What's the Biggest Problem in Healthcare? What would you do to solve it?

[jenv1082]

I'm gonna have to agree with RP on this one...

I, at one point, did entertain the idea that universal healthcare would be the better option...but why should the wealthy have to pay for everything?

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[DW]

Originally posted by jenv1082
I'm gonna have to agree with RP on this one...

I, at one point, did entertain the idea that universal healthcare would be the better option...but why should the wealthy have to pay for everything?

ok, so we're still responding to this thread.

allright, the devil's advocate has come to see the light, since the rich pays for everything, lets get rid of all health related public expenditures!!!!! Why stop at trashing insurance legislation?!?!? Throw out Medicare and Medicaid!!!!!! As a matter of fact, we're blowing billions of dollars through that whole blasted NIH thing, shut it down, throw out those damn grants!!!!! Hell, jot's resume is good enough, he doesn't need any more work!!!!! Save tax payer revenue, WOOHOO!!!!!! Down with HHS!!!!

 

[jenv1082]

Hahaha

Well I wasn't actually thinking that extreme...but you know...

 

[relatively prime]

DW: Come on now... you're not really just playing "devil's advocate" now are you? There's a little communist deep inside you screaming to get out. If you were just playing "devil's advocate" you'd try to make more sense, not use extreme examples, and ease up on the !!!'s. I think you're expressing your real opinion, but are too afraid to claim it. Don't be afraid DW, we're civil people here (or at least most of us).

Regarding NIH and government funded research... personally, yes, I'd do away with almost all government funded projects. But that's the libertarian in me speaking... not the practical side.

So basically my reasonable arguement is... some gov. funded projects benefit everyone (rich and poor alike) other only benefit the poor and others only benefit the rich. Since the rich pay for most everything... I am against projects that only benefit the poor. That's it.

 

[jot]

There's a little communist deep inside you screaming to get out.

you say it like its a bad thing. you wanna a little communist in you? (JK!)

allright, the devil's advocate has come to see the light, since the rich pays for everything, lets get rid of all health related public expenditures!!!!! Why stop at trashing insurance legislation?!?!? Throw out Medicare and Medicaid!!!!!! As a matter of fact, we're blowing billions of dollars through that whole blasted NIH thing, shut it down, throw out those damn grants!!!!! Hell, jot's resume is good enough, he doesn't need any more work!!!!! Save tax payer revenue, WOOHOO!!!!!! Down with HHS!!!!

thats what i've been trying to say for years! (minus the jot part )

 

[DW]

Originally posted by relatively prime
DW: Come on now... you're not really just playing "devil's advocate" now are you? There's a little communist deep inside you screaming to get out. If you were just playing "devil's advocate" you'd try to make more sense, not use extreme examples, and ease up on the !!!'s. I think you're expressing your real opinion, but are too afraid to claim it. Don't be afraid DW, we're civil people here (or at least most of us).

Regarding NIH and government funded research... personally, yes, I'd do away with almost all government funded projects. But that's the libertarian in me speaking... not the practical side.

So basically my reasonable arguement is... some gov. funded projects benefit everyone (rich and poor alike) other only benefit the poor and others only benefit the rich. Since the rich pay for most everything... I am against projects that only benefit the poor. That's it.

Yeah, MOST of us are civil here.

Ha Ha, Ms. McCarthy, you caught me! I definitely not a "communist", if I lean towards any form of alternative government, I was always a big fan of feudalism.

In all honesty, no need to make left wing accusations, I'm just a moderate (conservative or liberal depending on the subject, anti welfare, pro choice, i'm all over the place) speaking for the sake of debate here.

My examples aren't that extreme, and dont convey my true feelings on the matter, as i'm just extending the logic presented to me on this thread.

So if some government funded research only produced some expensive intervention for some crucial ailment that only the mostly upper classes could afford in the long run and the lower classes couldn't, you would be entirely for it without any reservation, since the rich are picking up the tab for it anyways? Would a govt program that only benefits the rich (regardless if its health related) be acceptable in your opinion?

In different terms, should the government take no account for employing elements of mercy and social justice in these health related policies, in your opinion?

 

[relatively prime]

Originally posted by DW



Ha Ha, Ms. McCarthy, you caught me! I definitely not a "communist", if I lean towards any form of alternative government, I was always a big fan of feudalism.

Honestly I was only teasing with the communist thing...


Look, it's really impossible to make overarching statements in political theory. All I'm saying is that since it's the rich that foot most of the bill... they should benefit or get some satisfaction out of all government funded programs. However! I believe that the government has an obligation to maintain order and to protect the innocent and/or helpless. So, for example, I believe the government should pay for wheel chairs for people who can't walk... and support people with severe disablities. These things don't benefit the rich.... however, I feel that the government has an obligation to these citizens because they are in a situation where they simply cannot help themselves.

 

[freakazoid]

*bump*

 

[Hallm_7]

This may not be the worst problem in medicine, but it definetely is a very large one. The issue of exorbitant malpractice premiums has the potential to destroy the medical communities in a number of cities and states across the country. Earlier this year Las Vegas had to shut down its only Level I trauma center. West Virginia is having trouble keeping doctors in the state. Mississippi is in the same boat, and so are several more states around the country. About a month ago malpractice premiums started to drive some OB/GYNs out of Kentucky and into Indiana. This is worst in and around Louisville because of the close proximity of cheap premiums found across the river. OB/GYNs seem to be the worst hit. One of the OBs in Louisville said his premiums went from $30,000 a year to $120,000 a year.

There has to have been a few lives lost already in Las Vegas because they have to fly all victims in need of a Trauma Center a couple hours away. And it has to have a negative effect on small communities that may only have one doctor in town. If that doctor is forced to quit practicing then that community is going to be without anyone in the medical profession at all.

This can be solved by limiting awards in given in court. It's going to be tough to do since most state legislatures and several governor's mansions are filled with trial lawyers who make their living off suing people like physicians. And it will be even tougher since historically doctors have not banded together as they should have. (ie. Fighting HMO and insurance companies for decent rates).

 

[freakazoid]

Are there really no doctor organizations where a bunch of doctors lobby for rights or fighting or whatever? Anybody know?

 

[tkim]

Truly the dilemnas thrown at you at interviews or posed on essay questions are more a gauge of how well you argue your position - not whether your position is right. There are some very convincing posts here!

The topic shrunk down focuses on the problems in healthcare - blown up it's a litmus test to see what type of society you like the most. Now I'm going to discard the obligatory reference to Hobbes and Rousseau, though just by mentioning them ... Heh.

If you burn away the specific circumstances detailed in all of your posts, your ideal societal choices comes out - stratification or equal for everyone.

Merit-based: work hard, contribute to society, ya get the better stuff.

Problems: How and who determines what's a worthwhile contribution to society. Where does art fall into this? What if a person works very hard the first 30 years of their life, then coasts? Will it be based on a 'what have you doen for me (society), lately' condition? How about a person that does absolutely nothing the first part of their life, but becomes massively productive later on?

Egalitarian: equal care for everyone - no stratification! The IVDA on the street gets the same shot for a liver transplant as little Ricky next door who delivers newpapers. We value everyone's intrinsic value as a human being.

Problems: Many. This form of society will have massive problems providing equal services for everybody. Say if I am allotted X dollars for all my healthcare - which is the same allottment as everyone else in my society. Perhaps I am blessed with good health and never really have to spend that money. Now, does that money/resources/materials earmarked for me go back into circulation? That would be a violation of equal care, since if I gave it up, I would no longer have acccess to it. Also, would equal care means that if everyone can't get the most exotic/expensive treatments, then NO ONE gets it?

The problems associated with either side - how do we limit care, or how do we provide equal care to all, have no real answer. If any of you had one, you'd not only get into any med school, you'd be walking the red carpet in Stockholm in a couple of years.

To answer the question effectively and personally, you have to ask yourself - am I the kind of person that thinks ya get what you give, or that every human being is equal period.

Too much of a quid pro quo and you're labeled blackheart - too much Kumbaya, and you're labeled a bleeding heart. Too much in the middle, and you're a waffle.

Should people take more responsbility for themselves and pay the consequences for poor choices? Or does society have the right to protect you - even from yourself, by limiting the choices you can make?

Interesting stuff.

Malpractice awards - also very interesting. When I get awarded a huge settlement, am I truly being 'compensated'? Can one really put a dollar value on pain and suffering? And for wrongful death, why doesn't the dead person get awarded the money? Surely that person suffered the most? And if I get awarded less money than another person who suffered the same way, does this mean I suffered less?

What if the I suffered the same injury, but experienced less pain or loss of use than someone else? Does this mean that I deserve less money?

Whoops - 2am. Bed <- me.

Excellent book: Contested Commodities, by Radin.

- Tae

 

[Squidaronimous J]

Originally posted by relatively prime

Regarding NIH and government funded research... personally, yes, I'd do away with almost all government funded projects. But that's the libertarian in me speaking... not the practical side.

So basically my reasonable arguement is... some gov. funded projects benefit everyone (rich and poor alike) other only benefit the poor and others only benefit the rich. Since the rich pay for most everything... I am against projects that only benefit the poor. That's it.

This is a bit of a naive point of view. I work on a number of research studies funded by the Feds (NIH, BPHC, etc). The majority of projects that help improve the human condition are funded by the federal government at some level (if not altogether). If it were not for that money, those projects would never take place.

I think the libertarian model is a nice dream, but very unrealistic. And it somewhat infuriates me to hear people bash the feds when they do not seem to realize how much of the comforts and safety of their life comes directly from (or indirectly from) federal research dollars.

--------------

It is very naive to sit back and say, "I don't support research that only helps the poor." That is a down-right ignorant statement. Very few things in this world only benefit one group without having any benfits for other groups.

For example, one of the projects I am working on is a federally funded review of the community health care systems in the nation. Now, you may say, "So what does that have to do with me. I have insurance, when will I ever need to go to one of those places. That just helps out poor people."

But that would be wrong. In some ways, CHCs are the first responders (in the IT sense) of the nation's health care system. If an epidemic hits, they will probably see the first signs of it and be able to recognize it and notify the rest of the medical community in time stop it from becoming a pandemic.

Spending federal money (your taxes) to evaluate the current CHC community, its resources and communication abilities is essentially asking the question, "Since most CHCs will likely be the first responders to epidemics or biological terrorist attacks in this country, are we sure that these clinics have the necessary staff and communications tools to 1) do their job and 2) notify [the rest of the medical community] of potential or actual medical threats to the surrounding regions and/or nation?"

Very few projects that directly benefit one group in this country do so without influencing or, in some cases, protecting the other groups.


Squid J

 

[relatively prime]

I NEVER said that research only supports the poor. That's just stupid and not something I would ever say. In fact, if anything, research helps the rich the most... because let's face it, only the rich are going to be able to afford cutting-edge technology.

I don't know where you interpreted that I think research is only for the poor... if I somehow implied that I certainly didn't mean to at all!!!

 

[angelic02]

I agree that this thread is important, so I'll post a reply simply for the purpose of keeping it alive, eventhough I don't have any answers to the questions posted on this thread.

 

[DW]

Originally posted by angelic02
I agree that this thread is important, so I'll post a reply simply for the purpose of keeping it alive, eventhough I don't have any answers to the questions posted on this thread.

so, in more concise terms...."bump"

 

[jenv1082]

I think I basically believe in working hard and therefore being rewarded. Whether you worked hard early in life or later on in your life, you worked hard, period. And consequently can afford better services.

No free 'stuff'. Of course there are exceptional circumstances, but thats where the gov comes in with their 'safety programs' such as Medicaid.

But the humanitarian inside of me wants to give healthcare to everyone. Treat everyone equal.

Can I really have two differing opinions inside my head at once??

Man, I think I'm going crazy

 

[tkim]

Originally posted by jenv1082
I think I basically believe in working hard and therefore being rewarded. Whether you worked hard early in life or later on in your life, you worked hard, period. And consequently can afford better services.

No free 'stuff'. Of course there are exceptional circumstances, but thats where the gov comes in with their 'safety programs' such as Medicaid.

But the humanitarian inside of me wants to give healthcare to everyone. Treat everyone equal.

Can I really have two differing opinions inside my head at once??

Man, I think I'm going crazy

'Course one can have opposing opinions!

My question is, if the distribution of scarce goods and services are to be determined by merit, how and who determines what is meritorious?

If I drive a hack all day, getting people from point A to point B, for 30 years, pay my taxes, put kids through school, do I deserve more or less than the guy who never did a thing in his life, but happened to save a baby from a burning building one day? How do things such as length of service, and type of service scale? Can it be scaled?

Certainly one should desire to see healthcare for everyone, but the troubling part is at what cost? Do we all have access to basic, preventative health care at the cost of exotic surgeries and drug treatments? Does equalization mean that 10000 kids get oral antibiotics, or do they go without so one child can get a new liver?

I believe that some sort of stratification of services needs to happen. Everyone should have at the very least some access to medical services, but the hard part is where the basic services stop and the advanced services begin. I am uncomfortable in widening the access to basic health care if it means limiting or eliminating advanced, expensive procedures.

Such a move perhaps would generally benefit the entire population in some way, but as the cost of the sickest people with complicated and expensive illnesses. It is still shifting resources from one segment of the population to another. A simple utilitarian exercise.

I'm reminded of the final scene in THX1138, when Robert Duvall's character is climbing up metal rungs to escape to the surface with a robot policeman in pursuit. Somewhere in a control center, a cost counter reaches some predetermined limit, and they give up on chasing Duvall, because he went over budget.

- Tae

 

[DW]

Originally posted by tkim6599

I believe that some sort of stratification of services needs to happen. Everyone should have at the very least some access to medical services, but the hard part is where the basic services stop and the advanced services begin. I am uncomfortable in widening the access to basic health care if it means limiting or eliminating advanced, expensive procedures.

I like the points you've raised tkim6599,

but, here's where i find some gray area with U.S. healthcare. Yes, we are the trend setters in medical technology, we have shorter wait times than nations with socialized care, easier access to elective procedures, etc. But are all these extra expensive interventions really helping us THAT much? There was a great study in Health Affairs journal in mar 1999, that I'll sum up in one statement: While the U.S. spends on average twice as much per capita on healthcare expenditure, there was no difference in morbidity and mortality rates in the U.S. versus other industrialized nations. And, lo and behold, in these nations there is a satisfactory ratio of pcps to specialists.

granted we have the prettiest facilities, the smartest med students and the shortest wait times, but breaking it down to a cost benefit analysis, is the current state of american healthcare optimal? Are all our resources being used in the most efficient manner possible? Is the relative emphasis on primary prevention/cost gating versus curative/acute interventions appropriate? Just throwing that out there, i'm not really making any suggestions here......

next on the docket, we'll discuss the merits of defined contribution and capitation

 

[tkim]

Originally posted by DW


There was a great study in Health Affairs journal in mar 1999, that I'll sum up in one statement: While the U.S. spends on average twice as much per capita on healthcare expenditure, there was no difference in morbidity and mortality rates in the U.S. versus other industrialized nations.

I'd be interested to see how whether any objective scale of 'suffering' (if there is such a thing) was included in the study. What might be missing in the study is the amount of suffering that our twice-as-much per capita spending reduced versus other medical systems.

What I mean by this is that a person who has kidney stones who perhaps is put on a waiting list for surgury, who gets the standard hydration and pain meds while waiting for it, versus the guy who has that first bad attack, then has them surgically removed or tripsed if they don't pass in 24-36 hours.

It may cost half as much for the country that makes a person wait for surgery for a non-life-threatening procedure, but depending on the wait time for surgery or lithotripsy, that poor sod's going to have to deal with the flare ups for whatever amount of time that person has to wait to get definitive treamtent.

I'd dare say that most people would prefer to spend twice as much to reduce the length of a person's suffering. All relative, yes. And perhaps not an example rooted in reality. But, it does make me think beyond mortality and morbidity to 'quality'.

- Tae

 

[DW]

good point, cant argue with that. at the same time however, wouldn't you say some of these non infectious/chronic malignancies might be better addressed if we took more of a "cut it off at the pass" approach instead of speding money on our better but really expensive interventions post the long buildup to something like nephrolithiasis? (which was the implicit jist of the study i referenced)

i'm not making a prevention versus cure argument here. i just feel that more emphasis on the primary care in synergy with those wonderful specialized US treatments, in a cost effective insurance model, would serve our needs best and make healthcare expenditures more manageable. Do i think the balance between specialized care and primary prevention is appropriate, personally? most definitely not, but thats just mho, i dont have the right answer.

 

[Hallm_7]

We could solve most of these problems if the number of law schools dropped to the number of med schools.

What's the biggest problem in medicine today?----->Lawyers

 

[DW]

Originally posted by Hallm_7
We could solve most of these problems if the number of law schools dropped to the number of med schools.

What's the biggest problem in medicine today?----->Lawyers

well, not so much that, but the concept of a "medical education" is expanding hopefully. While med school has always produced great clinicians, the physician workforce as a whole has not been well equipped to tackle some of the economic, legal, and political issues it faces. So, its nice that there is a rise in M.D./JD, MD/MPH, MD/MBA programs at med schools, so when these crucial decisions that affect healthcare are made, there could be someone with a real clinical perspective in the board room/on the senate floor/in the courtroom to influence said decision.

 

[Hallm_7]

DW,
Good comment. I think that physicians will have to band together more and more in the future in order to get things done in Washington and in the various state capitals. Currently there's the AMA, but it doesn't do enough lobbying in my opinion.

The AMSA has actively spoken out on residents' hours and endorsed legislation limiting hours worked. In fact, it seems a large group of them went to Washington and hand delievered endorsements supporting this legislation. More of this needs to be done in order to stop the decline in physician salaries and in attempts to recapture the doctor's ability to make decisions on treatment possibilities.

 

[chopsuey]

bump

 

[gramcracker]

I agree completely. Doctors (as well as scientists) rarely get political or take interests in the larger issues that affect them and their patients. I'm not sure why... perhaps the idea that to remain "objective" in their fields, they can't partake in action in other spheres?

AMSA does a lot more for progressive causes (better work hours, national health insurance) than the AMA. In fact, the AMA has bitterly fought against a national health insurance program since the early 1920s (so did labor unions), even though it would provide universal coverage for all people, and in most cases, increase physicians' and nurses' salaries.

Check out The American College of Physicians . They're a little more progressive. And the AMA only represents about 28% of doctors anymore. Physicians aren't happy with it either.

 

[KUamanda]

I too agree that the biggest problem in healthcare is underinsured or uninsured people. I am a child of a family of "working poor" parents and I didn't have access to the proper medical care throughout my childhood and adolescence. It's very unfortunate really.
Something need be said about those countries throughout this world that are able to grant all it's citizens basic healthcare. There are countries like this in Europe that make sure their people are cared for. Why? Because it's like an insurance policy for the good of their country...keep the people and their children healthy and they won't miss work. If they don't miss work the production and service can go on without a hitch. Makes sense.
And I agree that, though everyone hates taxes, it's for the greater good.
Just some food for thought.

 

[cabruen]

Gramcracker --

Without giving away whether I am for or against socialized health care....I am for it....socialized health care will most certainly decrease physicians salaries, not increase it.

 

[gramcracker]

Okay, maybe I overstated/assumed on the point that physicians would make more. At the same time, many physicians' net incomes may actually increase, even though they would make less gross income.

Under a single payer system, doctors are always paid for their services within 30 days, and only have one organization to bill. Most estimates put this savings at about 12% of total costs. And malpractice costs are much lower with a national insurance plan. Even in the most expensive province of Canada (Ontario), for the most expensive malpractice (neurosurgery), it's only $40,000. Most annual malpractice costs for doctors are about $20,000. Here in the US they can be $200k.

And remember, physicians' incomes increased by 35% when single-payer health care (hospital and medically necessary/physician insurance) was instituted in Canada in 1965.

So, some docs make more, some make a little less, and none have to deal with the hassle of complicated billing, late payments, or huge malpractice costs. Win-win to me.

 

[Random Access]

Originally posted by gramcracker
And malpractice costs are much lower with a national insurance plan. Even in the most expensive province of Canada (Ontario), for the most expensive malpractice (neurosurgery), it's only $40,000. Most annual malpractice costs for doctors are about $20,000. Here in the US they can be $200k.

But is the lower malpractice cost a result of being in Canada? Or a result of the socialized healthcare? Here people can sue like hell and are encouraged to do so. In a torts case, a lawyer doesn't collect unless he/she wins, so anyone can sue easily. In other countries, this practice might be considered unethical.

What's the rationale behind saying that nationalized insurance would lower malpractice costs?


-RA

 

[Random Access]

On a side note...if nationalized insurance indeed did lower malpractice costs, it would be great for rural areas, where doctors are leaving because the malpractice insurance runs higher than income, particularly for OB/GYN.


-RA

 

[Dynastar]

Socialized medicine is NOT the answer. Raising taxes is NOT the answer. If you want to see a good example of the government running something, go check out Social Security. It is going broke as will socialized medicine.

I'm not saying that the unrestricted market place is providing the best health care for everyone. It's not. However, we would be better off not going with a "cradle to grave" health care system.

Government bureacracy is not a fix for health care.

If you want to fix health care you need to:

1. Reduce the number of malpractice lawsuits against doctors.
2. Give tax breaks and incentives to companies to insure poorer citizens who do not have the money to pay for high insurance
3. Give tax breaks to employers so they can invest in health insurance for their workers

Bottom line...stimulate the market place to correct the problem, don't haul government into and expect them to fix it.

 

[gramcracker]

I wasn't ever advocating socialized medicine, Dynastar. I totally agree, that would not be the answer.

I'm talking about national health insurance; they're two completely different things.

In socialized medicine, the government employs the physicians and all other health care workers.

In national health insurance (universal health care, socialized insurance, whatever you want to call it), the government simply pays for the coverage. In NHI, most medical care is still entirely privatized. Doctors' decisions are rarely if ever questioned (unlike the current system, where managers who know little about health and medicine make medical decisions about patient care), patients can see any doctor they want, everyone's covered, and annual health care costs are slowed. And, patients almost never see a bill, and pay just about the same amount--taxes or private insurance costs. Imagine that: never seeing a bill!

Socialized medicine is NOT the answer. Raising taxes is NOT the answer. If you want to see a good example of the government running something, go check out Social Security. It is going broke as will socialized medicine.

Sure, some government programs work better than others. At this point, with more and more corporations lying about their accounting practices, and more workers losing their health insurance in the name of greater corporate profits, I'd go with the government. At least we each get a vote in how it's run.

I'm not saying that the unrestricted market place is providing the best health care for everyone. It's not. However, we would be better off not going with a "cradle to grave" health care system.

I don't know, DynaStar. National health care seems to be working in almost every other industrialized country. Health care isn't cheap, but it's at least cheaper in every other country with NHI, and it covers all its citizens. The US ranks 27th of all countries in terms of infant mortality, and our life expectancy, for being the wealthiest country in the world, is 24th.

2. Give tax breaks and incentives to companies to insure poorer citizens who do not have the money to pay for high insurance

Again, I just don't trust corporations. Their ethos is to make money for their shareholders, ethically or unethically. Medical errors are higher at for-profit hospitals than not-for-profit ones; the quality of care is lower in for-profit HMOs than not-for-profit ones; many HMOs invest in tobacco stocks.

 

[cmspilot]

The key to getting to a workable solution to fix the problems of uninsured/underinsured population in the US is to find a middle ground where conservatives and liberals can agree, otherwise no real legislation will ever get through Congress. Conservatives are going to outright reject any ideas of raising taxes, and liberals are going to want Government controlled health-care with raises in taxes. I know, though, that no matter what side of the political debate a person is that they really do care about coming up with solutions to the problems we face. Nobody, unless malicious, wants people to go without proper health care.

Where would be a middle ground that still solves the problem? I was interested in solutions I read about in a transcript of a meeting with two politicians, one conservative and one liberal on this website on the issue of healthcare : http://www.theatlantic.com/issues/2000/10/millertranscript.htm

The overview of the solutions they discussed were possible TAX BREAKS for those individuals who need health insurance. Instead of raising taxes for providing national health care, reduce the tax burden on lower incomes on a graduated scale upward in income. The reduction in taxes would allow those people whose employers do not provide health insurance to buy into private health insurance plans. I think it could help in a lot of ways if those reductions were mandated that they be used for purposes of health insurance (a prereq for the reduction perhaps). This is just the general overview of what is contained in the article.. so check it out if interested. But one thing is for sure, we need solutions and we need to work together with people of opposite political points of view to get solutions.

I feel personally that we must find solutions that DO NOT lead us into a socialization of medicine in the United States. The consequences are too great and the United States needs to stay at the forefront on Medical Research and breakthroughs, which with socialism has a tendency to stifle. Besides, socialism, in my opinion, is just a stepping stone to communism.

 

[Random Access]

Originally posted by cmspilot
I feel personally that we must find solutions that DO NOT lead us into a socialization of medicine in the United States. The consequences are too great and the United States needs to stay at the forefront on Medical Research and breakthroughs, which with socialism has a tendency to stifle. Besides, socialism, in my opinion, is just a stepping stone to communism.

Thanks Senator McCarthy.

GramCracker definitely wasn't advocating socializing medicine. Only health insurance. Indeed tax breaks to corporations will only make corporations try to find ways to increase the tax breaks without actually improving access to healthcare.

I'm all for capitalism, but if you give someone a loophole, they're going to take it, without considering why the loophole is there.


-RA

 

[Dynastar]

Gamecracker, I can see how you made a distincton between socialized medicine and NHI. However, the two are not too far off.

As soon as you start a NHI, it won't be much longer before the government starts employing doctors directly. However, I won't go down that road at the moment.

As I see it, a NHI will do two things (among many).

1. Yes, everyone will have health insurance but that is not necissarily a good thing. You mentioned G.B. as an example, however you failed to mention that wait times for procedures and surgeries are far longer in G.B. than in the U.S. Basically, you have a population paying really high taxes so that everyone can have health care. Of course, this comes down to whether or not you lean more on the socialist side of politics or not. However, I for one do not want to be taxed any more than we already are.

2. A NHI will most definitly become a "mediocre" insurance. Very rarely do you get government programs that are more efficient or successfull than the private sector. Health care is no different.

I know the current "craze" is to say that all corporations are greedy, non-ethical monsters. However, I won't buy into to that logic. Just because Enron and WorldCom go under for bad accounting practices doesn't mean that private sector health care is doomed and that we must turn to government to solve our problems.

I know that this issue rides along the same track as political bias but what doesn't . Anyway, love the debate.

 

[gramcracker]

Conservatives are going to outright reject any ideas of raising taxes, and liberals are going to want Government controlled health-care with raises in taxes.

The overview of the solutions they discussed were possible TAX BREAKS for those individuals who need health insurance. Instead of raising taxes for providing national health care, reduce the tax burden on lower incomes on a graduated scale upward in income. The reduction in taxes would allow those people whose employers do not provide health insurance to buy into private health insurance plans.

I feel personally that we must find solutions that DO NOT lead us into a socialization of medicine in the United States. The consequences are too great and the United States needs to stay at the forefront on Medical Research and breakthroughs, which with socialism has a tendency to stifle. Besides, socialism, in my opinion, is just a stepping stone to communism.

A couple of points: I don't see NHI as really "raising taxes," just a redirection of funds. Most NHI advocates don't advocate changing the current level of health care spending, just changing the way it's allocated. Also: Liberals don't want government controlled health care, either (at least most of them--myself included--don't).

The problem with a tax-based solution, as I've read, is that most proposals aren't willing to subsidize nearly enough to pay for it. Health care costs are rising too quickly for what most tax policy wonks are willing to subsidize. Another pro for NHI, especially for conservatives, is that NHI will help motivate people to leave the welfare system. A great deterrent for many people on welfare is the fact that the jobs they're eligible for, or are available in their area, don't offer health insurance. Whereas Medicaid does.

Again, I'm not arguing for socialized medicine, I'm arguing for socialized insurance.

 

[gramcracker]

Originally posted by Dynastar

As soon as you start a NHI, it won't be much longer before the government starts employing doctors directly. However, I won't go down that road at the moment.

I'm not sure where you're getting this information; Canada, Sweden, Denmark, and Norway have all had single-payer health insurance since the 1960s, and none to my knowledge have become socialized medicine states. Sure, some doctors choose to be in salaried positions in hospitals (public or private ones, mind you), but a doctor is free to choose to work as fee for service, salaried, or group practice. Again, in single-payer, the government only serves as administrator--payments are negotiated for doctors by a doctor's board (made up of physicians) and the government.

You mentioned G.B. as an example, however you failed to mention that wait times for procedures and surgeries are far longer in G.B. than in the U.S.

I don't think I mentioned Great Britain, and if I did, I didn't mean to. Britain has a much different program--much closer to socialized medicine, where there is a national health service: this is where doctors are actually employed by the government.

2. A NHI will most definitly become a "mediocre" insurance. Very rarely do you get government programs that are more efficient or successfull than the private sector. Health care is no different.

I have to wholeheartedly disagree. Depending on the poll, Canadians are generally between 85-95% satisfied with their health program, whereas Americans are much, much lower. (Americans that even *have* health insurance, that is. I would imagine the 43 million that don't aren't too happy.)

I know the current "craze" is to say that all corporations are greedy, non-ethical monsters. However, I won't buy into to that logic. Just because Enron and WorldCom go under for bad accounting practices doesn't mean that private sector health care is doomed and that we must turn to government to solve our problems.

Point taken. Although I haven't just recently jumped on the "evil corporations" bandwagon. I've thought that way for years.

I think competition is great for some industries. It works wonderfully. Supply and demand works perfectly for manufacturing. I wouldn't have it any other way. But I don't think it's the solution for everything. Health care is a completely different industry. Supply and demand, in my opinion, shouldn't really apply--and don't need to. It's not like anyone chooses to get sick or need an operation... the demand exists because people want to stay alive. It's not the same as "demand" in terms of "this many people want a certain type of television set."

 

[Dynastar]

"A great deterrent for many people on welfare is the fact that the jobs they're eligible for, or are available in their area, don't offer health insurance. Whereas Medicaid does."

I think the answer here is not government. Give the people getting off of welfare and Medicaid tax breaks to buy health insurance. Give businesses incentives to hire these people and give them health insurance. Government is EXTREMELY inefficient. Anyone who believes otherwise is misinformed in my opinion. A NHI means a new government bureaucracy and that's something I'm just not in favor of.

I believe the same result can be achieved and the patients would be better served than creating a "Social Security system of the health world."

 

[gramcracker]

Government is EXTREMELY inefficient. Anyone who believes otherwise is misinformed in my opinion. A NHI means a new government bureaucracy and that's something I'm just not in favor of.

Okay, last response, then I've got to get to bed. :>

The whole economic feasability of single-payer (which has been supported by many health economists and private studies--one was just conducted in Vermont, and other in Maine to examine the feasibility of statewide single-payer) is that it's more economically efficient to use a single, government payer than the current hundreds-of-payers system we have right now.

HMOs spend between 15-30% of every health care dollar on administration and paperwork. For all the money they spend on denying patients heart transplants , they could be providing them. Medicare administrative costs are around 3%. Figuring NHI into the administration, most estimates approximate the administrative costs to increase to around 6%, I think (I'll have to double-check that number). With that savings--in terms of paper-pushing, hospital fees for all the paperwork, doctors' billing, not to mention the hassle and time wasted on excessive paperwork and DRGs, the savings of a single-payer system are between $110 and $150 BILLION dollars a year. (This is assuming our health care GDP costs stay the same in the US, which are currently around 15% of GDP.)

It's not a big bureaucratic system, DynaStar--I'd urge you to read any number of books about Universal Health Care in Canada. Canadians show their card to a hospital or physician, the provider gets an imprint of it (I think it's electronic or digital by now). The provider submits their information to their regional payment office, and within 30 days, doctors have all their bills paid. And they get an extra 10-15% if they're not paid within 30 days (which is rare and almost non-existent). There's no itemized billing when you're staying in a hospital. If a patient needs a tube of toothpaste, they get a tube of toothpaste. And it doesn't show up as a big charge (like in US hospitals with HMOs and private insurance), 'cause you don't even see a bill.

 

[LoveDoc]

I work for an HMO and really wish I could disclose my views on this topic but I know BIG BROTHER is watching.

I will however take the liberty to express general comments.

HIPAA The Health Insurance Portability and Accountability Act of 1996 mandates HMOs to be more reliable in their billing, privacy, and security acts. I believe the "due date" of meeting standards is Oct 2003.

I see first hand why patients are turned down for insurance, what their rates are and am privy to underwriting clauses that constitute the decisions. The term 'single payer system' especially caught my eye. This concept however admirable is a far cry from current reality.

Not at liberty to say more but take a look at some of the salaries HMO CEOs are pulling in.

I believe that sums up my feelings on this topic.

 

[cmspilot]

Originally posted by gramcracker
Again, I'm not arguing for socialized medicine, I'm arguing for socialized insurance.

I just do not see the logic in creating yet another inefficient government program, socializing insurance. We have already a wavering Social Security system that is exponentially larger in scheme than its founders invisioned... GRAMCRACKER do you really believe that all we will be doing is reallocating funds? That would intensify its inefficiency. Even if the program was started just by reallocating funds and not raising taxes, it would no doubt snowball into something much bigger and bigger just the same as social security has done. Taxes would then have to be raised just to keep face for the program. The simple fact is, and I would like to hear any argument to the contrary, private business is much more efficient, and can provide better service than anything in the public sector.

There have been many calls for privatizing Social Security because of better returns on investment that would occur, so why don't we come up with solutions that keep health insurance in the private sector. We want all people to have access to the proper health care, but lets not make the mistake of thinking that NHI is the solution. A QUESTION: isn't giving tax relief to people without health insurance(so they can buy private insurance policies) a "Reallocation of government funds."

Of course, we will need to provide adequate relief and opportunity for purchase of Health insurance through tax breaks... that is something politicians have to face... cutting wasted and porkbarrel spending so that such a TAX CUT would be possible and feasible as to make it possible for privatization of Health insurance across all income levels.

And if you really get into the crux of the matter, conservatives and liberals alike get what they want in a general, but effective way: Universal Health Insurance for everyone.. as long as you are a contributing member of society by means of employment. And there are the cases of the most disadvantaged and disabled, whereas a revamping of Medicaid is probably the answer.. but it should be limited to those people who really need it, otherwise people are going to have to work to earn their health insurance just like everyone else.

 

[DW]

Originally posted by Dynastar

1. Reduce the number of malpractice lawsuits against doctors.
2. Give tax breaks and incentives to companies to insure poorer citizens who do not have the money to pay for high insurance
3. Give tax breaks to employers so they can invest in health insurance for their workers

i like these ideas. and i'll piggyback a little.

point 1: very crucial. some states are working on tort reform to limit malpractice payouts, but its been a slow process (once again, docs need to get together and fight for their rights!). once we lower the ridiculous legal/insurance burden of the american physician, it will make things run a lot more smoothly. or,we could just start kidnapping lawyers

point 3: not only that, but i'd say throw in more incentives for companies that have things like succesful wellness programs, fitness centers, etc., for their employees. good for both the employee, the employer, and by the "healthy worker effect" good for the ecomony

also, the health plan i get as a federal employee is something that should be implemented more across the board in private companies: defined contribution. basically, we all get a "defined" uniform payout from our employer for health insurance, not a lot of money. depending on the level/type of coverage you want, you pay extra accordingly, and there are multiple different plans to chose from. so i, being a healthy 22 year old, have the option of saving money on insurance by paying for minor things like drugs and eyeglasses out of pocket, while my plan will give me a reasonable deductible for pressing medical concerns while i pay basically nothing extra on top of my employer payout. a person who has much higher expected medical expenses can tailor their plan and extra contribution accordingly to what services they may/may not need. it fits closer to the perfect insurance economic model (at least to the employer) while making people more accountable for their medical expenditures, thereby reducing moral hazard and adverse selection.

i think having the decision for restriction of care given to the patient, and NOT the provider/third party, would not only be more fair but alleviate some of the legal issues that managed care gatekeeping has caused.

the government, by providing incentives to those employers and insurance companies that get a lot of people (the uninsured "working poor", etc) under insurance, providing research and public health services to augment our acute care services with cost effective preventive care intervention, and by providing coverage ONLY to those extreme cases in a revamped Medicaid program, could be an an active stimulant (not necessarily a participant) in increasing coverage while promoting market competition.

i dont believe in socialized medicine, but i feel the feds and states could stir the drink and make the private healthcare market a lot more pleasant for everyone without necessarily increasing tax burden. first above all, we have to get rid of the lawyers

just my two cents though