialist societies in the past 50 years of having a single-payer healthcare system.

Nobody is saying that a single-payer system is without its flaws. However, a single-payer system is becoming the better option in our HMO era. The high costs of HMO premiums, automatic 10-15% denials, re-classification of items as "pre-existing" conditions and cancelling insurance, etc. are all making our current healthcare system receive failing marks.

 

[genesis09]

You see that with PPIs for all insurance because one PPI, Prilosec, is OTC.

 

[Miami_med]

My HMO has a limited formulary. They only cover one PPI. If you must use another PPI, you must either petition the HMO (which is often denied) or you must pay out of pocket (which almost always happens).

Some people seem to think that the advocation of a single payer system is advocation of eliminating all corporations, making everything government controlled, and giving every American a government salary. Nobody is adovcating that, and the governments of the UK, Canada, France, Italy, etc. have certainly not become socialist societies in the past 50 years of having a single-payer healthcare system.

Nobody is saying that a single-payer system is without its flaws. However, a single-payer system is becoming the better option in our HMO era. The high costs of HMO premiums, automatic 10-15% denials, re-classification of items as "pre-existing" conditions and cancelling insurance, etc. are all making our current healthcare system receive failing marks.

50% of all healthcare dollars come from the government now, and virtually all major changes in the way it's delivered have already been by government mandate. Hillary Clinton was one of the major proponents of the "gatekeeper" model that blossomed into the modern HMO in the infancy of the modern era. This is what continues to perplex me. We can all theorize about the pluses and minuses about universal healthcare, but the reality is that it can't happen without giving more power to the government, which has already proven that it is incapable of effectively managing money. The HMOs maintain their stranglehold on the market through numerous governmenment mandates, restrictions on competition, and funding through Medicare money diversion. The government is almost by definition always in someone's pocket. No amount of theorizing changes the practical reality of what actually happens.

No amount of comparing us to other countries changes what happens in THIS country. Most of the rest of the world has been moving away from a limited government payment model, because it is bankrupting everyone. We're just ahead in terms of spending a lot, because while we don't cover everyone, we spend a heck of a lot more on marginal treatment for those that we do. I haven't noticed anything showing that Medicare has created an efficiency utopia for every patient over 65.

 

[m3unsure]

Who will run your life?

HMO/PPO or Big Brother

Just get used to idea of working harder and getting paid less.

To all pre-meds, go pull teeth like asudds. It's easier on you in the end. Or better yet, be a lawyer.

 

[Faebinder]

Well, medicare is getting bankrupt and so reimburisement will hit rock bottom. Sooner or later physicians will stop accepting medicare, although oddly enough it's currently one of the best payers but it demands sooooo much paperwork.

 

[Drogba]

Am I the only one who sees incredible irony in denouncing socialism and globalism in the same sentence? I guess some people only have faith in the market when it delivers wealth directly into their pocket.

 

[mm3781]

Its bad for everyone. Anything socialized fails. When was the last time the government did anything better than the private sector? This Post office vs UPS/FedEX, The VA System, etc...

Here's how to fix the healthcare problem:

People should stop living beyond their means and realize that they might just have to give up the new LCD TV for healthcare. We live in a culture that embraces material goods to the point that people spend money they dont have aquiring possesions that they dont need. They then turn to politicians pandering to this sector of society crying for universal healthcare because its "too expensive."

In reality, most people can afford healthcare. I know people who work part time (10 hrs per week minimum) in retail shops at the mall who have excellent healthcare for less than 40 dollars a month! Some healthcare is too expensive and the answer to that is tort reform.

The answer is not to demand that mommy and daddy government pay for it. You think healthcare is expensive now? Imagine how expensive it will be when its free! Most realistic analysts calculate a figure around $200+ Billion dollars a year!

Healthcare and the insurance problem needs to be reformed, but to socialize medicine would be disastrous, there are better ways to get healthcare to more people. If people really want to universalize healthcare I think it should be a state issue, that way when it completely fails it will be limited to whichever state adopts it (California) and the rest of the country will be able to see how bad of an idea it really was.

I agree with you totally, I've seen too many people on medicaid who "can't afford a prescription", yet they are driving a brand new tahoe on 24" rims with their bluetooth headsets.

 

[oldManDO2009]

consider innovation - right now companies have an incentive (money & profits) to create new medical devices/technologies. I was in surgery todays and saw some pretty innovative devices that reduce operating time, size of incision, and patient complications. Who will innovate if there is no incentive?

 

[Miami_med]

There's also no incentive to drive prices down. Thanks to Medicare, medical technologies are the only technologies that get MORE expensive as they get older.

 

[emtcsmith]

Medicare controls way to much, last time they went through a radical funding change for prehospital services it caused a serious change in how departments ran and often decrease in units in service for the public. So if medicare decreases payments again or just plain goes broke then the future damage to the EMS/prehospital/transport services would be serious.

From my understanding the medicare payscale is typically what other insurance companies base there reinbursment rates around, all which are sadly below what the actual cost of service is. Some insurance companies like Atena have been know to send reinbursment checks to patients and leave the EMS squad left to try and get the check that was theres.

Who knows what the solution to the issue is but creating a bigger goverment system then we already have doesn't seem like it.

 

[AwesomO]

And, just as an aside; Michael Moore is a con-artist who is interested in very little other than the manipulation of people and their emotions and making money. The fact that anything he says is truthful must be understood to be incidental to the fact that it helps him manipulate people's emotions and make money. Just look at the guy. How concerned about health care could he really be?

LOL now Moore is attacking the British system
[YOUTUBE]http://www.youtube.com/watch?v=lQ1sgNH20nc&feature=related[/YOUTUBE]