socialized medicine

[mtoto]

Here's an interesting read as well. Good points to counter some of your's, if not a bit long. I don't think the wikipedia summary is a good way to form an opinion by the way.

http://www.cato.org/pubs/pas/pa532.pdf

Read most of this though it got kinda long toward the end so I drifted off a bit. Gosh I love this thread.

I agree with many of the things talked about in this article. Undoubtly our Canadian health system has problems. In fact generally as Canadians, we consider ourselves in somewhat of a healthcare crisis. It is true that healthcare is rationed by wait lists and that rural areas are underserved and that you may be able to jump the queue for an MRI if your uncle's a radiologist. And how many times do I have to say that I agree that generally insured Americans are get better care then Canadians.

But my point has never been that the US should adopt a single payer system (though I do think it is one of Canada's strengths). What the article does not discuss are the 40 million Americans who currently do not have any insurance (private, public whatever). The point is that the US spends 30% more per capita on health care while leaving 40 million people completely without care. It's not like the US system is not subsidized by the government/taxes- it is and more so than in Canada. And it does this while leaving 1/5 of it's population uninsured. Why should the rich have their care subsidized while the poor go completely without?

Therefore my point is that there should be universal care... however you do it, public, private, whatever- pick your bag.

And here is where Miami and I differ and we can talk stats and studies until we are blue in the face but if we can not agree on the same values then we will never agree.

I realize that some people would just like to be left alone. They do not want their hard earned salaries taxed. They want to be able to every once in a while when they are feeling especially godly to walk out of their fortress and throw some $20 bills onto the homeless single mother that lives in the dump down the street.

I think that charity can be a good thing... but more often then not it is problematic. The problems of Africa are actually case in point. The developed world's attitiude toward Africa has for many years been one of charity. The result is just what Miami has described, money is spent on short term projects at the whim of the developed world's good intent. Buildings are built one year and abandoned the next. There is no commitment to development. Commitment to development would require consistent funding and a long term outlook. Funding should be there for things that can jump start an economy... like roads and infrastructure. I think that charity is a good thing but it is not a substitute for long term commitment to improving the condition of a people.

Imagine if you really cared about something... like if you had a son and your attitude to your son was one of charity- and charity alone. When you have a good day you feed your son 7 times and buy him 4 toy trucks. On your bad weeks, you kid starves. What kind of kid do you think you would end up with in 10 years?

About "self preservation". I want you to think about what it means to be human. I was raised to believe that it is the choices we make that define our humanity. Any animal is capable of "self preservation"... it is the most basic instinct. Even animals with brains the size of a needle point can self-preserve. But what animal is able to exercise compassion the way humans do- to sacrifice, to comtemplate meaning and and the existence of gods. I feel that this is what makes us human... our ability to think for eachother in complex ways, our ability to plan for a future we may never see, and to care for people a thousand miles away.

But it's true that we may choose not to exercise that ability... but then what a waste of a human being... such a person would have done just as well as a dung beetle (bless dung beetles as they are essential to nature's ecosystem).

Anyway, it's getting late and I really have to get to sleep... but I wanted to make the argument that if you don't care about the 40 million people in your country that have no healthcare... you are selling yourself short.

P.S. Mammograms are not hard to come by in Canada!

---

Members don't see this ad.

 

[Miami_med]

Read most of this though it got kinda long toward the end so I drifted off a bit. Gosh I love this thread.

I agree with many of the things talked about in this article. Undoubtly our Canadian health system has problems. In fact generally as Canadians, we consider ourselves in somewhat of a healthcare crisis. It is true that healthcare is rationed by wait lists and that rural areas are underserved and that you may be able to jump the queue for an MRI if your uncle's a radiologist. And how many times do I have to say that I agree that generally insured Americans are get better care then Canadians.

But my point has never been that the US should adopt a single payer system (though I do think it is one of Canada's strengths). What the article does not discuss are the 40 million Americans who currently do not have any insurance (private, public whatever). The point is that the US spends 30% more per capita on health care while leaving 40 million people completely without care. It's not like the US system is not subsidized by the government/taxes- it is and more so than in Canada. And it does this while leaving 1/5 of it's population uninsured. Why should the rich have their care subsidized while the poor go completely without?

Therefore my point is that there should be universal care... however you do it, public, private, whatever- pick your bag.

And here is where Miami and I differ and we can talk stats and studies until we are blue in the face but if we can not agree on the same values then we will never agree.

I realize that some people would just like to be left alone. They do not want their hard earned salaries taxed. They want to be able to every once in a while when they are feeling especially godly to walk out of their fortress and throw some $20 bills onto the homeless single mother that lives in the dump down the street.

I think that charity can be a good thing... but more often then not it is problematic. The problems of Africa are actually case in point. The developed world's attitiude toward Africa has for many years been one of charity. The result is just what Miami has described, money is spent on short term projects at the whim of the developed world's good intent. Buildings are built one year and abandoned the next. There is no commitment to development. Commitment to development would require consistent funding and a long term outlook. Funding should be there for things that can jump start an economy... like roads and infrastructure. I think that charity is a good thing but it is not a substitute for long term commitment to improving the condition of a people.

Imagine if you really cared about something... like if you had a son and your attitude to your son was one of charity- and charity alone. When you have a good day you feed your son 7 times and buy him 4 toy trucks. On your bad weeks, you kid starves. What kind of kid do you think you would end up with in 10 years?

About "self preservation". I want you to think about what it means to be human. I was raised to believe that it is the choices we make that define our humanity. Any animal is capable of "self preservation"... it is the most basic instinct. Even animals with brains the size of a needle point can self-preserve. But what animal is able to exercise compassion the way humans do- to sacrifice, to comtemplate meaning and and the existence of gods. I feel that this is what makes us human... our ability to think for eachother in complex ways, our ability to plan for a future we may never see, and to care for people a thousand miles away.

But it's true that we may choose not to exercise that ability... but then what a waste of a human being... such a person would have done just as well as a dung beetle (bless dung beetles as they are essential to nature's ecosystem).

Anyway, it's getting late and I really have to get to sleep... but I wanted to make the argument that if you don't care about the 40 million people in your country that have no healthcare... you are selling yourself short.

P.S. Mammograms are not hard to come by in Canada!

I'll say just a couple of things. #1: I've always argued that the government should get out of healthcare COMPLETELY. I don't believe that they should subsidize the system AT ALL. I'm not pro-rich or pro-poor. I'm pro-independence and freedom of choice.

The vast majority of the "charity" going to Africa has been supplied by governments, and I think that it is a much better case and point to prove that governments are bad at distributing charity. The fact of the matter is, that no public sector program can create an economy. The public sector needs to tax a private sector to exist. Thus, the private sector needs to build the economy. Charity is always temporary, public or private. It has to be.

As a final point, I think that you misunderstand me on a lot of points. I like to make sick people better, and I don't live in an ivory tower. I have been involved in missions from Jamaica to Nicaragua. I've volunteered multiple times at our student clinic here in Miami for poverty stricken immigrants who don't speak English. I even chose to come to Miami because of the mutual benefit that the very ill and I could give each other in the setting of a place like Jackson Memorial. You've made a lot of assumptions. I can tell you that right now, NO ONE in the United States can't get care in an Emergency. That has NEVER been the case in the modern era. Having no insurance doesn't mean no medical care. My family never had insurance until about 10 years ago, and we paid out of pocket for everything just fine. It's the era of big insurance that drove up prices to the point where that couldn't be done.

All of that being said, I do not exist to be a sacrificial lamb for others to abuse at their whims. When I choose to help people, I do so by choice, and I benefit as much as those whom I help. It is a mutual exchange of feeling, if not money. That relationship is corrupted by the hands of the government, often with significant consequences to those whom are supposed to be helped. It creates bitterness on the part of the provider and a mentality of unappreciative entitlement on the part of the patient. We already see this in places like EDs where the government is involved in demanding mandatory care. I love medicine, and I love people. I think that every patient I have ever worked with would agree that I reflect that. That doesn't give those people the right to demand my service. When I help people, I do it for me. My patient receives the help for himself. We both benefit, and the relationship is a good one.

 

[naegleria brain]

In my opinion, if making money is more important to you than helping patients then maybe medicine isn't the place for you.

you, my friend, are in for a rude awakening

one visit to a VA hospital will illustrate and take away any doubt of its "superior care"

yes, prevention is the way to go. but the socialists don't do prevention any better. with all the cost-saving cuts, they don't get the necessary equipment and tests for the medical side of prevention (scans, MRI's, mammograms, US, etc.)

when these patients do go on to develop disease, and aren't treated properly, the best cost-saving measure is, well, death. this is why in german industries, you'll see the vast majority of workers smoking with absolutely no educational prevention. the on-site docs will even admit that it's cheaper to let them die than spend the money caring for them after theyve quit smoking and extended their life for x years.

this may be complicated by the fact that europeans smoke like chimneys; the docs there doubt the evidence linking smoking to long-term illnesses. go figure. if you've been to a european medical conference, they make fun of americans and their coffee breaks where they stuff their faces with coffee and cakes to get fat. meanwhile, european medical conferences have "smoke breaks" giving them a chance to go out and smoke. yes, theyre actually called smoke breaks

and the argument for healthcare for everyone doesn't hold. an individual who contracts AIDS from lack of foresight to buy a one-dollar condom translates into thousands of dollars of treatment. who takes on this burden? the rest of us. all because of his own stupidity.

are you going to pay for their abortions, shots, AIDS meds, etc? are you going to pay for their condoms as "prevention"? on an aside, nothing would piss me off more than being in and studying while watching other city-idiots going out and "scoring" knowing you are paying for his condom while learning about the drugs you'll have to give him when he doesn't use the darn thing and gets AIDS.

or what about the guy who decides to smoke for sixty years and now you are shelling out money for his radiation.

or the drug-user who know has shot both his kidneys and youre helping pay the 200 grand a year required for his dialysis.

healthcare is not a universal right and for good reason; the above are examples. the best prevention is rewarding good sense; the next is our job with screening. our health system does both whereas canada's does neither

 

[glc549]

One word for all those who think the Government can do a better job at managing healthcare than the private sector: KATRINA.

 

[random-dude]

How about two words SOCIAL SECURITY

 

[LuckyMD2b]

you, my friend, are in for a rude awakening

one visit to a VA hospital will illustrate and take away any doubt of its "superior care"

yes, prevention is the way to go. but the socialists don't do prevention any better. with all the cost-saving cuts, they don't get the necessary equipment and tests for the medical side of prevention (scans, MRI's, mammograms, US, etc.)

when these patients do go on to develop disease, and aren't treated properly, the best cost-saving measure is, well, death. this is why in german industries, you'll see the vast majority of workers smoking with absolutely no educational prevention. the on-site docs will even admit that it's cheaper to let them die than spend the money caring for them after theyve quit smoking and extended their life for x years.

this may be complicated by the fact that europeans smoke like chimneys; the docs there doubt the evidence linking smoking to long-term illnesses. go figure. if you've been to a european medical conference, they make fun of americans and their coffee breaks where they stuff their faces with coffee and cakes to get fat. meanwhile, european medical conferences have "smoke breaks" giving them a chance to go out and smoke. yes, theyre actually called smoke breaks

and the argument for healthcare for everyone doesn't hold. an individual who contracts AIDS from lack of foresight to buy a one-dollar condom translates into thousands of dollars of treatment. who takes on this burden? the rest of us. all because of his own stupidity.

are you going to pay for their abortions, shots, AIDS meds, etc? are you going to pay for their condoms as "prevention"? on an aside, nothing would piss me off more than being in and studying while watching other city-idiots going out and "scoring" knowing you are paying for his condom while learning about the drugs you'll have to give him when he doesn't use the darn thing and gets AIDS.

or what about the guy who decides to smoke for sixty years and now you are shelling out money for his radiation.

or the drug-user who know has shot both his kidneys and youre helping pay the 200 grand a year required for his dialysis.

healthcare is not a universal right and for good reason; the above are examples. the best prevention is rewarding good sense; the next is our job with screening. our health system does both whereas canada's does neither

[sigh]... where to start?

First of all, I don't have any vague generalizations and truthiness -- such as Europeans smoking like chimneys, but you should take a look at the article I referenced on my first post. Healthcare in England is better than in the United States even when controlled for race, SES, and smoking, and overweight/obesity did not account for the observed differences. AND WE PAY MORE for healthcare!! while getting worse results.

As for paying for dialysis. THE GOVERNMENT DOES PAY FOR DIALYSIS FOR EVERYONE WHO NEEDS IT!! http://www.medicarerights.org/q&aesrd.html

And the guy who smoked for 60 years and has cancer now, we do pay for his health care because he is eligible for medicare now (unless he started smoking when he's 3.)

Plus like Miami-med stated, everyone is entitled to Emergency care in the ER, regardless of insurance status, right? Whether they need a rapid strep test, a pelvic exam, a head CT, or an emergency thoracotomy -- everyone who comes to the ED expects (and deserves) to be treated. So I would argue that most of America disagrees with you in saying that healthcare is not a basic human right.

The problem is people without insurance get their only health care in the emergent setting. When it costs the most and outcomes are inferior. We have the ability to do better and I think that all Americans should have some form of insurance and access to quality primary health care.

 

[Miami_med]

[sigh]... where to start?

First of all, I don't have any vague generalizations and truthiness -- such as Europeans smoking like chimneys, but you should take a look at the article I referenced on my first post. Healthcare in England is better than in the United States even when controlled for race, SES, and smoking, and overweight/obesity did not account for the observed differences. AND WE PAY MORE for healthcare!! while getting worse results.

As for paying for dialysis. THE GOVERNMENT DOES PAY FOR DIALYSIS FOR EVERYONE WHO NEEDS IT!! http://www.medicarerights.org/q&aesrd.html

And the guy who smoked for 60 years and has cancer now, we do pay for his health care because he is eligible for medicare now (unless he started smoking when he's 3.)

Plus like Miami-med stated, everyone is entitled to Emergency care in the ER, regardless of insurance status, right? Whether they need a rapid strep test, a pelvic exam, a head CT, or an emergency thoracotomy -- everyone who comes to the ED expects (and deserves) to be treated. So I would argue that most of America disagrees with you in saying that healthcare is not a basic human right.

The problem is people without insurance get their only health care in the emergent setting. When it costs the most and outcomes are inferior. We have the ability to do better and I think that all Americans should have some form of insurance and access to quality primary health care.

Efficient use of resources scale:

1.Self-Pay>2.Insurance Pay>>>3.Government Pays with properly allocated resources in a perfect world>>4.Weird System of half paying for things for certain interest groups that have political clout or garner pity.

You advocate moving from #4 to #3. I'd like to go to #1 and #2. I also think that #3 is impossible and that the quality indicators that are mentioned are not universal, not measured properly, not expandable, and that they would work worse in the vast land that we call the US anyway.

The funny thing is that with all of you guys pushing for universal healthcare in the US, most of Europe is instituting market reforms and allowing people to start opting OUT of the government health systems. They are going BROKE.

 

[naegleria brain]

Efficient use of resources scale:

1.Self-Pay>2.Insurance Pay>>>3.Government Pays with properly allocated resources in a perfect world>>4.Weird System of half paying for things for certain interest groups that have political clout or garner pity.

You advocate moving from #4 to #3. I'd like to go to #1 and #2. I also think that #3 is impossible and that the quality indicators that are mentioned are not universal, not measured properly, not expandable, and that they would work worse in the vast land that we call the US anyway.

The funny thing is that with all of you guys pushing for universal healthcare in the US, most of Europe is instituting market reforms and allowing people to start opting OUT of the government health systems. They are going BROKE.

the cost of dialysis alone is a very good indication that medicare is about to go broke as well. as to the previous poster, yes, we already burden a lot of the cost, and my point is that this is entirely unfair; the government has no role in providing healthcare; maybe research, at best, but even that is questionable

 

[dynx]

Read most of this though it got kinda long toward the end so I drifted off a bit. Gosh I love this thread.

I just wanted to post some more information, I didn't want to enter the debate, its been done to death. It's really a belief system when you come down to it. You're wrong and you're going to pave the road to hell with good intentions but I can't convince you of it (why shouldn't everybody share equally Mr. Marx...it'll be utopia!!!!). So if I have time I'll respond but please forgive me if Im to lazy.

 

[mtoto]

You're wrong and you're going to pave the road to hell...

You don't seem very open-minded.



Miami- I was not thinking that you live in an Ivory tower. I'm sorry if it came across that way on the thread. I generally try not to make any assumptions. It's interesting that you have done mission trips abroad. Are you affiliated with a church? Just curious, personally, I am not very religious.

It seems that there is one thing we do agree on... and that is that the US med system needs to change (since it is #4).

I have been thinking the last couple of days about your #1 self pay... I am not entirely against it... but I'm not sure if it's practical. Healthcare costs are so high due to advancing technologies and expensive meds (that as Brain pointed out is 2ndary to R and D costs)... that if we all had to self pay, only a handful of individuals would be able to afford care.

I'm not sure that your #2 would work either since... without govt subsidies/involvement I think that all the insurance companies would go broke unless they charged super high premiums that no one could afford.

And of course I would argue that an imperfect #3 is maybe the "best" that can be accomplished in this very imperfect world.

 

[dynx]

You don't seem very open-minded.

No Im not. Its quite sad actually...I used to like to debate and explore ideas, I type long posts with arguments and post data,. Now I just insult people. It may surprise you but both methods are equally effective in persuading people.

 

[powermd]

So I would argue that most of America disagrees with you in saying that healthcare is not a basic human right.

Health care is most certainly NOT a basic human right. The right of an innocent person not to be killed constitutes a basic human right. Health care is a service that costs money. You don't have a right to anyone's services for free (that would make them a slave, which they have a basic human right not to be), and you certainly don't have a right to money that you did not earn.

Are you confusing a 'right' with a 'privelege'?

A government can grant priveleges, such as Medicaid/Medicare, which may fund your health care.

As a provider of services that "most of America" feels they have a "right" to, the distinction between a right and a privelege is the difference between me being a free man, and a slave. As a resident I am particularly sensitive to the distinction!

 

[Miami_med]

Miami- I was not thinking that you live in an Ivory tower. I'm sorry if it came across that way on the thread. I generally try not to make any assumptions. It's interesting that you have done mission trips abroad. Are you affiliated with a church? Just curious, personally, I am not very religious.

It seems that there is one thing we do agree on... and that is that the US med system needs to change (since it is #4).

I have been thinking the last couple of days about your #1 self pay... I am not entirely against it... but I'm not sure if it's practical. Healthcare costs are so high due to advancing technologies and expensive meds (that as Brain pointed out is 2ndary to R and D costs)... that if we all had to self pay, only a handful of individuals would be able to afford care.

I'm not sure that your #2 would work either since... without govt subsidies/involvement I think that all the insurance companies would go broke unless they charged super high premiums that no one could afford.

And of course I would argue that an imperfect #3 is maybe the "best" that can be accomplished in this very imperfect world.

Yeah, I'm not really religious in any particular sense, though my first "international experience" was with a church.

It is interesting that in EVERY OTHER INDUSTRY, technology drives prices DOWN. Think about everything from computers to TVs. In most industries, a new technology originally is the domain of the ultra wealthy. In time however, the lucrative prospect of mass marketing drives prices down, as some entrepeneur realizes that he can make a mint off of lowering prices on the technology before his competitor. Think of cars before and after Ford. A market does ration technology, and technology HAS to be rationed, because resources are not infinite. The difference between market rationing and government rationing, is that the former provides incentive to lower prices in the future, thus diminishing the amount of necessary rationing. Government rationing has the EXACT opposite effect. People want to drive prices UP in order to compete for a larger share of the pie. That is what is happening today. Rationing WILL happen, or we will go broke.

You've made me think of a good point however, and that is that the US is NOT remotely free market in medicine. It is just more free market than other countries. Our costs are very high, and our resources are misallocated. There is no real counter argument to those who point out that we don't cover everyone while spending more government money. This of course, has nothing to do with the significantly greater number of options afforded the private sector (and the public by proxy) in the US. Quality indicators are poor, and the differences between all developed nations (including the US) are probably statistically insignificant after adjusting for confounding even with the poor indicators. The vast majority of health has more to do with clean water and access to all of the basic food groups than advanced medical care.

Will some people have unequal access in a free market system. YES. However, the majority will have better care than the majority in a marxist styled universal system. I just don't believe that we have made some kind of noble statement by taking the hard earned money of a working American by force through taxation and using it to pay for the medical care of someone else who hasn't earned it. Providing the CEO of Coca-Cola (who has been charged by a majority vote of his shareholders to make decisions that impact millions of people and worldwide financial interests) the same care as the guy who comes in with a cocaine induced heart attack doesn't seem like supreme morality. Maybe some people deserve the extra effort that can't be efficiently given to everyone. Who are any of us to decide this? This centralized decision making is removed in a market economy, with people affording benefits proportional to the value of their contribution. You are punishing the MORE productive members of society to pay for the LESS productive members of society. Even OncoCap concedes that the majority of Americans are looking for more health security FOR THEMSELVES. Universal care loses support when people think that they are disproportionately paying for other people. Of course, the whole purpose of Universal care is disproportionate payment for OTHER people's care.

Remember, it would be CHEAP to buy the healthcare of 20 years ago. Most people can pay cash for that. The breaking of the system occurs when every new technology that hits the market is suddenly a "right" of everyone. This also prevents that technology from ever getting cheaper. We can't all have everything.

Keep the dialogue going. Sorry for the rant.

 

[LuckyMD2b]

Health care is most certainly NOT a basic human right. The right of an innocent person not to be killed constitutes a basic human right. Health care is a service that costs money. You don't have a right to anyone's services for free (that would make them a slave, which they have a basic human right not to be), and you certainly don't have a right to money that you did not earn.

Are you confusing a 'right' with a 'privelege'?

A government can grant priveleges, such as Medicaid/Medicare, which may fund your health care.

As a provider of services that "most of America" feels they have a "right" to, the distinction between a right and a privelege is the difference between me being a free man, and a slave. As a resident I am particularly sensitive to the distinction!

That 40y/o single mother without insurance who comes in for that lap chole must feel truly priveleged to need to be treated by you -- Resident Almighty Decider of Who gets treated and who doesn't.

Slavery? you are joking right? You have an option to be a doctor or not, for the most part patients don't choose whether or not to be sick. From what I've been taught it is the physician who has the privelege to treat/help people. You decided to go to medical school, and from what I recall, slaves never really volunteered for what they did.

Privilege (noun): 1. a right, immunity, or benefit enjoyed only by a person beyond the advantages of most: the privileges of the very rich.
2. a special right, immunity, or exemption granted to persons in authority or office to free them from certain obligations or liabilities: the privilege of a senator to speak in Congress without danger of a libel suit. 4. the principle or condition of enjoying special rights or immunities [dictionary.com]

I believe everyone has a right to some degree of medical care, especially in an emergency situation (I don't think anyone disagrees with this). Furthermore i don't think that having some kind of basic insurance package for every adult and child to provide basic preventative medicine (monitoring blood pressure, cholesterol, glucose, and providing cheap drugs --- statins, HCTZ, and metformin.); is something that should be reserved for the privileged few.

The following scheme still requires patients to pay some amount for their care --> and a similiar approach has already been apporved by the Govt of Massachusetts and I think Arnold is proposing something even more comprehensive in Cali. Also the MDs and residents taking care of patients still get paid -- relatively well (compared to slaves).

 

[naegleria brain]

the slave issue...i thought all residents were slaves to their attendings.

what about the AIDS guy who was too foolish to use a condom, and the fifty grand/yr for his treatment comes out of our pockets? does he have the right to foolishness? yes. but does his right extend to us compensating for it?

healthcare to a select few? the majority--vast majority, do have healthcare. i say if you have the money, you should be given a choice to receive superior care. trying to change a system to get that last percentage uninsured and decrease the quality for all is a huge mistake. it takes away our right to do what we want with our money.

and what's more vexing is the 60yr smoker whom we have to cover the cost of chemo/surgery/radiation to extend her life for a few more months when she spent the last 40 yrs slowly killing herself.

 

[LuckyMD2b]

the slave issue...i thought all residents were slaves to their attendings.

what about the AIDS guy who was too foolish to use a condom, and the fifty grand/yr for his treatment comes out of our pockets? does he have the right to foolishness? yes. but does his right extend to us compensating for it?

healthcare to a select few? the majority--vast majority, do have healthcare. i say if you have the money, you should be given a choice to receive superior care. trying to change a system to get that last percentage uninsured and decrease the quality for all is a huge mistake. it takes away our right to do what we want with our money.

and what's more vexing is the 60yr smoker whom we have to cover the cost of chemo/surgery/radiation to extend her life for a few more months when she spent the last 40 yrs slowly killing herself.

First of all, none of us know what it is like to be a slave so stop throwing that word around. It pisses me off that priveleged educated DOCTORS are comparing themselves to slaves; that's truly obnoxious.

If there was a single buyer system -- then AIDS drugs wouldn't cost 50grand/year. The economics would be completely different because a large purchaser has a lot of leverage for negotiating a 'reasonable' price for meds/treatments.

The reason why you don't think it's worth it to change the system to include the last percentage (several million people) who are uninsured, is because you either don't know or don't care about any of those people. Our government spends a lot of money on things that are a waste, when that money could be better spent taking care of its own citizens.

The difference between me and you is the that I am a populist and you an elitist. When it comes to healthcare I don't think anyone should be left out, and unlike you there are times in my life when I have been foolish and I know that I am not immune from mistakes. And seeing many patients with AIDS I dont think that "FOOLISHNESS" is sufficient reason to sentence anyone to a slow death from a treatable disease.

 

[beefballs]

so how is your m1 year going?

 

[dynx]

so how is your m1 year going?

Surely you give it to much credit. That rant had a distinct pre-med odor.

 

[naegleria brain]

First of all, none of us know what it is like to be a slave so stop throwing that word around. It pisses me off that priveleged educated DOCTORS are comparing themselves to slaves; that's truly obnoxious.

If there was a single buyer system -- then AIDS drugs wouldn't cost 50grand/year. The economics would be completely different because a large purchaser has a lot of leverage for negotiating a 'reasonable' price for meds/treatments.

The reason why you don't think it's worth it to change the system to include the last percentage (several million people) who are uninsured, is because you either don't know or don't care about any of those people. Our government spends a lot of money on things that are a waste, when that money could be better spent taking care of its own citizens.

The difference between me and you is the that I am a populist and you an elitist. When it comes to healthcare I don't think anyone should be left out, and unlike you there are times in my life when I have been foolish and I know that I am not immune from mistakes. And seeing many patients with AIDS I dont think that "FOOLISHNESS" is sufficient reason to sentence anyone to a slow death from a treatable disease.

couple things:

1) i understand your distaste with the word "slave" but honestly, if you don't lighten up, im not sure how youll react when the residents actually do put in 130 hrs a week and call themselves slaves for their bastard attendings. then again, you'll probably be too tired on your 125th hour of the week to really say anything. your previous posts indicate a lot of ortho-talk. be prepped to hear it when working with ortho residents, or maybe you should consider a more appropriate, laid back field. in my experience, they still are a boy's club, and men joke around (ie the debate of men vs. guys). just a heads up

2) i guess AIDS is touchy. how bout the 60 year old who decided to smoke for 40 years? that's not foolishness one time. That's foolishness for however many cigarettes in the hundreds of packs of his life. if you can't agree that that's foolishness, then we're clearly on different pages.

and as to everyone making mistakes; yes we do. my mistakes go more along mislabeling ACTH levels in micrograms instead of picograms on an exam or forgetting to chew gum after eating a tuna sandwich. I've never had unprotected sex with a random person; that's a foolish mistake, you know the risk, take action to not do it.

society is not here to hold your hand every step of the way. people are independent, and we look out for ourselves. just because they messed up, whether smoking for forty years of having unprotected anal sex multiple times, is not something i should be paying for out of my pocket.

this isn't socialsm, and communism failed.

 

[mtoto]

No Im not. Its quite sad actually...I used to like to debate and explore ideas, I type long posts with arguments and post data,. Now I just insult people. It may surprise you but both methods are equally effective in persuading people.

I also noticed this quote from one of your earlier posts:

A little rudeness and disrespect can elevate a meaningless interaction to a battle of wills and add drama to an otherwise dull day.

I can't decide whether or not you are being serious. Whether you are just being "tough" and sarcastic or whether you actually believe this. I agree that rudeness and disrespect can be dramatic and... I won't throw out the idea that insults can persuade people (though I've never seen it really work).

So assuming that you are serious, I would want you to consider... you know, that something you say or do might have a significant effect on someone else. Not to cheese out or anything but I believe that disrespect in particular can be very hurtful.

On the other hand, the person who is respectful... who respects everyone (obviously rare)... even when no one is looking, even on an anonymous forum, this is meaningful. I believe this very much. It is sometimes useful to "debate and explore ideas" and perhaps momentarily it's fun to engage in a "battle of wills" but I would argue that there is more value to dialogue and argument then those things... it can be a way to show someone that you respect them even if you can't agree, it can be a way to inspire people, to make people think of things they had not thought of before... to change people... to lose the argument perhaps but "win the war".

I'm sure everyone's confused right now reading this post. I'm confusing myself in fact! I just am finding that Dynx seems a bit cavalier...

 

[dynx]

I also noticed this quote from one of your earlier posts:

A little rudeness and disrespect can elevate a meaningless interaction to a battle of wills and add drama to an otherwise dull day.

I can't decide whether or not you are being serious. Whether you are just being "tough" and sarcastic or whether you actually believe this. I agree that rudeness and disrespect can be dramatic and... I won't throw out the idea that insults can persuade people (though I've never seen it really work).

So assuming that you are serious, I would want you to consider... you know, that something you say or do might have a significant effect on someone else. Not to cheese out or anything but I believe that disrespect in particular can be very hurtful.

On the other hand, the person who is respectful... who respects everyone (obviously rare)... even when no one is looking, even on an anonymous forum, this is meaningful. I believe this very much. It is sometimes useful to "debate and explore ideas" and perhaps momentarily it's fun to engage in a "battle of wills" but I would argue that there is more value to dialogue and argument then those things... it can be a way to show someone that you respect them even if you can't agree, it can be a way to inspire people, to make people think of things they had not thought of before... to change people... to lose the argument perhaps but "win the war".

I'm sure everyone's confused right now reading this post. I'm confusing myself in fact! I just am finding that Dynx seems a bit cavalier...

1. Yes sarcasm, no tough.

2. My point was that they are both equally ineffective, not that insulting people is an effective means of persuasion. slipped it by you eh? Its just that one is more entertaining to me.

3. I honestly hope that nothing flip that I say on an online forum would actually warrant a second thought from professional adults. When I am being serious I think its pretty apparent, maybe Im wrong. When Im being sarcastic I think its also pretty obvious and easily laughed at or brushed off.

 

[mtoto]

Yeah, I'm not really religious in any particular sense, though my first "international experience" was with a church.

It is interesting that in EVERY OTHER INDUSTRY, technology drives prices DOWN. Think about everything from computers to TVs. In most industries, a new technology originally is the domain of the ultra wealthy. In time however, the lucrative prospect of mass marketing drives prices down, as some entrepeneur realizes that he can make a mint off of lowering prices on the technology before his competitor. Think of cars before and after Ford. A market does ration technology, and technology HAS to be rationed, because resources are not infinite. The difference between market rationing and government rationing, is that the former provides incentive to lower prices in the future, thus diminishing the amount of necessary rationing. Government rationing has the EXACT opposite effect. People want to drive prices UP in order to compete for a larger share of the pie. That is what is happening today. Rationing WILL happen, or we will go broke.

You've made me think of a good point however, and that is that the US is NOT remotely free market in medicine. It is just more free market than other countries. Our costs are very high, and our resources are misallocated. There is no real counter argument to those who point out that we don't cover everyone while spending more government money. This of course, has nothing to do with the significantly greater number of options afforded the private sector (and the public by proxy) in the US. Quality indicators are poor, and the differences between all developed nations (including the US) are probably statistically insignificant after adjusting for confounding even with the poor indicators. The vast majority of health has more to do with clean water and access to all of the basic food groups than advanced medical care.

Will some people have unequal access in a free market system. YES. However, the majority will have better care than the majority in a marxist styled universal system. I just don't believe that we have made some kind of noble statement by taking the hard earned money of a working American by force through taxation and using it to pay for the medical care of someone else who hasn't earned it. Providing the CEO of Coca-Cola (who has been charged by a majority vote of his shareholders to make decisions that impact millions of people and worldwide financial interests) the same care as the guy who comes in with a cocaine induced heart attack doesn't seem like supreme morality. Maybe some people deserve the extra effort that can't be efficiently given to everyone. Who are any of us to decide this? This centralized decision making is removed in a market economy, with people affording benefits proportional to the value of their contribution. You are punishing the MORE productive members of society to pay for the LESS productive members of society. Even OncoCap concedes that the majority of Americans are looking for more health security FOR THEMSELVES. Universal care loses support when people think that they are disproportionately paying for other people. Of course, the whole purpose of Universal care is disproportionate payment for OTHER people's care.

Remember, it would be CHEAP to buy the healthcare of 20 years ago. Most people can pay cash for that. The breaking of the system occurs when every new technology that hits the market is suddenly a "right" of everyone. This also prevents that technology from ever getting cheaper. We can't all have everything.

Keep the dialogue going. Sorry for the rant.

I try not to do this because sometimes I feel like we lose the big picture responding to the details of a post but here I can't resist.

You talk about other industries and a free market driving down prices... and I agree that for EVERY OTHER INDUSTRY there should be a free market. But basic healthcare is not a commodity the way other products are "from computers to TVs". People don't decide to take meds because they want to... or because of marketing (at least they shouldn't). In fact, given a choice most patients don't want to be sick... and they don't want to be treated. Sometimes they don't want treatment even when they are sick!!

Therefore mass marketing should not be allowed for meds/medical treatments (can you imagine companies trying to get EVERYONE to install a pacemaker "just to regulate their heart")

What is the incentive for makers of meds/medical products to lower prices when pts don't really have a choice about whether or not to purchase that product. How can we put a price on health? People will pay anything if they need it... but if they don't need it (are not sick) they wouldn't buy it even if it was discounted.

In fact b/c of the nature of healthcare and health technologies, govts around the world do much to protect the healthcare sector. Govts pour tonnes of money into R&D (basic science) because the private sector is not willing to make the investment until the very last stages of drug/technology development. In addition govts legislate drug patents that prevent generic companies from selling the same drug for less for 20ish years after the initial release of the drug.

Importantly patents in medicine can not be compared to patents in other industries. Like say I wanted an set of speakers... while it may be true that Bose has a patent on the "Wave" technology that produces a more realistic listening experience... since I can't afford Bose speakers I would have to buy JVC speakers (incidentally does anyone here have one of those Bose Wave radios, I've always wanted one, are they really that great?). While that's unfortunate, it's hardly a matter of life and death. Speakers are speakers... and either speaker would serve it's intended purpose. Same with cars... so I can't afford the custom Lexus with leather interior... a Honda Civic would still get me to work on time. On the other had, if I came to you with MRSA osteomyelitis and I couldn't afford Vanco... it's not like I could just take penicillin. In fact if you gave me pen, I would die. And if a rich person comes in with Strep throat it's not like you would prescribe Imipenem just b/c that person is rich and can afford it... you would give pen b/c that's it's the cheapest effective drug.

I don't necessarily think that saying that there should be universal BASIC healthcare means that the Coca Cola CEO will get the same treatment as the cocaine addict if they were to both come in with an MI. Maybe the CEO will get a private room, with 1 to 1 nursing care, flat screen TV and sleep in 600 thread count linens and the street person with have to share a room with 3 other pts. On the other hand what you seem to be saying is that if they both turned up in the ER the CEO should get care while the street person should be left to gasp for his last breaths on the hospital doorsteps (and this it is how it would be in the US if govt didn't make it mandatory to treat people for lifethreatening conditions in the ER). What I mean when I say that there should be universal care is that known lifesaving treatments such as morphine, O2, nitro, ASA, CXR, ECG and possibly TPA or a stent should be provided to both the CEO and street person who comes in with an MI. And in addition such care should not be limited to the ER setting but should include the primary care setting as well.

Last I disagree with you that meds/medical technology is expensive simply because govt. subsidies have driven prices up. I would argue that these things are actually expensive! The healthcare of 20 yrs ago was cheap b/c there wasn't much to it. In fact, I would say before penicillin 50 yrs ago... medicine was only barely a credible specialty... we probably did more harm than good! Of course this brings up the issue of the appropriate use of technologies and cost benifit ratios... but that is an entirely different debate... that has little to do with universality.

I'm spending way too much of my time on this thread!

 

[mtoto]

1. Yes sarcasm, no tough.

2. My point was that they are both equally ineffective, not that insulting people is an effective means of persuasion. slipped it by you eh? Its just that one is more entertaining to me.

3. I honestly hope that nothing flip that I say on an online forum would actually warrant a second thought from professional adults. When I am being serious I think its pretty apparent, maybe Im wrong. When Im being sarcastic I think its also pretty obvious and easily laughed at or brushed off.

Oops Silly me. Well then, you can just ignore my last post. Just wanted to share with you how special I think respect is.

Also, Brain I will try to respond to your posts about the AIDS pt, and the smoker with lung ca and the achoholic with cirrhosis since pts with "self inflicted" injuries seem to be a sore point for you. I do understand where you are coming from. In fact I have a friend here in Canada who vehemently believes that smokers should pay a higher health premium since they are such a drain on our health system...

 

[Miami_med]

First of all, none of us know what it is like to be a slave so stop throwing that word around. It pisses me off that priveleged educated DOCTORS are comparing themselves to slaves; that's truly obnoxious.

If there was a single buyer system -- then AIDS drugs wouldn't cost 50grand/year. The economics would be completely different because a large purchaser has a lot of leverage for negotiating a 'reasonable' price for meds/treatments.

The reason why you don't think it's worth it to change the system to include the last percentage (several million people) who are uninsured, is because you either don't know or don't care about any of those people. Our government spends a lot of money on things that are a waste, when that money could be better spent taking care of its own citizens.

The difference between me and you is the that I am a populist and you an elitist. When it comes to healthcare I don't think anyone should be left out, and unlike you there are times in my life when I have been foolish and I know that I am not immune from mistakes. And seeing many patients with AIDS I dont think that "FOOLISHNESS" is sufficient reason to sentence anyone to a slow death from a treatable disease.

Without the 50k/year, no new AIDS drugs would be developed. The magic world where everyone come together for someone elses idea of the common good doesn't exist. People require incentive. Companies are amoral (note amoral, not immoral), and they follow the path of least resistance to profits by and large. Bargain for cheap HIV drugs, and their resources will go into cosmetics.

When I signed up for medicine, I DID NOT agree to treat everyone all the time. I never agreed to universal healthcare. I never agreed to sacrifice myself for the faceless masses. I agreed to take on patients by choice or by virtue of their affiliation with my training institutions and to provide them with the best care that I could offer them. Your emotionally charged posts do very little in actually explaining the impact on such policy economically. The creation of negative incentives to productivity through taxes, or even taxing the middle class out of their homes to pay for AIDS drugs IS NOT good for the economy. What feels good isn't always what works best when applied globally.

Feeling like people should get to keep what they earn isn't "elitist." It is good economics and good social policy. Your "populist" ideaology actually hurts the majority in favor of a special anti-elitist underclass of AIDS patients and single mothers.

 

[Miami_med]

I try not to do this because sometimes I feel like we lose the big picture responding to the details of a post but here I can't resist.
......

Food. Housing.

I'll let you come up with other things that are more necessary than access to doctors, provided by the free market in the US, and are more readily available here than anywhere else on earth. The average American lives in a much larger residence than his European counterpart, and I think that looking at the average American is incredible evidence that the market can provide food far in excess even of need. We aren't rationing Big Macs centrally through the government. Any proposed need cannot be a carpe blanche right to take things from other people. I'll take my little overpriced rental house that I somehow afforded in one of the countries most expensive markets on a student income over shared soviet bloc housing any day.

 

[mtoto]

Food. Housing.

I'll let you come up with other things that are more necessary than access to doctors, provided by the free market in the US, and are more readily available here than anywhere else on earth. The average American lives in a much larger residence than his European counterpart, and I think that looking at the average American is incredible evidence that the market can provide food far in excess even of need. We aren't rationing Big Macs centrally through the government. Any proposed need cannot be a carpe blanche right to take things from other people. I'll take my little overpriced rental house that I somehow afforded in one of the countries most expensive markets on a student income over shared soviet bloc housing any day.

Miami, you're running out of arguments. Just admit it... the US healthcare system needs reform!

I think you've named 'em, pretty much only food, water and housing are more basic to life then healthcare and in warm climates... I would say only food and water.

And you are making it sound like Americans invented the free market... food and housing are provided by the free market EVERYWHERE (except maybe Cuba, N. Korea, China and Vietnam... the professed "communist" countries.. though I have personally spent significant amounts of time in Vietnam and it is probably one of the most cutthroat free markets in existence). And in all the non third world free market food and housing economies (that I can think of right now), when people don't have food and housing the govt does step in to provide... re. welfare (do you have this in the US?).

And what has the average American living in bigger a house got to do with anything? The ave. American probably lives in a bigger house b/c there is MORE land/percapita in the US. But that is besides the point, because housing in Europe is free market also... so what is your point?

Also people in Europe do not live in "shared Soviet bloc housing". In fact wasn't most of Western Europe allied with the US during the cold war? Ergo shared capitalistic values.

Are you trying to say that if govt. pulled entirely out of healthcare that the ave. person would then get the best care in the world? This does not seem possible to me considering the current state of affairs. Without govt subsidies only a handful of the very rich would be able to afford healthcare.

Food and housing while being basic needs (ie. necessary for life) also... are different in 2 important ways from healthcare needs.

First they are relatively affordable. Food in particular... widely available and very affordable. Again though here the rich will have cavier and filet mignon while the poor are stuck with Big Macs. But since both serves the purpose of nutrition it is acceptable that poor people will not be able to eat too much cavier. Housing again, if you are willing to rent, is affordable ($500/mo). Neither of these commodities is dependant on advanced techonologies or resource intense research.

Second, food and housing needs are predictable. Basically you know that you need a roof over your head every night and 2000cal/day. You can plan for this type of need. You can save (and people do) for retirement for instance. Healthcare is completely different. You can live 60 yrs of your life without spending a dime on healthcare... then, overnight, you may receive a terrible diagnosis such as cancer, or get into a terrible vehicle accident... which has the ability to bankrupt you ($3000/day minimum if you are admitted) in the space of several months. You might argue that we should then plan for the worst case... and make sure that we have serveral million in our accounts at all times in case of sudden illness... but who can afford this... is this being realistic?

P.S. I have spent much time in the US and I would disagree that good food is more readily available in the US then "anywhere else in the world". While there does seem to be a lot of donuts and burgers... I find that good food (like fresh healthy food) is easier to come by in Canada, France, Italy, Cyprus... and I would hardly cite America's epidemic of obesity secondary to a market that "can provide food (you mean fast food) far in excess even of need" as being one of the great successes of America's markets. In fact don't you find it inappropriate that there's a MacDonald's in every other Children's Hospital? Maybe the govt. should step in!!

 

[Miami_med]

Alright, I wasn't going to do this, but what the heck...

Miami, you're running out of arguments. Just admit it... the US healthcare system needs reform!

I've admitted that from the beginning. I just believe that it should be market based reform. And I've consistently pointed out reasons why moving away from market economics is the reason we're in this mess in the first place.

I think you've named 'em, pretty much only food, water and housing are more basic to life then healthcare and in warm climates... I would say only food and water.

My city averages over 10 inches of rain every June. Have you ever been in S. Florida during a hurrican season? Shelter is very much needed here.

And you are making it sound like Americans invented the free market... food and housing are provided by the free market EVERYWHERE (except maybe Cuba, N. Korea, China and Vietnam... the professed "communist" countries.. though I have personally spent significant amounts of time in Vietnam and it is probably one of the most cutthroat free markets in existence). And in all the non third world free market food and housing economies (that I can think of right now), when people don't have food and housing the govt does step in to provide... re. welfare (do you have this in the US?).

Well no, I don't care who invented the free market. I've just pointed out that what we have in healthcare in the US is closer to a free market than other countries. Our Economic system overall tends to be more of a free market system than any of the EU or Canada. A 50% tax rate is incompatable with a free market. A rate like that means that intervention (both visible and invisible) is high.

In the US, the government does supply food and housing to the poor. We have a large population in the US that does no work and has children in order to attain these benefits. Large areas of public housing are generally known as "the projects" or "the ghetto," and they are by far the most dangerous places in America to live. It is not what I wish for healthcare to be.

And what has the average American living in bigger a house got to do with anything? The ave. American probably lives in a bigger house b/c there is MORE land/percapita in the US. But that is besides the point, because housing in Europe is free market also... so what is your point?

Interesting, i was just reading an article yesterday about how British land use laws have created a system of impossibly expensive housing coupled with vast undeveloped tracts. http://www.mises.org/story/2471 That is not a free market. We don't have a true free market in the US either. We're just a little closer. Maybe a different fact would be that the average house size in the US is growing, and our population is growing as well. Much of Europe has declining house sizes AND populations. The opposite of what you would expect if the amount of land were the issue.

Also people in Europe do not live in "shared Soviet bloc housing". In fact wasn't most of Western Europe allied with the US during the cold war? Ergo shared capitalistic values.

No. I don't think you really understand what I mean by true capitalism. It's okay, because few people do. True capitalism is allowing the free market to guide the economy by the individual choices of the millions of people involved. It is a system of little to no government intervention and a system that respects private property rights absolutely. Most of Europe, and the US as well, kept marginal tax rates between 70 and 90% during this time, and regulation of EVERYTHING soared. This produced Stagflation. Since then, some of the regulations and taxes have been repealed, with the big changes occuring in the US under Reagan and Britain under Thatcher. With all the problems that all of our countries have under the still somewhat centralized systems, they seem to prevent employment rioting in the streets akin to the French system. Britain is now instituting a number of market reforms in its healthcare system. We never went as far as the Soviet Bloc. What the Soviet Bloc is a great example of however, is the inevitable consequence of central planning.

Are you trying to say that if govt. pulled entirely out of healthcare that the ave. person would then get the best care in the world? This does not seem possible to me considering the current state of affairs. Without govt subsidies only a handful of the very rich would be able to afford healthcare.

If the government pulled out of healthcare, the average person would have the highest average quality of life. The second statement you made is also false. The government doesn't create productive enterprise. It is a redistribution and regulatory entity that utilizes force in the pursuit of its goals. All the money it uses to fund healthcare comes from the people. They obviously have it, or it wouldn't be takeable. What the current system does is drive prices up, because of the government money, pricing healthcare out of the more and more people's pockets.

Food and housing while being basic needs (ie. necessary for life) also... are different in 2 important ways from healthcare needs.

First they are relatively affordable. Food in particular... widely available and very affordable. Again though here the rich will have cavier and filet mignon while the poor are stuck with Big Macs. But since both serves the purpose of nutrition it is acceptable that poor people will not be able to eat too much cavier. Housing again, if you are willing to rent, is affordable ($500/mo). Neither of these commodities is dependant on advanced techonologies or resource intense research.

Quite the oppposite, Big Macs are horrible nutritional choices, but it would be impossible to give everyone cavier. Cavier is more scarce, which makes it more expensive. Everyone can't have everything. Also, in terms of housing, you can't find a Studio within 50 miles of Miami for $500/month.

Second, food and housing needs are predictable. Basically you know that you need a roof over your head every night and 2000cal/day. You can plan for this type of need. You can save (and people do) for retirement for instance. Healthcare is completely different. You can live 60 yrs of your life without spending a dime on healthcare... then, overnight, you may receive a terrible diagnosis such as cancer, or get into a terrible vehicle accident... which has the ability to bankrupt you ($3000/day minimum if you are admitted) in the space of several months. You might argue that we should then plan for the worst case... and make sure that we have serveral million in our accounts at all times in case of sudden illness... but who can afford this... is this being realistic?

Well, food supplies have become predictable in our market economy. Housing is certainly not predictable. Feel free to consult with any of the Individuals living in New Orleans about this one. In fact, the one truth about this whole system is that EVERYONE will get sick and eventually die. That is the only truly predictable thing. Perhaps, the better question might be why it costs $3,000 (or more) to hospitalize someone for a day.

P.S. I have spent much time in the US and I would disagree that good food is more readily available in the US then "anywhere else in the world". While there does seem to be a lot of donuts and burgers... I find that good food (like fresh healthy food) is easier to come by in Canada, France, Italy, Cyprus... and I would hardly cite America's epidemic of obesity secondary to a market that "can provide food (you mean fast food) far in excess even of need" as being one of the great successes of America's markets. In fact don't you find it inappropriate that there's a MacDonald's in every other Children's Hospital? Maybe the govt. should step in!!

No, I mean food. Americans just like to eat garbage. There is plenty of non-garbage available. My wife and I shop for 3 at Walmart, buying plenty of healthy food, and we spend about $150/month. This occurred because Walmart undersold all of its previous competitors and dropped our grocery bill by 40% for better food. The government didn't help. In fact, it is probably cheaper to buy good food at Walmart than bad food at McDonalds. The one role of the government in Walmart has been fighting its existance from the beginning, making it harder for people to get cheap good food in their own towns. Compare this to Europe. The Heritage Foundation estimates that most Europeans pay 80-100% MORE for food than people in the US due to social legislation and special subsidies. Of course, this is an argument about the merit of free markets in general. It is only peripherally related to healthcare.

I actually have MANY arguments left, but I only have so much time to post. I'd also say that I'm not sure you've really managed to defeat any of my previous arguments. However, I agree that this is fun. If you're a really big fan of socialized healthcare, head over to the allopathic forum. There's a guy posting on one of the threads over there in your favor who has probably published his own encyclopedia.

 

[dilated]

On the other hand what you seem to be saying is that if they both turned up in the ER the CEO should get care while the street person should be left to gasp for his last breaths on the hospital doorsteps (and this it is how it would be in the US if govt didn't make it mandatory to treat people for lifethreatening conditions in the ER)

Is this why so many people were left dying on the steps of the ED because they didn't have health insurance before EMTALA passed in the mid 80s? Hmm, wait a second...

 

[rgarrig]

Health care is most certainly NOT a basic human right. The right of an innocent person not to be killed constitutes a basic human right. Health care is a service that costs money. You don't have a right to anyone's services for free (that would make them a slave, which they have a basic human right not to be), and you certainly don't have a right to money that you did not earn.

Are you confusing a 'right' with a 'privelege'?

A government can grant priveleges, such as Medicaid/Medicare, which may fund your health care.

As a provider of services that "most of America" feels they have a "right" to, the distinction between a right and a privelege is the difference between me being a free man, and a slave. As a resident I am particularly sensitive to the distinction!

QFT

 

[gida]

Why should the rich have their care subsidized while the poor go completely without?

Um, because the rich can afford it? Keep in mind, many of the poor CHOOSE to spend their money on WANTS rather than NEEDS.

They want to be able to every once in a while when they are feeling especially godly to walk out of their fortress and throw some $20 bills onto the homeless single mother that lives in the dump down the street.

What the HE** are you talking about??

P.S. Mammograms are not hard to come by in Canada!

Give me a break, your country doesn't even have routine colon cancer screening!!! How do I know? Trained in Canada for EUS.


We all privately buy our own car insurance...should healthcare be different? If I can't pay to get my car fixed, the mechanic isn't forced to do it for free??
Also, I'm not against health coverage for almost everyone, just against cutting doctors pay or raising taxes in order to do it!!

 

[jubb]

I'm totally against socialized medicine. I've seen it first hand in england, I saw a lady waiting 6 months to get her artificial hip replaced as it was slipping out. She was totally lopsided, basically immobile, and on a waiting list.

We talk and talk about the uninsured in america, but how many people have you seen not get care cuz they don't have insurance? I've never seen it, on the surgical side of things. I've seen people not be able to afford the latest and greatest medicines, but there are plenty of affordable substitutes that will only be slightly less effective. Yeah it's true people are more reluctant to go to the doctor if they don't have insurance, but they still ultimately get care if they need it.

Why are we skipping making it required to have health insurance? That seems like a much more important step than jumping straight to completely government run health care.

It bothers me when people argue that corporations are corrupt and that's why we need to turn it over to the government. I think it's corrupt government or government interfering in markets that allows corrupt corporations to exist. I don't buy that government will remove corruption from healthcare, I think it will just get worse.

Justin

 

[gida]

Yeah it's true people are more reluctant to go to the doctor if they don't have insurance, but they still ultimately get care if they need it.

Examples contrary to your beliefs (I'm in PP)
1) a guy moves near my town and sees me because he has Primary Sclerosing Cholangitis (PSC), 26 years old, no job, no insurance, self pay.
FACT: The average amount of time from diagnosis to Liver Transplant in PSC is 8 years. There is no treatment...we give people URSO ( a few $100 a month but not proven to improve time to transplant or survival).
So what could I do? I told him that he needs to see a social worker and get in some "system"....not to mention he should have routine labs and a bone scan....but he can't pay for this so he can't get them.
Doubt he can get corporate insurance cuz they know he has PSC.

2) an older guy, former alcoholic, sees me for new diagnosis of cirrhosis, he also has ascites. He has no job, and also is 'self pay.'
He needs the following:
a) vax vs. Hep A and Hep B
b) labs
c) Ultrasound to screen for hepatocellular carcinoma
d) Diuretics for his ascites
e) EGD to evaluate for esophageal varices
So all I could do was write him for a Rx for lasix and spironolactone and tell him to get a social worker to get on some 'system'

Why are we skipping making it required to have health insurance? That seems like a much more important step than jumping straight to completely government run health care.

I'd be up for that idea...

But, I mean, I'm a capitalist and definitley think after all this training I deserve a VERY good salary, and I abhor thinking about socialized medicine...but this 26 year old kid with PSC is up shi*tcreek!!

Ultimately we might have a 2 tier system....private insurance and the bettter care that goes with it...and then some 'universal' coverage for those in dire straights.....maybe they can look at your W-2 and if you make below a certain amount then you get the universal coverage.
But what about those freaking illegal immigrants....they send their kids to the public schools I pay for with taxes...they don't pay taxes....they too will get even more healthcare that we pay for???
Can't they pay like $100 bucks per year per kid to the public schools???

 

[arrhythmia7]

This is an interesting thread. I just have a couple of points to add:

1. Supply and demand. It is hard to become a doctor in America, and a lengthy process to say the least. There are very few of us, and a whole sh*tload of sick people. Sure there are the med school/residency classmates that would love to martyr themselves out for meager wages, but that is not the norm, and as long as we're in the minority, the market will pay us what we please.

2. Drs. wages are about as low as they're going to get right now, and it is a result of MediCare hitting the seen in the last decade. The bottom line is that we already have "socialized medicine" in the sense that if you show up in an ER, you will get taken care of whether you make 5 dollars a year or 500k dollars a year. The socialized medicine we have is just very poorly run.

3. Even with physician salaries humbling compared to 20 years ago, we still average way more than any other profession - even CEOs. For every I-banker that gets a 7 million dollar bonus for one outstanding year, there are about 20 doctors that are pulling in over a million year in and year out for their surgical expertise, large practice management, or involvement in industry.

4. Pharma/Device/Biotech is a goliath economic force and one of the few that is keeping the economy afloat right now. There is also huge lobbying bodies behind this force. It is not going away anytime soon.

 

[jubb]

Examples contrary to your beliefs (I'm in PP)
1) a guy moves near my town and sees me because he has Primary Sclerosing Cholangitis (PSC), 26 years old, no job, no insurance, self pay.
FACT: The average amount of time from diagnosis to Liver Transplant in PSC is 8 years. There is no treatment...we give people URSO ( a few $100 a month but not proven to improve time to transplant or survival).
So what could I do? I told him that he needs to see a social worker and get in some "system"....not to mention he should have routine labs and a bone scan....but he can't pay for this so he can't get them.
Doubt he can get corporate insurance cuz they know he has PSC.

2) an older guy, former alcoholic, sees me for new diagnosis of cirrhosis, he also has ascites. He has no job, and also is 'self pay.'
He needs the following:
a) vax vs. Hep A and Hep B
b) labs
c) Ultrasound to screen for hepatocellular carcinoma
d) Diuretics for his ascites
e) EGD to evaluate for esophageal varices
So all I could do was write him for a Rx for lasix and spironolactone and tell him to get a social worker to get on some 'system'

I don't know how the social workers do it, but they seem to get our patients on systems that allow them to get care and get operations. I doubt they could get someone a liver transplant though. If we don't go socialized we may have medical tourism programs for our uninsured to cut costs.

 

[Faebinder]

This is an interesting thread. I just have a couple of points to add:

1. Supply and demand. It is hard to become a doctor in America, and a lengthy process to say the least. There are very few of us, and a whole sh*tload of sick people. Sure there are the med school/residency classmates that would love to martyr themselves out for meager wages, but that is not the norm, and as long as we're in the minority, the market will pay us what we please.

2. Drs. wages are about as low as they're going to get right now, and it is a result of MediCare hitting the seen in the last decade. The bottom line is that we already have "socialized medicine" in the sense that if you show up in an ER, you will get taken care of whether you make 5 dollars a year or 500k dollars a year. The socialized medicine we have is just very poorly run.

3. Even with physician salaries humbling compared to 20 years ago, we still average way more than any other profession - even CEOs. For every I-banker that gets a 7 million dollar bonus for one outstanding year, there are about 20 doctors that are pulling in over a million year in and year out for their surgical expertise, large practice management, or involvement in industry.

4. Pharma/Device/Biotech is a goliath economic force and one of the few that is keeping the economy afloat right now. There is also huge lobbying bodies behind this force. It is not going away anytime soon.

EXACTLY!

You Are All Missing The Point! We are already in a single payor system... you all just pretend it is not. EMTALA and private insurance based on medicare is the reason we are in a single payor system.

Fix it and forget about going 100% private.. it wont happen... no one will risk their neck by cancelling EMTALA and if they don't then we will remain single payor system forever. Let them at least go abolish the stupid private insurance and give the government full control. EMTALA makes it impossible to negotiate with the insurance companies, so lets fix it and get rid of them and leave only one source of pain... the government.

 

[tussy]

I've been following this thread with interested and finally had to speak up as a Canadian physician to correct a few myths that have been presented about the Canadian health care system. I think our system of socialized medicine is far from perfect, however i believe in the premise that everyone deserves access to adequate health care.

First off, for those that say Canadian don't have access to screening mammograms, colorectal cancer screening, etc are simply mistaken. We have access to these things (maybe in some remote and underserviced regions this isn't quite the case but generally it is). When i turn 40 I can walk into the "breast screening centre" and get my mammogram without a referal from my family physician and there is no fee as long as i have a valid provincial health card (all Canadians should have this card free of charge).

In clinic today i saw 4 new referals with rectal cancer. 2 were discovered last week at their colonoscopy (one was a screening and one was being investigated urgently for rectal bleeding), 1 was found by a GP doing an annual physical and 1 was found by a urologist doing a prostate exam. All 4 patients will be getting their CT scans on monday. 2 were early cancers and will be having their surgery next week and the other 2 were more advanced and will be seen in the cancer centre for neoadjuvent chemo/rads. None of the patients have any worries about who will pay for their therapy; in fact it isn't a thought at all. they have enough to worry about. The canadian system works - not perfect, but it does work.

It's true that people with non-life threatening may wait an unacceptably long time and we are working hard to deal with these shortages in the Canadian system. This is why many of us believe a two-tierd system (universal coverage for everyone with the option to pay for expediated services for those that can afford it) would be a good idea. Like i said - not perfect, but where i choose to live and work. I recognize that it isn't for everyone.

 

[gida]

In clinic today i saw 4 new referals with rectal cancer. 2 were discovered last week at their colonoscopy (one was a screening and one was being investigated urgently for rectal bleeding), 1 was found by a GP doing an annual physical and 1 was found by a urologist doing a prostate exam. All 4 patients will be getting their CT scans on monday. 2 were early cancers and will be having their surgery next week and the other 2 were more advanced and will be seen in the cancer centre for neoadjuvent chemo/rads.

It's true that people with non-life threatening may wait an unacceptably long time and we are working hard to deal with these shortages in the Canadian system. This is why many of us believe a two-tierd system (universal coverage for everyone with the option to pay for expediated services for those that can afford it) would be a good idea. Like i said - not perfect, but where i choose to live and work. I recognize that it isn't for everyone.

4 patients with rectal cancer....and only 1 was picked up on a SCREENING colonoscopy! And 2 were ADVANCED lesions!!

I literally just spent the last 3 months in CANADA and was told by attendings they are too busy scoping symptomatic patients that they don't have time to do screening colons. I saw many T3 and T4 rectals lesions in people in thier 50s who present with bleeding. COLO/RECTAL CANCER IS PREVENTABLE.

 

[tussy]

4 patients with rectal cancer....and only 1 was picked up on a SCREENING colonoscopy! And 2 were ADVANCED lesions!!

I literally just spent the last 3 months in CANADA and was told by attendings they are too busy scoping symptomatic patients that they don't have time to do screening colons. I saw many T3 and T4 rectals lesions in people in thier 50s who present with bleeding. COLO/RECTAL CANCER IS PREVENTABLE.

Actually 2 were under 50 with no family history so don't even meet the guidelines for screening.

Any patient that wants screening can get it - most just don't want it. There is a screening colonoscopy clinic here where patients can self-refer themselves. Don't try and tell me that every patient in the USA over age 50 gets a colonoscopy!

 

[Faebinder]

Actually 2 were under 50 with no family history so don't even meet the guidelines for screening.

Any patient that wants screening can get it - most just don't want it. There is a screening colonoscopy clinic here where patients can self-refer themselves. Don't try and tell me that every patient in the USA over age 50 gets a colonoscopy!

Well he didnt know the age involved so no harm. Still I agree with your assessment overall. We have our priorities mixed up.