The Future of Healthcare

[VFrank]

There are lots of threads floating around about opinions on the current state of healthcare in America. However, I did a search and I can't find anything on the future of healthcare. Honestly, what do you guys think will happen in the next ten years? Next 20? What do you think SHOULD happen? I know this sounds like an interview question, but it's something I was talking about with one of my preceptors the other night and I wanted to know what you all thought. I personally like the idea of a single-payer system where the government consolidates Medicare/Medicaid into one lump account and initiates a progressive tax to augment it. From that account, governmental healthcare vouchers are given out to EVERYONE and may be used to purchase a private insurance policy. If the policy costs more than the voucher, citizens must pay the difference.

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[rpkall]

Well, I personally don't want to get too political, but I don't like the concept of government sponsored healthcare in the US. The capabilities of our nation are higher than most other nations as far a pharmaceutical development, research, and implementation of public health directives without financial strain on the individual taxpayer. There's got to be another way to solve this problem. I don't want to pay higher taxes because the guy across the street smokes, drinks, and eats Big Macs all day. Nor do I want him to have to pay for me if I make those health decisions. That just doesn't seem right to me. Individual responsibility and individual accountability.

That's just my personal 2 cents, anyway. I hope to actually do some research on this stuff; I find it fascinating, and it would be nice to be a little more well-read in the field of medical sociololgy. I never had a chance to take a course in undergrad, though I wanted to.

Interesting discussion topic, though. I wonder if anyone else will care to post.

 

[LauraMac]

Well, I personally don't want to get too political, but I don't like the concept of government sponsored healthcare in the US. The capabilities of our nation are higher than most other nations as far a pharmaceutical development, research, and implementation of public health directives without financial strain on the individual taxpayer. There's got to be another way to solve this problem. I don't want to pay higher taxes because the guy across the street smokes, drinks, and eats Big Macs all day. Nor do I want him to have to pay for me if I make those health decisions. That just doesn't seem right to me. Individual responsibility and individual accountability.

That's just my personal 2 cents, anyway. I hope to actually do some research on this stuff; I find it fascinating, and it would be nice to be a little more well-read in the field of medical sociololgy. I never had a chance to take a course in undergrad, though I wanted to.

Interesting discussion topic, though. I wonder if anyone else will care to post.

you make very good points. people should be held accountable for their own actions. just remember to keep in mind the person who can't afford organic vegetables and has to eat big macs cause they're cheap. also remember the people who received terrible educations or for whatever other reason just don't understand just how bad certain foods are. for example, my dad was just put on blood pressure medication, and i mumbled something like, look how much salt is in here, about something he was eating. and then he looked at the nutrition label as if never looking at one before. so, i had to show him what the different numbers meant.

 

[Fermata]

Well....you get screwed either way.....

With socialized healthcare you pay for everyone.

With insurance companies you have to pay for all those who couldn't keep their hands off the pizza and cigarettes so the cost just gets shifted to you.

(Also note how the costs went up because the insurance companies blew a lot of their money in the stockmarket.)

That being said, socializing healthcare is a BAD IDEA.

It makes much more sense to me to extend free healthcare to children and the disabled. If you can work, then you should.

I also think that there should be special plans for those who are self-employed and maybe some plans for part-timers(or those between jobs).

I see no problem with making healthcare available to all as long as they work(exception: if they can't provide for themselves - see disabled and children).

 

[WavesOfPdine]

Healthcare is expensive, and its economic cost will end up hitting the consumer whether its in the form of a tax to fund a single payer system or in the form of an insurance premium to fund a HMO. Of course, in places like Canada they don't spend as much as we do on healthcare, but this is at the expense of quality of care. No one in the United States would accept a six-month wait for heart surgery.

If there was a simple solution, it would simply be to make our quality of care better. Reduce mistakes and eliminate ineffective treatments that result in longer hospital stays and malpractice lawsuits. How? A fair question, and not one that is easily answered. Increasing the use of technology would have great utility in eliminating obvious errors doctors make in ordering prescriptions, for example. Electronic charts reduce paperwork costs and the risk of losing a patients chart, as well as consolidating all patient information from many clinics. We must also refuse to pay for ineffective and / or experimental treatments, why waste money on something that does not work? Research certainly is central to the study of medicine, but a clinic is not the place to do it.

The use of technology in medicine is moving very slowly, it will be up to us as physicians to ensure that we utilize it to make our care as efficient and effective as we can.

 

[pandamonium]

it sounds as though the people that have written come from a relatively well off family that has health insurance. i want to try and write a little bit from the other side. health care is expensive and not everyone can afford it. not everyone works for a company that provides health care. what do you do if you are a small business owner and you have to choose between food/rent or health insurance. what do you do if companies won't hire you full time so you get two part time jobs to pay for all of the necessities? part time job means no benefits. health insurance should not be a commodity that people buy and sell like a car. it should be something that everyone has. by privatizing health care, the objective becomes making the most profit, not helping the most people. after all, this is still a company with shareholders. Come on people. you're trying to be doctors. have some compassion.

on the argument of not wanting to pay for other people's mistakes. i understand. if someone chooses a stupid habit or eats mcdonalds three times a day, i certainly don't want to pay for their health care but if you look at the big picture, i think in the end you may pay more for our current system. think about it. if you have no health insurance, you have no primary physician. if you are sick, the first place you go will be the ER. do you think this is really a good allocation of resources when poor people with just a cold or any non-life threatening illness comes into an ER and doctors are forced to run thousands of dollars of tests to rule out everything? what about the people who don't come into the hospital until their illness has gone way too far because they have no health insurance? i personally know of someone who didn't go to the hospital for his stomache ache and didn't go in until his appendix burst. i imagine a lot of people would do this. so now, instead of a simple surgery and a one day stay, he's staying for over a week (still counting) so that the doctors can make sure that there is no infection. what happens if these people are poor and can't afford to pay for their stay? they just won't pay and the cost will come in the form of higher premiums and more expensive policies and in the end, you will still pay for their health care. since you're going to pay for it anyways, wouldn't it be better to help people when curing them would be cheap? in order to do this, you probably need some sort of health care system that includes everyone.

damn.. really long... just some of my thoughts..

 

[Fermata]

it sounds as though the people that have written come from a relatively well off family that has health insurance. i want to try and write a little bit from the other side. health care is expensive and not everyone can afford it. not everyone works for a company that provides health care. what do you do if you are a small business owner and you have to choose between food/rent or health insurance. what do you do if companies won't hire you full time so you get two part time jobs to pay for all of the necessities? part time job means no benefits. health insurance should not be a commodity that people buy and sell like a car. it should be something that everyone has. by privatizing health care, the objective becomes making the most profit, not helping the most people. after all, this is still a company with shareholders. Come on people. you're trying to be doctors. have some compassion.

on the argument of not wanting to pay for other people's mistakes. i understand. if someone chooses a stupid habit or eats mcdonalds three times a day, i certainly don't want to pay for their health care but if you look at the big picture, i think in the end you may pay more for our current system. think about it. if you have no health insurance, you have no primary physician. if you are sick, the first place you go will be the ER. do you think this is really a good allocation of resources when poor people with just a cold or any non-life threatening illness comes into an ER and doctors are forced to run thousands of dollars of tests to rule out everything? what about the people who don't come into the hospital until their illness has gone way too far because they have no health insurance? i personally know of someone who didn't go to the hospital for his stomache ache and didn't go in until his appendix burst. i imagine a lot of people would do this. so now, instead of a simple surgery and a one day stay, he's staying for over a week (still counting) so that the doctors can make sure that there is no infection. what happens if these people are poor and can't afford to pay for their stay? they just won't pay and the cost will come in the form of higher premiums and more expensive policies and in the end, you will still pay for their health care. since you're going to pay for it anyways, wouldn't it be better to help people when curing them would be cheap? in order to do this, you probably need some sort of health care system that includes everyone.

damn.. really long... just some of my thoughts..

I respect your opinion but will have to disagree.

 

[WavesOfPdine]

Out of curiosity, Pandamonium, are you advocating for a single payer system or another arrangement? I agree that there are problems with the status quo, but solutions can be elsuive. Medicaid and Medicare currently provide health care for many Americans who are unable to work. The Americans who dont have healthcare coverage are those who are not elgible for etiher of these programs. For them, health care must be purchased and it must be affordable. There is certainly room for innovation on behalf of our government or private industry in order to find a solution for the midnight emergency room visits for pneumonia that developed from something minor which could have been prevented. Eliminating situations like these is in the best interest of anyone. I wish I had more answers.

PS. I must admit I resent the judgement at the beginning of your post, for the record I have been purchasing health insurance the last three years. Lets keep this a clean discussion on the issues, and especially on solutions. Thanks.

 

[cluelesspremed]

ok, so I really have no idea what you guys are talking about (i really wish i did)

do you all know of any good places where i could read up on health care today and possible ways of improving it?

could someone PM me if they have any help for me

i really appreciate it!

 

[Attentive]

ok, so I really have no idea what you guys are talking about (i really wish i did)

do you all know of any good places where i could read up on health care today and possible ways of improving it?

could someone PM me if they have any help for me

i really appreciate it!

Hey there. I got my start off this site, thought it might be helpful for others as well. It's pretty much a lecture with rotating subjects each week.

http://www.healthpolitics.com/program_info.asp?p=prog_28

Hope this helps and Good Luck!

 

[MadameLULU]

I respect your opinion but will have to disagree.

Just curious-- Besides Pandamonium's judgment calls, what do you disagree with? Do you not think that healthcare is expensive and even those who do work may not be able to afford it. I read your "argument" above and you claim that if people can work, then they should. However, people can work but may not be able to afford healthcare. Besides coverage, COST is a key issue.

Or do you not agree with the point someone made about not wanting to pay for other' ppls mistakes (eating Big Macs all day and so forth). Someone in an earlier post mentioned we need individual responsibility and accountability. While I can understand this point of view, I don't think it's quite fair to lay the blame soley on the individual. Why are there 50 million McDonald's/Burger King/Wendy's/(INSERT NASTY FOOD CHAIN HERE) on every corner? Why do these unhealthy places market this crap to kids? Why do schools serve crappy and unhealthy food to children? My point is: THIS IS NOT JUST AN INDIVIDUAL problem. The environment/society is also at work. You aren't just paying for an individual's mistakes, but society's as well.

 

[Fermata]

Just curious-- Besides Pandamonium's judgment calls, what do you disagree with? Do you not think that healthcare is expensive and even those who do work may not be able to afford it. I read your "argument" above and you claim that if people can work, then they should. However, people can work but may not be able to afford healthcare. Besides coverage, COST is a key issue.

Or do you not agree with the point someone made about not wanting to pay for other' ppls mistakes (eating Big Macs all day and so forth). Someone in an earlier post mentioned we need individual responsibility and accountability. While I can understand this point of view, I don't think it's quite fair to lay the blame soley on the individual. Why are there 50 million McDonald's/Burger King/Wendy's/(INSERT NASTY FOOD CHAIN HERE) on every corner? Why do these unhealthy places market this crap to kids? Why do schools serve crappy and unhealthy food to children? My point is: THIS IS NOT JUST AN INDIVIDUAL problem. The environment/society is also at work. You aren't just paying for an individual's mistakes, but society's as well.

I think that you have reasoned your position well.

There are some people who do work but cannot afford coverage - I blame this on corporations. It used to be where if one person worked at a company for a set amount of years they could look forward to retirement with pension. Those days are gone. However, in recent years there has also been a lot less company loyalty with people jumping jobs all the time. This encourages employers cut benefits. I personally don't agree with this, but this is a root cause.

Healthcare is very expensive. People always complain about copays on medications until they actually realize what they'd have to pay out of pocket if the insurance company wasn't helping out.

To this end, I think there should be more encouragement for people to buy self-employed type insurance since they won't have to worry about staying in some dead-end job because they wouldn't have healthcare coverage without it. The main problem here is making it affordable.....this is where some strong support for new legislature should come in.

As time changes it seems like people take less and less responsibility for themselves. I think if people had to keep track of their own insurance then this would encourage being more responsible. Who knows.....owning one's own insurance might always encourage people to live healthier lives....and thus avoid the Big Mac's?

Yea....perhaps too idealistic.


I think the main problem is insurance companies and corporation tie-ins...but that's a rant for another day.

However, I am VERY adamant that universal healthcare is not the answer.

 

[rpkall]

Part of the big problem is that healthy choices are less available to people in lower socioeconomic situations. i.e., there ARE fewer supermarkets per capita in the inner city as opposed to the suburbs. So this does translate into fewer choices and poorer eating habits, etc.

But.

We can't go around blaming companies for marketing and capitalizing on the commercial climate of the times. That's the whole point of capitalism, isn't it? Now, McDs and Burger King are coming out with healthy choices that are just as cheap as the crappy food they sell. These salads are just as accessible to low SES families in the inner cities as big macs. Yet these healthy items don't sell as well as the crappy foods. Obviously. No one can "miss" the fact that a salad is healthier than a cheeseburger. That's a choice. And that's not Burger King's fault, is it? They're marketing and selling products; they're in the business of making crappy food for people, just like Welch Allyn is in the business of making crappy stethescopes. Or Pfizer. Or GE. Or Siemens. Or Marlboro. It's all money, isn't it? Business.

I do think a society has a basic responsibility to protect its citizens from harm, foreign or domestic. But where do we draw the line? Do we have the government regulate McDonalds, tobacco--do we mandate that more supermarket companies move new branches into bad neighborhoods? Do we make Burger King KEEP salads on the menu even if they lose profits stocking the lettuce every day and no one buys it?

If peoples freedoms to MAKE these bad choices are going to be preserved, then the free market must be preserved. Isn't that freedom? It goes both ways, I think.

So then you have to talk about educating the public. Food pyramid posters. Committees to research how to best reach people about these issues. I agree that money is much better spent on preventive medicine. If we can get people to stop smoking, we save money on bronchodilators and chemotherapy in the long run. The problem is when there are 100 dollars in the budget, and killing islamic fundamentalists costs $80, are the 20 bucks leftover better spent on food pyramid charts or buying a medicare patient's monthly prescription?

Politics sucks. There's no solution to anything. hehe

 

[delchrys]

my vision of the future (including one major element no one has mentioned yet):

1. single-payer system (big brother), with option to buy premium services (pay cash and dictate your service, e.g., 'i want a CT scan to detect pancreatic cancer early so it's not a freakin death sentence')

2. individuals who engage in behaviors that increase their chance of getting negative conditions as a result fo those behaviors get reduced coverage for those conditions (liver treatment for alcoholic, HIV meds for someone who engages in sex without condom, lung issues for smokers, heart problems for cholesterol eaters and sedentary bastiges, etc.). pretty much everyone would have several areas of coverage where they'd get less coverage than the more 'voluntarily low risk' people. that way, i'm not paying for your optional bad habits, and vice-versa.

3. PREVENTION. genetic screening followed by individualized preventative care regimen/lifestyle suggestions, etc. opting out of recommended regimen is automatically considered "optional bad habit" territory and you get reduced coverage. serious incentive to be healthy. they are already starting the screening/lifestyle change suggestions at duke with their employee health insurance. privacy laws will change in scope as the years roll on if health care comes under the single-payer regime.

4. some form of cutoff relating to age or total monthly cost of drugs--if you need 8k worth of pills every month, should you just be dead? what about 80k? what about 800k? at what point does my "should you just be dead" question shift from cruel and heartless to practicle and common sense? i don't know, but i do know that the government agency put in charge of health care would figure out a limit.

those who argue that the single-payer system doesn't work only say this because the examples that we have (canada being the first one most think of) involve less money spent than the united states can afford to spend. we can afford to spend LOTS and not hurt ourselves in other aspects of society (take a few hundred billion out of the military budget...). also, studies show that leaving a person uninsured costs twice as much as insuring them. (See this past Sunday's Detroit Free Press for a recent example.) but what i honestly believe is that the folks who argue against a single-payer system simply don't think that health care is an inherent right of the individual. those who do want a single-payer system tend ot think that it IS the right of every person to have adequate health care. i honestly don't see how anyone can claim to want to be a physician while simultaneously not wanting medical coverage for everyone. hmm...patient to come in for early diabetes treatment for cost over 40 years at a couple grand, or patient to come in with advanced renal failure at the one-time special cost of 200,000.00, just to put them back out on the street so they can come back later for a second round, if not just die and have their next of kin sue the crap out of the hospital (by the way, with a single-payer, government health care structure, it would be a lot harder to sue docs and hospitals).

i'm not saying single-payer system is the holy grail. if, however, you start with the premise that "health coverage for each person is a basic right," then universal health care is the most realistic way to get there.

here's a question to the crowd: how many of you who oppose your tax money being spent on someone's health care also oppose your tax dollars funding the war in iraq? that one REALLY blows my mind..."i want to be a doctor and heal heal heal, but i oppose my tax money being used to heal others, while i simultaneously support my tax dollars being used to bomb iraqis"

 

[Fermata]

my vision of the future (including one major element no one has mentioned yet):

1. single-payer system (big brother), with option to buy premium services (pay cash and dictate your service, e.g., 'i want a CT scan to detect pancreatic cancer early so it's not a freakin death sentence')

2. individuals who engage in behaviors that increase their chance of getting negative conditions as a result fo those behaviors get reduced coverage for those conditions (liver treatment for alcoholic, HIV meds for someone who engages in sex without condom, lung issues for smokers, heart problems for cholesterol eaters and sedentary bastiges, etc.). pretty much everyone would have several areas of coverage where they'd get less coverage than the more 'voluntarily low risk' people. that way, i'm not paying for your optional bad habits, and vice-versa.

3. PREVENTION. genetic screening followed by individualized preventative care regimen/lifestyle suggestions, etc. opting out of recommended regimen is automatically considered "optional bad habit" territory and you get reduced coverage. serious incentive to be healthy. they are already starting the screening/lifestyle change suggestions at duke with their employee health insurance. privacy laws will change in scope as the years roll on if health care comes under the single-payer regime.

4. some form of cutoff relating to age or total monthly cost of drugs--if you need 8k worth of pills every month, should you just be dead? what about 80k? what about 800k? at what point does my "should you just be dead" question shift from cruel and heartless to practicle and common sense? i don't know, but i do know that the government agency put in charge of health care would figure out a limit.

those who argue that the single-payer system doesn't work only say this because the examples that we have (canada being the first one most think of) involve less money spent than the united states can afford to spend. we can afford to spend LOTS and not hurt ourselves in other aspects of society (take a few hundred billion out of the military budget...). also, studies show that leaving a person uninsured costs twice as much as insuring them. (See this past Sunday's Detroit Free Press for a recent example.) but what i honestly believe is that the folks who argue against a single-payer system simply don't think that health care is an inherent right of the individual. those who do want a single-payer system tend ot think that it IS the right of every person to have adequate health care. i honestly don't see how anyone can claim to want to be a physician while simultaneously not wanting medical coverage for everyone. hmm...patient to come in for early diabetes treatment for cost over 40 years at a couple grand, or patient to come in with advanced renal failure at the one-time special cost of 200,000.00, just to put them back out on the street so they can come back later for a second round, if not just die and have their next of kin sue the crap out of the hospital (by the way, with a single-payer, government health care structure, it would be a lot harder to sue docs and hospitals).

i'm not saying single-payer system is the holy grail. if, however, you start with the premise that "health coverage for each person is a basic right," then universal health care is the most realistic way to get there.

here's a question to the crowd: how many of you who oppose your tax money being spent on someone's health care also oppose your tax dollars funding the war in iraq? that one REALLY blows my mind..."i want to be a doctor and heal heal heal, but i oppose my tax money being used to heal others, while i simultaneously support my tax dollars being used to bomb iraqis"

Let me ask you this question: What percentage of practicing doctors do you think would be interested in a unversal healthcare system?

I think that somewhere during the medical school years the average "altruistic" student suddenly comes to terms with the nature of the healthcare beast.

Once again, though, this is a well-argued position.

You are definately right about the "healthcare as a right" philosophy.

Then again, you are not guaranteed food in this country....let alone healthcare.

 

[delchrys]

and just a point of fact that seems to have been somehow disregarded throughout this thread: fast food is not cheaper than groceries bought intelligently. "the poor" as they are referred to in this thread and elsewhere, are not only not forced to buy BK or taco bell by those same companies, but they are presented with options regardless of the reduced availability of grocery stores. they choose to not shop there. it is a socioeconomic thing, but at some point responsibility for one's choices needs to kick in. i could give a rat's ass about the poor fat noncompliant diabetic waste of human flesh who continually stuffs high-sugar, high-fat, high-cholesterol food into his mouth despite repeated explanations from medical professionals and the state of common knowledge (yes, even in "poorpersonland" it is common knowledge that foods high in fat, cholesterol, and sugar are bad for you and that the doctor's job is to make you live longer and better). the guy just chooses to do it, and i don't care if it's because he is depressed or because his kids are mean to him or because his wife is ugly or because he has less money than so-and-so. it is an unacceptable crutch to say that, because someone is poor, they are excused from being responsible for their actions. everyone gets a hardon to see martha stewart or enron execs get burned in court, but then we all shed a sympathetic tear for the economically disadvantaged who are unfairly prosecuted even though they had such a harsh, tough childhood, and going on about the hard environment poor folks have when it comes to being healthy is an extension of that. yes, it is a statistical fact that poor people are less healthy. part of that reason is that good doctors often don't want to work in poor areas for less money and with less safety in their environment. there are a myriad other factors as well. but none of them involve actively forcing a person to choose an unhealthy option.

all i'm saying is that it's irrelevant whether someone is poor or not when it comes to their unhealthy choices--free will and choice are the hallmark of human beings, and no "being poor made me do it" excuse will ever fly with me. when it comes to health care, income should be irrelevant there, too--everyone should be entitled to health coverage, minus the more expensive treatments that the individual's optional bad habits make necessary.

 

[Fermata]

Can we atleast agree that all these issues have many facets and that no simple solution will fix any of them?

 

[delchrys]

i have zero clue how many doctors think universal healthcare is a right. i do know that my friends who rotate in downtown (inner city) detroit hospitals would much rather see the homeless and other poor who come in there come MUCH earlier and get treated for the little crap than to see them come in when the shizzle has hit the fan so hard that they need 200k+ to keep them alive.

i guess my point is that if you don't want your money wasted on health care for the people who otherwise wouldn't have health care, then you should, ironically enough, WANT TO GIVE THEM GOOD HEALTH CARE OUT OF THE GOV'T COFFERS, because it's a LOT more expensive for the system to care for the uninsured who walk in with really bad situations than it is to care for the poor long before crap gets ugly.

unless, of course, you would go so far as to advocate changing the laws such that hospitals could turn away patients who could not show that they can pay prior to treatment. but if that's the case, i hope you never get in a car wreck and lose your ID.

 

[delchrys]

there is definitely no simple solution. it is going to take the following:

things must get a LOT worse for the government to be forced into effective action.

the government must exhaust the other politically popular alternatives.

things must then get even WORSE than before.

then...maybe the government will take a serious, rather than rhetoric-filled, political-campaign-motivated look at this mess.

i doubt it, though.

 

[Fermata]

the government must exhaust the other politically popular alternatives.

things must then get even WORSE than before.

then...maybe the government will take a serious, rather than rhetoric-filled, political-campaign-motivated look at this mess.

i doubt it, though.

I can assure you that no change is really going to happen in the next 4 years, regardless of who gets elected.

 

[Code Brown]

I can assure you that no change is really going to happen in the next 4 years, regardless of who gets elected.

Hey, if Kerry wins, maybe they'll have a big push to promote ketchup over mayo and then cholesterol levels will go down

 

[freaker]

I can't believe I'm saying this, but I'm slowly becoming a proponent of a single-payer system. Overhead costs in HMOs are WAY higher than they are for Medicare, Medicaid, or other state-run programs. On top of this, you have former non-profit HMOs becoming for-profit institutions, saving up and investing cash so they can invest and buy out or merge with other HMOs, effectively eliminating competition within the market and jacking up premiums, witholding service, and diverting money from patients.

I still hate the idea of hitching our economy to what will be a permanent beaurocracy and giving people the expectation that they are entitled to healthcare provided by the government. I expect major social upheavals in Europe and Japan when their low birthrates and less-than-successful familes finally catch up with them. They're going to have no tax base, huge medical bills, an aging population, and no way to pay for any of it. I think people need to pay for their healthcare in one way or the other. Just the act of paying relieves a sense of entitlement. Maybe something comparable to the German or Japanese plan would be best, perhaps a water-down version of both.

I do not see healthcare as a right. Rights are God-granted liberties of life, liberty, and the pursuit of happiness--intangibles. Attending to the sick is a noble aim of a society, but it is not an obligation.

Several things are going to have to happen if we go down the single-payer route:

1) pharmaceutical advertising needs to be banned. Only 11% of pharma companies' budgets go to R&D. The soaring prices of pharmaceuticals is ridiculous and needs to be capped. Advertising is a good start. More will have to be done, as price controls have been least effective in pharmaceuticals over the decades.

2) illegal immigration needs to be clamped down on and stamped out.

3) Tax the hell out of cigarettes and go after alcohol some more, too. There is every reason to discourage their use.

4) MOST IMPORTANTLY: We're going to HAVE to focus on public health. It may mean having a personal trainer in a school (maybe contracting them out) (not some dumb coach who doesn't know anything, anyway) helping kids set up physical goals, helping them understand how to reach them, and grading them on how they progress. It means shaping up school lunches. I'm all for taxing people who have too high a percentage of bodyfat or cholesterol.

Other things on the list: privatize Social Security. This is something that can work best removed from government. I'm becoming less convinced corporate entities can reasonably cap prices.

It's going to be tough, as you get a lot of useless drivel about expenses.

(e.g. US spends 13% of GDP on healthcare and Canada 8-9%; nevermind that the US GDP per capita is ~45% higher)l

 

[freaker]

Hey, if Kerry wins, maybe they'll have a big push to promote ketchup over mayo and then cholesterol levels will go down

Unfortunately, the high sodium content of ketchup is going to send blood pressures soaring. Not to mention the high GI carbs are going to get stored on as pork.

Don't look for Kerry to turn on Mayo, though; it's highly favored by the French.

 

[MadameLULU]

We can't go around blaming companies for marketing and capitalizing on the commercial climate of the times

I disagree, if we can blame the individual then we also need to blame the companies and the environment. Am I saying that these companies are solely responsible? NO, but they are PART of the problem.

These salads are just as accessible to low SES families in the inner cities as big macs

Do you really think this? Next time you go to McD's look at the price of the alads compared to the price of a cheesburger/Big Mac. Give me a break. These healthier items are more expensive than the other items. Even though they are on the menu, it doesn't mean they are accessible to poor SES if they can't afford them.

So then you have to talk about educating the public. Food pyramid posters. Committees to research how to best reach people about these issues. I agree that money is much better spent on preventive medicine. If we can get people to stop smoking, we save money on bronchodilators and chemotherapy in the long run. The problem is when there are 100 dollars in the budget, and killing islamic fundamentalists costs $80, are the 20 bucks leftover better spent on food pyramid charts or buying a medicare patient's monthly prescription?

Education isn't the only tool-- It doesnt ALWAYS equal BEHAVIOR change! Changes also need to be made in the environment! If you look at any successful intervention where the health problem is a factor of the individual and environment, the intervention ALWAYS focused on the ENVIRONMENT. These interventions work better than those that only focus on the individual.

 

[GATORade]

The first changes should be implemented to increase community health centers for primary and preventative care in underrepresented and lower income areas. I don?t think US taxpayers would mind funding this as it will likely lead to lower premiums for all in the future. Furthermore, the majority of the unemployed are employees and owners of small businesses. The government should offer the small business owners the same discount given the large businesses that group together to spread out the liability to lower premiums when purchasing healthcare. Individuals that can afford to do so should begin to fund health savings accounts (HSA). HSA are saving accounts used to fund individual and family healthcare costs. HSAs are coupled with low premium, high deductible insurance that kicks in after the high deductible is met. HSAs are tax-sheltered investments that if invested properly can gain significant interest, tax-free. If individuals are given the opportunity to fund their own healthcare they will likely take better care of themselves and shop around for care thus lowering costs through market competition. Those who are financially unable to fund HSAs should be given greater tax breaks from the government in order to fund the accounts. These changes in theory will cover a large amount of the unemployed without significantly increasing the tax burden on US citizens. Capping rewards on frivolous lawsuits wouldn?t hurt either.

 

[delchrys]

(1) i submit that you are wrong when you say people will take better care of themselves if they are given the opportunity to fund their own healthcare. people smoke cigarettes knowing full well what they do, and people who have NO insurance, and thus the highest medical bill potential, don't take any better care of themselves than the next guy. if there is data that shows otherwise, i'll be glad to look at it, but i think you're making an assumption that is way off.

(2) U.S. taxpayers pretty much DO mind funding health care for the poor. why? because the average middle class american has coverage that takes care of less and less of their costs each year and gets more expensive each year, and no matter what you tell them (e.g., 'lowering theirs will lower your health care, mr. anderson') they will see it as their taxes giving someone else a free lunch while they try to figure out how to make a 50% copayment on a 300 bottle of pills.

 

[rpkall]

I don't think the notion of personally devoting your life to healing others and the concepts of leftist politics go hand in hand. In fact, that's the whole point of moderate or conservative thinking: it's focused on the basic concept of the american dream. That each person can make a personal decision for themselves and pursue whatever it is they want to do; AND they can have certain opinions of what a government's responsibilities are. Just because I don't like spending more of my tax dollars on Medicare or medicaid doesn't mean I'm opposed to volunteering in a free non-profit clinic for the underserved as a physician. In fact, I would rather love to do that on certain days of the month, over the long term. BUT--my point is in the policial principles of helping others. This, like smoking, drinking, becoming a physician, architect, welder, real estate agent, should be a personal decision--not something mandated by a big and left-wing government that shows itself in the form of stealing MORE of my money every day.

People who are politically conservative are not less personally compassionate. They believe it is the responsibility of the individual to make things better in a way that doesn't put undue pressure on a government system or the other taxpayers.

We're all going to disagree--and that's cool. I just hate to see people thinking that the only way to be a really compassionate person is to go around believing that tax money should only be spent on domestic issues. Compassion is a personal thing, and doesn't necessarily reflect itself in your vision of the ideal political process.

 

[delchrys]

while much of your reply makes solid sense, you are missing one key thing. when you talk about the validity of socially conservative politics, and how you don't want the government to steal your money, you need to realize that what you are saying at the same time (since we're in the specific context of health care for poor americans) is that you do not want the poor of america to have health care if they can't afford it. you cannot claim on the one hand to want to keep the tax dollars that would otherwise be spent on health care and then claim on the other hand that you want the poor to receive adequate health care, because unless you propose a different system that works, when you talk about keeping your money you're also talking about keeping the poor from receiving adequate healthcare.

that IS less compassionate. and note: i'm not saying you need to BE more compassionate. i just find it interesting the hoops conservatives will go through to justify what essentially boils down to pure selfishness--"i want my money, so even if it only marginally benefits me, that marginal benefit outweighs the potential good it could otherwise bring strangers. therefore, i will justify my want of my money by claiming that the government spends it badly, even though i support a war in a foreign country that was no threat to my country and has already cost 200 billion dollars and 1,000 american lives plus untold iraqis." dress it up how you like, that's the way it is. the only time that becomes a problem is when a conservative is in denial about that because they don't want to see themself as selfish, so when someone calls them out on it they get defensive.

i mean, either you want resources to go to providing health care to all, or you don't. if you don't, then you are saying, by necessity, that you do not want poor people to have health care (a). if you do want resources to go to providing health care to all, either you want to do it through a single-payer system (b) or you want to do it some other way (c). if it's (a), then yes, you are not compassionate. if it's (b), then we wouldn't be having this conversation. if it's (c), please explain.

 

[bostonabe]

I don't think the notion of personally devoting your life to healing others and the concepts of leftist politics go hand in hand. In fact, that's the whole point of moderate or conservative thinking: it's focused on the basic concept of the american dream. That each person can make a personal decision for themselves and pursue whatever it is they want to do; AND they can have certain opinions of what a government's responsibilities are. Just because I don't like spending more of my tax dollars on Medicare or medicaid doesn't mean I'm opposed to volunteering in a free non-profit clinic for the underserved as a physician. In fact, I would rather love to do that on certain days of the month, over the long term. BUT--my point is in the policial principles of helping others. This, like smoking, drinking, becoming a physician, architect, welder, real estate agent, should be a personal decision--not something mandated by a big and left-wing government that shows itself in the form of stealing MORE of my money every day.

People who are politically conservative are not less personally compassionate. They believe it is the responsibility of the individual to make things better in a way that doesn't put undue pressure on a government system or the other taxpayers.

We're all going to disagree--and that's cool. I just hate to see people thinking that the only way to be a really compassionate person is to go around believing that tax money should only be spent on domestic issues. Compassion is a personal thing, and doesn't necessarily reflect itself in your vision of the ideal political process.

So basically you're saying that if the government leaves everything to the choice of the individual then magically poor people will somehow start receiving adequate healthcare.

 

[BeatArmy]

i just find it interesting the hoops conservatives will go through to justify what essentially boils down to pure selfishness--"i want my money, so even if it only marginally benefits me, that marginal benefit outweighs the potential good it could otherwise bring strangers. therefore, i will justify my want of my money by claiming that the government spends it badly, even though i support a war in a foreign country that was no threat to my country and has already cost 200 billion dollars and 1,000 american lives plus untold iraqis." dress it up how you like, that's the way it is

Your thoughts and arguments about health care reform are well articulated and a welcome addition to this thread.
Your repeated attempts to work defense spending issues into the conversation only detract from your valid, on-topic, points.

 

[the other Dr.]

i could give a rat's ass about the poor fat noncompliant diabetic waste of human flesh who continually stuffs high-sugar, high-fat, high-cholesterol food into his mouth despite repeated explanations from medical professionals and the state of common knowledge (yes, even in "poorpersonland" it is common knowledge that foods high in fat, cholesterol, and sugar are bad for you and that the doctor's job is to make you live longer and better). the guy just chooses to do it, and i don't care if it's because he is depressed or because his kids are mean to him or because his wife is ugly or because he has less money than so-and-so.

Wow, that is some diatribe from someone who obviously has little to no clue about "poorpersonland". Even if physicians did constantly dispense "common knowledge" about diet and health, the typical poor person doesn't see a physician often enough to benefit from this advice. Public schools no longer consistently teach about nutrition, and funding from big soda and big candy mean that these foods are always sitting on the shelves in the cafeteria. What an asinine assumption, too, that poor people just choose to eat unhealthy food. Sometimes one's budget allows no other options (speaking from experience) than the crap food your mom buys or no food at all. It's like saying an anorexic person (anorexia, btw, having the highest mortality rate of any mental disorder at ~20%) chooses not to eat. And as for people whose eating is related to a medical condition like depression or anxiety, as it is for the MILLIONS of Americans of ALL socioeconomic groups (including at least 30% of obese people according to the DSM IV), you had better do a little research to discover for yourself the medical validity of these eating disorders. Some people are depressed and hide in food... wow, they feel like crap about their lives, and food stimulates pleasure receptors, so what would you expect? Or people feel fat or ugly, so they starve themselves. Either way, these psychological disorders will manifest themselves in physical maladies that YOU will have to treat, which means recognizing why a middle age man is morbidly obese or a skinny teenager hasn't started her period yet. Experts estimate that 1 in 3 children born in 2000 will be diabetic by their teens! Eating disorders, nutrition, diet, etc are obviously unaddressed issues in the general public, whether the person is poor or rich or a minority or a suburbanite. Find a little compassion before you enter the medical field, please.

 

[Nuel]

Of course, in places like Canada they don't spend as much as we do on healthcare, but this is at the expense of quality of care. No one in the United States would accept a six-month wait for heart surgery.

The part in bold is a flagrant lie. Canada has a remarkably healthier population that the US. This has been factually documented by the World Health Organization and independent groups of researchers. With this, one can justifiably infer that the general quality of healthcare for the average person is better in Canada than in the US, given the monies spent by both countries on health. And contending that the waiting times for specialized procedures affects healthcare quality is failure to acknowledge the effect social /financial status has on medicine in a class/capitalist society. In Canada, it is unlikely that a person of high social and financial standing would wait for 6 months before getting specialized attention. And in the US, a financially destitute individual may never get a heart-surgery, let alone wait for 6 months. The healthcare issue is more complex than you make it.

This topic has been discussed in the everyone Forum. You may want to check it out.

 

[benbk]

Can we atleast agree that all these issues have many facets and that no simple solution will fix any of them?

at least
definitely

Ooh, I can't wait for the debates tomorrow night!

Ben

 

[Fed Meat]

The part in bold is a flagrant lie. .

It really isn't. Cancer survival rates, for instance, are far and beyond higher in the United States than they are anywhere else in the industrialized world.

 

[gobblety_gook]

Everyone keeps bringing up fast food as an example of why some sort of single-payer/universal health care system is not such a great idea...I'm curious as to how much is actually spent on treating the fat middle-aged individual who binge eats BigMacs and fries all day. I would argue that the majority of the people who will benefit from such a system will be the homeless, underprivaledged children, and the elderly, and that any health care tax that the public pays, most of that money will go to helping an underprivaledged child MUCH MORE SO than the middle aged fat guy who eats too many BigMacs.

I personally believe that everyone in this country is entitled to some access of health care...and the argument I will use is that people should NOT be hindered by inaccessible health care for an oppurtunity to succeed in society. To excel in a career, maintain a job, or even to pursue an education, having good health is a necessity that should be granted as part of the equal freedom everyone has to pursue happiness.

Also, what about the abnormal costs people without health insurance pay for a visit to the emergency room or an emergency procedure? Depending on the nature of the emergency, I don't think its fair for these people to have to pay exorbitant amounts for emergency care.

The major issue (in my mind) is where do you draw the line between gratuitious health care coverage and legitimate health care coverage in the context of publicly funded health care. Everyone should, at least, have some degree of emergency care and some degree of general health care coverage that should be driven by a non-profit agency...the real debate is where you draw that line.

 

[WavesOfPdine]

Nuel, please read what I said critically before you leap to the conclusion that something is a inaccurate, or in your words, a "flagrant lie." What I said is that in the United States, quality of care is better. Maybe you disagree with that, but your rationale did not support your conclusion. I believe that the United States has the best healthcare quality in the world. What you are speaking of is the actual health of the citizens. Even if you have the greatest quality of care in the world, unfortunately this does not mean that the people will be the healthiest. All it means is that those who are sick who seek care will receive the highest quality care. Unfortunately, the American lifestyle is not healthy. We work too hard and eat too much. Obesity causes a host of health problems, and we are right now hitting record levels.

If we want to talk about fixing the healthcare problem, it must involve improving the health of our citizens. This is done through prevention of conditions like obesity and, again, high quality of care to ensure that those who are sick are not so for long. We cannot afford to support our aging population if they do not take care of themselves, whether the funding comes publicly or privately. Instituting a single-payer system will create equality in the search for healthcare. This is good. It will also place big government in control of our healthcare. This has not been good for Canada.

In Canada, people are indeed healthier. The average life expectancy is 2 or 3 years longer than ours. There are probably many reasons relating to their lifestyle why this is so. But it has nothing to do with the quality of care provided by their healthcare system.

http://seattletimes.nwsource.com/html/opinion/2001977834_cihak13.html

 

[beep]

The proposal that people who have "caused" their illnesses receive less coverage seems very complicated to implement. I can think of very few diseases that aren't multifactorially determined, which makes establishing causality complicated in many cases. Also, unhealthy behaviors exist on a continuum. How much McDonald's is enough to signify irresponsible eating? How much stress is too muh? And... how do we monitor this stuff? How do we know that the lung cancer patient who says he never smoked (they do exist...) is telling the truth? And is it fair that the smoker with cancer has to pay, but the smoker who never develops cancer doesn't? They made the same choices, after all.

I think maybe focusing on public health measures and getting serious about preventative medicine instead makes the best sense.

 

[Nuel]

It really isn't. Cancer survival rates, for instance, are far and beyond higher in the United States than they are anywhere else in the industrialized world.

IT IS. Let's make an analogy. All other things being equal, suppose there 6 elements in set A such that only 2 of those elements are not as good as 2 corresponding elements in set B, does that make set B GENERALLY better? No, this is because set A has 4 elements that supercede corresponding elements in set B. For instance, Canada has a lower mortality rate compared to the US. You are acting as if what researchers are saying is that Canada is better than America in EACH AND EVERY aspect of healthcare--this is not the contention. However, this exemplifies the mistake in your logic. I am not the one saying that the Canadian population is generally healthier than that of the US despite the dollars thrown by the former into healthcare, it is the World Health Organization and independent researchers that say it. It's up to you to prove them wrong.

 

[WavesOfPdine]

But the problem Nuel with your logic is that you are relying on a nations health to asses the quality of its healthcare system. Correlation is not causation. Cultural differences, as I mentioned earlier, have an impact on a nation's health. Just because Canada is healthier than US doesn't mean its healthcare system is doing fine.

 

[Nuel]

Nuel, please read what I said critically before you leap to the conclusion that something is a inaccurate, or in your words, a "flagrant lie." What I said is that in the United States, quality of care is better. Maybe you disagree with that, but your rationale did not support your conclusion. I believe that the United States has the best healthcare quality in the world. What you are speaking of is the actual health of the citizens. Even if you have the greatest quality of care in the world, unfortunately this does not mean that the people will be the healthiest. All it means is that those who are sick who seek care will receive the highest quality care. Unfortunately, the American lifestyle is not healthy. We work too hard and eat too much. Obesity causes a host of health problems, and we are right now hitting record levels.

If we want to talk about fixing the healthcare problem, it must involve improving the health of our citizens. This is done through prevention of conditions like obesity and, again, high quality of care to ensure that those who are sick are not so for long. We cannot afford to support our aging population if they do not take care of themselves, whether the funding comes publicly or privately. Instituting a single-payer system will create equality in the search for healthcare. This is good. It will also place big government in control of our healthcare. This has not been good for Canada.

In Canada, people are indeed healthier. The average life expectancy is 2 or 3 years longer than ours. There are probably many reasons relating to their lifestyle why this is so. But it has nothing to do with the quality of care provided by their healthcare system.

http://seattletimes.nwsource.com/html/opinion/2001977834_cihak13.html

I don't want to waste time rehashing ideas members of this board have articulately adressed. Here is a abridged copy of Nora's post (SDN User ID) on the everyone forum:


If the issue of health care expenditure is not about how much you spend, then what is it? Canadians complain about their healthcare but wouldn't even consider the one present in the US. It is easy to throw around 'how little they get' but you must be a consumer to judge that. As others have pointed out, the accessibility issue is one that is most urgent for those in rural areas, a problem the US and other contries also struggle with.

According to the OECD that you've referenced in an earlier thread, the US does have the best five year survival rate for breast cancer while Canada has the best 5 year survival rate for kidney and liver transplants. Australia has the best breast cancer screening rates and the lowest asthma mortality with the US is the only country of the five (New Zealand and England included) to have rising asthma mortality rates. Speaking of New Zealand, they have the lowest spending per capita on health care $1710 and the highest 5-year survival rate for colorectal cancer.

We can compare and contrast these indicators to make any argument but it remains that the US spends a great deal of money on healthcare and is on level and at times lower than countries of similar socioeconomic standards.

I wouldn't be so proud of the mass availability of diagnostic equipment if it does not translate to superior health outcomes.


The Federal government, unnecessarily alarmed by a report in the early 90s that there would be too many physicians per capita slashed med school places by 10%. The medical profession, being one that practices birth control to a fault, went along. The effects have been disastrous with shortages of family doctors and seen in just a few years. Med school spots have since increased steadily in the past few years (although residency problems still need to be solved) and the shortage is expected to ease in 5-10 years. Again, there may still be a shortage with an aging population but that is a problem that will need solved.


My take: the quality of healthcare in Canada is better than that in America. Facts are facts. I think what you are trying to say is "As far as you can afford ADEQUATE heathcare in America, then you'll get high quality service." I agree with that, but I am talking with regards to the general population. Not many Americans have access to healthcare. Just as lack of doctors affect accessibility to healthcare in Canada, so does the class nature of the American healthcare system.

 

[Nuel]

But the problem Nuel with your logic is that you are relying on a nations health to asses the quality of its healthcare system. Correlation is not causation. Cultural differences, as I mentioned earlier, have an impact on a nation's health. Just because Canada is healthier than US doesn't mean its healthcare system is doing fine.

So the World Health Organization is wrong? The researchers who study healthcare in the US vis-a-vis Canada are wrong? This is not opinion--IT IS ESTABLISHED FACT. According to Longwoodguy (very well stated): We are paying more than any other country for healthcare, yet we, as Americans, are at the bottom end of the developed world in terms of our health indicators. That sucks.

http://www.jhsph.edu/Press_Room/Press_Releases/PR_2004/Starfield_childhealth.html

http://www.jhsph.edu/Press_Room/Press_Releases/PR_2004/Hussey_healthcare.html

I am not saying anything concerning this topic on this thread as some of you are obstinate to accept established facts that have resonated over years.

 

[Nuel]

Just because Canada is healthier than US doesn't mean its healthcare system is doing fine.

Nobody said distribution of healthcare is perfect, it is indeed complex, but the Canadian system, by health indicators, performs better than US--undisputable.

Good day

 

[Nuel]

All it means is that those who are sick who seek care will receive the highest quality care.

Again, the above is false. Not every-"those who are sick" and "seek care will receive" care, let alone HIGHEST QUALITY CARE!!! I hope you are joking.

 

[WavesOfPdine]

Nuel, I think we are on the same page now. You are right in stating my position as being that for those who have access to health care, our quality of care is the best you can find. Of course I realize that is a very qualified statement, considering that forty million Americans are without health care. Something about that needs to be done, and the trouble is finding out how to make health care affordable, whether for the consumer or for a single-payer government.

And now we are back on topic--what will the future of medicine be so that we will be able to provide high quality care at a cost that is affordable. This question is the same regardless of who pays for care. Is the answer technology? Tort reform? Increased HMO regulation? Reduced access to care? Lower wages for caregivers? It is a difficult question.

PS I posted this before I saw some of your other responses, I am sure I am fueling the fire pretty good now.

 

[bostonabe]

Quote from Johns Hopkins Article:

"The United States is the most income-inequitable country among the industrialized nations. Past studies have shown that geographic areas that are more income-equitable have better health and that the ill effects of social disadvantage and income inequality can be partly reduced by better primary care services."

So maybe one direction we as a society should be taking to improve our system is to (and this is under the assumption that healthcare should be accessible to all):

1. decrease the distribution of wealth gap between rich and poor
2. tax the wealthy more for healthcare (like an income tax) so that there is enough funding for accessible healthcare for all.
3. stop allocating so much damn money on defense spending (and pissing off the rest of the world) and redirect it to healthcare/education.
4. end healthcare as a for-profit endeavor
5. educate: stress prevention of disease
6. More primary care physicians

 

[Nuel]

Nuel, I think we are on the same page now. You are right in stating my position as being that for those who have access to health care, our quality of care is the best you can find. Of course I realize that is a very qualified statement, considering that forty million Americans are without health care. Something about that needs to be done, and the trouble is finding out how to make health care affordable, whether for the consumer or for a single-payer government.

And now we are back on topic--what will the future of medicine be so that we will be able to provide high quality care at a cost that is affordable. This question is the same regardless of who pays for care. Is the answer technology? Tort reform? Increased HMO regulation? Reduced access to care? Lower wages for caregivers? It is a difficult question.

PS I posted this before I saw some of your other responses, I am sure I am fueling the fire pretty good now.

As for healthcare reform I am still thinking of something. The more I think of it the more I realize how complex it is. I am planning on doing research so I am not too bothered with the healthcare quagmire, but as, hopefully, future innovators/distributors of healthcare schemes, it is a topic worth considering.

 

[Nuel]

Quote from Johns Hopkins Article:

"The United States is the most income-inequitable country among the industrialized nations. Past studies have shown that geographic areas that are more income-equitable have better health and that the ill effects of social disadvantage and income inequality can be partly reduced by better primary care services."

So maybe one direction we as a society should be taking to improve our system is to (and this is under the assumption that healthcare should be accessible to all):

1. decrease the distribution of wealth gap between rich and poor
2. tax the wealthy more for healthcare (like an income tax) so that there is enough funding for accessible healthcare for all.
3. stop allocating so much damn money on defense spending (and pissing off the rest of the world) and redirect it to healthcare/education.
4. end healthcare as a for-profit endeavor
5. educate: stress prevention of disease
6. More primary care physicians

this is remarkable, but with a capitalist and money-hungry society, 2 will be a problem, but let's hope the rich are the minority.

 

[dmoney41]

This is not opinion--IT IS ESTABLISHED FACT. According to Longwoodguy (very well stated): We are paying more than any other country for healthcare, yet we, as Americans, are at the bottom end of the developed world in terms of our health indicators. That sucks.

For someone who wants to be a "researcher" you seem to have a lot of trouble wrapping your brain around the idea that correlation is not causation.

Let me try and make it more simple. Let's say there are 2 possible causes of the US health care outcomes (clearly there are far more, but we'll say 2) performing objectively worse than their optimum.

1) Systemic inefficiencies
2) Income inequities (even in single payer, poor people do worse; worse nutrition, etc)

Guess what? You're never going to have as good an outcome as Canada even if you adopt their system because they've got a more even distribution of wealth. You are comparing apples and oranges, and you have at no time presented quantitative evidence that says the inefficiencies of having multiple health care providers are the sole (or even a majority) factor in differing health care outcomes. It's certainly possible that single payer would help outcomes as an aggregate, but it's also possible that there are some problems inherent to the US as a country and it would leave outcomes relatively unchanged (for example, newfound insurance for 20% offset by increased waiting times for the other 80%).

And that's an argument purely on ends, not even touching any issues of morality and the role of government.

 

[Rubick]

I agree with pandamonium. When private companies are involved in the health care system, it becomes too easy for the goals to become financial. Right now everyone gets free health care. If you are sick or hurt and call 911, an ambulance has to take you to the hospital. All you have to say is, "I'm sick. I want to go to the hospital." It doesn't matter that they've taken your vitals and you appear fine. People who can't afford healthcare do this, which eventually costs the taxpayers more money.

So pandamonium has a point. The current system probably is more expensive than a government-based system. Taxpayers are paying for healthcare for the poor, and the insurance companies are competing which in turn inflates the price of healthcare.

A purely government based system seems a little too idealistic. I think a better plan would be a partially government-based system. Perhaps an independent agency that could insure people or insurance companies up to a certain amount. Something similar to the FDIC might be a better option than our current system.

On a side note, I just graduated from undergrad last May. As a graduation present, I was given a surf trip to Costa Rica! Pretty sweet! Anyway, the second night I was there, I was sitting next to this swimming pool when a drunk guy decided to dive into the shallow end. He broke a few neck bones and was paralyzed from the neck down. It took the ambulance 40 minutes to get there. Keep in mind it was about a 7-8 minute drive. Once they got there they refused to take him to the clinic without some sort of credit card or passport to insure that they would be paid. I know that Costa Rica is considered 3rd world, but this experience opened my eyes. I realized how much I was taking the US for granted. I know that the US has plenty of problems and room for improvement, but putting high medical expenses aside, it is a pretty nice place to live.

Also I know people always say that we should take money out of military spending for other purposes, such as health care and education, but I'm pretty sure that there are other recipients that get more money every year. For instance, the largest recipient of governmental spending is the welfare system. I'm not against cutting back on military spending, but I think it might be wiser to allocate welfare money towards healthcare for the poor.

I don't think this is unethical, because the government would be spending money more efficiently for the poor. I know it sounds unappealing (taking money from the poor), but in a sick way, it's not really their money to begin with. And this way, they could receive better medical attention. This is what governments are supposed to do, right?

Cheers

 

[rpkall]

that IS less compassionate. and note: i'm not saying you need to BE more compassionate. i just find it interesting the hoops conservatives will go through to justify what essentially boils down to pure selfishness--"i want my money, so even if it only marginally benefits me, that marginal benefit outweighs the potential good it could otherwise bring strangers. therefore, i will justify my want of my money by claiming that the government spends it badly, even though i support a war in a foreign country that was no threat to my country and has already cost 200 billion dollars and 1,000 american lives plus untold iraqis." dress it up how you like, that's the way it is. the only time that becomes a problem is when a conservative is in denial about that because they don't want to see themself as selfish, so when someone calls them out on it they get defensive.

i mean, either you want resources to go to providing health care to all, or you don't. if you don't, then you are saying, by necessity, that you do not want poor people to have health care (a). if you do want resources to go to providing health care to all, either you want to do it through a single-payer system (b) or you want to do it some other way (c). if it's (a), then yes, you are not compassionate. if it's (b), then we wouldn't be having this conversation. if it's (c), please explain.

Firstly, I don't appreciate the judgement on my personal levels of compassion, but I really did want to respond--not to incite bickering, but to clear the air a little bit. Everyone is entitled to their own opinions, but the fact remains that my position on healthcare doesn't come from a need to see poor people without healthcare. Nor does it come from a desire to keep all my money. It comes from a firm belief that the government should not control people by mandating that they donate money for charitable causes. I think that should be an individual decision--and I believe that is the responsible decision of a well-adjusted individual who recognizes the true value in generosity and compassion. I was raised this way. Volunteerism, charitable donations, not-for-profit private charities are a key component of this.

Some people, when they hear this argument, say, "Well, only upper middle class and upper class people think that way, because they haven't had to deal with the hardship the lower- and middle-classes face in this society." But it's not about how much money a person has, or doesn't, it's about whether you believe the government has a right to take more and more of it, and decrease that persons economic freedoms in the process. My wife comes from a lower-middle class family that was always struggling, and she was raised in an environment with the same emphasis on compassion, personal responsibility, volunteering, donating, etc. Conservatism is not just an excuse for the rich to veil their selfishness; it's an actual philosophy that really is based on the notion that everyone should have the basic right to keep their money, make their own choices, and not have the government making decisions that minimize the financial freedoms of an individual or family unit.

And, incidentally, it is possible to be conservative on certain issues and liberal on others, with a basic emphasis on the above principles--i.e., the government shouldn't tell people what to do and how to do it. And it is still possible to be a compassionate person but say no to the idea that the government should pay for everything. It's more of a philosophical issue, that's all.