"That's the problem: President Bush suggests uninsured children go to ED..."

[mlw47]

http://www.chron.com/disp/story.mpl/editorial/4989306.html

After the Senate Finance Committee approved an expansion of the federal Children's Health Insurance Program to cover nearly 10 million kids, President Bush offered a strange rationale for threatening to veto it.
"People have access to health care in America," he told an audience in Cleveland. "After all, you just go to an emergency room."

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Members don't see this ad.

 

[kbrown]

http://www.chron.com/disp/story.mpl/editorial/4989306.html

After the Senate Finance Committee approved an expansion of the federal Children's Health Insurance Program to cover nearly 10 million kids, President Bush offered a strange rationale for threatening to veto it.
"People have access to health care in America," he told an audience in Cleveland. "After all, you just go to an emergency room."

for lack of better words...F@!*I&G IDIOT!!!!!!!!!!! He just doesn't get it.

 

[ERMudPhud]

Makes me want to grab him, shake him, and scream

"AND WHERE ARE THEY SUPPOSED TO GO AFTER THAT FOR DEFINITIVE CARE OF THEIR ASTHMA, DIABETES, OBESITY, LEUKEMIA, AUTISM..."

 

[GeneralVeers]

Makes me want to grab him, shake him, and scream

"AND WHERE ARE THEY SUPPOSED TO GO AFTER THAT FOR DEFINITIVE CARE OF THEIR ASTHMA, DIABETES, OBESITY, LEUKEMIA, AUTISM..."

(sarcasm on)
Just keep saying that. After all the Democrats have posed a much better solution in the form of European-style socialist care (sarcasm off)

 

[FoughtFyr]

Read the rest of the article, there's even more to love!

"Perhaps the most dubious reason cited by the White House for opposing the increase concerns the tax hike on cigarettes, which would go up from 39 cents a pack to a dollar. According to spokesman Tony Fratto, it would unfairly penalize the poor "to finance a new subsidy for the middle class." He didn't mention that higher tobacco taxes would likely reduce teen access to cigarettes and lower the health care costs of treating millions of Americans for respiratory disease and cancer caused by smoking."

My god. I'm actually going to be forced to vote democrat. I mean look at the choice - raw greed and stupidity or f*cking socialized healthcare. We really need more than two parties...

- H

 

[mfleur]

Read the rest of the article, there's even more to love!



My god. I'm actually going to be forced to vote democrat. I mean look at the choice - raw greed and stupidity or f*cking socialized healthcare. We really need more than two parties...

- H

Agreed...I say we get rid of the dems and reps and give the communists and the liberatarians a try. Bush makes my tummy hurt...

Watching last nights Daily show...I love Jon Stewart!

 

[igcgnerd]

I calmed my rage by sending a two page tirade to the editor of my local papers. Trust me it helps.

 

[71263]

Libertarians have been around for a while, and I keep telling people to vote, but they just wont listen, will they?

"Look at me!! Im voting for a candidate I dont truly believe in simply because everyone else is! Theyre all doing it, so why dont I?? Thats the cool thing to do!!" -most of the *******es in this country. And what's the result? A toss-up between Bush and Kerry, both *******es (though one much worse than the other).

Seriously, if you believe in someone, vote for them! Who gives a f#ck about which candidate your neighbors are voting for?? Stop being such ******* and think for yourself! God, this is precisely the reason I hate people (well, one among many).

 

[ERMudPhud]

(sarcasm on)
Just keep saying that. After all the Democrats have posed a much better solution in the form of European-style socialist care (sarcasm off)

That grossly misrepresents the democratic proposals for health care reform. None of the current top three candidates are proposing a single payer system like Canada or the european social democracies. Some of the more left candidates are but I'd take even their proposals over one that says "We don't need health care reform. Just go to your local ER and ERMUDPHUD will fix whatever is wrong with you for free." EMTALA was signed by Reagan and the product of a narrowly divided house and republican senate. Since then the democrats may not have come up with much but then they haven't held the house, senate, and presidency simulatenously except for 2 years in the early 90's. The republicans controlled all three spots for over 4 years recently but their only health care plan appears to be the "Go see ERMUDPHUD for free plan" Even the more right wing ER docs on this forum ought to have a problem with a health care plan based on an unfunded mandate that says the solution is for them to care for the poor for free. That doesn't fit well with republican or libertarian principles. Here's just a short list of why that is so wrong.

1. ER's are expensive and for acute illnesses. Much of the health care burden in this country is from chronic illnesses like diabetes, CAD, COPD and we don't manage those things very well at all.

2. Did you know that EMTALA doesn't apply to admitted patients. We already have problems with the consultants refusing to see admitted patients and leaving the hospitalists holding the bag. For certain problems our hospitalists won't accept a patient in transfer or agree to admit the patient unless we have a verbal commitment from the specialist to see and care for the patient. It might get to the point where we are forced to have them see the patient in the ER just to get their name in the chart. So much for waiting until your K is 9 to come to the ER for dialysis if the nephrologist refuses to see you after your admitted. Same for your laryngeal tumor occluding your airway or you leukemic blast crisis.

3. Why should the few thousand ER docs in the country pay for the entire uninsured by seeing them all for free. Spread the burden to the rest of medicine and the rest of America. I watched one hospital where I worked go from 5% self pay to >40% self pay with a big chunk of poorly paying medicaid. Most of this was from working lower middle class whose employers either dropped health insurance or made it so expensive they couldn't afford it. Some increase in taxes would be better than seeing half my patient for free. Since I can't write off the half I see for free against the half I'm being paid to see the net result puts me in ">60% tax bracket" Half the patient seen for free due to an unfunded mandate equals a tax rate of 100% and the income from the other half taxed around 35%(fed, state, FICA, etc...). Once you are out in private practice you might land at Spyders gig or my new job where the majority of the patients are insured but those jobs are hard to come by. You are more likely to be treating half your patients for free. Every time you do thank the republicans for that tax rate of 100% . Just curious for all the attendings out there what percent of your patients are uninsured?

So, yes even if the democrats were proposing a european social democracy style single payer, single administrator, government run health care system, which they're not, that would still be better for me than the "Go see ERMUDPHUD for free plan" At least I'd be getting paid something and in my book something is always better than nothing.

 

[dilated]

3. Why should the few thousand ER docs in the country pay for the entire uninsured by seeing them all for free. Spread the burden to the rest of medicine and the rest of America.

Do you really think of it as "paying for the uninsured"? It really makes no sense to look at it that way. EM physicians are already paid well above the average physician's salary. If universal coverage occured, then EM reimbursements would simply be slashed to maintain salaries at the current rate (or lower, given the bargaining power of the government). The idea that EM physicians who see 50% uninsured and make 200k a year are going to make 400 (or even 250k) once they see 100% insured because of universal coverage is bizarre. You're not "paying for the uninsured", the insured are. In the form of massively higher ED bills than they would receive if they weren't paying for both themselves and the uninsured.

 

[GeneralVeers]

So, yes even if the democrats were proposing a european social democracy style single payer, single administrator, government run health care system, which they're not, that would still be better for me than the "Go see ERMUDPHUD for free plan" At least I'd be getting paid something and in my book something is always better than nothing.

As much as I hate the Republicans right now, I can't agree with the Democrats on the issue. It is true that they are not advocating a completely socialist system right at the moment. What they are advocating is a stepwise progression of increased government involvement, and gradual addition of more and more universal coverage, with the EVENTUAL goal of European-style healthcare.

As I see it, this change is inevitable, as so many of the population has been sold on the idea of "free healthcare" without actually realizing how much it will cost, and how much autonomy they will have to give up.

To all my EM colleagues, my advice is to save up your money while you can, as this golden era of high reimbursement isn't going to last, and once the government starts to control more and more of the reimbursement you will inevitably see your salary fall. It happened to the doctors in Canada, and precisely the same thing is going to happen here.

 

[The White Coat Investor]

Just curious for all the attendings out there what percent of your patients are uninsured?

0%. We're looking to hire a few good docs if you're interested. The benefits are great....all expense paid trips to hot, sandy locations.

 

[ERresponsible]

Can't agree more - two parties is a travesty. If American history is any guide, we'll get a new health care system that will cover half the uninsured but screw the taxpayer, hospitals and healthcare workers. I have this sneaky suspicion that even with a Demo in office, the Pharma and Insurance industries will do just fine.


Speaking of Jon Stewart, take a look at this hilarious video.
http://www.youtube.com/watch?v=b0sNJhphi7U

 

[ERMudPhud]

Do you really think of it as "paying for the uninsured"? It really makes no sense to look at it that way. EM physicians are already paid well above the average physician's salary. If universal coverage occured, then EM reimbursements would simply be slashed to maintain salaries at the current rate (or lower, given the bargaining power of the government). The idea that EM physicians who see 50% uninsured and make 200k a year are going to make 400 (or even 250k) once they see 100% insured because of universal coverage is bizarre. You're not "paying for the uninsured", the insured are. In the form of massively higher ED bills than they would receive if they weren't paying for both themselves and the uninsured.

We pay way more than the insured do. The increased premiums are spread amongst everyone. I pay those increased premiums like everyone else but I also still see lots of patients who have absolutely no way of paying their bill and right now that is the only government health care plan. Only the ER docs are forced by the government to work for free. Furthermore, those increased bills and premiums don't help the uninsured or at least not in an equitable way.

Right now the government and by extension the insurance companies cap what we can bill per patient and that cap is not adjusted based on the frequency of uninsured patients in your ER. The bill is the same whether every patient is paying or only 10% of patients are paying. That's why ER doc's in areas with 100% insured patients can make more than 400K per year while those in other areas make less than 150K. Sure, increased insurance premiums and bills help pay for the uninsured but that burden is not spread evenly. The increased bills make the docs in say Santa Barbara rich while doing nothing to help the poor and bankrupt hospitals in say inner city New York where less than 10% of patients are paying their bill anyway.
If a universal health care plan meant that all my uninsured patients had followup for their acute conditions and managment of their chronic conditions I'd be all for it even if it cost me 10%-20% of my income. I doubt it would. Not having to worry about bad outcomes from patients with no follow up alone would be worth it. I sometimes spend huge chunks of my shift begging subspecialists for help and sometimes I just have to shrug my shoulders, hand the patient a list of phone numbers, apologize, and wish them luck. I'm sure for many specialists,some EM docs in high reimbursement areas, and some citizens who will pay higher taxes it will cost far more than that but for the ER docs treating all the hoards of uninsured that Bush has told to "just go to the ER if you don't have insurance" I doubt it will be a net loss.

Whenever you change the ground rules there will be winners and losers. With Bush's go to the ER plan the only losers are the patients, the hospitals, and the ER docs in the poor areas. With universal coverage I doubt that the losers would remain the same.

 

[ERMudPhud]

0%. We're looking to hire a few good docs if you're interested. The benefits are great....all expense paid trips to hot, sandy locations.

Ah yes... the other national health care plan.

 

[EM2BE]

Here's the link to the whole speech for those that are interested: http://www.whitehouse.gov/news/releases/2007/07/20070710-6.html

 

[RisingSun]

Do you really think of it as "paying for the uninsured"? It really makes no sense to look at it that way. EM physicians are already paid well above the average physician's salary. If universal coverage occured, then EM reimbursements would simply be slashed to maintain salaries at the current rate (or lower, given the bargaining power of the government). The idea that EM physicians who see 50% uninsured and make 200k a year are going to make 400 (or even 250k) once they see 100% insured because of universal coverage is bizarre. You're not "paying for the uninsured", the insured are. In the form of massively higher ED bills than they would receive if they weren't paying for both themselves and the uninsured.

I hear this argument all the time but where is your proof? This is the same old hackneyed talking point that has no basis in recent precedent. There is absolutely no indication that physician reimbursement will be slashed across the board if a single payer system were to be realized. Really, the only system that I can think of in recent years that went from a private to a publicly-financed single-payer system is the Australian one, and I have read that Australian physician income has increased significantly compared to what it was before.

Take your average private practice PCP. He/her has to employ sometimes 2 or 3 people just to hound insurance companies to get paid. Think of the money in overhead that would be saved if those people did not have to be employed because, although medicare or whatever single-payer system there may be might not be the highest payer, it reliably pays every time, on time. The same cannot be said for many (most?) private insurers. I'm not privy to the world of EM reimbursement like the rest of you so I may be totally off base for what your reality is, but at least in terms of primary care medicine, a single-payer system (note: this is not a French/Canadian/Cuban universal healthcare system where we are taxed to the teeth) should only increase incomes, not hurt them.

 

[deleted77919]

Under a single payer system that outlaws private insurance (yes they've been proposed) what incentive is there to ever increase reimbursement? Or even to not decrease reimbursement? Faith that Uncle Sam will provide is all you have.

At least at the moment there is the option to not take medicare.

 

[deleted77919]

ut at least in terms of primary care medicine, a single-payer system (note: this is not a French/Canadian/Cuban universal healthcare system where we are taxed to the teeth) should only increase incomes, not hurt them.

Why? Whats to stop the new national insurance plan from deciding that a standard 15 minute PCP appointment is billable to the tune of $1.50?

 

[ERMudPhud]

At least at the moment there is the option to not take medicare.

Not in EM, at least not hospital based EM. Don't get me wrong, I like medicare, I'm glad to take medicare, medicare is great for my parents.

 

[ERMudPhud]

I'm not privy to the world of EM reimbursement like the rest of you so I may be totally off base for what your reality is,

My 30 physician group has an entire company with I think at least a dozen employees dedicated to hounding insurance companies

 

[RisingSun]

Under a single payer system that outlaws private insurance (yes they've been proposed) what incentive is there to ever increase reimbursement? Or even to not decrease reimbursement? Faith that Uncle Sam will provide is all you have.

At least at the moment there is the option to not take medicare.

I understand what you are saying. I think that it would be easy to get around that by adding a provision to the legislation on the table to maintain current medicare rates and each year to have a COL increase of 3% or something to that effect. Most government employees are guaranteed a modest COL raise per year, why shouldn't physicians in a single-payer system also? Besides, I still think that if most people coming to the clinic or ED were insured that it would positively effect the overall income of physicians, even if they were reimbursed less per visit, because there would be significantly fewer write-offs.

I'm less advocating a complete switch to a single-payer system than the option of inexpensively enrolling in a national health care plan, like medicare for all. People who can/want to enroll in private plans can, those who can't afford private or would rather take medicare, can. The bottom line would be fewer un/under-insured people in our offices/ERs.

 

[ERMudPhud]

Here's the link to the whole speech for those that are interested:

Its a nice speech and I hope that some of those ideas make it in to a National Health plan; private insurance with individuals able to apply as groups just like corporations do, a tax incentive for buying your insurance, penalties or disencentives if you choose to go bare, subsidies so the poor can buy private insurance, health savings accounts, etc... I'm not a total communist. I recognize the value of market forces and the political realities of health reform in America.

But trying to say that things are fine right now because even if you don't have insurance you can always just go to the ER is stupid, naive, and disengenuous. Given the source I guess I shouldn't be so angry and surprised.

 

[EM2BE]

Its a nice speech and I hope that some of those ideas make it in to a National Health plan; private insurance with individuals able to apply as groups just like corporations do, a tax incentive for buying your insurance, penalties or disencentives if you choose to go bare, subsidies so the poor can buy private insurance, health savings accounts, etc... I'm not a total communist. I recognize the value of market forces and the political realities of health reform in America.

But trying to say that things are fine right now because even if you don't have insurance you can always just go to the ER is stupid, naive, and disengenuous. Given the source I guess I shouldn't be so angry and surprised.

I agree.

 

[WilcoWorld]

0%. We're looking to hire a few good docs if you're interested. The benefits are great....all expense paid trips to hot, sandy locations.

funniest post this forum's seen in some time

 

[medivac]

This is oversimplification, but everytime I read this:

After the Senate Finance Committee approved an expansion of the federal Children's Health Insurance Program to cover nearly 10 million kids, President Bush offered a strange rationale for threatening to veto it.
"People have access to health care in America," he told an audience in Cleveland. "After all, you just go to an emergency room."

I think this:

"But the people have no bread to eat"

"Let them eat cake"

(which is often attributed to marie antoinette depending on who taught you your history)

 

[docB]

As a Bush supporter I will admit I am disappointed by this comment. However, this is the attitude of the lay public. Ask your non-medical friends. All of my friends believe that the ED is an appropriate place to get care if you have no where else to go, regardless of the severity or acuity of the complaint. They all believe that if you are poor and can't pay your medical bills that the government pays them for you. They also believe that when the EDs get busy and wait times lenghten that it's the EDs fault for not staffing enough.

It sounds like Bush is in touch with the attitude of the public.

 

[Faze2]

for lack of better words...F@!*I&G IDIOT!!!!!!!!!!! He just doesn't get it.

What are you guys talking about? Bush is an extremely intelligent, articulate person. I mean, after all, he did go to Yale, right? Guys?............Right?........

 

[GeneralVeers]

It sounds like Bush is in touch with the attitude of the public.

....Or he's as intelligent as those who believe the ED is the appropriate place to be seen for their runny nose or med refill.

 

[docB]

....Or he's as intelligent as those who believe the ED is the appropriate place to be seen for their runny nose or med refill.

That's my point. Intelligent, regular people think that's what we're here for. This attitude is bolstered by their employers (I don't want to be stuck with a work comp issue so you have to go to the ER to get checked out.), their PMDs (I'm too busy to see you. Just go to the ER.), their insurers (We can't approve your test unless it's an emergency and you go to the ER.) and society in general. Seriously, talk to some of your non-medical friends and see what they think. You'll find they just don't understand.

 

[EM2BE]

That's my point. Intelligent, regular people think that's what we're here for. This attitude is bolstered by their employers (I don't want to be stuck with a work comp issue so you have to go to the ER to get checked out.), their PMDs (I'm too busy to see you. Just go to the ER.), their insurers (We can't approve your test unless it's an emergency and you go to the ER.) and society in general. Seriously, talk to some of your non-medical friends and see what they think. You'll find they just don't understand.

I do respect your comments, but that is just not what I see. Where my parents live, rarely does a person go to the ED. I read them (my parents) the article and they fully understood the problem, and they are Bush supporters. And no, neither of them is medical, and not too many in the town are. Maybe it's because we are in a smaller town, but distance to the closest ED is only 20-25 minutes. Distance is not what keeps them away. It's the belief that the ED is for emergencies only that keeps them away unless necessary. Just my 2 cents.

 

[EM OR BUST]

It sounds like Bush is in touch with the attitude of the public.

The Polls say otherwise.

 

[CS_22]

I understand what you are saying. I think that it would be easy to get around that by adding a provision to the legislation on the table to maintain current medicare rates and each year to have a COL increase of 3% or something to that effect. Most government employees are guaranteed a modest COL raise per year, why shouldn't physicians in a single-payer system also? Besides, I still think that if most people coming to the clinic or ED were insured that it would positively effect the overall income of physicians, even if they were reimbursed less per visit, because there would be significantly fewer write-offs.

I'm less advocating a complete switch to a single-payer system than the option of inexpensively enrolling in a national health care plan, like medicare for all. People who can/want to enroll in private plans can, those who can't afford private or would rather take medicare, can. The bottom line would be fewer un/under-insured people in our offices/ERs.

I have to agree with you on a point here RisingSun...

Most physicians seem to think that if we move towards a Universal Health Care System that it will have to be a single-payer, government only system, like the Canadian model. But there are plenty of other ways to set it up while still guaranteeing coverage for all. For example, look at the Australian system which has a basic coverage for all that everyone pays into, with a private insurance tier on top that is not connected to employment but rather compete for individuals (similar to car insurance plans). If I remember right, 70% of Australians enroll in supplemental insurance beyond the basic insurance the government provides. With the two tier approach, you don't necessarily have the prolonged waits for necessary procedures, while still maintaining minimum coverage for all.

We're in a position now where things are just going to get worse under the current system. Its an economic cycle that will just keep continuing. You have a set number of insured and uninsured. You only collect from the uninsured "self pay" person a small percentage of the time, so you in turn raise fees charged to the insurance companies. They continue getting charged higher fees and while trying to maintain a profit, they raise rates, pricing out the lower end patients who instead cancel their policies (ie, the working poor), thinking that they can go without. More uninsured, less collection, higher fees, higher rates, more uninsured...

This is going to continue to be a problem until the middle class is completely priced out of reasonable insurance. Then, the pure numbers of voters will spur a change. It will happen... I think its just a matter of time. What we should be doing as physicians (ACEP, AMA, etc) is trying to contribute a REAL solution to the problem.

Chet

 

[Faze2]

That's my point. Intelligent, regular people think that's what we're here for. This attitude is bolstered by their employers (I don't want to be stuck with a work comp issue so you have to go to the ER to get checked out.), their PMDs (I'm too busy to see you. Just go to the ER.), their insurers (We can't approve your test unless it's an emergency and you go to the ER.) and society in general. Seriously, talk to some of your non-medical friends and see what they think. You'll find they just don't understand.

From the majority of people I've seen and dealt with, you are right on the ball. They simply do not understand anything about an ER or how it (is supposed to) work(s).

 

[AML]

If you're working poor, you go to the ER because.... when you can't afford to pay $200 up front, you can't go to a doc-in-the-box. Because doc-in-the-box closes at nine pm. If you have a primary care provider, it takes a week to a month to get in to see them.

I've gone to the ER for what looked like a kidney infection and turned out to be a kidney infection, and I spent a while annoyed that we hadn't waited til morning (doesn't matter I was crying in pain) because not only did it cost us $500, but we got to pay another $800 in six weeks because of an unexpected side effect from the antibiotic. That's a month's salary before taxes for us. Husband broke his fibula and we wound up waiting seven hours for anyone to look at him (I don't count the clerk who wanted to know if we had insurance and took his name). And around Christmas I had chest pains off and on. One night it got really bad. So I went to the ER, like everyone tells you to. Turned out my potassium was low. That'll be six hundred dollars, please. Plus another three hundred for the EKG.

Yes, I know I'm paying for "what if it WAS a heart attack". I wouldn't mind that so much if it wasn't for the weight of the cost on my family. That's another year I go without seeing a dentist. That's another year I make these glasses work and hope my vision doesn't change. That's another year we go without fixing that spot on the roof where it's starting to leak. That's another year my husband swallows more tylenol and ignores the clicking and jamming of his knee. In the future, I know we'll wait far, far longer before going to the ER. We're too moral to give a false name.

From my position, I don't know the answer, I only know that things aren't right the way they stand now.

 

[hyperbaric]

If you're working poor, you go to the ER because.... when you can't afford to pay $200 up front, you can't go to a doc-in-the-box. Because doc-in-the-box closes at nine pm. If you have a primary care provider, it takes a week to a month to get in to see them.

I've gone to the ER for what looked like a kidney infection and turned out to be a kidney infection, and I spent a while annoyed that we hadn't waited til morning (doesn't matter I was crying in pain) because not only did it cost us $500, but we got to pay another $800 in six weeks because of an unexpected side effect from the antibiotic. That's a month's salary before taxes for us. Husband broke his fibula and we wound up waiting seven hours for anyone to look at him (I don't count the clerk who wanted to know if we had insurance and took his name). And around Christmas I had chest pains off and on. One night it got really bad. So I went to the ER, like everyone tells you to. Turned out my potassium was low. That'll be six hundred dollars, please. Plus another three hundred for the EKG.

Yes, I know I'm paying for "what if it WAS a heart attack". I wouldn't mind that so much if it wasn't for the weight of the cost on my family. That's another year I go without seeing a dentist. That's another year I make these glasses work and hope my vision doesn't change. That's another year we go without fixing that spot on the roof where it's starting to leak. That's another year my husband swallows more tylenol and ignores the clicking and jamming of his knee. In the future, I know we'll wait far, far longer before going to the ER. We're too moral to give a false name.

From my position, I don't know the answer, I only know that things aren't right the way they stand now.

So how much did you pay for your fully tattooed back?

 

[GeneralVeers]

If you're working poor, you go to the ER because.... when you can't afford to pay $200 up front, you can't go to a doc-in-the-box. Because doc-in-the-box closes at nine pm. If you have a primary care provider, it takes a week to a month to get in to see them.

Great, so under nationalized healthcare you'll get "free" care, but oh-by-the-way, they forgot to mention the 5-10% they'll be taking off the top of your paycheck to pay for the "free care".

 

[BKN]

So how much did you pay for your fully tattooed back?

 

[bulgethetwine]

I don't get it, Brian... ????

 

[Seaglass]

I second that. Kind of a low blow . . .

 

[CS_22]

Great, so under nationalized healthcare you'll get "free" care, but oh-by-the-way, they forgot to mention the 5-10% they'll be taking off the top of your paycheck to pay for the "free care".

Wouldn't you pay 5-10% for guaranteed basic healthcare? And you could even cap it like they do with FICA now. Nothing extra after your first 60000.

Look at it from the other side. Wouldn't you rather everyone that come into your ED have some sort of coverage that will help pay the bill vs no coverage/self pay that only 10% or so will end up paying? Keep in mind that in the two tier system, 70% of people in australia have private insurance too.

And sorry, didn't mean to hijack this thread and make it another Universal Healthcare Speech. I just think that as a whole, there are a lot of misconceptions about universal health care -- it doesn't have to be very different than what we have now.

So back to the OP point -- As a registered republican and first time Bush voter , he's an idiot.

 

[GeneralVeers]

Wouldn't you pay 5-10% for guaranteed basic healthcare? And you could even cap it like they do with FICA now. Nothing extra after your first 60000.

I'm merely trying to point out that it's not free. Those people who argue that they can't support their families, much less pay healthcare costs with their current salaries don't seem to fully understand. One way or another you're going to pay for it.

I wouldn't mind the 5-10%, but I don't want government to control it, like in Canada. I get superior health care through my work right now to anything the government could ever provide. I'm not willing to take a cut in the quality of my care to fulfill some socialist egalitarian ideal.

 

[bulgethetwine]

I'm merely trying to point out that it's not free. Those people who argue that they can't support their families, much less pay healthcare costs with their current salaries don't seem to fully understand. One way or another you're going to pay for it.

I wouldn't mind the 5-10%, but I don't want government to control it, like in Canada. I get superior health care through my work right now to anything the government could ever provide. I'm not willing to take a cut in the quality of my care to fulfill some socialist egalitarian ideal.

GV,

Be more specific by what you mean by "government controlled" health care in Canada, and why you're so sure it's a bad thing. Does it mean the government decides who gets care and who doesn't? Ah, No. Does it mean that the government decides on treatment plans and encroaches on physician autonomy? Nope. Does it mean that I have to put up with ridiculous HIPAA inspectors telling me I can't have coffee in the docs area? Again, No. Does it mean that I only get reimbursed a certain percentage of my billings? No once more. So what does it MEAN?

Well, it does mean a few things....

1) You only bill one source, that source pays nearly 100% of the billings, and you don't have to chase the insurance company for it.

2) High income taxes, sure -- but cross over the bridge at Windsor or Buffalo and you'll see that those taxes also pay for better roads, too. And thus lower car repair costs. And lower insurance costs. Plus, Canada has better schools, and a smaller rich-poor gap then the U.S. Sure, you could argue the robust welfare system takes away the incentive for some to work, but the point is, it's much more complex than just comparing tax rates and healthcare coverage.

3) SOME (not all) elective procedures (although admittedly some shouldn't be elective, e.g. hip replacements and certain indications for MRI) take long. But this is more related to a shortage of trained personnel than the healthcare system

All I'm saying is that I have a lot of respect for a lot of the things I've seen you post in this thread and others over the years. But speaking as someone who has a lot of experience here in the U.S. as well as abroad (including Canada and other places where there are two-tiered systems like Western Europe) this feeling that certain Americans get that Canadian medicine is somehow a bad thing because of the connotation of words like "socialized" is holidng up meaningful dialogue on change in this country (the U.S.).

As always, just my .02

 

[Seaglass]

I'm merely trying to point out that it's not free. Those people who argue that they can't support their families, much less pay healthcare costs with their current salaries don't seem to fully understand. One way or another you're going to pay for it.

I wouldn't mind the 5-10%, but I don't want government to control it, like in Canada. I get superior health care through my work right now to anything the government could ever provide. I'm not willing to take a cut in the quality of my care to fulfill some socialist egalitarian ideal.

Really? What's so superior about your care compared to say medicaid? You get to see your doctor - they see their doctor. Both are board certified and so we'll call them equivalent.

You pay a copay - they pay a copay.

You go to the ER or are admitted, you pay a percentage of your bill up to a certain amount. They get admitted and they pay a percentage up to a certain amount.

You need a test, you get it. They need a test, they get it.

You need a drug - you either get one form your plan's formulary or you pay through the nose. THey need a drug and they either get one through their plan's formulary or pay through the nose.

I don't see how yours or my insurace is gets us anything more than people are getting with medicare or medicaid these days. The only benefit perhaps is that there is a wider choice of doctors available to us, but in a single payor system every provider will have to participate (or go cash only) and so in fact the choice for everyone gets better.

 

[CS_22]

Really? What's so superior about your care compared to say medicaid? You get to see your doctor - they see their doctor. Both are board certified and so we'll call them equivalent.

You pay a copay - they pay a copay.

You go to the ER or are admitted, you pay a percentage of your bill up to a certain amount. They get admitted and they pay a percentage up to a certain amount.

You need a test, you get it. They need a test, they get it.

You need a drug - you either get one form your plan's formulary or you pay through the nose. THey need a drug and they either get one through their plan's formulary or pay through the nose.

I don't see how yours or my insurace is gets us anything more than people are getting with medicare or medicaid these days. The only benefit perhaps is that there is a wider choice of doctors available to us, but in a single payor system every provider will have to participate (or go cash only) and so in fact the choice for everyone gets better.

And the thing I don't understand is why everyone always associates universal coverage to having a Canadian system. Everyone looks at the downfalls of the Canadian system which is primarily rationing. But what people don't look into are the two tier systems that exist in places like Australia and France. Where minimum coverage exists as provided through a government sponsored plan (ie, just like Medicare for all), but individuals also by into a private system that physicians can still bill to. Finally I agree with the point that rationing is more a result of availability of resources, not because everyone is trying to get the same procedure/test just because its free. With a two tiered system, those without the private insurance may have to wait longer than those with private insurance, but how is that any different than now. At least those without the private insurance, when they do get the test/procedure, at least they don't have to worry about mounting medical expenses and potential bankruptcy.

And sure, governmental control is what it is, but at least it would control costs.

 

[CS_22]

I'm merely trying to point out that it's not free. Those people who argue that they can't support their families, much less pay healthcare costs with their current salaries don't seem to fully understand. One way or another you're going to pay for it.

I wouldn't mind the 5-10%, but I don't want government to control it, like in Canada. I get superior health care through my work right now to anything the government could ever provide. I'm not willing to take a cut in the quality of my care to fulfill some socialist egalitarian ideal.

The problem GV, is that although me and you get superior coverage through our work right now, there are 45 million out there who don't.

So here's the problem -- all the people who are fighting to leave the system the same are the same one's who have excellent medical coverage through the employer based system. Let me tell you what will eventually happen though... Health care costs are going to continue to rise, and this will continue to increase premiums that middle class (& working poor) have to pay. Essentially, they're going to be priced out of their health insurance coverage (something that we as physicians will never have to worry about). They'll have to decide whether its more important to pay their mortgage or pay their health insurance and they'll hope that since their only in their 40's they won't need any coverage. Something catastrophic will happen and they'll be forced into bankruptcy. My brother, 24 yo, is already looking at having this happen.

It sucks.

Good conversation though. Glad that we can have this discussion while respecting opinions.

 

[GeneralVeers]

I grew up in Canada (left when I was 18). The problems with the system in Canada, actually greatly resemble the problems with the VA system down here. There are not enough doctors who are willing to stay there and practice. Many physicians, like my father finished residency and then escaped to the United States as soon as possible. The resulting shortage forces Canadian hospitals to recruit physicians from foreign countries. Many of these physicians have excellent training, although I have serious questions about some of the 3rd-world trained physicians.

My family is from Niagara Falls, a city of about 70,000. Up until about 1998 there was no CT scanner in the entire city. I'm not certain how anyone can practice modern medicine without access to a CT-scanner, and most U.S. cities of that size have several (plus an MRI). Since medicare in Canada largely forbids private entities from running hospitals, and the government didn't have the funds, there was no way to pay for it. The hospital had to have a public drive which took several years, and eventually raised the money to purchase one.

Canada is perhaps worse than Australia and Britain, who at least allow their citizens to purchase supplemental private health insurance. The Canadian medicare system was founded on a supposedly higher principal of equal access by all Canadians. The result was that it forced all doctors to work for the government, and made it illegal to practice any sort of private medicine. Fortunately this policy is being relaxed in some of the more sane provinces (like Alberta, who now have private clinics for some specialties).

In Quebec there is a shortage of Emergency physicians, so two years ago the Provincial government FORCED primary care physicians to put in several shifts a month in an Emergency Department. If physicians refused to do this, potentially they would lose their license to practice, and hence all reimbursement.

Maybe I'm unreasonably opposed to government running health care in America, but I don't want what happened in Canada to happen here.

 

[hyperbaric]

I second that. Kind of a low blow . . .

Point taken, but I didn't mean it to be as such. People value services differently and I want to know how much the above poster is willing to pay for tattoos vs medical care to r/o an MI.

My apologies to all for the low blow.

 

[CS_22]

I grew up in Canada (left when I was 18). The problems with the system in Canada, actually greatly resemble the problems with the VA system down here. There are not enough doctors who are willing to stay there and practice. Many physicians, like my father finished residency and then escaped to the United States as soon as possible. The resulting shortage forces Canadian hospitals to recruit physicians from foreign countries. Many of these physicians have excellent training, although I have serious questions about some of the 3rd-world trained physicians.

My family is from Niagara Falls, a city of about 70,000. Up until about 1998 there was no CT scanner in the entire city. I'm not certain how anyone can practice modern medicine without access to a CT-scanner, and most U.S. cities of that size have several (plus an MRI). Since medicare in Canada largely forbids private entities from running hospitals, and the government didn't have the funds, there was no way to pay for it. The hospital had to have a public drive which took several years, and eventually raised the money to purchase one.

Canada is perhaps worse than Australia and Britain, who at least allow their citizens to purchase supplemental private health insurance. The Canadian medicare system was founded on a supposedly higher principal of equal access by all Canadians. The result was that it forced all doctors to work for the government, and made it illegal to practice any sort of private medicine. Fortunately this policy is being relaxed in some of the more sane provinces (like Alberta, who now have private clinics for some specialties).

In Quebec there is a shortage of Emergency physicians, so two years ago the Provincial government FORCED primary care physicians to put in several shifts a month in an Emergency Department. If physicians refused to do this, potentially they would lose their license to practice, and hence all reimbursement.

Maybe I'm unreasonably opposed to government running health care in America, but I don't want what happened in Canada to happen here.

Point well taken GV. I think there is a fine medium that can exist.

Another option is to open the Federal Gov't Insurance program to the general public as well (the one used by Congressmen, Senators and federal employees) thus opening up the system and getting it away from the employer-tied system. There are options out there, but there has to be serious discussions had and compromises made.

 

[Faze2]

If you're working poor, you go to the ER because.... when you can't afford to pay $200 up front, you can't go to a doc-in-the-box. Because doc-in-the-box closes at nine pm. If you have a primary care provider, it takes a week to a month to get in to see them.

I've gone to the ER for what looked like a kidney infection and turned out to be a kidney infection, and I spent a while annoyed that we hadn't waited til morning (doesn't matter I was crying in pain) because not only did it cost us $500, but we got to pay another $800 in six weeks because of an unexpected side effect from the antibiotic. That's a month's salary before taxes for us. Husband broke his fibula and we wound up waiting seven hours for anyone to look at him (I don't count the clerk who wanted to know if we had insurance and took his name). And around Christmas I had chest pains off and on. One night it got really bad. So I went to the ER, like everyone tells you to. Turned out my potassium was low. That'll be six hundred dollars, please. Plus another three hundred for the EKG.

Yes, I know I'm paying for "what if it WAS a heart attack". I wouldn't mind that so much if it wasn't for the weight of the cost on my family. That's another year I go without seeing a dentist. That's another year I make these glasses work and hope my vision doesn't change. That's another year we go without fixing that spot on the roof where it's starting to leak. That's another year my husband swallows more tylenol and ignores the clicking and jamming of his knee. In the future, I know we'll wait far, far longer before going to the ER. We're too moral to give a false name.

From my position, I don't know the answer, I only know that things aren't right the way they stand now.

Do you not have insurance? If no, why not? And if yes, I've never heard of any copay or deductible more than $150 for an ER visit.