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You want universal healthcare? Why not donate your own money?

Discussion in 'Topics in Healthcare' started by typeB-md, Mar 7, 2007.

  1. typeB-md

    typeB-md Be more like McCain!
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    All this talk about medi-cal and portions of doctor's paychecks being taken is great, but the real solution is just to make the "well i don't care about my salary, i'd rather there be less uninsured people" doctors put their money where their mouths are.

    If you think universal healthcare is a great idea, you need look no further than your own paycheck. As a physician, many of the "compassionate" types will make plenty of money to sacrifice 60% or more of their salary to a voluntary universal healthcare fund. If you do the average doc's salary at $150K, that's approximately $80K PER PERSON! Could you imagine how much money this fund would have if even half of the self-righteous doctors would stop being heartless and just donate their money? I mean the solution seems so simply.

    And remember, before you talk about how big of a chunk 60% of your salary is, the most important thing is that not one soul will go without medical care. And don't ever forget, as a physician you'll also be making more than most of your patients, even with a 60% reduction in your salary. :hugs: for everyone!!
     
  2. trustwomen

    trustwomen Senior Member
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    Not necessary. You just need a general increase in income tax. The highest Canadian tax brackets (federal and provincial combined) average around 40-45% (varies by province, from 29% in Alberta to 54% in Quebec).

    And, since income taxes are progressive, doctors will already pay a higher proportion of that than your average Joe.
     
  3. ortho060802

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    I think his point was that most don't want " a general increase in income tax." If people want to give more then they could just do it on their own. Trust me the gov will take it. They try and take as much as they can anyway. Its like many rich in the environmental movement. Lets get people to be taxed while I have my accountants put my money off shore to protect it.


    Side note:I found it funny how George Soros just bought millions in Halliburton stock.
     
  4. EctopicFetus

    EctopicFetus Keeping it funky enough
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    How about big Als 30K electric bill plus a big big gas bill? How about the FACT that flying in a private jet cross country ONCE (like he does) emits as much CO2 as a Hummer H2 in the course of a full yr.

    The problem is that liberals dont want to put their money (and effort) where their (loud) mouths are.
     
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  5. EctopicFetus

    EctopicFetus Keeping it funky enough
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    FYI as it is the top 50% of income earners in the US pay 97% of the tax. On top of that the top 1% of AGI earners pay 37 % of all tax revenue collected. The top 5% (which includes most docs) pays 57% of all taxes collected. Just a thought.
     
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  6. QuikClot

    QuikClot Senior Member
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    I'd rather use the money of the rich. If they don't like it, they can go to jail. If they already pay most of the tax, and they are richer than ever (http://www.nytimes.com/2007/03/29/business/29tax.html?pagewanted=print) I say let them pay all of it, and pay for universal care as well. If they don't like it, they can immigrate (but any money or assets stay here, of course.)
     
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  7. dilated

    dilated Fought Law; Law Won
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    I wish you the best of luck in getting your fellow Americans to agree. In fact, the last President elected on a wealth redistribution platform was.. well.. was.. oh. Well, maybe you'll have better luck in the future. Or you could always emigrate to a country that believes in extremely high taxes on the rich - don't worry, you're allowed to take money and assets with you.
     
  8. QuikClot

    QuikClot Senior Member
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    In fact, the majority of Americans support universal healthcare, which is presented by the OP as an undue burden on the rich. While Americans may on average not go as far as I would, you may be surprised as to how far they will go. We'll see. The people voted in Democrats across the board, so I don't think I'll be needing to immigrate just yet.
     
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  9. dilated

    dilated Fought Law; Law Won
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    I've heard this one before, I think. Certainly nothing will happen before 2008 at the earliest. Then even if they win the Presidency, they have no chance of getting 60 seats in the Senate, so any plan they craft will have to lure over some Republicans in order to pass. Large, powerful groups (insurers, hospitals) stand to lose EVERYTHING if single payer passes and they've got a quite a bit of money and clout. I think mandatory insurance a la Arnold/Romney is a far likelier outcome because it basically forces everyone to give the insurers money and the politicians can claim "universal coverage".

    I don't see why this can't be done at the state level. If single payer is so hot and everyone wants it, then it will be a wonderful success and everyone else will adopt it. If it sucks, then we can escape it without taking the irreversible step of dismantling the entire private health care system. Actually, I guess that's probably why single payer supporters don't like it.
     
  10. EctopicFetus

    EctopicFetus Keeping it funky enough
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    wow how short sighted are you? People support these things until they look at the details. Much like the lefties thought gay marriage would slide through. Initially it was 60% for it.. then as it got pushed it was 60% or more against it and the righties pushed silly laws through in numerous states making gay marriage illegal. They tried something like that here and thankfully the gay marriage ban died in my state.

    Tell the old farts that 85 yr olds wont be getting 35K dollar AIDs or pacers, or getting cathed. Tell them that surgery wont be an option for 90 yr old grandpa. Then we will see how they vote.
     
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  11. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Oh some juice.

    5. But support for universal coverage drops significantly if such a program would mean limitations on access to medical care. For example, while 62 percent in the October 2003 Washington Post/ABC poll said they wanted universal health care system run by the government, rather than the current system, that support dropped to 35 percent if that limited choice of doctors and to 38 percent if that meant longer waits for nonemergency treatment.

    http://www.motherjones.com/commentary/columns/2005/09/universal_healthcare.html

    As usual people arent willing to walk the walk..
     
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  12. QuikClot

    QuikClot Senior Member
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    As long as everyone is covered, I'm happy. Politics is about compromise. Right now, the top 10% of earners are reaping big gains while the bottom 90% fall, and at the same time the marginal tax rate for the wealthy has been dropped from 39.5% to 30%. Now, it's said no one ever went broke underestimating the intelligence of the American public, and certainally the Republican party has proved that aphorism in the political sphere. But they're losing ground, and smart money says they'll lose a lot more before they're through.

    It's starting at the state level. The difficulties include; huge numbers of healthcare dollars come from the feds (Medicare, Medicaid) and so the federal government must either waive its rules entirely, or participate in the necessary reforms, and; extending care in some regions but not others could result in an influx of the poor, resulting in a disincentive for pioneers. Overall, no one is trying to discourage states from expanding care. Of course, supporting state action can also be used as an excuse to defer comprehensive action, which is why anti-reformists like it.
     
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  13. QuikClot

    QuikClot Senior Member
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    Not enough to spend my prime writing 7000+ posts on an Internet forum, that's for sure. You are definitely . . . sighted . . . in a different way from me.

    Much like the Iraq war.

    Congrats to you and your life partner.

    I think parts of the electorate may be developing a tolerance for your brand of fearmongering and lies. We'll see. But in the end, something will replace the current system, because it is not remotely sustainable. It seems likely to me that the ranks of the uninsured will be, if not eliminated, at least greatly reduced. And that ultimately is what I care about.
     
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  14. hye345

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    There is a single word that will sum up all of this balony: communism.

    Might I recommend Cuba... I hear that their cigarretes are the best in the world.
    And don't worry if you get cancer afterwards, I'm sure they will be happy to foot the bill for your operation. That is if you are under 65...
     
  15. QuikClot

    QuikClot Senior Member
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    Just like public schools, mininum wage laws, farm subsidies, and utility rate boards.

    If taxing people, especially well-off people, to provide a social safety net is communism, then we have been living under communism since FDR.

    If the electorate wants your money, and votes a tax, it gets your money. That's democracy. As for the scaremongering; the 70s called. They want their boogeyman back. "Communism," honestly. :p

    Not so long ago, the top bracket for income was 39.5%, capital gains was higher as well. Tax both high-earners and investors at that same rate -- 39.5% -- and you could not only pay for universal heath coverage, but slash taxes on the bottom 90% to a fraction of what they are today. Love it or hate it, it'd be simple law to write and it's easy to see how one would market it to secure a majority. While the last six years have seen conservatives, waving the bloody shirt, roll back some of the gains, the past hundred years has seen a dramatic movement away from the robber baron model and towards things like Social Security, Medicare, Medicaid, labor and enviromental law, workplace safety, and the income tax -- none of which existed in anything like their current form in 1907.

    We are now looking at the greatest inequality of wealth since 1928 (Ibid, see above). In 1928, too, the rich thought their party would go on forever.
     
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  16. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Yawn... Keep believing in your hippie beliefs.. hey it aint the 60s anymore. Wake up. your premise is hilarious. thanks for the laugh this morning. I needed it cause it was a long call last night.

     
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  17. kelaskov

    kelaskov Junior Member
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    :laugh: It's so funny to see all these med students defending tax cuts for the wealthy, saying there is nothing wrong with the exponentially enlarging disparities between rich and poor in America. Probably because they have fantasies about one day living the life of the wealthy. Sorry, but unless you stop quibbling about things like this and start dealing with the downward pressures in physician income, you won't even be in the top tax bracket. Managed care, medicaid and medicare are squeezing physicians from every side. Meanwhile, the pharma companies are free to charge whatever they want. All other health care workers get an annual increase in reimbursement from medicare, every year physicians are threatened with a growing cut, and then get flatfunded, which equals a cut when you factor in inflation. Doctors need to start taking more leadership, and get a better lobby in DC. Doctors need to stick together, everyone wants a piece of the action. Insurance companies calculate their annual premiums based first and foremost an a guaranteed profit, for example 5% of all revenue (they can do this b/c they have so many enrollees and actuaries working for them). Physicians are stuck with whatever xyz tells them they will have, and then xyz tells them what they can and cant order for tests, meds, etc. The system seems to be gearing up to make docs dispensable, with the ebm based flowcharts, insurance company generated forms for chronic disease, prior authorization for imaging, therapy and medication. Hmm, at this rate someone could do a physicians job with just 2 years training and no residency, meaning more profit for the shareholders of the ins co's. Oh wait, that's already happening!
     
  18. Lshapley

    Lshapley Old Man Med Student
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    Well said. Doctors are generally not in the top 1% of the income bracket. Investment bankers, lawyers and top executives have that position nailed down (all with much less education and educational debt than doctors). I say we tax that top 1% real good and leave the next couple of percentiles alone...that is where you will find the doctors.

     
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  19. tantrum

    tantrum Senior Member
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    http://en.wikipedia.org/wiki/Upper_middle_class
    Based on the table provided, earning $166K will put you in the top 5% of income. Basically earning more than $200K will put you in the top 1%. It's not that difficult for a doctor to earn $200K. With the Democrats plan, they will definitely increase the taxes for the highest bracket and that will include doctors.
     
  20. Lshapley

    Lshapley Old Man Med Student
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    According to the NYTimes, as of 2005 the top 1% are those people who earn more than $348,000/year. http://select.nytimes.com/gst/abstract.html?res=F00917FC3B540C7A8EDDAA0894DF404482

    Here is the full article, it is based on IRS data.
    http://www.iht.com/articles/2007/03/29/business/income.4.php

    You are making a big leap from the top 5% to the top 1%. That is a $200,000 leap. I am arguing for taxes on the top 1%, not the top 5%. A good majority of doctors below the top 1%. IMO, if you are making more than $350k a year, you can spare a little change.
     
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  21. EctopicFetus

    EctopicFetus Keeping it funky enough
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  22. bsmcga0

    bsmcga0 Junior Member
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    are you going to train all the unskilled to do their jobs if they emigrate, to train an engineer you will probably have to start with basic algebra for the average union worker

     
  23. sirus_virus

    sirus_virus nonsense poster
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    Yo hippie!! whats up man? I think we ought to stick it to the man. Legalize marijuana. Yeah!
     
  24. Arc

    Arc
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    I dont know about you, but no one is going to voluntarly take a 60% salary hit. This goes double to people who's education costs are near the size of a house. If anyhting, this is a good way to scare people away from the profession that's already lacking workers.

    Would you put up with 4 years of med school, and 4+ years ofm residency only to come out making only $70K?
     
  25. QuikClot

    QuikClot Senior Member
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    You miss the sarcasm. What he is really expressing is his frustration that we live in a democracy where we decide what service the government will provide and who will pay for it based on the decisions of the voters. It's not a serious proposal.

    If it were, there is a simply answer to it; no, I'd rather everybody contributed. If you don't like it, simply write a letter to the IRS explaining your decision to steal the money you owe as taxes, and society will deal with you like it deals with other criminals. If the principle means so much to you, don't preach to us about it. Stand up for your revolutionary belief that the government has no right to tax you, and give the rest of us a laugh as you're hauled off to jail.
     
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  26. Miami_med

    Miami_med Moving Far Away
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    Um.....

    The fact that the government can haul you off to jail doesn't make what they do right. In the 60s, if you decided that fighting in Vietnam just wasn't for you, they hauled you off to jail too. If you protested too loud, they just shot you. That might bother some of those on the other side of the political spectrum. Thankfully, as a libertarian, I'm an equal opportunity hater of government coercion.

    Democracy is not a magic panacea. You write as though the whims of people or the politicians puts a magic number on your possesions. Today, I can keep 90% of my money. If people change their minds tomorrow, I am suddenly stealing if I keep the same 90%!? That makes no sense. As they say, "the best argument against a direct democracy is a ten minute conversation with the average american."

    As a purely practical matter, whoever has the most power can do what they want. This doesn't make what they do right. If someone aims an assault rifle at my head, they can make me empty my bank account too. That doesn't make it right.
     
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  27. QuikClot

    QuikClot Senior Member
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    But the OP has not presented any serious argument that taxes are wrong. He is just saying that instead of taxing him, those that support the idea of providing the service should do so at their own expense. The answer to that proposal is "No, I'd rather everyone contributed, especially those that have profited the most under the social contract."

    You write as if you have possesions. Without the government's nod, you have nothing. Property is a function of law. The law says what belongs to whom. Once the government charges you with a tax, the money is now their possession, not yours.

    Elsewhere, you may recall, you argued that the person who made the thing owns it. If you look carefully at "your" money, you'll find that it was manufactured by the US Mint. By your logic, it's theirs. What are you doing with the government's money, anyway? ;)

    Turn it around. If the government taxed you at 90%, then at 15%, then at 90% again, is the government stealing? Taxes have been far higher in the past than they are today.

    Property is a function of law. I go home as normal on May 4th. On May 5th, I lose my house in a lawsuit. If I go home as normal on May 6th, I am tresspassing. When the government taxes you, what were your possessions are now their possessions. If you then try to withold their possessions from them, you are stealing.

    Naturally you may say the law is unjust. You may think you had a right to kill the person whose murder you are charged with, or you may think you have a right to live in this country, whatever the INS says. And you may in some cases be correct. What I suggested to the OP was that if he feels the law is unjust, the logical course is to defy the law and take the consequences, rather than whining about the fact that the people determine what services will be provided and who will pay for them.

    And they also say "Democracy is the worst form of government, except all the others which have ever been tried."
     
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  28. Miami_med

    Miami_med Moving Far Away
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    I guess this is premised on the idea that there is actually such a thing as a social contract. Since I never signed such a contract, I'm not inclined to believe that such a thing exists. You act as though everyone got together and made agreed on rules which favored certain individuals, who then agreed to give back some of their wealth in exchange for the favors. Of course, none of us agreed to any of this. We all have an idea as to how we think things should work, and some of us fight to overcome everyone else's idea. If we really wanted to explore the "social contract," I could go back to the founding of the US, what the constitution actually says, and the fact that Federally funded healthcare is a blatant violation of the 10th amendment. However, if the constitution is a contract, the courts long ago ceased to enforce it.

    I do have posessions. If someone steals it, then I no longer have it. That doesn't mean that it isn't stealing.

    Ah, but the government willingly gave the money initially to a crony in the banking industry. That individual then willingly lent it out to someone in the general population. That individual then willingly traded it for food at the restaurant where my wife works. The restaurant than willingly traded it to my wife for labor. My wife then willingly put it in our mutual bank account. There was no coercion.
    Nice try though ;)

    I sometimes feel that this is stealing. As I said however, they have guns, and I don't openly fight with people who will beat me. Again, if a bandit stole my money, they would then have it. It would no longer be mine. It's still stealing.

    This isn't logical at all. The OP may both feel that the law is unjust AND still understand that he has to play by the rules set by the guys with the guns. This is perfectly logical. I exist in the current system. I pay taxes and accept financial aid. I think the whole process is ridiculous, but it's the one we have, and as someone who doesn't want to openly defy the law due to the risk, I can sympathize with the OP. That doesn't make the law correct. As a Hobbsian, you would most assuredly admit that the OPs decision to not defy the law in the name of his own self-preservation makes perfect sense.

    They sure do :(
     
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  29. QuikClot

    QuikClot Senior Member
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    I take issue with most everything you've said here, from your continued assertion that you own things (without law there is no ownership, and without a social contract there is no law) to your assertion that the things the government says you own came to you via an unbroken chain of voluntary exchange (which is easy to disprove). You are wrong about the 10th amendment, which says nothing about providing services (a service is not a "power"), and you ignore the 16th amendment, which establishes the legality of taxing you to pay for it. And so on.

    But I'd like to step back for a moment and take a broader view. What are the chances that either you or I are going to radically restructure our concepts of morality, law and government based on this conversation? Pretty slim, I would say. I once held many of the same beliefs you hold today, and only time, experience and reflection led me to change my opinions; no one argued me out of them. So, in the meantime, can we find an area of common ground?

    I would suggest that we can. Presently, the government spends roughly 9% of the GDP on healthcare. It gives generous tax breaks to companies that fund private plans. There is Medicare and Medicaid. There is the unfunded mandate to private providers to provide emergency care (EMALTA). Each one of those things separately costs hundreds of billions of dollars. Together the costs are astronomical, and they are only going to get higher as the population ages and more people are covered under Medicare.

    So what I suggest is that we hold our philosophical disagreements in abeyance and agree that there is a better way to spend that money. The system we have is illogical and wasteful. You might wish the government spent nothing, but politically that is a non-starter. I might wish to fund generous universal healthcare paid for entirely with the assets of the richest 1% of Americans, but that is unlikely in the foreseeable future, too.

    What is practical and desirable is to replace an irrational and inefficient system with one that covers everyone, except those who chose to opt out and pay for their own insurance, and pays only for treatments and tests shown to be cost-effective and supported by EBM.

    John Kitzhaber, my former governor (and ER doc) uses this analogy; when we argue over the public school system, and how much it is going to cost us, we argue not over which people will get to go to school, but the size of the classes, the extracurriculars, the number of school days in the year. In other words, we argue about the size of the benefit. We do not argue about access. This is how the government spends its educational budget, and it is a better model for how it could spend its healthcare dollars.

    I respectfully suggest you consider how you would spend the government dollars if (as seems likely) the government continues to spend them. We can continue to argue over what an ideal society would look like, but that need not preclude from reforming the existing system.
     
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  30. Miami_med

    Miami_med Moving Far Away
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    I take issue with most of your assertions as well. As usual, it is clear that we differ so fundamentally in our basic views on life, that this conversation is never going to be more than kicking the proverbial dead horse. We won't even get started on arguing what the 10th amendment means.

    I think that the public school analogy is good one. In fact, I think that it's a little too good. My wife used to teach, and the public school system is always my prime example when I slip a little and think that government healthcare wouldn't be too bad. I just think about my wife's experiences and the hell she encountered at what was considered to be a "good" school. There's always a part of me that wishes that we could jump to a two tiered system quickly, and atleast allow me to operate independently before the government destroys the private sector with its meddling. However, since the government system would destroy the financial base of the private system (making everyone pay the public system even if they didn't use it), it would still be terrible. This is the same as system that forces parents right here in my own district to put their children in the woefully inadequate public schools (that also spend twice as much as their European counterparts, just like medicine). Many of these parents spend thousands in school taxes annually, and without that burden, could afford to put their kids in the almost univerally better private schools.

    I agree that what we do now is crazy. I don't believe that government should involve itself in healthcare beyond infectious disease, but like you, I'm not holding my breath. My issue isn't just with money, but with control. And of course, how much money should we spend on one person? Also, healthcare is not a benefit per se. The government doesn't currently give Medicare patients money and say, "buy services." They use this money as a de facto control mechanism over the entire healthcare system. This also drives up costs and thwarts competition. Perhaps your solution should look more like a voucher program? Give 'em a certain amount and set them loose on a private system that competes for it. I totally disagree with such a system, but I'd spend less time arguing about. Of course, it would only be a matter of time before some politician decided to use said money as a mechanism of control for political gain. That's what they do.

    EBM is good, but it is also dangerous. People should have the right to deviate. Patients are not uniform beings. Feel free to browse through these very forums to see what even some of the most benign "quality indicators" that are being imposed now are doing to aspects of physician practice. The government is in no position to determine how to practice medicine. That should be left to physicians and their patients. Your example of "waste" is exactly what I fear the most about the practical aspect of universal healthcare, regardless of my philosophical disagreements with its funding.
     
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  31. QuikClot

    QuikClot Senior Member
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    People are perfectly free to spend their own dollars on whatever healthcare they want. It is only the public money that would be restricted to treatments shown to be effective and affordable. As an individual rights guy, I'm sure you appreciate the distinction.

    You are worried, as one might predict from your basic philosophical stance, that the government, by defining the benefit, would exert control over the market. But you answer your own objection; it already does, through Medicare and EMALTA and all the other programs. The system we have bears no resemblance to a lassie-faire healthcare market.

    In fact, from a lassie-faire point of view, it might be better to have a single, well defined benefit provided to all. As I'm sure you know, economic theory holds that if you are going to have a market distortion like a regulation or a tax, it is better for it to be universal, stable, and predictable, like the income tax, rather than selective and variable, like anti-dumping legislation or farm subsidies. Today, our patchwork of government mandates and services are more like the latter; a single universal benefit would be more like the former.

    The problem with vouchers is that people's need for healthcare services is highly variable. You could give vouchers for insurance plans, like Part D, but unfortunately when you do that insurance companies tend to spend a lot of time trying to figure out how to attract the healthy people and get the sick people off their rolls. I'm also not sure how much competition that would add, given that the government would still have to dictate what services a plan had to provide in order to be eligible to receive a voucher.

    My ambulance company has a county contract that specifies our response times, the equipment we must carry, the training we must have, etc. Maybe you could do something similar with insurance companies, letting them bid for territories, and set population benchmarks for health and good care (like those the VA system requires of its doctors). That would avoid the incentive to avoid covering sick people, whilst retaining the incentive to provide the best care at the lowest cost.

    In general, I have no objection to building market incentives and competition into these programs; as long as everyone is covered, and the incentives are for the right behavior, I'm happy.
     
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  32. Miami_med

    Miami_med Moving Far Away
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    You are correct that the current system isn't lassies-faire capitalism. I agree that the current system is riddled with flaws, and it is within this context that I occasionally dream of a two tiered system with a free tier into which I could escape. However, I already pointed out the flaws that would develope in such a system.

    You are correct, that if you taxed only the top 1% of the population and created a two tiered system, that it would create a window in which those of us that want to be left alone might be able to operate. However, my problem with this is a global one. This will probably bring us back down to our most fundamental of disagreements. I am personally rather fond of all of the amenities of modern living, and I feel that I would be remiss if I failed to point out that even a more predictable tax structure still causes distortions. Though it is probably antithetical to your view, the more targeted to the wealthy, the earlier you catch money in the market, and the greater the distortion as wealth is disseminated within the population. However, a tax that reaches the middle class will effectively price them out of seeking treatment on the secondary market, as they would be forced to pay for the government healthcare with tax dollars. Thus, you leave two options of either destroying the economy at large (with all of the implications for the middle and lower classes) or destroying the ability of all but the wealthy to autonomously determine where they wish to seek healthcare. I like neither.

    I am actually strongly against quasi-public entities. Insurance companies that controlled regional territories (based on bids with our highly ethical politicians) would simply result in tax dollars being both mismanaged and lining the pockets of CEOs. It would be the Haliburton of healthcare. I have no problem with a CEO making a well earned fortune in voluntary exchange, but I highly resent them doing it off of my tax dollars. That isn't capitalism. I see no way around the government buying products off of the private market, but it shouldn't have private companies doing it's work for it. In that sense, I think that we should take all of the private companies off of the dole within the current system. We can fight about Medicare/Medicaid later, but I don't think that these entities should be using the private market. Generally, I believe public should be public and private should be private. Not many things should be public in my opinion. Our disagreement comes from the fact that you want to expand the benefit, thus increasing the cost (or alteast the interference) and increasing the distortions in the economy at large.
     
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  33. QuikClot

    QuikClot Senior Member
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    I think you may have misunderstood what I was suggesting above. I was offering that, as a thought experiement, we look at the amount the government is spending now, and considering how to spend it in a better way. We can put aside the question of whether we should change the tax structure or reduce or increase that amount, and just look at how we would spend the money presently spent by the government in a better way.

    It's a somewhat artificial set of conditions, put it is also in a sense very practical, because there is no strong political movement for either defunding government healthcare or reforming the taxation system.

    I am a little mystified at how can come to this conclusion. We are talking about money the government is already spending, so I don't see how providing a broader benefit would "destroy[] the ability of all but the wealthy to autonomously determine where they wish to seek healthcare." People would have the same after-tax income they do now, the same employers, etc. So either they don't have that freedom today, or they would still retain it.

    That doesn't surprise me. However, anyone who bills for Medicare is a quasi-public entity. They get money from the government and they must meet certain conditions in return. They don't want government money, they don't have to meet government standards. It's a contract, not coersion.

    You are describing the present system, and attributing its features to my idea with no evidence that it would actually unfold in that way, other than the dogmatic believe that government always fails. But, again, the important point is that this government money is already in the system. If you're right, people should be getting rich off Medicare. If people aren't getting rich off Medicare, a massive government healthcare program, there's a problem with your theory.

    The size of the distortion comes from three things (according to theory. Other economic theories, it should be pointed out, recognize the benefits to the economy of things like universal health care.) The magnitude of the cost; the distribution of the cost; and the distribution of the benefit. The magnitude of the cost remains the same. The distribution of the cost remains the same. The distribution of the benefit becomes broader and more predictable, reducing the distortion.

    I'm suggesting we move past the debate over how much the governent should spend or where it should get it, and look instead at this question; if it continues to spend what it is spending today, how could it better spend it? Smarter spending does not equal greater distortion. If there is a certain amount of money budgeted for roads, it is not good for lassie-faire if half the money is embezzled and the roads are built out of sandstone. The present administration has attempted the strategy of reducing support for government programs by administering them incompetently, but so far, they have only suceeded in reducing confidence in themselves.
     
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  34. Miami_med

    Miami_med Moving Far Away
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    You are correct, I misunderstood you. I agree that the government could spend the money it currently spends more efficiently. If you're saying that you'd like to not change anything, except divert the bazillions of dollars, I won't fight you. I am opposed to distortion in general, but I concur that streamlining the current usage of money is better than not doing so. I'd agree with you if you said we should pay for all mandatory vaccines and infectious disease screenings universally before we do anything else with the money.

    Again, I misunderstood your original quote.

    You're right, the person getting screwed isn't the CEO or the doctor, it's the person who is forced to pay for Medicare through FICA. However, as a physician, the fact that the government forcibly removes money from the middle class, impacts me, as they can't afford to pay twice. I can't sell them a better service, because they're forced to buy Medicare.

    Well, Medicare did make many people rich for a long time. Remember the Cataract millionaires of the 70s. Also, those sly dogs with the right connections in congress who run the hospitals themselves have noticed steady and significant increases in Medicare payments, as the poorly organized physician lobby has seen decreases. Hmmmm..... Good connections, increased pay. Poor connections, diminishing pay. You see, the well connected CEO is still getting rich. He's just managed to con a group of people (physicians) into accepting the peanuts as pay that are being offered. Many physicians often miss the fact that they are getting screwed because they are so indoctrinated with a sense of self-sacrifice. However, current medicine is a great example of exactly what I've been saying. I won't even go into how the Medicare HMOs or military Tricare make money on the current government health system.

    I'm going to have to take the Austrian view on this and claim that broader distribution doesn't diminish the distortion. However, I'll buy that it doesn't increase the distortion.

    But what it is spending today is unsustainable, and whatever we do with the money from today will no longer work in ten years anyway, with a wave of retirees clamoring for benefits as they stop paying into the system. You are right, that I would prefer that the money be spent better that we have today. I just don't think that we can move beyond the debate of what the government should spend, because that really is far too important a factor. As I said, we should fund screening and treatment for certain infectious disease. For those things, we should find however much we need.

    As a final point, the market has attempted on numerous occasions to get out from under Medicare's thumb, and every attempt is met with resistance up to a full on legal onslought. I can't open a hospital without permission (even if I don't take Medicare), surgicenters are under fire, fee for service and concierge practices are under fire. I still need CONs to buy equipment on the free market. If too many people stop taking Medicare, the government will just make it mandatory. You see, we can debate the semantics of the worlds perfect healthplan forever, but at the end of the day, the government's intention isn't and never has been to help elderly people. It's all about power and control, and I dare you to show me a statesman who managed to retain power for any length of time in this country while thinking any other way.
     
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  35. QuikClot

    QuikClot Senior Member
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    I agree that this is very important. Many things I have been through and read in the past few years have turned my thoughts to trying to find common ground with people, as opposed to concentrating all one's efforts towards winning an argument (1). I love to win arguments, so it's a challenging thing for me, but I think it's worthwhile, not as a substitute for debate over principles, but as an adjunct to it.

    If we spend the money more wisely, perhaps it will further clarify how much we should spend, because we will have a better idea of what the money can accomplish in the best case, as well as what problems remain once some of the more glaring absurdities have been addressed.

    I have a lot of immunology to catch up on, so I'm going to put SDN aside for a while, but I'll be back. And I'm glad to see that we see eye to eye on more things than it might have seemed at the start.

    1. Among others, Carnegie's "How to Win Friends and Influence People," and a recent, great book by two clinical psycologists about why people cling to their beliefs "Mistakes Were Made (But Not By Me)."
     
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  36. Miami_med

    Miami_med Moving Far Away
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    Until we meet again :thumbup:

    I should follow your example and not fail my boards in a month.
     
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  37. Goguryo

    Goguryo Membership Revoked
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    i have medi-cal and am physically fit
    6 medications per month

    does a driver license = identification card?
     
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  38. presentationmal

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    Thanks for your information.
     
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  39. Boblazar

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    I want to take this opportunity to recommend staying informed about the upcoming presidential election as it is going to affect your future as a physician and as a citizen. If you have 5 minutes to just Youtube/ google Ron Paul, the Texas House of Representative who is also a physician who once practiced in Galveston, and listen for at least 5 minutes, I guarantee it will change your outlook on US economy and healthcare. You will understand why his approach will strengthen the US dollar value, restore healthcare for the patients and the physicians, and promote civil liberty. He also studied economics and is really well versed in it. I also recommend youtubing other candidates to get some type of exposure as basis of comparison.
     
  40. snz12x

    snz12x Junior Member
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    Interesting idea. But really, I think that a solution instead of "universal" health care would simply be if physicians would be willing to charge less for patients, especially for patients with greater financial need. I don't see why as a physician, I should deny someone health care because they can't pay my price. I'll have to take a salary "cut," but at least it was done by my own choice. I think the price of some procedures could be reduced as well. As a patient, I don't understand why I had to pay so much $$$ for services that benefited me very little or none at all (or rather, dis-serviced me), yet I was mandated to pay for them all while being a student. And at the same time, I can see that my physicians were leading handsome lifestyles. How was I supposed to have this kind of money?

    But anyway, the "liberal" physicians could really consider this as an alternative to universal health care. Hopefully, we became doctors to help people, right? Not to get rich?
     
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  41. lilnoelle

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    Offering different payments for different people is sort of a tricky thing as I understand it. I don't really know any details, but I'm pretty sure you can't charge less than the Medicare price if you accept Medicare. Also - how do you decide who can pay and who can't?
     
  42. m3unsure

    m3unsure Junior Member
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    All these super-rich people who want to support the Obama idea because they feel bad about their family ravaging people for generations.

    It won't really hurt their gas tank because what's 50% to them. They don't really have loans or think about working for their future.

    How many docs really are super-rich (1M+ homes, five sports cars, etc.) without busting their nads for like 30 years and never being around to enjoy it?
     
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  43. cocojambo

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    They might be earning $150k, more like average of $100k but remember doctors have sh**loads of debt, so their net disposable income is a lot lesser; at least that's what it is like in Canada.
     
  44. Coldfusion079

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    Raising taxes or any other method to raise money to pay the ridiculous cost of health care just feeds the completely twisted incentives system of hospitals and insurance companies.

    There needs to be accountability, costs need to be regulated, charges need to be challenged.

    Remember, as a doctor, you wouldn't need to earn so much if your own operating costs weren't exorbitant as well. Not to mention escalating malpractice insurance costs.

    Also, http://www.google.com/url?sa=t&ct=res&cd=3&url=http%3A%2F%2Fbmj.bmjjournals.com%2Fcgi%2Freprint%2F334%2F7587%2F236.pdf&ei=obRhSOzjE5ioiAGe3520Aw&usg=AFQjCNGgq56e91Dcz_x8txGamSPJz99Nag&sig2=Am53CJiS9IOWpDVHcPBQjA

    GP's in UK average 250,000 GBP a year. currently 1 GBP = 1.97 USD, WOW, almost 500,000 USD/year in a socialized national health care program! No one is going to sympathize with doctors making 500,000 USD instead of 600,000USD a year.
     
    #44 Coldfusion079, Jun 24, 2008
    Last edited: Jun 24, 2008

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