The Babylonians are coming

[Faebinder]

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Like I said in another thread, it is time for doctors to put their hands up and fight, and get ready to fight anybody(democrat or republican) who intends to sacrifice you and your family's walfare for political leverage.They don't mess with other labor unions at will, the don't mess with insurance companies at will, why should they have the luxury of stumping physicians whenever they choose.

No need to use phrase like "it is inevitable" or "we are going to get screwed". Put your hands up and fight. Whatever policies they choose, universal or no universal, they need to factor you into the whole equation.You did not rack up decades of education and debt so that you could get pushed arround by some political thug who works 26hr/week but thinks you are underworked, overpayed and incompetent. They know what is causing the rising healthcare costs(and since physicians income has been declining, I dare to say that is not the problem), but they still attack physicians' pay like that is the problem. Yes, we need to cover the poor and uninsured, but why must that be at the expense of physicians. Why do physicians always have to be the sacrificial lambs? Healthcare costs are rising, but isn't it mysterious that everyone in the medical community except doctors are experiencing increased pay? Do not let them use your compassion to hold you hostage.

It is time to stare the politicians in the eye and say "there will be consequencies if you continue to push us". Force them to factor your feelings into their decision making, because right now, they are not. You are the rightfull custodians of the healthcare system, don't allow those f#ckers hijack it from you. In a democracy, no one is going to fight for you if you don't fight for yourself, and the last time I checked, doctors have rights too. How much more ground do you plan on loosing before you wake up? It is time to stop hiding behind patient care and start fighting for your own rights. Put away that idealist sophistication that makes you justify your own beat-down and fight.

Doctors need to come together under one voice and send a clear message to
both political parties. Let them know that "enough is enough". You need to demand to get treated like key members of the healthcare community, right now, you are not.

Then the first step is to make the AMA lobby to allow physician unions. That should stop everyone from being a herd of cats.

 

[dutchman]

Then the first step is to make the AMA lobby to allow physician unions. That should stop everyone from being a herd of cats.

Thank you very much.

PAs have banded together and they are making gains. NPs and nurses have banded together, and they are making gains. Why cant physicians come together and protect their own interests?

 

[deleted4401]

There is old-school thinking that the three true professions are ministry, medicine, and the law. The law has already sold itself out ... so maybe there is just two professions left.

Aside from self-regulation, taking all business that comes to you, a code of ethics, an oath ... there is also the general philosophy that those of a true profession do not organize. There is a separation between us and the nurses and other ancillary staff. Not saying we're better than or anything like that, but as part of doing our job, unionization carries it's own risks of ... cheapening medicine. If things get bad, do you really want to strike? And if the answer is yes ... geez ... I just don't like the idea of 51% of my peers making decisions for me.

-S

 

[badgas]

I just don't like the idea of 51% of my peers making decisions for me.

-S

Better than rich, fat politicians who know less than nothing about medicine making those same decisions.

 

[sirus_virus]

Better than rich, fat politicians who know less than nothing about medicine making those same decisions.

That is exactly what came to my mind.

 

[dutchman]

There is old-school thinking that the three true professions are ministry, medicine, and the law. The law has already sold itself out ... so maybe there is just two professions left.

Aside from self-regulation, taking all business that comes to you, a code of ethics, an oath ... there is also the general philosophy that those of a true profession do not organize. There is a separation between us and the nurses and other ancillary staff. Not saying we're better than or anything like that, but as part of doing our job, unionization carries it's own risks of ... cheapening medicine. If things get bad, do you really want to strike? And if the answer is yes ... geez ... I just don't like the idea of 51% of my peers making decisions for me.

-S

The non-professionals that you describe are well on their way to capturing your so called "true profession" and taking you as a slave. I will repeat myself: loose the sophistication and open your eyes. Are you saying you will accept every work condition layed on you on the pretense that you are a special breed of professional? BTW, what is wrong with strikes? Are you any better than these doctors?

http://www.accessmylibrary.com/coms...=2930&purchase_type=ITM&item_id=0286-12761813

http://abcnews.go.com/International/wireStory?id=2119384&CMP=OTC-RSSFeeds0312

http://www.ndtv.com/template/template.asp?template=health&id=92358&callid=1

http://www.bmj.com/cgi/content/full/312/7027/332

http://www.turks.us/article~story~20031105130926224.htm

http://www.ncpa.org/health/pdh36a.html


What are your suggestions on how to handle things when the going gets tough? I hope you do not plan on getting on your knees and begging, because that is not professional either. I maintain, you put your hands up and fight.

 

[OldPsychDoc]

There is old-school thinking that the three true professions are ministry, medicine, and the law. The law has already sold itself out ... so maybe there is just two professions left.

Aside from self-regulation, taking all business that comes to you, a code of ethics, an oath ... there is also the general philosophy that those of a true profession do not organize. There is a separation between us and the nurses and other ancillary staff. Not saying we're better than or anything like that, but as part of doing our job, unionization carries it's own risks of ... cheapening medicine. If things get bad, do you really want to strike? And if the answer is yes ... geez ... I just don't like the idea of 51% of my peers making decisions for me.

-S

What would you say if I mentioned that there might be some system in some country somewhere where almost all of the funding for a certain professional activity is provided by the national government?
That politicians of all parties almost always support this funding enthusiastically?
That the funds are apportioned to professionals almost entirely on the basis of the merit of the activity?
That the decisions are made by a panel of professionals in that field?
And that almost everyone agrees that it is the right way to do this?



What utopian fantasy is this?
Am I talking about Canada? Scandanavia? Cuba? North Korea?




Nope--this describes the greatest research enterprise in world history:
competitive, peer-reviewed funding of independent scientific research via the National Institutes of Health and National Science Foundation here in the United States.
Although no one who has competed for these grants would describe the system as perfect, I think it does stand as an example of how government funding and professional peer review can work together to achieve impressive outcomes for all. It doesn't have to be doctors versus the government!

 

[Faebinder]

What would you say if I mentioned that there might be some system in some country somewhere where almost all of the funding for a certain professional activity is provided by the national government?
That politicians of all parties almost always support this funding enthusiastically?
That the funds are apportioned to professionals almost entirely on the basis of the merit of the activity?
That the decisions are made by a panel of professionals in that field?
And that almost everyone agrees that it is the right way to do this?



What utopian fantasy is this?
Am I talking about Canada? Scandanavia? Cuba? North Korea?




Nope--this describes the greatest research enterprise in world history:
competitive, peer-reviewed funding of independent scientific research via the National Institutes of Health and National Science Foundation here in the United States.
Although no one who has competed for these grants would describe the system as perfect, I think it does stand as an example of how government funding and professional peer review can work together to achieve impressive outcomes for all. It doesn't have to be doctors versus the government!

What are you talking about? The NIH? sheesh... we all know it gives grants according to the prestige of the university..... it favors basic science over clinical science and has no interest in how we use the tools... just in making the tools....

Otherwise we would see all physicians do research.... just ask the ER people how hard it is to get an ER doctor into academia vs private. There is a reason why people dont do research.. difficulty is not one of them (after all, all these people went through med school, I am sure they can learn to do research).

 

[deleted4401]

Simply put, yes. I'm different than those doctors. Like Vincent Chase said on "Entourage" - 'Don’t forget, I came from nothing, and as much as I love all the toys, I don’t need them.'

It's a blessing to make the money we do, have the prestige we do. If it means losing some salary and actually having to practice cost-effective, evidence-based medicine to aid in providing more accessability, it doesn't bother me. But we're all different. That's why a union doesn't work for me.

-S

 

[YouDontKnowJack]

There is old-school thinking that the three true professions are ministry, medicine, and the law. The law has already sold itself out ... so maybe there is just two professions left.

Aside from self-regulation, taking all business that comes to you, a code of ethics, an oath ... there is also the general philosophy that those of a true profession do not organize. There is a separation between us and the nurses and other ancillary staff. Not saying we're better than or anything like that, but as part of doing our job, unionization carries it's own risks of ... cheapening medicine. If things get bad, do you really want to strike? And if the answer is yes ... geez ... I just don't like the idea of 51% of my peers making decisions for me.

-S

I'll take a large pay increase over dignity any day, so long as i'm not required to perform any homosexual acts. I see nothing wrong with walking out. "F**k you, pay me."

 

[badgas]

I'll take a large pay increase over dignity any day, so long as i'm not required to perform any homosexual acts. I see nothing wrong with walking out. "F**k you, pay me."

Bingo! Those are the 4 simple words that will be used w/ hospital administration in the future. It is not all about the money but if I wanted to work for free or get walked all over then I would volunteer in a free clinic. Physicians are everyones bitches lately and it's time to put a foot down, not roll over.

 

[dutchman]

Simply put, yes. I'm different than those doctors. Like Vincent Chase said on "Entourage" - 'Don’t forget, I came from nothing, and as much as I love all the toys, I don’t need them.'

It's a blessing to make the money we do, have the prestige we do. If it means losing some salary and actually having to practice cost-effective, evidence-based medicine to aid in providing more accessability, it doesn't bother me. But we're all different. That's why a union doesn't work for me.

-S

Good for you, step aside.

 

[Faebinder]

Simply put, yes. I'm different than those doctors. Like Vincent Chase said on "Entourage" - 'Don’t forget, I came from nothing, and as much as I love all the toys, I don’t need them.'

It's a blessing to make the money we do, have the prestige we do. If it means losing some salary and actually having to practice cost-effective, evidence-based medicine to aid in providing more accessability, it doesn't bother me. But we're all different. That's why a union doesn't work for me.

-S

no one said all docs should join the union... the subspecialties are in less need of a union than primary care.

 

[3dtp]

Simply put, yes. I'm different than those doctors. Like Vincent Chase said on "Entourage" - 'Don’t forget, I came from nothing, and as much as I love all the toys, I don’t need them.'

It's a blessing to make the money we do, have the prestige we do. If it means losing some salary and actually having to practice cost-effective, evidence-based medicine to aid in providing more accessability, it doesn't bother me. But we're all different. That's why a union doesn't work for me.

-S

SimulD,
I don't think we are as different as you think. I'll pm you with some reasons. We do agree on a lot of things, probably far more than you think we do. We all want to solve the same problems, but we are not sure the best way to do it and as you have so eloquently stated, it's broke boys.

The problem we have now, and what the preceding generation has allowed to happen is to turn physicians into commodity labor. When a GM Industrial and Operations Engineer follows a physician through his office doing a time and motion study and produces a report saying that the essential work of a physician in a typical r/v office appointment can be fully accomplished in 8.23 minutes and therefore the optimum schedule should consist of 9 minute slots to allow for room turnover and dictation/note writing, then it is clear that the people paying the bills are the ones turning us into an overhead commodity.

I would like to think that the vast majority of those going into medicine are from Samaria, and will not cross to the other side of the street when a sick person is lying on the side of the road, but the reality is, that we do have to survive, economically to personally have the resources to take care of those who cannot take care of themselves. Otherwise, we will not have the money to offer the innkeeper to take care of the injured until we return.

The moral of the story is you cannot afford to be altruistic with someone else's resources, only your own, and to have the resources, you must charge on the average, a fair price and be paid that fair price. I think you know this, intellectually, it's the heart that gets in the way. Believe me, every time I see a crack user in my clinic whining she can't get an OTC lotion because she can't afford it, I'm tempted to reach in my pocket and give the $14 bucks. I can afford it, but does it solve the problem? Does it help her divert the $50 she just spent on her latest load of blow? Likely not. And even knowing this it is the hardest part of my professional life, not to do just that.

Churchill once said, "If you are not a liberal when you are young, you have no heart. If you remain a liberal when you are older, you have no head."

 

[YouDontKnowJack]

Believe me, every time I see a crack user in my clinic whining she can't get an OTC lotion because she can't afford it, I'm tempted to reach in my pocket and give the $14 bucks.

you are too generous. Most (99%) people wouldn't give a sh** about that crack user. They wouldn't even think about giving a dollar. The guys working the ED just roll their eyes at these people and talk sh** about them behind their backs.... or right in their faces.

 

[bkpa2med]

Forget the druggies, there alot more better people who need treatment!

 

[TUCOMSam]

Oh 5% of "high" income kids are uninsured.. interesting..

Uh-huh... now THAT is f'ing ridiculous. Let it first be said, I am also for kids' health yadda yadda yadda... but COME ON! WTF is up with THIS statistic?!? If the govt wants to further its hand in our bidness, why are these apparent irresponsible "high-income" parents not being forced to pay out of their deep pockets for their damn healthcare? I think if they make $xx and they obviously CHOOSE not to pay their damn bills the govt can take their plasma tv, cell phone, car, house, dog, cleaning lady, etc.

Another strange part of those statistics is the fact that most of the states with the largest percentage of uninsured are in the south... why don't we just separate the US into the north and the south again? 🙂 minus slavery, naturally.

Ugh! THis thread has made me jaded i think... seems like I entered med school at the ideal time... finish up residency just as we become univeral-healthcare, and then make less than i did as resident which i'm SURE will just make my 1/4 million dollar medschool debt disappear.

 

[dutchman]

The moral of the story is you cannot afford to be altruistic with someone else's resources "

Enough said.

 

[logos]

Uh-huh... now THAT is f'ing ridiculous. Let it first be said, I am also for kids' health yadda yadda yadda... but COME ON! WTF is up with THIS statistic?!? If the govt wants to further its hand in our bidness, why are these apparent irresponsible "high-income" parents not being forced to pay out of their deep pockets for their damn healthcare? I think if they make $xx and they obviously CHOOSE not to pay their damn bills the govt can take their plasma tv, cell phone, car, house, dog, cleaning lady, etc.

There are some relevant reasons for why one might not want to insure their kids. For example, why would Bill Gates want to have health insurance?

 

[Lovologist]

I am all for universal health care. Every day our kids can wake up and salute Mother Russia's glorious Hammer and Sickle. While the patients are waiting they can read enlightening literature on Mao and Stalin. Then they can end the day by pissing on the American flag, falling asleep to tales of revolution and uprising.

All hail Comrade Obama!

 

[EctopicFetus]

you are too generous. Most (99%) people wouldn't give a sh** about that crack user. They wouldn't even think about giving a dollar. The guys working the ED just roll their eyes at these people and talk sh** about them behind their backs.... or right in their faces.

LOL.. ill treat their problems in the ED (if they are real) but the ED is not a hotel or a place where the nurses double as housekeepers. If someone needs and wants that lotion that bad perhaps they cut their $40/day crack habit?

I mean where the F is the personal responsibility? Seriously? Should we just keep throwing money at problems that we cant/wont fix?

 

[EctopicFetus]

There are some relevant reasons for why one might not want to insure their kids. For example, why would Bill Gates want to have health insurance?

Ill bet he does. It is true he could self insure and it would likely cost him less in the long wrong and if it didnt it wouldnt matter, but for a "high income" person it could cripple them.

I mean say you are a family of 3.. making 100K per yr.. One month in the ICU is 100K+ thats it bye bye money. it simply could cripple an otherwise financially healthy family and lead them to poverty and ruin their Quality of life.

Some things are more optional IMO like Life insurance but if you are the breadwinner in your fam then IMO there is almost no excuse.

 

[EctopicFetus]

I am all for universal health care. Every day our kids can wake up and salute Mother Russia's glorious Hammer and Sickle. While the patients are waiting they can read enlightening literature on Mao and Stalin. Then they can end the day by pissing on the American flag, falling asleep to tales of revolution and uprising.

All hail Comrade Obama!

Quality.. dont forget about Lenin, Marx and the other leaders of our brothership! Comrades unite.. what could be greater? Hey while we are at it we should let the government run the newspapers and limit what we can see on the net.

 

[deleted4401]

Anything that is not a private, free-market solution is immediately branded as Communist or fascist. Any system that is not American is branded as Leninist and Maoist ... It's a wonder you can't have discourse about health care without your political/idealogical motives being labeled.

-S

 

[sirus_virus]

Anything that is not a private, free-market solution is immediately branded as Communist or fascist. Any system that is not American is branded as Leninist and Maoist ... It's a wonder you can't have discourse about health care without your political/idealogical motives being labeled.

-S

Yes, because free-market is the American way while socialism is the communist/fascist way. A doctor should be allowed to sell his/her skills in the free-market like any other red blooded American. It is so easy to come up with socialist solutions ie "let the government control it all and force people to do stuff". The real genius is the person that can come up with free-market solutions, because that actually involves critical thinking. The same critical thinking that has put the American economy in the #1 spot globally.

 

[Chulito]

Yes, because free-market is the American way while socialism is the communist/fascist way. A doctor should be allowed to sell his/her skills in the free-market like any other red blooded American. It is so easy to come up with socialist solutions ie "let the government control it all and force people to do stuff". The real genius is the person that can come up with free-market solutions, because that actually involves critical thinking. The same critical thinking that has put the American economy in the #1 spot globally.

🙄

 

[TUCOMSam]

There are some relevant reasons for why one might not want to insure their kids. For example, why would Bill Gates want to have health insurance?

Pretty damn sure someone in Bill Gates' position (which, by the way is NOT the top 10% of people in this country) would pay their medical bills out of pocket easily. Now a reality check... <0.0001% of americans are as rich as Bill Gates, so what was the point again???

I grow tired of this. Let's just go back to the bartering system... I take out your appendix for 3 loaves of bread, a block of swiss cheese, and your wife's donkey. If you want sutures, that'll be an extra loaf of bread.

 

[EctopicFetus]

Pretty damn sure someone in Bill Gates' position (which, by the way is NOT the top 10% of people in this country) would pay their medical bills out of pocket easily. Now a reality check... <0.0001% of americans are as rich as Bill Gates, so what was the point again???

I grow tired of this. Let's just go back to the bartering system... I take out your appendix for 3 loaves of bread, a block of swiss cheese, and your wife's donkey. If you want sutures, that'll be an extra loaf of bread.

Actually 0 americans are as rich as he is..He is the richest but like i said someone with a good income 100K or so could be bankrupted by a medical illness thats the point..

 

[3dtp]

LOL.. ill treat their problems in the ED (if they are real) but the ED is not a hotel or a place where the nurses double as housekeepers. If someone needs and wants that lotion that bad perhaps they cut their $40/day crack habit?

I mean where is the personal responsibility? Seriously? Should we just keep throwing money at problems that we cant/wont fix?

You are correct. Throwing money at the problems will have unintended consequences of continuing to enable self-destructive behaviour while increasing overall costs due to a downward spiraling health of the irresponsible person.

 

[3dtp]

Anything that is not a private, free-market solution is immediately branded as Communist or fascist. Any system that is not American is branded as Leninist and Maoist ... It's a wonder you can't have discourse about health care without your political/idealogical motives being labeled.

-S

Sim,
The government is us, and if we as a society agree then we will act. The problem arises when we are compelled to provide a service under unpalatable working conditions. We tried this once and it led to a civil war. As a trained economist, you might have learned that any system that is not based on sound economic principles is destined to collapse. The only question is how long will it take?

The fact is that any discussion of health care will be political since it is a political topic. Since the government has been involved, and there is a huge transfer payment, from my pocket and yours to theirs (and in the future possibly the other way around), it is political. Then the question becomes which of the philosophies of optimization of process do we wish to use?

Adam Smith's? or Karl Marx? or something in between? Perhaps Nash's theories?

Our government exists for specific reasons, and one of those stated reasons is to "promote the general welfare" of our citizens. Surely health care falls under that rubric. The question before us is how to best accomplish this.

We all cherish the fine roads and highways we have. We all pay for those roads by buying gasoline which is taxed which pays for the roads. And we pay for those roads in proportion to our use. The government doesn't dictate the price we pay to contractors, but rather competes the contract, and spends the money it collects.

With health care, government, at present, is not competing the contract, nor is it taxing on an amortized true costs basis. It is saying, if you want to play, here's what we'll pay. That is why this is a political debate and cannot be anything but that.

We all agree, I think, that in the ideal world, we'd like to provide everything for everyone. We also all agree, I think, that this is infinitely too expensive. Therefore we must make decisions to optimize what we can do. How to do that is political.

I think Aprogdirector (the Sith Lord) pointed out the three legged stool we sit on. You can have it cheap, you can have it universally available, or you can have high quality. Pick any two and the debate is over. What you can't have is all three as has been repeatedly demonstrated throughout the world.

 

[EctopicFetus]

Sim,
The government is us, and if we as a society agree then we will act. The problem arises when we are compelled to provide a service under unpalatable working conditions. We tried this once and it led to a civil war. As a trained economist, you might have learned that any system that is not based on sound economic principles is destined to collapse. The only question is how long will it take?

I agree overall but all systems historically have collapsed so I dont know if this is true.

We all cherish the fine roads and highways we have. We all pay for those roads by buying gasoline which is taxed which pays for the roads. And we pay for those roads in proportion to our use. The government doesn't dictate the price we pay to contractors, but rather competes the contract, and spends the money it collects.

Truth is they dont do a good job at all when it comes to govt contracts. They tend to overspend and the stories are legendary. All that being said in the one area that is the #1 cost in healthcare (drugs) the government currently is NOT allowed to negotiate prices. How freakin ridiculous is that? you drop 51% of all costs and you can not legally negotiate a price? Of course the fact that it is 51% is a problem in and of itself.

With health care, government, at present, is not competing the contract, nor is it taxing on an amortized true costs basis. It is saying, if you want to play, here's what we'll pay. That is why this is a political debate and cannot be anything but that.

As stated above this is only true toward physicians and hospitals and not medications. I cant remember where I read this little tid bit but.. the VA (which isnt bound to this rule) pays a little over $1 for a bag of NS, the Medicare/Medicaid system pays like 7 or 8 bucks).. Do you know how much NS we use? Holy crap!

We all agree, I think, that in the ideal world, we'd like to provide everything for everyone. We also all agree, I think, that this is infinitely too expensive. Therefore we must make decisions to optimize what we can do. How to do that is political.

👍 Everyone should have a mansion, a maid, and a couple of spouses..but it isnt realistic!

I think Aprogdirector (the Sith Lord) pointed out the three legged stool we sit on. You can have it cheap, you can have it universally available, or you can have high quality. Pick any two and the debate is over. What you can't have is all three as has been repeatedly demonstrated throughout the world.

this is called the Iron Triangle of Healthcare. It states you can have 2 of the 3 of cost, quality and access. Old idea and still holds true!

 

[deleted4401]

When something is a public good, you regulate it in such a way that may lead to inefficient pricing, but it serves the public interest. We have one military, one federal interstate system, NYC has one subway, and there is a ton of examples. I'm not saying there needs to be one health care system, and I don't think like a Marxist. If people just read what I wrote before, health care isn't a perfectly competitive market, the product/service being provided isn't a widget, so you can't always use market mechanisms.

I agree we can't have perfect scores on all measures - but we don't have even two right now. Basically, we have the highest quality in the world. It's too expensive, and it's not accessible. If we can have two, we should have two. If we are spending 30-50% more than many industrialized countries, then we should be able to re-engineer a little bit, for better outcomes. You cannot tell me that costs can't be controlled, and it should be left to the wind. If we did that in the 1980s, instead of 14% of GDP, health care would be 20% of GDP. A pure fee-for-service system with a third party paying the bills feeds right into greed of physicians and patients, and that's what was happening. Something had to be done.

I agree - any system based on unsound principles will collapse. That's why throwing market solutions to a system that doesn't work like a tradtional market may lead to its collapse. But sounds systems that are not funded will collapse, as well, and that's happening in a lot of countries. It's a matter of finding the right (or rightest) way, and promising to pay for it.

As far as The father, Adam Smith, he lived in the world of a 'goods' economy. His thinking, writing, and beautiful concept of 'the invisible hand' work great ... for bananas and Chevys. It doesn't explain how to fix the public schools or run a hospital or a clinic. The demand curve and the supply curve don't intersect in our world - they overlap. That's not in his books or his theories, that comes later.

About that war in the 1800s? Any Southern boy will tell you wasn't about human conditions, it was about States' Rights and Northern aggression 🙂

-S

 

[dutchman]

Solutions to the healthcare problem are welcome. The only thing that is not welcome is the notion that screwing doctors is a prerequisite to such a fix. Enough is enough.

 

[Miami_med]

I agree - any system based on unsound principles will collapse. That's why throwing market solutions to a system that doesn't work like a tradtional market may lead to its collapse. But sounds systems that are not funded will collapse, as well, and that's happening in a lot of countries. It's a matter of finding the right (or rightest) way, and promising to pay for it.

As far as The father, Adam Smith, he lived in the world of a 'goods' economy. His thinking, writing, and beautiful concept of 'the invisible hand' work great ... for bananas and Chevys. It doesn't explain how to fix the public schools or run a hospital or a clinic. The demand curve and the supply curve don't intersect in our world - they overlap. That's not in his books or his theories, that comes later.


-S

But public schools and hospital systems are already heavily regulated or controlled by the government. Before the government founded public schools in the late 1800s and became a force in healthcare financing (the 1930s), these institutions functioned on the exact same principles as Chevys, Bananas, Widgets, and everything else. You are putting the chicken before the egg. It is the intervention that prevents these things from following market principles.

By definition, government intervention into a market makes it no longer a free market. The only reason that healthcare is a "system" is due to intervention. If not, the healthcare "system" would be no different than the "housing system" or "video game distribution" system that we call capitalism.

 

[Faebinder]

When something is a public good, you regulate it in such a way that may lead to inefficient pricing, but it serves the public interest. We have one military, one federal interstate system, NYC has one subway, and there is a ton of examples. I'm not saying there needs to be one health care system, and I don't think like a Marxist. If people just read what I wrote before, health care isn't a perfectly competitive market, the product/service being provided isn't a widget, so you can't always use market mechanisms.

I agree we can't have perfect scores on all measures - but we don't have even two right now. Basically, we have the highest quality in the world. It's too expensive, and it's not accessible. If we can have two, we should have two. If we are spending 30-50% more than many industrialized countries, then we should be able to re-engineer a little bit, for better outcomes. You cannot tell me that costs can't be controlled, and it should be left to the wind. If we did that in the 1980s, instead of 14% of GDP, health care would be 20% of GDP. A pure fee-for-service system with a third party paying the bills feeds right into greed of physicians and patients, and that's what was happening. Something had to be done.

I agree - any system based on unsound principles will collapse. That's why throwing market solutions to a system that doesn't work like a tradtional market may lead to its collapse. But sounds systems that are not funded will collapse, as well, and that's happening in a lot of countries. It's a matter of finding the right (or rightest) way, and promising to pay for it.

As far as The father, Adam Smith, he lived in the world of a 'goods' economy. His thinking, writing, and beautiful concept of 'the invisible hand' work great ... for bananas and Chevys. It doesn't explain how to fix the public schools or run a hospital or a clinic. The demand curve and the supply curve don't intersect in our world - they overlap. That's not in his books or his theories, that comes later.

About that war in the 1800s? Any Southern boy will tell you wasn't about human conditions, it was about States' Rights and Northern aggression 🙂

-S

That's not true.... go to the ER and you are covered if you can't pay for ER visits... the procedures inaccessable at the moment are electives, which are a way of reducing access to reduce pricing... if you want to see less prices for highest quality then you either reduce access more (make more emergency stuff covered by ER into elective) or raise your prices in the ER (which is already crazy high).

The iron triangle is still in action.

 

[Faebinder]

Solutions to the healthcare problem are welcome. The only thing that is not welcome is the notion that screwing doctors is a prerequisite to such a fix. Enough is enough.

Yup, we should become more of a private contractor to the hospitals... But to do that you need other locations to do your work that way if the hospital says we want to pay you less, you can give them the finger....

Either start allowing more to be done out of hospitals or unionize to fight the power of a hospital to dictate what you get paid.

 

[3dtp]

When something is a public good, you regulate it in such a way that may lead to inefficient pricing, but it serves the public interest. We have one military, one federal interstate system, NYC has one subway, and there is a ton of examples. I'm not saying there needs to be one health care system, and I don't think like a Marxist. If people just read what I wrote before, health care isn't a perfectly competitive market, the product/service being provided isn't a widget, so you can't always use market mechanisms.

Ahh, but are you sure? The government just put a price tag on the worth of a life in a GAO report. How does $50,000 sound. And based it on Medicare reimbursement rates. Should we then allocate $50k and when it's gone it's gone? Does my buddy the crack user have any more or less intrinsic value than Mr. Gates? (personally as a unix user I'm going to keep my editorial mouth shut on this one, since I'm not so sure a monopolist has any value in a market society).

I agree we can't have perfect scores on all measures - but we don't have even two right now. Basically, we have the highest quality in the world. It's too expensive, and it's not accessible.

Do we? I read recently that US trained physicians have set up a shop in India, free of US constraints and regulations and now provide cardiac care at US quality at a small fraction of the costs. Americans, paying cash, are travelling to India for care that is unaffordable with insurance in the US. So, perhaps we are on the verge of being forced to become more competitive?

If we can have two, we should have two. If we are spending 30-50% more than many industrialized countries, then we should be able to re-engineer a little bit, for better outcomes. You cannot tell me that costs can't be controlled, and it should be left to the wind.

Not saying that at all, Am saying TANSTAAFL. (There ain't no such thing as a free lunch.) All that government/insurance company paperwork must be paid for by someone. Do you really think that spending 120 hours figuring out your income tax and keeping records is free and cost effective? If you earn a typical salary, you will pay around $10k - $20k in income taxes and spend 3 weeks (lost opportunity cost) or around $12k in your time just figuring out how to pay them. Unless you hire an accountant who will cost $60k/year to do it.

If we did that in the 1980s, instead of 14% of GDP, health care would be 20% of GDP. A pure fee-for-service system with a third party paying the bills feeds right into greed of physicians and patients, and that's what was happening. Something had to be done.

Exactly. Get rid of the third party payers. Once the cost of something is reassociated with the benefits then perhaps we will once again a.) take responsibility for our own health and b.) as unique individuals assess and select and negotiate our best outcomes and choices. And that may include a vacation to India for our bypass.

I agree - any system based on unsound principles will collapse. That's why throwing market solutions to a system that doesn't work like a tradtional market may lead to its collapse. But sounds systems that are not funded will collapse, as well, and that's happening in a lot of countries. It's a matter of finding the right (or rightest) way, and promising to pay for it.

On this we will disagree, as does the government. The government is artifically depressing the market. A recent survey study was made of mammography pricing and costs. I don't recall who did it, but the gist of the study was that mammography was available to women who did not have insurance and were not medicare/medicaid eligible. Due to the MQSA, mammography centers must all meet the same standards which levels the playing field among providers. Obtaining a mammogram was voluntary and insurers are forbidden from dictating from whom you will obtain a mammogram. The authors found that the mean price of a mammogram was $186. Considering the ACR estimates the costs associated with a mammogram are $96 and medicare pays something like $36, it seems clear that the free market is subsidizing the government.

This is a tax which is not accounted for as a tax. It does create overlap in the supply demand curve and this happens in everything the government does. This is not about overpaid fat doctors getting rich and buying Lear Jets. It is about providing a service of value to those how value it at the lowest possible cost which covers the entry price for suppliers, in this case, 10 plus years of training in the most economically productive years of most people's lives who don't do this arcane training process we call medical education, as well as the cost of running a business, including capital equipment, personnel, insurance, and other costs. All the while the government claiming that medicare is cost effective, while it understates dramatically the costs incurred. As governments have done in the beginning, now and forever, world without end, amen.

About that war in the 1800s? Any Southern boy will tell you wasn't about human conditions, it was about States' Rights and Northern aggression 🙂

-S

And they are right! The South was failing even then economically and if we had been more patient we might have been able to end slavery without a war. But when you're the slave, who wants to be patient. Want a 20 year residency? 'Night 😀 😀

 

[Lovologist]

I grow tired of this. Let's just go back to the bartering system... I take out your appendix for 3 loaves of bread, a block of swiss cheese, and your wife's donkey. If you want sutures, that'll be an extra loaf of bread.

Shhh...Don't give medical schools any ideas. One kidney for first year, a skin graft for second, a liver for third....

 

[Mephisto]

A question for all of you that are anti-universal health care: Do you at least think that our country should do *something* to get health care to those millions of Americans that go without?

Because you're starting to scare me. Call me idealistic, but I still think access to health care in the first place is more important than physician salary or physician autonomy. And I think your examples of government control are a bit drastic. From people I've talked to in Britain and Canada, they all think our current system is barbaric and would never trade for ours. Obviously if a new system goes through compromises need to be made and physicians need to be heavily involved in the formation. No system is perfect -- but isn't it better that we stop ignoring millions of American citizens?

I haven't read the whole thread yet, but I just had to respond to this. Previously you mentioned a sad story about your father. I wonder if anyone mentioned that in Britain (I don't know about Canada), if your father was over a certain age, he would not be receiving dialysis. That's POLICY. Something like if you're over 70, and your kidneys start to fail, the gov't will NOT cover dialysis.

When free healthcare steps in, there are drastic changes in how we view health as a country and culture. Frankly, I think Americans prefer the current healthcare system. Our culture is such that we are a country that REACTS. We want to be covered for traumas and emergencies and catastrophies, but we could care less about preventive care (which is the benefit of free healthcare). In all other "free healthcare societies", the healthcare delivery is concentrated on evidence-based, prentive, public health (that means MANY people don't get treated for serious and rare diseases so that MANY MANY more can be treated for the common ailments like diabetes, heart disease, etc...). I don't think we as a country can do that. I also don't think we as a country are willing to be taxed 70% of our income to fund healthcare.

 

[toothless rufus]

I also don't think we as a country are willing to be taxed 70% of our income to fund healthcare.

Please tell me that the 70% is not true.😱

 

[OncoCaP]

Interesting thread. I'm in favor of a single payer system, maybe based on per-state basis to make it more manageable. The countries that have a successful healthcare system (one that provides the best quality care to as many of its citizens as possible, etc.) all seem to use a single payer system primarily, in some cases with private health insurance as an add-on. Our system appears to be in very poor shape compared to other industrialized nation's systems and adding a lot of unnecessary cost (wasting money; inappropriately restricting access to health insurance and thus care). Probably the most telling fact is that we spend more per capita than any other industrialized nation, yet we have millions of uninsured (high percentage of our population) that other nations do not have. We ration care based on type of employment and cash in the bank, which may not be what Americans want (I don't think so anyway).

A single payer system could threaten to lower pay and worsen working conditions for physicians, although, for example, in Canada pay initially went up when they went to a single-payer sytem. Underfunding of a single payer system is a potential problem, so private health insurance is probably necessary to make up any such deficit, albeit as a secondary (smaller) source of healthcare funding. I'm for taking steps to protect the quality of physician jobs; however, I'm not in favor of doing this at the expense of the care of patients.

As the #1 domestic issue and an upcoming presidential election, I'm sure we'll be hearing a lot about various healthcare system concerns and plans. It will be interesting to see how this shakes out.

 

[toothless rufus]

I believe that the quality of physician jobs has a direct relationship with the quality of patient care.

Regarding elections: politicians need to stop trying to bedazzle the public to garner votes by offering ridiculous healthcare plans.

People need to be genuine.

 

[sirus_virus]

This is why there is no genuine solution to our healthcare "crisis", and why we find it hard to measure up to other industrialized nations:

1)Politicians like to promise free healthcare in exchange for votes without being realistic.

2)Politicians dont like using the words 'raising' or 'taxes'.

3)Americans like reform only when it's free, or at the expense of someone else.

3)Politicians love insurance and pharmaceutical companies, they really do.

4)Americans sue doctors and hospitals with the greatest frequency of all industrialized nations.

5)Defensive medicine is virtually exclusive to the American system(>100 billion dollars a year)

6)America ranks #1 in obesity.

7)America ranks #1 in tobacco consumption.

8)America ranks #1 in sedentary lifestyle.

9)#s 6,7 and 8 are the leading precursors of disease and death in industrialized nations.

 

[EctopicFetus]

Americans sue doctors and hospitals with the greatest frequency of all industrialized nations.

I agree with your overall position but can you tell me where you found this?

Look our political system is a great one but one of the very obvious and serious issues is that there is NO incentive to do anything that is costly now with a great return on the investment in the future.. Why??

Politicians get elected by making promises now and worry about paying it later, there is no incentive for these crooks errr.. politicians to do anything else.

 

[Jejton]

Frankly, I think Americans prefer the current healthcare system. ..........I also don't think we as a country are willing to be taxed 70% of our income to fund healthcare.

First, if Americans actually preferred our current health care system, there wouldnt be all these threads, books, political platforms about changing the system.

Second, where the heck did you come up with a figure of 70%?

 

[group_theory]

Individual mandates for health insurance are suggested in Utah. And meets a lot of resistance because it "infringes on personal freedom."


http://www.healthdecisions.org/News/default.aspx?doc_id=105543

No Insurance a Crime? Pitch Goes Nowhere
Salt Lake City Tribune, Linda Fantin
February 08, 2007


Rep. Brad Daw floated a bill Wednesday that would make it a crime for Utahns to forgo health insurance - a bold proposal that received mostly boos from citizen lobbyists. But the day wasn't a complete disaster. Fellow Republicans praised Daw, R-Ogden, for the "courage" to raise the issue of personal responsibility.

But if there is anything Utah's conservative Legislature loathes more than an entitlement, it's a mandate, and the sponsor acknowledged his bill isn't likely to pass out of committee. The bill would force all Utahns to purchase catastrophic health insurance for themselves and dependents - policies tied to huge deductibles and health savings accounts - or something better.

The minimum policy would have an annual deductible equal to the average salary in Utah (about $34,600), meaning coverage wouldn't kick in until that spending level. Daw pitched the bill as a way to stop the uninsured from freeloading and forcing everyone else to pay their health costs.

Insurance lobbyist Kelly Atkinson said it was the first time in 15 years he had heard a lawmaker talk about personal responsibility. Just as rare: Affordable health care advocate Judi Hilman and conservative activist Gayle Ruzicka lined up against the bill. Hilman said it would invite employers to drop existing coverage. Ruzicka said it infringed on personal freedom.

"This is a mandate on people who can't afford it and we live in a country that doesn't do this to families," she said.

 

[Mephisto]

First, if Americans actually preferred our current health care system, there wouldnt be all these threads, books, political platforms about changing the system.

Second, where the heck did you come up with a figure of 70%?

Yeesh, I should have made it clear that there was a little hyperbole there. But if you want some real figures, check out http://en.wikipedia.org/wiki/Image:Income_Taxes_By_County.svg

To highlight: Belgium is at 55%, Germany is over 50%, and France just about hits 50%. Sweden (one of the best healthcare systems in the world) is at almost 50%. The US? The US is around 27%. You seem to forget that the US public is simply uneducated and stupid. They can scream free healthcare all they want, but then you explain to them that your income taxes will nearly double in order to be like a country that provides it, I'm sure they'll clam up.

 

[OncoCaP]

Yeesh, I should have made it clear that there was a little hyperbole there. But if you want some real figures, check out http://en.wikipedia.org/wiki/Image:Income_Taxes_By_County.svg

To highlight: Belgium is at 55%, Germany is over 50%, and France just about hits 50%. Sweden (one of the best healthcare systems in the world) is at almost 50%. The US? The US is around 27%. You seem to forget that the US public is simply uneducated and stupid. They can scream free healthcare all they want, but then you explain to them that your income taxes will nearly double in order to be like a country that provides it, I'm sure they'll clam up.

Hi Mephisto,

Those income taxes are not going to healthcare exclusively. They are paying for a lot of different budgetary items.

When you look at per capita healthcare spending (there are many sources, here are a couple and you can probably also find them on wiki: http://ucatlas.ucsc.edu/spend.php , http://www.medicalnewstoday.com/medicalnews.php?newsid=27348 ) you find that we spend more than anyone (by far).

In other words, other industrialized countries' citizens spend less on healthcare (taxes + insurance) than we do ... and cover every citizen's healthcare expenditures (while we have millions of uninsured). We are already paying enough for every man woman and child in the U.S. to have 100% health and prescription coverage with no copay if we switched to a single payer system that was as successful as those in other industrialized nations.

http://www.medicalnewstoday.com/medicalnews.php?newsid=27348
"Anderson said, "We pay more for health care for the simple reason that prices for health services are significantly higher in the United States than they are elsewhere." Karen Davis -- president of the Commonwealth Fund, which supported the study -- said that the United States "does not get commensurate value for its health care dollar" (Girion, Los Angeles Times, 7/12).

 

[Mephisto]

Hi Mephisto,

Those income taxes are not going to healthcare exclusively. They are paying for a lot of different budgetary items.

When you look at per capita healthcare spending (there are many sources, here are a couple and you can probably also find them on wiki: http://ucatlas.ucsc.edu/spend.php , http://www.medicalnewstoday.com/medicalnews.php?newsid=27348 ) you find that we spend more than anyone (by far).

In other words, other industrialized countries' citizens spend less on healthcare (taxes + insurance) than we do ... and cover every citizen's healthcare expenditures (while we have millions of uninsured). We are already paying enough for every man woman and child in the U.S. to have 100% health and prescription coverage with no copay if we switched to a single payer system that was as successful as those in other industrialized nations.

http://www.medicalnewstoday.com/medicalnews.php?newsid=27348
"Anderson said, "We pay more for health care for the simple reason that prices for health services are significantly higher in the United States than they are elsewhere." Karen Davis -- president of the Commonwealth Fund, which supported the study -- said that the United States "does not get commensurate value for its health care dollar" (Girion, Los Angeles Times, 7/12).

I understand that. I was saying that the culture of a country with free healthcare is one where there are a lot of other social programs as well and hence the high taxes. And it would definitely be a farce to say that the US can institute a free system without seeing a very significant hike in taxes, at least in the short term.

That said, it's important to mention one thing. Where do a good majority of pharmaceutical and scientific reasearch go on? Where is there more innovation? It's the US. Look at Nature, Science, JBC...nearly every paper every month is from a US university or US biotech firm.

I don't know how it would work, but if you take away pricing freedom from the innovators (i.e. the medical instrument companies, pharma, etc) which is where free healthcare and restriction eventually lead, you take away any motivation to innovate.

The NIH fundds more research (including private pharm research) than the other countries combined. THe other countries like Canada merely buy the drugs that are produced here and sell them cheaply to their citizens. Hence, you have Americans going to Canada to buy drugs and bringing them back over the border. The other countries MOOCH off of US. Our citizens pay out the nose and are essentially subsidizing meds for other countries.

Just another point I thought I'd add.

 

[deleted4401]

It wouldn't be a farce to say that you could pay for the system without a tax hike. It would be a farce to say that it can't be done. There is more than enough money in the system. People keep repeating that - we spend more than anyone to begin with. Much of it goes to CEOs of for-profit health systems, overhead for the 500 different versions of forms that need to filled out for reimbursements, extra costs for emergency care b/c lack of use of PCP, the multiple softwares that people have to use for e-records that ends up defeating the purpose of e-records, the increased cost of pharmaceuticals because we subsidize research for the rest of the world and b/c each individual health system is too small to make a dent in the price, and multiple more cost-ineffective issues. Regardless of your view of whether universal coverage is culturally compatible with the American public and medical professionals, the argument that there isn't enough money in the system is bankrupt.
-S