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Universal Healthcare Poll

Discussion in 'Emergency Medicine' started by Blue Frog, Mar 3, 2007.

As an EM doc, what do you see as best for the US?

  1. Universal health insurance - not single payer

    32 vote(s)
    41.0%
  2. Single payer universal health insurance

    14 vote(s)
    17.9%
  3. Our current system or something similar

    25 vote(s)
    32.1%
  4. Something significantly different from any of the above (please comment)

    10 vote(s)
    12.8%
Multiple votes are allowed.
  1. Blue Frog

    Blue Frog Junior Member 2+ Year Member

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    In response to the socialized medicine thread I am curious as to what a poll of EM Doc's would show on this topic.
    *I would like to note however, that none of the above options are true socialized medicine. (defined by the government controlling healthcare and doctors being employed by the government)
     
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  3. GeneralVeers

    GeneralVeers Globus Hystericus Physician 10+ Year Member

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    The single payer system is socialized. When the government sets all reimbursement rates, we would in essence become employees. If the government doesn't want you to practice in a big city, they can refuse to reimburse you for practicing there, and tell you there is only reimbursement for going to an "underserved community". This is precisely what happened in Canada.
     
  4. LovingItAll

    LovingItAll Member 7+ Year Member

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    Government has proven time after time after time after time after time after time after time after time after time after time.....that it does nothing but make things worse. (Medicare and Medicaid sure are stellar examples).

    I voted for option #4. We need waaaaay less government government regulation and involvement, not more.
     
  5. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Agreed I continue to ask anyone who wants socialized medicine to point out ONE program the government runs and does a good job at.. Im still waiting.. More government leads to more waste.
     
  6. JO1234

    JO1234

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    I think the problem with this debate, is that universal coverage does nothing to solve the inherint problem of cost. You cannot cover everyone in our system and give out contracts to pharmaceuticals and newer technologies to the rate we are doing and still expect to curb costs. Also there would have to be a cutoff in what we are rationally willing to treat and be able to live with it. Are we willing to not put an 80 yr old in an ICU for weeks on end for a terminal disease with little chance of them ever leaving the hospital. Are we willing to let disease take its course with some people where the chance for hope lies to expensive experimental or nonproven measures? In the end, universal coverage only goes as far as how the actual care is administered and what we prioritize(To give care to all you have to sacrifice areas of care in some respects). Plus I never understood why universal health coverage always meant a doctor needed their salaries drastically slashed. Doctor salaries are not the reason for the healthcare costs. The costs come from using zopenex over albuterol without discriminating for indications. "Pan labing" instead of judicious management. Now some will argue you need to practice defensive medicine for fear of lawyers. But in the end, if your management is based on sound medical judgement, you might be sued (and this might happen reguardless of your management) but your chance of losing is slim to none.
     
  7. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Actually not true.. The standard is based on what is expected in your community. (It is worded a little differently but thats the bottom line). So even some things like Otitis and the watch and wait approach even if proven medically might leave you open to liability if it is not the norm in your community if a bad outcome occurs.
     
  8. Dr. Will

    Dr. Will 10+ Year Member

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    Why is this topic being discussed AGAIN?!
     
  9. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    Despite the recent Walter Reed scandal, the VA system isn't bad for providing a system that establishes a basic system for a large and often very sick population. It has had problems but has made headway recently (again, apart from Walter Reed). It is far from perfect and is far from efficient, but given it's lack of funding and influx of wounded/sick vets I think it does a decent job. It isn't a Mercedes, but more like a Chevy (which may be fine for most things but certainly not all).

    And just because something is a private system doesn't mean that it won't have waste also (its just that the private system "waste" goes to other things and is harder to see). Remember the article about the admistrative costs between the Canadian and US systems?
     
  10. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    I do and I would argue that anything the govt does can be done as well if not better by a private company who could do it cheaper and squeek out a profit as well. I think comparing us to canada or anyone else is comparing apples to oranges. We are sicker. I pointed that out in one of those threads, we are unhealthier and we provide more care due to this. Now pharma thats a different thing. BTW you know the US govt (CMS) (not the VA) cant even negotiate drug prices? ARE YOU KIDDING ME? How about if it applied this same logic to doc fees? We would be filthy rich. Well im gonna charge the govt $1K per office visit, but ill only charge $65 for the insurers. Stupidly insane.
     
  11. Dr. Will

    Dr. Will 10+ Year Member

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    If you guys don't start I'm going to do something drastic! I'm going to start a THIRD thread about universal health care! Don't make me do it!
     
  12. LovingItAll

    LovingItAll Member 7+ Year Member

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    Here's an idea: if you don't want to discuss universal healthcare, then don't open threads with the phrase "Universal Healthcare" in their title.
     
  13. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    relax.. a sense of humor is helpful!
     
  14. Miami_med

    Miami_med Moving Far Away Moderator Emeritus 7+ Year Member

    We could see how many threads about universal healthcare we could put on the same page. If we do a really good job, Fetus, Hawk, and I could take them all over with various permutations of the same debate.:D
     
  15. Hard24Get

    Hard24Get The black sleepymed 7+ Year Member

    Maybe to give people who weren't given the opportunity to express their opinons before. :laugh: Besides, even the lurkers vote on polls...

    I think it is important for us to discuss this; with a new congress and new president coming to power we have to figure out our position and FIGHT for it!

    I think someone here mentioned having a program akin to medicare/CHiP type programs for everyone - this makes the most sense to me. That way, if you don't have insurance, it is your primary, and if you do have health insurance, it can back you up in times of need.

    Free clinics will always be of lower quality and no one wants the US healthcare system to start looking like the VA. :scared:
     
  16. nocallaochicas

    nocallaochicas Member 5+ Year Member

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    Feb 4, 2006
    I agree with that. Cover everyone and if the rich want to pay for good care then they can get insurance or pay out of pocket or whatever.
    ncc
     
  17. GeneralVeers

    GeneralVeers Globus Hystericus Physician 10+ Year Member

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    That's the Canadian system. The very rich get to fly the U.S. for care, while the other 95% of Canadians settle for substandard care. When I say substandard, it's an average relative to U.S. care. Some places in Canada have excellent healthcare, but for the most part if you're not in a city that has a large academic institution, you have little choice but to settle.
     
  18. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    If you vote for what we have now you have your head buried in the sand or you haven't been in medicine very long. On our current course the current system is not sustainable. Health care costs have out raced most other economic measures. At that rate health care will eventually be our entire economy.

    On a more personal level every year I see more and more of my patients who used to have insurance now without it. That or with insurance that leaves such big holes they are afraid to get sick. 20% copay on an acute MI with a trip to the cath lab and a few days in the CCU could cost many of the working lower middle class their entire savings. I had a guy with Ekg changes and a low positive troponin sign out AMA for exactly that reason only a month ago. I realize single payer will never fly here. The only question is will we fix the current system before it crumbles under its own growth.

    I think some of the criticism of the Canadian system is from people with very little experience with the system. I have a relative who lives in the middle of nowhere in the Yukon and has had two bone marrow transplants done at a major Canadian academic center. My heme friends here tell me transplant is still considered experimental for his disease in the USA and thus wouldn't even be covered by our much vaunted private insurance system. His transplants have given him several more productive years but had no chance of curing him. That doesn't fit with the way the Canadian system is usually depicted over here.
     
  19. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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  20. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    I realize that the stats dont take $ into account but IMO it shouldnt if we focused more on those who are less sick maybe things would be better. Otherwise we will be where we are which is throwing good money behind a bad problem.
     
  21. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    Do you think that a private company could or would provide the same level of military protection as our current military for a lower price? I'm not talking about parts...I'm talking about the whole thing. What about the public school system? Could a private non-religious company take in ALL of our public students (i.e. not cherry pick) and provide the same level of education as our present system for less money? Education is far from perfect here, but I am not sure that private schools could do any better if they had to take all comers (learning disabilities, disiplinary problems, non-english speakers, etc) at our present level of funding for the entire education system. What about the police, fire, and public safety systems? Transit and roads? NASA? The NIH and the CDC? The FAA? The FBI, SBI, and the justice system? I doubt that many private companies would want to even come close to touching alot of these things.

    And please don't mistake me for someone who thinks that government is the answer to all our problems (FAR from it). I just think that many of the things necessary for our society can't (or won't) be performed by private industry for the same costs at the same level we now have or would want to have in the future. Even if you could find a firm willing to take on one of these massive undertakings, it would be even harder to find multiple firms to provide any meaningful competition (which would be the whole point). Competition may even be a bad thing and even more wasteful in some areas if we needlessly duplicate the infrastructure and create wasteful redunancy.

    Dear lord, I just realized how far off topic we are here.... my apologies.


    Don't get me started on the farce that is the present Medicare prescription drug program. I'm in too good a mood after the UNC win! :)
     
  22. Dr. Will

    Dr. Will 10+ Year Member

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    :rolleyes: I've actually enjoyed reading the threads but have also enjoyed posting something to break up the bickering. Geez...pull the stick out of your a$$
     
  23. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    A slightly old but more rigid analysis of kidney transplant in Canada

    1: Med Care. 1997 Jul;35(7):686-700.

    Mortality, hospital admissions, and medical costs of end-stage renal disease in
    the United States and Manitoba, Canada.

    Hornberger JC, Garber AM, Jeffery JR.

    Department of Health Research and Policy, Stanford University School of
    Medicine, CA 94305-5092, USA.

    OBJECTIVES: National registry data suggest that mortality rates among patients
    with end-stage renal disease are lower in Canada than in the United States.
    Casemix and treatment variables, although limited in such instances, do not
    explain this difference. Using a more complete set of casemix and treatment
    variables from clinical databases, this study assesses mortality, hospital
    admission, and the cost of medical care for patients with end-stage renal
    disease treated in Manitoba, Canada and the United States. METHODS: Mortality
    rates were compared in patients with end-stage renal disease treated in the
    Province of Manitoba and a random sample of US patients enrolled in the US Renal
    Data System Casemix Severity Study. Hospital admission rates and costs of care
    were compared in Manitoba patients and in patients with end-stage renal disease
    in a large health care organization in Detroit, Michigan. RESULTS: Levels of
    serum creatinine, urea, and estimated glomerular filtration rate indicated more
    severe renal impairment at the outset of treatment in Manitoba than in the
    United States. Manitoba patients were more than twice as likely to receive
    kidney transplants as US Renal Data System patients. No patients in Manitoba
    used reprocessed dialyzers, compared with 57% of US Renal Data System patients.
    After adjustment for all casemix and treatment variables, the mortality rate was
    47% higher in the United States. The hospital admission rate in Detroit was 41%
    lower than the hospital admission rate in Manitoba, which primarily reflects the
    doubled rate of transplantation in Manitoba. Adjusted total monthly costs were
    $503 higher in Detroit than in Manitoba. CONCLUSIONS: The higher mortality rates
    in the United States cannot be fully explained by adjustments for observable
    casemix or treatment variables. Further research is needed to identify factors
    that explain how Manitoba achieves a lower mortality rate while paying less for
    end-stage renal disease care than the United States.
     
  24. Blue Frog

    Blue Frog Junior Member 2+ Year Member

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    Yes, the single payer system is socialized, but as I said, it is not "socialized medicine" it is socialized insurance. I understand the implications may be similar, but there are some important differences. In socialized insurance the government can affect your pay maybe even enough that you chose to work somewhere else. In socialized medicine the government is your employer and can fire you. Socialized insurance allows for cash payments or even supplemental insurance assuming it is funneled through the individual (as in a patients submits their bill to insurance and the physician's office doesn't deal with that aspect of billing) In socialized medicine the government can tell a physician he is not allowed to provide a given service at all. Although many advocate for a single payer system, very few advocated for government-owned healthcare in the US.
     
  25. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Ok lets not confuse the issue. Some things like military, police etc are different. They almost by definition require that they be run by the govt. We could get all into it but ill just talk about some of the less complex issues.

    Public schools.. Why couldnt they be religious? And it wouldnt have to be ONE company. Its not like the feds run all the schools it is done on a local basis with some fed money. To answer your question I do believe this could be done with and without religious schools. perhaps you are aware that what ends up happening with kids with mod to severe problems end up going to private places that then are paid for by the public.

    You realize jails are becoming privatized cause they do it better. Things that arent run like a business like police, fire etc cant be done by private systems because of how intertwined they are with public safety. The roads are a disaster are you kidding me? Do you know how much money is wasted on these things? Do you know cities are so broke they are selling off their tolls to get more money? Typical of politicians selling the future for money today.

    Do you know what has happened since deregulation of industries? Things have gotten cheaper for consumers and better. Anyways I disagree with your opinion.

    As far as the military why do you suppose private industry designs the planes, cars, weapons, boats etc. Why do you think Haliburton and a ton of the other defense contractors are up about 150% in the market since 2001 better than the S&P which is up about 40%. If the govt could do all this so well why wouldnt they do this in house.

    Dont get me wrong things that can be put to the free market are better.

    Do you really think that govt is more efficient than private business? There is no reason why a govt wants to increase efficiency. Look the USPS is pretty good, I mean crap 37 cents to send a letter cross country! But.. they are financially screwed meanwhile UPS and FedEx are doing well and there has long been talk of the USPS going private with FedEx buying them. Think about it. The free market fixes its problems itself, thats the beauty of the whole thing. The govt just raises taxes, moves money from one place to another and leaves us in debt. The govt has shown that they cant even balance the budget! Come on now. We are screwed with big govt and the bigger it gets the worse things will become.

    i wont pontificate again on this cause I dont have the stamina to read these long ass posts cause I got Judy T and Peter R I need to get thru!
    Dear lord, I just realized how far off topic we are here.... my apologies.




    Don't get me started on the farce that is the present Medicare prescription drug program. I'm in too good a mood after the UNC win! :)[/QUOTE]
     
  26. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Thats a different argument though. I thought you were trying to say that we dont do transplants in the US as often as in Canada and that access is limited.

    Data is 10+ yrs old but I get your point. I think data is out there that shows the opposite however.
     
  27. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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  28. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Another quick thing I found. The study obviously has its problems but..

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1380891

     
  29. LovingItAll

    LovingItAll Member 7+ Year Member

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    too much time son
     
  30. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Huh? Dude lighten up.
     
  31. Dr. Will

    Dr. Will 10+ Year Member

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    Yeah it's pretty sweet to be on a rotation with no responsibilities, have plenty of time to do everything I want, AND waste time on SDN.

    And you called me "son." How original. :thumbup:
     
  32. Hawk22

    Hawk22 Senior Member 7+ Year Member

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  33. Miami_med

    Miami_med Moving Far Away Moderator Emeritus 7+ Year Member

    #1: The current medicare drug plan is a perfect example of why the government SHOULD NOT be more involved in medicine. The argument that if they just didn't let people pay them off and bow to their constituents, they could do a good job, is irrelevant. The government ALWAYS lets people pay them off and bows to their constituency. Everything the government does is political by definition. Find me a government anywhere in any place at any time that didn't give special priveledges to someone and alter policy in some way that sacrificed absolute efficiency in order to give a perk to buddy.

    #2: Here's why the military can't be privatized: By definition, whoever controls the military and the police IS the government. Your privatized military will then be the new government. You can have a group of people who get together and make laws, but if there is no enforcement, there is effectively no law. This analogy doesn't cross well to healthcare.
     
  34. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Hawk, I like you bud but I have to DEMAND :) you learn how to quote me. It is otherwise impossible to read your posts when you quote me.

    I tried and I see your point but I just dont agree.
     
  35. LovingItAll

    LovingItAll Member 7+ Year Member

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    I'm relaxed, light, etc. I just don't see why a discussion about this important topic needs to be littered with unnecessary negativity from those who have nothing better to do with their "sweet" time. I stand by my decision to defend the thread.
     
  36. Dr. Will

    Dr. Will 10+ Year Member

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    Maybe you should turn your "sarcasm" meter on. As I've said, I'm glad these threads are on the forum and that these topics are being discussed. You should lighten up because no one but you is taking what aren't even "negative comments" seriously. This types of "negative comments" were made by myself and others in the previous thread. Seriously...stick out of a$$.

    Carry on.

    Oh and...if you hate my comments so much...put me on ignore. You don't have to read what I write.
     
  37. LovingItAll

    LovingItAll Member 7+ Year Member

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    Feb 18, 2003
    :sleep:
     
  38. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    Sorry Fetus, my bad!!! I edited that thing many times and just couldn't get it to do the multiple quote thing. Not sure why I can't get it to work, but I'll keep trying.

    And feel free to disagree, as I'm no expert and just as likely as the next guy to be completely wrong. :)
     
  39. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

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    Thanks man.. Hansborough broke his nose.. Ouch..
     
  40. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    Even though I don't agree with this completely, I think this is a pretty fair and valid point. I've asked myself more than once that if the government couldn't get the design of the Medicare Prescription Drug plan right and instead chose one of the worst plans I could imagine, how can they ever be trusted to do anything right in healthcare? Pretty depressing.
     
  41. Hard24Get

    Hard24Get The black sleepymed 7+ Year Member

    All you need is to add a "/" before the last quote, ie (pretend the "{" are "/") {quote} Ectopic {/quote} :)
     
  42. Miami_med

    Miami_med Moving Far Away Moderator Emeritus 7+ Year Member

    :clap: Hawk, We just almost agreed on something :thumbup: :clap:
     
  43. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    lol Yes, there's hope! :thumbup: :D


    Thanks Hard2Get.....I'll try that next time.
     
  44. Ceez

    Ceez Senior Member 10+ Year Member

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    Mar 31, 2002

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