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constructor said:
Umm, I wrote a published paper on the subject, I have read a little bit about it.
What's wrong with America's Heath Care System?
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Umm, I wrote a published paper on the subject, I have read a little bit about it.
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medic170 said:
yeah, i'm not buying it judging by your words of wisdom on this thread alone... and i know for a fact that you're wrong because just about every major study discredits almost everything you say.
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My $0.02 on a single-payer system in the US:
Right now there is a shortage of doctors in the US in many fields; this is why doctors have to work their a$$es off to keep up with the patient caseload. With a pretty much fixed number of yearly seats in medical school and an aging baby-boomer population, this problem will worsen. Now throw in 45 million people who, previously uninsured, now have access to care under a single-payer system, and many of whom have serious health or mental health problems that have been left untreated for years do to lack of coverage. How will doctors physically be able to handle this sudden influx in caseload? Either doctors will have to work even more rediculous schedules, we will need to add many more seats in schools across ALL health care fields (MD, DO, PA, RN) to add more workers, or there will be a long waitlist for patients to be seen by a doctor. Either way, the quality of health care will decline.
Other issues with single payer system in the US:
1) How can we guarantee that there will be any administrative cost savings? Sure there is a lot of red tape with HMOs, but do we know for sure that there won't be just as much when the government is put in charge of paying bills for hundreds of millions of people?
2) What will happen to doctors' salaries? What will keep the government from paying unfair fees to doctors? (This could also eventually take a toll on quality of care; many doctors are coming here from Canada b/c they can earn more money practicing in the US)
3) How will a bill like this ever get passed? Many people already think the government is too big and has too much power. Also, a single-payer policy goes against capitalism and is a step towards socialism. Will a majority of voters be able to accept this?
My point is, the healthcare problem that WE (not Canada, Britain, etc) are facing is VERY complex, and a single-payer system, although it sounds nice and has worked elsewhere, will probably not be completely successful, given that it is received well by the public. There will still be many problems to face, and until someone can convince me otherwise, I will continue to be skeptical of this "solution" to the healthcare problem...
Right now there is a shortage of doctors in the US in many fields; this is why doctors have to work their a$$es off to keep up with the patient caseload. With a pretty much fixed number of yearly seats in medical school and an aging baby-boomer population, this problem will worsen. Now throw in 45 million people who, previously uninsured, now have access to care under a single-payer system, and many of whom have serious health or mental health problems that have been left untreated for years do to lack of coverage. How will doctors physically be able to handle this sudden influx in caseload? Either doctors will have to work even more rediculous schedules, we will need to add many more seats in schools across ALL health care fields (MD, DO, PA, RN) to add more workers, or there will be a long waitlist for patients to be seen by a doctor. Either way, the quality of health care will decline.
Other issues with single payer system in the US:
1) How can we guarantee that there will be any administrative cost savings? Sure there is a lot of red tape with HMOs, but do we know for sure that there won't be just as much when the government is put in charge of paying bills for hundreds of millions of people?
2) What will happen to doctors' salaries? What will keep the government from paying unfair fees to doctors? (This could also eventually take a toll on quality of care; many doctors are coming here from Canada b/c they can earn more money practicing in the US)
3) How will a bill like this ever get passed? Many people already think the government is too big and has too much power. Also, a single-payer policy goes against capitalism and is a step towards socialism. Will a majority of voters be able to accept this?
My point is, the healthcare problem that WE (not Canada, Britain, etc) are facing is VERY complex, and a single-payer system, although it sounds nice and has worked elsewhere, will probably not be completely successful, given that it is received well by the public. There will still be many problems to face, and until someone can convince me otherwise, I will continue to be skeptical of this "solution" to the healthcare problem...
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constructor said:
GDP per capita in the US: 36,000
GDP per capita in the UK: 25,000
We'd better be spending more on each case. We are far wealthier than the UK, and this gap is widening. But in all honesty, how much is a human life worth? And yes, in socialist systems, a patient may have to wait months before beginning treatment after a cancer is diagnosed due to the patient load.
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Any evidence to back up these claims?constructor said:
Socialized medicine is ok in some countries, but if you're going to try and say that Canada has a system we should adopt then I'm just going to have to read something that backs that up.
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meister said:
your statement seems to be motivated by some sort of general contempt for canada as a country... i suggest you put this bias behind you and look at comparative reports of the US vs. the canadian healthcare system. i'm not going to spoonfeed you information about how things work in these countries; it's up to you to figure things out for yourself if you're curious. i'm confident of my facts and i've used them to form my opinions. if other people have citations they'd like to put up pertaining to these studies, that would be great, but i'm not going to waste my time for the sake of argument.
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constructor said:
Classic. You tell me that I am dead wrong and insult me for "not reading up on the subject". When the truth is, I am not afraid to post a link or cite real research, and you are unwilling or unable to do so. making claims and refusing to back them up, now that is sure compelling. You can have all the opinions you want, but when you go and accuse others of being "completely wrong" and say "you might want to actually read up on how things work in those countries before you respond so you at least sound like you have something semi-intelligent to say" you better look in the mirror and be ready to back up your claims with some evidence. Instead, you dodge a request for you to cite something to back up your claims. If you want to be viewed as credible and opine on a subject, than be ready to backup your claims.
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medic170 said:
there's nothing in the link you mentioned that refutes my points so i'm not sure what "evidence" you're talking about. i'm just telling you that you can look up this stuff for yourself because it's all very basic and the information is out there and easily accessible through a google search. i'm not trying to prove anything here so why should i waste my time?
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The most important point to doctors is still the same: there's only one game in town and it has no incentive not to pay you as little as the bureaucrats that set the fee scheduling want. If the new Department of Health Insurance decides to pay CT surgeons 2 dollars for all their procedures, they can't decide not to accept national health insurance, and they have to do something.
I also like how all of these proposals invariably claim that they would just "even out" physician salaries. If you're reading this post and you want to be a FP, fine. If you want to be a neurosurgeon, ponder the joys that await when you make as much as your average FP.
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constructor said:
Then why are you wasting your time posting anything at all? youre not trying to prove anything? Well, I guess your right there, you are only trying to state an unfounded opinion, not PROVE anything.
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dnelsen said:
That is a very "liberal/democratic" way to define it. However, anytime you get the government involved and they are providing services to individuals who otherwise would not have them at the expense of other individuals, it can be argued that it is a form of social welfare (which it is). Thus, it is a form of socialized medicine; everyone is equal. They just throw the word "private" into the conversation to make it sound better, and you obviously took the bait, hook, line, and sinker.
On another issue. Back to research. I feel that if we ever lose our minds and offer universal healthcare (another one of those "euphemisms" for socialized medicine; universal healthcare.....hmmm...oh it just sounds so positive!!!! Yeah that sounds good.....I am for universal healthcare....FREE Healthcare!!! I don't have to spend a dime at the doctor to pay him/her a reasonable amount for his/her time!!!.....In fact, lets provide childcare to everyone that needs it!!!...OH! And don't forget about dental coverage!!! Oh, and while we are at it, lets make sure that EVERYONE makes at least $15 an hour.......oh, and oh, and oh......Point is that if you study the history of the US (or any other country), socialization is definitely an instance in which the slippery slope argument is true) the world will suffer dramatically. Many of you are not aware, but the United States provides over 10x's the amount of money to research than any other country. In fact at one point it was approaching or reached the point that US expenditures on research were more than the rest of the world combined. Lets not underestimate this fact. Research is the backbone of medicine.
Furthermore, I enjoy the fact that I can go to ANY US hospital and get an MRI, etc--hell, I can practically have it done at a drive-thru. If I were Canadian, I would probably be held up to the light while some Art major traced my insides, unless I were fortunate enough to live near one of the very FEW hosopitals with routine access to such equipment.
You can read any economics 101 textbook and realize that capitalism works. Why should medicine be the exception? Oh, the percieved morality of it all--another issue completely. Let the market dictate pricing. Its a simple law of economics. If the price is too high, people won't pay, if its too low..........Oh you get the picture.
Now I'll just sit here while I get blasted by many of you stat sluts--oh the WHO says this---F#@& the WHO and the hippies who run it. It is really much simpler that people make it. It's a question of whats right and wrong. Oh, teachers don't get paid enough, or the blue-collar worker in the factory didn't get his overtime. WHY THE HELL ARE PHYSICIANS EXEMPT FROM THE SAME RIGHTS GIVEN TO OTHERS? Well it's simple, politicians need votes, and free s#@t is always good.
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Here is a good artice by Lawrence W. Reed (2000), president of the Mackinac Center for Public Policy, a research and educational institute headquartered in Midland, Michigan. This is yet another one of those things called "evindence to back up statements" things I mentioned 🙄
I have posted a bunch of facts now backing up my statements, I would really like to see some that refute.
According to a national poll, four out of five Canadians are unhappy with their socialized health care system and believe it has worsened noticeably in just the past five years. Doctors in Manitoba apparently agree: Almost half of them?an astonishing 1,800?have left the province in the past decade alone.
David Gratzer, a Canadian health policy commentator, published a blockbuster book last year entitled Code Blue. Gratzer revealed that the quality of care Canada's system provides to ordinary citizens matters less to its apologists than the quality of care it denies to the so-called rich. The egalitarian impulse that drives Canada's "universal" health care system calls for treating everybody the same; all patients get "free" care in the public system and are generally denied the option of getting faster or better care for a fee in the private sector.
Gratzer asks, "With health care, is our true goal that Mr. Smith, who owns three cars, not be allowed to get a quick (private) cataract surgery? Or is it that Mr. Jones, who just makes rent every month, gets (publicly funded) heart surgery when he needs it? The way [the system's] advocates carry on, you'd think that it was fine that Mr. Jones suffered crushing chest pain after walking three steps just as long as Mr. Smith had to stumble around blindly for six months."
Thanks to this idiocy, an estimated 212,990 Canadians were on hospital waiting lists for surgical procedures in 1998. The average total waiting time of 13.3 weeks was up from 11.9 weeks in 1997 and up a shocking 43 percent since 1993. No wonder that when former Quebec Premier Bourassa was diagnosed with cancer, he avoided "free" care in his home country and instead sought treatment in Cleveland.
I have posted a bunch of facts now backing up my statements, I would really like to see some that refute.
According to a national poll, four out of five Canadians are unhappy with their socialized health care system and believe it has worsened noticeably in just the past five years. Doctors in Manitoba apparently agree: Almost half of them?an astonishing 1,800?have left the province in the past decade alone.
David Gratzer, a Canadian health policy commentator, published a blockbuster book last year entitled Code Blue. Gratzer revealed that the quality of care Canada's system provides to ordinary citizens matters less to its apologists than the quality of care it denies to the so-called rich. The egalitarian impulse that drives Canada's "universal" health care system calls for treating everybody the same; all patients get "free" care in the public system and are generally denied the option of getting faster or better care for a fee in the private sector.
Gratzer asks, "With health care, is our true goal that Mr. Smith, who owns three cars, not be allowed to get a quick (private) cataract surgery? Or is it that Mr. Jones, who just makes rent every month, gets (publicly funded) heart surgery when he needs it? The way [the system's] advocates carry on, you'd think that it was fine that Mr. Jones suffered crushing chest pain after walking three steps just as long as Mr. Smith had to stumble around blindly for six months."
Thanks to this idiocy, an estimated 212,990 Canadians were on hospital waiting lists for surgical procedures in 1998. The average total waiting time of 13.3 weeks was up from 11.9 weeks in 1997 and up a shocking 43 percent since 1993. No wonder that when former Quebec Premier Bourassa was diagnosed with cancer, he avoided "free" care in his home country and instead sought treatment in Cleveland.
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ajnak182 said:
Also, uninsured typically get charged a higher rate because it is expected that the person will get the debt knocked down by a collection agency. to compensate for that decrease the hospital or insurance company (not sure which) charges more.
does anyone have good sources about the cause for the increasing costs of healthcare in this country? i'd really like to learn more about that.
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mamaMD said:
Bush did promise to partly privatize social security and then didn't. He also created a HUGE deficit shortly before the babyboomers retire, will require lots of medical care in their old years. So yes politicians often don't do what they can for their constituents but since Bush is in office, we should put more scrutiny on his promises and lack of fulfillment.
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constructor said:
You have to be careful though because atleast in talking with people from btoh Canada and France that sometimes it can take quite a while to get in to see a doctor in state-run healthcare systems. Look also at England-- some people in need of various surgeries go to the mainland because they can get it done faster. So government run programs do have drawbacks.
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What's wrong with this health care system is that the average American cannot get the same health care as the celebrities and the rich. Despite all the technology that we have, the access to that technology is the problem. The HMOs make that access harder for doctors and patients.
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shawred said:
Well I am a conservative/republican but I do in fact believe that healthcare is a right, not a privilege.
The site I mentioned doesn't tap dance around the issue at all. It says that it is not socialized medicine, but it is socialized insurance. They aren't scared to use the word "socialized," but maybe they should be because it is obvious that the word scares the crap out of you...
I'm sure you will come back and say it is all semantics and it basically boils down to the same thing, but that would be a load of crap so save your breath.
If anyone wants some quick and concise info on the single-payer system, check out the FAQ section of the site I mentioned before:
http://www.pnhp.org/facts/singlepayer_faq.php
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DocMizzle said:
To address your first point, maybe the government and schools need to give incentives for more to go into this field. The first thing they could do is not drive up the cost of school by adding faculty members when the number of students remains roughly the same year to year over decades. Cost is a huge deterrant for lots of people that are well suited to do the work and could make a difference.
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medic170 said:
Ranked by the Organization for Economic Cooperation and Development (OECD). Just because, we are "AMERICA", does NOT mean we have the best overall healthcare outcomes in the world. Don't be mislead! We absolutely don't! I suggest that you read a couple of articles....
"Is US Health Really the Best in the World?" Jama july 2000 Vol 284 No. 4
"health spending, access, and outcomes: Trends in industrialized countries" health spending" 1999. Health Affairs Vo 18. No. 3
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People need to get off their "America is the best" attitude. While American healthcare has its advantages, it also has some huge problems. Just like other countries' socialized schemes. Their is not one "BEST" system.
Second, universal access does not mean free necessarily. In countries where socialized medicine exists, a huge percentage of peoples' salaries goes toward taxes, which in turn help pay for that care. So it's not free care.
Lastly, free care would not be a good idea. While I don't have research studies to back me up, I have heard by a few people in healthcare that if you make people pay for something, they value it much more. If you made care "free" in this country, then you risk that people will run to the doctor at the slightest hint of a cold or zit. This is why many insurance companies require a copay at eac doctor visit-- to decrease frivolous visits.
My personal opinion is that universal healthcare is needed and desired, if it is done correctly, and that it needs to be done at a much lower cost. If the Clinton Foundation can bargain hard with Becton Dickinson to lower reagents needed to monitor HIV patients on a volume basis, why can't insurance companies do the same? This is just one part of a problem with no easy solution but as future physicians we need to keep exploring ideas to get more people affordable care.
Second, universal access does not mean free necessarily. In countries where socialized medicine exists, a huge percentage of peoples' salaries goes toward taxes, which in turn help pay for that care. So it's not free care.
Lastly, free care would not be a good idea. While I don't have research studies to back me up, I have heard by a few people in healthcare that if you make people pay for something, they value it much more. If you made care "free" in this country, then you risk that people will run to the doctor at the slightest hint of a cold or zit. This is why many insurance companies require a copay at eac doctor visit-- to decrease frivolous visits.
My personal opinion is that universal healthcare is needed and desired, if it is done correctly, and that it needs to be done at a much lower cost. If the Clinton Foundation can bargain hard with Becton Dickinson to lower reagents needed to monitor HIV patients on a volume basis, why can't insurance companies do the same? This is just one part of a problem with no easy solution but as future physicians we need to keep exploring ideas to get more people affordable care.
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Fed Meat said:
I will admit that I did make a mistake. We aren't ranked 35 for infant mortality, but according to a 2000 article, we are ranked 13th. Howevever, we still don't have the best outcomes. 5-year cancer survival is just a tiny slice of the health outcomes pie. That statistic, if true, does not proove we have the best healthcare outcomes. If you look at the MAJOR indicators, which I mentioned in my intial post, those give a much better picture of health outcomes (Infant mortality rate, LE, LBW, YPLL).
In addition, I never mentioned health care quality, I mentioned OUTCOMES. Infant mortality has a lot to do with health care outcomes.
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PookieGirl said:
So true.
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Early, in the summer, I read a book by George Lundberg. I agree very closely with his recommendations. I believe that it is unreasonable, given our system of values, to accept an entirely socialized healthcare system that gaurantees identicle care to all. We do not have identicle dress, incomes, or most anything else. This concept, many believe, is a major reason that the Clinton plan failed. What we need is a plan that provides basic medical care to all, but also allows individuals the ability to purchase (with their own money) whatever care they wish, provided that it doesn't interfere with the basic care of others.
What we should have, is gauranteed basic medical coverage that covers catastrophic care and some forms of preventive care that save money and lives. Regular checkups and routine visits should not be covered by government based insurance. In addition, insurance reform should follow similar lines. The illusion that medical care is essentially free is what caused costs (and physician's incomes during the 70's and 80's) to skyrocket. The insurers paid whatever the providers billed. To cut back on costs, people should be exposed to the economic realities of their medical care and doctors and other providers should compete by quality and price.
What we should have, is gauranteed basic medical coverage that covers catastrophic care and some forms of preventive care that save money and lives. Regular checkups and routine visits should not be covered by government based insurance. In addition, insurance reform should follow similar lines. The illusion that medical care is essentially free is what caused costs (and physician's incomes during the 70's and 80's) to skyrocket. The insurers paid whatever the providers billed. To cut back on costs, people should be exposed to the economic realities of their medical care and doctors and other providers should compete by quality and price.
so much for conflicting positions. America's healthcare is the best because it pours an "inordinate" amount of cash into researh. No it sucks because over 40 million americans are uninsured. Opinions are being offered for what I think are the wrong reasons. I was watching this show on PBS, and the issue of drug cost was directly treated. It was stated that certain Americans prefer buying their drugs from Canada since they were cheaper and couldn't afford them in the US; however the menace of law-forbidden purchase of drugs outside the US was pushed by Pharm companies since that would make them lose profits or recoup the millions of dollars spent on research.
Actually the healthcare thing confuses me. Where there is a problem, people claim there isn't. I am beginning to think that there are lots of problems, at least when compared with Europe and certain parts of the world, and that people who can make the change just adopt an ostrich attitude while deciding which things to discuss and what not to. As a result we get conflicting opinions on what needs to be fixed and what is problem-free.
Again people seem to make the mistake that a huge percentage of the uninsured are the bums and slothfuls. However I have personally encountered families with insurance who are strung on healthcare debts of $3000 or more because someone got sick, and they make well over 35 to 40 grand a year; literally they are paying through their nose. I mean, healthcare is getting too expensive, people can't afford insurance. For something such as health, this should not be the case. I read an article which opined that the unwillingness of the government to step in to curb this problem is costing the nation about $40 billion dollars a year or so. The reform I think the article was hoping to suggest was creating a healthy but systematized hybrid of government (socialistic) and privatized healthcare systems. I think the UK has this MO. What this implies is that for more expensive or complicated procedures or treatments, the patient will have to bear a reasonable fraction of the cost. remember that not everyone on insurance is getting ill, and this suggests that the insurance premiums paid by this "strong" individuals should be going somewhere. So in a way this can help those who are quasi-chronically ill.
Actually the healthcare thing confuses me. Where there is a problem, people claim there isn't. I am beginning to think that there are lots of problems, at least when compared with Europe and certain parts of the world, and that people who can make the change just adopt an ostrich attitude while deciding which things to discuss and what not to. As a result we get conflicting opinions on what needs to be fixed and what is problem-free.
Again people seem to make the mistake that a huge percentage of the uninsured are the bums and slothfuls. However I have personally encountered families with insurance who are strung on healthcare debts of $3000 or more because someone got sick, and they make well over 35 to 40 grand a year; literally they are paying through their nose. I mean, healthcare is getting too expensive, people can't afford insurance. For something such as health, this should not be the case. I read an article which opined that the unwillingness of the government to step in to curb this problem is costing the nation about $40 billion dollars a year or so. The reform I think the article was hoping to suggest was creating a healthy but systematized hybrid of government (socialistic) and privatized healthcare systems. I think the UK has this MO. What this implies is that for more expensive or complicated procedures or treatments, the patient will have to bear a reasonable fraction of the cost. remember that not everyone on insurance is getting ill, and this suggests that the insurance premiums paid by this "strong" individuals should be going somewhere. So in a way this can help those who are quasi-chronically ill.
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JDAWG07 said:
You make good points but those "regular checkups and routine visits" are the forms of preventative care that save money and lives in the longrun. You don't want to wait until catastrophic care is necessary because it is too expensive. That is the biggest problem with the uninsured population: they have to wait until they have serious problems before they seek care and then to care for them is much more expensive than it would have been had they had access to initial regular checkups.
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Bfriccia1 said:
You address only part of the problem with the uninsured. Sure, many of the major illnesses could be prevented with regular checkups, but another problem is the uninsured being seen in the ER for complaints/illnesses (stomach aches, toothaches, pregnancy tests, etc) that should be seen in a clinic by a primary care doc, not in the ER. These non-emergencies treated in the ER cost much more than they would at a clinic, but since the ER is the only place legally required to treat the uninsured, this is where they go for common complaints.
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Bfriccia1 said:
Anecdotally, I can say that many of my friends and family, who aren't uninsured, still don't see their doctors regularly. So even for those that ARE insured, it still needs to be emphasized to them that they should have regular checkups (yearly? every 2-3 years I don't know).
Another group of people I know go to the doctor for the stupidest things. Colds for example. Maybe people need basic education as to when it is NOT a time to go to the doctor, like in health class.
If anyone's interested, the WHO published an extensive comparative study of health care systems a few years back. The US ranked poorly overall among industrialized nations, but the criteria used focus more on patient care issues than economic issues. It's worth taking a look.
http://www.who.int/whr/2000/en/
http://www.who.int/whr/2000/en/
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PookieGirl said:
I hear ya on both of the things brought up here. First, people tend not to go to the doctor if they have a $5000 deductible, the only plan they could afford. They get the catastrophic coverage, but no prevention.
The deal with people going to the doctor for colds is so stupid, but they still do it. And then they demand antibiotics, but that's a whole other issue in itself...
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Mumpu said:
I can't comment on insurance co's, but pharma co's are regulated pretty heavily by the FDA. Am I misunderstanding what you are saying?
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medic170 said:
Can you -try- and back up your claim that America has the best OVERALL health outcomes in the world? Perhaps you should follow your own advice.
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dmoney41 said:
We have a ton of hockey players from Canada at my school, and anytime they need an MRI they do it in the US, even though it'll cost here. There was one girl that opted to have an MRI in Canada, and she waited from early October til just after Christmas. That was the earliest she could get.
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Well, heres my medical story from another country. My boyfriend was with his son in Australia, and his son had a boil on his leg that needed to be lanced. When it was all over he tried to pay the hospital, they wouldn't let him. Cool.
There are plusses and minuses to both types of medical systems. Personally I would rather wait several months to see a doctor than not see one at all because I couldn't afford it.
There are plusses and minuses to both types of medical systems. Personally I would rather wait several months to see a doctor than not see one at all because I couldn't afford it.
dnelsen said:
THAT was an AWESOME link. For another great article that really helps explain things, check out this article by Hillary Clinton on the NY times magazine. It was about a year ago but it's not on the site. you can probably search for it online.
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the WHO's ranking criteria is geared towards the European system of healthcare anyway. Of course the US is going to rank low. Doesn't mean the US has a system that is as bad as those countries that are ranked close to it. Not in the least.kdtrinh said:
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A few thoughts on socialized medicine....
While it would certainly be nice for everyone to have coverage, a single-payer system would do little or nothing to the problem of cost containment. 45 million people are insured BECAUSE it costs too much. The cost should be our primary focus, not the number of uninsured. Lower the costs, and the number of uninsured will drop.
While I generally disagree with Bush, I like his idea of a catastrophic insurance plan/tax-free medical savings account. Let's compare it to car insurance. You need it when you wreck your car, but it doesn't pay for your gas. In the past, when insurance programs started, people weren't on a whole lot of drugs all the time. Now a lot of people I know seem to be on permanent drug programs for the rest of their life. Anti-depressants, ADHD meds, statins, anti-hypertensives, etc. come to mind. This type of thing is not what insurance was designed to do. Bush would have us pay for our own medical care out of a tax free savings account. Then we would be forced to make more economical choices. For example, maybe I should get the $1 a pop claritin generic from Wal-mart for the few days a month my allergies bother me instead of the expensive nasonex spray I have to take permananently. Maybe I should limit spicy food instead of buying the rather expensive "purple pill". I realize these examples don't apply to all situations, but you get the idea. Then we could have an insurance policy for when we really are in trouble--trauma, cancer, etc.
I think this would help, but a lot of our exploding costs accrue in end-of-life situations. Because of our amazing research in the US, we are getting more and more interventions to extend life. Problem is, they cost a lot of money. As the elderly population increases, we wil pretty much be able to do as many interventions as we want to. It eventually comes down to this question-how much of our gdp should we spend on health care? 10%, 20%, 50%? We really could spend as much as we wanted to, but after a point it would wreck our economy.
Resolving this will come down to a very dirty word-rationing. We do it already. The rich can get more treatments than the poor, who often just go into a corner a die. In a socialized system, the government would eventually have to decide who recieves the limited amount of care we can afford to provide, or what care will be provided. Essentially, they will decide who lives and who dies. I'm a little uncomfortable with this. I'm not saying the capitalist distribution system is any more fair or morally palatable. There are no easy answers here.
Many of these high end-of-life costs arise because people are so uncomfortable about death. It is unacceptable, a failure. We strive for cures beyond the point of reason, when maybe we should be focusing of palliative care at the end. It certainly would be much more cheaper, and often more humane. I saw the suffering a relative of mine experienced fighting aggressively against cancer beyond the point of recovery.
I think this is the reason people will always be upset with the healthcare system, no matter how good it gets--People are pissed off that they have to die.
While it would certainly be nice for everyone to have coverage, a single-payer system would do little or nothing to the problem of cost containment. 45 million people are insured BECAUSE it costs too much. The cost should be our primary focus, not the number of uninsured. Lower the costs, and the number of uninsured will drop.
While I generally disagree with Bush, I like his idea of a catastrophic insurance plan/tax-free medical savings account. Let's compare it to car insurance. You need it when you wreck your car, but it doesn't pay for your gas. In the past, when insurance programs started, people weren't on a whole lot of drugs all the time. Now a lot of people I know seem to be on permanent drug programs for the rest of their life. Anti-depressants, ADHD meds, statins, anti-hypertensives, etc. come to mind. This type of thing is not what insurance was designed to do. Bush would have us pay for our own medical care out of a tax free savings account. Then we would be forced to make more economical choices. For example, maybe I should get the $1 a pop claritin generic from Wal-mart for the few days a month my allergies bother me instead of the expensive nasonex spray I have to take permananently. Maybe I should limit spicy food instead of buying the rather expensive "purple pill". I realize these examples don't apply to all situations, but you get the idea. Then we could have an insurance policy for when we really are in trouble--trauma, cancer, etc.
I think this would help, but a lot of our exploding costs accrue in end-of-life situations. Because of our amazing research in the US, we are getting more and more interventions to extend life. Problem is, they cost a lot of money. As the elderly population increases, we wil pretty much be able to do as many interventions as we want to. It eventually comes down to this question-how much of our gdp should we spend on health care? 10%, 20%, 50%? We really could spend as much as we wanted to, but after a point it would wreck our economy.
Resolving this will come down to a very dirty word-rationing. We do it already. The rich can get more treatments than the poor, who often just go into a corner a die. In a socialized system, the government would eventually have to decide who recieves the limited amount of care we can afford to provide, or what care will be provided. Essentially, they will decide who lives and who dies. I'm a little uncomfortable with this. I'm not saying the capitalist distribution system is any more fair or morally palatable. There are no easy answers here.
Many of these high end-of-life costs arise because people are so uncomfortable about death. It is unacceptable, a failure. We strive for cures beyond the point of reason, when maybe we should be focusing of palliative care at the end. It certainly would be much more cheaper, and often more humane. I saw the suffering a relative of mine experienced fighting aggressively against cancer beyond the point of recovery.
I think this is the reason people will always be upset with the healthcare system, no matter how good it gets--People are pissed off that they have to die.
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the government in a socialized system does NOT determine who lives and who dies... that's a very simplistic way of looking at socialized medicine that's just not right. in canada (i lived there for 4 years), for example, the rich people have the right to choose whether or not they get treatment and also where they get their treatment if they don't approve of what the government (actually the province) does. in other words, money can buy you better care even in canada because all the medical practices are still privately owned. however, unlike here in the US, lack of money will almost NEVER keep you from getting reasonably good care by western standards and excellent care by global standards. there are small problems with even such a system (such as waiting times) but in terms of reaching out and providing for everyone this is without question a very successful setup and one of the most impressive in the world.
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djlucas1 said:
These are excellent points. Our aging population is a major source of rising costs. Currently, many people who are on death's doorstep, cognitively impaired, etc still get expensive, drastic procedures done on them, mainly because their families do not have to bear the full cost of the treatment, and many family members feel they must do every single thing technologically possible to preserve life (even if they're only prolonging their loved one's misery). I'm not saying that these people are wrong in their behavior, only that it contributes to rising costs.
Correct me if I'm wrong, but in Britain, it is very difficult for the elderly to get certain treatments (like kidney dialysis) covered by the gov't (though a rich elderly person can still get the treatment if he pays for it himself). I think that we will eventually need to put in place some sort of rationing, if we turn to a socialized system. No pacemakers or transplants above age 70, etc.
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Has anyone brought up the high per capita that the US spends on healthcare? Its somewhere around 5000 USD (compared with approx. 1/2 that for UK and Canada). While % GDP says one thing, per capita seems to tell a different story. Whether this excess is due to greater costs or excessive care--I think its a little of both.
I believe that part of the problem with the US healthcare system is the large population and the size of the country. Unlike many smaller countries, the US population is spread over such a large geographical space. Maintaining the infrastructure alone is a huge expense. While high population density medical centers are very efficient, rural health care centers are not.
I agree with the above poster that costs have got to be brought down. I 100% support the "Just because we can, doesn't mean we should" argument. But, I also think that we have to make better decisions on dispensing health care. While I believe everyone should be able to get the care necessary, why is it that emergency rooms can't turn anyone away? Why not triage the incoming patients and send the non-emergency cases to an urgent care clinic next door with a much less expensive overhead. Many hospitals in my area have found success with this, but I think they should enforce that coughs and sneezes go to the alternate clinic and not the emergency room. Heck, run a 24 hr. shuttle between the ER and the clinic and send the triage info electronically--it'll probably end up being cheaper.
One thing that I do feel strongly about is that health insurance companies should not be for profit. I almost fell out of my chair when I read that the United Healthcare CEO made around 54 million USD's last year. And the profit of the company is in the Billions. Billions! Insurance premiums are sky high and it makes me sick how insurance companies can make billions in profit, yet deny coverage to people who need care. And actually, I am fine with the fact they make profit--I have insurance--but put the extra money I paid back into the system to provide care to those without insurance.
I believe that part of the problem with the US healthcare system is the large population and the size of the country. Unlike many smaller countries, the US population is spread over such a large geographical space. Maintaining the infrastructure alone is a huge expense. While high population density medical centers are very efficient, rural health care centers are not.
I agree with the above poster that costs have got to be brought down. I 100% support the "Just because we can, doesn't mean we should" argument. But, I also think that we have to make better decisions on dispensing health care. While I believe everyone should be able to get the care necessary, why is it that emergency rooms can't turn anyone away? Why not triage the incoming patients and send the non-emergency cases to an urgent care clinic next door with a much less expensive overhead. Many hospitals in my area have found success with this, but I think they should enforce that coughs and sneezes go to the alternate clinic and not the emergency room. Heck, run a 24 hr. shuttle between the ER and the clinic and send the triage info electronically--it'll probably end up being cheaper.
One thing that I do feel strongly about is that health insurance companies should not be for profit. I almost fell out of my chair when I read that the United Healthcare CEO made around 54 million USD's last year. And the profit of the company is in the Billions. Billions! Insurance premiums are sky high and it makes me sick how insurance companies can make billions in profit, yet deny coverage to people who need care. And actually, I am fine with the fact they make profit--I have insurance--but put the extra money I paid back into the system to provide care to those without insurance.
