Views on Healthcare Reform and Psych

[OldPsychDoc]

I don't care about property ownership, but how about a Civics test or something...If you can't pick the 3 branches of government from 4 choices, you can't vote.

Oh-- so literacy testing then?
I believe that was done frequently in the South prior to 1960 or so...


The bottom line is, you either believe in Democracy, and extend rights regardless of whether they are "deserved"--or you are suggesting possibly some other form of government....

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[futureapppsy2]

I agree that prevention as a whole is good, but it's NOT a panacea. Like others have pointed out, many, many people who get sick (including psych disorders like schizophrenia, bipolar, etc., which have a significant heritable component) or injuried live "low-risk" lifestyles. Case in point: I was born with a physical disability, certainly nothing I did brought it on (and my mother, for that matter, followed all of the "rules" while pregnant--prenatal vitamins, good diet, exercise, avoided may additives, didn't smoke or drink while pregnant--while she saw other soon-to-be mothers who ate poor diets and smoked and yet had [apparently] healthy newborns nonetheless). I am automatically excluded from all private, non-group health plans, even though my disability is non-progressive and non-fatal. Similarly, I've know many kids/adolescents/young adults who have had cancer--again, (in all likelihood) not their fault--still not insurable. Cancer risk and other risks (heart disease, etc.) can be REDUCED not eliminated.

For those who are simply "unlucky," so to speak,the current system (and the no-group-coverage plans proposed by some in Congress) have gapping holes.

 

[masterofmonkeys]

yes, some people are 'unlucky'. They're either born with or develop through accident, trauma, or freak illness, serious health issues. I myself had my life turned upside down by vaccine injury. I seem to spend all of my freetime rehabbing and recuperating so I can pretend to be normal during work. Also uninsurable. (Thank god I'm going to be an academic I guess). I really have next to no healthcare expenditures because I work so damned hard at maintaining normalcy. And yet the one time I need an MRI, and the one surgery I've had (less than 5k in total), I had to fight tooth and nail with my insurance to get covered. And they only caved when i threatened to use my daddy's lawyer.

And yes, I agree that something has to be done about us. As a consequentialist libertarian I do believe in the concept of market failure and recognize that government intervention is occasionally necessary. As such, I am not opposed to 'true' safety nets. But people in such circumstances have very little to do with the cost of healthcare overall. While our individual healthcare costs can be quite high, we are a relatively small proportion of both the chronically ill and the population as a whole.

Even with the seriously medically messed up, though, the rules of empowerment and agency still apply. I work hard in the gym, I've read whole textbooks on exercise physiology and kinesiology to come up with the most customized andd scientifically researched rehab plans I could think of, take in several gallons of fish oil and other natural anti-inflammatories and joint support supplements, and have taught myself every form of psychological pain management I could think of. My healthcare expenditures (if I'd paid in full and not had insurance cover some of it) are under a 1000 a year that I've had these issue. How many people with parsonage-turner syndrome, facet syndrome, multi-level radiculopathy, etc. can say the same thing? And for my pains, I pay no less a premium than someone who wasn't as proactive.

Let me once again state that I'm not talking about preventive medicine; I am talking about healthy living, which isn't particularly expensive. And while there aren't all that many studies on it, from personal experience, it does seem to work. 'Preventive medicine' as far as I can tell consists of medicating high-risk people and intervening early in the disease process, not preventing the disease processes or lowering risk in the first place.

Putting a diabetic on a statin, someone with HBP on lisinopril, etc. is preventive medicine. healthy living prevents that person from becoming diabetic or becoming heavy enough to develop hypertension. Maintaining a healthy weight, working out, and eating right prevent the need for medicine in the first place.

One of the things I talked about in the link I posted was the problem of 'discounting the future'. I think an easy way to get around that is to build in a refundable deposit of your premium that more closely approximates the actual, eventual costs of not engaging in a healthy activity. OPD's insurance offers him 20 bucks a month for hitting the gym 12 times a month. But how much in healthcare costs does he save himself by doing that? A hell of a lot more than 240 a year, I can tell you that much. Since, as I mentioned earlier, working out even lightly at the gym is twice as effective as a statin and considerably cheaper, in only a single domain. Make the refund payable quarterly. And make it resemble its actual worth.

In fact, in such a system, I would have far fewer objections to pooled-risk or 'community assessed' premiums. Because the only risk and the only conditions I'd be subsidizing would be the ones that DIDN'T have to do with modifiable risk factors.

 

[OldPsychDoc]

Yet another perspective...

 

[whopper]

Perhaps we should return to property ownership as a requirement for voting rights?

IMHO not a valid argument because in our current legal & Constitional infrastructure healthcare is not a right.

Owning property is a right, as well as voting.

No where in the Constitution does it say the government has to provide healthcare for all.

Now of course on a humanitarian viewpoint, we should strive to provide healthcare to as many people as possible which is exactly what providing incentives would do IMHO by decreasing costs.

But getting outside of the Constitution....
Another legal & philosophical standpoint--"you can swat your arms as much as you want so long as you don't hit my nose" which is the basis of social liberalism and analogous to the philosophy, "do whatever you want so long as it doesn't hurt anyone else" which is something I believe in and a big basis in my own social liberal beliefs, well gov healthcare steps on that. People who live responsibly shouldn't have to shoulder the costs of those who willingly choose to make harmful choices & have no intention of changing it despite that they know it is harmful, and have the capacity to make that decision. As I mentioned before, people should not be penalized for medical problems that a reasonable person could not avoid such as schizophrenia, a genetic disorder, or getting hit by a drunk driver.

Its also a basis for our commitment system. We aren't supposed to force someone into inpatient hospitalization for alcohol dependence after they've sobered up.

But how much in healthcare costs does he save himself by doing that? A hell of a lot more than 240 a year, I can tell you that much.

We live now in a society where we have so many products, options & services where use of one really does drive up the cost of the other. As Bill Maher has said several times, he doesn't believe there is an outright conspiracy between the food & healthcare industry, but its as if there really is one. Our food technology has gotten to the point where it can produce the exact food the person wants, so cheaply that now the lower class can afford. Problem is that our brains are evolutionarily hard wired for us to crave fat, sugar, salt & carbs, and people in America are eating too much of it. Lower cost of food to the point where it is now does create higher healthcare costs. However there is not filter/buffer that puts that message onto the consumer.

Its a product of the quick fix mentality Americans have. We get sick--we want a pill that fixes it. We want to feel better, we ask for an antidepressant or xanax even when we might not be clinically depressed or anxious. We want cheap, fatty, salty, high carb food--> we got it. We aren't thinking of the long term consequences.

A McD's hamburger is cheap thanks to industrial factory farming which has tremendous unethical processes (mistreatment of animals, environmental problems, reduced nutrition vs organically grown food). However if one were to get the real costs to society--in terms of healthcare problems, environmental impact etc, It'd be much higher, and consumers of that hamburger are not paying for those consequences. Unfortunately, at least for healthcare impact, all of us do pay with our taxes & health insurance for that person's hamburger.

 

[Sneezing]

I am an American. Medical care is not a right. Health care is knowledge that is freely accessible to everyone, and choosing not to employ it is your own darn fault. You are responsible for yourself. I believe it is not the role of the government to fund social programs or meddle in medicine.

It is our duty as citizens to reach out to each other. This would include those who aren't captured in the medical insurance net (like MoM mentioned). We can do it far more effeciently than any government system. How many people do we send out into the world on missions and humanitarian expeditions? Yet, how much of the world still hates us and doesn't give a darn that we give back so much? Getting rid of government nanny programs would only incentivize our own citizens to stay state side to volunteer.

We have the resources to treat/care for all our citizens, but expecting the government to be our saviour is a fool's errand and will only accelerate our economic collapse.

I vote freedom. I vote personal responsibilty. I support my community.

 

[futureapppsy2]

People who live responsibly shouldn't have to shoulder the costs of those who willingly choose to make harmful choices & have no intention of changing it despite that they know it is harmful, and have the capacity to make that decision. As I mentioned before, people should not be penalized for medical problems that a reasonable person could not avoid such as schizophrenia, a genetic disorder, or getting hit by a drunk driver.

But how do you draw that line? For example, do you automatically deny coverage for breast cancer tx to anyone with a BMI of over 25 because a *correlation* has been found between BMI and breast cancer?

I am an American. Medical care is not a right. Health care is knowledge that is freely accessible to everyone, and choosing not to employ it is your own darn fault. You are responsible for yourself. I believe it is not the role of the government to fund social programs or meddle in medicine

Not everything is preventable. Hell, even never smokers sometimes get lung cancer! Does this mean exercise, diet, not smoking, etc., aren't good ideas? No, of course not, and such things should be encouraged! But it's major employment of the "just world" fallacy to say sick=guilty, healthy=virtuous; people can--and should--pro,mote their health, but that won't prevent everything, and no one lives a risk-free lifestyle.

Also, some things have a certain degree of trade-off--for example, studies have shown that greater activity and mobility in people with CP leads to more joint-related secondary conditions later in life (and similar, though less drastic things, can be said about hard-core "normal" athletes, especially runners). Obviously, exercise has health benefits, but by the logic used in some of these posts, that is a something that should pre-empt coverage because it does have known health consequences.

Also, the argument of about people just spending thoughtlessly with government health care: CMS offers additional perscription funding for low-income beneficaries... Free money, basically. It's a huge, huge effort to get eligible beneficaries to sign up, despite massive targeted knowledge campaigns by CMS. Would some people abuse a govt/universal healthcare system? Sure, some people will abuse any system... or the lack thereof.

 

[digitlnoize]

But how do you draw that line? For example, do you automatically deny coverage for breast cancer tx to anyone with a BMI of over 25 because a *correlation* has been found between BMI and breast cancer?

I wouldn't even go so far as to say that we should DENY coverage. However, people with higher BMI's, who are not taking steps to correct their lifestyle, should pay higher premiums to cover their higher costs of care.

It is not fair to the part of the population that works their butt off to stay healthy, for them to have to subsidize the laziness of another segment of the population.

 

[BabyPsychDoc]

Healtcare debate is as hot as it always is on this forum...Having read all threads, I am posting my own thoughts - kind of a "synthetic response" to the posts of others here.

Life is not fair. It is frequently difficult, if not impossible, to establish roots of a particular disease, even if it's pathophysiology is well-known. Everyone knows that Hep C is a blood-borne virus - but the majority of carriers don't even know they have it. When I had a patient (decent middle-aged man, immigrant from Caucasus, no risk factors) diagnosed with chr hep C as a result of a routine blood test, I could not answer his questions, "Why?" or "Why me?" For all I know, he might have experimented with drugs as a teenager; or, maybe he was one of the unlucky 5% of babies that get the virus from their mothers; or, maybe he got it during vaccinations, as a result of healthcare workers re-using the needles. Is the illness his "fault"? And if his illness is a result of drug experiments, is not the illness itself enough of the "punishment"? After all, millions of teens do the same thing, and then live happily ever after. Of course, millions get hooked on the drugs after these experiments and slowly kill themselves through their (shortened) lives. Is addiction their fault? Or, is it the fault of their parents, who also never knew life without narcotics? Isn't the addiction enough of a punishment by itself? Yes, it can be TREATED. But, to make the treatment work you have to make their life worth living without drugs. Can you do that? Can anyone do that?

MoM, I stand in awe before your resolve and dedication to take your life back from your illness, whatever it is. I admire the strength of your spirit and can't help but respect the great lengths you went to, to "maintain normalcy" as you say. However, you are an immensely intelligent person who is dedicated to his goal. It would be cruel (not to say unrealistic) to demand this level of intelligence or dedication from an average Joe. The overwhelming majority of people are simply are NOT CAPABLE of it.

Later...

 

[whopper]

But how do you draw that line? For example, do you automatically deny coverage for breast cancer tx to anyone with a BMI of over 25 because a *correlation* has been found between BMI and breast cancer?

I already answered this question a few times in the thread.

I never said deny coverage to those paying insurance. I did say higher premiums. Those that are not taking care of their health, while still paying for insurance still get coverage--just at the end of the year, that person who is overweight will end up paying more money to the system. How much? I'd rather leave that to the acturarial data. It'd have to be an amount that actually causes some actual deterrant on the person, but need not be an amount the person absolutely cannot afford.

The system would be based on very easy to understand factors--1)weight, cholesterol, BP 2)regular doctor's visits (at least once a year), and following the doctor's advice with full ability to get a 2nd opinion 3) no substances of abuse--you are found drunk driving or having a (+) UDS, your premium goes up. No penalities for any form of preventative care such as routine visits, cholesterol meds, BP meds.

Like I said--the NJ car insurance system--you speed, you get another point added to your point system your insurance goes up about $200/year, and with no further tickets, you get a point subtracted each year. You get more taken off if you attend safe driving classes.

I wasn't a safe driver when I was 17--and my insurance went up $1000. That was a big lesson that did help to put some real emotional incentive to drive more safely.

 

[michaelrack]

Perhaps we should return to property ownership as a requirement for voting rights?

That's a good idea, but I would rather see the payment of federal income taxes as a requirement for voting rights. This country is rapidly reaching the point in which a majority of those who make the decision how much to tax (by voting for Federal office holders who ultimately make the decision) don't pay taxes themselves.

 

[masterofmonkeys]

That's a good idea, but I would rather see the payment of federal income taxes as a requirement for voting rights. This country is rapidly reaching the point in which a majority of those who make the decision how much to tax (by voting for Federal office holders who ultimately make the decision) don't pay taxes themselves.

40% of the country paid no income tax in 2008. Some estimate that if all of the proposed obama tax cuts and credits go into effect this will rise to 60%. The game theoretics of this just don't work out, especially when we take into account the effect of discounting the future (i.e. focus on short term gain). This is not a good situation to be in, when a sizable chunk of the voting populace has absolutely no stake in reining in the size of government, and considerable stake in choosing not to.

If you look at per capita expenditure by the government, it turns out that only a quarter of the populace pay anywhere near in income tax what the government spends on them. Again, not terribly good.

It's funny that the left have styled themselves the 'defenders of evolution' but fail to really take the lessons of evolution to heart and apply them to how we think about government.

As for the voting franchise, I am amused by people who think that democracy is an end in and of itself, rather than a means. Throughout time, the great political philosophers have acknowledged that it is making the best of a bad situation. Opening the voting franchise to all is certainly better than situations we had in the past where arbitrary restrictions were used as a means of oppressing various peoples, but to say it is some sort of ideal is disingenuous.

In a nation in which the power of government is carefully and scrupulously restricted (i.e. the way we used to be), such a problem is alleviated because no matter which way the vote goes, government cannot be used as a vehicle of force by one group against another, such as it is being used now. In a government where for all practical purposes no limits to power exist (i.e. now) abuse of power by one voting bloc against another can become a very serious problem, as it is rapidly becoming now.

The idea that people who benefit disproportionately from government intervention, while paying little to nothing for the service, can choose to force others to pay for their benefits unchecked, is just plain silly.

If you're going to have a vote in how the government is run, it's not particularly insane to think that you should probably have some part in maintaining it.

 

[masterofmonkeys]

I also wanted to say, that uninsurability notwithstanding and how that might change under universal coverage, nothing changes for me. I still expect to pick up the tab, 100% on my services.

Proponents of universal coverage, at least those with any intellectual honesty, will admit that waiting for treatment is a huge problem in universal coverage societies. As is denial of coverage. Rationing by any other name is still rationing.

And guess what? When I need those back surgeries, when I can no longer traction or exercise away the pain and weakness, I cannot wait 18-24 months as you have to in the UK or Canada. By then the nerve damage from radiculopathy/myelopathy would likely leave me in a wheelchair and forever addicted to narcotics.

I've lived in the UK; I know what it's like. And I am not exaggerating.

I have to be ready to pay out of pocket, at a minute's notice when I do need serious medical intervention.

 

[st2205]

That's a good idea, but I would rather see the payment of federal income taxes as a requirement for voting rights. This country is rapidly reaching the point in which a majority of those who make the decision how much to tax (by voting for Federal office holders who ultimately make the decision) don't pay taxes themselves.

Ten minutes ago I was just speaking with my wife about this same issue. Those who run the country (in terms of providing its finances) pay salaries of officials and pay to support those on government benefit programs. Those receiving the benefits keep voting in more people that continue to perpetuate the same plans.

Obviously there are problems with the healthcare system, but I still can't understand all this fuss about so many people being uninsured (with the implication that it's people who can't afford it). Anyone who can't afford health insurance and doesn't work can receive Medicaid.

My wife and I just got insurance, but the previous year we had no coverage because 1. we couldn't afford it and 2. we didn't qualify for Medicaid because I work. For the past couple years I've been working in a steelyard doing a pretty strenous job that many people quit and couldn't keep, yet I couldn't quit because I had a family I was providing for. I have a 32 year old brother, on the other hand, who's living in my parents basement with his wife and two kids. He hasn't worked in over a year, doesn't get out of bed typically before 11 am, and spends his day watching television, surfing the internet, or going and hanging out with friends (hasn't legitimately tried to find a job). He and his wife have Medicaid and receive food stamps. We don't qualify because I work. I made so little that we can't spend anything outside of our budget. I would say quite a few people can relate to this.

Like was mentioned earlier, I have a hard time appreciating why hard-working people who take care of their health and their lives are the ones who end up suffering as a result of increased government involvement. Healthcare isn't the real issue. Healthcare is just a manifestation of a bigger socioeconomical problem, yet politicians of whose salaries I'm paying are about to spend an exorbitant amount of money to "fix" a field that they know little about. They've volunteered physicians and the tax payer to help fund their ideas, but I haven't heard anything about them volunteering anything themselves to help (I believe congressional and senate salaries of $173,000 should put them almost identical in income as physicians, those whom they've volunteered to help pick up the tab). Thanks, guys!

 

[kugel]

I just wanted to say, "Thank You!"
I'm learning a lot from this thread, often about things outside of the original "healthcare reform" topic.
I'm learning a lot about political theory and philosophy. And a lot about my own assumptions regarding politics and gov't.

I'm particularly impressed with the thoughtfulness and conviction on many sides -but without any outright attacks on others.
Seriously. No sarcasm or irony intended.

 

[BabyPsychDoc]

I also wanted to say, that uninsurability notwithstanding and how that might change under universal coverage, nothing changes for me. I still expect to pick up the tab, 100% on my services.

Proponents of universal coverage, at least those with any intellectual honesty, will admit that waiting for treatment is a huge problem in universal coverage societies. As is denial of coverage. Rationing by any other name is still rationing.

And guess what? When I need those back surgeries, when I can no longer traction or exercise away the pain and weakness, I cannot wait 18-24 months as you have to in the UK or Canada. By then the nerve damage from radiculopathy/myelopathy would likely leave me in a wheelchair and forever addicted to narcotics.

I've lived in the UK; I know what it's like. And I am not exaggerating.

I have to be ready to pay out of pocket, at a minute's notice when I do need serious medical intervention.

It is easy to take this stand when you can AFFORD to pay out of pocket.

Two years for a back surgery IS an exaggeration, at least in the UK. Three months is the max waiting time. Can't speak for Canada.

MoM, I do not want to offend you, but some may also argue that dedicating all your time to "maintaining normalcy" is not exactly normal (pardon for pun).

Monitoring gym usage...great idea, and yes, physicians could do it in the 21st century by pulling data from the membership cards. Of course, that would not stop anyone from going to the gym, having a chat with a friend and going home. Besides, I do not find the concept of policing my patients terribly appealing.

Obesity is bad...slim is good...While I am not aware of any SOLID evidence to confirm genetic predisposition to obesity, obesity does run in families. Again, we do not develop in the vacuum and we pick up our eating/cooking/exercising habits from our parents/siblings/friends. Who is "responsible" for obesity in kids?

And when a kid develops an eating disorder, should we make them pay higher premiums, too? Because they brought it upon themselves, you know.

I agree with billy that sin taxes must be increased and levied on a broader selection of merchandise (even though taxing soda will hurt me, too , and I could argue that I should not pay for someone else's obesity problem).

I agree that the concept of personal responsibility is a great one - and we should encourage it in our patients, educating them as appropriate.

I disagree with the statement that those disagreeing with medical advice should pay higher premiums or denied coverage (not in the least because our medical knowledges is finite - following this logic we would have to levy higher premiums on people eating eggs in the 80s).

I believe that there must be universal coverage for a limited number of treatments in a limited number of conditions - and the rest must be available on a private basis (which you can pay out of pocket or purchase private insurance for it). Unfortunately, Obama's administration did not consult me when putting their proposals together.

 

[digitlnoize]

Monitoring gym usage...great idea, and yes, physicians could do it in the 21st century by pulling data from the membership cards. Of course, that would not stop anyone from going to the gym, having a chat with a friend and going home. Besides, I do not find the concept of policing my patients terribly appealing.

Really? I would love to have the time to examine my patients' habits in greater detail, talk to them, and figure out how to make them healthier...

Who is "responsible" for obesity in kids?

The parents. Just as they are responsible for everything else.

My child, for the most part, makes healthy diet choices on her own, because we have talked about how important it is. She knows that she shouldn't always pick the french fries at school lunch. She often gets carrots, in no small part because she has grown up eating them and liking them, unlike myself. I don't think I even ate a vegetable until I was an adult, and didn't learn to like them until around 26 or so...thanks mom and dad!

And when a kid develops an eating disorder, should we make them pay higher premiums, too? Because they brought it upon themselves, you know.

As long as they are taking the proper steps to correct the disorder (be it obesity, anorexia, whatever) then they would see no increase in their fees. Compliant patients are (usually) healthy patients.

I disagree with the statement that those disagreeing with medical advice should pay higher premiums or denied coverage (not in the least because our medical knowledges is finite)

While I agree that medical knowledge is far from complete, we do KNOW some things.

1. Obesity is bad for your health. This is not disputed. You might dispute the exact, perfect BMI, but no one can argue that being 100lbs overweight is not detrimental to your health. I would say BMI >35-ish would be a good cut off for this program...

2. Smoking is bad for your health. Also, not disputed. You can't tell me that, one day in the future, doctors will tell their patients, "Smoke a pack a day...it'll keep you healthier."

3. Uncontrolled diabetes is bad for your health. Again, not disputed.

Again, and since no one seems to be listening, let me say it a little louder:

I would NOT apply this concept to all disease states or behaviors.

In fact, I would probably stop at the 3 listed above. I firmly believe in the "KISS" policy, especially where government is concerned.

Better control of the 3 disease states listed above would have PROFOUND effects on the overall health of our society. Then, maybe we can move on.

 

[whopper]

Better control of the 3 disease states listed above would have PROFOUND effects on the overall health of our society. Then, maybe we can move on

When I made my proposed system-weight, BP, cholesterol, regular doctors visits & no substances of abuse, that IMHO is easy to understand. I should also add have end of life planning already done.

These are IMHO easy to follow. Culturally people know how to weigh themselves, and know being overweight it bad for health. They know they are supposed to got the doctor on regularly scheduled visits. Like you stated with the weight, tobacco & diabetes, there is very little grey area if any.

With a simple system, IMHO there is little room for debate on "where do you draw the line?". Just draw the line with the things I mentioned--in things that people within our culture do understand. I also never advocated no coverage if you don't take care of yourself, just higher premiums.

As for the UK, I too lived there. There are good & bad things about the difference in their system. I have seen waiting lists--longer than 3 months, in fact some of them were about a year or more for hernia surgeries, however things may have changed since I last lived in the UK about 7 years ago.

Another problem was I saw a lot of lazy doctors turfing hard to deal with patients around. Happens in our own system today, but in private managed care, doctors at least do have some incentive to keep a patient. The turfing usually happens with salary based doctors in a hospital who get paid the same amount no matter what. They don't like a patient--they turf to the other department.

Another point, and this is a cultural issue is the Brits are highly taxed--the point where I saw several that if living in America would work. The gov provides several benefits to people who don't work, and its to the point that if they actually did work, they wouldn't earn much more money. So it became an issue of-either don't work and get a lot of benefits & have a lot of free time, or work full time and make an amount that's not much more because taxes take a lot of your money away.

That's not a criticism because their culture is different. Their national identity differs from us Americans. However I don't think that idea would fly well in America. We in America for the most part believe that if we work hard, we should reap the benefits of that hard work. Several of us also believe that those that don't pull their end that are fully capable of doing so should not be living off of the hard work of others (and I emphasize the "fully capable" because I'm not saying we don't care for those in need that can't help themselves). Also several American don't want government involved in their lives.

This is my opinion, but there is much more cultural uniformity in the UK, as well as several of the other industrialized nations that have socialized healthcare, and this is a cultural contributor to those nations having socialized care. When you've lived in a town, and can trace your roots back to that town well over 300 years, and with all likelihood your roots in that town probably started earlier than that, you have more of a kinship with your neighbors, who for all intents & purposes are distant relatives. There is closer national bond-and group think, and this creates a bigger desire to see that nation as a single body. We however in America pride ourselves on cultural diversity, and this creates several groups of people who feel that they have no connection with several other people in our country. (The UK does too of course, but America is different--more diversity, national identity is younger, and based on limited government).

 

[digitlnoize]

When I made my proposed system-weight, BP, cholesterol, regular doctors visits & no substances of abuse, that IMHO is easy to understand. I should also add have end of life planning already done.

These are IMHO easy to follow. Culturally people know how to weigh themselves, and know being overweight it bad for health. They know they are supposed to got the doctor on regularly scheduled visits. Like you stated with the weight, tobacco & diabetes, there is very little grey area if any.

With a simple system, IMHO there is little room for debate on "where do you draw the line?". Just draw the line with the things I mentioned--in things that people within our culture do understand. I also never advocated no coverage if you don't take care of yourself, just higher premiums.

Regular doctor visits should be a given, as long as there is enough supply.

I'm amazed how states can require a car inspection every year, but not a body inspection...wtf?!?!

I think it'd be tough to get all "substances of abuse" into this type of program. Too many substances, and too much gray area...plus the difficulties with addiction...Cigs, however, are SO prevalent and there is enough aids to cessation available that I think it could be included. We'd have to track cig purchases, obviously...but as long as they're in some type of cessation program, and reducing their intake...making progress...no increased fees (or, decreased fees, if you prefer)

I think bp and cholesterol would be difficult to implement, as there are MANY other factors at work here, although I think that if we tracked obesity well, we'd see these two factors fix themselves fairly quickly.

I'm glad we're on the same page here. I've been feeling like I was the only person who felt people should take some responsibility for their own health...

 

[Indryd]

It seems to me like much of this debate about personal responsibility is pretty useless considering the majority of our healthcare expenditure goes into keeping people alive in a hospital for a few weeks before they finally die.

Regardless of your life choices, you're going to die. And if you live in America, chances are very good that someone is going to spend a LOT of money keeping you alive for a few weeks before you do die.

All the red herrings and straw men from both the right and the left (but especially the right!) about waiting lists for back surgery and going to the gym and eating vegetables are meaningless from an economic point of view if this is going to be our priority.

This is where one of the arguments from this thread DOES apply: imagine if we took all that money we spend extending the end of life and invested half of it in a public health campaign targeting obesity, sedentary lifestyle, nutrition, substance abuse, etc. We could still extend lives, but we would be adding years of healthy life instead of a few weeks of miserable hospital life.

EDIT: I hope to not be accused of dismissing personal responsibility. On an individual basis, and even on a large scale, personal responsibility is going to be key to any solution to our health care "crisis", but the economic reality is that even if you got everyone eating the perfect diet and exercising every day and not smoking, etc, they are still going to get sick and die. And under our current system, we are still going to devote the majority of our health care expenditure keeping them alive just a little longer.

 

[notdeadyet]

I'm amazed how states can require a car inspection every year, but not a body inspection...wtf?!?!

Because you need to prove that your car meets certain standards in order to have a license to drive it on the road.

Cigs, however, are SO prevalent and there is enough aids to cessation available that I think it could be included. We'd have to track cig purchases, obviously...

I'm a far cry from a Libertarian, but I think I'd like to think I'd be in the majority of saying that it'd be a cold day in hell before I voted to give the government the authority to keep a database of consumer purchases for things like cigarettes or gym visits.

I'm glad we're on the same page here. I've been feeling like I was the only person who felt people should take some responsibility for their own health...

Everyone agrees people should take some responsibility for their own health. And for their own kids. And for their own debt. And for their own vote.

Personal accountability is a good thing. Getting the government involved in snooping to make sure folks are hitting gyms and buying the right products? Bad juju.

 

[digitlnoize]

Because you need to prove that your car meets certain standards in order to have a license to drive it on the road.

By the same logic, you should need to prove that YOU meet certain standards in order to have a license to drive a car on the road. How many accidents are caused by health problems (heart attacks, etc) each year. How many drivers have slowed responses due to: joint pain, msk problems, dementia, etc?

I'm a far cry from a Libertarian, but I think I'd like to think I'd be in the majority of saying that it'd be a cold day in hell before I voted to give the government the authority to keep a database of consumer purchases for things like cigarettes or gym visits.

Everyone agrees people should take some responsibility for their own health. And for their own kids. And for their own debt. And for their own vote.

Personal accountability is a good thing. Getting the government involved in snooping to make sure folks are hitting gyms and buying the right products? Bad juju.

Who cares if the government monitors your gym visits? I know some people are paranoid that it would degenerate into 1984, but the reality is that there is a big difference between the gov't knowing how many times you went to the gym and their monitoring of your every waking moment.

I've heard people make the same arguments about traffic cameras at red lights. I just don't understand it. It seems to me that the only people who complain are people that WANT to be able to run the red lights. I understand that there must be limits, but since our population is obviously unable to motivate themselves, the government has a responsibility, dictated by the constituition to "promote the general welfare".

I'll also add that the gov't doesn't HAVE to know. Perhaps only the physician would have access to the database.

I'll ALSO add, that we don't really have to track gym visits at all. If a patient is obese, and returns each month for a "weigh-in" with no weight decrease...then their premiums are higher. The end.

 

[digitlnoize]

It seems to me like much of this debate about personal responsibility is pretty useless considering the majority of our healthcare expenditure goes into keeping people alive in a hospital for a few weeks before they finally die.

Regardless of your life choices, you're going to die. And if you live in America, chances are very good that someone is going to spend a LOT of money keeping you alive for a few weeks before you do die.

All the red herrings and straw men from both the right and the left (but especially the right!) about waiting lists for back surgery and going to the gym and eating vegetables are meaningless from an economic point of view if this is going to be our priority.

This is where one of the arguments from this thread DOES apply: imagine if we took all that money we spend extending the end of life and invested half of it in a public health campaign targeting obesity, sedentary lifestyle, nutrition, substance abuse, etc. We could still extend lives, but we would be adding years of healthy life instead of a few weeks of miserable hospital life.

EDIT: I hope to not be accused of dismissing personal responsibility. On an individual basis, and even on a large scale, personal responsibility is going to be key to any solution to our health care "crisis", but the economic reality is that even if you got everyone eating the perfect diet and exercising every day and not smoking, etc, they are still going to get sick and die. And under our current system, we are still going to devote the majority of our health care expenditure keeping them alive just a little longer.

I agree 100%. I'd also like to add that dead people don't pay taxes. If we can increase the average lifespan of the population by decreasing obesity, smoking, and diabetes, the gov't would see the $$$ in their coffers rise handsomely.

 

[Sneezing]

1) Personal Responsibility - We will never have it as long as there is a humanitarian out. As long as we value the fact that we will support and keep a person alive more than what they can contribute to society, we will have our system taken advantage of. As long as we have EMTALA we will always be paying for peoples health care. We can raise premium prices with a point system all we want, but you can't cure laziness. A lazy person will still choose to not pay, and before you know it end up disabled because of their size and getting care under the unfunded EMTALA mandate. Until we as a society put the value of a person's life back in the hands of the person, we will have people taking advantage of all of us.

*Yes there are those who truly are incapable of caring for themselves and functioning, especially in psych, and these people will become wards of the state as they always have.

**Every one who falls under hard times (whether illness, or lay off, etc.) should not turn to the government, but to their community. They should look to their church, look to their family, look to other volunteer organizations. This is how we rebuild community in our country, by bringing back the need for community, not replacing it with the government. Is a person more likley to abuse unemployment or the helping funds from Father Joe down the block? Government depersonalizes handouts, and makes it easier to abuse than a real person and face in your community.

2) We also must remember smoking and obesity aren't necessarily a bad thing...
http://www.plosmedicine.org/article/infooi/10.1371/journal.pmed.0050029

With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and "healthy-living" persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.

 

[whopper]

It seems to me like much of this debate about personal responsibility is pretty useless considering the majority of our healthcare expenditure goes into keeping people alive in a hospital for a few weeks before they finally die.

Which is why I added end of life planning to the list of things that people should have to fit the lowest premiums.

Personal accountability is a good thing. Getting the government involved in snooping to make sure folks are hitting gyms and buying the right products? Bad juju.

You don't have to do that. That was a suggestion, however one could for example make them tax deductible, with the person on their own choosing to deduct it or not, or at least not taxable by the state.
Personally IMHO the incentive system I mentioned would have to be an easy to implement thing. Weight, BP, Cholesterol, doctor's visits, no (+) UDS, end of life planning. Things like a gym, keeping a diet, etc at some point go too far and make this too complicated.

 

[OldPsychDoc]

It seems to me like much of this debate about personal responsibility is pretty useless considering the majority of our healthcare expenditure goes into keeping people alive in a hospital for a few weeks before they finally die.

Regardless of your life choices, you're going to die. And if you live in America, chances are very good that someone is going to spend a LOT of money keeping you alive for a few weeks before you do die.

All the red herrings and straw men from both the right and the left (but especially the right!) about waiting lists for back surgery and going to the gym and eating vegetables are meaningless from an economic point of view if this is going to be our priority.

This is where one of the arguments from this thread DOES apply: imagine if we took all that money we spend extending the end of life and invested half of it in a public health campaign targeting obesity, sedentary lifestyle, nutrition, substance abuse, etc. We could still extend lives, but we would be adding years of healthy life instead of a few weeks of miserable hospital life.

.

Or how about if we took that money and purchased or subsidized health insurance that emphasizes primary care, prevention, and compliance for the 40 million + Americans ("The Greatest Country on Earth", blah, blah, blah...) who have no insurance and therefore access physicians via EXTREMELY expensive ER visits?

Just wondering...

 

[digitlnoize]

Or how about if we took that money and purchased or subsidized health insurance that emphasizes primary care, prevention, and compliance for the 40 million + Americans ("The Greatest Country on Earth", blah, blah, blah...) who have no insurance and therefore access physicians via EXTREMELY expensive ER visits?

Just wondering...

U.S. Population = ~300 million

13% of Americans lack health insurance. (40 million)

27% of Americans are obese. (81 million)

Of course, these numbers don't overlap, but certainly a large number of Obese Americans have health insurance.

How will this reform help them? How will it help the millions of others who already have healthcare access, but whose health (as a population) continues to deteriorate?

 

[BabyPsychDoc]

Really? I would love to have the time to examine my patients' habits in greater detail, talk to them, and figure out how to make them healthier...

It's different in the real world. And it is different from policing them by pulling data from their gym membership cards (which, as I have mentioned, would not really prove anything). Policing your patients violates the fundamental principle of therapeutic relationship - TRUST. If there is no trust, they won't give a damn about you or your advice or your best intentions.

The parents. Just as they are responsible for everything else.

Sure, I do not doubt it. So, if the kid has not had time/opportunity to break the wonderful habits of childhood, would you still have them pay higher premiums once they get their own insurance. Or, would you give them a moratorium, say, until they are 21 (drinking age)?

My child, for the most part, makes healthy diet choices on her own, because we have talked about how important it is. She knows that she shouldn't always pick the french fries at school lunch. She often gets carrots, in no small part because she has grown up eating them and liking them, unlike myself. I don't think I even ate a vegetable until I was an adult, and didn't learn to like them until around 26 or so...thanks mom and dad!

Good for you - and your kid.

As long as they are taking the proper steps to correct the disorder (be it obesity, anorexia, whatever) then they would see no increase in their fees. Compliant patients are (usually) healthy patients.

Next time I see a (consistently) compliant patient with an eating disorder, I will celebrate the occasion on this board.

While I agree that medical knowledge is far from complete, we do KNOW some things.

1. Obesity is bad for your health. This is not disputed. You might dispute the exact, perfect BMI, but no one can argue that being 100lbs overweight is not detrimental to your health. I would say BMI >35-ish would be a good cut off for this program...

2. Smoking is bad for your health. Also, not disputed. You can't tell me that, one day in the future, doctors will tell their patients, "Smoke a pack a day...it'll keep you healthier."

3. Uncontrolled diabetes is bad for your health. Again, not disputed.

Again, and since no one seems to be listening, let me say it a little louder:

I would NOT apply this concept to all disease states or behaviors.

In fact, I would probably stop at the 3 listed above. I firmly believe in the "KISS" policy, especially where government is concerned.

Better control of the 3 disease states listed above would have PROFOUND effects on the overall health of our society. Then, maybe we can move on.

It is a great goal - which is unfortunately unlikely to work. As many other posters stated, the bureaucracy involved would kill the any potential monitoring program before it is even started. Not to mention that as a physician, I would find anything like that extremely uncomfortable.

 

[BabyPsychDoc]

It seems to me like much of this debate about personal responsibility is pretty useless considering the majority of our healthcare expenditure goes into keeping people alive in a hospital for a few weeks before they finally die.

Regardless of your life choices, you're going to die. And if you live in America, chances are very good that someone is going to spend a LOT of money keeping you alive for a few weeks before you do die.

All the red herrings and straw men from both the right and the left (but especially the right!) about waiting lists for back surgery and going to the gym and eating vegetables are meaningless from an economic point of view if this is going to be our priority.

This is where one of the arguments from this thread DOES apply: imagine if we took all that money we spend extending the end of life and invested half of it in a public health campaign targeting obesity, sedentary lifestyle, nutrition, substance abuse, etc. We could still extend lives, but we would be adding years of healthy life instead of a few weeks of miserable hospital life.

EDIT: I hope to not be accused of dismissing personal responsibility. On an individual basis, and even on a large scale, personal responsibility is going to be key to any solution to our health care "crisis", but the economic reality is that even if you got everyone eating the perfect diet and exercising every day and not smoking, etc, they are still going to get sick and die. And under our current system, we are still going to devote the majority of our health care expenditure keeping them alive just a little longer.

I could not agree more with this post.

And I do agree that we should spend perhaps more on public health campaigns addressing issues of smoking, obesity etc. However, the key is to MOTIVATE people to change their behaviour. My parents-in-law know everything about what they need to eat, how they need to exercise (and even have their gym subscription paid for by their insurance company) and that smoking is bad for them. Yet, they continue eating junk food, have not been to the gym for the last 10 months and one of them keeps smoking - despite several different cancers over the last 20 years. They have all the facts - they just do not have any motivation. From my experience, they are a fairly representative sample of a middle-class American family.

 

[OldPsychDoc]

U.S. Population = ~300 million

13% of Americans lack health insurance. (40 million)

27% of Americans are obese. (81 million)

Of course, these numbers don't overlap, but certainly a large number of Obese Americans have health insurance.

How will this reform help them? How will it help the millions of others who already have healthcare access, but whose health (as a population) continues to deteriorate?

I know that truth is the first casualty of war, and that 99% of statistics are used dishonestly, and all that, but I'm wondering...

There should be data out there somewhere that demonstrates that having insurance, having access to health care, improves overall health. I think that that is the reason behind near-unanimous bipartisan support for CHP programs. Can anyone direct us? And conversely, if there is actual evidence that providing a population with guaranteed access to health care actually WORSENS health...well we need to know that too. Perhaps then reform requires abolishing health insurance entirely.

However--is there possibly a SOCIETAL benefit to ensuring access to basic healthcare for all? And is it a benefit potentially worth the costs?

Just wondering, that's all...
Just suggesting this might be a Public Health issue, and perhaps could be treated as such.

 

[BabyPsychDoc]

Or how about if we took that money and purchased or subsidized health insurance that emphasizes primary care, prevention, and compliance for the 40 million + Americans ("The Greatest Country on Earth", blah, blah, blah...) who have no insurance and therefore access physicians via EXTREMELY expensive ER visits?

Just wondering...

First, a great number of those uninsured choose to be uninsured. Just a point.

I stand by my notion that primary care and certain specialist care should be made available to everyone (regardless of their level of personal responsibility) by the government. This basic package could then be topped up privately by those who can afford it (and the money could be used to subsidise the "basic package" expenditure).

Incidentally, here is an example of "personal responsibility at work" that I agree with. http://news.bbc.co.uk/1/hi/england/london/8159813.stm

 

[digitlnoize]

I know that truth is the first casualty of war, and that 99% of statistics are used dishonestly, and all that, but I'm wondering...

There should be data out there somewhere that demonstrates that having insurance, having access to health care, improves overall health. I think that that is the reason behind near-unanimous bipartisan support for CHP programs. Can anyone direct us? And conversely, if there is actual evidence that providing a population with guaranteed access to health care actually WORSENS health...well we need to know that too. Perhaps then reform requires abolishing health insurance entirely.

However--is there possibly a SOCIETAL benefit to ensuring access to basic healthcare for all? And is it a benefit potentially worth the costs?

Just wondering, that's all...
Just suggesting this might be a Public Health issue, and perhaps could be treated as such.

Few people would argue that guaranteed access worsens health. Our problem lies in how that access is used.

For some reason, we are perfectly willing to take Cisplatin for our Cancer, but unwilling to take Carrots for our Obesity.

We are willing to have our chests spread open to fix our LAD, but unwilling to get on a treadmill for 15 minutes a day.

What we wind up with is a "healthy" segment of the population (with or without insurance), who later become the un-healthy segment (with or without insurance. This is why so many young people are un-insured. They think they're healthy, even if they're 50lbs over weight. They aren't having the knee pain yet, or the angina. They just aren't there yet.

I would bet the the research, if/when we find it, will show that patients who already have clinical disease benefit greatly from insurance, but would show little benefit to those who do not have clinical disease. After all, if you don't have clinical disease, you probably aren't seeing the doctor...

If you DO go for your regular checkups, do they really spend the time with you to talk about your pre-clinical disease states? Not in the current reimbursement system. Hence the need for reform.

I've been to many doctors in my lifetime, and I've been ~20lbs overweight since I was 9...I've had exactly one doctor address my weight issues.

Policing your patients violates the fundamental principle of therapeutic relationship - TRUST. If there is no trust, they won't give a damn about you or your advice or your best intentions.

I don't disagree, but this aspect of the physician-patient relationship died long ago. We are now in the era of "I've been waiting for 20 minutes so I'm gonna sue". This is a two way relationship, and patients have committed the far greater violations of malpractice and noncompliance.

And, I don't really buy this argument. Do you trust your mechanic any less because he checks your odometer for tampering? Do you trust police any less because they videotape traffic stops? I think the younger generation is far more comfortable with e-monitoring than the older generation. We're used to having our every move recorded for posterity by The Internet, with no ill effects.

I for one, enjoy the targeted advertising we see on, say, Amazon.com. So what if Amazon is tracking my purchases? It just allows them to make better educated guesses about what I might like to buy next.

I know that we all paranoid that the British are going to come knocking looking for their tithe, but in all honesty, in the modern world, it's hard to be invisible.

Sure, I do not doubt it. So, if the kid has not had time/opportunity to break the wonderful habits of childhood, would you still have them pay higher premiums once they get their own insurance. Or, would you give them a moratorium, say, until they are 21 (drinking age)?

Age doesn't matter. Let's say an 18 year old patient comes in after this plan is enacted. Height = 5'6, Weight = 350lbs. You advise them that they need to exercise, diet, and start losing weight or the government will raise their premiums.

Pt returns in 3 months. Weight is now 330lb. Pt has been following advice. Premiums stay low. Pt returns in 3 more months. Weight now 300lbs. Pt stays at low premium.

If the patient had come back for his first 3 month followup weigh-in, and had gone up 10lbs, his premium would have gone up. He wasn't taking steps to correct his behaviors.

I don't believe in taxing (or raising premiums) on people who have a disease. I believe in taxing (or raising premiums) on people who aren't trying to correct that disease.

 

[billypilgrim37]

First, a great number of those uninsured choose to be uninsured.

And of course, they have that luxury because when they develop a devastating, disabling illness, they'll suddenly find themselves with a social security check and some form of public assistance covering their new health insurance, once they've sold off all their assets, of course.

I know that libertarians think people should be able to play blackjack with their lives, but given that my tax dollars get drained because of their misinformed decision to forgo health insurance, I think I should get to tell them they can't. Given that half of you think we should be using CIA satellites to watch people as they go into their local gym, I don't know why have trouble with my well-precedented form of government intrusion.

Since we like to play with anecdotes, I'll never forget the 50 year old guy last year w/ 3 kids and a construction business who hadn't been to the doctor in about 5 years. I'm guessing walking around at 180/110 and with an LDL of 190 on admission may have contributed to the disabling stroke he suffered. His family couldn't understand why they were going to have to sell their 350k house, and were of course angry at their oldest son, who they'd sent to Duke to get a philosophy degree, and who now spent his days in the basement playing XBox Live. They had foregone health insurance because it was expensive, and he was the owner of his small construction company which depended on his labor and expertise as well as administration.

So, if, when people "lose" their gamble to forego the health insurance they could easily afford, they simply wind up with public assistance (and a devastated lifestyle), how come they get to gamble at all?

 

[Sneezing]

Precisely. We should remove the public assistance so that people will think twice before gambling.

And if you still gambled and lost, you then have to explain/convince some one in your community to bail you out. That is a lot harder to do then simply saying my medicaid/medicare will cover me. It adds accountability that currently doesn't exist in our system.

We as a society are a hybrid between personal responsibility and societal burden. Both systems lose. We need to pick one to maximize the benefits of the chosen system. I don't believe socialism will work, especially in America, thus I advocate for a libertarian approach.

 

[digitlnoize]

Given that half of you think we should be using CIA satellites to watch people as they go into their local gym...

I would NEVER advocate using CIA satellites for this purpose. That's horribly inefficient. Someone would have to be watching the satellite, and ID-ing each person that walked in...so wasteful and...governmental.

I would rather just monitor the patients weight and not worry about anything else.

"If the numbers ain't dropping, neither are your premiums."

So, if, when people "lose" their gamble to forego the health insurance they could easily afford, they simply wind up with public assistance (and a devastated lifestyle), how come they get to gamble at all?

This is similar to one big complaint people have about ObamaCare. With the new laws saying that pre-existing conditions must be covered, what's to stop people from forgoing insurance and not paying a premium, then jumping on board when they get a serious disease?

 

[billypilgrim37]

With the new laws saying that pre-existing conditions must be covered, what's to stop people from forgoing insurance and not paying a premium, then jumping on board when they get a serious disease?

I'll get the whips, you get the chains.

Of course, you just made an argument for why current proposals don't go far enough towards universality.

 

[notdeadyet]

By the same logic, you should need to prove that YOU meet certain standards in order to have a license to drive a car on the road.

No. I don't know any states that do this. Many states have a requirement that you need to pass a written and/or eye exam when you hit a certain age, but that's it. If you believe everyone should need physicals every year, you're in a very small movement. Made up almost entirely of physicians, PAs, and NPs that love doing physicals, I'd imagine...

Who cares if the government monitors your gym visits?

I do. I also have a problem if they tap my phone. That's why we have laws to prevent the government from doing so. It's a privacy thing.

I know some people are paranoid that it would degenerate into 1984, but the reality is that there is a big difference between the gov't knowing how many times you went to the gym and their monitoring of your every waking moment.

Telling folks to not worry about giving up small rights because at least they're not giving up all rights is faulty logic. People have a right to privacy. The government better have a very good reason to invade it. How many times Sally went to the gym does not qualify.

Sorry, but when someone tries to tackle a public problem with a solution that involves the sacrificing of personal privacy, it just won't fly. There are only very rare instances it does, and ones that are personally critical (reportable diseases, etc.).

 

[OldPsychDoc]

...Telling folks to not worry about giving up small rights because at least they're not giving up all rights is faulty logic. People have a right to privacy. The government better have a very good reason to invade it. How many times Sally went to the gym does not qualify.

Sorry, but when someone tries to tackle a public problem with a solution that involves the sacrificing of personal privacy, it just won't fly. There are only very rare instances it does, and ones that are personally critical (reportable diseases, etc.).

It's kind of ironic that the interest in increased monitoring of health behaviors is coming from the folks who want "less government involvement" in healthcare funding, isn't it?

 

[notdeadyet]

This is similar to one big complaint people have about ObamaCare. With the new laws saying that pre-existing conditions must be covered, what's to stop people from forgoing insurance and not paying a premium, then jumping on board when they get a serious disease?

You're right. Great argument for the need for universal coverage.

I don't think any doctor of any ethical standards would advocate ignoring a patient in need. So the whole "preexisting condition" thing is really just an insurance issue.

A pre-existing condition is only an issue when you're shopping around for private policies. People forgo treatment and end up having things reach the crisis stage. It involves ER visits, unnecessary surgeries, disability payments and social security payments to orphans and whatnot. Bad, bad waste.

I really don't know why folks are so married to our model. It doesn't work by any yardstick. You won't find an industrialized country around that would trade places with us. Docs like it and the rich like it. Great people to have on your side of the lobby, but it sure doesn't make for a majority...

 

[OldPsychDoc]

....I really don't know why folks are so married to our model. It doesn't work by any yardstick. You won't find an industrialized country around that would trade places with us. Docs like it and the rich like it. Great people to have on your side of the lobby, but it sure doesn't make for a majority...

Yeah, but fewer docs are liking it these days (hence an AMA endorsement for the current bill, etc) and at least a few rich, who understand the drag of healthcare costs on the economy and business expenses, are starting to dislike it as well.

 

[Indryd]

Or how about if we took that money and purchased or subsidized health insurance that emphasizes primary care, prevention, and compliance for the 40 million + Americans ("The Greatest Country on Earth", blah, blah, blah...) who have no insurance and therefore access physicians via EXTREMELY expensive ER visits?

Just wondering...

That sounds good too.

 

[Indryd]

It's kind of ironic that the interest in increased monitoring of health behaviors is coming from the folks who want "less government involvement" in healthcare funding, isn't it?

AHAHA! I was gonna say this, but I didn't want to get in trouble

 

[masterofmonkeys]

I
I believe that there must be universal coverage for a limited number of treatments in a limited number of conditions - and the rest must be available on a private basis (which you can pay out of pocket or purchase private insurance for it). Unfortunately, Obama's administration did not consult me when putting their proposals together.

That is actually something this libertarian wouldn't puke over.

 

[futureapppsy2]

RE: welfare/government help--even before the bailouts this year, corporations, NOT individuals, received by far the most government "welfare" (whether this is good, bad, or in-between is another matter completely). "Welfare" is not synomous with the stereotyped lazy individual--it's far broader than that. For that matter, don't medical residencies receive government support as well, IIRC?

 

[masterofmonkeys]

RE: welfare/government help--even before the bailouts this year, corporations, NOT individuals, received by far the most government "welfare" (whether this is good, bad, or in-between is another matter completely). "Welfare" is not synomous with the stereotyped lazy individual--it's far broader than that. For that matter, don't medical residencies receive government support as well, IIRC?

Yes, you're right, residencies do receive government support. And the government has a vested interest in paying for residency. Ever think about how wonderful it is for their bottom line to have something like 100,000 doctors working for 12 to 20 dollars an hour?

 

[BabyPsychDoc]

And of course, they have that luxury because when they develop a devastating, disabling illness, they'll suddenly find themselves with a social security check and some form of public assistance covering their new health insurance, once they've sold off all their assets, of course.

I know that libertarians think people should be able to play blackjack with their lives, but given that my tax dollars get drained because of their misinformed decision to forgo health insurance, I think I should get to tell them they can't. Given that half of you think we should be using CIA satellites to watch people as they go into their local gym, I don't know why have trouble with my well-precedented form of government intrusion.

Since we like to play with anecdotes, I'll never forget the 50 year old guy last year w/ 3 kids and a construction business who hadn't been to the doctor in about 5 years. I'm guessing walking around at 180/110 and with an LDL of 190 on admission may have contributed to the disabling stroke he suffered. His family couldn't understand why they were going to have to sell their 350k house, and were of course angry at their oldest son, who they'd sent to Duke to get a philosophy degree, and who now spent his days in the basement playing XBox Live. They had foregone health insurance because it was expensive, and he was the owner of his small construction company which depended on his labor and expertise as well as administration.

So, if, when people "lose" their gamble to forego the health insurance they could easily afford, they simply wind up with public assistance (and a devastated lifestyle), how come they get to gamble at all?

THis is exactly why I am not buying the "40+ million uninsured" argument. This family could have lived in a 150K house and buy insurance. The chose not to. Now the taxpayer has to pick up the bill.

 

[whopper]

Or how about if we took that money and purchased or subsidized health insurance that emphasizes primary care, prevention, and compliance for the 40 million + Americans ("The Greatest Country on Earth", blah, blah, blah...) who have no insurance and therefore access physicians via EXTREMELY expensive ER visits?

Agree with this to some degree. ER visits are extremely expensive, and going to a PCP is far cheaper.

However, I'm wondering how many of those would still not go to the PCP. Several of those people don't have insurance because they can't afford it. Several others don't go because they choose not to have insurance, and are in a state of denial & or ignorance about their health.

That's not to defeat the idea, just saying that there are other factors into consideration and this is in general a good idea.

(which is another reason why I added that regular doctor's visits should be in the incentive plan I mentioned).

I don't think any doctor of any ethical standards would advocate ignoring a patient in need. So the whole "preexisting condition" thing is really just an insurance issue.

The healthcare system, legal system, the free market system and our medical ethics do not coincide with each other. There are several areas where they are in contradiction to each other, and work against each other.

Which only adds to the frustration of working in a system where doctors regularly fudge notes to keep a patient in inpatient, patients are denied coverage for things that they are supposed to have coverage on, and have to fight with the insurance companies for days before they get their right coverage (and in fact in the past if not present, insurance companies actually told their employees to deny coverage to customers until the person called & complained after the 3rd time--because after that studies showed they'd possibly launch a lawsuit), seeing malingerers get away with medical fraud on a daily basis because doctors have no ability to inform the authorities, but then at the same time must either face the hospital's wrath or write a bogus diagnosis of Depressive DO NOS.......

I could go on.

 

[HCE]

By the same logic, you should need to prove that YOU meet certain standards in order to have a license to drive a car on the road. How many accidents are caused by health problems (heart attacks, etc) each year. How many drivers have slowed responses due to: joint pain, msk problems, dementia, etc?



Who cares if the government monitors your gym visits? I know some people are paranoid that it would degenerate into 1984, but the reality is that there is a big difference between the gov't knowing how many times you went to the gym and their monitoring of your every waking moment.

I've heard people make the same arguments about traffic cameras at red lights. I just don't understand it. It seems to me that the only people who complain are people that WANT to be able to run the red lights. I understand that there must be limits, but since our population is obviously unable to motivate themselves, the government has a responsibility, dictated by the constituition to "promote the general welfare".

I'll also add that the gov't doesn't HAVE to know. Perhaps only the physician would have access to the database.

I'll ALSO add, that we don't really have to track gym visits at all. If a patient is obese, and returns each month for a "weigh-in" with no weight decrease...then their premiums are higher. The end.

I find it curious that those who shiver at the thought of government monitoring your health seem to have no problem when Insurance companies do exactly the same thing. I'm still convinced that the current state of healthcare in the U.S. is a direct result of the unbridled power granted (or ceded) to Insurance companies and Big Pharma, but I'm open to being convinced otherwise.

 

[whopper]

I find it curious that those who shiver at the thought of government monitoring your health seem to have no problem when Insurance companies do exactly the same thing

There's a lot of contradictions, and the talking heads, with their agenda based drivel aren't exactly helping the situation.

The Right IMHO are attacking Obama's healthcare proposals based on special interests & not based on the interest of making the best healthcare system possible. They are giving a lot of disingenuous criticisms--e.g. it'll ration healthcare. Ahem, its already ratioined even with private care. Or "Do you want a government bureaucrat between you & your doctor?" Moot if you ask me because there's already an accountant between me & the doctor.

I'm not for O-care either. I worry that with our current economic state, adding another trillion dollars will only devalue our dollar even more, raise inflation, skyrocket our deficit, and put us further dependent on China.

The Right for years have called upon more personal responsibility with healthcare, but have done little if anything to get private companies to insert an incentive based system.

The point is, this just goes to show you how off the politicians & political pundits are. They do not understand healthcare, the economics, and are too entrenched with the special interests.

 

[digitlnoize]

No. I don't know any states that do this. Many states have a requirement that you need to pass a written and/or eye exam when you hit a certain age, but that's it. If you believe everyone should need physicals every year, you're in a very small movement. Made up almost entirely of physicians, PAs, and NPs that love doing physicals, I'd imagine...

I know that this isn't done. My question is: why not? We treat our cars better than we treat ourselves. It's *****ic.

I do. I also have a problem if they tap my phone. That's why we have laws to prevent the government from doing so. It's a privacy thing.

Telling folks to not worry about giving up small rights because at least they're not giving up all rights is faulty logic. People have a right to privacy. The government better have a very good reason to invade it. How many times Sally went to the gym does not qualify.

I don't think that the number of times you go to a public place counts as privacy. As someone pointed out, many "private" things are tracked by both government and corporations right now.

No one seems to have a problem with the government knowing how much money you earn in a year. What happened to the right of privacy there? You can't tell me that there aren't other ways to tax people besides income tax.

Actually, there is no "right to privacy". Here's a great article on the subject:

http://www.law.umkc.edu/faculty/projects/ftrials/conlaw/rightofprivacy.html

It's kind of ironic that the interest in increased monitoring of health behaviors is coming from the folks who want "less government involvement" in healthcare funding, isn't it?

I don't want increased monitoring of health behaviors by the government. I want increased monitoring of health behaviors by PHYSICIANS. There is a difference.

And, again, not all health behaviors. Just weight, blood sugar, and smoking.

If anyone has a better idea for improving the health of the american population I'd like to hear it. Throwing more money at "Prevention Programs" isn't going to help. It's just going to print more pamphlets that no one reads, or air more commercials that no one watches. There's currently TONS of money thrown at smoking prevention, but look what good that's done. The only thing that's curtailed that has been increased prices.

On the subject of ER visits: This is one area where I think we COULD use a "prevention program". People need to be educated about the reasons to need an ER visit. A large chunk (not all, obviously) of unneeded ER visits comes from well insured, educated people, who STILL freak out because they have a sore throat. A little bit of patient education could go a long way here.