Universal Health Care and Anesthesia

[EtherMD]

You guys need a break from the Match, rotting in the Operating Room, Board exams, etc. So, check out www.trunkmonkey.com and have a good laugh.

---

Members don't see this ad.

 

[EtherMD]

Once Universal Health Care hits how much will the government slash CRNA reimbursement rates? That is, compared to 2007 rates will the government cut CRNA solo cases by 30%?

Part of the problem of Medicare is that is treats CRNA solo Anesthesia and MD/DO solo Anesthesia the same. This is ridiculous and needs to be corrected. Physician administered care needs to have a different level of reimbursement. Or, will the government decide that MD/DO Anesthesiologists are not needed except in hospitals? Thus, the government reimburses Anesthesia at 30% less than 2007 rates except in the hospital setting.

Remember, Medicare does differentiate reimbursement for facility fees depending on the location (ASC vs. Hospital). It could do the same for Anesthesia. Solo CRNA's receive 30% less than today's rate while MD/DO Anesthesiologists at the hospitals receive today's rate. Or, will the government finish off Anesthesiology as a medical specialty by paying only CRNA rates for everyone?

 

[Be a Pro]

Public message discussion over at the Private Forum with examples and sure to be soon bloody debate.
Check it out.

BaP

 

[MacGyver]

Although I cant stand the evils of universal healthcare, I have come to the realization that its inevitable, and doctors would be better served in a pure socialist model rather than a public/private hybrid.

The reason is thus:

if a hybrid system exists, it means the insurance companies are still in play, and they still would capture approx 30% of all healthcare dollars. That means 30% of the pie is removed from doctors straight off the top.

However, if we went to a pure socialized system, doctors THEORETICALLY could capture some of that 30% that would otherwise go to insurance companies.

The best scenario under universal healthare is that doctors are made employees of the federal government and paid a flat salary on the standard government wage scale. Say perhaps 150k for primary care, max 300k for specialists.

Flat salaries are necessary, because otherwise healthcare utilization will skyrocket as docs try to "game" the system by doing 15 CABGs per day on people who dont need them. That increased utilization will force the government's hand to cut down reimbursements even further. Thats whats happening in today's Medicare. Overall utilization costs skyrocket every year, and as a resopnse the govt cuts per-procedure reimbursements meaning docs earn less for each patient, therefore seeking new patients, etc driving a vicious cycle. A salary system would break this cycle and lead to less reimbursement cuts because the increased utilization costs would be minimized.

Another reason for government salaries is plausible deniability. Under a hybrid system with the insurers in play, the government could slash reimbursement and say "hey its not our problem its the insurance sector's problem." Furthermore they could claim ignorance on overall doctor incomes, claiming they are only slashing per-procedure rates and not responsible for the overall loss of income. Essentially it would give the govt a free hand to say "hey you have other options besides us, go make money elsewhere." Of course that wold be a red herring argument, because the reality is that very few docs would be in markets capable of avoiding the universal system. Last time I looked Bel Air has an oversaturation of doctors.

Under a direct salary scheme, its blatantly obvious how much doctors make and the government has no plausible deniability to claim that they cant track incomes or how doctors are doing. It removes the veil of secrecy and the govt no longer has the power to divert reimbursemnt issues by saying we can make money elsewhere.

Another problem with hybrids is that we will still have 5000 systems of paperwork that will continue to drag down productivity. Under a single socialized model, the paperwork would be standardized and there would be one model for dealing with bureaucratic hassles instead of 5000 separate systems.

The bottom line is that reimbursement is going to get slashed regardless of what universal system we have. The question is why would we still want the insurance middle man siphoning profits off the top that could otherwise go to doctors?

 

[EtherMD]

Politics. Republicans are going to align themselves with the Insurance Industry and their potent PAC. The odds of a true Government run system is very small. Most likely, both parties will work out a compromise which keeps the insurance industry in the health care business for at least 20 more years.

Like it or not, politics trumps money most of the time at the Federal level.
Look at the Iraq War, the war budget, Billions of wasteful federal projects, etc. When it comes to our government you can not use "common sense" as the solution to a complex political problem. The hybrid system will happen in the next 5 years. Politics demands it.

 

[MacGyver]

Politics. Republicans are going to align themselves with the Insurance Industry and their potent PAC. The odds of a true Government run system is very small. Most likely, both parties will work out a compromise which keeps the insurance industry in the health care business for at least 20 more years.

Like it or not, politics trumps money most of the time at the Federal level.
Look at the Iraq War, the war budget, Billions of wasteful federal projects, etc. When it comes to our government you can not use "common sense" as the solution to a complex political problem. The hybrid system will happen in the next 5 years. Politics demands it.

I agree I know the political realities will favor a hybrid system. I'm simply arguing that doctors would be BETTER OFF in a pure socialized model.

 

[EtherMD]

I agree I know the political realities will favor a hybrid system. I'm simply arguing that doctors would be BETTER OFF in a pure socialized model.

The government doesn't care about Doctors' needs. The agenda of their political party and re-election are what matters. If covering every "poor" person in the USA was a priority this country could make it happen. Do you know how much the Iraqi war is costing us? My bet the number will be around 400 Billion Dollars when every last dollar is counted. This is is a lot of health care at Medicaid rates.

The fact is that many employed workers don't have health insurance. This is an active decision to go "without" coverage. We could encourage basic health care for everyone by requiring every USA Citizen show proof of Health Insurance annually. Those making below a certain level of income would qualify for "subsidized" care. Even our elderly would need to pay something for health care if total assets exceed a certain value. The government is not good at running any business and everyone will be better off with a subsidized private system.

Baby Boomers have a lot of money. They buy expensive cars, second homes, Dental Implants ($10-$30,000) and lots of Plastic Surgery. They can afford a real Co-Pay for Health Care. The government needs to take care of the poorest Citizens by "subsidizing" their care via private insurance. This would work and work well provided the government gets out of the health care business. Let the market determine rates and costs. Let the individual become more active in "shopping" for health care. If the patient is paying for the care through a larger co-pay or directly out of pocket "cost" becomes a factor.

"Free Care" only encourages over-utilization of the system with an emphasis on more of everything. Let the market place do what is does best: Control Rates. The government needs to get out of health care or go bankrupt.
Taxes can be used to pay for the POOREST Citizens to receive basic health care via an HMO. If you want "Rolls-Royce" care you need to pay for it.

The hybrid system would work for the nation. A small increase in taxes would be needed but everyone pays this tax. The tax needs to be higher at the lower income levels and gradually diminish as your income rises. This is because the people receiving the subsidy will be the lower level income workers. Again, the government does a terrible job at health care. Everyone needs to be involved with controlling costs and this starts with the patient.

Our elderly will only qualify for fully "subsidized basic care" if they meet the following:

1. Fully retired- age greater than 67.
2. Documented Assets below $2 million dollars. The asset requirement increases to $3 million dollars at 70 and is done away with at age 75.
3. U.S. Citizenship.
4. Income earned after age 67 can be used to pay for health care costs without taxes (up to one million dollars earned). This promotes health savings for the elderly in part-time jobs. This income can be used for their Insurance Co-pay as well.


Just some ideas.

 

[Robert Loblaw]

ethermd, what would be your estimate for annually salary be for anesthesiolgists, pain physician, and anesth-CC specialists in the next 5, 10, and 20 years? i ask you, in particular, because you seem to have a good grasp on these issues, but anyone else is game to estimate.

 

[Monty Python]

I agree I know the political realities will favor a hybrid system. I'm simply arguing that doctors would be BETTER OFF in a pure socialized model.

In May of last year I started a poll, on the odds of socialized medicine becoming reality in the US.

http://gasforums.studentdoctor.net/showthread.php?t=282927

It's interesting to compare and contrast those comments from last year to the posts on the current thread.

 

[EtherMD]

ethermd, what would be your estimate for annually salary be for anesthesiolgists, pain physician, and anesth-CC specialists in the next 5, 10, and 20 years? i ask you, in particular, because you seem to have a good grasp on these issues, but anyone else is game to estimate.

I would like to answer this question. However, POLTICS at the Federal level has a lot do with our income. I will lay out three likely scenarios.

1. Republicans Win the White House- Modest reforms. At most a "hybrid" system like I explained above. Taxes increase about 3-5% to pay for Universal Health Care/HMO coverage for all Citizens. Medicare no longer pays the Physician/Hospital directly but rather the Insurance Company. Anesthesiologist Income increases slightly in this scenario. No major changes to SOLO MD/DO Anesthesia is needed for at least 8-10 years. The AANA is happy as well because CRNA's continue to earn Family Practice M.D. income.
Income remains stable for the first five years but decreases about 15% by 2020.

2. Democrats win the White House- Significant reforms. Still, I believe a hybrid system is available for most U.S. Citizens. Medicare and Medicaid remain available as well. All U.S. Citizens given basic health care which means Federal Medicaid for many Citizens earning a good living off the books.
Taxes increase a solid 5% and the Medicare Care tax applies to every dollar earned. This results in a big tax increase for the upper income earners.
Still, Anesthesiologist income decreases only about 15% with this scenario.
MD/DO Solo Anesthesia still exists in the lucrative spots of the USA. THe AANA is less happy but CRNA income remains at 2007 levels. Income declines gradually over the next 10 years become of more Medicare and Medicaid which results in a 30% drop in salary by 2020 compared to 2007.

3. Democrats win the WHite House- Republicans lose more seats and become a significant minority in both chambers. Ted Kennedy et al., has a field day with socialized medicine. President OBAMA signs the US government health system into law. Only 5% of U.S. Citizens can afford private insurance. SOLO MD/DO Anesthesia finished except in just a few locations. Many MD's out of work because they won't except this level of income ($150,000) as a SOLO MD. (CRNA level income now $100,000)
The Supervisor role pays $250,000 plus benefits at most hospitals. These jobs are hard to find. The MD to CRNA ratio is 7:1. The AANA is unhappy as CRNA's get a 30% pay cut. SOLO CRNA's only get a 20% pay cut. There are too many Anesthesiologists in the market place and a few go back to train in other areas. Many senior guys retire or take part-time CRNA level work.


I believe scenario One or Two will occur in the next 5-10 years. However, twenty years from now scenario three becomes more likely.

 

[mille125]

I would like to answer this question. However, POLTICS at the Federal level has a lot do with our income. I will lay out three likely scenarios.

1. Republicans Win the White House- Modest reforms. At most a "hybrid" system like I explained above. Taxes increase about 3-5% to pay for Universal Health Care/HMO coverage for all Citizens. Medicare no longer pays the Physician/Hospital directly but rather the Insurance Company. Anesthesiologist Income increases slightly in this scenario. No major changes to SOLO MD/DO Anesthesia is needed for at least 8-10 years. The AANA is happy as well because CRNA's continue to earn Family Practice M.D. income.
Income remains stable for the first five years but decreases about 15% by 2020.

2. Democrats win the White House- Significant reforms. Still, I believe a hybrid system is available for most U.S. Citizens. Medicare and Medicaid remain available as well. All U.S. Citizens given basic health care which means Federal Medicaid for many Citizens earning a good living off the books.
Taxes increase a solid 5% and the Medicare Care tax applies to every dollar earned. This results in a big tax increase for the upper income earners.
Still, Anesthesiologist income decreases only about 15% with this scenario.
MD/DO Solo Anesthesia still exists in the lucrative spots of the USA. THe AANA is less happy but CRNA income remains at 2007 levels. Income declines gradually over the next 10 years become of more Medicare and Medicaid which results in a 30% drop in salary by 2020 compared to 2007.

3. Democrats win the WHite House- Republicans lose more seats and become a significant minority in both chambers. Ted Kennedy et al., has a field day with socialized medicine. President OBAMA signs the US government health system into law. Only 5% of U.S. Citizens can afford private insurance. SOLO MD/DO Anesthesia finished except in just a few locations. Many MD's out of work because they won't except this level of income ($150,000) as a SOLO MD. (CRNA level income now $100,000)
The Supervisor role pays $250,000 plus benefits at most hospitals. These jobs are hard to find. The MD to CRNA ratio is 7:1. The AANA is unhappy as CRNA's get a 30% pay cut. SOLO CRNA's only get a 20% pay cut. There are too many Anesthesiologists in the market place and a few go back to train in other areas. Many senior guys retire or take part-time CRNA level work.


I believe scenario One or Two will occur in the next 5-10 years. However, twenty years from now scenario three becomes more likely.

or scenario 4...........everything stays exactly the same......

 

[mille125]

The truth of the matter is: "no one knows what will happen". Look at all of the doomsday scenarios for anesthesiology in the mid 90's. Guess what? The experts were wrong.......

 

[Disciple]

I would like to answer this question. However, POLTICS at the Federal level has a lot do with our income. I will lay out three likely scenarios.

1. Republicans Win the White House- Modest reforms. At most a "hybrid" system like I explained above. Taxes increase about 3-5% to pay for Universal Health Care/HMO coverage for all Citizens. Medicare no longer pays the Physician/Hospital directly but rather the Insurance Company. Anesthesiologist Income increases slightly in this scenario. No major changes to SOLO MD/DO Anesthesia is needed for at least 8-10 years. The AANA is happy as well because CRNA's continue to earn Family Practice M.D. income.
Income remains stable for the first five years but decreases about 15% by 2020.

2. Democrats win the White House- Significant reforms. Still, I believe a hybrid system is available for most U.S. Citizens. Medicare and Medicaid remain available as well. All U.S. Citizens given basic health care which means Federal Medicaid for many Citizens earning a good living off the books.
Taxes increase a solid 5% and the Medicare Care tax applies to every dollar earned. This results in a big tax increase for the upper income earners.
Still, Anesthesiologist income decreases only about 15% with this scenario.
MD/DO Solo Anesthesia still exists in the lucrative spots of the USA. THe AANA is less happy but CRNA income remains at 2007 levels. Income declines gradually over the next 10 years become of more Medicare and Medicaid which results in a 30% drop in salary by 2020 compared to 2007.

3. Democrats win the WHite House- Republicans lose more seats and become a significant minority in both chambers. Ted Kennedy et al., has a field day with socialized medicine. President OBAMA signs the US government health system into law. Only 5% of U.S. Citizens can afford private insurance. SOLO MD/DO Anesthesia finished except in just a few locations. Many MD's out of work because they won't except this level of income ($150,000) as a SOLO MD. (CRNA level income now $100,000)
The Supervisor role pays $250,000 plus benefits at most hospitals. These jobs are hard to find. The MD to CRNA ratio is 7:1. The AANA is unhappy as CRNA's get a 30% pay cut. SOLO CRNA's only get a 20% pay cut. There are too many Anesthesiologists in the market place and a few go back to train in other areas. Many senior guys retire or take part-time CRNA level work.

I vote for Scenario #1.

Neither Hillary nor Obama are really "electable".

 

[zippy2u]

Scenario #5: Doctors quit being limp-wristed, piano-handed panzys and bail on all forms of insurance. It's cash, check or credit card from now on. Don't have money?---Oh, you go over to the public hospital and they'll take care of ya over there where the docs are on salary paid by the US government like the VA system. Let the hospitals and surgery centers continue to play the insurance charade to collect their monies---not the docs. Regards,---Zip

 

[EtherMD]

The truth of the matter is: "no one knows what will happen". Look at all of the doomsday scenarios for anesthesiology in the mid 90's. Guess what? The experts were wrong.......

Not this time. The politicians, business groups and public all agree something needs to be done about health care. Unlike the 1990's there is the will to pass some sort of legislation with the next President.

Do I hope it is "weak" and keeps government out of the health care business?
Yes. But to believe that the the next election won't have a health care mandate for U.S. citizens as part of the party platform is incorrect.

Sorry. But, this go around the Democrats are going to get something passed regarding health care. Like the Medicare Prescription benefit plan there will be compromise involved; but, if a Democrat wins the White House I believe Health Care will be number one on the agenda.

Even the show Bulls and Bears which I watch on Fox most Saturdays thinks health care will CHANGE after the next general election.

 

[Robert Loblaw]

i wonder whether some of this walter reed business will resurface when this debate reallyhit full stride in election season, and then finally in the congress sometime in 2009. this exposure to the VA health system, while extreme but not surprising to those of us who have seen the VA system at work, is certainly a shocking eye-opener to the average american, who can expect VA quality care if scenario #3 evolves...i wouldn't want to politicize the conditions in which our vets are living, but I'm sure someone else would.

 

[mille125]

Scenario #5: Doctors quit being limp-wristed, piano-handed panzys and bail on all forms of insurance. It's cash, check or credit card from now on. Don't have money?---Oh, you go over to the public hospital and they'll take care of ya over there where the docs are on salary paid by the US government like the VA system. Let the hospitals and surgery centers continue to play the insurance charade to collect their monies---not the docs. Regards,---Zip

scenario 5 is very plausible if doctor are pushed too much....politicians and insurers are aware of this

 

[EtherMD]

scenario 5 is very plausible if doctor are pushed too much....politicians and insurers are aware of this

Hybrid system still maintains our salaries. Taxes go up but Health Care remains intact. Everyone (except Ted Kennedy) is afraid of too much radical change to the system. It is much easier politically and much safer to move slowly. Privatize Health Care and get the government out. Then, everyone gets to blame the insurance companies. Politicians like it that way and the public will buy it, at least for now.

 

[dhb]

So where is the money come from?
Here's a quote from congressman Ron Paul :

"The Coming Entitlement Meltdown

March 5, 2007

David Walker, Comptroller General at the Government Accountability Office, appeared on the show “60 Minutes” last evening to discuss the federal budget outlook. If you saw the show, you know that he painted a very sobering picture regarding the federal government’s ability to meet its future obligations.

If you didn’t see the show, Mr. Walker’s theme was simple: government entitlement spending is like a runaway freight train headed straight at American taxpayers. He singled out the Medicare prescription drug bill, passed by Congress at the end of 2003, as “probably the most fiscally irresponsible piece of legislation since the 1960s.”

When it comes to Social Security and Medicare, the federal government simply won’t be able to keep its promises in the future. That is the reality every American should get used to, despite the grand promises of Washington reformers. Our entitlement system can’t be reformed- it’s too late. And the Medicare prescription drug bill is the final nail in the coffin.

The financial impact of the drug bill cannot be overstated. Government projections that the program would cost $400 billion over the next decade were a joke, as everyone in Congress knew even as they voted for the bill. The real cost will be at least $1 trillion in the first decade alone, and much more in following decades as the American population grows older.

The Medicare “trust fund” is already badly in the red, and the only solution will be a dramatic increase in payroll taxes for younger workers. The National Taxpayers Union reports that Medicare will consume nearly 40% of the nation’s GDP after several decades because of the new drug benefit. That’s not 40% of federal revenues, or 40% of federal spending, but rather 40 % of the nation’s entire private sector output!

The politicians who get reelected by passing such incredibly shortsighted legislation will never have to answer to future generations saddled with huge federal deficits. Those generations are the real victims, as they cannot object to the debts being incurred today in their names.

The official national debt figure, now approaching $9 trillion, reflects only what the federal government owes in current debts on money already borrowed. It does not reflect what the federal government has promised to pay millions of Americans in entitlement benefits down the road. Those future obligations put our real debt figure at roughly fifty trillion dollars- a staggering sum that is about as large as the total household net worth of the entire United States. Your share of this fifty trillion amounts to about $175,000.

Don’t believe for a second that we can grow our way out of the problem through a prosperous economy that yields higher future tax revenues. If present trends continue, by 2040 the entire federal budget will be consumed by Social Security and Medicare alone. The only options for balancing the budget would be cutting total federal spending by about 60%, or doubling federal taxes. To close the long-term entitlement gap, the U.S. economy would have to grow by double digits every year for the next 75 years.

The answer to these critical financial realities is simple, but not easy: We must rethink the very role of government in our society. Anything less, any tinkering or “reform,” won’t cut it. A good start would be for Congress to repeal the Medicare prescription drug bill. "

If other countries are set as a standard physician pay will go down by half (at least in the US)

 

[MacGyver]

Hybrid system still maintains our salaries. Taxes go up but Health Care remains intact. Everyone (except Ted Kennedy) is afraid of too much radical change to the system. It is much easier politically and much safer to move slowly. Privatize Health Care and get the government out. Then, everyone gets to blame the insurance companies. Politicians like it that way and the public will buy it, at least for now.

What you fail to recognize is that a hybrid system wont be a 50/50 mix of public and private models.

When the public plan is offered as "free" healthcare to the public, there is going to be a MASSIVE shift from the private ot public sectors. The bottom line is people are going to fudge their income levels or do whatever they have to do to get this "free" healthcare plan.

My guess is that at least 80% of the population will switch over to the public system, quickly overwhelming it and leading to far greater costs than the politicians planned on. When that happens, the govt's first priority will be to cut costs, and of course they are going to slash doctor incomes to accomplish this.

The government currently controls about 50% of all dollars spent on healthcare. Under a hybrid system I would expect this to be at least 80% if not more. That will give the govt ENORMOUS leverage to slash doctor incomes at the altar of cost controls.

So I absolutely do NOT agree with you that "our salaries will be maintained" in a hybrid system.

 

[EtherMD]

What you fail to recognize is that a hybrid system wont be a 50/50 mix of public and private models.

When the public plan is offered as "free" healthcare to the public, there is going to be a MASSIVE shift from the private ot public sectors. The bottom line is people are going to fudge their income levels or do whatever they have to do to get this "free" healthcare plan.

My guess is that at least 80% of the population will switch over to the public system, quickly overwhelming it and leading to far greater costs than the politicians planned on. When that happens, the govt's first priority will be to cut costs, and of course they are going to slash doctor incomes to accomplish this.

The government currently controls about 50% of all dollars spent on healthcare. Under a hybrid system I would expect this to be at least 80% if not more. That will give the govt ENORMOUS leverage to slash doctor incomes at the altar of cost controls.

So I absolutely do NOT agree with you that "our salaries will be maintained" in a hybrid system.

It all depends on how much government vs. private sector we end up with.
I envision a system of private insurance companies competing for 100% of all health care dollars. The government provides a subsidy to those who are too poor for health insurance. This includes the old, the young and the unemployed. The insurance companies become extremely big, powerful and very profitable. "Basic" health care means you get limited health care providers, certain facilities and a "gatekeeper" to manage your care.

This system has the government limiting its expenses by passing the buck to the patient and the HMO. Uncle Sam then has "deniability" when care is poor or denied. The insurance carriers can bargain with Physicians by having HUGE numbers of patients.

Do I think this system has a chance to pass? Yes. If the Republicans retain the White House and the Insurance Industry has its way this is what the USA will get as health care reform.

If the Democrats win the push will be for a more "socialized" system like Canada or Great Britain. My bet is the public would prefer to try the private approach first because most people and big business understand that government run systems are not efficient and will hinder care.

How do we come out in these scenarios? Well, we come out fine in the private system with perhaps a 0-20% decrease in income vs. a 50-70% decrease in income with the socialized medicine.

One thing is very likely in the next 5 years: Change is coming to USA Medicine in a BIG way. The AMA and the ASA need to speak clearly and loudy the way they believe the country should go. The Status-quo will not be an option.

 

[Jinterpol]

Will we adopt a system like Canada? Because the current Medicare system is crap and if we want socialized Medicine then stop calling it Universal health Care and call it by its real name: Government Health Care System.

Will Co-Pays be allowed? Will the government limit the Co-Pay? Will Anesthesiology finally be treated by the government as a real Medical Specialty? Will the Relative Value system be scrapped? Will Family Practice Doctors become gatekeepers like in Britain?

Do you really think that the USA will adopt a system that is similar to the other National Healthcare plans. When I was 22, I had just come home from Europe, and was ready to haul in a new healthcare revolution in the US. "Dude, where's my healthcare?"...kind of thing. Seeing that the National systems can and do work efficiently, I didn't think my opinion would ever change...

Yet three years later I realize that although I had explored a leftist country in great detail, I had yet to fully explore my own. Once a small town kid, now an urbanite, I just don't see the same America I used to. This land of opportunity wasn't built on long traditions of attempting to sustain a culture and standard of living like those in Europe; America is and always has been a country of invention, of competition, and was actually founded with the principles of classical liberalism in mind. Do you really think that the country who put opening up free markets on the global agenda is going to hand over its admittedly flawed healthcare system to a National plan like that of our neighbors in Canada? The pharmaceutical industry that was built on this competition is without question a booster of our economy. You take away the competition on a local scale and America doesn't seem like "home" anymore. On a national scale, it now seems unimaginable to me.

I'm not saying I'm against National Healthcare Plans. Healthcare is an undeniable right, not a prerogative. Yet equally undeniable is the fact that although this country proclaims that all are equal, all do not share equal success. Healthcare can be a money-making environment, and it is the American way to squeeze as much money out of it as it/we can. Hence, I don't see us having a single-payer plan much like we've seen adopted many times before.

I think the powers that be will ensure that there is still thriving competition, and instead of focusing on state markets for insurance, plans at the federal level might make the difference to create viable low income heathcare plans. Tax reform can also increase competition, while increasing its progressivity and benefiting those who do not really pay taxes.

I don't have the answers for healthcare in America, and I don't think Canada or Denmark or anyone else will have the answer either. This is a problem that will require us to manifest a new way of thinking about solving the healthcare crisis in America as a unique, diverse, competition/consumption-driven, and money-making state. Maybe I'm the crazy one, but I think the solution is going to be another great American invention.

 

[EtherMD]

Do you really think that the USA will adopt a system that is similar to the other National Healthcare plans. When I was 22, I had just come home from Europe, and was ready to haul in a new healthcare revolution in the US. "Dude, where's my healthcare?"...kind of thing. Seeing that the National systems can and do work efficiently, I didn't think my opinion would ever change...

Yet three years later I realize that although I had explored a leftist country in great detail, I had yet to fully explore my own. Once a small town kid, now an urbanite, I just don't see the same America I used to. This land of opportunity wasn't built on long traditions of attempting to sustain a culture and standard of living like those in Europe; America is and always has been a country of invention, of competition, and was actually founded with the principles of classical liberalism in mind. Do you really think that the country who put opening up free markets on the global agenda is going to hand over its admittedly flawed healthcare system to a National plan like that of our neighbors in Canada? The pharmaceutical industry that was built on this competition is without question a booster of our economy. You take away the competition on a local scale and America doesn't seem like "home" anymore. On a national scale, it now seems unimaginable to me.

I'm not saying I'm against National Healthcare Plans. Healthcare is an undeniable right, not a prerogative. Yet equally undeniable is the fact that although this country proclaims that all are equal, all do not share equal success. Healthcare can be a money-making environment, and it is the American way to squeeze as much money out of it as it/we can. Hence, I don't see us having a single-payer plan much like we've seen adopted many times before.

I think the powers that be will ensure that there is still thriving competition, and instead of focusing on state markets for insurance, plans at the federal level might make the difference to create viable low income heathcare plans. Tax reform can also increase competition, while increasing its progressivity and benefiting those who do not really pay taxes.

I don't have the answers for healthcare in America, and I don't think Canada or Denmark or anyone else will have the answer either. This is a problem that will require us to manifest a new way of thinking about solving the healthcare crisis in America as a unique, diverse, competition/consumption-driven, and money-making state. Maybe I'm the crazy one, but I think the solution is going to be another great American invention.

I appreciate your post. I hope we don't go the Canadian route in the USA.
However, some Democrats like Edwards, Clinton, etc. may push hard for just such a system.

My hope is the USA stays with the free market system. This means competition exists in the field and the government provides a subsidy to the private insurance carriers to help out those in need like our elderly, poor and unemployed. The patient needs to show a financial need for assistance and apply for a government subsidy to be applied to their monthly health insurance payment. Our elderly are not automatically given free health care without an application. In addition, the insurance carrier determines which providers you get to see along with which facilities depending on your plan option.

Such a solution embraces the free market system of the USA and provides help to those that really need it.

 

[proman]

The irony is that means testing (having to document "need") adds to the cost of a health care system. It's actually cheaper due to lower administrative costs to just cover everyone (like Medicare does).

 

[EtherMD]

The irony is that means testing (having to document "need") adds to the cost of a health care system. It's actually cheaper due to lower administrative costs to just cover everyone (like Medicare does).

We 'Means test' Medicaid Patients now. By adding the elderly, the working poor and the unemployed we are stating that the government only helps those that need it. The rest of us need to support ourselves through savings and work. This is the American way and is what makes us different than most of Europe. We are not a "socialist" country and thus "means testing" is necessary to receive government hand-outs. This sends a clear message that everyone is not "entitled" to government support.

If we decide to cover everyone the message is very different; it tells the people BIG DADDY is going to take care of your needs so why work to pay for health care or retirement? The government and the "rich" will pay for everything. This promotes the LAZY attitude that pervades Europe.