Premeds: Do you believe access to healthcare is a right or a privilege?

[LoneWolf85]

theProwler I cannot find consistent stats on the medicare per capita costs, but I cannot find your $10,000 amount either. IF they were that high, then the argument could be made that the people using medicare (over 65) are the most costly individuals in our health care system, thus they will have a much higher per capita rate. ESPECIALLY since there is not the rest of the younger country to counter balance that ratio.

Regardless, privatized per capita spending is large and it helps keep our per capita spending around $7,000. That is double almost every other 1st world nation, and we have some of the worst health care for our troubles. None of you arguing for keeping our current competitive based health care system is addressing the glaring issue of overhead costs and administrative headaches that are inherent in having such a complicated system.

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[T12]

Yep, I actually know a few physicians who decided to cut their private practice hours by a third (thus making 1/3 the annual income) and open a free HIV clinic. They work with the city's HIV awareness group to get subsidized medication for these patients, since otherwise they wouldn't be able to afford the drugs due to an inability to get insurance (it's hard to get insurance if you became HIV positive while uninsured, pre-existing condition clause and all that stuff). I would love to do something like that in the future back in my home state, since there aren't a lot of places like this available there.

Either you missed or ignored my previous post, but this quote highlights my point once again. There are those willing to become physicians and work for whatever the government will pay them. There are also a great deal who would be saving lives and develop ground-breaking treatments who decide that the field is too burdensome under a socialist system to realistically support themselves and their families the way they intend.

There is a shortage of doctors NOW. Schools will continue generating the same amount doctors as they do now, but the quality will be unquestionably less as a great deal of talented students will choose other more lucrative fields where they can provide an equally important service and live a more comfortable life.

 

[Quix]

Either you missed or ignored my previous post, but this quote highlights my point once again. There are those willing to become physicians and work for whatever the government will pay them. There are also a great deal who would be saving lives and develop ground-breaking treatments who decide that the field is too burdensome under a socialist system to realistically support themselves and their families the way they intend.

There is a shortage of doctors NOW. Schools will continue generating the same amount doctors as they do now, but the quality will be unquestionably less as a great deal of talented students will choose other more lucrative fields where they can provide an equally important service and live a more comfortable life.

If you are extending this idea to all forms of universal coverage, you are zero-summing and making assumptions that universal coverage requires a particular ideology. There is no guarantee that universal coverage will affect salaries or doctor availability, because there are a number of models meeting this standard covering a broad range of political and economic ideologies.

 

[T12]

If you are extending this idea to all forms of universal coverage, you are zero-summing and making assumptions that universal coverage requires a particular ideology. There is no guarantee that universal coverage will affect salaries or doctor availability, because there are a number of models meeting this standard covering a broad range of political and economic ideologies.

I am replying to a particular poster's frequent suggestions of a conversion to a socialized healthcare system modeled on that of certain European countries.

That is to say, I am not entirely opposed to the idea of universal COVERAGE. Mandating health insurance and government-run healthcare are not the same thought.

 

[VneZonyDostupa]

Either you missed or ignored my previous post, but this quote highlights my point once again. There are those willing to become physicians and work for whatever the government will pay them. There are also a great deal who would be saving lives and develop ground-breaking treatments who decide that the field is too burdensome under a socialist system to realistically support themselves and their families the way they intend.

There is a shortage of doctors NOW. Schools will continue generating the same amount doctors as they do now, but the quality will be unquestionably less as a great deal of talented students will choose other more lucrative fields where they can provide an equally important service and live a more comfortable life.

Whoops! Must have missed your post in while responding to Darknight's.

I'm sure there will be people who will opt opt of medical school if the pay was reduced slightly. What I'm more concerned with, though, is increasing primary care, not specialists. If we could keep primary care salaries at the current level or raise them a bit as an incentive, that would be great. I would think that most people who already want to do primary care would do so regardless of whether we have a private or social health system, so long as they are being paid roughly the same. If we lose some of our specialists, no biggie. Hopefully, people will start learning to live healthier and specialists won't be in such high demend. Plus, there's no real evidence that doctors' salaries would be hit much, if at all. Physicians still make great living wages in European systems.

Granted, we couldn't, and wouldn't make these changes overnight, so it's not like we're suddenly dropping the number of specialists in the system.

 

[Quix]

I am replying to a particular poster's frequent suggestions of a conversion to a socialized healthcare system modeled on that of certain European countries.

That is to say, I am not entirely opposed to the idea of universal COVERAGE. Mandating health insurance and government-run healthcare are not the same thought.

Gotcha. Part of the problem of jumping halfway into long conversations.

 

[DarknightX]

Darkknight I cannot find consistent stats on the medicare per capita costs, but I cannot find your $10,000 amount either.

Darkknight, comparing our system to India's is quite a stretch...

Bro, I never said either of those things..I think your getting me confused with ayushman80 and theProwler.

 

[LoneWolf85]

Ah, so I did, my apologies Darkknight.

To Quix: Thanks for the Clarke Thomas link. Good read.

 

[T12]

Whoops! Must have missed your post in while responding to Darknight's.

I'm sure there will be people who will opt opt of medical school if the pay was reduced slightly. What I'm more concerned with, though, is increasing primary care, not specialists. If we could keep primary care salaries at the current level or raise them a bit as an incentive, that would be great. I would think that most people who already want to do primary care would do so regardless of whether we have a private or social health system, so long as they are being paid roughly the same. If we lose some of our specialists, no biggie. Hopefully, people will start learning to live healthier and specialists won't be in such high demend. Plus, there's no real evidence that doctors' salaries would be hit much, if at all. Physicians still make great living wages in European systems.

Granted, we couldn't, and wouldn't make these changes overnight, so it's not like we're suddenly dropping the number of specialists in the system.

It's important to note the size of the countries who have had relative success with the system you support. The populations they have to support are remarkably small in comparison to our own. I should clarify by saying that I mean their population of irresponsible citizens is remarkably low compared to the United States.

We have the greatest healthcare innovations and practice on Earth and rightly so, as we have the most irresponsible populace reagrding health. European systems work with some success because the costs to support their populations are not that great. I can not believe that a similar system here would have that sort of success. This would immediately defer importance to a previous poster's point of prevention as a solution before all else.

 

[VneZonyDostupa]

It's important to note the size of the countries who have had relative success with the system you support. The populations they have to support are remarkably small in comparison to our own. I should clarify by saying that I mean their population of irresponsible citizens is remarkably low compared to the United States.

We have the greatest healthcare innovations and practice on Earth and rightly so, as we have the most irresponsible populace reagrding health. European systems work with some success because the costs to support their populations are not that great. I can not believe that a similar system here would have that sort of success. This would immediately defer importance to a previous poster's point of prevention as a solution before all else.

Oh, of course prevention should come first. A few pages back I mentioned that Sweden implemented several programs to teach basic health awareness and exercise programs along with their health system. I think America could use a good kick in the butt when it comes to health, myself included.

That being said, having one of the greatest practices doesn't do you much good if you don't have similarly great access. Anyone can go to the ER for emergent needs, but what happens if you need a specialist? I'm fortunate enough to have decent health care (working for a state medical school), but if I was unlucky enough to be diagnosed with some sort of cancer tomorrow, there's no way I could pay the portion left over once insurance pays their part (they pay 70% of the total bill, but 30% of a $20,000 treatment [MRI or CT, blood work, consultations, specialist charges, etc., I'm using a family members estimated charges as an example] is still $6000). I would have to either dig myself thousands of dollars into credit card debt or ruin my credit (and thus risk ruining my chances of getting better insurance later), despite the fact that I am an insured individual.

 

[bobsagat]

I believe the distinction here is moot. The only rights acknowledged by the US government are those in the Constitution and the (duh) Bill of Rights.

I was going to talk about how legal counsel is a privilege afforded by the US government. Then I realized that it's actually in the Bill of Rights. I honestly think the analogy holds true from a philosophical and theoretical viewpoint. A person is, by both chance and by virtue of the way he or she lives, called to court to defend himself, and the United States government considers professional legal defense a right.

Why is coming to the doctor's office with an affliction that happened due to factors which may or may not be under one's control any different? In both cases professional advocates are paid for by the government to help prevent personal catastrophe. The personal risk, be it legal or medical, is socialized.

Now if you want to talk about the difference in cost between a public defender and running a doctor's office/obtaining proper medications/running proper tests, etc, then that's fine. But the similarities here are striking from a theoretical perspective, in my view at least.

I guess I just contradicted my original point... It's a right! (or it should be)

 

[Ella Shepherd]

I noticed an interview question that asked the question, "Do you believe healthcare access is a right or a privilege?"

To me, the answer was obvious : It's a right. If you can afford it, you can get healthcare anytime.

Maybe the question should have been, "Do you believe health insurance is a right or a privilege?"

Regardless, what do you guys think?

Healthcare is a right. Everybody has to be and deserves to be healthy, just as every child has the right to learn and to be educated.

 

[T12]

This highlights a flaw in our current system, yes, but does nothing to answer the question of how our government could support a population of remarkably unhealthy individuals growing at an almost exponential rate.

Our parents' generation is currently the one that is stretching the system. I for one do not believe for one second that I have lived as healthy of a lifestyle as my parents up to the age of 20. The burdens they produce now will not compare to what we will produce.

History has proven that bureaucracies fail when given enormous tasks. A United States Socialized Healthcare system would be far-and-away the largest, most complicated bureaucracy in history. It's failures would be no less in magnitude.

If we place this problem in the government's hands now, we will certainly see our mistake first hand when our time of sickness comes and innovation and quality has remained stagnant for half a century.

 

[bobsagat]

This highlights a flaw in our current system, yes, but does nothing to answer the question of how our government could support a population of remarkably unhealthy individuals growing at an almost exponential rate.

Our parents' generation is currently the one that is stretching the system. I for one do not believe for one second that I have lived as healthy of a lifestyle as my parents up to the age of 20. The burdens they produce now will not compare to what we will produce.

History has proven that bureaucracies fail when given enormous tasks. A United States Socialized Healthcare system would be far-and-away the largest, most complicated bureaucracy in history. It's failures would be no less in magnitude.

If we place this problem in the government's hands now, we will certainly see our mistake first hand when our time of sickness comes and innovation and quality has remained stagnant for half a century.

I fail to see how it would be larger than instituting public education, where every single child under the age of 18 spends 8 hours of 3/4 of their weekdays in a classroom under the supervision of a government-paid teacher.

Or the implementation and maintenance of an interstate highway system spanning an entire continent. We seemed to get that one right.

Costs may be different, but a lot of the system is still in place. It's not like we'd have to train completely new medical personnel.

 

[VneZonyDostupa]

This highlights a flaw in our current system, yes, but does nothing to answer the question of how our government could support a population of remarkably unhealthy individuals growing at an almost exponential rate.

I understand this, which is why the system isn't like flipping on a switch, it's gradual. As the baby-boomers die out, there is less of a strain on cost-intensive health care and social security.

History has proven that bureaucracies fail when given enormous tasks. A United States Socialized Healthcare system would be far-and-away the largest, most complicated bureaucracy in history. It's failures would be no less in magnitude.

I don't know...the EU is a pretty big bureaucracy and it's doing alright.

If we place this problem in the government's hands now, we will certainly see our mistake first hand when our time of sickness comes and innovation and quality has remained stagnant for half a century.

I still don't understand this whole "innovation will stop" standpoint. Most innovation comes from the university scientific community, funded by the NIH. Why would these people stop their research all of a sudden?

And with that, I'm going to sleep. It's been fun =) I'll check in again tomorrow for the inevitable replies.

 

[T12]

I fail to see how it would be larger than instituting public education, where every single child under the age of 18 spends 8 hours of 3/4 of their weekdays in a classroom under the supervision of a government-paid teacher.

Or the implementation and maintenance of an interstate highway system spanning an entire continent. We seemed to get that one right.

Costs may be different, but a lot of the system is still in place. It's not like we'd have to train completely new medical personnel.

You would be one of few who feel our education system is on par other countries.

And about our interstate highway system, I'll defer to Wiki first, http://en.wikipedia.org/wiki/I-35W_Mississippi_River_bridge

It is interesting to note that our Interstate Highway System, which was initially constructed as a potential defense to Communist attack, is now referenced as a support for its ideals.

 

[bcat85]

Whoops! Must have missed your post in while responding to Darknight's.

I'm sure there will be people who will opt opt of medical school if the pay was reduced slightly. What I'm more concerned with, though, is increasing primary care, not specialists. If we could keep primary care salaries at the current level or raise them a bit as an incentive, that would be great. I would think that most people who already want to do primary care would do so regardless of whether we have a private or social health system, so long as they are being paid roughly the same. If we lose some of our specialists, no biggie. Hopefully, people will start learning to live healthier and specialists won't be in such high demend. Plus, there's no real evidence that doctors' salaries would be hit much, if at all. Physicians still make great living wages in European systems.

Granted, we couldn't, and wouldn't make these changes overnight, so it's not like we're suddenly dropping the number of specialists in the system.

Primary care is ultra-cheap. Why should anyone pay for other people's primary care. It's like 100 bucks to see a PCP. If you either (a) smoke or (b) have cable TV (as many of the "underserved" do), you can afford 100 bucks a year to see your primary care doctor and maybe 10 bucks a month for an ACE inhibitor to control your blood pressure.

And with regards to the bold, are you serious? Have you been outside lately? I sat in the cafeteria at my hospital and watched 3 large people devour the sum equivalent of a side of beef... it ain't gonna happen. Incidentally, it turns out that obesity doesn't respond to medical intervention by a primary care physician.

Oh, of course prevention should come first. A few pages back I mentioned that Sweden implemented several programs to teach basic health awareness and exercise programs along with their health system. I think America could use a good kick in the butt when it comes to health, myself included.

See above. You have to remember that Americans are very unhealthy as a whole. I would imagine that the medical firepower required to treat our country would probably treat almost all of India.

Healthcare is a right. Everybody has to be and deserves to be healthy, just as every child has the right to learn and to be educated.

False. Who's going to give it to these people? The magical doctor machine?

 

[T12]

I understand this, which is why the system isn't like flipping on a switch, it's gradual. As the baby-boomers die out, there is less of a strain on cost-intensive health care and social security.

OK, this is my last one too, but I have to go ahead and respond to this stinker.

The baby-boomers are nothing compared to their kids. We're fatter, lazier, and more populous. Take every baby-boomer, multiply by 3 to account for their offspring, subtract 20 years of riding their bikes to school, and add about 1,000,000,000 more units of soda and french fry grease to their arteries and you get our generation: I'll call them the baby-atomic-boomers.

The idea that, as they die, the burden will be lessened is hopelessly optimistic, and tragically flawed. For now, please rethink whatever foundations of your logic you developed while believing this.

 

[VneZonyDostupa]

Primary care is ultra-cheap. Why should anyone pay for other people's primary care. It's like 100 bucks to see a PCP. If you either (a) smoke or (b) have cable TV (as many of the "underserved" do), you can afford 100 bucks a year to see your primary care doctor and maybe 10 bucks a month for an ACE inhibitor to control your blood pressure.

If all you need from your PCP is a check-up and an ACE inhibitor, you're right, it's cheap.

You know those aren't the only things people go to PCPs for, right?

And with regards to the bold, are you serious? Have you been outside lately? I sat in the cafeteria at my hospital and watched 3 large people devour the sum equivalent of a side of beef... it ain't gonna happen. Incidentally, it turns out that obesity doesn't respond to medical intervention by a primary care physician.

Ah, yes. I forgot that the American people are a large, unmoving, immutable mass.

Seriously, you don't understand that culture is constantly shifting and evolving? Look at the ideal of the perfect woman's body and how it's changed in the past 50 years, for example. I'm not saying we can change current obese adults, but who says we can't lower the obesity rate in the next generation by further integrating health education in schools in all grades? And who says it won't be even lower in the generation after that? And so on, and so on.

Okay, now I'm seriously going to sleep. Lots of rats to work with in the morning, and they need their cocaine fix (addiction study), otherwise they get antsy.

 

[VneZonyDostupa]

OK, this is my last one too, but I have to go ahead and respond to this stinker.

The baby-boomers are nothing compared to their kids. We're fatter, lazier, and more populous. Take every baby-boomer, multiply by 3 to account for their offspring, subtract 20 years of riding their bikes to school, and add about 1,000,000,000 more units of soda and french fry grease to their arteries and you get our generation: I'll call them the baby-atomic-boomers.

The idea that, as they die, the burden will be lessened is hopelessly optimistic, and tragically flawed. For now, please rethink whatever foundations of your logic you developed while believing this.

Sorry for such a short response, but see my above post. You posted this as I was responding to a similar post from another user. G'night! It's been great debating with you guys, real stimulating.

 

[45408]

Why? I haven't seen any real, hard data to support that stance from anyone yet other than lame comparisons to the DMV.

Try not to think too hard on this one. The US already spends more than any other country in the world. Many people in the US have no coverage at all, and most people in the US don't have coverage coming from the federal government. If we INCREASE the number of people being covered by the federal government by a significant integer, our expenses will vastly increase. Medicare is already slated to overtake our federal income in the coming decades. That's why.

 

[Greonis]

Whether or not later generations are more or less healthy than the baby boomers is certainly a problem, but the real change that is needed is how we treat those at the end of their lives.

We keep people (or, better put, the shells of people) "alive" for years whose quality of life has long since slipped away, spending thousands of dollars per month on them in tests and transportation costs. They clog up hospitals and clinics, are breeding grounds for treatment-resistant bacteria/viruses due to rampant/irresponsible drug abuse, and put a massive strain on an already-burdened healthcare system. Why is it like this? Because of ideology that everyone needs to be treated all of the time, and that - god forbid - it would be a failure for us to allow someone to pass away when they reach a natural end of their life. Not to mention the climate of fear that enshrouds all physicians these days. Want to fix the system? Fight for tort reform and doctors who can use their experience to refuse treatment when it is deemed to have no long-term beneficial effects for the patients. Moreover, people need to learn that keeping a loved one "alive" whose mind is gone and will never be anything more than a shell is costly to the public, a burden to the system, and a source of nothing but agony and stress for the family. But nothing is ever done. Why? Because it is not politically correct and is "offensive" to those with family members in that situation. It's something that just doesn't want to get heard, ever.

This is a massive problem that will only be exacerbated as more and more people retire and qualify for medicare. It is also one major reason why US healthcare is so expensive, as most other countries do not irresponsibly aggrandize these end-of-life issues. If only more politicians were to want to talk about it over universal health care, which hides these issues under the more manageable "free market vs. big brother" debates.

 

[bobsagat]

This is a massive problem that will only be exacerbated as more and more people retire and qualify for medicare. It is also one major reason why US healthcare is so expensive, as most other countries do not irresponsibly aggrandize these end-of-life issues. If only more politicians were to want to talk about it over universal health care, which hides these issues under the more manageable "free market vs. big brother" debates.

Yeah, good luck trying to work that political angle against elderly voters, who for my money matter less and vote more than any other demographic. Read: Social Security.

You would be one of few who feel our education system is on par other countries.

And about our interstate highway system, I'll defer to Wiki first, http://en.wikipedia.org/wiki/I-35W_Mississippi_River_bridge

It is interesting to note that our Interstate Highway System, which was initially constructed as a potential defense to Communist attack, is now referenced as a support for its ideals.

1. I never said that our education system was better than other countries'. I'm saying that despite the problems you don't see any presidential candidates running on a platform promising to do away with public education. The flawed system is worlds better than the alternative. (no system) Can you imagine the educational disparity if the only schools around were private schools?

2. Same argument. Just because there are events that expose important flaws in the system doesn't mean the system is an abject failure. Under a single payer system, medical malpractice would continue, but it's a rather moot point. Let's not toss the baby out with the bathwater.

3. I agree that it's ironic, but the point still stands. No one is clamoring for a reduction in funding for the IHS.

 

[T12]

Who constructs the highway systems for the most part? government construction workers?

Or do private firms COMPETE for certain large projects? The highway system gets funding so they can pay private firms. Your logic doesn't support the analogy. The government isn't actually responsible for constructing and maintaining the highways. If so, bridges would have been collapsing much more frequently, in my opinion.

Your analogy applies more so to the idea of universal coverage, although only loosely. The government pays money that will then be used to pay competing private companies and practitioners.

 

[bobsagat]

Ok, I'll concede the point on the highway system, but just because it's not a good counterexample doesn't prove the rule.

By the logic in one of your above posts, it would be a catastrophic failure to provide government-dispensed medical care to all citizens, and yet we know that many first world countries are quite happy with their socialized health care systems. There are certainly no perfect systems in place in any country, but the argument still stands: everyone else's system seems to be working far better for them than ours does for us.

I've heard the argument that a country with a population as large and diverse as ours couldn't make it with universal coverage, to which I'll just reply that it could easily be implemented on a state-level or even smaller (read: Massachusetts' experiment intrigues me).

 

[T12]

This is much more realistic, yes, as state-run governments can handle their own individual populations much more effectively. However, if you're going to give the responsibility of reforming healthcare to the states, you also have to give the states the right to decide for themselves how to reform it. So any grand reformation plan that you had in mind is pointless if you're going to leave it up to the states to implement, because they're going to do it their way, not yours.

And Romney-care does look intriguing, but I think you'll find it is nothing like what some of the very loud liberal voices in this country have in mind. It's an insurance coverage mandate providing coverage to those around and below the poverty level. Reasonable, and similar to what some major politicians have proposed, but a FAR cry from what has been suggested on this very thread.

 

[45408]

I've heard the argument that a country with a population as large and diverse as ours couldn't make it with universal coverage, to which I'll just reply that it could easily be implemented on a state-level or even smaller (read: Massachusetts' experiment intrigues me).

Which is an entirely different solution, one that I would in fact be interested in having implemented. This way, different states could try different approaches, and citizens of a state with a terrible system could move if they wanted. It's not likely that anyone would actually leave the entire USA because of a bad federal system, but a state-by-state system would leave a lot more flexibility and choice up to the individual. Furthermore, a smaller system could be more easily revised and adjusted than one that was 50-100 times larger. Besides, a federally-run system is unconstitutional, whereas a state-run system - within the guidelines of that state's constitution - poses no such problem.

 

[bobsagat]

Which is an entirely different solution, one that I would in fact be interested in having implemented. This way, different states could try different approaches, and citizens of a state with a terrible system could move if they wanted. It's not likely that anyone would actually leave the entire USA because of a bad federal system, but a state-by-state system would leave a lot more flexibility and choice up to the individual. Furthermore, a smaller system could be more easily revised and adjusted than one that was 50-100 times larger. Besides, a federally-run system is unconstitutional, whereas a state-run system - within the guidelines of that state's constitution - poses no such problem.

How would it be unconstitutional? And if unconstitutional, how would the states be able to get around that, wouldn't the ACLU (or a similar group) sweep in and "save" everyone? Washington, DC tried to pass a law stating that guns must be stored in a disassembled state, and they were sued for the law being against the second amendment despite it not being against their constitution.

 

[xiaoyi666]

privilege. if it's a right then you're entitled to it, unless you can provide yourself with medical care, then someone else has to provide it for you. Who and what medical care to provide is the provider's choice. Since you're receiving the care at someone else's "expense" (doctor's time, other patients' time...) then it's a privilege that you received it at all. Does that mean people don't deserve medical care? no, it just means people shouldn't feel entitled to it but should be grateful for everything they receive.

 

[45408]

How would it be unconstitutional?

Good question. Now, granted, I have a fairly literal read of most of the Constitution, but I think this is fairly clearly spelled out in the Tenth Amendment (so if you disagree, you must change the Constitution before you make a law): "The powers not delegated to the United States [this would be the federal government] by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

And if unconstitutional, how would the states be able to get around that

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

wouldn't the ACLU (or a similar group) sweep in and "save" everyone? Washington, DC tried to pass a law stating that guns must be stored in a disassembled state, and they were sued for the law being against the second amendment despite it not being against their constitution.

Because DC tried to prevent people from a right that was guaranteed to them. Your state can create ADDITIONAL RIGHTS - such as the right to free health care - but it CAN NOT remove rights, like free speech or women's right to vote.

 

[8744]

Why single-payer, universal coverage, socialized medicine, or whatever you call it will bankrupt the nation no matter what you do...

http://thehappyhospitalist.blogspot.com/2008/09/your-new-home-is-happys-hospital.html

 

[astrife]

Free markets are the most effecient way to allocate limited resources. That said, I think there is a major market failure that is keeping the medical industry from being more efficient.

A healthcare consumer does not directly spend his/her own money for healthcare services. This creates a disconnect in the consumer's mind of how much healthcare actually costs, and consequently makes it less likely that they make fiscally responsible decisions. This is compounded by the fact that no transparent system is in place which allows consumers to compare cost/quality of healthcare providers.

Health Savings Accounts are really quite nifty in my opinion for solving this problem, and if the funds aren't used they can be used for retirement.

With an HSA a person is going to be alot more cautious in their healthcare expenditures because it is directly tied to their own money. Catastrophic coverage is still in place when necessary because no one is realistically going to save $500,000 dollars up in case they need brain surgery. One big problem I see, however, is that most of the population isn't responsible enough to fund their own 401k so an HSA is probably going to be underfunded as well by most people.

Also I think that a health insurance mandate is the best idea on the table right now. People in general do not plan well, and many people will not get health insurance unless forced to. As smart as I think Obama is, I cannot believe he doesn't embrace it. I voted for Ron Paul in the republican primary, but I was rooting for Hillary over Obama soley because she was smart enough to back that position.

In essence, what I'm getting at with this rambling is that I think the healthcare industry would behave more like the potatoe chip industry (ie. more efficient) if some specific regulations were put into place to correct for the market breakdown that results from the healthcare's industry's special nature.

 

[VneZonyDostupa]

A blog of anecdotes and opinions relating to why single-payer, universal coverage, socialized medicine, or whatever you call it may bankrupt the nation no matter what you do...

http://thehappyhospitalist.blogspot.com/2008/09/your-new-home-is-happys-hospital.html

Fixed that for you. Good read, though.

 

[xiaoyi666]

Free markets are the most effecient way to allocate limited resources. That said, I think there is a major market failure that is keeping the medical industry from being more efficient.

This is only true to an extent. The most efficient allocation occurs only during cases of "infinite" buyers and sellers. In industries where operating cost are exceptionally high, i.e. healthcare, SOMETIMES it is better to be managed. Due to the high cost of operating in the industry, it is difficult to have many sellers. Sellers are at a very high risk when starting the industry and few have the capital to do so. At worst oligopolies or monopolies may form and when unregulated, could be an even larger problem. Thus, federal government often allow only one seller and eliminate the competition but heavily regulate the seller.

One example of this is your electricity. Electric companies are heavily regulated by federal law and there is almost no "competition" within a region. Sometimes competition is bad. I'm not saying managed healthcare is the way to go bc of the many problems it also leads to. Just raising a point about economics.

 

[BlitzSleep]

I'm still trying to figure out how people cannot afford insurance. The only people that I know that do not have health insurance are the ones that get a little unemployment check every month. I mean come on my health insurance is like $50 less a month than my car payment.

I guess transportation will be the next "basic human right."

 

[VneZonyDostupa]

I'm still trying to figure out how people cannot afford insurance. The only people that I know that do not have health insurance are the ones that get a little unemployment check every month. I mean come on my health insurance is like $50 less a month than my car payment.

I guess transportation will be the next "basic human right."

You should ask your employer how much of your insurance payment they make for you every month. My insurance is relatively cheap ($120/month), but my employer pays about $350/month for me. Many employers either can't or won't pay for any portion of an employee's health insurance, and you can forget a family plan.

Just something to think about before you mischaracterise a whole group based on your personal experiences...

 

[BlitzSleep]

You should ask your employer how much of your insurance payment they make for you every month. My insurance is relatively cheap ($120/month), but my employer pays about $350/month for me. Many employers either can't or won't pay for any portion of an employee's health insurance, and you can forget a family plan.

Just something to think about before you mischaracterise a whole group based on your personal experiences...

Okay, let me think...$470 a month for health insurance if the employer doesn't pay a dime... I pay that much a month in gas to go back and forth to school....I guess you're right, why should I expect someone to stop smoking and drinking so that they COULD afford healthcare...you know, so they can go to the doctor when they have bronchitis or something. My bad.

 

[VneZonyDostupa]

Okay, let me think...$470 a month for health insurance if the employer doesn't pay a dime... I pay that much a month in gas to go back and forth to school....I guess you're right, why should I expect someone to stop smoking and drinking so that they COULD afford healthcare...you know, so they can go to the doctor when they have bronchitis or something. My bad.

You spend over $450/month in gas just to drive to and from school? Let's break that down. I'll be generous and assume you drive there seven days a week for studying, etc.:

$470/30days = $15.66/day spent on gas

$15.66/$3.64 (current nat. average) = 4.30 gallons

Assuming you drive a Hummer H2 (just to show an extreme), that would mean you are driving 60 miles roundtrip, assuming it is all in the city. If you are driving on the highway, it is 77.4 miles.

Do you really expect me to believe that your "monthly gas" cost is reasonable for someone who "only drives to an from school"? Realistically, if you drive an average car and are only driving 10-15 miles to and from school, you're only spending about $130 ([30miles * 30 days / 25mpg] *3.64).

Maybe you should stop using hyperbole to support a bad stance and just stick to reality. When I had just graduated and was looking for a job, there was no way I could pay COBRA insurance, it's insanely expensive. When I did get a lab job, there would have been no way I could pay rent, car payment, AND a $450 monthly health insurance payment. Luckily, the employer paid a good portion of it. Just because you've been suckered into the whole idea that ALL poor people smoke/do drugs/drink/want to be poor, doesn't mean it's true.

Whether or not you agree with the idea of universal healthcare, you would have to have your head in the sand if you think that the current system works.

 

[8744]

Fixed that for you. Good read, though.

Well no. The fundamental problem is overuse, not access. As the Happy Hospitalist points out, the patient he describes is in no way unusual and until we get a handle on the terrific costs associated with not only futile care but many other areas in our system where money is figuratively speaking flushed down the crapper, it doesn't much matter what we do in regards to controlling costs.

I would say that for me, on a typical shift, at least half of the patients have no need of any medical care whatsoever and could be sent home from triage except that there are two incentives to see every minor complaint that walks in and give it the full monty (so to speak). The first is the fear of litigation for missing a diagnosis. Since there is no penalty for over-reacting (because it's not my money) and a huge penalty for missing something which is incredibly rare or not very likely, the tendency is to over-react. The second disincentive to economy is the sure knowledge that minor complaints still pay pretty well and medicaid patients, for example, the cash cows of Emergency Medicine who use medical care like drunken sailors, are money in the bank...like taking candy from a baby and there is no reason not to work them up.

At least two patients I see out of twenty or so every shift, on the other hand, are completely "played out," at the end with no quality of life whatsoever and more diseases than you can possibly imagine but we still admit them to the ICU for a hundred thousand bucks worth of medical care before they either die or return to their nursing homes even sicker (if that's possible) until the next time.

Anecdotal, perhaps, but I'm sure some of the residents on SDN in every specialty can chime in with their own assessment of the monstrous waste in our system from too much access and too much use by too many people.

 

[VneZonyDostupa]

Well no. The fundamental problem is overuse, not access. As the Happy Hospitalist points out, the patient he describes is in no way unusual and until we get a handle on the terrific costs associated with not only futile care but many other areas in our system where money is figuratively speaking flushed down the crapper, it doesn't much matter what we do in regards to controlling costs.

I would say that for me, on a typical shift, at least half of the patients have no need of any medical care whatsoever and could be sent home from triage except that there are two incentives to see every minor complaint that walks in and give it the full monty (so to speak). The first is the fear of litigation for missing a diagnosis. Since there is no penalty for over-reacting (because it's not my money) and a huge penalty for missing something which is incredibly rare or not very likely, the tendency is to over-react. The second disincentive to economy is the sure knowledge that minor complaints still pay pretty well and medicaid patients, for example, the cash cows of Emergency Medicine who use medical care like drunken sailors, are money in the bank...like taking candy from a baby and there is no reason not to work them up.

At least two patients I see out of twenty or so every shift, on the other hand, are completely "played out," at the end with no quality of life whatsoever and more diseases than you can possibly imagine but we still admit them to the ICU for a hundred thousand bucks worth of medical care before they either die or return to their nursing homes even sicker (if that's possible) until the next time.

Anecdotal, perhaps, but I'm sure some of the residents on SDN in every specialty can chime in with their own assessment of the monstrous waste in our system from too much access and too much use by too many people.

For once, and I know this will be shocking, I agree with you, Panda. There is an absolutely abhorrent amount of abuse/over-prescription in our system, plus a ton of preventative testing to avoid malpractice. That's one of the reasons people in socialised health settings have waitlists (not the only reason, but one). The health care providers look at their patient lists and those patients' health concerns, and decide who to see first. Sure, you hear people complaining that it took them 6 months to get a hip replacement, but you don't hear about people waiting 6 months to get a rabies shot after being bitten by a rabid animal.

If you were able to turn people away who don't *really* need your help and see mostly people who do need it, wouldn't you prefer that system?

 

[astrife]

This is only true to an extent. The most efficient allocation occurs only during cases of "infinite" buyers and sellers. In industries where operating cost are exceptionally high, i.e. healthcare, SOMETIMES it is better to be managed. Due to the high cost of operating in the industry, it is difficult to have many sellers. Sellers are at a very high risk when starting the industry and few have the capital to do so. At worst oligopolies or monopolies may form and when unregulated, could be an even larger problem. Thus, federal government often allow only one seller and eliminate the competition but heavily regulate the seller.

One example of this is your electricity. Electric companies are heavily regulated by federal law and there is almost no "competition" within a region. Sometimes competition is bad. I'm not saying managed healthcare is the way to go bc of the many problems it also leads to. Just raising a point about economics.

You sound more formally educated in economics than I am, so I'll take your word for it.

However, I wonder what you might have to say about recent states who deregulated their electricity industries to allow more competition into the system? There are mixed results in these states so it's not really clear the result. It is quite telling that some of the more progressive states (ie. New York, and California) are experimenting with it since they are the first to do most everything 'right' in major US policy.

 

[45408]

Okay, let me think...$470 a month for health insurance if the employer doesn't pay a dime... I pay that much a month in gas to go back and forth to school....I guess you're right, why should I expect someone to stop smoking and drinking so that they COULD afford healthcare...you know, so they can go to the doctor when they have bronchitis or something. My bad.

Not everyone's premium is so cheap. My parents' health insurance premium is over $25,000 a year, and their deductible is another $5000, and even then it's not 100% coverage. Not many people can afford that.

 

[xiaoyi666]

You sound more formally educated in economics than I am, so I'll take your word for it.

However, I wonder what you might have to say about recent states who deregulated their electricity industries to allow more competition into the system? There are mixed results in these states so it's not really clear the result. It is quite telling that some of the more progressive states (ie. New York, and California) are experimenting with it since they are the first to do most everything 'right' in major US policy.

I'm not too familiar with the deregulated system. My guess would be that the states want some form of competition to help lower prices in addition to providing a safety net for the consumers. Without competition, the actual "price" of electricity that would benefit both the seller and buyer would be fairly inaccurately determined. Maybe it could also be due to demand for alternative energy sources. Im fairly confident that regardless of the competition, just simply because everyone cannot live without electricity, the monopsony or oligopsony market will be heavily regulated.

 

[bobsagat]

Free markets are the most effecient way to allocate limited resources. That said, I think there is a major market failure that is keeping the medical industry from being more efficient.

A healthcare consumer does not directly spend his/her own money for healthcare services. This creates a disconnect in the consumer's mind of how much healthcare actually costs, and consequently makes it less likely that they make fiscally responsible decisions.

Well no. The fundamental problem is overuse, not access.

For once, and I know this will be shocking, I agree with you, Panda. There is an absolutely abhorrent amount of abuse/over-prescription in our system, plus a ton of preventative testing to avoid malpractice.

Hey, sweet. Looks like some of us are actually agreeing!

I think this is an important point that people tend to miss. Medical consumerism, fostered by ads from Big Pharma and other medical supply industries, are able to "educate" patients only to the extent that they believe that product X is something they desperately need. So they wind up at the doctor's office, eager to spend someone else's money armed only with a reductionist's guide to medicine.

Doctors know that if the patient doesn't get the Rx from them, they'll get it somewhere else. And on top of that, they're pushed to prescribe more than they probably ought to for fear of medical malpractice.

This is all stuff I've been reading in the book linked to in the signature. It's written by a former clinical faculty member at Harvard. Sorry to make this sound like a book report, but I think it's a good read. Still not done with it, though.

Concerning HSA's, have there been any good studies on the health of the people using these plans? I'd be curious to know what kind of disincentive there is to go to an annual checkup if you're afraid of getting in a car wreck or having some kind of other catastrophic medical mishap.

 

[BlitzSleep]

Not everyone's premium is so cheap. My parents' health insurance premium is over $25,000 a year, and their deductible is another $5000, and even then it's not 100% coverage. Not many people can afford that.

Well come on use some common sense, my mom makes like $25k a year, is her insurance that high? No where near it. Your parents probably make a ton, cause I have never heard of anyone's insurance being over $2k a month.

Do you really expect me to believe that your "monthly gas" cost is reasonable for someone who "only drives to an from school"?

You shouldn't assume on a forum. For one thing I have to use premium gasoline, and for another I travel ~110 miles a day back and forth to school. I put $20 in my tank every day. I do go to the gym every other day, but that's only a couple miles out of the way.

Anyways, back on topic. Health care is not a right in non-life threatening situations. Take for example someone has a cold. Why is it considered a right for that person to be treated? It's a waste of time. Going to the doctor in a circumstance like that is a privilege. Now if someone is about to die, then yes, they have the basic human right to live.

I agree with u , these days medical insurance is too expensive
but its well worth

I guess what they say is true....You get what you pay for.

 

[pianola]

I'm not going to jump into this conversation on page 6 but I'd just like to say I really appreciate VneZonyDostupa's enlightening/interesting posts. His/her arguments are sophisticated and well-expressed and help to remind me that there are beliefs that, IMHO, are nobler than the simplistic "an eye for an eye" mentality.

That said, I think Retsage is partially right about it being a semantics argument. Retsage gave the clearest example of why this was true.

 

[193250]

I haven't really read any of the other posts, but I'd say it's a right. Imo, if someone is in dire need of medical attention, I'd say fix them up first and worry about payments later.

 

[BlitzSleep]

I haven't really read any of the other posts, but I'd say it's a right. Imo, if someone is in dire need of medical attention, I'd say fix them up first and worry about payments later.

Read my last post.

Btw, that is how our healthcare is right now. When I was in a car accident with my cousin we were both sent to the ER. He didn't have insurance, but they still treated him. The hospital is allowing him to pay off his medical bills by monthly payments.

 

[amidoinitrite]

Panda Bear, Premedprincess, DarkKnightX, The Prowler, and NomoreAMCAS got it right.

For you others:


http://www.merriam-webster.com/dictionary/sophomoric

 

[VneZonyDostupa]

You shouldn't assume on a forum. For one thing I have to use premium gasoline, and for another I travel ~110 miles a day back and forth to school. I put $20 in my tank every day. I do go to the gym every other day, but that's only a couple miles out of the way.

You're either lying, or you made some horrendously poor decisions. Why buy a care that can "only use premium" gasoline? Why live 55 miles away from your school? If your case is accurate, which it very well may be, then you are an extreme, and it s unfair for you to compare your abve averagel fuel costs to average insurance costs.

Anyways, back on topic. Health care is not a right in non-life threatening situations. Take for example someone has a cold. Why is it considered a right for that person to be treated? It's a waste of time. Going to the doctor in a circumstance like that is a privilege. Now if someone is about to die, then yes, they have the basic human right to live.

Why do you think certain people in socialised systems are given long wait times? It's because their illness is not critical and a poor use of resources. If you live in Sweden and you go to the ER over a cold or sinus problem, you will have to wait while the MI patient is seen, then the car wreck, then the gunshot, the pregnant woman with pre-term cramps, and on and on, and even then you may just be told to go home. This is why home remedies are so popular in the UK and other countries. They know that their condition isn't bad enough to warrant a trip to the hospital, so why bother?

In America, you still have to wait some time, but you will most likely see a physician who will give you some sort of treatment, thus soaking up time and resources better spent elsewhere.