Hillary Clinton wants to socialize healthcare!!!

[Miami_med]

It is official, you win the award for largest post volume in history on this thread.

Yes, true. It's an expensive system, and it's expensive now. Your criticisms are totally valid.

There could be a private solution. Personally, I actually like your ideas of cash-paid healthcare for ordinary expenses (we might differ on major medical; I'm not sure if you are fine with private health insurance for major medical expenses). However, when it comes to policy (politics) and economics, I'm in favor of a single-payer system.

If you think that private is a valid option, why are you seeking the opposite solution?

Where will they flee to? Canada? They already have a single-payer system. Mexico? Also single-payer.

Yes, we need to do what we can to make sure that everyone pays their fair share, so to speak. I'm not an expert when it comes to the political side of things, so I'm not sure how to accomplish that. Maybe by having co-pays for everything, we can help ensure that even the poor pay something. The reasons you give are some of the reasons why we might not have a single-payer system.

I think you misunderstood me. I meant that they would withdraw from a private system, not flee to Canada. I don't understand this "fair share" idea. When my care breaks down, I don't demand that the rest of the world pay its fair share of my repair expenses. When my rent goes up, I don't demand that the rest of the world pay its fair share. I definitely don't demand that higher income people pay a greater proportion of my rent than me, because of some idea of equality. You are just trying to apply universally failing marxist ideaology to healthcare. It might be able to survive on the back of other parts of the economy that are not socialized, but that still makes it inefficient and in no way ideal. I believe that your idea of "fair" is seriously flawed. When you go to work, do you let everyone who decided to stay home that day take your paycheck because you have more than your fair share of the money?

Well, my thought is with respect to voters overall, not just physicians. So, recent polls of all voters are 75% pro-universal healthcare.

And therein lies the problem with absolute majority rule. People who actually know the system are generally opposed, but you think that a majority of people who are pretty ignorant as to how everything works should be able to overrule them and force them into essential servitude to a government system in order to do their jobs.

The AMA now has their own universal healthcare proposal. I'm not sure that it is a very good proposal, but they are getting on board, so to speak.

It's not supposed to be good. The AMA doesn't actually support it. AMA is a progressively weakening political organization, whose power is falling along with that of physicians. It has no spine to stand up to the politicians, so it makes alternate proposals in hope of atleast lengthening the road to complete failure. I tend to think that this is a horrible approach, but it is the truth nevertheless.

So do you want to get rid of public eduation?

Public education was primarily created as a method to destroy individual cultural institutions and make everyone more "American." This primarily applied to the Native Americans and the Irish Catholics. It was a social engineering scheme from the beginning. Today, we spend billions on education. People in poor neighborhoods still get essentially no education in their crappy school districts. They do spend 13 years in a non-productive environment and emerge with no useful skills. Children from middle class families and up have been consistently educated even before the advent of public schools over 100 years ago. Over 90% of the kids in Boston were in school before public schools came about. Thus we waste a lot of money and educate the kids who would be educated privately anyway.

I am not in favor of public schools, and I don't think that they actually accomplish their purpose. Please do not turn this into a thread about that. I just put a disclaimer on my opinion so that people actually understood why I think the way that I do. Of course, I have no idea how to get back from the current mess to a private education system. I'm trying to prevent the same mess in medicine. Just as an aside note, we spend more money per student than any other country. Private or public, the US often spends more on large systems than other countries. This may relate back to your noted "lower cost" of Universal Healthcare by comparing to European systems.

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[Towelie]

I think someone's been reading a bit too many Ayn Rand books...


I did very much enjoy reading your blog though. It would be nice to see more people with well-articulated opinions on these issues, even if they are opinions that I strongly disagree with.

 

[OncoCaP]

First of all, Universal healthcare has been tested and they are all financially distressed all over the world. If we go by what you are saying then we should not even touch it with a stick. It is not a trillion dollar experiment to float a government owned private insurance co. So you don't think the government can employ the right talent to handle a smaller insurance company, but you want to entrust them with the entire enchilada. It is not a game. For you who is struggling with private insurance, single payer is a good idea, but remember there are Americans who are just fine with their $100 a month insurance that they get from their work. It will entail you telling them to loose so that you can gain. You also forget that there are Americans that choose to go without insurance. That is their own business IMO. It is not in my place to try to force them into anything. If you truly believe that private insurance companies are evil and they are grabbing money and running, then why are you afraid of a government owned non-profit insurance company that you could choose to buy your insurance from at a cheaper rate and won't defraud you. Telling me that will be a risky experiment or a game shows me that you might just be promoting a bandwagon political philosophy without an interest in viable alternative solutions.

The situation is not as bleak as you make it out to be. The difference between you and me is one of perspective and what concerns us. I respect your opinion; my opinion is just different and I do have information to support that single-payer could provide a number of advantages. You make it sound like all the single-payer healthcare systems out there are ready to go under at any moment. This is not the case. There are some systems that are doing worse and others better. However, even the worst of the European system or the Canadian systems covers all its citizens and provides better care than the uninsured get in the U.S. We have plenty of public systems (such as the schools, roads, etc.) and while there are discrepancies in quality, they are achieving their mission overall. I would argue that even our military is quite good despite the struggles we are facing in Iraq (which are more political in nature, actually). The FDA has done a decent job as well. We have many government agencies and they are not inferior to private firms overall. There is a distribution of quality among private firms as well.

You are proposing an idea of questionable merit (non-profit insurance as a solution to the U.S. healthcare crisis) and then complain that if the government can't do that, then they shouldn't do the right thing. That would be like suggesting that because you can't intubate a conscious patient with a wooden spoon, you shouldn't be allowed to become an anesthesiologist. Your standard is arbitrary and irrelevant unless you can show that being able to grow a non-profit from nothing somehow qualifies a government to run an excellent single payer system.

A better example would be to say, how efficient and effective is Medicare. From what I know, it's a very well-run system (far bigger and more complex than any non-profit insurance company that you are proposing). Does our government (including Medicare) have its flaws? Yes it does. At the same time, there is a huge difference between starting a non-profit with no funding from taxes and growing it fast enough to cover all the uninsured in the U.S. and running a single-payer system. The two are quite different.

I'm actually not struggling with private health insurance. My family can pay it and we do. Some of my children might or might not be covered to the extent that I would like, but we'll deal with it. We're doing fine, actually. A few of my personal concerns with the present system are as follows: (a) the current system is wasting a lot of $$'s and getting ready to waste even more, (b) if something were to happen to us (lose job, etc.), we could lose our health insurance and healthcare, (c) the situation with healthcare financing (affordable, available healthinsurance) is getting worse for many Americans, and (d) the current system has unfunded mandates such as EMTALA that affect the quality of care everyone, including my family, gets at the emergency room.

Also, I'm not trying to trivialize the complexity of a single-payer system and I'm actually not opposed to a non-profit health insurance company. It's just that an experiment with a non-profit health insurance company run by the government wouldn't prove or accomplish anything, even if it succeeded. It would be a difficult system to administer a single-payer system well, and there are many challenges (like when do you tell a patient that we have done all we are willing to pay for?). However, just because a single-payer system is difficult and other countries have struggled with it doesn't mean we shouldn't consider it. We're just discussing it informally. Ultimately, our politicians will haggle this out and the reasons why we do or don't get a single-payer system may or may not be very impressive. I'm advoating the best system that I know, and then seeing what happens and how it all works out. The outcome will directly affect the cost and quality of care of my family and that of all other 300 million Americans.

 

[OncoCaP]

It is official, you win the award for largest post volume in history on this thread.

Yeah, I see what you mean. For me it's recreational to talk about these kinds of difficult topics.

If you think that private is a valid option, why are you seeking the opposite solution?

I'm one of those people that can consider other people's points of view. Just because I hold one opinion doesn't mean that a different perspective is invalid or necessarily non-functional. There are just different perspectives, concerns, and opinons. I'm confortable with uncertainty, and I recognize that even though something may seem to be a great option, there may be an even better possibility.

I think you misunderstood me. I meant that they would withdraw from a private system, not flee to Canada.

Oops sorry.

I don't understand this "fair share" idea. When my care breaks down, I don't demand that the rest of the world pay its fair share of my repair expenses. When my rent goes up, I don't demand that the rest of the world pay its fair share.

Yes true. However, if you thought that our healthcare financing system was unfair in that health insurance companies did things that you disagreed with, you have a right to complain about it and you do so on your blog.

I think what you are speaking of is that people should take responsibility for their lives and own well-being (such as getting a job with great health insurance, etc.). I agree with this to a certain extent. Where we differ is in the amount of faith we put in the market working out the optimal solution. You might be right about this, but from what little I know, you're not. So it's just a discussion with different concerns, values, priorities, and perspectives, that's all. Ultimately it will be decided (for now anyway) by our politicians who represent various constituencies.

I definitely don't demand that higher income people pay a greater proportion of my rent than me, because of some idea of equality. You are just trying to apply universally failing marxist ideaology to healthcare. It might be able to survive on the back of other parts of the economy that are not socialized, but that still makes it inefficient and in no way ideal. I believe that your idea of "fair" is seriously flawed. When you go to work, do you let everyone who decided to stay home that day take your paycheck because you have more than your fair share of the money? ...

Deep down, I'm a "he who does not work shall not eat" type of person. I believe in personal responsibility and I also love my freedom. If you make bad choices, you should take responsibility for the consequences. I like being able to choose my health plan or no health plan. I don't really like the entitlement system (although I'm in favor of a safety net -- not a safety hammock). Many social problems, including many that are related to healthcare, are caused by stupid and immoral decisions that I personally could not disagree more with (illegal drug use, etc.). Granted, many Americans are going bankrupt or are not getting the care they need through no fault of their own and despite their own best efforts. Also, there are examples like Anna Nicole Smith who live a life opposite of what I would suggest and are perfectly able to pay for their consequences financially and otherwise (I'm guessing she paid for her healthcare). Also, just because people are more able to pay for their healthcare doesn't mean that they are somehow "more worthy." A wealthy scam artist might be able to pay his health bills, whereas a poor honest private school teacher with no health insurance might go bankrupt. Life can be very unfair. There is a range of causes for the strain on our healthcare system. Even obesity could be improved with better choices, but in some cases there appears to be a strong genetic component that has nothing to do with the sensibility of the obese person. At the end of the day, no matter what the causes are, I live in a country that is big on entitlements and letting people do what they want and then helping them with their messes. There is no getting around this.

As a further and probably more controversial example, I disagree with the promotion of pornography that takes place in many ways around us. I'm a guy and I love women, and many are beautiful, and that's a good thing and should be appreciated in an appropriate way and manner (I'm family oriented). However, I disagree with many of the things our sex industries are doing. What do I do about it? Well, I take responsibility for my own actions as much as I can and try not to be a burden to others. I live my life as best as I can and help others when I have the opportunity. When there is an appropriate opportunity, I express my opinion. However, I'm not going to refuse to treat a drug dealer or prostitute because I don't agree with my lifestyle. I'll help them as best as I can. Am I encouraging and promoting something I disagree with? Well, no. As their physician it will be my responsibility to provide them with a high level of care, not to dress them down on their moral choices. Similarly, I'll advocate a healthcare system that works best for the society that we have, even if it's not the society I would prefer. I've looked at the information, and the single-payer system seems to be the best one. I'm not going to expect people to change to my perspective and advocate a system that only works well for people like me. I have considered the economic, moral, and logistical factors, and a single-payer system has a lot to offer in this respect.

And therein lies the problem with absolute majority rule. People who actually know the system are generally opposed, but you think that a majority of people who are pretty ignorant as to how everything works should be able to overrule them and force them into essential servitude to a government system in order to do their jobs. ...

I'm not sure that "[p]eople who actually know the system are generally opposed." Ask the Brits about our system (and they have a poorly run system in my opinion and most Brits would probably agree) and they think our system is barbaric. Yes, there are different opinions, and I respect yours, even though we don't agree.

Interesting perspective on public education, by the way. I also have my grave concerns, but I'm not in favor of eliminating it.

I also appreciate your efforts to prevent a mess in medicine. We already have a mess, but it could get worse. You offer a lot of food for thought.

 

[sirus_virus]

Oncocap, if you are interested in making your point valid, stop using the word 'medicare'. Do you know that medicare patients still average about $2000 a year expenses to cover medicare shortfalls. Medicare's only management skills is to set artificial low fee schedules(not in line with economic realities) and payment cuts. Do you know that if a dcotor accepted only medicare patients they would run a loss ie, negative income. medicare cannot even grow at the same rate as inflation. The ultimate experiment is for us to give all these "socialized" healthcare systems arround the world another 30 years and see how they hold up. BTW, we are on the verge of bankrupting our huge social experiment(social security), infact our generation can kiss soc security benefits goodbye, but our response is to embark on another crazy quest. I am really sorry for our kids, because the era of America being #1 is fast winding down.

 

[OncoCaP]

Oncocap, if you are interested in making your point valid, stop using the word 'medicare'. Do you know that medicare patients still average about $2000 a year expenses to cover medicare shortfalls. Medicare's only management skills is to set artificial low fee schedules(not in line with economic realities) and payment cuts. Do you know that if a dcotor accepted only medicare patients they would run a loss ie, negative income. medicare cannot even grow at the same rate as inflation. The ultimate experiment is for us to give all these "socialized" healthcare systems arround the world another 30 years and see how they hold up. BTW, we are on the verge of bankrupting our huge social experiment(social security), infact our generation can kiss soc security benefits goodbye, but our response is to embark on another crazy quest. I am really sorry for our kids, because the era of America being #1 is fast winding down.

Yes, true the Medicare system is not perfect -- it has flaws. However, many physicians do take it (and some take it as a large fraction of their reimbursement). Some family practices use PA's to take care of a large Medicare/Medicaid patient base. One Heart Hospital I volunteered at was heavily dependent on Medicare and they seemed to be doing well. It's probably reasonable to have some out of pocket expenses for any system (in my opinion anyway).

I'm not counting on social security being there, but despite its mismanagement and faults, it's still there. If you are eligible, you'll get your check for now. It's a life-saver for many people. Until the boat sinks, it's a floater! Keep in mind that the purpose of these systems is not to make a profit. It is to serve the public. There are financial issues, but so far, bills are getting paid. There should be reform of SocSec and Medicare, and we have already seen some efforts along these lines.

I'm less pessimistic about our future. Yes, sure, our society could collapse for any number of reasons, from terrorist nuclear attacks to just not being very competitive in the world market. However, I'm not ready to start telling our kids that "give it up, we are losing." There are a lot of positive and exciting possibilities for the future for our kids and kids in the industrialized world in general. People are working on helping kids in developing and underdeveloped countries as well (not easy).

 

[OncoCaP]

http://www.pnhp.org/news/2007/february/unitedhealths_lab_c.php

UnitedHealth's lab contract disruptive

Doctors Fear New UnitedHealth Policy
By Theresa Agovino
Houston Chronicle
February 14, 2007

Doctors say UnitedHealth Group Inc. is threatening to fine them over something they can’t control: patients’ behavior.

Beginning March 1, UnitedHealth said it could fine a doctor $50 if a patient has tests done in facilities besides Laboratory Corp. of America or other labs that the company has selected. Doctors with patients who go out of network could also be subject to lower reimbursement and to exclusion from United’s network.

Last October, UnitedHealth announced that effective Jan. 1, 2007, its major national carrier would be Lab Corp. instead of Quest Diagnostics Inc. and began communicating with physicians about the switch. The fines don’t go into effect until next month to give both doctors and patients an opportunity to adjust to the change.

Some physicians say the size of the new network is too small.

The American Medical Association said this is the first time a doctor could be financially punished for a patient’s behavior. AMA trustee Dr. James Rohack said doctors can refer patients to in-network labs but patients may choose to go elsewhere because of convenience or preference.

Rohack remains skeptical about UnitedHealth’s pledge to work with doctors to avoid fines and other financial penalties. He said the current policy is more about saving UnitedHealth money than providing the best coverage for patients.

“They (United) always say they are going to play nice in the sandbox,” Rohack said. “But if the stock price starts to get shaky, they don’t place nice anymore.”

http://www.chron.com/disp/story.mpl/ap/fn/4554211.html

 

[sirus_virus]

Op needs to change the title of this thread to "Oncocap wants to socialize medicine".

 

[OncoCaP]

Op needs to change the title of this thread to "Oncocap wants to socialize medicine".

Maybe I should start arguing for private health insurance 50% of the time just to make it fair.

 

[WALKE219]

I have been reading, but learly of even posting... there is so much people can say, and judging from the half a page posts I'm not far off

I think that for a lot of people, who are not informed on the issue, socialized healthcare sounds great. This would be the vast majority of the voters. I think most people who know about the subject would agree with an earlier post that switching would be a pretty big nightmare (at least for awhile). I have spoken with physicians who did practice in Canada who said there are a whole lot of downsides to the system. The pay issue never even came up.. Obviously there is a huge issue with waiting times and whatnot.

The problem in this country is that people are typically uninformed voters. Most people would hear socialized healthcare and think "Yay, I don't have to pay as much." Their motivation is simply ruled by saving money. Few people, I believe, would stop to consider that they would be waiting 18 months to see a specialist.

I doubt highly that many voters are thinking about the poor who can't afford coverage.. The truth probably lies much closer to their pocktbooks

I wonder why then it is construed as greed when physicians are worried about money when that is the sole driving force for switching systems to many voters.

Physicians spend over $100,000 on school, and are in college for over 8 years.. NOT to mention the long residencies for all the specialists people require. It seems a little hanious for anyone to suggest that they should be making comparable wages to an autoworker, who may or may not have any college eduation.

*not to attack auto workers, just an example.

 

[dutchman]

That is why I typically look at the wording of any poll question on universal healthcare. I have talked to almost 8 people thus far about universal healthcare and most think it means free healthcare, and these are educated people, imagine what the uneducated ones think. My fear is that politicians are willing to exploit that misconception for short term political gains. Do Americans really know that in a universal healthcare systems you have to pay an average of 12% more in taxes, pay for medical students' education, loose the luxury of throwing all sorts of lawsuits at doctors and hospitals, loose the luxury of choosing wether or not to continue treatment if terminally ill? they probably don't, and politicians will make sure they keep that a secret. That is why I have always sited American politics as the culprit in most of our systemic failures.

 

[OncoCaP]

Glad to see someone else providing their thoughts. Saving money and making money are important. Physicians should be concerned about pay and their working conditions. I'm in favor of increasing physician pay and reducing the number of working hours required (although those who want to set up a cot at the hospital should be free to do so).

One problem with the current system is that private insurance companies do things that hurt physician pay as well (see my post above), so choosing to stay with the current system is not exactly helping physicians in every case. That being said, physician pay and how much people spend should not be the only considerations. I agree that choice is a good thing and perhaps we could provide the public with some choices and optional add-on insurance for those who want and are willing to pay for faster access, extra care, etc.

One concern about the current system is that it is not serving many patients very well. There are many motivations in this discussion, and not all of them are selfish. For example, Miami_med really likes freedom. He feels that the current system and a single payer system are too intrusive and harmful because the interfere with the market aspect of healthcare, driving up costs and restricting choice.

For the average voter this issue is not just about saving money but also maintaining or getting access to care. If you are a diabetic, for example, you may not qualify for health insurance at all, and you may not be able to put food on the table and pay for your medications, depending on your earnings. If there is a system where the price of care for diabetics could be improved while maintaining the quality of the care, we should look at that. If the average voter had the understanding that universal healthcare meant waiting 18 months to see a specialist, they probably would not vote for that unless they currently can't afford to see a specialist at all (which is often the case). Somehow I don't think that if we all were extremely well informed on this issue that we would necessarily prefer the current system necessarily. There are many motivations here.

 

[thewebthsp]

I would be more interested in having this discussion mean more than simply another thread in a chatroom on some website

We are future doctors and these ideas should be given some kind of other audience-- what do you guys think?

Btw, there is no doubt our medical system will be entirely shaken up in the next administration; almost all of the democratic presidential candidates have spoken that they will want to change the current system; and I think Giuliani mentioned universal health care on larry king the other night. So this is a real issue, not just one that is merely academic.

And for doctors, a new health care system is definitely not just about pay, it's also about the quantity and quality of time with patients, and also of general public health. We should care that a lot of people aren't getting any preventive care, regardless of whether or not this hurts or helps our salary. We are also invested in making sure we don't create a worse system.

 

[OncoCaP]

I would be more interested in having this discussion mean more than simply another thread in a chatroom on some website

We are future doctors and these ideas should be given some kind of other audience-- what do you guys think?

...

Yes. This is an important issue. Let me know what you are thinking of. There are a number of conventions, conferences, and lectures on this topic. Thus, if you are looking for some ideas, I could provide some.

Here is one forum: http://www.healthcareforalltexas.org/ . I went to one of their meetings near Rice in Houston (meets the 2nd Thursday of the month); they are led by an attending physician. This group consists of single payer advocates. People can PM me if they want more information about that venue.

There are many other groups as well, such as Physicians for a National Health Program (http://www.pnhp.org/) that might be willing to host some kind of dialogue. I haven't talked to their members yet.

Heck, maybe we can get one or more of the presidential candidates to get on SDN for a little while and talk with people. I'm not sure. Even better, maybe we can get invited by Larry King! Now that would be cool.

 

[WALKE219]

Well as doctors and future doctors we hold the trump card

An all out strike.. haha

they can't really just randomly replace people who have had all this education ... like they could an auto worker or something


(before I get attacked, I'm simply joking around)

 

[Miami_med]

Yeah, I see what you mean. For me it's recreational to talk about these kinds of difficult topics.




I'm one of those people that can consider other people's points of view. Just because I hold one opinion doesn't mean that a different perspective is invalid or necessarily non-functional. .....

As I said before, I fear that we may take over this thread if we go at it again. I wish you the best of luck in all of your endeavors, provided that those endeavors don't mandate my unwillfull cooperation. As an aside, I'd love to discuss, perhaps privately, ideas for expanding access to care that don't involve the government. If you just argued that we can find a better way to help people, I'd agree with you. I don't think that helping people mandates a universal system. On the contrary, I think that it mandates exactly the opposite.

 

[Miami_med]

I think someone's been reading a bit too many Ayn Rand books...


I did very much enjoy reading your blog though. It would be nice to see more people with well-articulated opinions on these issues, even if they are opinions that I strongly disagree with.

Thank you.

 

[YupGypsy]

I'm quite irgnorant on this subject but I have to say the stuff dutchman & miami post makes a lot of sense.

There's no sense turning a trillion-dollar system into a nightmare so we can help a few folks afford their diabetic treatment.

 

[sirus_virus]

Well as doctors and future doctors we hold the trump card

An all out strike.. haha

they can't really just randomly replace people who have had all this education ... like they could an auto worker or something


(before I get attacked, I'm simply joking around)

Em.. I think dutchman is serious about that though.

 

[YupGypsy]

so when will socialized medicine become reality?

 

[sirus_virus]

so when will socialized medicine become reality?

As soon as a plan that balances the the philosophies of our widely contrasting political backgrounds emerges, meaning--not anytime soon.

 

[thewebthsp]

Um, the costs of healthcare are growing exponentially and the presidential candidates are for the most part serious about some kind of reform of both health care costs and accessibility. The reform naturally would try to deal with both of these problems. It'd be even better if they would tackle malpractice reform as well.

What I would hate to happen is that the rush to "fix" the system creates a worse one (like pure single payer -- pnhp advocates this terrible idea!). Two-tiered or mandatory insurance aren't getting too much airplay. Bush's let's give $2,000 to poor people with tax credits is way too little.

 

[OncoCaP]

As I said before, I fear that we may take over this thread if we go at it again. I wish you the best of luck in all of your endeavors, provided that those endeavors don't mandate my unwillfull cooperation. As an aside, I'd love to discuss, perhaps privately, ideas for expanding access to care that don't involve the government. If you just argued that we can find a better way to help people, I'd agree with you. I don't think that helping people mandates a universal system. On the contrary, I think that it mandates exactly the opposite.

Sure; feel free to PM me with your ideas. I have also looked at your blog a few times as well and exchanged messages, so I feel like I'm aware of some of your ideas at least. I don't think either one of us is going to get any satisfaction from what happens in the next couple of years in healthcare funding in the U.S., but it is worth getting good information out there to the extent possible. Educating ourselves, our colleagues, and the public is beneficial no matter what.

 

[OncoCaP]

so when will socialized medicine become reality?

Private insurance companies are formidable and will not go away without a huge and expensive fight, combined with many legal challenges and maneuvers. There is just too much money in it for too many powerful people, creating a very low probability of success for anyone wanting to eliminate private health insurance as a primary financing mechanism. If some variation of single-payer happens in the U.S., I would not expect it until 2015 at the earliest. Starting in 2020s or 2030s might be a more realistic target.

Practically speaking and based on what I've heard to date, I would expect some combination of increased taxes, laws requiring employers to provide insurance, and programs to assist or coerce the uninsured into getting private insurance in the 2009 - 2010 timeframe. Expect physicians to get lower reimbursables with the current system and insurance companies become more powerful and organized. Physicians and their associations can expect more serious and aggressive confrontations with insurance companies, Medicare, and Medicaid. It is important that we protect physician's jobs so that we can attract the best people to the profession. It's important to control costs, but that is not the only consideration.

My own take is that despite what I may favor (single payer with a private insurance supplement/backup), I expect that politicians will first try some combination of private health insurance assistance and expansion of existing programs like Medicare or Medicaid. There may also be standardization in the filing of medical claims and similar paperwork, which could provide enormous savings without going to a single-payer system. Medical malpractice reform could also produce savings in the 100s of billions of dollars and improve access to care by reducing "defensive medicine." There are many improvements that can be made that don't involve high-risk changes like the public financing or increasing taxes for increased healthcare. It would make sense to start with these points of common agreement and build rapport and relationships among the players before tackling the more controversial issues like private insurance and financing reform, but that's not generally the way that politics works.

 

[def jeff]

Also, I think that the public school system is an excellent example of why the government shouldn't take over healthcare. Literacy is dropping, teachers lives suck, the process keeps getting longer (1st grade, then kindergarden, then K4), and people keep paying more for less. What a disaster.

I think the DMV is an even better example of why the government should not take over health care.

 

[OncoCaP]

I think the DMV is an even better example of why the government should not take over health care.

Our DMV here in Austin is great. http://texasonline.state.tx.us/NASApp/rap/apps/dpsdl/jsp/eng/welcome.jsp. You even do business in Spanish (not available at many doctors offices).

Usually I can just interact over the web or by mail. I think e-mail is also available. Every ten years I go in person and I'm out of there in 30 minutes ... try that at a physician's office. They also have several local offices so people don't have to go to far to get there. No appointment required. $24 you're done (also cheaper than healthcare).

Maybe our state government is just better than yours! (I'm just kidding)

 

[QuikClot]

It is strange to me how more and more of the threads on SDN seems to be dominated by fear. Whether the thread is about white coats or PAs or naturopaths or universal healthcare, the endless refrain is of "barbarians at the gate" come to wreak some terrible harm on allopathic physicians. I don't think, given the relatively sunny prospects of the people making these compliants, that this very real and avidly expressed fear and anger is actually being directed at its proper source. I hope that everyone privileged to go to medical school and become a doctor is able to enjoy their wonderful good fortune, even though it's hard for everyone to appreciate what they have.

In this particular discussion, there are a lot of faulty assertions floating about. For example, the idea that universal healthcare is a cause of the uninformed. A partially list of organizations on record as supporting universal healthcare includes: the AMA, the AAFP, ACP-ASIM, American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons.

This also gives the lie to the idea that universal health care is in some form of attack on doctors. In fact, much of the pressure for universal healthcare comes from doctors. To a doctor facing the gradual erosion of Medicare payments, the unsustainablity of the current course is not a distant fear, but a rapidly advancing reality.

Another misconception is that one's income or property is, or has ever in the history of Western civilization been, or ever could be in the absolute control of the owner. Your rights to your money and your stuff are negotiated with society, which is obliged to respect them only to the extent that it is in the interests of society to do so. There are arguments for strong property rights, which can promote economic efficiency, but there are also arguments for limits to those rights, which include taxation, zoning, environmental regulations, eminent domain, confiscation of property in the case of a criminal conviction, civil judgments, and so on. There is no moral or ethical principle that is violated by this. While the Bible (for example) says "do not steal," it also endorses the paying of taxes, mandatory debt forgiveness, and restrictions on the conditions of loans, all of which compromise your rights to "your" money.

In the case of healthcare, which is increasingly expensive to those who pay for it, and continues to be free (via the emergency room and Medicaid) to those who cannot, we face a classic example of the tragedy of the commons. Our limited healthcare resources are being used in an unsustainable way, and those that can pay for it resort to accessing the healthcare system in ways that are hideously expensive and make the system even more unsustainable. A comparable situation would be desertification in Africa, as people suffering from deforestation eat grass and tree bark and burn forests for fuel, worsening the deforestation.

The doctors on the boards above are not all altruists, and probably few of them believe, as I do, that we would be morally obligated to care for the indigent even if we have no remuneration from the government at all. What they are are realists. Costs cannot continue to increase as they are, but under the current system they cannot help but increase. If the system collapses, no one will suffer more than physicians. Hence, just as many large companies like Shell and GE have decided that it is in their long-term interests to spend billions on better environmental practices, doctors as a community have decided that the risk that a new system will compensate them less richly is not as worrisome as going down with the old one.

Some of the student doctors in this thread disagree with this course of action. That is very fine; but no one, least of all themselves, should think they are leading a consensus of doctors. They are leading themselves outside the consensus, where they are welcome in the company of the global warming skeptics, intelligent design biologists, and those that think the "surge" will stabilize Iraq. When America, by whatever method it chooses, joins the rest of the developed world in providing universal health insurance to its population, we can expect them to respond with bitter prophecies of doom, followed by a sullen silence. Until then, on the Internet if not among serious people, the debate will grind on.

 

[dutchman]

It is strange to me how more and more of the threads on SDN seems to be dominated by fear. Whether the thread is about white coats or PAs or naturopaths or universal healthcare, the endless refrain is of "barbarians at the gate" come to wreak some terrible harm on allopathic physicians. I don't think, given the relatively sunny prospects of the people making these compliants, that this very real and avidly expressed fear and anger is actually being directed at its proper source. I hope that everyone privileged to go to medical school and become a doctor is able to enjoy their wonderful good fortune, even though it's hard for everyone to appreciate what they have.

In this particular discussion, there are a lot of faulty assertions floating about. For example, the idea that universal healthcare is a cause of the uninformed. A partially list of organizations on record as supporting universal healthcare includes: the AMA, the AAFP, ACP-ASIM, American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons.

This also gives the lie to the idea that universal health care is in some form of attack on doctors. In fact, much of the pressure for universal healthcare comes from doctors. To a doctor facing the gradual erosion of Medicare payments, the unsustainablity of the current course is not a distant fear, but a rapidly advancing reality.

Another misconception is that one's income or property is, or has ever in the history of Western civilization been, or ever could be in the absolute control of the owner. Your rights to your money and your stuff are negotiated with society, which is obliged to respect them only to the extent that it is in the interests of society to do so. There are arguments for strong property rights, which can promote economic efficiency, but there are also arguments for limits to those rights, which include taxation, zoning, environmental regulations, eminent domain, confiscation of property in the case of a criminal conviction, civil judgments, and so on. There is no moral or ethical principle that is violated by this. While the Bible (for example) says "do not steal," it also endorses the paying of taxes, mandatory debt forgiveness, and restrictions on the conditions of loans, all of which compromise your rights to "your" money.

In the case of healthcare, which is increasingly expensive to those who pay for it, and continues to be free (via the emergency room and Medicaid) to those who cannot, we face a classic example of the tragedy of the commons. Our limited healthcare resources are being used in an unsustainable way, and those that can pay for it resort to accessing the healthcare system in ways that are hideously expensive and make the system even more unsustainable. A comparable situation would be desertification in Africa, as people suffering from deforestation eat grass and tree bark and burn forests for fuel, worsening the deforestation.

The doctors on the boards above are not all altruists, and probably few of them believe, as I do, that we would be morally obligated to care for the indigent even if we have no remuneration from the government at all. What they are are realists. Costs cannot continue to increase as they are, but under the current system they cannot help but increase. If the system collapses, no one will suffer more than physicians. Hence, just as many large companies like Shell and GE have decided that it is in their long-term interests to spend billions on better environmental practices, doctors as a community have decided that the risk that a new system will compensate them less richly is not as worrisome as going down with the old one.

Some of the student doctors in this thread disagree with this course of action. That is very fine; but no one, least of all themselves, should think they are leading a consensus of doctors. They are leading themselves outside the consensus, where they are welcome in the company of the global warming skeptics, intelligent design biologists, and those that think the "surge" will stabilize Iraq. When America, by whatever method it chooses, joins the rest of the developed world in providing universal health insurance to its population, we can expect them to respond with bitter prophecies of doom, followed by a sullen silence. Until then, on the Internet if not among serious people, the debate will grind on.

If only you had left the whole left wing flavor out of the post, it would have been a reasonable post. If you are implying that doctors are default democrats then that will come to me as a shock. I have no political affiliation and will never completely align my beliefs with any one party for fear of tunnel vision. If a solution is viable, sustainable and realistic for all parties(doctors included), I will support it regardless of it's source.

 

[Ross434]

It is strange to me how more and more of the threads on SDN seems to be dominated by fear. Whether the thread is about white coats or PAs or naturopaths or universal healthcare, the endless refrain is of "barbarians at the gate" come to wreak some terrible harm on allopathic physicians. I don't think, given the relatively sunny prospects of the people making these compliants, that this very real and avidly expressed fear and anger is actually being directed at its proper source. I hope that everyone privileged to go to medical school and become a doctor is able to enjoy their wonderful good fortune, even though it's hard for everyone to appreciate what they have.

In this particular discussion, there are a lot of faulty assertions floating about. For example, the idea that universal healthcare is a cause of the uninformed. A partially list of organizations on record as supporting universal healthcare includes: the AMA, the AAFP, ACP-ASIM, American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons.

This also gives the lie to the idea that universal health care is in some form of attack on doctors. In fact, much of the pressure for universal healthcare comes from doctors. To a doctor facing the gradual erosion of Medicare payments, the unsustainablity of the current course is not a distant fear, but a rapidly advancing reality.

Another misconception is that one's income or property is, or has ever in the history of Western civilization been, or ever could be in the absolute control of the owner. Your rights to your money and your stuff are negotiated with society, which is obliged to respect them only to the extent that it is in the interests of society to do so. There are arguments for strong property rights, which can promote economic efficiency, but there are also arguments for limits to those rights, which include taxation, zoning, environmental regulations, eminent domain, confiscation of property in the case of a criminal conviction, civil judgments, and so on. There is no moral or ethical principle that is violated by this. While the Bible (for example) says "do not steal," it also endorses the paying of taxes, mandatory debt forgiveness, and restrictions on the conditions of loans, all of which compromise your rights to "your" money.

In the case of healthcare, which is increasingly expensive to those who pay for it, and continues to be free (via the emergency room and Medicaid) to those who cannot, we face a classic example of the tragedy of the commons. Our limited healthcare resources are being used in an unsustainable way, and those that can pay for it resort to accessing the healthcare system in ways that are hideously expensive and make the system even more unsustainable. A comparable situation would be desertification in Africa, as people suffering from deforestation eat grass and tree bark and burn forests for fuel, worsening the deforestation.

The doctors on the boards above are not all altruists, and probably few of them believe, as I do, that we would be morally obligated to care for the indigent even if we have no remuneration from the government at all. What they are are realists. Costs cannot continue to increase as they are, but under the current system they cannot help but increase. If the system collapses, no one will suffer more than physicians. Hence, just as many large companies like Shell and GE have decided that it is in their long-term interests to spend billions on better environmental practices, doctors as a community have decided that the risk that a new system will compensate them less richly is not as worrisome as going down with the old one.

Some of the student doctors in this thread disagree with this course of action. That is very fine; but no one, least of all themselves, should think they are leading a consensus of doctors. They are leading themselves outside the consensus, where they are welcome in the company of the global warming skeptics, intelligent design biologists, and those that think the "surge" will stabilize Iraq. When America, by whatever method it chooses, joins the rest of the developed world in providing universal health insurance to its population, we can expect them to respond with bitter prophecies of doom, followed by a sullen silence. Until then, on the Internet if not among serious people, the debate will grind on.

Wow, one of the most informed, well written and useful posts i've seen on SDN in a while!

 

[Miami_med]

It is strange to me how more and more of the threads on SDN seems to be dominated by fear. Whether the thread is about white coats or PAs or naturopaths or universal healthcare, the endless refrain is of "barbarians at the gate" come to wreak some terrible harm on allopathic physicians. I don't think, given the relatively sunny prospects of the people making these compliants, that this very real and avidly expressed fear and anger is actually being directed at its proper source. I hope that everyone privileged to go to medical school and become a doctor is able to enjoy their wonderful good fortune, even though it's hard for everyone to appreciate what they have.

In this particular discussion, there are a lot of faulty assertions floating about. For example, the idea that universal healthcare is a cause of the uninformed. A partially list of organizations on record as supporting universal healthcare includes: the AMA, the AAFP, ACP-ASIM, American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons.

This also gives the lie to the idea that universal health care is in some form of attack on doctors. In fact, much of the pressure for universal healthcare comes from doctors. To a doctor facing the gradual erosion of Medicare payments, the unsustainablity of the current course is not a distant fear, but a rapidly advancing reality.

Another misconception is that one's income or property is, or has ever in the history of Western civilization been, or ever could be in the absolute control of the owner. Your rights to your money and your stuff are negotiated with society, which is obliged to respect them only to the extent that it is in the interests of society to do so. There are arguments for strong property rights, which can promote economic efficiency, but there are also arguments for limits to those rights, which include taxation, zoning, environmental regulations, eminent domain, confiscation of property in the case of a criminal conviction, civil judgments, and so on. There is no moral or ethical principle that is violated by this. While the Bible (for example) says "do not steal," it also endorses the paying of taxes, mandatory debt forgiveness, and restrictions on the conditions of loans, all of which compromise your rights to "your" money.

In the case of healthcare, which is increasingly expensive to those who pay for it, and continues to be free (via the emergency room and Medicaid) to those who cannot, we face a classic example of the tragedy of the commons. Our limited healthcare resources are being used in an unsustainable way, and those that can pay for it resort to accessing the healthcare system in ways that are hideously expensive and make the system even more unsustainable. A comparable situation would be desertification in Africa, as people suffering from deforestation eat grass and tree bark and burn forests for fuel, worsening the deforestation.

The doctors on the boards above are not all altruists, and probably few of them believe, as I do, that we would be morally obligated to care for the indigent even if we have no remuneration from the government at all. What they are are realists. Costs cannot continue to increase as they are, but under the current system they cannot help but increase. If the system collapses, no one will suffer more than physicians. Hence, just as many large companies like Shell and GE have decided that it is in their long-term interests to spend billions on better environmental practices, doctors as a community have decided that the risk that a new system will compensate them less richly is not as worrisome as going down with the old one.

Some of the student doctors in this thread disagree with this course of action. That is very fine; but no one, least of all themselves, should think they are leading a consensus of doctors. They are leading themselves outside the consensus, where they are welcome in the company of the global warming skeptics, intelligent design biologists, and those that think the "surge" will stabilize Iraq. When America, by whatever method it chooses, joins the rest of the developed world in providing universal health insurance to its population, we can expect them to respond with bitter prophecies of doom, followed by a sullen silence. Until then, on the Internet if not among serious people, the debate will grind on.

I think that it is necessary to immediately refute some assertions in this post. First of all, the entire basis for the creation of the United States Government is based on Lockean principles. Private property is considered, atleast according to the constitution, to be very important. The government isn't supposed to be able to search your property without a warrant, the government isn't allowed to take your property without just compensation. The determination of just compensation in eminent domain is one of the few legal proceedings left that actually mandates a full 12 member jury. You even mention the tragedy of the commons in your post and then blatantly contradict yourself by claiming that the solution to this essentially making EVERYTHING common property that is negotiated by some faceless mass called society. Please tell me what society is? Am I a member of it, because if I am, then I consider my private property a social good that I am perfectly willing to negotiate with myself (as a member of society of course)

You see, most of what is consistently advocated by you and other proponents of Universal Healthcare is actually bad for society. Spending lots of money to make sure that a single mother with HIV and no job gets HAART is actually a poor economic choice for society. We, as physicians, want to do these things because we care, but they have NOTHING to do with being good for society. Long term care for paparpalegics, people with chronic disease, elderly people with cancer, people with genetic conditions, and other such maladies isn't good economics AT ALL. On top of that, all of the effort that allows these people to survive actually weakens the entire genetic foundation of our society in the long run, as individuals who wouldn't have been able to function or have children now pass along these genes to the next generation.

I am NOT an advocate of not helping people. I went into medicine because I want to help all of the people that I wrote about in the above paragraph. I'm just pointing out the blatant contradiction and hypocrisy in the idea that universal healthcare is some kind of supreme social good that will provide benefit to society that a free market will not. The fact of the matter is, that with basic infectious disease control and a few antibiotics in a world with access to food and clean water, almost every healthy individual would live through all of their productive years. All of that being said, people want medicine because it can make life better and longer for some people. That is why we need a free market to determing its proper place in society based on individual desire to utilize scarce resources to access it. That balance in the bank accounts of every individual does a better job of weighing quality of life vs. other uses of money than ANY centralized planning ever has.

The majority of the arguments I hear promoting a Universal system are rife with a sort of anti-aristocratic elitism. Yours is no different. The "social goods" that are promoted are more of a perceived benefit of "sticking it to the man." How dare that "rich" guy get more healthcare than the poor guy. You assume, quite falsely, that equality is the greatest of social goods. That is in fact the only premise that justifies a Universal Healthcare scheme. Well you know what, the hunter-gatherers in the Amazon have good equality, but I'm perfectly content to live in my world of high technology and accept the fact that Bill Gates is richer than I am.

Resources only become a limited pie when they are centralized and redistributed. The reason that your ideas of centralized ownership by "society" always fail when taken to the extreme is that you rely on individuals to keep working. Innovation makes life better for everyone in time. That is a true social good. People work for themeselves and those that they care about. The examples of Soviet Russia, Cuba, North Korea, etc... are stunning in their show of the inability of a centralized authority to even maintain a standard of quality, let alone move it forward.

Whatever the case, what's mine is mine and you cannot have it.

 

[Towelie]

I think you are living in Ayn Rand's fantasy world. Socialism, taken to an extreme (e.g. the Soviet Union, Cuba, North Korea), does not function. However, capitalism in it's purest form (e.g. Ayn Rand's utopia in Atlas Shrugged) has never, and could never exist. Libertarians are every bit as naive and idealistic as Marxists are, holding belief in a utopian society that could never sustain itself.

Your "what's mine is mine" argument makes little sense. You earn your property because you are part of a society that allows you to earn it. By being part of this society, you enter a social contract--you pay taxes and obey laws. The debate in reasonable societies is not whether wealth should be redistributed for the good of society, it is how much wealth should be redistributed for the good of society. In thriving industrialized nations in today's world, you see a range of wealth redistribution, from low (e.g. the US) to high (e.g. Scandanavian countries).

I'm not going to argue for universal healthcare. All I will argue is that the current system needs to be changed, and that basic access to healthcare should be a right, not a privilege. I don't think that we necessarily need a single-payer system to accomplish this; in fact, I think that implementing one would have the potential to do a lot more harm than good.

You see, most of what is consistently advocated by you and other proponents of Universal Healthcare is actually bad for society. Spending lots of money to make sure that a single mother with HIV and no job gets HAART is actually a poor economic choice for society. We, as physicians, want to do these things because we care, but they have NOTHING to do with being good for society. Long term care for paparpalegics, people with chronic disease, elderly people with cancer, people with genetic conditions, and other such maladies isn't good economics AT ALL. On top of that, all of the effort that allows these people to survive actually weakens the entire genetic foundation of our society in the long run, as individuals who wouldn't have been able to function or have children now pass along these genes to the next generation.

I believe Adolf Hitler made many of these same arguments. Be careful.

How would these people that you describe get healthcare in a truly free market? Unless they had family members to pay for their treatment, I don't see how they would.

 

[sirus_virus]

It is strange to me how more and more of the threads on SDN seems to be dominated by fear. Whether the thread is about white coats or PAs or naturopaths or universal healthcare, the endless refrain is of "barbarians at the gate" come to wreak some terrible harm on allopathic physicians. I don't think, given the relatively sunny prospects of the people making these compliants, that this very real and avidly expressed fear and anger is actually being directed at its proper source. I hope that everyone privileged to go to medical school and become a doctor is able to enjoy their wonderful good fortune, even though it's hard for everyone to appreciate what they have.

In this particular discussion, there are a lot of faulty assertions floating about. For example, the idea that universal healthcare is a cause of the uninformed. A partially list of organizations on record as supporting universal healthcare includes: the AMA, the AAFP, ACP-ASIM, American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, and American College of Surgeons.

This also gives the lie to the idea that universal health care is in some form of attack on doctors. In fact, much of the pressure for universal healthcare comes from doctors. To a doctor facing the gradual erosion of Medicare payments, the unsustainablity of the current course is not a distant fear, but a rapidly advancing reality.

Another misconception is that one's income or property is, or has ever in the history of Western civilization been, or ever could be in the absolute control of the owner. Your rights to your money and your stuff are negotiated with society, which is obliged to respect them only to the extent that it is in the interests of society to do so. There are arguments for strong property rights, which can promote economic efficiency, but there are also arguments for limits to those rights, which include taxation, zoning, environmental regulations, eminent domain, confiscation of property in the case of a criminal conviction, civil judgments, and so on. There is no moral or ethical principle that is violated by this. While the Bible (for example) says "do not steal," it also endorses the paying of taxes, mandatory debt forgiveness, and restrictions on the conditions of loans, all of which compromise your rights to "your" money.

In the case of healthcare, which is increasingly expensive to those who pay for it, and continues to be free (via the emergency room and Medicaid) to those who cannot, we face a classic example of the tragedy of the commons. Our limited healthcare resources are being used in an unsustainable way, and those that can pay for it resort to accessing the healthcare system in ways that are hideously expensive and make the system even more unsustainable. A comparable situation would be desertification in Africa, as people suffering from deforestation eat grass and tree bark and burn forests for fuel, worsening the deforestation.

The doctors on the boards above are not all altruists, and probably few of them believe, as I do, that we would be morally obligated to care for the indigent even if we have no remuneration from the government at all. What they are are realists. Costs cannot continue to increase as they are, but under the current system they cannot help but increase. If the system collapses, no one will suffer more than physicians. Hence, just as many large companies like Shell and GE have decided that it is in their long-term interests to spend billions on better environmental practices, doctors as a community have decided that the risk that a new system will compensate them less richly is not as worrisome as going down with the old one.

Some of the student doctors in this thread disagree with this course of action. That is very fine; but no one, least of all themselves, should think they are leading a consensus of doctors. They are leading themselves outside the consensus, where they are welcome in the company of the global warming skeptics, intelligent design biologists, and those that think the "surge" will stabilize Iraq. When America, by whatever method it chooses, joins the rest of the developed world in providing universal health insurance to its population, we can expect them to respond with bitter prophecies of doom, followed by a sullen silence. Until then, on the Internet if not among serious people, the debate will grind on.

Just tell us which democratic candidiate you are cheering for and save us the literature.

 

[thewebthsp]

It's funny how this discussion brings out strong opinions -- btw, everyone should respect each other even if they disagree completely with each others' opinions.

There seem to be a lot of reactions to others' statements, except for the first essay by Quikclot. I think that post has some very interesting ideas, especially about whether or not doctors are realizing the current system needs to be changed (eg fleeing a sinking ship). However, as others have posted it defends the single payer system, which Oncocap and I have been discussing for the past 3 pages now! It might work as a Hong Kong idea, (one health industry, two systems) but as a standalone product it really screws over people with more means who want better care. I did some research about this for patients in Canada, and a private clinic that was offering some ortho services without huge wait times was put out of business since they didn't want richer people getting an unfair "advantage." My parents came from a communist country; obviously America isn't going communist any time soon but a communist health care system might, and such economic programs generally create a highly inefficient, expensive system that forces rationing on everyone. As I posted earlier, savings on overhead alone are not sufficient means to create a worse system than the current one.

At the same time, Miami Med's post, while also interesting at times has some overreactionary statements. Look, no one is going to allow sick people to die on the street, ever. And we're not going to euthanize sick or ******ed people because it is "economically advantageous." (there was also a pro-eugenics statement there, and as we all know eugenics is bogus) At the same time the US doesn't wealth redistribute, except in heavily restricted welfare (thank goodness the republicans put restrictions on that crappy program in 95). Entitlements (Social security, medicare) still in theory come from tax payments on the elderly when they were younger. Redistribution of wealth is a horrible idea because it penalizes individual's productivity and innovation. It also releases people from personal responsibility. Obviously inheriting money is a different story, but one's investments and to a lesser extent, their income is something that should be taxed as little as possible. Taxes in socialist countries like Sweden approach 60% -- that would not be good economic policy for the US. If we were truly a socialist country, we would provide luxurious, intensive education for all people in poor areas starting at age 2, and let the rich pay for their child's education in private schools. That being said we do need to fix the health care system-- the problems I posted earlier still apply, namely a) declining reimbursement b) excess patients/day c) insufficient coverage d) unreasonable malpractice issues. In fact the issue of pay and patient safety are both tied together...

Socially concerned physicians need not be on the fringes of the economic left wing. I think the idea of single payer alone will merely delay reform, and continue the ****ty system we have today. The best solution would be for a unified plan for medical reform that a consensus of physicians and medical students support, and lobby for to the federal government.

 

[sirus_virus]

It's funny how this discussion brings out strong opinions -- btw, everyone should respect each other even if they disagree completely with each others' opinions.

There seem to be a lot of reactions to others' statements, except for the first essay by Quikclot. I think that post has some very interesting ideas, especially about whether or not doctors are realizing the current system needs to be changed (eg fleeing a sinking ship). However, as others have posted it defends the single payer system, which Oncocap and I have been discussing for the past 3 pages now! It might work as a Hong Kong idea, (one health industry, two systems) but as a standalone product it really screws over people with more means who want better care. I did some research about this for patients in Canada, and a private clinic that was offering some ortho services without huge wait times was put out of business since they didn't want richer people getting an unfair "advantage." My parents came from a communist country; obviously America isn't going communist any time soon but a communist health care system might, and such economic programs generally create a highly inefficient, expensive system that forces rationing on everyone. As I posted earlier, savings on overhead alone are not sufficient means to create a worse system than the current one.

At the same time, Miami Med's post, while also interesting at times has some overreactionary statements. Look, no one is going to allow sick people to die on the street, ever. And we're not going to euthanize sick or ******ed people because it is economically advantageous. (there was also a pro-eugenics statement there, and as we all know eugenics is bogus) At the same time the US doesn't wealth redistribute, except in heavily restricted welfare (thank goodness the republicans put restrictions on that crappy program in 95). Entitlements (Social security, medicare) still in theory come from tax payments on the elderly when they were younger. Redistribution of wealth is a horrible idea because it penalizes individual's productivity and innovation. It also releases people from personal responsibility. Obviously inheriting money is a different story, but one's investments and to a lesser extent, their income is something that should be taxed as little as possible. That being said we do need to fix the health care system-- the problems I posted earlier still apply, namely a) declining reimbursement b) excess patients/day c) insufficient coverage d) unreasonable malpractice issues. In fact the issue of pay and patient safety are both tied together...

Socially concerned physicians need not be on the fringes of the economic left wing. I think the idea of single payer alone will merely delay reform, and continue the ****ty system we have today. The best solution would be for a unified plan for medical reform that a consensus of physicians and medical students support, and lobby for to the federal government.

That is why as someone pointed out we cannot come up with a solution by simply drawing party lines and throwing political rhetoric arround. We cannot create a healthy system from the democrats idea of laying the entire burden on the so called "wealthy" people in society, nor can we come up with a healthy system with the Republicans idea of protecting insurance companies at all cost. We all have to chip in collectively to build the system. That is why I am more receptive of Oncocap's arguments than QuickClots political rants.

 

[Towelie]

At the same time the US doesn't wealth redistribute, except in heavily restricted welfare (thank goodness the republicans put restrictions on that crappy program in 95). Entitlements (Social security, medicare) still in theory come from tax payments on the elderly when they were younger. Redistribution of wealth is a horrible idea because it penalizes individual's productivity and innovation. It also releases people from personal responsibility. Obviously inheriting money is a different story, but one's investments and to a lesser extent, their income is something that should be taxed as little as possible.

I don't think you understand what redistribution of wealth is. Right now we have a taxation system in which individuals earning more are taxed a higher percent than those earning less. That IS redistribution of wealth. It happens in every industrialized country on this planet.

 

[OncoCaP]

Wow, what an improvement in the quality of discussion! Thank you QuickClot for injecting a healthy dose of intelligence!

Even thought I'm on the opposite side of the political spectrum from Quickclot, it's nice to see that both sides of the "aisle" can agree that reform of our current healthcare financing system to provide universal care is a necessity that has broad support both inside and outside the community of physicians and medical students. It's not just Democrats or Liberals who are advocating change. I have never voted for a Democratic president, and I'm not sure I ever will. I'm a Republican conservative, but that doesn't mean I only care about my own well-being. If a program is seriously broken, like our current healthcare financing system is, I don't support it.

People across the political and ideological spectrum realize that we have a serious problem. While we may not be in agreement on what the perfect solution, hopefully we can reach concensus on one sooner rather than later.

One of the major points of contention in this discussion is the role of the "free market" in providing efficiency and quality in healthcare. The idea that healthcare should be a "free market" like the market for bananas or automobile repair services is a matter of some debate. On the one hand you get arguments from the Pharmaceutical Research and Manufacturers of America (PhRMA) who clearly have done very well and have much to gain from the current system. They are strongly opposed to anything that would cut into their bottom line, and universal healthcare reforms could pose such a threat. (http://www.phrma.org/about_phrma/st...ealth_care_solutions_are_best_for_patients/):

"Free Market Health Care Solutions Are Best for Patients

"Billy Tauzin, PhRMA President & CEO
...
"The strength and success of America's pharmaceutical research industry, I am proud to say, is just one example of what we work for when we fight for free-markets, reducing government interference in the economy and for fostering of an economic environment that promotes opportunity and innovation.

"We all know that we face many difficult health care challenges in America – including challenges of access, insurance and the cost of services.

"As we face those challenges and debate how to solve them, we must also remember that America is today the envy of much of the world when it comes to the quality of the health care available to most Americans.

"In particular, the strength and success of America's pharmaceutical research companies in creating life-saving cures and treatments is admired and envied the world over.

"Why? Because – so far at least – there is still exists an economic environment here that still rewards risk-taking, entrepreneurship and innovation.

"By contrast, in many competing economies and political systems around the globe, they have fallen victim to over regulation and crippling government price-controls in the health care sector that drive away innovators and risk takers -- -- such as those European countries that once had flourishing pharmaceutical research industries but who now increasingly lag behind the U.S. pharmaceutical industry.

********
On the other hand we have a variety of universal care advocates who are dismayed at the poor and decreasing quality of healthcare that many Americans are receiving, have seen the steady erosion of physician reimbursements and quality of life, and have much to gain from an improved system of healthcare financing. PNHP is one of those organizations:
http://capa.pnhp.org/clay_feet_of_health_care_reform.php
"Clay Feet of Health Care Reform

By Jeoffry B. Gordon, MD, MPH

I am a family doc who has been practicing medicine in San Diego for over twenty five years. I have watched the steady deterioration of our Country's commitment to the health of our citizenry since the implementation of Medicare was restricted to just a limited population. The public policy and political action around changing the system - Schwarzenegger included - revolves around two rather important but also technical fallacies, i.e. (1) That health care is most efficiently distributed by a free market mechanism and (2) That medical services are an ordinary commodity. I would argue - on the basis of looking at European successes and our Country's failures in solving the provision of medical services over the past 40 years - that the "free market" model is a failing economic and public administration ideology used to rationalize and justify corporate control of the health care system to profit from the enterprise. This pervasive perspective has obscured the successes and potential efficiencies possible and actual in governmental management of health services. Medical services are not an ordinary commodity but more like a "public good" which should be distributed using a regulated public utility model.

******
Probably the sharpest contrast between the above positions is the view of the success or failure of our own country's healthcare system and that of the European systems. Objective evaluation of those systems, as opposed to ideological evaluation, is the best opportunity for fostering mutual understanding and respect and perhaps the development of broadly accepted and effective solutions and reforms.

Making an effort to agree to some common assumptions, objectives, and measures would go a long way fostering mutually acceptable solutions. For example, if wait times are a concern, let's compare wait times for procedures. Let's compare the efficiency of financing and innovation. I have provided quantitative comparisons. I invite my critics to do the same. By really understanding the differences and exploring their root causes we can more intelligently advocate solutions that have predictable outcomes.

While the subjective perspectives and values are critical foundations, as long as we have divergent perspectives on our own country's and Europe's healthcare quality and efficiency, we will never be able to develop a win-win solution in healthcare. Instead we will be in a situtation where we are fighting each other every step of the way and probably will wind up with a much worse system than we would have otherwise.

 

[def jeff]

I believe Adolf Hitler made many of these same arguments. Be careful.

I think you misunderstood Miami med’s words. I don’t think he was justifying these arguments. I believe he was pointing out the conflict that could arise when the single payer (i.e. government) must assume the position to decide “what is good for society” while at the same time, evaluating this “good” against the costs.

 

[Miami_med]

I think you are living in Ayn Rand's fantasy world. Socialism, taken to an extreme (e.g. the Soviet Union, Cuba, North Korea), does not function. However, capitalism in it's purest form (e.g. Ayn Rand's utopia in Atlas Shrugged) has never, and could never exist. Libertarians are every bit as naive and idealistic as Marxists are, holding belief in a utopian society that could never sustain itself.

Your "what's mine is mine" argument makes little sense. You earn your property because you are part of a society that allows you to earn it. By being part of this society, you enter a social contract--you pay taxes and obey laws. The debate in reasonable societies is not whether wealth should be redistributed for the good of society, it is how much wealth should be redistributed for the good of society. In thriving industrialized nations in today's world, you see a range of wealth redistribution, from low (e.g. the US) to high (e.g. Scandanavian countries).

I'm not going to argue for universal healthcare. All I will argue is that the current system needs to be changed, and that basic access to healthcare should be a right, not a privilege. I don't think that we necessarily need a single-payer system to accomplish this; in fact, I think that implementing one would have the potential to do a lot more harm than good.

We'll have to agree to disagree on this point.

I believe Adolf Hitler made many of these same arguments. Be careful.

How would these people that you describe get healthcare in a truly free market? Unless they had family members to pay for their treatment, I don't see how they would.

Well #1, I'm Jewish enough that Hitler and I don't exactly get along. The majority of Hitler's extermination was actually aimed at relatively productive people who sought no benefit from the state at all.

There is a significant difference between Hitler and myself. I am not advocating the mass extermination of anyone. I've even expressed a desire to help some of the people I spoke about. What I take issue with is the argument that it is a greater social good to seperate money from people who earn it in order to support people who do not. Pay=incentives. If the welfare system has taught us anything, it has proven that giving people money for doing nothing will create more doing nothing. If you take away the incentive from the most productive and give it to the least productive, you are creating a situation that encourages risky behavior and discourages productive behavior. The benefit to the single mother with AIDS is a benefit to that individual, not to society at large. When it comes at someone else's expense, it hurts society at large. Of course, any significant reading of my arguments will show you that I think individual benefits are more important than social benefits, as society is nothing but a conglomeration of individuals. When we help someone by choice, that benefit comes at no one's expense and the benefit to the individual becomes a benefit to society. It is not the case when the money is taken by force.

 

[Miami_med]

I don't think you understand what redistribution of wealth is. Right now we have a taxation system in which individuals earning more are taxed a higher percent than those earning less. That IS redistribution of wealth. It happens in every industrialized country on this planet.

There are some of us that think that this IS the problem. Political corruption occurs in all industrialized countries as well, but that doesn't mean that it is something we should strive for. In fact, I'd say that the two are pretty closely linked.

 

[Miami_med]

At the same time, Miami Med's post, while also interesting at times has some overreactionary statements. Look, no one is going to allow sick people to die on the street, ever. And we're not going to euthanize sick or ******ed people because it is "economically advantageous." (there was also a pro-eugenics statement there, and as we all know eugenics is bogus) At the same time the US doesn't wealth redistribute, except in heavily restricted welfare (thank goodness the republicans put restrictions on that crappy program in 95). Entitlements (Social security, medicare) still in theory come from tax payments on the elderly when they were younger.

Well, as a person with a Jewish backgroudn and a number of physical conditions that require treatment, I think you are misunderstanding anything that you construe as eugenics. It is an interesting reaction from people to see that everyone has this reactionary feeling to the truth. If I couldn't generate the income to take care of myself in the long run, it would be economically disadvantageous to take care of me from the outside. I have NEVER advocated euthanizing anyone. I've never even said that we as individuals shouldn't take care of people. I just pointed out that doing so isn't the greatest "public good." No has attempted to refute that statement. I believe that anyone who works to take care of himself and pays for his own expenses is entitled to ALL of the rewards of that labor, regardless of race, mental status, disability, etc... That is true equal protection.

 

[OncoCaP]

There are some of us that think that this IS the problem. Political corruption occurs in all industrialized countries as well, but that doesn't mean that it is something we should strive for. In fact, I'd say that the two are pretty closely linked.

Miami_med, would you say that you advocate a "survival of the fittest" in society? In other words, you accept a situation that, if for whatever reason, people could be dying in our streets for lack of food or medical care (that they cannot afford or do not qualify for and not enough people want to help them, etc.)? Or do you think that only small number would face such a demise and the rest would "learn the lesson" and do what they can to survive?

What about anittrust? You accept monopolies that collaborate to regulate and control prices (no anti-trust legislation)?

 

[dutchman]

Miami_med, would you say that you advocate a "survival of the fittest" in society? In other words, you accept a situation that, if for whatever reason, people could be dying in our streets for lack of food or medical care (that they cannot afford or do not qualify for and not enough people want to help them, etc.)? Or do you think that only small number would face such a demise and the rest would "learn the lesson" and do what they can to survive?

What about anittrust? You accept monopolies that collaborate to regulate and control prices (no anti-trust legislation)?

While the question was not directed at me, let me give you my opinion. I think we should care for the trull needy, but we must not..I repeat NOT create a safe haven for lack of productivity. Every now and then you will find a social program that does exactly that.

Let me elaborate: Why should I go to school, work hard in life or have ambitions when society can provide me with free food, shelter, healthcare, etc? You could actually take away the incentive to produce by overdoing the "hand me" style of society, and productivity is what keeps a society going.

 

[Towelie]

We'll have to agree to disagree on this point.


Well #1, I'm Jewish enough that Hitler and I don't exactly get along. The majority of Hitler's extermination was actually aimed at relatively productive people who sought no benefit from the state at all.

There is a significant difference between Hitler and myself. I am not advocating the mass extermination of anyone. I've even expressed a desire to help some of the people I spoke about. What I take issue with is the argument that it is a greater social good to seperate money from people who earn it in order to support people who do not. Pay=incentives. If the welfare system has taught us anything, it has proven that giving people money for doing nothing will create more doing nothing. If you take away the incentive from the most productive and give it to the least productive, you are creating a situation that encourages risky behavior and discourages productive behavior. The benefit to the single mother with AIDS is a benefit to that individual, not to society at large. When it comes at someone else's expense, it hurts society at large. Of course, any significant reading of my arguments will show you that I think individual benefits are more important than social benefits, as society is nothing but a conglomeration of individuals. When we help someone by choice, that benefit comes at no one's expense and the benefit to the individual becomes a benefit to society. It is not the case when the money is taken by force.

I wasn't equating you to Hitler. I was merely stating that your arguments put you on a very slippery slope.


Your argument that only individual benefits are for the good of society seems overly simplistic. Game theory suggests (via the Nash-Cournot equilibrium) that an optimal solution is reached at an intermediate point between what is best for the individual and what is best for the group (society). We cannot rely on individuals to do this out of the goodness of their hearts, as you propose, and hope that all works out for the best. Again, this seems to show an overly idealistic view of the world. Just because it worked in Atlas Shrugged doesn't mean it would work in the real world.

Again, I ask you the question: in your pure free market, how does the single mother with AIDS get healthcare? Because some philanthropist decides to help her out? Is this really a viable system? You claim that you want to "help" these people, yet your worldview provides them no alternative other than extermination.

 

[OncoCaP]

While the question was not directed at me, let me give you my opinion. I think we should care for the trull needy, but we must not..I repeat NOT create a safe haven for lack of productivity. Every now and then you will find a social program that does exactly that.

Let me elaborate: Why should I go to school, work hard in life or have ambitions when society can provide me with free food, shelter, healthcare, etc? You could actually take away the incentive to produce by overdoing the "hand me" style of society, and productivity is what keeps a society going.

Agreed. For example, my own impression is that > 50% of the people on Medicaid have a viable private alternative but for cultural or personal reasons choose not to (don't want to work at McDonalds, want to collect from the government and their side job, etc.). Billions go to support and, in a sense, encourage, a life of dependence and subsistence. The amount of fraud is just over the top. One Medicaid recipient was picking up his prescription at the pharmacy, where his co-pay was $1. He asked if he could pay with his LoneStar card (food stamps; welfare) and was told that he could not. So, this unfortunate soul whips out a $100 bill and laments that he was hoping not to break it. I wish this was the exception, but it's not in my own experience. There are plenty of truly needy people and then there is a mass of parasites that could do something but don't want to work that hard or otherwise stand to gain.

Don't get me wrong; I'm not suggesting that there isn't equally or more fraud in the private sphere. There are dishonest or lazy people across the economic spectrum. People who are wealthy are not necessarily more hardworking than people at the bottom of the economic latter (lazy & dishonest people seem evenly distributed from what I can tell). Based on my experience in business, there is much more fraud in the private economy because there is simply more there to be stolen and embezzled. In private industry there is also less of a paper-trail and less rigorous auditing than in government, so it's relatively easy to steal money without being noticed. As an employer, I wouldn't even bother with theft under $5K because it's legally not worth it to prosecute (although getting rid of the person was worth it). Even a $40K theft is a tough call on whether to file charges since it proably would cost at least $20K to try to recover the money, and it is rare to recover anything. Most employers just fire the criminal and that person hops from unsuspecting employer to unsuspecting employer. Once someone like that gets to comptroller or CFO, they can steal millions or perhaps even billions (and some do that). The nice thing in government is that there is so much paperwork that you can usually track how much money was stolen and perhaps even who did it if you want to take the time to investigate it.

A contrasting example to the guy on Medicaid who didn't want to break his $100 bill (which he had several of in his wallet) is a family I know where the mother contracted breast cancer (caught at a late stage -- III/IV). The father worked as a salesman for a small not-for-profit that offered very limited health insurance that did not cover her treatment. Maybe their income was in the $20K-$40K range depending on his sales and her treatment cost ~$100K at least (I received only a few details). She also worked, but had taken a year off to spend some time with her children. He had to quit his job to take her to treatments in another city that offered charitable care and then became essentially her full-time nurse because they obviously couldn't afford to have her stay at a hospital or to pay for a nurse.

A number of charities helped out, and they did not declare bankruptcy, but their family was financially and emotionally destroyed by this experience. Their life savings and retirement were whiped out. They will be paying her medical bills for the rest of their lives. This was not a poor family. This was not a lazy family. They were respected and active members of the community who paid their bills; they were average, productive Americans in many ways. We can design a system that addresses such needs in a better way. Although she was originally given only 6 months to live, she has survived three years in a rather miraculous situation. One of the best cancer centers in the world provided some of the most advanced medical and surgical care for as little as $2000/year. Thus, there is evidence of "good" in our system but I'm confident we can do much better. This family's experience is part of my inspiration, part of why I'm going into medicine with an interest in oncology (there are many other reasons as well).

What we need is a system that gives people an fair chance at accessing the healthcare system, forces patients to pay their share of the costs to the extent that they are able, and creates a system where providing excellent care for patients is economically viable. The example of the family above shows that there are gaps in the way that our health insurance system works. Maybe that family could have been more aggressive in seeking better medical coverage on their own. I'm not sure if the average American knows how to get excellent medical coverage and how to distinguish it from poor coverage. If the employer doesn't provide great coverage, most people don't seem to go out looking for it on their own. Good information and advice about health insurance and its importance would certainly be a good starting point.

Affordable, comprehensive health coverage is also a big need. As someone who has applied for individual coverage for a family, I can assure you that there is nothing easy or fair about it, even for a healthy professional with a healthy family. The health insurance company only wants perfectly health people, and if there is any hint of a health condition, they view that as a potential point to reject you. It was easier to apply to medical school (for me anyway). Right now I'm not sure that I can get my 1-year-old and 2-year-old boys covered this year beyond the very low total expense policy we have now (~$20K) because they don't meet the height & weight requirements (they are not obese but inherited my tall athletic genes -- high risk compared to average skinny people, plus they are young and could hurt themselves easily). For practial purposes (major medical), we are self-insured with respect to healthcare and we really shouldn't be in that position. We don't qualify for state programs like CHIP because our family earns too much money. I may also not qualify because I take cholesterol medication, but I may be able to get coverage from my medical school. We have a plan for comprehensive coverage for my family next year, so there is a solution for us, but I can empathize with those who don't have as many options as I do.

Is there a system out there that you do like? I've listed a few, like the Austrian system, for example. The Scandanavian healthcare systems also get high marks from what I understand (and that part of their economy doesn't cost more than our healthcare system per capita).

 

[thewebthsp]

Hi Miami med--

Yeah, I think you were trying to make a point that "what is best for society" can result in some truly frightening conclusions. Maybe so -- although I would wager that people dying on the street would actually be very bad for society-- the morale of the people tends to nosedive when people around them croak on the sidewalk (like what happened in the black death). Morale affects productivity, which is "economically bad." There is of course a difference between extreme things (like not giving HIV treatment to HIV infected babies and people dying in the streets) and moderately "uncompassionate" things (like a hard working family being bankrupted by cancer medical bills, or the man with diabetes that loses limbs because of poor preventive care). Taken to the other extreme, which I despise, is, everyone should make the same amount of money regardless of their profession -- communism. THen things are of very poor quality (cause why should you do a good job, if everyone gets paid the same?), and the culutre of people there devolves to -- how do I cheat the system to make more money than I should be getting?

In Soviet Russia the most lucrative profession was being a butcher. Because you could give people a cut of bad meat and charge them the "Standard price." A lot of butchers stashed lots of rubles this way; too bad tho cause the waiting list for a car was 3 years. My dad went to work in Siberia for a while just so he was "allowed" to have his own apartment and car.

In any event I can understand why you responded the way you did, but the examples you provided weren't realistic, that was my point. It was also hard to see on first glance that you were using satire, so taken literally what you wrote was a little shocking. Anyways, no harm done.

I'm much like you in political philosophy in that I think we need to be very very careful about how we change the current system. (Clot's idea is very radical and is unlikely to ever be implemented in the US)

Well, as a person with a Jewish backgroudn and a number of physical conditions that require treatment, I think you are misunderstanding anything that you construe as eugenics. It is an interesting reaction from people to see that everyone has this reactionary feeling to the truth. If I couldn't generate the income to take care of myself in the long run, it would be economically disadvantageous to take care of me from the outside. I have NEVER advocated euthanizing anyone. I've never even said that we as individuals shouldn't take care of people. I just pointed out that doing so isn't the greatest "public good." No has attempted to refute that statement. I believe that anyone who works to take care of himself and pays for his own expenses is entitled to ALL of the rewards of that labor, regardless of race, mental status, disability, etc... That is true equal protection.

 

[Miami_med]

Miami_med, would you say that you advocate a "survival of the fittest" in society? In other words, you accept a situation that, if for whatever reason, people could be dying in our streets for lack of food or medical care (that they cannot afford or do not qualify for and not enough people want to help them, etc.)? Or do you think that only small number would face such a demise and the rest would "learn the lesson" and do what they can to survive?

I'm not in agreement with "survival of the fittest," as a personal philosophy. However, a scientific argument might point to the fact that the fittest are more prone to survive in any environment. Human culture, productivity, and even law change the environment.

I'll give you an example. Having poor vision is a big disadvantage in a world before glasses. This was a trait that was relatively rare in young humans before the advent of glasses. Now, many years after glasses became prominent, 1/3 of all young people are near sighted. This is because having good vision was no longer all that superior to poor vision as a survival mechanism. Thus, good vision no longer made a person more fit.

My desire to fight universal healthcare comes less from an ideaology of survival of the fittest and more from an ideaology of the superiority of truth. People like to rant and rave about people dying in the streets, but this is simply not the case in a non-universal system. Before Medicare in the 1960s, most elderly people HAD medical care. Most physicians DID see them for what they could pay. The philosophy behind Medicare, as was put by one proponent, "Doctors have a fine tradition of providing services without charge to those who are unable to pay but many people feel uncomfortable in asking for and obtaining something for which they cannot pay." The background behind major government involvement in medicine was dishonesty. Making people who are charity cases feel as though they are not charity cases is not a social good. You now promote a system in which everyone demands the work of highly trained professionals as an entitlement, eschewing the notion that it should be any other way. I have provided more than my fair share of free medical care even as a medical student. I have been involved with many groups that have done so. The best example of what would happen without the government in healthcare is to look at the time before the government was in healthcare. It wasn't that long ago. (By the way, healthcare spending was at less than 5% of GDP at the time)

What about anittrust? You accept monopolies that collaborate to regulate and control prices (no anti-trust legislation)?

Well, I've always found anti-trust suspicious. The government is the biggest monopoly of them all. The vast majority of monopolies that come into existance do so by using government favors to undermine the competition or by being in a position to comply with all sorts of regulatory requirements that the upstarts cannot afford to comply with. The only other real possibility is to use physical force to remove competition (Think Rockefeller). The government should stop the force. Aside from that, if someone offers a good at such a cheap price that no one can compete or challenge them, then I am not against monopolies.

 

[Miami_med]

I wasn't equating you to Hitler. I was merely stating that your arguments put you on a very slippery slope.


Your argument that only individual benefits are for the good of society seems overly simplistic. Game theory suggests (via the Nash-Cournot equilibrium) that an optimal solution is reached at an intermediate point between what is best for the individual and what is best for the group (society). We cannot rely on individuals to do this out of the goodness of their hearts, as you propose, and hope that all works out for the best. Again, this seems to show an overly idealistic view of the world. Just because it worked in Atlas Shrugged doesn't mean it would work in the real world.

And that is the point of the free market. Individuals who provide more in the way of services or goods that people want are able to afford more for themselves personally. In your world, is society just the poor people? Are rich people part of society too? As I've said before, I'm not a true objectavist. I'm really more of an economic libertarian in the Misesian Tradition. I've enjoyed some of my reading of Ayn Rand, because she is one of the few authors that ever employs any of these principles.

Again, I ask you the question: in your pure free market, how does the single mother with AIDS get healthcare? Because some philanthropist decides to help her out? Is this really a viable system? You claim that you want to "help" these people, yet your worldview provides them no alternative other than extermination.

Well, even as you said yourself, the needs of the individual need to be balanced against those of society. I just believe that it happens best in a free market. I believe that private property is best for the individual and thus for society by proxy. Society is nothing but a conglomeration of individuals. The $400,000 or so worth of lifetime AIDS drugs you want to give this woman should be looked at more closely. Universal Healthcare isn't balancing the needs of individuals against society at all. It is pitting certain individuals against other individuals who have earned more. You will harm an awful lot of people to supply those drugs. We can't support everyone indefinitely with unlimited resources going to unlimited treatments. That is the harsh reality. We can only do the best we can. I trust physicians to make hard economic decisions with their patients far more than I trust George Bush, Hillary Clinton, or Mr. Obama. We can expect nothing more than the political resource wasting that has taken over everything from Social Security to the military to swallow up healthcare as well in a Universal System. A Mandatory insurance system will only do the same thing with a bunch of politically connected insurance companies getting rich.

 

[sirus_virus]

Nobody answered my question. How can you compare our health to these other countries when we are so obese?

Japan
Life expectancy at birth > Total population: 81.25 years
Obesity: 3.2%

Switzerland
Life expectancy at birth > Total population: 80.51 years
Obesity: 7.7%

Italy
Life expectancy at birth > Total population: 79.81 years
Obesity: 8.5%

Canada
Life expectancy at birth > Total population: 80.22 years
Obesity: 14.3%

Netherlands
Life expectancy at birth > Total population: 78.96 years
Obesity: 10%

United Kingdom
Life expectancy at birth > Total population: 78.54 years
Obesity: 23%

United States of America
Life expectancy at birth > Total population: 77.85 years
Obesity: 30.6% and rising.

Click on each country in this link and see how life expectancy almost follows obesity. http://www.nationmaster.com/graph/h...t_pop-expectancy-birth-years-total-population

Are we sure we are pointing the finger at the right source? We are projected to hit 40% obesity in 20 years. let me be the first to go on record saying--no matter which healthcare system we choose, universal or intergalactic, our healthcare expenditure is going to hit an unimaginable/unbearable high 20 years from now due to obesity.

 

[OncoCaP]

Miami_med: Thanks for clarifying that.

In terms of points of agreement, do you agree that private insurance companies should get out of the direct-bill/pay relationship they have with physicians or what reforms to private insurance do you advocate?

I assume you also want phase-out/elimination of Medicare and Medicaid as they are today? If these systems were converted such that Medicare was privatized (essentially an optional private insurance program perhaps with some government guarantees that people could pay into) and Medicaid was made an optional charitable system, would you be ok with them then?

 

[OncoCaP]

sirus: Yes, we are more obese. However, are we getting more care for these obese people? No, we aren't (look at my previous message -- we don't have more doctors per capita, we don't have more nurses per capita, and obese people are not getting to see physicians more often than slim people are in other countries). Our physician visits per capita and care delivered per capita are not larger. We just pay more. Just step over the border to Canada. They get the same drugs we do, but they pay much less for them because drug companies must negotiate with some tough negotiators. Instead, it's the silly Americans who get to subsidize care for the rest of the world (drug development costs). Show me that Americans overall are actually getting more visits and care. Be sure to include the uninsured in your statistics (people who cannot afford to see physicians). We also speak more English than the rest of the world, and we eat more cheeseburgers, but we aren't getting more care, even though we might be sicker.

Nobody answered my question. How can you compare our health to these other countries when we are so obese?

Japan
Life expectancy at birth > Total population: 81.25 years
Obesity: 3.2%

Switzerland
Life expectancy at birth > Total population: 80.51 years
Obesity: 7.7%

Italy
Life expectancy at birth > Total population: 79.81 years
Obesity: 8.5%

Canada
Life expectancy at birth > Total population: 80.22 years
Obesity: 14.3%

Netherlands
Life expectancy at birth > Total population: 78.96 years
Obesity: 10%

United Kingdom
Life expectancy at birth > Total population: 78.54 years
Obesity: 23%

United States of America
Life expectancy at birth > Total population: 77.85 years
Obesity: 30.6% and rising.

Click on each country in this link and see how life expectancy almost follows obesity. http://www.nationmaster.com/graph/h...t_pop-expectancy-birth-years-total-population

Are we sure we are pointing the finger at the right source? We are projected to hit 40% obesity in 20 years. let me be the first to go on record saying--no matter which healthcare system we choose, universal or intergalactic, our healthcare expenditure is going to hit an unimaginable/unbearable high 20 years from now due to obesity.