"Universal" Health Coverage in California?

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There are already unqualified people all over the market place. My mom insists on seeing a quack pharmacist that gives her random crap and charges her a fortune. Like most regulation, legitimate providers have to deal with all sorts of crap, while the snake-oil salesman go underground and make a fortune. I just want to be able to compete with these guys AS a legitimate provider. Just go on the internet if you doubt this.

Yes, there are some now. There would be many more ... and you wouldn't be able to tell a properly trained physician from an untrained one.

I agree that we treat the uninsured now. It is a complete disaster. EMTALA is destroying emergency medicine. Yet, your solutions are more government market interventions (like mandatory EHR). In a free market, if this is the most efficient solution, the guy who provides it first will outperform his competitors, take market share, and it will become the standard. It can also be tried competitively. Right now, no one can say for sure whether EHR is the answer, because there is no free market in medicine. My problem is not everyone having insurance. My problem is taking money by force to give it to them.

You don't seem to have a problem taking money by force to pay for a military. Why is health care so "not worth it" when it comes to government spending?

If we don't give healthcare away for free, and people are responsible for their own actions, there is no need for taxes on alcohol or motorcycles. These people will be responsible to pay for their own mistakes.

Yes, in an ideal world. I've been in the real world too long to pretend that everyone can just take care of themselves and that we are so independent and isolated from one another that someone else's problem (such as poor health) will not become my problem.


As a final point, there is NO reason why the current residency system has to be the way that it is. Highly trained professionals in many other fields learn on the job for much higher salaries with more job flexibility. Residency, in its current form, is a relic that has failed to keep up with the times due to its ingraining in legislation. It's not that it can't exist, but mandating that everyone go through it just creates another pseudo-monopoly that this time screws you.

Yes, agreed. We should just get our training "on the job" after medical school. There should be some control over the training of physicians to make sure it's legit. Perhaps there could be exams for various specialties to make sure the that "on the job training" actually was effective. But, yes, forcing med students to provide "cheap" labor as residents to become board certified is wrong. When are we voting on the renewal of the residency system ;-) ?
 
Yes, there are some now. There would be many more ... and you wouldn't be able to tell a properly trained physician from an untrained one.

Maybe, but independent sources, such as a consumer reports, would arise in order to sort them out.


You don't seem to have a problem taking money by force to pay for a military. Why is health care so "not worth it" when it comes to government spending?
I just try to bring things closer to the ideal. In a voluntary association, the money is not taken by force. However, whoever does defense has the guns. Whoever has the guns can use force and power needs to be limited. Any service offered on the free market can be patronized or ostracized by its clientel. The government can use force to compel people to act against their own interests. Society is a collection of individuals. Forcing individuals to all act against their own interests at gun point is bad for society.

Yes, in an ideal world. I've been in the real world too long to pretend that everyone can just take care of themselves and that we are so independent and isolated from one another that someone else's problem (such as poor health) will not become my problem.
It doesn't need to be to the extent that it is. The more we interfere, the more of a problem they become.



Yes, agreed. We should just get our training "on the job" after medical school. There should be some control over the training of physicians to make sure it's legit. Perhaps there could be exams for various specialties to make sure the that "on the job training" actually was effective. But, yes, forcing med students to provide "cheap" labor as residents to become board certified is wrong. When are we voting on the renewal of the residency system ;-) ?
I believe that the private sector could provide those credentials, but we are mostly in agreement here 🙂 . Without all of the regulation, the private market will create ways of assessing quality. It already does now in other types of professions.
 
Maybe, but independent sources, such as a consumer reports, would arise in order to sort them out.

Here in Austin, we have www.citysearch.com, which, believe it or not, rates physicians (giving them a numerical score). I have used their service to find specialists and I have never been disappointed (when I just followed a referral I frequently was disappointed). So, we already have these sources, but very very few people use them. So, it's a public health issue as far as I'm concerned (an unhealthy population). I can see the "discount" surgical centers now ... "nobody, I mean nobody beats our prices."

I just try to bring things closer to the ideal. In a voluntary association, the money is not taken by force. However, whoever does defense has the guns. Whoever has the guns can use force and power needs to be limited. Any service offered on the free market can be patronized or ostracized by its clientel. The government can use force to compel people to act against their own interests. Society is a collection of individuals. Forcing individuals to all act against their own interests at gun point is bad for society.

Being idealistic with real people = disaster. Prepare to be stomped on by everyone. There is someone who wants to steal all of your money ... are you going to "force" him or her to act against his or her interests ... yes, at gunpoint if necessary. Also, we can control the incentives, so that it becomes in everyone's best interest to perform mutually beneficial actions ... like driving on the right side of the road in the U.S. as opposed to just driving wherever, making up your own rules as you go.

It doesn't need to be to the extent that it is. The more we interfere, the more of a problem they become.

We have the system that the people with the most power want (I'm sad to say). Our healthcare system works well enough for the wealthy and generates enormous wealth for certain powerful people (including many physicians). Your idealistic notions about the role of gov't ignore the fact that powerful interests (like big corporations, unions, wealthy politicians, etc.) will and always have "interfered" in the economy and lots of other areas, such as healthcare. To pretend that if the government (supposed the "bad guy") gets out that all the smart/nice/fair people (the good guys) will now be in charge is just not realistic.


I believe that the private sector could provide those credentials, but we are mostly in agreement here 🙂 . Without all of the regulation, the private market will create ways of assessing quality. It already does now in other types of professions.

The private sector does not always work as well as you make it out to. Without enviromental regulations, you wouldn't be able to drink the water from your tap. As a society, we have common interests (such as a healthy populace) and government has the responsibility to legislate and tax toward those ends. There are crooks everywhere, in gov't and in the private sector. At least with gov't we can vote many of them out or vote for people who will remove them. In the private sector, there is really nothing we can do in many cases to remove criminals without the government's help.
 
I'll just preface by saying that your arguments here are very thorough and thought out.

Here in Austin, we have
www.citysearch.com, which, believe it or not, rates physicians (giving them a numerical score). I have used their service to find specialists and I have never been disappointed (when I just followed a referral I frequently was disappointed). So, we already have these sources, but very very few people use them. So, it's a public health issue as far as I'm concerned (an unhealthy population). I can see the "discount" surgical centers now ... "nobody, I mean nobody beats our prices."

I think that most people don't use them because of the fact that it is assumed that MD=competent. Allowing other people to practice wouldn't make them MDs. In an environment where people were responsible for this information, more would turn to things like www.citysearch.com, and doctors could be rated accordingly. False MDs could also be pointed out.

In terms of discount centers. That would be GREAT. Just like Walmart, poorer people would be able to afford microwaves AND surgery. Discount surgery centers would actually be a step in the direction of providing affordable healthcare to the poor with no government market intervention.


Being idealistic with real people = disaster. Prepare to be stomped on by everyone. There is someone who wants to steal all of your money ... are you going to "force" him or her to act against his or her interests ... yes, at gunpoint if necessary. Also, we can control the incentives, so that it becomes in everyone's best interest to perform mutually beneficial actions ... like driving on the right side of the road in the U.S. as opposed to just driving wherever, making up your own rules as you go.

I disagree with your initial premise here. I will say that my freedom's end where yours begin. I just think that this works both ways. I can't rob you, you can't rob me, politicians shouldn't be able to rob either of us. Controlling incentives is no different than interfering in people's choices. It is using force to make someone do what you want in order to prevent actions that do not violate your freedoms.


We have the system that the people with the most power want (I'm sad to say). Our healthcare system works well enough for the wealthy and generates enormous wealth for certain powerful people (including many physicians). Your idealistic notions about the role of gov't ignore the fact that powerful interests (like big corporations, unions, wealthy politicians, etc.) will and always have "interfered" in the economy and lots of other areas, such as healthcare. To pretend that if the government (supposed the "bad guy") gets out that all the smart/nice/fair people (the good guys) will now be in charge is just not realistic.

I haven't pretended this at all. To quote DeCartes: "Power corrupts, and absolute power corrups absolutely." I want to decentralize power. An evil person can head a corporation, but he doesn't have the guns of the government. Right now, many of these heads use the government through shady dealings to use those guns to their advantage. With a limited government, that doesn't deal significantly in the economy, there would be no evil men with guns enforcing false market controls to the detriment of the common man. I am acknowledging that corruption is just a part of human nature, and that the solution to corruption is a de-centralization of power that prevents a few corrupt individuals from controlling everything.



The private sector does not always work as well as you make it out to. Without enviromental regulations, you wouldn't be able to drink the water from your tap. As a society, we have common interests (such as a healthy populace) and government has the responsibility to legislate and tax toward those ends. There are crooks everywhere, in gov't and in the private sector. At least with gov't we can vote many of them out or vote for people who will remove them. In the private sector, there is really nothing we can do in many cases to remove criminals without the government's help.

We'll probably stop arguing here, but I'll make a couple of points. Environmental regulations are a two way street. I disagree with them completely when they interfere with someone's use of his own property. I do not disagree when they regulate someone violating neighboring property. That is chemical aggression, and it is a legitimate role of the government. The government's role is to protect private property, from unwanted people, microbes, and chemicals. This is part of stopping aggression. This doesn't apply if the people actually want the people, microbes, or chemicals on their property.

With regards to the corrupt people everywhere, please read my response to your last paragraph. Remember, the government isn't perfect now. The total corruption level might be decreased, even if some other entity managed to get away with a little more. I want to minimize coercion and maximize freedom in all human endeavors.
 
Some people here think our healthcare delivery system is broken, inefficient or what have you.

Until the Saudi kings and princes, the elite europeans and the rich russians quit coming to America for all their medical needs, I think we're doing just fine
 
Some people here think our healthcare delivery system is broken, inefficient or what have you.

Until the Saudi kings and princes, the elite europeans and the rich russians quit coming to America for all their medical needs, I think we're doing just fine

Hmm.

1. If you have a lot of extra cash, the U.S. medical system is probably among the best.
2. Do Saudi princes come here because they buy their health care here (as opposed to other systems, which are not for sale) or is it because it is the best system? I'm also not sure that they get their primary care here (perhaps they have their own local private doctors for that).
 
Some people here think our healthcare delivery system is broken, inefficient or what have you.

Until the Saudi kings and princes, the elite europeans and the rich russians quit coming to America for all their medical needs, I think we're doing just fine

Oh my God, I could actually hear the quality of this discussion fall when you decided to join in . . .
 
Why do you choose to live in a country that steals from its citizens? Why not move somewhere where the government does not tax its citizens (a lawless place, say, Somalia, for example).

Why does it have to be lawless? What about, say, the Cayman Islands? I think they sound pretty nice, relatively high standard of living (for the caribbean), relatively safe, and no income tax, property tax, sales tax, etc. There is a stamp tax that is 7.5% on property transfers and very high duties (I think 20%) on all imported goods. But if you can live off things made on the island you can live very well, and even if you buy a lot of imported stuff that's a far lower tax burden than in the US.

And yes, I do understand that this is a British Overseas Terriritory so they don't have to fund a military to protect themselves . . . but still, a low tax model that works pretty well.
 
Why? Because he said something true?

So you're arguing that the Russian oligarchy and House of Saud will be able to single-handedly support the entire American medical infrastructure?

C'mon, not even you are that out there.
 
Why does it have to be lawless? What about, say, the Cayman Islands? I think they sound pretty nice, relatively high standard of living (for the caribbean), relatively safe, and no income tax, property tax, sales tax, etc. There is a stamp tax that is 7.5% on property transfers and very high duties (I think 20%) on all imported goods. But if you can live off things made on the island you can live very well, and even if you buy a lot of imported stuff that's a far lower tax burden than in the US.

And yes, I do understand that this is a British Overseas Terriritory so they don't have to fund a military to protect themselves . . . but still, a low tax model that works pretty well.

You answered your own question, Dakota. He thinks taxation is stealing. That means that any tax is theft. I would argue that U.S. taxes are low as well. It's all a question of what you compare it to. That's why I didn't suggest the Cayman islands.

However, you do have a point. Maybe the lower crime rate (taxes) would be attractive: Miami_med: How would you like to live in the Cayman Islands instead ... the government steals less of your money! It's a pretty place to visit; I'm not sure how nice it would be to actually live there. Here is a ranking of "quality of life" by country. See if you agree: http://www.il-ireland.com/il/qofl06/index.php
 
If you are saying that physicians and hospitals don't have enough political power to prevent socialization of medicine so that they earn less and work more, you may be right. Maybe physicians will be earning as much as school teachers by the time this is over with. However, I would be surprised if this happens.[/QUOTE]



Do you think anyone other than physicians cares a damn if this happens? Does anyone care that you work 80-120 hours a week with no overtime pay for the same salary as a teacher while in residency? What is to prevent this from happening once the inital changes take effect...it is a very slippery slope.

Let me acqaint you with the reality of life in medicine: everybody wants to give you nothing for something, at the expense of your financial security, family and personal life.
 
If you are saying that physicians and hospitals don't have enough political power to prevent socialization of medicine so that they earn less and work more, you may be right. Maybe physicians will be earning as much as school teachers by the time this is over with. However, I would be surprised if this happens

Do you think anyone other than physicians cares a damn if this happens? Does anyone care that you work 80-120 hours a week with no overtime pay for the same salary as a teacher while in residency? What is to prevent this from happening once the inital changes take effect...it is a very slippery slope.

Let me acqaint you with the reality of life in medicine: everybody wants to give you nothing for something, at the expense of your financial security, family and personal life.

I can see where you are coming from. Many people do want something (like healthcare) for nothing. Let me clarify what I was hinting at: physicians and hospitals probably have enough power and there are other factors (perhaps our capitalistic culture) to hinder the socialization of medicine.

Our current U.S. healthcare situation is that if someone has a heart attack, it's not ok for the EMT or ER doctor to run a credit check to see if a patient is able to pay before providing care or to refuse critical care based on the ability of a person to pay for the care. Given that it is not cultural acceptable to refuse to provide critical care to anyone, all warm bodies on our soil should have to pay for the system that is required to care for them (in my opinion anyway). The only question is how do you do that operationally, economically, and politically. California is proposing one of several possible approaches.
 
I'll just preface by saying that your arguments here are very thorough and thought out.

Thanks! You make intelligent arguments as well.

I think that most people don't use them because of the fact that it is assumed that MD=competent. ...

We both know that this is often a good assumption, but not a perfect one. This is one example as to why the government needs to help, IMO.

Allowing other people to practice wouldn't make them MDs. In an environment where people were responsible for this information, more would turn to things like www.citysearch.com, and doctors could be rated accordingly. False MDs could also be pointed out.

Without government regulation, you would be able to get an MD with much less education and training than we currently receive and that most people would find acceptable. It's tough enough to get rid of incompetent MD's right now. I couldn't imagine a system without medical boards.

In terms of discount centers. That would be GREAT. Just like Walmart, poorer people would be able to afford microwaves AND surgery. Discount surgery centers would actually be a step in the direction of providing affordable healthcare to the poor with no government market intervention.

It would be great until a relatively large percentage of patients started getting injured from complications. It's one thing to get cheated by a used car dealer. It's quite another to have your gallbladder surgery botched.

I disagree with your initial premise here. I will say that my freedom's end where yours begin. I just think that this works both ways. I can't rob you, you can't rob me, politicians shouldn't be able to rob either of us. Controlling incentives is no different than interfering in people's choices. It is using force to make someone do what you want in order to prevent actions that do not violate your freedoms.

We do disagree on the fundamental question: what is the proper role of government. You want the free market to operate unfettered. I have spent too much time in the free market and government-run organizations to pretend that we just want to turn the free market lose in something like health care. People are people, and they often don't play nice. At least with government, we have a little electoral control over them. I'm not suggesting that the government should control everything, which is why I actually like the idea of many competing health insurance companies doing much of the heavy lifting when it comes to paying for healthcare.

I haven't pretended this at all. To quote DeCartes: "Power corrupts, and absolute power corrups absolutely." I want to decentralize power. An evil person can head a corporation, but he doesn't have the guns of the government.

Our government doesn't have absolute power. If it did it would be more corrupt. The ironic thing is that several countries that tax heavily actually see less corruption:

http://www.nationmaster.com/graph/gov_cor-government-corruption

I also suspect that corruption would organize despite your efforts to decentralize. Also, criminals (even the white collar kind) do have guns, but usually they just take money because that's all they want.

Right now, many of these heads use the government through shady dealings to use those guns to their advantage.

I would argue that U.S. corruption is slightly less than in a place like, say, Russia or Cayman islands.

With a limited government, that doesn't deal significantly in the economy, there would be no evil men with guns enforcing false market controls to the detriment of the common man. I am acknowledging that corruption is just a part of human nature, and that the solution to corruption is a de-centralization of power that prevents a few corrupt individuals from controlling everything.

In theory maybe. The EU has heavily decentralized government compared to the U.S. with its states and has some of the highest taxes in the world. Your ideas don't seem to match what is happening.

... I want to minimize coercion and maximize freedom in all human endeavors.

I would like to maximize quality of life and minimize suffering for the population while preserving freedoms as well. It's a question of balance, priorities, methods, and, values. The devil is in the details. Because he is a fellow citizen, Does a poor landscaper deserve heart medication even if he cannot afford to pay the full price? If so, how much care $$ does he deserve and how are we going to pay for it. I would say he deserves to get some baseline level of care even if that means "stealing" some money with taxes from the person who can pay for medication. You disagree. If he can't pay for it without going without food or shelter, too bad. Moreover, you're unwilling to have the government step in if he is getting incompetent care. If the landscaper can't tell a competent physician from an incompetent physician, too bad.
 
Thanks! You make intelligent arguments as well.



We both know that this is often a good assumption, but not a perfect one. This is one example as to why the government needs to help, IMO.
Actually, I think it is an example of the problem. The government controls those medical boards, and bad doctors still exist. The mandatory years of training and all the credentials in the world have just made it difficult to become a good doctor. All of the quacks don't become doctors, don't go through medical boards, and can market themselves much more efficiently to the detriment of quality medicine.

Without government regulation, you would be able to get an MD with much less education and training than we currently receive and that most people would find acceptable. It's tough enough to get rid of incompetent MD's right now. I couldn't imagine a system without medical boards.
Again as above. I think that some of what I learn is unnecessary, and some of what I should learn is glossed over. Perhaps 11 years minimum training from High School to minimum board certification is excessive.


It would be great until a relatively large percentage of patients started getting injured from complications. It's one thing to get cheated by a used car dealer. It's quite another to have your gallbladder surgery botched.
I can tell you that atleast in Miami, you're much more likely to be killed by your car than your doctor. Why does discount have to equal incompetence. It wouldn't take many deaths before the news leaked out, and companies would have strong incentives not to kill people for that very reason.


We do disagree on the fundamental question: what is the proper role of government. You want the free market to operate unfettered. I have spent too much time in the free market and government-run organizations to pretend that we just want to turn the free market lose in something like health care. People are people, and they often don't play nice. At least with government, we have a little electoral control over them. I'm not suggesting that the government should control everything, which is why I actually like the idea of many competing health insurance companies doing much of the heavy lifting when it comes to paying for healthcare.
I agree that not everyone plays nice in the free market. The problem is that they don't play nice in government either. Don't take this the wrong way, but I think that you have to be delusional to think that we have any control at all. Our two party system is no different than the choices that they had in communist Russia. You can vote for comrade Yakov or Comrade Strabinsky. The electoral process delivers a false choice. As a third party voter, I can tell you that my candidate (who happens to come from the 3rd largest political party in America) was not allowed to participate in debates held at taxpayer expense.

The other thing here, is that I believe that my rights supercede a democratic majority. I have specific constitutional freedoms that should not be taken away. The modern electoral process continually progresses to abolish the Republican ideals on which we were founded in the name of a mob rule democracy, and I don't like what the mob has to say about my personal property and freedoms.

I have written a number of things about the market and healthcare on my blog. Writing them here would be excessive. Feel free to read them there.

Our government doesn't have absolute power. If it did it would be more corrupt. The ironic thing is that several countries that tax heavily actually see less corruption:

http://www.nationmaster.com/graph/gov_cor-government-corruption

I also suspect that corruption would organize despite your efforts to decentralize. Also, criminals (even the white collar kind) do have guns, but usually they just take money because that's all they want.
You're right. They don't have absolute power. I hope to keep it that way. You are correct that criminals have guns. My point was that the biggest guns of all are in the hands of the government. When the government takes my money under threat of arrest and gives it to another person against my will, it is no different than if a thug robs me on the street corner because he "needs money."

I am not nieve enough to believe that coercion will cease to exist. I want to spread around power, so that the ability to coerce on a large scale is limited.

As to your last point, taxing at a high level by definition IS corruption in my book, so the statement you made cannot be true above. Of course, that is because we define corruption differently.


I would argue that U.S. corruption is slightly less than in a place like, say, Russia or Cayman islands.
I don't know anything about the Cayman Islands. Russia is less than 20 years out of outright communism, and it is worse. That doesn't make it acceptable here.

In theory maybe. The EU has heavily decentralized government compared to the U.S. with its states and has some of the highest taxes in the world. Your ideas don't seem to match what is happening.
The EU didn't even exist not too long ago. The individual governments in the EU countries are FAR more centralized than they are in the US. The rapid rise in centralization of power within the EU, with individual governments turning more power over to the union leaders, is a speedy and dangerous trend. Your statement divorces the EU from its own history. European countries have become SO centralized, that they actually took government outside of their own borders and created a new EU government so that they could be even further centralized. I think this example just proves my point.


I would like to maximize quality of life and minimize suffering for the population while preserving freedoms as well. It's a question of balance, priorities, methods, and, values. The devil is in the details. Because he is a fellow citizen, Does a poor landscaper deserve heart medication even if he cannot afford to pay the full price? If so, how much care $$ does he deserve and how are we going to pay for it. I would say he deserves to get some baseline level of care even if that means "stealing" some money with taxes from the person who can pay for medication. You disagree. If he can't pay for it without going without food or shelter, too bad. Moreover, you're unwilling to have the government step in if he is getting incompetent care. If the landscaper can't tell a competent physician from an incompetent physician, too bad.
Just because a person is a fellow citizen doesn't give him a hold over me. I don't owe him anything. I may choose to help him, and I believe that is good, but I should not HAVE to. A person deserves what he has earned. Anything beyond that is charity, and charity shouldn't be forced. The poor landscaper earns a certain amount, and that is what he deserves. I also disagree with your assumption that the government being in the market prevents him from getting competent care. On the contrary, the control of the supply of drugs and physicians is probably why he can't afford heart medication.

Feel free to read my blog on the topic of positive vs. negative rights for further explanation.
 
So you're arguing that the Russian oligarchy and House of Saud will be able to single-handedly support the entire American medical infrastructure?

C'mon, not even you are that out there.

I never said that at all. He said that they come here, because we can give healthcare that no one else can. I said that was true, because it is.
 
So you're arguing that the Russian oligarchy and House of Saud will be able to single-handedly support the entire American medical infrastructure?

C'mon, not even you are that out there.


No, not at all. I'm not implying the foreignors can support us, but rather we're obviously doing something right when they all categorically choose America when in ill health.

I'm just saying that people (not necessarily you) like to whine and moan about how many problems our healthcare system has and how we should move to a more socialist approach (canadian/european), but I don't know of any wealthy people who willingly choose the socialist way over the American one. whew, long sentence.

America has the best healthcare system in the world despite some of our problems. I don't think anybody here will disagree with that.

Now, "universal healthcare coverage in cali" is a socialist move by a RINO politician. my fears are this:
- socialist medicine will lower our quality of care. Just ask the average Joe's in canada/europe caught up in the so called "free healthcare" multi-year operation waiting lists.
- There will always be a set amount of "bums" that won't pay anything, but will benefit from the rich covering them.
- there will be a sacred few who earn so little, they will be exempt, but covered.
- politicians will dictate how to spend the rich's taxed money for this delivery system.


Truthfully, I would be very concerned right now if I lived in California.
 
I never said that at all. He said that they come here, because we can give healthcare that no one else can. I said that was true, because it is.

Seems I read him wrong. I had interpreted his sentence to mean, "We're doing fine because foreigners are brining a lot of money into the system."

My appologies.
 
no, didn't mean that at all. 😉

I know people here think we're backwards for not providing health coverage for all, but the fact is, if the free market system we have now was so wrong, the super rich wouldn't be treating themselves and their families here. Europe is a much closer destination for the saudi's and russians, but they still come here.

a free market system is still the best course for this country b/c the quality of healthcare remains high.
 
Actually, I think it is an example of the problem. The government controls those medical boards, and bad doctors still exist. The mandatory years of training and all the credentials in the world have just made it difficult to become a good doctor. All of the quacks don't become doctors, don't go through medical boards, and can market themselves much more efficiently to the detriment of quality medicine.

So with your reasoning, we should abondon the police forces because, after all, criminals do get away once in a while. My suggestion is that we don't dump the entire system just because it has some flaws.

Again as above. I think that some of what I learn is unnecessary, and some of what I should learn is glossed over. Perhaps 11 years minimum training from High School to minimum board certification is excessive.

Conceptually I agree with you. I would also like it if physicians were always kind and considerate to one another and the staff. I could go on and on with my wishes. Wishes aside, the current system is workable and provides us with excellent physicians for the most part. Physicians also have a decent career and aren't wondering if they will have a job when they do make it through.

I can tell you that atleast in Miami, you're much more likely to be killed by your car than your doctor. Why does discount have to equal incompetence. It wouldn't take many deaths before the news leaked out, and companies would have strong incentives not to kill people for that very reason.

In the U.S. people die or are injured every day in preventable industrial accidents and you will almost never hear about these accidents unless the fireball is so atomic in size that the company cannot hide it (which is partly why these facilities are often in the middle of nowhere). Unless you've been in the business and seen these accidents with your own eyes, like I have, you would never know about them. One particularly memorable call to a company I did a lot of work with went something like this: we did this and that (totally misusing this company's industrial product) and next thing you know it was raining fire at our plant ... and right now we have every person is out there with a firehose trying to contain the blaze. This incident never made the news.

Bigger explosions do make it on the news, of course. I still remember when the Phillips 66 plant blew near Houston 1989. I still remember looking out of my window in the Galleria and seeing this huge column of black smoke rising in the far distance on a beautiful clear October day. I was working on a project for that plant. Had I been there on that day I could have been killed or injured.

http://www.mpri.lsu.edu/workshop/SACHE%20Text.pdf
"On October 23, 1989, a massive explosion demolished the Phillips 66 Company polyethylene plant in Pasadena, TX, (a Houston suburb) when more than 85,000 lbm of flammable material was instantaneously released to the atmosphere. This massive gas cloud was ignited within less than two min. The initial explosion threw debris as far away as six miles and registered between 3 and 4 on the Richter scale on Rice University seismographs. There were many secondary explosions. In all, 23 lives were lost and 314 people were injured. Capital losses were initially estimated at over $715 million. Business disruption losses were nearly as great, $700 million."

You would think that after something like that the company itself would be a little more careful. The incident was 100% preventable and caused by maintenance bypassing the safety features of the equipment involved, maybe because it saved a few dollars. Insurance paid for a lot of the losses so the company really didn't take that big of a hit. Did they learn from the experience? Well, read this:

http://www.chron.com/disp/story.mpl/special/05/blastarchive/505309.html
"MARCH 27, 2000
Phillips plant blast kills 1, injures 71
Investigators seek cause of inferno

"An explosion and fire ripped through a section of the Phillips Petroleum Co. plant in Pasadena on Monday, killing one worker, injuring at least 71 others and shutting the complex down.
At least three of the injured were listed in critical condition at Memorial Hermann Hospital, and six were listed in serious condition. Officials there and at other hospitals that received victims said the injuries included burns, cuts from flying fragments of debris, and injuries from falls.

Huge flames erupted after the 1:22 p.m. blast, sending a massive column of black smoke upward and spurring area school officials to seal their buildings and keep children inside as a precaution against the possibility of toxic fumes. The fire finally was extinguished shortly before 5 p.m., and Phillips officials said their monitors found no sign that anyone outside the plant was exposed to toxic chemicals. "

Phillips was actually a pretty good company by comparison ... by far not the worst. The bottom line for too many companies is their bottom line. There are millions of dollars to be made, and a few dozen workers lives will be sacrificed to achieve this goal.

When was the last time your tax return blew up and started a massive inferno with several people dead and dozens injured?

If healthcare was run like these industrial companies (some say we are already experiencing that to an unacceptable extent) ... more or less by the free market with people who have few government regulated requirement compared to healthcare, the cost to human life and injury would be enormous and unacceptable to most Americans.

Yes, could argue that these explosions happened despite extensive government regulations. While the government does heavily regulate these industries, it is pretty clear that what our society expects from these companies and what the company would like to do are often not aligned because it can be hard to compete in a market and the temptations to cut corners are huge. Also, in comparing our facilities to facilities overseas where the government is much more lax, the work-related injuries and effect on the neighboring population in birthdefects and serious health issues are the price that the population pays. As bad as we have it here, others with minimal government have it much much worse.

Have you followed the oil spills related to the Alaska pipeline? When BP didn't like the inspection results they saw, they just stopped inspecting altogether. Even after several environmental spills the company seems to be doing very little, and what it is doing is being driven by the action of government.

Companies provide work situations where people are killed or injured all the time and no one really gives a flip except the government in some cases, because the amount of cash to be made is huge by avoiding the expense of a safe operation and the downside is very small by comparison. Without the government's role, we would be living in a toxic swamp and we would have a lot more amputees running around.

Although government regulators are often fairly weak, I have seen them save lives on numerous occasions by forcing companies to make corrections. The public often never knew about the issue, and, even if they did, could do absoutely nothing about it without the government's role.

I agree that not everyone plays nice in the free market. The problem is that they don't play nice in government either. Don't take this the wrong way, but I think that you have to be delusional to think that we have any control at all. Our two party system is no different than the choices that they had in communist Russia. You can vote for comrade Yakov or Comrade Strabinsky. The electoral process delivers a false choice. As a third party voter, I can tell you that my candidate (who happens to come from the 3rd largest political party in America) was not allowed to participate in debates held at taxpayer expense.

Ah, no. There are opportunities to influence the government. You mentioned Miami. Do any close election counts come to mind ... something close to Miami? Maybe you have followed Florida elections where candidates were elected by the slimmest of margins? Votes really do count more than you are making it out to be. If you want to do more than vote, you can also get involved in the political parties themselves or lobby lawmakers directly. No, it isn't easy, but it's much easier than controlling what a private company does, which is effectively impossible without government intervention.

The other thing here, is that I believe that my rights supercede a democratic majority. I have specific constitutional freedoms that should not be taken away. The modern electoral process continually progresses to abolish the Republican ideals on which we were founded in the name of a mob rule democracy, and I don't like what the mob has to say about my personal property and freedoms.

Yeah, well, the constitution continued legal slavery as well and didn't give women the right to vote either, so I would be careful in using the constitution as a gold standard. It was a document created by bright thinkers and was very well done, but it had mortal flaws that thankfully were correct by brilliant minds throughout our Nation's history. If you don't like what the "mob" has to say about your personal freedoms, try living in another country instead. Maybe you should try Saudi Arabia, Iraq, Iran, or Somalia and report back. Maybe if you get attacked by a real mob and publicly beaten for your lack of conformity you'll appreciate the freedoms we do have here. For the average person, America is about as good as it gets when it comes to freedom and quality of life. You seem very unappreciative of what you have here.

I have written a number of things about the market and healthcare on my blog. Writing them here would be excessive. Feel free to read them there.

Sure, I can understand that. However, SDN is a nice place to discuss issues as well.

You're right. They don't have absolute power. I hope to keep it that way. You are correct that criminals have guns. My point was that the biggest guns of all are in the hands of the government. When the government takes my money under threat of arrest and gives it to another person against my will, it is no different than if a thug robs me on the street corner because he "needs money."

My guess is that it has been a little while since a thug robbed you on the street or you wouldn't be talking like that. They are vastly different experiences and no one I know who has experienced a life-threatening experience involving armed robbery would ever dream of comparing it to filing a tax return and writing a check for $20,000 or whatever to Uncle Sam. Being robbed at gun-point is a truly life changing experience that people who have been through it would never trivialize or compare cutting a check or having taxes withheld the way you have done so here.

I am not nieve enough to believe that coercion will cease to exist. I want to spread around power, so that the ability to coerce on a large scale is limited.

So, you're more comfortable taking on the local Sheriff and his deputees than Federal Agents? I wouldn't give you one in a million odds in being able to take on either one successfully. Most of your interaction with government (sales taxes and the like) is already local. One hyperactive local city council can make your life very unpleasant.

The EU didn't even exist not too long ago. The individual governments in the EU countries are FAR more centralized than they are in the US. The rapid rise in centralization of power within the EU, with individual governments turning more power over to the union leaders, is a speedy and dangerous trend. Your statement divorces the EU from its own history. European countries have become SO centralized, that they actually took government outside of their own borders and created a new EU government so that they could be even further centralized. I think this example just proves my point.

Europeans have indeed voted to centralize government among their countries to create the EU. They did this to compete and improve their economic situation and quality of life. The EU has been a huge success in this regard. One thing it has done has enabled Europeans to eliminate the many different currencies, the exchange of which was costing the economies a lot of money every year for basically nothing and leaving individual countries vulnerable to exchange rate swings. On the legal front it has enabled them to take on the likes of Microsoft and making sure that large multinationals are held accountable to the standards that Europe wants and benefit them (this would have been much much more difficult for the smaller individual states). However, you also trivialize the role of local government in Europe. You can rest assured that Europeans have a long history of strong local government across the continent ... with some cities (relatively small by our standards) having a city-state tradition considerable local power. A lot of that kind of local power has been eliminated because it was ineffective, inefficient, and, at times, unfair. Europeans have realized the benefit of coordinating economic, educational, and military efforts, and the EU has been doing quite a bit in this regard to protect European interests in a way that the individual member states would have a difficult time accomplishing.

Closer to home ... have you ever dealt with a homeowners association gone awry? That's local "government" of sorts, and, oh boy, can it get nasty. I wouldn't wish a nutty homeowners association on my worst enemy. I know people who were essentially forced to move because they got into a fight with the homeowners association. If you think that such local "government" is somehow less likely to interfere with your property, you are missing a lot of experiences that I have seen too often. I realize that the homeowners assocation is not the same thing as a government, but it acts a little bit like a government and is about as local as you can get. A nutty small town government would not be any better. I'm glad that there is a federal government that can step in when the local mayor starts buying votes to get re-elected.

Just because a person is a fellow citizen doesn't give him a hold over me. I don't owe him anything. I may choose to help him, and I believe that is good, but I should not HAVE to. A person deserves what he has earned. Anything beyond that is charity, and charity shouldn't be forced. The poor landscaper earns a certain amount, and that is what he deserves. I also disagree with your assumption that the government being in the market prevents him from getting competent care. On the contrary, the control of the supply of drugs and physicians is probably why he can't afford heart medication.

You are fighting American culture and values here. You might think that Americans have no social obligation to provide health care to the poor who are unable to afford it, but most Americans think we do have a least a minimal care obligation. How many votes did the Libertarian party get in recent election? 3%? You are part of a small fringe group that is out of step with the mainline culture. In order for your ideas to be implemented, your opinion would need to prevail over the other ~97% of the population, which would be well beyond unfair. There are probably more racists in this country than Libertarians, and I don't think we should cater to either group. Idealisticly, I would agree with Libertarians that everyone should take responsibility for paying for their health, food, shelter and so on, but from what I can tell, this would take us in the wrong direction toward a society similar to that of the 3rd world where a few rich families rule the roost and millions of others are lucky if they have running water.

Feel free to read my blog on the topic of positive vs. negative rights for further explanation.

Sure, I took a brief look at it. There are similar arguments to what we have discussed here. Here is a comment from one of your readers:

http://www.blogger.com/comment.g?blogID=33603150&postID=116145205194367406
"Society changes and shouldn't the law and government change with it? Certainly the other way around would be no good.
Also, the concept of a free market works wonderfully for most things. But healthcare is fundamentally unlike most things. It is a matter of life and death. It can be catastrophic and completely unexpected, and last a lifetime. It can stop a person from working, from functioning, change their life 180 degrees. Things like housing and food are considered part of rights because society has changed HOW we live. We live in houses and eat a certain amount to be considered healthy. We have certainly changed, like you mentioned, how we treat illness. And society/law should change with it."
 
"They did this to compete and improve their economic situation and quality of life. The EU has been a huge success in this regard. "


double digit unemployment isn't exactly the mark of a "huge success". come on, you libs were all over Bush when unemployment rose over 6% in the economy he inherited and that was the mark of a "huge failure".

you can't make this too easy for me.
 
"They did this to compete and improve their economic situation and quality of life. The EU has been a huge success in this regard. "


double digit unemployment isn't exactly the mark of a "huge success". come on, you libs were all over Bush when unemployment rose over 6% in the economy he inherited and that was the mark of a "huge failure".

you can't make this too easy for me.

You're right. The EU still has a long way to go. By huge success, I meant that it eliminated a lot of waste (particularly in currency exchange) compared to the "local rule" that Miami_Med was singing the praises of.

The EU has helped member countries by centralizing their government more (although many Europeans are dissatisfied with progress):

http://www.dti.gov.uk/europeandtrade/europe/benefits-eu-membership/page22676.html
EU Gross Domestic Product (GDP) in 2002 was 1.8% higher (€164.5 billion) [£110 billion] than it would have been without the Single Market.
Over ten years, the Single Market has boosted the EU's GDP by €877 billion [£588 billion]. This represents €5,700 [£3,819] of extra income per household.
EU Employment has grown (1992-2002) by 1.46% (an extra 2.5 million jobs) thanks to the Internal Market. Up to 3 million British jobs are linked to exports to the EU, around ten percent of the total workforce.
Intra-EU trade has increased as a percentage of GDP from less than 25% in 1993 to 35% in 2005
Foreign direct investment in the Single Market has risen from €23 billion [£15.4 billion] in 1992 to €159 billion [ £106.5 billion] in 2005.
60 Million customs clearance documents per year no longer need to be completed, cutting bureaucracy and reducing costs and delivery times.

Also Euro Zone unemployment is not double-digit:

http://www.tutor2u.net/economics/content/topics/europe/unemployment_introduction.htm

"The recent slowdown in the Euro Zone economy has seen unemployment rising above 8.5% in the summer of 2003."

EU (black) unemployment went down while U.S. (blue) unemployment went up:

europe_unemployment_1.gif


http://epp.eurostat.cec.eu.int/pls/...REREL_YEAR_2006_MONTH_03/3-01032006-EN-BP.PDF
Current (Jan 2006): Euro-zone unemployment stable at 8.3%. EU25 unchanged at 8.5%

http://www.federalunion.org.uk/europe/060610EuropevsAmerica.shtml
"The main reason the US is richer is because, first, a higher proportion of Americans are in employment and, secondly, they work about 20 per cent more hours per year than Europeans. When we look at GDP in 2005 per person per hour worked, there is virtually no difference between Germany, France and the US. ...

"Equally, if we look at employment data by age group, Americans join the work force earlier and leave it far later than Europeans. The key to understanding why this has happened is the change in US income distribution over the past 30 years. Since 1979, the bottom 40 per cent of income earners in the US has been treading water while the bottom 20 per cent has become poorer. US workers have needed to put in more years and longer hours simply to maintain their real income position. "

However, I do prefer living in the U.S. because I believe that there are more opportunities here, both economic and otherwise. You do have the opportunity to work harder and make a better life for yourself in a way that is more difficult in Europe as far as I can tell. I also think the U.S. does a better job incenting people to work than the EU does. In Europe you can be lazy and take advantage of social services and benefits that is not possible in the U.S. My preference is to learn from both and pick the best practices and respect the culture of each country. Also, I love the wide-open spaces, etc. This country has provided an excellent life for me, and I appreciate that. This is actually a big reason I am going into medicine: to give something back. I value our freedom and constitutional rights. At the same time, I disagree with extreme positions such as those taken by Libertarians who want to remove all social services and benefits.

I consider myself to be conservative. At the same time, I, like most Americans, believe that universal basic health care is something we can afford to provide and that such expenditure, not unlike roads or public education, are investments that pay positive dividends. Looking at it purely in economic terms, a healthy population has a greater economic output than a sick one. I have many differences with liberals. For example, I believe that even the poor should pay something for their health care services ... even if it's small change. By contributing to the cost of the care, they would appreciate it more and do what they can. Everyone should contribute to our public systems, not just the middle class and the wealthy.
 
Comparing Public Roads to Universal Health Care is a much less than ideal analogy, although it sounds slick and tidy. Generally, Construction workers on Road Projects are getting paid on par with workers on Privately funded projects. Don't miss this fundamental key: Publicly-funded Road Projects are awarded to Construction companies through a Bidding Process. This allows the market to set the price for the Road Construction that occurs with Public Funding.

This is not the case with Publicly Funded Health Care. The government would not be taking bids from Healthcare providers and thereby letting market forces prevail. Uncle Sam would dictate the price by setting the reimbursment schedule. Healthcare workers would be compelled to accept these fees, which would more than likely be much less than the market price.

If you look at the State sponsored Health care systems currently in place, you will see that most are not doing so well - Medicare and Medicaid are the prime examples. Neither of these systems are well known for remunerating healthcare professionals at the market determined healthcare prices. Who is taking the cut in pay here? Well, taxpayers as a whole are taking a cut through their tax burden, and Doctors have the additional cut taken directly out of their salaries in the form of low government reimbursment.
 
Universal coverage is great. Now everyone can have an ambulance take them to the ER for every headache they get. The EMTs can't diagnose them, so they don't know if it's a migraine or an aneurysm, so off to the hospital they go!
 
If I experience the worst headache of my life you can beat that I'll be in the ED. Now for me, at the moment, this requires taking an elevator ride, so no ambulance involved . . . but I'd still want to be evaluated by a physician post haste.
 
Comparing Public Roads to Universal Health Care is a much less than ideal analogy, although it sounds slick and tidy. Generally, Construction workers on Road Projects are getting paid on par with workers on Privately funded projects. Don't miss this fundamental key: Publicly-funded Road Projects are awarded to Construction companies through a Bidding Process. This allows the market to set the price for the Road Construction that occurs with Public Funding.

This is not the case with Publicly Funded Health Care. The government would not be taking bids from Healthcare providers and thereby letting market forces prevail. Uncle Sam would dictate the price by setting the reimbursment schedule. Healthcare workers would be compelled to accept these fees, which would more than likely be much less than the market price.

If you look at the State sponsored Health care systems currently in place, you will see that most are not doing so well - Medicare and Medicaid are the prime examples. Neither of these systems are well known for remunerating healthcare professionals at the market determined healthcare prices. Who is taking the cut in pay here? Well, taxpayers as a whole are taking a cut through their tax burden, and Doctors have the additional cut taken directly out of their salaries in the form of low government reimbursment.

Yes, these are valid concerns. The recent Medicare Prescription Drug Benefit plan has shown that it is possible to take bidders, and that costs can actually come in lower than expected with a program like that. On the downside the program was criticized as being much more complicated than the more typical government program. Overall, I get the impression it is a good program.

Health professionals do have a choice. They are not required to accept Medicare, Medicaid, Medi-Cal, etc., and some choose not to. Many who do accept these programs also throttle their participation in those programs by limiting the number of patients of these groups that they accept.

You can't deny the fact that adding 4 million or however many uninsured to the system in California is going to increase revenues for physicians and hospitals overall. I'm convinced that there aren't enough physicians in California who would be able to pick up the slack and they will be in a relatively strong negotiating position ... stronger than they are now anyway. Remember most of these programs still use health insurance companies to actually manage much of the business side. Physicians who have enough patients can limit the insurance / programs that they accept. I suppose they could even move to another state if it turns out to be really bad. States are experimenting with various universal coverage program and want to strike the right balance between meeting the health needs of the population and controlling costs. It's going to be tough, but the problem must be addressed one way or the other. The uninsured are swamping emergency rooms and some argue that they are actually costing more this way then the would if they had insurance.
 
Universal coverage is great. Now everyone can have an ambulance take them to the ER for every headache they get. The EMTs can't diagnose them, so they don't know if it's a migraine or an aneurysm, so off to the hospital they go!

Exactly. With insurance coverage, they, in theory could see a less expensive primary care physician. In practice, I don't think we have enough physicians. Maybe PA's will pick up the slack, but there aren't very many of them either.

Right now, the more high-tech procedures a physician or hospital does, the more they get paid. Hence, we get more high-tech procedures (MRI's etc, @ $450 profit per use). Maybe HMO's are the answer. I'm not sure. What I do know is that right now the financial incentives in medicine are not in alignment with improving health of our population. In fact, the sicker the population gets, the more physicians stand to make financially.
 
Exactly. With insurance coverage, they, in theory could see a less expensive primary care physician.
Haha. My city is full of people on T19 (free) insurance, and they could go see a doctor regularly, or they could wait until the problem was horrible and call an ambulance at 3am to go to the ER and waste thousands of dollars. The number of people who do the latter is just astounding. People call 911 and go to the ER when they have a hangover. Why? Because it's freeeeeee. There needs to be a system of co-pays at the least, or the system will be abused mercilessly.
 
Haha. My city is full of people on T19 (free) insurance, and they could go see a doctor regularly, or they could wait until the problem was horrible and call an ambulance at 3am to go to the ER and waste thousands of dollars. The number of people who do the latter is just astounding. People call 911 and go to the ER when they have a hangover. Why? Because it's freeeeeee. There needs to be a system of co-pays at the least, or the system will be abused mercilessly.

People should have to pay to use the system (co-pays). People who cannot pay should provide community service instead, such as helping in a daycare, litter patrol, etc. In fact, we could put them to work right after they sleep off the hangover. That should cut down on frivolous trips to the ER. Let's see, discharge orders, ok, you'll be mopping the east wing 2nd floor today ... :laugh:
 
So with your reasoning, we should abondon the police forces because, after all, criminals do get away once in a while. My suggestion is that we don't dump the entire system just because it has some flaws.
I'm not exactly sure how many times I have to say that I think that defense is the one role of the government. I believe in having police, though I do recognize them as often being less than ideal.

Conceptually I agree with you. I would also like it if physicians were always kind and considerate to one another and the staff. I could go on and on with my wishes. Wishes aside, the current system is workable and provides us with excellent physicians for the most part. Physicians also have a decent career and aren't wondering if they will have a job when they do make it through.
Yes, though the current system is very expensive. I've never said that everything is horrible, but I see the current suggestions in California as a dangerous road that will take some of the serious flaws in the system and make them potentially fatal.

In the U.S. people die or are injured every day in preventable industrial accidents and you will almost never hear about these accidents unless the fireball is so atomic in size that the company cannot hide it (which is partly why these facilities are often in the middle of nowhere). Unless you've been in the business and seen these accidents with your own eyes, like I have, you would never know about them. One particularly memorable call to a company I did a lot of work with went something like this: we did this and that (totally misusing this company's industrial product) and next thing you know it was raining fire at our plant ... and right now we have every person is out there with a firehose trying to contain the blaze. This incident never made the news. .......

I just cut off the bottom of this because it was too long to repost.

I've actually worked in the business and seen accidents. I did warehouse labor in the shipping department of a factory that produced car speakers, landscaping, and I even had a stint at Home Depot (which was admittedly not very accident prone, though I was almost killed by a forklift once). The thing about these companies, is that no one is enslaved to work for them. They do it as a choice. People, and companies, have to weigh the risk and benefits of certain courses of action all of the time. It's not that I don't want people to be safe at work. It's that the determination of how safe is safe, and how safe is necessary are not single-handed, and they shouldn't be decided by the government.

When you talk about preventable, these things have a cost of prevention. Every dollar spent on prevention lowers total productivity, lowers efficiency, and lowers the quality of life in terms of higher prices for all of the people who use a product. There are plenty of good arguments for prevention as well. You know them, and I won't bother to re-write them. However, there has to be a balance, and a worker has to determine whether that balance suits him when he takes a job with a company. If he feel endangered, he should quit and find new work. If he can't find new work, then one has to argue whether current market conditions allow for different working conditions in his industry, and whether the economic reality of things really makes "preventable" accidents preventable.

Phillips was actually a pretty good company by comparison ... by far not the worst. The bottom line for too many companies is their bottom line. There are millions of dollars to be made, and a few dozen workers lives will be sacrificed to achieve this goal.
Your argument assumes that workers are powerless. They are not. Unless you are talking about a military draft (which for some reason is allowed to violate our constitutional ban on involuntary servitude), no one has even argued that private slavery should be legal in this country for 50 years. These lives put themselves in harms way. If the company intentionally lied about working conditions, then they committed fraud, and that is the crime that should be prosecuted. That is a violation of the rights of the individual who was lied to. If the worker knew the job was dangerous however, that was a choice.

When was the last time your tax return blew up and started a massive inferno with several people dead and dozens injured?
All of the people who can't afford healthcare due to hospital pseudo-monopolies enforced by a police force funded by my tax dollars come to mind. Of course, if you really need an example, please turn on the TV and watch the war in Iraq, where over 100 times as many Americans have died as all of the industrial accidents you mentioned, and the economic cost is more per day than the grand total of all the losses that you mentioned.

If healthcare was run like these industrial companies (some say we are already experiencing that to an unacceptable extent) ... more or less by the free market with people who have few government regulated requirement compared to healthcare, the cost to human life and injury would be enormous and unacceptable to most Americans.
Then they would pay a premium for safer conditions, and the company that was safer would make more money and put the others out of business. Competition can occur with lower prices or higher quality. We live in a world that supports McDonald's and Steak Houses.

Yes, could argue that these explosions happened despite extensive government regulations. While the government does heavily regulate these industries, it is pretty clear that what our society expects from these companies and what the company would like to do are often not aligned because it can be hard to compete in a market and the temptations to cut corners are huge. Also, in comparing our facilities to facilities overseas where the government is much more lax, the work-related injuries and effect on the neighboring population in birthdefects and serious health issues are the price that the population pays. As bad as we have it here, others with minimal government have it much much worse.
Because society is a collection of individuals, it cannot expect anything. What you really mean is that many people within society expect regulation. You may be right, but I believe that it is irrelevant. They are still intruding on a willing contract between two individuals, and that violated the fundamental rights of property AND association.

The other countries you are talking about have other problems. Causing birth defects in the population IS aggression against those populations, and the companies should be held accountable. This is NOT because of the danger or lack of it, but because the companies violated the rights of the individuals who DID NOT choose to be involved with the company.

Someone who has toxic waste leak into their water without their knowledge, drinks it, and has an unhealthy child HAS BEEN WRONGED. Their rights have been violated. Defending them IS a valid role of government, but it is because they did not CHOOSE to associate with the company involved, and were not given the right to choose to take the risks that they took.

[QUOTE}
Have you followed the oil spills related to the Alaska pipeline? When BP didn't like the inspection results they saw, they just stopped inspecting altogether. Even after several environmental spills the company seems to be doing very little, and what it is doing is being driven by the action of government.[/QUOTE]

This is actually a problem of a lack of private property. It falls under the law of the commons. Because nobody owns the area that these spills occur in, no one cares to take care of it. In fact, if oil companies actually owned the places that they drill, rather than leasing it from the government, they would have MUCH larger incentives to protect it.

Companies provide work situations where people are killed or injured all the time and no one really gives a flip except the government in some cases, because the amount of cash to be made is huge by avoiding the expense of a safe operation and the downside is very small by comparison. Without the government's role, we would be living in a toxic swamp and we would have a lot more amputees running around.
Not if private property rights were enforced. Your house would only be a toxic swamp if you chose to let it become so.

Also realize that there are ways to stop a company without getting the government involved at all. If people were REALLY unhappy, rather than complaining that the government should do something, they will stop buying your product. A boycott can do more damage to a company than a regulation. If people keep buying the product, even by your own arguments, they must not REALLY disapprove of the companies operations enough to not take what they are selling.

Although government regulators are often fairly weak, I have seen them save lives on numerous occasions by forcing companies to make corrections. The public often never knew about the issue, and, even if they did, could do absoutely nothing about it without the government's role.
There is also no reason why a company, for public relations, couldn't subject itself to a private quality control third party. If people really are in favor of this, they will support the company for doing so. If you argue that they could pay off the company, this can already be done with government officials. A company cannot survive without support from the workers and the people. The public controls the fate of a company. They will only sacrifice lives for lower prices if the public willingly buys the products.

Ah, no. There are opportunities to influence the government. You mentioned Miami. Do any close election counts come to mind ... something close to Miami? Maybe you have followed Florida elections where candidates were elected by the slimmest of margins? Votes really do count more than you are making it out to be. If you want to do more than vote, you can also get involved in the political parties themselves or lobby lawmakers directly. No, it isn't easy, but it's much easier than controlling what a private company does, which is effectively impossible without government intervention.
I'm not saying that we didn't influence the 2000 election. I said that the choice was a false one. Both choices were bad. In the 2004 election, my candidate was excluded from all national debates, he wasn't allowed to fundraise effectively due to campaign finance reform (easy to get around if you are DEM or REP, hard if you are LIB and don't have expensive lawyers), and he had to compete against the major parties that used MY tax dollars to compete AGAINST my candidate.


[QUOTE[
Yeah, well, the constitution continued legal slavery as well and didn't give women the right to vote either, so I would be careful in using the constitution as a gold standard. It was a document created by bright thinkers and was very well done, but it had mortal flaws that thankfully were correct by brilliant minds throughout our Nation's history. If you don't like what the "mob" has to say about your personal freedoms, try living in another country instead. Maybe you should try Saudi Arabia, Iraq, Iran, or Somalia and report back. Maybe if you get attacked by a real mob and publicly beaten for your lack of conformity you'll appreciate the freedoms we do have here. For the average person, America is about as good as it gets when it comes to freedom and quality of life. You seem very unappreciative of what you have here.[/QUOTE]
1. We have a method to amend the constitution. I have a philosophy about what it should say, but I am not using it as perfect. I do think that our laws should follow it, and if a law is in violation of the constitution, it should be abolished.

2. I never said that I didn't appreciate what I had. That doesn't mean that I won't fight to keep it. It also doesn't mean that I won't fight to make things better.

3. I agree that the average American has it best. I believe that it is a DIRECT result of the freedoms we do have and the amount of capitalism in the economy. I want to keep it that way. I believe what I believe, because I do appreciate what I have, and I would hate to see it disappear. As I said before, I stay here because this country most closesly resembles my ideals compared to any other option.

As was said by George Bernard Shaw (ironic because he was a socialist)- "A reasonable man adapts to the world around him, while an unreasonable man expects the world to adapt to him. Therefore, all progress is made by unreasonable men." I may have not quoted that perfectly, but the idea is the same.


My guess is that it has been a little while since a thug robbed you on the street or you wouldn't be talking like that. They are vastly different experiences and no one I know who has experienced a life-threatening experience involving armed robbery would ever dream of comparing it to filing a tax return and writing a check for $20,000 or whatever to Uncle Sam. Being robbed at gun-point is a truly life changing experience that people who have been through it would never trivialize or compare cutting a check or having taxes withheld the way you have done so here.
As they say, give the robber what he wants. The only reason that the guns haven't come for me, is because I give Uncle Sam EVERYTHING he asks for. I break no laws. I pay my taxes. I'm sure that if you talked to someone who failed an IRS audit or ran afoul of the FBI, that their experience would seem eerily similar to the thug scenario. My father-in-law is an attorney, and he could tell you about more than one case where a person had guns drawn on them by the government. I can even give you some local cases where police officers DID kill people who hadn't even violated a law, and nothing happened to them.


So, you're more comfortable taking on the local Sheriff and his deputees than Federal Agents? I wouldn't give you one in a million odds in being able to take on either one successfully. Most of your interaction with government (sales taxes and the like) is already local. One hyperactive local city council can make your life very unpleasant.
Yep, but I could move on to the other side of the bridge, maintain my community and education, and never deal with them again. This is also less than ideal, but the one crazy councilman can do far less damage than one crazy president. I'm realistic, and I don't think we'll see a utopia. However, this councilman has probably violated my rights, and a more local government would allow for me to have a better chance of getting laws passed that have more checks and balances.


Europeans have indeed voted to centralize government among their countries to create the EU. They did this to compete and improve their economic situation and quality of life. The EU has been a huge success in this regard. One thing it has done has enabled Europeans to eliminate the many different currencies, the exchange of which was costing the economies a lot of money every year for basically nothing and leaving individual countries vulnerable to exchange rate swings. On the legal front it has enabled them to take on the likes of Microsoft and making sure that large multinationals are held accountable to the standards that Europe wants and benefit them (this would have been much much more difficult for the smaller individual states). However, you also trivialize the role of local government in Europe. You can rest assured that Europeans have a long history of strong local government across the continent ... with some cities (relatively small by our standards) having a city-state tradition considerable local power. A lot of that kind of local power has been eliminated because it was ineffective, inefficient, and, at times, unfair. Europeans have realized the benefit of coordinating economic, educational, and military efforts, and the EU has been doing quite a bit in this regard to protect European interests in a way that the individual member states would have a difficult time accomplishing.

You're mixing two things. Common trade, without government barriers, is capitalism, and that has helped them. I'm not sure that things like taking on Microsoft have. This is a REALLY long and complicated topic. I'll just say that the capitalism that has grown under the EU has masked what is becoming a rapid centralized takeover of European policy. Give it time, the EU WILL shoot down the open border capitalism it was created for in order to solidify central planning. Either that, or it will decentralize.

Closer to home ... have you ever dealt with a homeowners association gone awry? That's local "government" of sorts, and, oh boy, can it get nasty. I wouldn't wish a nutty homeowners association on my worst enemy. I know people who were essentially forced to move because they got into a fight with the homeowners association. If you think that such local "government" is somehow less likely to interfere with your property, you are missing a lot of experiences that I have seen too often. I realize that the homeowners assocation is not the same thing as a government, but it acts a little bit like a government and is about as local as you can get. A nutty small town government would not be any better. I'm glad that there is a federal government that can step in when the local mayor starts buying votes to get re-elected.
I actually said that there was less that a local government could do to interfere with my property, not that they wouldn't try hard to. If the local government violates the proper role of government, they also will create problems. People by and large continue to vote for *****s. However, this local government is also unjust. The difference is, that a local government gone wrong violates the rights of a few individuals, in a relatively small space, with relatively easy escape. A national government gone wrong is a lot more difficult. I still argue that ALL government should exist to protect individual rights. State or local.

As to homeowner's associations. I've never bought a home that came under one, because I hate mini-communes. They are a flagrant example of why the government no one nitpick people's property. though in this case, people gave up their property rights by choice, and I am not hurt by it. I did once leave an apartment complex due to management issues.


You are fighting American culture and values here. You might think that Americans have no social obligation to provide health care to the poor who are unable to afford it, but most Americans think we do have a least a minimal care obligation. How many votes did the Libertarian party get in recent election? 3%? You are part of a small fringe group that is out of step with the mainline culture. In order for your ideas to be implemented, your opinion would need to prevail over the other ~97% of the population, which would be well beyond unfair. There are probably more racists in this country than Libertarians, and I don't think we should cater to either group. Idealisticly, I would agree with Libertarians that everyone should take responsibility for paying for their health, food, shelter and so on, but from what I can tell, this would take us in the wrong direction toward a society similar to that of the 3rd world where a few rich families rule the roost and millions of others are lucky if they have running water.

First of all, I don't want to tell the other 97% what to do AT ALL. If they all want to start a charity organization that gives care to the poor, that's fine. I might even contribute. My problem is they want to tell ME what to do with my property. It is my right to be out of step. (By the way, it's more than 3% who agree, because we are not all libertarians who agree on this issue).

I don't think that we should cater to racists or stop them, unless they violate other people's rights. Being racist is an irrational choice, as you exclude yourself from all beneficial encounters with people of a specific race. The person most often hurt (where property is protected) is the racist.

ALL major 3rd world countries have corrupt governments. I've been there and seen them. That is the problem. In these places, the rich get rich BY violating property rights and stealing through the government. That is precisely what I do not want to happen here, but it IS what will happen if we continue down the road that this bill takes us on.

I was on a medical mission trip to a formerly communist third world country this last spring. They had a universal healthcare system, but they had no running water in most of the houses. In fact, their system was so bad, that the doctors went on strike, and we were the only game in town when we arrived. Corruption was the problem, and no amount of Universal Healthcare fixed it.

Sure, I took a brief look at it. There are similar arguments to what we have discussed here. Here is a comment from one of your readers:

http://www.blogger.com/comment.g?blogID=33603150&postID=116145205194367406
"Society changes and shouldn't the law and government change with it? Certainly the other way around would be no good.
Also, the concept of a free market works wonderfully for most things. But healthcare is fundamentally unlike most things. It is a matter of life and death. It can be catastrophic and completely unexpected, and last a lifetime. It can stop a person from working, from functioning, change their life 180 degrees. Things like housing and food are considered part of rights because society has changed HOW we live. We live in houses and eat a certain amount to be considered healthy. We have certainly changed, like you mentioned, how we treat illness. And society/law should change with it."
As I would reply to this reader, that is EXACTLY why healthcare should be a part of the free market. The market does a better job of creating a quality product that any other system. Healthcare is no different than other things on the market. Engineers, Car makers, etc... make life and death decisions ALL THE TIME. I agree that we should adapt, but I find the suggestion of a government mandated universal healthcare scheme to be Maladaptive. That is a change that we should not take.
 
Health professionals do have a choice. They are not required to accept Medicare, Medicaid, Medi-Cal, etc., and some choose not to. Many who do accept these programs also throttle their participation in those programs by limiting the number of patients of these groups that they accept.

The specialty clinic that my wife works in is the only one in the SW 1/4 of my state that takes the state child health insurance. They won't take adult Medicaid patients at all due to liability reasons. As a result, their schedule is usally booked with lower reimbursing pts who drive up to 2 hrs sometimes, but that is the decision that the practice made because they value the health of our state's children.

Exactly. With insurance coverage, they, in theory could see a less expensive primary care physician. In practice, I don't think we have enough physicians. Maybe PA's will pick up the slack, but there aren't very many of them either.

This is the reason that medlevel staffed clinics have popped up. They are filling a gap in the healthcare system for even less money than the PCP physicians.
 
I'm not exactly sure how many times I have to say that I think that defense is the one role of the government. I believe in having police, though I do recognize them as often being less than ideal.

Yes, we agree on the police force. I was simply extending your argument, to show that it doesn't make sense on this point because it could be used to justify eliminating police if they occasionally don't catch a criminal, that's all.

Yes, though the current system is very expensive. I've never said that everything is horrible, but I see the current suggestions in California as a dangerous road that will take some of the serious flaws in the system and make them potentially fatal.

Oh, ok. That makes sense. Yes, a lot of people are worried about what CA is doing, and these are legitimate concerns.

There is one question that I would like you to very clearly answer. My question is this: Do you propose eliminating health care for anyone who cannot pay for it (except for infectious disease, such as TB)? This means that if a poor person is injured by a hit & run driver and bleeding on the sidewalk, they might just lie there until they die unless someone feels sorry for them and offers to personally provide care or pay for their care, correct?

The reason this is an important point is as follows: currently, people without insurance can get treatment at an emergency room. This care is expensive compared to more typical primary care. I hope we can agree on this. Assuming that you do agree then, wouldn't it be better to provide this care in a less expensive setting? I realize not everyone would take advantage of this, but if we did provide primary care to everyone (subsidized were deemed necessary), it might actually save us money & taxes, don't you think? I'm not suggesting that anyone should be able to get any type of care or that it should be provided in an unlimited way. As I stated in one of my previous messages, perhaps those unable to pay cash would be required to provide some type of community service hours, for example.

...I've actually worked in the business and seen accidents. I did warehouse labor in the shipping department of a factory that produced car speakers, landscaping, and I even had a stint at Home Depot (which was admittedly not very accident prone, though I was almost killed by a forklift once). The thing about these companies, is that no one is enslaved to work for them. They do it as a choice. People, and companies, have to weigh the risk and benefits of certain courses of action all of the time. It's not that I don't want people to be safe at work. It's that the determination of how safe is safe, and how safe is necessary are not single-handed, and they shouldn't be decided by the government.
...

Your argument assumes that workers are powerless. They are not. ... If the company intentionally lied about working conditions, then they committed fraud, and that is the crime that should be prosecuted. That is a violation of the rights of the individual who was lied to. If the worker knew the job was dangerous however, that was a choice.

I can see where you are coming from. I strongly prefer a government that enforces safe working conditions, but it's a matter of opinion, of course. Some people enjoy living in 3rd world conditions; I don't.

All of the people who can't afford healthcare due to hospital pseudo-monopolies enforced by a police force funded by my tax dollars come to mind. Of course, if you really need an example, please turn on the TV and watch the war in Iraq, where over 100 times as many Americans have died as all of the industrial accidents you mentioned, and the economic cost is more per day than the grand total of all the losses that you mentioned. ...

It's true that hospitals and physicians have an expensive monopoly. In effect, we already have a kind of free market for medicine with chiropractors, accupuncturist, herbalists, traditional Chinese doctors, etc. It's already out there. It's not reducing cost in areas where they can practice. I'm unwilling to experiment with surgery by unlicensed physicians.

...

The other countries you are talking about have other problems. Causing birth defects in the population IS aggression against those populations, and the companies should be held accountable. This is NOT because of the danger or lack of it, but because the companies violated the rights of the individuals who DID NOT choose to be involved with the company.

Someone who has toxic waste leak into their water without their knowledge, drinks it, and has an unhealthy child HAS BEEN WRONGED. Their rights have been violated. Defending them IS a valid role of government, but it is because they did not CHOOSE to associate with the company involved, and were not given the right to choose to take the risks that they took.

Oh, ok. I see where you are coming from. My concern would be that the people who have been wronged would have recourse on paper, but no recourse practically speaking. By and large the only way to prevent poisoning the population is to control what happens on the industrial site. For the common citizen to trace back their lung cancer to a plant down the road would be impossible. There are too many factors. They would almost never win in court, here in the U.S. because an individual going up against a corporation is at a huge disadvantage (starting with the fact that they could not afford a lawyer). Prosecutors don't have time, resources, information, or expertise for this stuff either. Prevention really is the only effective first line of defense, in my opinion.

Have you followed the oil spills related to the Alaska pipeline? When BP didn't like the inspection results they saw, they just stopped inspecting altogether. Even after several environmental spills the company seems to be doing very little, and what it is doing is being driven by the action of government.

This is actually a problem of a lack of private property. It falls under the law of the commons. Because nobody owns the area that these spills occur in, no one cares to take care of it. In fact, if oil companies actually owned the places that they drill, rather than leasing it from the government, they would have MUCH larger incentives to protect it.

Oil companies have routinely poluted their own land. They do it all the time, even now. They have no incentive to prevent polution ... none save government prosecution that would cost more than their profit (even then they often try to see if they can sneak it by).

Not if private property rights were enforced. Your house would only be a toxic swamp if you chose to let it become so.

Also realize that there are ways to stop a company without getting the government involved at all. If people were REALLY unhappy, rather than complaining that the government should do something, they will stop buying your product. A boycott can do more damage to a company than a regulation. If people keep buying the product, even by your own arguments, they must not REALLY disapprove of the companies operations enough to not take what they are selling.

That's just it. I don't have the financial resources to take on the ExxonMobil legal team. My case would never make it to trial in my lifetime. There are plenty of cases pending against oil companies that never have and never will see their day in court. Also boycotts don't work in a global marketplace for a commodity such as oil. They never have and never will. The ordinary citizen doesn't buy oil by the barrel.

Same thing goes for a hospital. I wouldn't be able to sue a hospital if they were not held to very high standards of practice by the government. If it were ok to sell incompetent medical services, I would be getting what I paid for and could have chosen higher quality hospital if I had the money. My care would depend on whether my physician felt like doing a good job that day or if he was tired from a previous case.

There is also no reason why a company, for public relations, couldn't subject itself to a private quality control third party. If people really are in favor of this, they will support the company for doing so. If you argue that they could pay off the company, this can already be done with government officials. A company cannot survive without support from the workers and the people. The public controls the fate of a company. They will only sacrifice lives for lower prices if the public willingly buys the products.

Have you ever worked with a major oil company (I'm not talking about at a gas station, I'm talking about actually worked at their corporate headquarters or a major office)? You really do not understand how they operate and how much power they have over everyone they come in contact with. There is no third party that comes anywhere close to being able to influence them. Same goes for many other companies that are legitimately controlled by the government. They strongly control their workforce and generally do not tolerate any kind of dissent. They have more power than you seem to realize.

{snip for brevity}

2. I never said that I didn't appreciate what I had. That doesn't mean that I won't fight to keep it. It also doesn't mean that I won't fight to make things better.

3. I agree that the average American has it best. I believe that it is a DIRECT result of the freedoms we do have and the amount of capitalism in the economy. I want to keep it that way. I believe what I believe, because I do appreciate what I have, and I would hate to see it disappear. As I said before, I stay here because this country most closesly resembles my ideals compared to any other option.

Cool. Just checking.

As was said by George Bernard Shaw (ironic because he was a socialist)- "A reasonable man adapts to the world around him, while an unreasonable man expects the world to adapt to him. Therefore, all progress is made by unreasonable men." I may have not quoted that perfectly, but the idea is the same.

...

Good quote!
 
The specialty clinic that my wife works in is the only one in the SW 1/4 of my state that takes the state child health insurance. They won't take adult Medicaid patients at all due to liability reasons. As a result, their schedule is usally booked with lower reimbursing pts who drive up to 2 hrs sometimes, but that is the decision that the practice made because they value the health of our state's children.



This is the reason that medlevel staffed clinics have popped up. They are filling a gap in the healthcare system for even less money than the PCP physicians.

Yes, these are good things. They are a part of an optimal solution no doubt.
 
I consider myself to be conservative. At the same time, I, like most Americans, believe that universal basic health care is something we can afford to provide and that such expenditure, not unlike roads or public education, are investments that pay positive dividends. Looking at it purely in economic terms, a healthy population has a greater economic output than a sick one. I have many differences with liberals. For example, I believe that even the poor should pay something for their health care services ... even if it's small change. By contributing to the cost of the care, they would appreciate it more and do what they can. Everyone should contribute to our public systems, not just the middle class and the wealthy.

And be less likely to abuse it as well.

I think that health care should be affordable for everyone. If we make it completely free it leaves the system open for abuse and rising costs.
 
And be less likely to abuse it as well.

I think that health care should be affordable for everyone. If we make it completely free it leaves the system open for abuse and rising costs.

Yes ... and this would probably require subsidies for the poor, because they can't afford much. From my perspective, all care should have at least a nominal charge. However, I have been told by people who actually serve people in the lower income bracket that any fee (even $1) serves as a strong deterent to purchase, say an antibiotic. So, if you really want someone doing, say, well-baby check-ups you must make them free. I have a hard time believing that someone would be unwilling to spend $1 for a well-baby checkup, but I guess I'll get to learn about this on my own soon enough.
 
Yes ... and this would probably require subsidies for the poor, because they can't afford much. From my perspective, all care should have at least a nominal charge. However, I have been told by people who actually serve people in the lower income bracket that any fee (even $1) serves as a strong deterent to purchase, say an antibiotic. So, if you really want someone doing, say, well-baby check-ups you must make them free. I have a hard time believing that someone would be unwilling to spend $1 for a well-baby checkup, but I guess I'll get to learn about this on my own soon enough.

I have a hard time believing that as well (unless that person were a drug addict to messed up to care about their health, or negligent parent, in which case simply making the service free might not be enough incentive for either one). I also think that a little LTFU (loss to follow up) is acceptable. Any new health policy we employ is going to have its failings. I feel that $1 might be a deterrant in Afghanistan, but here it's just an excuse.

In any case, its the principle of accountability that matters as far as preventing rising costs. Right now we see people who have excellent insurance demanding all the newest prescriptions they see advertised on TV and any other expensive test they feel they need even if the doctor disagrees. If you make people financially accountable (while still affordable) the idea is that they'll think twice about what they truly need.

But the implementation needs to be thought out carefully. For example, when medicare started covering prescriptions, the idea was to make recipients responsible for some of the costs. This was supposed to make the elderly more cost-conscious. But approximately 10% of medicare recipients currently falll into the "donut hole"(where the patient is responsible for 100% of the cost of their drugs). And of course the poor patients simply cut their pills in half or skip buying certain drugs they need because they can't afford it.
 
I'm not sure how much California spends on healthcare for its citizens, but in Texas, Medicaid takes up something like 25% of the state budget (2006) and is increasing. Our legislature is getting ready to take a look at this behemoth. It's going to take a lot of property tax increase to pay for this program unless something changes.

http://www.hhsc.state.tx.us/Medicaid/reports/PB/pb_pdf/Cover-Contents-Disclaimer.pdf

State Fiscal Year 2002 Health and Human Services funding as a percentage of the total state budget (all funds): 32 percent1

Medicaid as a percentage of the appropriated 2002 Texas budget (all funds): 22.6 percent

Medicaid as a percentage of the appropriated 2002 Texas budget (state funds): 16 percent

Percentage of Texas Medicaid budget spent on children in 2000: 22 percent2*
Total projected dollars to be spent for Medicaid in 2002: $13.7 billion
 
Yes, we agree on the police force. I was simply extending your argument, to show that it doesn't make sense on this point because it could be used to justify eliminating police if they occasionally don't catch a criminal, that's all.
I actually think that the corruption on Police Forces is a striking example of government failure. It's degree is obviously heterogenous between departments. The difference is that, unlike medicine, there is really no logical way to provide police service privately. Almost by definition, whoever controls the Police IS the government.

There is one question that I would like you to very clearly answer. My question is this: Do you propose eliminating health care for anyone who cannot pay for it (except for infectious disease, such as TB)? This means that if a poor person is injured by a hit & run driver and bleeding on the sidewalk, they might just lie there until they die unless someone feels sorry for them and offers to personally provide care or pay for their care, correct?

The reason this is an important point is as follows: currently, people without insurance can get treatment at an emergency room. This care is expensive compared to more typical primary care. I hope we can agree on this. Assuming that you do agree then, wouldn't it be better to provide this care in a less expensive setting? I realize not everyone would take advantage of this, but if we did provide primary care to everyone (subsidized were deemed necessary), it might actually save us money & taxes, don't you think? I'm not suggesting that anyone should be able to get any type of care or that it should be provided in an unlimited way. As I stated in one of my previous messages, perhaps those unable to pay cash would be required to provide some type of community service hours, for example.

First of all, I don't believe in EMTALA. I think that it is a disaster, and I don't believe that anyone should be able to FORCE doctors in an ED to see them.

With regards to your suggestions, it only saves money to provide free primary care compared to a plan where ED care is given for free. If ED care isn't free, then primary care isn't cheaper. Before EMTALA (like in the 80s), people didn't die on the streets. Charity hospitals have existed for a long time, and people knew that these were places to take people who couldn't pay. This was just recognized as charity, rather than the current system of having every junkie and gang banger walking into the ED with threats of lawsuits to every doctor who doesn't give them Morphine at their whim.

I don't believe that community service is the answer, because that doesn't actually help the people who are providing the service. They should be paid, by the person. The better solution might be a payment plan, and you could let people work and pay off the cost of their treatment. In that sort of system, the financial incentive would exist to treat those who aren't currently able to pay. We do it with cars, and I'm sure we could do it with medicine.

I can see where you are coming from. I strongly prefer a government that enforces safe working conditions, but it's a matter of opinion, of course. Some people enjoy living in 3rd world conditions; I don't.
We'll just have to disagree as to whether that would actually be the result. Perhaps a compromise might be a system in which an employer would be liable for damages to employees on the job. In that system, the employer could give the worker a list of risks that would be exempt upon hiring. An employee who agreed to the risks couldn't sue the employer if the explicit risk actually occured. That way, everyone would know what the deal was, and employers couldn't subvert their employees with hidden risks.


It's true that hospitals and physicians have an expensive monopoly. In effect, we already have a kind of free market for medicine with chiropractors, accupuncturist, herbalists, traditional Chinese doctors, etc. It's already out there. It's not reducing cost in areas where they can practice. I'm unwilling to experiment with surgery by unlicensed physicians.
#1. Hospitals are more expensive than physicians, and no one is really challenging their power due to protectionist rackets. This "free market" hurts legitimate doctors, who undergo endless restrictions and licensing beauracracy, while the other guys fly under the radar in many cases. They always will, and I just want to compete equally in a true free market.

#2. Willing or not, the world of NPs, PAs, DPMs, and ODs will continue to push in on the realm of surgery. This only ever worries me because we DON'T have a free market. I believe in a lot of MD training, and I believe that a free market will vindicate legitimate surgeons in many cases. I trust that the government will slowly give away doctor's practice rights to these other providers to save money. This is the opposite of your view, but I think that time will prove me right.
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Oh, ok. I see where you are coming from. My concern would be that the people who have been wronged would have recourse on paper, but no recourse practically speaking. By and large the only way to prevent poisoning the population is to control what happens on the industrial site. For the common citizen to trace back their lung cancer to a plant down the road would be impossible. There are too many factors. They would almost never win in court, here in the U.S. because an individual going up against a corporation is at a huge disadvantage (starting with the fact that they could not afford a lawyer). Prosecutors don't have time, resources, information, or expertise for this stuff either. Prevention really is the only effective first line of defense, in my opinion.
YOU hit it right here. The government picks favorites. If a company can get away with poisoning a whole town under the current system, do you really think that they are actually stopped by "preventative restrictions?" What actually occurs is that the companies that you are worried about avoid the restrictions, and the little guy trying to compete is prevented from doing so on a level field. The system becomes a protectionist scheme, that stifles new competition in favor of the big corporations that you think are the bad guys.

Oil companies have routinely poluted their own land. They do it all the time, even now. They have no incentive to prevent polution ... none save government prosecution that would cost more than their profit (even then they often try to see if they can sneak it by).
They have the right to pollute their own land. However, things like the Exxon Mobile disaster would have been cleaned up, and that is because the company has a vested interest in protecting its own property. A quick search on google will show that many of the most polluted places in America are public lands that were leased by the government to private entities. As a ratio, most of these companies leave a much larger scale of destruction on public property.

This argument is very expandable. I think by the way, that they should have the right to do whatever they want to their own land. I'm just pointing out that they wouldn't damage it to the same degree.

That's just it. I don't have the financial resources to take on the ExxonMobil legal team. My case would never make it to trial in my lifetime. There are plenty of cases pending against oil companies that never have and never will see their day in court. Also boycotts don't work in a global marketplace for a commodity such as oil. They never have and never will. The ordinary citizen doesn't buy oil by the barrel.
True, but the ordinary citizen does buy gas from Mobil gas stations. The above is really more of a criticism of the legal system. Maybe it should be easier to seek retribution for damages. The fact that the government currently fails miserably at letting people collect damages is not a reason to say that they should have more regulatory power. You've just proven that the current system already protects the big guy, and I don't think we should give them even more power to effectively protect the big guy.

Same thing goes for a hospital. I wouldn't be able to sue a hospital if they were not held to very high standards of practice by the government. If it were ok to sell incompetent medical services, I would be getting what I paid for and could have chosen higher quality hospital if I had the money. My care would depend on whether my physician felt like doing a good job that day or if he was tired from a previous case.
No, you would agree as to what care you were paying for. You could sue for breach of contract or fraud depending on the level of violation. I don't like the current system where we set an arbitrary standard that no one can agree on called "standard of care." Fraud, as I've said before, is a violation of individual rights, and the government can intervene here. As long as both people agree on the standard, then there is no problem as you have described.

Doctors who did a poor job would have trouble finding business. I boycott restaurants that give me bad service, and I would assuredly do the same to a bad doctor. This might actually do a better job of weeding out some of the bad ones.


Have you ever worked with a major oil company (I'm not talking about at a gas station, I'm talking about actually worked at their corporate headquarters or a major office)? You really do not understand how they operate and how much power they have over everyone they come in contact with. There is no third party that comes anywhere close to being able to influence them. Same goes for many other companies that are legitimately controlled by the government. They strongly control their workforce and generally do not tolerate any kind of dissent. They have more power than you seem to realize.
The workers could still quit. If they can't, then that is slavery, and the government has the right to intervene and stop it. Also, I don't really believe that ANY company should be controlled or owned by the government. If your saying that the government already turns away, I'm not sure how giving them more power will suddenly make them intervene.
 
...
First of all, I don't believe in EMTALA. I think that it is a disaster, and I don't believe that anyone should be able to FORCE doctors in an ED to see them.

With regards to your suggestions, it only saves money to provide free primary care compared to a plan where ED care is given for free. If ED care isn't free, then primary care isn't cheaper. Before EMTALA (like in the 80s), people didn't die on the streets. Charity hospitals have existed for a long time, and people knew that these were places to take people who couldn't pay. This was just recognized as charity, rather than the current system of having every junkie and gang banger walking into the ED with threats of lawsuits to every doctor who doesn't give them Morphine at their whim.

You can't be serious. In 1987 we had ~30 million uninsured. Today we have ~47 million. (http://www.census.gov/prod/2006pubs/p60-231.pdf). If EMTALA was repealed, it would be a disaster for America's poor.

http://ps.psychiatryonline.org/cgi/reprint/53/10/1301
History of EMTALA
In the early 1980s, reports of widespread
"patient dumping" began to
appear in the press and the medical
literature (4–6). Schiff and associates
(7) estimated that 250,000 inappropriate
transfers of medically unstable
patients occurred in 1986, resulting in
increased patient morbidity and mortality.
Hospitals were under increasing
financial pressure to control
health care costs.
... Treating nonpaying patients became
increasingly financially burdensome.
As a result, it was believed,
many private hospitals were transfer-
ring patients to the streets or dumping
them on public hospitals before
they had adequately diagnosed or stabilized
these patients' emergency
medical condition. Schiff and associates
(7) documented the transfer of
unstable patients with emergency conditions
such as delirium tremens, confusion
after falling from a third story,
an acute cerebrovascular accident with
stuporous mental status, abdominal
trauma with syncope and falling hematocrit
level, and head trauma with unequal
pupillary reaction.
In response to this patient dumping,
Congress enacted the Consolidated
Omnibus Budget Reconciliation Act
in 1985. EMTALA was created within
the Medicare section of this large federal
budget legislation.

Politically repeal of EMTALA won't happen anytime soon, so it's pretty much a moot point. I looked around and see that you have already debated this point on SDN extensively, so I'm not sure there is much of a point in belaboring it here. Even so, it's an interesting topic.
http://forums.studentdoctor.net/showthread.php?t=341742

...
I don't believe that community service is the answer, because that doesn't actually help the people who are providing the service. They should be paid, by the person. The better solution might be a payment plan, and you could let people work and pay off the cost of their treatment. In that sort of system, the financial incentive would exist to treat those who aren't currently able to pay. We do it with cars, and I'm sure we could do it with medicine.

Yeah, and if they don't pay we repo the body? We already have payment plans, and the poor don't pay that. Comparing medical services to used car sales is really not going to win friends and influence people to your point of view. People have a whole different perspective when it comes to their health versus buying a car.

...
We'll just have to disagree as to whether that would actually be the result. Perhaps a compromise might be a system in which an employer would be liable for damages to employees on the job. In that system, the employer could give the worker a list of risks that would be exempt upon hiring. An employee who agreed to the risks couldn't sue the employer if the explicit risk actually occured. That way, everyone would know what the deal was, and employers couldn't subvert their employees with hidden risks.

Show me a country with lax government regulation of industry that doesn't have 3rd world working conditions. Show me a country with "free market" medicine that has a healthy population. It doesn't exist. You blame the difference on other factors.

However, the fact is that every shred of information you can conjure up is that without strong government involvement, most of us would be living in a slum and a few rich families would own pretty much everything. The only way to come to a different conclusion is to ignore essentially all economic history and data.

...
#1. Hospitals are more expensive than physicians, and no one is really challenging their power due to protectionist rackets. This "free market" hurts legitimate doctors, who undergo endless restrictions and licensing beauracracy, while the other guys fly under the radar in many cases. They always will, and I just want to compete equally in a true free market.

#2. Willing or not, the world of NPs, PAs, DPMs, and ODs will continue to push in on the realm of surgery. This only ever worries me because we DON'T have a free market. I believe in a lot of MD training, and I believe that a free market will vindicate legitimate surgeons in many cases. I trust that the government will slowly give away doctor's practice rights to these other providers to save money. This is the opposite of your view, but I think that time will prove me right.

Again, show me a single country (or even a single state or town) that is doing the "free market of medicine" that you propose and has a poverty rate comparable to that of the U.S. (say ~10% minimum) and then let's talk.

...
YOU hit it right here. The government picks favorites. If a company can get away with poisoning a whole town under the current system, do you really think that they are actually stopped by "preventative restrictions?" What actually occurs is that the companies that you are worried about avoid the restrictions, and the little guy trying to compete is prevented from doing so on a level field. The system becomes a protectionist scheme, that stifles new competition in favor of the big corporations that you think are the bad guys. Bad doctors are similarly difficult to track down. My argument is that without government regulation, we would have more of them, much as we did in the past before the government stepped in.

It would be worse without the government. In the 1930s-1950s we had very little regulation concerning heavy industry. As a result, the free market polluted the heck out of our country. It wasn't until the government created superfund, etc., that these lands were cleaned up. I know that you agree with certain enviromental regulations, but your idea of allowing companies to pollute their land with the dream that the pollution will just stay there is ignoring even the most basic science of how pollution spreads.

Health, safety, and environmental laws and regulations in industry are written with the blood of victims. You want to give industry another chance ... you want to let the lion out of the cage again because he looks friendly and you ignore what he did the last time he mauled people in the town.

...
No, you would agree as to what care you were paying for. You could sue for breach of contract or fraud depending on the level of violation. I don't like the current system where we set an arbitrary standard that no one can agree on called "standard of care." Fraud, as I've said before, is a violation of individual rights, and the government can intervene here. As long as both people agree on the standard, then there is no problem as you have described.

Next time you get a letter from Musa Abacha or Fred Kunte, go ahead and send them your bank account information in response to their e-mail invitation. After all, you can always sue them the for fraud if they do anything wrong (like empty your bank account, which they will do). Good luck roaming the alleys of Lagos to serve your judgement to the student who cleaned you out. Yes, your chances against a large U.S. company are better than against a Nigerian student scam artist, but not much better. Even open & shut cases take years to go to trial in the U.S. and then they take years of maneuvering and appeals. It's an expensive and difficult process that is best avoided by up-front government oversight.

...
Doctors who did a poor job would have trouble finding business. I boycott restaurants that give me bad service, and I would assuredly do the same to a bad doctor. This might actually do a better job of weeding out some of the bad ones.

Well, if your "bad doctor" amputates your leg instead of taking out your tonsils, I'm not sure the boycott is going to make you feel any better about hobbling around.

...
The workers could still quit. If they can't, then that is slavery, and the government has the right to intervene and stop it. Also, I don't really believe that ANY company should be controlled or owned by the government. If your saying that the government already turns away, I'm not sure how giving them more power will suddenly make them intervene.

Like I said before, if we pull the regulations (which are written in the blood of victims who happened in times past), we will become victims and you can't just quit and go down the road, because it's no different down the road. You think a company is going to tell its prospective hires, oh yes, you can burn to death in our plant. If you don't like it, don't work here. They won't say anything of the kind. There will just be this 100% preventable but mysteriously unexpected "accident" that they claim was not in their control. It's not until the government imposes standards and prosecutes the deadbeats that anything changes. It's not a perfect system, and it can be improved. However, removing all government involvement (even retaining your selected laws) is a recipe for disaster unless you find living in a 3rd world country to be a good thing. This has been proven time and time again throughout history. Unless you have a model with real data your ideas are going to be difficult to discuss.
 
You can't be serious. In 1987 we had ~30 million uninsured. Today we have ~47 million. (http://www.census.gov/prod/2006pubs/p60-231.pdf). If EMTALA was repealed, it would be a disaster for America's poor.

http://ps.psychiatryonline.org/cgi/reprint/53/10/1301
History of EMTALA
In the early 1980s, reports of widespread
“patient dumping” began to
appear in the press and the medical
literature (4–6). Schiff and associates
(7) estimated that 250,000 inappropriate
transfers of medically unstable
patients occurred in 1986, resulting in
increased patient morbidity and mortality.
Hospitals were under increasing
financial pressure to control
health care costs.
... Treating nonpaying patients became
increasingly financially burdensome.
As a result, it was believed,
many private hospitals were transfer-
ring patients to the streets or dumping
them on public hospitals before
they had adequately diagnosed or stabilized
these patients’ emergency
medical condition. Schiff and associates
(7) documented the transfer of
unstable patients with emergency conditions
such as delirium tremens, confusion
after falling from a third story,
an acute cerebrovascular accident with
stuporous mental status, abdominal
trauma with syncope and falling hematocrit
level, and head trauma with unequal
pupillary reaction.
In response to this patient dumping,
Congress enacted the Consolidated
Omnibus Budget Reconciliation Act
in 1985. EMTALA was created within
the Medicare section of this large federal
budget legislation.

Politically repeal of EMTALA won't happen anytime soon, so it's pretty much a moot point. I looked around and see that you have already debated this point on SDN extensively, so I'm not sure there is much of a point in belaboring it here. Even so, it's an interesting topic.
http://forums.studentdoctor.net/showthread.php?t=341742
Well, the repeal of EMTALA is one of the things that I argue that may have some popular support. This topic has been debated extensively, with the majority favoring reform at a minimum. I think that the public in general, if they realized that EMTALA was responsible for their 8 hour ED waits, might reconsider this one.

You can't order people to work for free, then give their services away to community members, and then expect it not to be a disaster. You have a problem with people getting paid by choice to work in dangerous conditions, but you have no problem with ED doctors being forced to expose themselves to AIDS, TB, Needles, etc.... for free with the chronic threat of being sued by the people that they are "helping."

In terms of dumping, this could be easily solved by taking people to Charity Hospitals in the first place. I'm realistic, and I have no problem phasing out EMTALA over a period of time to allow for alternative charitable infrastructure development.

For those of you who agree with EMTALA, put your money where your mouth is. Get together and create a charitable fund with YOUR money that pays for the care of unfunded people. If this has such profound support, people will happily give to this pool. My problem is the expectation that I will work for free because you think I should.


Yeah, and if they don't pay we repo the body? We already have payment plans, and the poor don't pay that. Comparing medical services to used car sales is really not going to win friends and influence people to your point of view. People have a whole different perspective when it comes to their health versus buying a car.
We give loans out all the time without collateral. My problem is that I don't see what is different between paying for medical care vs. a used car. Perhaps the existance of your "pay for the unfunded." fund that I have suggested you start with the public will provide some minimum compensation for facilities that treat people, allowing them to recoup atleast their losses if the patient doesn't pay.


Show me a country with lax government regulation of industry that doesn't have 3rd world working conditions. Show me a country with "free market" medicine that has a healthy population. It doesn't exist. You blame the difference on other factors.

You've argued many times that the regulations here were lax. Nevertheless, I believe that you have put the egg before the chicken. As societies became more advanced, governments have been more able to interfere in industry, not the other way around. Feel free to talk to anyone who has worked in a government factory in Russia or Cuba (i know many in the later category), and they will tell you what sort of conditions exist when the government ends up with final say over working conditions.

However, the fact is that every shred of information you can conjure up is that without strong government involvement, most of us would be living in a slum and a few rich families would own pretty much everything. The only way to come to a different conclusion is to ignore essentially all economic history and data.
Most countries in which these conditions exist are formerly or presently communist or highly socialist countries:
Russia, Cuba, Nicaragua, Mexico, Argentina, China, etc...

The other countries that are like that are formerly fascist countries or countries that are constantly in warring internally:
Paraguay, Haiti, Somalia, Rawanda, etc...

Please find me a country that has 3rd world working conditions without a strong government or pure violent anarchy. Those are the things that I argue cause those conditions. Do I have enough historical examples of socialism not equaling safe working conditions?

Again, show me a single country (or even a single state or town) that is doing the "free market of medicine" that you propose and has a poverty rate comparable to that of the U.S. (say ~10% minimum) and then let's talk.
Nobody. That is irrelevant, because even countries that are in pure anarchy officially maintain rules against a free market in medicine. It isn't being tried ANYWHERE.

It would be worse without the government. In the 1930s-1950s we had very little regulation concerning heavy industry. As a result, the free market polluted the heck out of our country. It wasn't until the government created superfund, etc., that these lands were cleaned up. I know that you agree with certain enviromental regulations, but your idea of allowing companies to pollute their land with the dream that the pollution will just stay there is ignoring even the most basic science of how pollution spreads.
If the pollution leaves their land, we should fix the legal system to allow people to collect their damages. The fact that the government created a highly interventional system that kind of fixed that problem doesn't mean that the interventionalist system is ideal.

Health, safety, and environmental laws and regulations in industry are written with the blood of victims. You want to give industry another chance ... you want to let the lion out of the cage again because he looks friendly and you ignore what he did the last time he mauled people in the town.
Actually, I want industry to operate as it wishes on its own property and to be 100% responsible for what happens on other people's property unwillingly due to its actions. I don't want to give it a free run to do whatever it wants when other unwilling people are involved.

Next time you get a letter from Musa Abacha or Fred Kunte, go ahead and send them your bank account information in response to their e-mail invitation. After all, you can always sue them the for fraud if they do anything wrong (like empty your bank account, which they will do). Good luck roaming the alleys of Lagos to serve your judgement to the student who cleaned you out. Yes, your chances against a large U.S. company are better than against a Nigerian student scam artist, but not much better. Even open & shut cases take years to go to trial in the U.S. and then they take years of maneuvering and appeals. It's an expensive and difficult process that is best avoided by up-front government oversight.
Well, luckily I've ignored all of my e-mails from Fred Kunte, and about 100 other people. I'm arguing that fixing the collections process is better than creating regulations. When dealing with con-men from distant impoverished nations, I would suggest that some personal responsibility would be in order. As I've said before, my father-in-law is an attorney. I know how the legal system works. It is full of flaws, and that is where we should fix things first.


Well, if your "bad doctor" amputates your leg instead of taking out your tonsils, I'm not sure the boycott is going to make you feel any better about hobbling around.
Well, I doubt that I signed a contract agreeing that he do that, so I'll sue him for violation of contract, which was to take out tonsils instead of amputation. This is similar to malpractice, and people already have to sue to get those compensations. Here however, there is violation of an actual agreement, rather than violation of "standard of care."

Like I said before, if we pull the regulations (which are written in the blood of victims who happened in times past), we will become victims and you can't just quit and go down the road, because it's no different down the road. You think a company is going to tell its prospective hires, oh yes, you can burn to death in our plant. If you don't like it, don't work here. They won't say anything of the kind. There will just be this 100% preventable but mysteriously unexpected "accident" that they claim was not in their control. It's not until the government imposes standards and prosecutes the deadbeats that anything changes. It's not a perfect system, and it can be improved. However, removing all government involvement (even retaining your selected laws) is a recipe for disaster unless you find living in a 3rd world country to be a good thing. This has been proven time and time again throughout history. Unless you have a model with real data your ideas are going to be difficult to discuss.

Well, I've argued that a company should be held liable if the workers are severely burned if they DON'T tell them about the risk. Very simple, rather than making random rules based on the whims of beauracrats and an occasional crying mother, we should hold companies responsible for results. A company that creates risks not agreed to by the employee would be liable for the damage to the employees property (his body in this case). Read all of the incredibly stupid warnings on common things that companies put on their to avoid liability. If warnings prevented lawsuits, the companies WOULD give their employees warning. In this case, honesty makes financial sense.
 
The impetus for this discussion is the decline of morals in society. Years ago, few people would take advantage of a system offering universal healthcare. In that time, socialized medicine may have worked. Today, things are different. Parasitism will increase as socialized programs increase. Due to lack of moral fabric in our society, any socialized service will be exploited.

So, do we choose to have the govt. provide for the truly needy and accept the rampant parasitism that will accompany this service, or do we make every person "fend for themselves".

It's sad that a decision like this has to be made, but w/o a population with decent morals I feel socialized medicine will be abused so badly that it just won't work.

We live in a wonderful country. Almost everyone can find a job doing something. But, if healthcare is being handed out for free, where is the motivation to get up at 6am and go paint/roof/pick-up garbage/fix cars/work in factory/cut lawns etc etc.

Providing these services at the publics expense is not the answer. Life can be hard. We all need to do our part and earn our keep. We do need to provide for those who TRULY need help (mentally ******ed, crippled, etc) though.
 
Well, the repeal of EMTALA is one of the things that I argue that may have some popular support. This topic has been debated extensively, with the majority favoring reform at a minimum. I think that the public in general, if they realized that EMTALA was responsible for their 8 hour ED waits, might reconsider this one.

I agree that EMTALA desperately needs to be reformed. I'm not very hopeful about this, however, from a political standpoint. There needs to be some way to stop abuse of the system while allowing those who have a legitimate need to get the care that they need. Allowing NP's and PA's to screen patients for true emergencies and sending the rest to primary care providers is one solution I'm curious about. I also agree that there should be a fee charged and fee assistance should be available. Since you agree that any change would need to be phased in, we probably agree more than disagree on this point.

You can't order people to work for free, then give their services away to community members, and then expect it not to be a disaster. You have a problem with people getting paid by choice to work in dangerous conditions, but you have no problem with ED doctors being forced to expose themselves to AIDS, TB, Needles, etc.... for free with the chronic threat of being sued by the people that they are "helping."

No one is forcing physicians to go into Emergency Medicine, and EM physicians aren't going hungry either (http://forums.studentdoctor.net/showthread.php?t=349646). EMTALA is part of the job. If you don't like the job, take your own advice: stay out of the job. Many EM docs are rich by any standard. If you don't like EMTALA, then stay out of that end of the business and leave those positions for physicians who do want to work under these conditions. There seem to be plenty of willing hands out there. Get a lab research job if you want to get paid by the hour.

In terms of dumping, this could be easily solved by taking people to Charity Hospitals in the first place. I'm realistic, and I have no problem phasing out EMTALA over a period of time to allow for alternative charitable infrastructure development.

Yes, "let them eat cake."

For those of you who agree with EMTALA, put your money where your mouth is. Get together and create a charitable fund with YOUR money that pays for the care of unfunded people. If this has such profound support, people will happily give to this pool. My problem is the expectation that I will work for free because you think I should.

We have a political process for making decisions, and it doesn't involve consulting every fringe group to make sure they are ok with it. The political process has been followed, and it's time to obey the law. If you don't like the law, work to change it. I don't give you much of a chance on this one, however.

We give loans out all the time without collateral. My problem is that I don't see what is different between paying for medical care vs. a used car. Perhaps the existance of your "pay for the unfunded." fund that I have suggested you start with the public will provide some minimum compensation for facilities that treat people, allowing them to recoup atleast their losses if the patient doesn't pay.

I agree that EMTALA should be reformed and funded. We actually agree on that. Where we differ is that you would probably want lower taxes than I do because we disagree about what the consequences of the respective choices are. I wish you would get realistic and actually demonstrate some credible studies that show that your reforms could work and are in the best interest of the population (including you).

You've argued many times that the regulations here were lax. Nevertheless, I believe that you have put the egg before the chicken. As societies became more advanced, governments have been more able to interfere in industry, not the other way around. Feel free to talk to anyone who has worked in a government factory in Russia or Cuba (i know many in the later category), and they will tell you what sort of conditions exist when the government ends up with final say over working conditions.

I do believe in limited government, but not as limited as the government you want. We actually agree on this point, but disagree on the extent.

Most countries in which these conditions exist are formerly or presently communist or highly socialist countries:
Russia, Cuba, Nicaragua, Mexico, Argentina, China, etc...

The other countries that are like that are formerly fascist countries or countries that are constantly in warring internally:
Paraguay, Haiti, Somalia, Rawanda, etc...

Please find me a country that has 3rd world working conditions without a strong government or pure violent anarchy. Those are the things that I argue cause those conditions. Do I have enough historical examples of socialism not equaling safe working conditions?

Nobody. That is irrelevant, because even countries that are in pure anarchy officially maintain rules against a free market in medicine. It isn't being tried ANYWHERE.

Since you refuse to confront reality on this, let me do it for you. Although they were communist in their healthcare system in the past, the Chinese healthcare system has implemented certain capitalistic changes that seem to be very similar to your recommendations and "for profit." As a result, there are a number of abuses that are driven by profit motives. See how you would like this in our country:

http://news.bbc.co.uk/2/hi/asia-pacific/4763312.stm
"A World Health Organization survey measuring the equality of medical treatment placed China 187th out of 191 countries.

"The WHO's Hana Brixi explains: "Healthcare providers need to raise revenues. They are not covered even for the delivery of public services.

"So they necessarily concentrate on those who have resources to spend. They provide excessive services to those who can pay, and limited services or no services at all to those who are unable to pay."

"The evidence suggests the poor are failing to seek medical treatment because of the cost, while the rich are paying more and more.

"Government figures show hospital visits actually dropped almost 5% between 2000 and 2003, yet hospital profits increased 70% over the same period.

"Behind such bald statistics lie heartbreaking stories, like that of Mrs Li. She lies semi-paralysed, unable to speak, in a well-known Beijing hospital.

This is the result of a failed operation after she suffered a brain aneurysm. Her family have paid $18,000 and they do not know where the money has gone.

Her daughter, Xie Pei, suspects the hospital increased the fees after finding out how wealthy they were.

"My friend was visiting and a doctor asked her what my financial circumstances were like and what model of car I drove. The next day the doctor said the cost of the operation had gone up by $5,000."

The fact is that you are advocating a system that would harm our healthcare system more than you are willing to admit, much as it has harmed China's system. The reason you don't want to quote examples is because the facts contradict what you are claiming. The only reason we should implement a system such as yours is to benefit the middle class and wealthy while neglecting the poor. I'm sure you don't feel obligated to help the poor, but many Americans do. We have a political system for resolving conflicts such as this and our representatives in government are doing exactly that.
 
The impetus for this discussion is the decline of morals in society. Years ago, few people would take advantage of a system offering universal healthcare. In that time, socialized medicine may have worked. Today, things are different. Parasitism will increase as socialized programs increase. Due to lack of moral fabric in our society, any socialized service will be exploited.

So, do we choose to have the govt. provide for the truly needy and accept the rampant parasitism that will accompany this service, or do we make every person "fend for themselves".

It's sad that a decision like this has to be made, but w/o a population with decent morals I feel socialized medicine will be abused so badly that it just won't work.

We live in a wonderful country. Almost everyone can find a job doing something. But, if healthcare is being handed out for free, where is the motivation to get up at 6am and go paint/roof/pick-up garbage/fix cars/work in factory/cut lawns etc etc. Work sucks, and with the lack of integrity that is acceptable in our culture, people are apt to take the handouts rather than work.

Providing these services at the publics expense is not the answer. Life can be hard. We all need to do our part and earn our keep. If everyone does their part, there will more than enough left over for those who TRULY need help (mentally ******ed, crippled, etc).

I'm also disturbed by the personal choices that some people make and then our social services pay for the consequences. I wish people paid for the consequences themselves. However, there are plenty of good things about our society to make up for these deficiencies. Even so, I'm not sure that morals have declined (maybe it depends on what you consider the time range of measurement, what you consider to be morals, and who and how you're measuring). There has always been a range of morals, from angelic to pretty rotten as far as I can tell. My impression is that people have been evenly distributed across the spectrum (i.e., not a normal distribution).

That being said, we do need to protect our public systems from abuse, much as they should have been protected in the past. People should have to pay for services and assistance should be provided where warranted. I agree that people should be expected to work more than the standards we see in place today. However, despite their flaws, our social systems do keep the poor happy and keep them from rioting and destroying the lives of the middle class and wealthy. Without such social systems, we would have squatters and shanty-towns, which would be major sources of social unrest. It would drag down the quality of life for everyone. If we do make reforms, we need to make sure we don't forget the needs of the poor or our society won't survive.
 
I agree that EMTALA desperately needs to be reformed. I'm not very hopeful about this, however, from a political standpoint. There needs to be some way to stop abuse of the system while allowing those who have a legitimate need to get the care that they need. Allowing NP's and PA's to screen patients for true emergencies and sending the rest to primary care providers is one solution I'm curious about. I also agree that there should be a fee charged and fee assistance should be available. Since you agree that any change would need to be phased in, we probably agree more than disagree on this point.
We'll just have to stay in disagreement on the specifics of this 🙂 .

No one is forcing physicians to go into Emergency Medicine, and EM physicians aren't going hungry either (http://forums.studentdoctor.net/showthread.php?t=349646). EMTALA is part of the job. If you don't like the job, take your own advice: stay out of the job. Many EM docs are rich by any standard. If you don't like EMTALA, then stay out of that end of the business and leave those positions for physicians who do want to work under these conditions. There seem to be plenty of willing hands out there. Get a lab research job if you want to get paid by the hour.
You are mixing up what I say here. I believe that workers should have the right to compete on the free market with companies. The "richness" of a person is irrelevant. There is no reason why someone shouldn't be able to practice Emergency Medicine and sell himself at a rate that market conditions will bare. There is no reason why a decision to practice EM means that a person should have to do any work for free. I've never suggested factory workers should work for free. I said that they should be able to negotiate a fair value for their work on the free market free of coercion. Free work is not part of Emergency Medicine, it is part of the mandates made by the government that regulate EM.

We have a political process for making decisions, and it doesn't involve consulting every fringe group to make sure they are ok with it. The political process has been followed, and it's time to obey the law. If you don't like the law, work to change it. I don't give you much of a chance on this one, however.
This is the problem with the political process. You are advocating mob rule. Because I have a minority opinion, the majority should be able to run all over me and do what they want with my money and my resources? There is no reason that private charity can't handle these problems. The BIGGEST problem in this country is that everyone wants government benefits and demands that SOMEONE ELSE pay for them. The government then finds ways to screw a minority group who don't have a voting majority. I don't have a problem with charity, but I will always resent the idea that the majority can take MY money at will. My resources are not communal, they are MINE. They do not belong to you, or the majority, or the government. When they are taken by force, it is theft. I bow to this theft and follow the "law" because I have no choice, but I will always call a spade a spade.

I agree that EMTALA should be reformed and funded. We actually agree on that. Where we differ is that you would probably want lower taxes than I do because we disagree about what the consequences of the respective choices are. I wish you would get realistic and actually demonstrate some credible studies that show that your reforms could work and are in the best interest of the population (including you).
I think we are still probably pretty far off on this one. What I want is private funding. I don't believe in taking money from one person by force and giving it to another person. I have no studies to quote you, because no one has funded such studies. I have real life examples of lower taxes and lower market intervention creating wealth and prosperity across the board. Compare US employment to ANY socialized country. Compare per capita income in the US to ANY other country with a large population. It's not even close, and the progress that has been made in Europe (especially countries like the UK, the whole eastern bloc and Switzerland) has come on the heels of market reforms that lowered taxes and regulations.

I do believe in limited government, but not as limited as the government you want. We actually agree on this point, but disagree on the extent.
I think in this case, you are the one who wants to let the proverbial lion out of the cage because he looks friendly.


Since you refuse to confront reality on this, let me do it for you. Although they were communist in their healthcare system in the past, the Chinese healthcare system has implemented certain capitalistic changes that seem to be very similar to your recommendations and "for profit." As a result, there are a number of abuses that are driven by profit motives. See how you would like this in our country:
China still has a strong medical establishment without significant alternative that operates in a still impoverished communist system through which wealth has only been created by recent market reforms

http://news.bbc.co.uk/2/hi/asia-pacific/4763312.stm
"A World Health Organization survey measuring the equality of medical treatment placed China 187th out of 191 countries.
I don't think equality is actually a measure of quality. If the poorest person gets 2x the care, while a rich person gets 1000x the care, I think that is better than both of them have 1x the care.

"The WHO's Hana Brixi explains: "Healthcare providers need to raise revenues. They are not covered even for the delivery of public services.

"So they necessarily concentrate on those who have resources to spend. They provide excessive services to those who can pay, and limited services or no services at all to those who are unable to pay."

"The evidence suggests the poor are failing to seek medical treatment because of the cost, while the rich are paying more and more.

"Government figures show hospital visits actually dropped almost 5% between 2000 and 2003, yet hospital profits increased 70% over the same period.

"Behind such bald statistics lie heartbreaking stories, like that of Mrs Li. She lies semi-paralysed, unable to speak, in a well-known Beijing hospital.

This is the result of a failed operation after she suffered a brain aneurysm. Her family have paid $18,000 and they do not know where the money has gone.

Her daughter, Xie Pei, suspects the hospital increased the fees after finding out how wealthy they were.

"My friend was visiting and a doctor asked her what my financial circumstances were like and what model of car I drove. The next day the doctor said the cost of the operation had gone up by $5,000."
This is all an example of a mixed system, like the ones being advocated in the US, failing. The last example about the raised prices would be a violation of contract, and the family could sue in the system I want. In my system, hospitals would also have to compete, so the family could just take the girl to the next hospital for the surgery at a cheaper price. You can't make it completely for profit without abolishing the government backed monopolies. Capitalism only works with competition. I've repeatedly argued that this is a major part of the problem here in the US.

The fact is that you are advocating a system that would harm our healthcare system more than you are willing to admit, much as it has harmed China's system. The reason you don't want to quote examples is because the facts contradict what you are claiming. The only reason we should implement a system such as yours is to benefit the middle class and wealthy while neglecting the poor. I'm sure you don't feel obligated to help the poor, but many Americans do. We have a political system for resolving conflicts such as this and our representatives in government are doing exactly that.

As I've said, NO ONE is trying my system. EVERY country on earth has had restrictions on hospitals, medical practice, and health funding for decades. You can't find an example that actually reflects what I want, because none exists. Because of that, I have to look at other industries to see the effect of capitalism on resource distribution. I think the evidence there is overwhelming.
 
You are mixing up what I say here. I believe that workers should have the right to compete on the free market with companies. The "richness" of a person is irrelevant. There is no reason why someone shouldn't be able to practice Emergency Medicine and sell himself at a rate that market conditions will bare. There is no reason why a decision to practice EM means that a person should have to do any work for free. I've never suggested factory workers should work for free. I said that they should be able to negotiate a fair value for their work on the free market free of coercion. Free work is not part of Emergency Medicine, it is part of the mandates made by the government that regulate EM.

Your complaint would be akin to a soldier who voluntarily enlisted in the Army and then complains about being sent off to Iraq, where he could lose his life. If you don't like EMTALA, stay out of EM.

This is the problem with the political process. You are advocating mob rule. Because I have a minority opinion, the majority should be able to run all over me and do what they want with my money and my resources? There is no reason that private charity can't handle these problems. The BIGGEST problem in this country is that everyone wants government benefits and demands that SOMEONE ELSE pay for them. The government then finds ways to screw a minority group who don't have a voting majority. I don't have a problem with charity, but I will always resent the idea that the majority can take MY money at will. My resources are not communal, they are MINE. They do not belong to you, or the majority, or the government. When they are taken by force, it is theft. I bow to this theft and follow the "law" because I have no choice, but I will always call a spade a spade.

Actually, your problem is really more with unfair people than with government. You are convinced that you would be better at the mercy of big business than at the mercy of government. Then you create a scenario where, on the one hand government is weak (or only strong where you think it is ok), but on the other hand the courts are supposed to protect us from big business abuses. Unfair people will always tilt things in their favor and to their advantage and some well-meaning people will mistakes in how the develop laws. People are ingenious. They would destroy your system and you wouldn't be happy with it at the end of the day. The reason you don't have studies is because the facts don't fit your reality. There is plenty of information out there and it contradicts what you are claiming.

I think we are still probably pretty far off on this one. What I want is private funding. I don't believe in taking money from one person by force and giving it to another person. I have no studies to quote you, because no one has funded such studies. I have real life examples of lower taxes and lower market intervention creating wealth and prosperity across the board. Compare US employment to ANY socialized country. Compare per capita income in the US to ANY other country with a large population. It's not even close, and the progress that has been made in Europe (especially countries like the UK, the whole eastern bloc and Switzerland) has come on the heels of market reforms that lowered taxes and regulations.

Don't get me wrong. The U.S. is a huge economic success. We are the 800 lb economic gorilla ... for now anyway. So if it ain't broke, don't fix it! :laugh: We don't need to try your fringe, unproven, unstudied shortcuts to prosperity. We already have prosperity, so don't mess it. We have a great balance of private and social systems.

Even so, there is plenty that people can be unhappy about on our economy. We might have a "top 5" per capita income (our "socialist" neighbor to the north actually is higher) and parity purchasing power:

http://en.wikipedia.org/wiki/Per_capita_income
Nominal per capita PPP per capita
1. Canada 99,288 Luxembourg 69,800
2. Norway 64,193 Norway 42,364
3. Iceland 52,764 United States 41,399
4. United States 50,532 Ireland 40,610
5. Ireland 48,604 Iceland 35,115
6. Denmark 47,984 Denmark 34,740
7. Qatar 43,110 Luxembourg 34,273
8. United States 42,000 Hong Kong, SAR 33,479
9. Sweden 39,694 Austria 33,432
10. Netherlands 38,618 Switzerland 32,571

Here is another list:

http://www.nationmaster.com/graph/eco_gro_nat_inc_percap-gross-national-income-per-capita
#1 Luxembourg: $37,499.20 per person
#2 Switzerland: $36,987.60 per person
#3 Japan: $35,474.10 per person
#4 Norway: $35,053.30 per person
#5 United States: $33,070.30 per person
#6 Denmark: $30,191.50 per person
#7 Iceland: $27,473.80 per person
#8 Sweden: $25,105.50 per person
#9 United Kingdom: $24,486.70 per person
#10 Austria: $23,824.10 per person


What this statistic fails to show is the following:
http://en.wikipedia.org/wiki/Income_distribution

"In the United States, income is distributed somewhat inequally, with those in the top two quintiles earning more than the bottom 60% combined. ...

What this means is that the top two quintiles have a world-class lifestyle, but the majority of our citizens might not.

Not only does Canada have more per capita income and Norway better parity purchasing power (albeit a very small country), their income is also better distributed than ours so that more of their population enjoys supreme prosperity thanks perhaps to their superior social systems and policy (and many other factors). Denmark has a lower per capita income and PPP, but because their income distribution is twice as even as ours, their overall population arguably enjoys more prosperity than ours, even though they are much more socialistic than ours.

http://en.wikipedia.org/wiki/List_of_countries_by_income_equality
Country UN Richest 20% to poorest 20% income
=================================
Norway 3.9
Japan 3.4
Finland 3.8
Hungary 3.8
Norway 3.9
Sweden 4
Denmark 4.3
Germany 4.3
Austria 4.4
Canada 5.5
U.S. 8.4

Also, when it comes to income taxes by country, it's countries like Mexico that have the best rates. So why aren't they doing so much better than we are? Because low taxes are not sufficient to overcome more important factors. If you look at the income tax burden (and other taxes), you'll find that it really isn't that great in the U.S. and there really isn't much of a correlation between income taxes (or other kind of taxes) and any quality of life measure, economic performance, etc.

http://www.infoplease.com/ipa/A0922307.html
Income Tax by Country, 2004
Country Single person
without
children One-earner
family with
two children
Australia 24.3% 24.3%
Austria 10.8 8.1
Belgium 26.6 15.2
Canada 17.8 13.9
Czech Republic 11.4 5.3
Denmark 30.6 25.4
Finland 24.2 24.2
France 13.1 7.1
Germany 19.6 –2.8
Greece 0.6 0.6
Hungary 12.4 4.7
Iceland 25.5 14.0
Ireland 10.6 2.2
Italy 18.6 11.9
Japan 5.9 2.7
Korea, South 2.2 1.4
Luxembourg 8.9 0.0
Mexico 3.0 3.0
Netherlands 8.5 8.3
New Zealand 20.7 20.7
Norway 20.9 18.0
Poland 6.1 4.1
Portugal 5.6 0.4
Slovakia 7.9 –5.3
Spain 12.7 4.3
Sweden 24.0 24.0
Switzerland 9.8 5.1
Turkey 15.4 15.4
United Kingdom 15.9 8.1
United States 16.5 2.4


I think in this case, you are the one who wants to let the proverbial lion out of the cage because he looks friendly.

I'm caging both of them ... 😉

China still has a strong medical establishment without significant alternative that operates in a still impoverished communist system through which wealth has only been created by recent market reforms

I don't think equality is actually a measure of quality. If the poorest person gets 2x the care, while a rich person gets 1000x the care, I think that is better than both of them have 1x the care.

This is all an example of a mixed system, like the ones being advocated in the US, failing. The last example about the raised prices would be a violation of contract, and the family could sue in the system I want. In my system, hospitals would also have to compete, so the family could just take the girl to the next hospital for the surgery at a cheaper price. You can't make it completely for profit without abolishing the government backed monopolies. Capitalism only works with competition. I've repeatedly argued that this is a major part of the problem here in the US.

I'm not sure where you get the 1x vs 2x numbers. You made those up. If you look at this article and others, the make it very clear that care for the poor has decline, care for the middle class has gone down with increasing costs. The only group that is getting care is the rich, and they are often getting care that costs a lot but is not appropriate for their condition. Basically, there are serious problems with physicians providing procedures just to make money, irrespective of what the patient needs. Thus, it would be more accurate that care for the poor has gone from 1x to 1/100th x and for the rich, more improper care is provided at enormous costs. There really is nothing in this article that would suggest any improvement in care. Even the government officials admit it's a broken system and are suggesting changes that would make it more like ours:

""Our hospital's state funding isn't enough to even cover staff salaries for one month. Under the current system, hospitals have to chase profit to survive."

The system has even been criticised by a government think tank, the State Council's Development Research Centre, which said healthcare reforms had "basically failed".

Reforms

It warned that social stability and public support for the government could be affected if the country does not overhaul healthcare. But health ministry spokesman Mao Qun'an disagreed.

"We're providing basic health services for 22% of the world's population with 2% of the resources. I think we've had enormous success," he told the BBC.

He also outlined an ambitious programme of further reforms, including building low-cost hospitals in cities and providing healthcare insurance to the whole population by 2010.

However, Mr Mao acknowledged the system of hospital funding was flawed and admitted there was some overcharging.

----
I would tend to agree with you that we should have more competition in medicine. However, I don't agree that the government needs to abolish its role in order for us to achieve this. Yes, there are tweaks that we could look into such make such as perhaps letting the market dictate pay for residencies and opening more positions (where more hospitals could offer residencies) allowing foreign national physicians to begin practicing after passing a thorough examination and evaluation of their skills and combining medical school education with undergraduate education so that it doesn't take so long, improving working conditions for physicians so that more people want to go into this field.

As I've said, NO ONE is trying my system. EVERY country on earth has had restrictions on hospitals, medical practice, and health funding for decades. You can't find an example that actually reflects what I want, because none exists. Because of that, I have to look at other industries to see the effect of capitalism on resource distribution. I think the evidence there is overwhelming.

As I've said before. People have looked at your system, and China is perhaps the closest to what you are advocating. People have looked it and found it to be totally unacceptable. The idea that a physician could negotiate a price for services with a patient who is sitting in an emergency room with a life-threatening condition is not something too many people outside of your fringe group are going to tolerate. There would be too much incentive for doctors to take advantage of vulnerable patients and the best solution is to prevent problems like this rather than trying to resolve them through the courts, which are slow, expensive, and often unfair. Many people will tell you that looking to the courts to police the healthcare system is probably one of the worst ideas out there.
 
Your complaint would be akin to a soldier who voluntarily enlisted in the Army and then complains about being sent off to Iraq, where he could lose his life. If you don't like EMTALA, stay out of EM.
My argument is more like a guy owning a private security company and the government telling him that all security companies have to go to Iraq. If I wanted to practice EM at a private hospital that didn't do charity work, EMTALA would make that illegal.

Actually, your problem is really more with unfair people than with government. You are convinced that you would be better at the mercy of big business than at the mercy of government. Then you create a scenario where, on the one hand government is weak (or only strong where you think it is ok), but on the other hand the courts are supposed to protect us from big business abuses. Unfair people will always tilt things in their favor and to their advantage and some well-meaning people will mistakes in how the develop laws. People are ingenious. They would destroy your system and you wouldn't be happy with it at the end of the day. The reason you don't have studies is because the facts don't fit your reality. There is plenty of information out there and it contradicts what you are claiming.
The government, like society, isn't a faceless mass, it is a constellation of different individuals. These individuals utilize the resources of the government unfairly for personal gain. The government is the biggest racket out there. A court system is the one valid way of dealing with competing interests without having the government intrude into every aspect of everyday life. These same ingenious people that you are talking about need a monopoly on force to prevent me from acting, and that is only possible through the government.


Don't get me wrong. The U.S. is a huge economic success. We are the 800 lb economic gorilla ... for now anyway. So if it ain't broke, don't fix it! :laugh: We don't need to try your fringe, unproven, unstudied shortcuts to prosperity. We already have prosperity, so don't mess it. We have a great balance of private and social systems.

Even so, there is plenty that people can be unhappy about on our economy. We might have a "top 5" per capita income (our "socialist" neighbor to the north actually is higher) and parity purchasing power:

http://en.wikipedia.org/wiki/Per_capita_income
Nominal per capita PPP per capita
1. Canada 99,288 Luxembourg 69,800
2. Norway 64,193 Norway 42,364
3. Iceland 52,764 United States 41,399
4. United States 50,532 Ireland 40,610
5. Ireland 48,604 Iceland 35,115
6. Denmark 47,984 Denmark 34,740
7. Qatar 43,110 Luxembourg 34,273
8. United States 42,000 Hong Kong, SAR 33,479
9. Sweden 39,694 Austria 33,432
10. Netherlands 38,618 Switzerland 32,571

Here is another list:

http://www.nationmaster.com/graph/eco_gro_nat_inc_percap-gross-national-income-per-capita
#1 Luxembourg: $37,499.20 per person
#2 Switzerland: $36,987.60 per person
#3 Japan: $35,474.10 per person
#4 Norway: $35,053.30 per person
#5 United States: $33,070.30 per person
#6 Denmark: $30,191.50 per person
#7 Iceland: $27,473.80 per person
#8 Sweden: $25,105.50 per person
#9 United Kingdom: $24,486.70 per person
#10 Austria: $23,824.10 per person
I'm not exactly sure where these statistics come from, but I KNOW that the Canadian income is incorrectly high. Wikipedia says that they come from the IMF, but I don't always trust Wilkipedia.

With regards to the second set of statistics (which I will concede are correct), this is before tax income. Luxembourg doesn't count, as I've said before. You have to compare countries that have larger populations and the concominant social issues. Switzerland mandates that anyone seeking citizenship from the outside come in with atleast $400k, so that skews them up a bit. However, Switzerland does have a tax system with rates more akin to the US than to Europe. Japan and Norway may have higher pre-tax incomes, but they will definitely have lower after-tax incomes. Japan is also the somewhat capitalist bastion surrounded by the east asian communists (N. Korea, China, Vietnam). Norway is the least oppressive (Though I will admit that this is weak) of the Scandanavian countries.

This also doesn't point out variations in cost of goods between these countries. According to the Heritage Foundation, Buyers in the EU pay 80-100% more for food than their American counterparts due to EU agriculture protectionist policy. A simple stroll down an average street in most European cities vs. those in America will reveal a higher level of material wealth in the US. We have bigger houses, bigger cars, more stuff, more access to goods, cheaper fuel, and more purchasing options. Per capita income income isn't the only measure of wealth.

What this statistic fails to show is the following:
http://en.wikipedia.org/wiki/Income_distribution

"In the United States, income is distributed somewhat inequally, with those in the top two quintiles earning more than the bottom 60% combined. ...

I've already said that income distribution is irrelevant to me. Equality doesn't equal quality in my book. The difference in the US also, compared to other countries, is the vast amount of mobility between the classes. If you read "The Millionaire Next Door," you will read that 90%! of American Millionaires are SELF-MADE.

What this means is that the top two quintiles have a world-class lifestyle, but the majority of our citizens might not.
I'm in the lower 1/2 of US income, and my lifestyle ain't too bad at all.

Not only does Canada have more per capita income and Norway better parity purchasing power (albeit a very small country), their income is also better distributed than ours so that more of their population enjoys supreme prosperity thanks perhaps to their superior social systems and policy (and many other factors). Denmark has a lower per capita income and PPP, but because their income distribution is twice as even as ours, their overall population arguably enjoys more prosperity than ours, even though they are much more socialistic than ours.
Have you ever lived in these countries? My best friend as a child came from a family that fled, in part, the taxes in Quebec? I've met more than one person in Miami who left their country of origin to escape these "supreme social systems." This was, by the way, a middle class family that consisted of a teacher and a nurse.

I've already said that equality isn't an indicator of quality. Someone who produces 10x as much should get 10x as much.

Also, when it comes to income taxes by country, it's countries like Mexico that have the best rates. So why aren't they doing so much better than we are? Because low taxes are not sufficient to overcome more important factors. If you look at the income tax burden (and other taxes), you'll find that it really isn't that great in the U.S. and there really isn't much of a correlation between income taxes (or other kind of taxes) and any quality of life measure, economic performance, etc.

http://www.infoplease.com/ipa/A0922307.html
Income Tax by Country, 2004
Country Single person
without
children One-earner
family with
two children
Australia 24.3% 24.3%
Austria 10.8 8.1
Belgium 26.6 15.2
Canada 17.8 13.9
Czech Republic 11.4 5.3
Denmark 30.6 25.4
Finland 24.2 24.2
France 13.1 7.1
Germany 19.6 –2.8
Greece 0.6 0.6
Hungary 12.4 4.7
Iceland 25.5 14.0
Ireland 10.6 2.2
Italy 18.6 11.9
Japan 5.9 2.7
Korea, South 2.2 1.4
Luxembourg 8.9 0.0
Mexico 3.0 3.0
Netherlands 8.5 8.3
New Zealand 20.7 20.7
Norway 20.9 18.0
Poland 6.1 4.1
Portugal 5.6 0.4
Slovakia 7.9 –5.3
Spain 12.7 4.3
Sweden 24.0 24.0
Switzerland 9.8 5.1
Turkey 15.4 15.4
United Kingdom 15.9 8.1
United States 16.5 2.4
Here is an example of how lower taxes = increased prosperity:
http://www.econlib.org/library/Enc/MarginalTaxRates.html

With regards to Mexico, they have a VAT, have just abandoned a corrupt political regime that has been in power for like 70 years, and their marginal tax rates are similar to US with much lower brackets. Everyone being broke, and thus paying taxes in lower brackets, is not a good comparison of lowering the tax brackets would do in the US. The opressive tax structure has already worked its magic in Mexico.


I'm not sure where you get the 1x vs 2x numbers. You made those up. If you look at this article and others, the make it very clear that care for the poor has decline, care for the middle class has gone down with increasing costs. The only group that is getting care is the rich, and they are often getting care that costs a lot but is not appropriate for their condition. Basically, there are serious problems with physicians providing procedures just to make money, irrespective of what the patient needs. Thus, it would be more accurate that care for the poor has gone from 1x to 1/100th x and for the rich, more improper care is provided at enormous costs. There really is nothing in this article that would suggest any improvement in care. Even the government officials admit it's a broken system and are suggesting changes that would make it more like ours:
My numbers were purely hypothetical. I used them to explain why equality was a poor measure of quality. My example was a system where everyone in the unequal system got better care than in the equal one. The unequal system would have MUCH better quality, but much "worse" equality. I used it only to prove that it was a poor indicator of health system quality.

""Our hospital's state funding isn't enough to even cover staff salaries for one month. Under the current system, hospitals have to chase profit to survive."

The system has even been criticised by a government think tank, the State Council's Development Research Centre, which said healthcare reforms had "basically failed".

Reforms

It warned that social stability and public support for the government could be affected if the country does not overhaul healthcare. But health ministry spokesman Mao Qun'an disagreed.

"We're providing basic health services for 22% of the world's population with 2% of the resources. I think we've had enormous success," he told the BBC.

He also outlined an ambitious programme of further reforms, including building low-cost hospitals in cities and providing healthcare insurance to the whole population by 2010.

However, Mr Mao acknowledged the system of hospital funding was flawed and admitted there was some overcharging.
You are NEVER going to convince me that a system in China, where people aren't even allowed to own private property, can be compared to the system I want to try in which all property is absolutely private. The GOVERNMENT is building the hospitals, because private citizens can't own them. That is NOT capitalist, and it is not comparable to a capitalist system.

----
I would tend to agree with you that we should have more competition in medicine. However, I don't agree that the government needs to abolish its role in order for us to achieve this. Yes, there are tweaks that we could look into such make such as perhaps letting the market dictate pay for residencies and opening more positions (where more hospitals could offer residencies) allowing foreign national physicians to begin practicing after passing a thorough examination and evaluation of their skills and combining medical school education with undergraduate education so that it doesn't take so long, improving working conditions for physicians so that more people want to go into this field.
This would be an improvement, though it would obviously fall short of the level of reform I would like.

As I've said before. People have looked at your system, and China is perhaps the closest to what you are advocating. People have looked it and found it to be totally unacceptable. The idea that a physician could negotiate a price for services with a patient who is sitting in an emergency room with a life-threatening condition is not something too many people outside of your fringe group are going to tolerate. There would be too much incentive for doctors to take advantage of vulnerable patients and the best solution is to prevent problems like this rather than trying to resolve them through the courts, which are slow, expensive, and often unfair. Many people will tell you that looking to the courts to police the healthcare system is probably one of the worst ideas out there.

As I've said before, China doesn't remotely resemble my system. I'm not sure what people you're talking about that have found it unacceptable. I'll happily let people choose to see whatever doctor they want. I just want to have the right to operate independently and have people see me by choice without all sorts of BS regulations getting in the way. I think that my system is best for the best quality of care if it were applied broadly, but I firmly believe that if everyone else wants to act against their best interests, that it is their perogative to do so. That doesn't give them the right to stop ME or those that agree to see me though.

With regards to emergency care, I think that much of this should be negotiated BEFORE the emergency. I have less of a problem with a standard fee for care, that would apply in the ABSENCE of choice negotiations between providers and potential patients. This would be sort of an opt-out program, that would be entirely by choice and require no coercion. That being said, you can't force people to treat people they don't want to treat and then force them to do it for free. That is the current system, and it is INCREDIBLY broken.

If a person is taken to the ED in a true emergency, then they will have negotiated, probably through insurance or directly through the hospital, beforehand. If they haven't, they could pay the standard. Hospitals could DECIDE whether they wanted to take the standard fee, and ambulances could take patients to hospitals that did, unless the patient specifically requested otherwise. A patient in severe distress could always be treated in this system. However, a walk-in who has 8 hours to wait for care could easily go to the charity hospital, and EMTALA is totally unnecessary here. Emergencies that are SO severe that negotiations can't be done are RARE, and they make up a miniscule number of medical encounters.
 

Interesting discussion. I certainly learned a lot. Many of these debates will be played out in our state capitals. There are many points we agree on (such as everyone going to the emergency room having to pay a fee, etc.). These issues have huge $$'s tied to them and I hope we see improvements in the future.
 
Interesting discussion. I certainly learned a lot. Many of these debates will be played out in our state capitals. There are many points we agree on (such as everyone going to the emergency room having to pay a fee, etc.). These issues have huge $$'s tied to them and I hope we see improvements in the future.

touche 🙂

I was about to kill this one as well. I might actually study now :laugh:
 
touche 🙂

I was about to kill this one as well. I might actually study now :laugh:

Don't worry; this issue isn't going away. We'll be able to talk about this area of mayhem from time to time as states try to keep afloat paying their escalating Medicaid and Medicare bills and ED's try to cope as well
 
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