Your school pushing universal health care?

[DarknightX]

I'm asking this because at my school (in CA), they are totally pushing us to lobby for a new universal health care bill. I was a little upset, because nobody has taken the time to explain the specifics of the bill, or the pros and cons of it, just that as med students we should automatically be for it.

Personally, I'm a bit sceptical of any government run system. Public schools are a disaster, the US tax code is a massive string of red tape, and profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. I expressed my opinion and concerns to some of my classmates, including the fact that this system could lead to a tax increase and a cut in physician pay. I mean, yes we became doctors to help people, but it is a job at the end of the day, and any smart individual should always be concerned about the compensation recieved for work done.

It bothers me that so many physicians and students are for a universal health care plan, but yet they don't know/don't care about the details.

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[Law2Doc]

I'm asking this because at my school (in CA), they are totally pushing us to lobby for a new universal health care bill.

They aren't pushing for it, but have conceded it is inevitable. I would agree that to the extent government or insurers get to dictate care for more people, it will likely have negative impact on physician income due to lack of bargaining power and a greater stranglehold on patient control. However it is hard to outright argue against a universal healthcare bill without suggesting a better replacement plan because our healthcare system is so broken. Unless you have a better idea of how to insure the uninsured and lower healthcare costs significantly, you add no value as a naysayer. And nobody in the lay public is going to sympathize with a physician's loss of income; the public perception is that doctors make too much money already. So that is not a compelling stance.

I do agree that since some kind of healthcare reform is probably inevitable, the smart course of action is to pick the bill that seems least ominous, and lobby hard for it. You are always better dictating your own poison rather than disagreeing with all and getting a worse one. So that is probably what your school is doing.

 

[Biscuit799]

I'm asking this because at my school (in CA), they are totally pushing us to lobby for a new universal health care bill. I was a little upset, because nobody has taken the time to explain the specifics of the bill, or the pros and cons of it, just that as med students we should automatically be for it.

Personally, I'm a bit sceptical of any government run system. Public schools are a disaster, the US tax code is a massive string of red tape, and profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. I expressed my opinion and concerns to some of my classmates, including the fact that this system could lead to a tax increase and a cut in physician pay. I mean, yes we became doctors to help people, but it is a job at the end of the day, and any smart individual should always be concerned about the compensation recieved for work done.

It bothers me that so many physicians and students are for a universal health care plan, but yet they don't know/don't care about the details.

Every school does this (pushes for univ coverage). Just put up with it for a few years and you'll graduate, be able to go into private practice, and never have to listen to their ivory tower babbling again.

 

[Reimat]

I do agree that since some kind of healthcare reform is probably inevitable, the smart course of action is to pick the bill that seems least ominous, and lobby hard for it. You are always better dictating your own poison rather than disagreeing with all and getting a worse one.

I think that is great advice. There is going to be reform in the future - if you get involved in advocacy work, at least you'll know what those changes are.

 

[g3pro]

Doesn't California already have like a $20 billion budget deficit? How are they going to pay for more healthcare entitlement without the money? And I would anticipate the illegal immigrant presence in CA to wreak havoc on any healthcare system over there.

 

[Reimat]

Every school does this (pushes for univ coverage). Just put up with it for a few years and you'll graduate, be able to go into private practice, and never have to listen to their ivory tower babbling again.

This isn't exactly "ivory tower babble," as Massachusetts has already instituted universal coverage in the state and multiple presidential candidates have healthcare plans that will move for national universal coverage. The details vary from plan to plan - but the push for big reforms in the healthcare system is very real. Certainly in 4-10 years, when those in med school now finish residency things could have changed a lot.

 

[gstrub]

Meaning that all us hard working intelligent responsible doctors and the rest of the productive capitalists in this country are going to foot the bill for another 40 million freeloaders and illegal immigrants. Can anyone say Atlas Shrugged?

 

[Maxprime]

This isn't exactly "ivory tower babble," as Massachusetts has already instituted universal coverage in the state and multiple presidential candidates have healthcare plans that will move for national universal coverage. The details vary from plan to plan - but the push for big reforms in the healthcare system is very real. Certainly in 4-10 years, when those in med school now finish residency things could have changed a lot.

I think Mass should be what everyone looks to in absolute panic and fear of just how bad things could be. I have friends with MassHealth - it is absolutely awful. With 3-4 months minimum for a regular office visit, ER's are going to fill up worse than they already do.

 

[linuxizer]

Universal healthcare does not necessarily equal single-payer healthcare. Furthermore, historically expansions in insurance coverage have led to increases in the reimbursement of physicians (at least initially, until cost increases become unsustainable and cost controls become inevitable).

Ari

 

[rgarrig]

I'm asking this because at my school (in CA), they are totally pushing us to lobby for a new universal health care bill. I was a little upset, because nobody has taken the time to explain the specifics of the bill, or the pros and cons of it, just that as med students we should automatically be for it.

Personally, I'm a bit sceptical of any government run system. Public schools are a disaster, the US tax code is a massive string of red tape, and profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. I expressed my opinion and concerns to some of my classmates, including the fact that this system could lead to a tax increase and a cut in physician pay. I mean, yes we became doctors to help people, but it is a job at the end of the day, and any smart individual should always be concerned about the compensation recieved for work done.

It bothers me that so many physicians and students are for a universal health care plan, but yet they don't know/don't care about the details.

They push UHC on us like prisoners push poop in... hard, and often. I attend a notoriously left-wing university, so it's to be expected, but still - sometimes I want to scream out,

"I KILL A COMMUNIST JUST FOR FUN!!!"
-Al Pacino, Scar Face

and then punch everyone in the face. Unfortunately, I really like the majority of my classmates, so no going Scar Face for me.

 

[Green Chimneys]

Universal healthcare does not necessarily equal single-payer healthcare.

Too many people use these terms synonymously. I think we should have a system whereby there are major tax incentives (see tax free) to set up private health care funds to be contributed by both employers and employees. You could manage this money just like you manage a retirement account, except you could use the money to pay for routine health care costs. Most people would also pick up some form of catastrophic insurance coverage, which would cost much less than their current policy. The government could assist people with the cost of their health care in a graded manner based on their income instead of the all or nothing system we have now, and the forced all system we would have under a single payer umbrella.

A system like this where people are largely in charge of their own money for health care would create a patient incentive to keep costs down. It would also cut out the middle man as private insurers would be less of a player (although I would like to see the government portion of the program administrated privately). I'm not smart enough to work out the dollars and cents of something like this, but it has to be better than what we've got for patients, and I think it would be better for physicians too. Now can I complain?

 

[Biscuit799]

This isn't exactly "ivory tower babble," as Massachusetts has already instituted universal coverage in the state and multiple presidential candidates have healthcare plans that will move for national universal coverage. The details vary from plan to plan - but the push for big reforms in the healthcare system is very real. Certainly in 4-10 years, when those in med school now finish residency things could have changed a lot.

I didn't mean "universal healthcare" is ivory tower babble (a bad idea, maybe, but not ivory tower babble...well, that too). I meant, the constant pushing for support and the degradation of anyone who doesn't support it, is ivory tower babble.

 

[Crixivan]

We are not encouraged to support universal health care, and the character of admin would not suggest that such would be supported.

The position of the government will always be contingent upon the amount of money generated by lobbyists. Show me a politician that can't be bought or pressured by party lines, and I'll show you one that is looking for another job. I currently see these presidential candidates presenting their drivel, and all I can say is, "Hello, you're a senator. You don't need to be the president to have a plan."

Of course in one case, the candidate was already in charge of the white house's position on health care reform, and apparently nothing came of that. This debate has been going on for at least 12 years now, and all I can say is that as long as rich people do not feel that they are helped by universal healthcare, we will not see it.

 

[Reimat]

I didn't mean "universal healthcare" is ivory tower babble (a bad idea, maybe, but not ivory tower babble...well, that too). I meant, the constant pushing for support and the degradation of anyone who doesn't support it, is ivory tower babble.

Ah - and I would agree.

 

[NonTradMed]

Universal healthcare does not necessarily equal single-payer healthcare.
Ari

So many people, especially on these boards seem to think it is.

It drives me nuts because I think it shows people simplifies a complex situation----healthcare is complicated, the solution to the problem isn't always between a one-payer system or a free-for-all (i.e cash-only business). There are a variety of models which can combine the two concepts.

 

[achamess]

It amazes me that despite a long history of failures, deception and inefficiency, for some reason beyond my comprehension, people still look to government to take control of the most important functions of society. Have we not learned that commands and mandates from a few elites fall short in nearly every case of meeting the needs of individuals the way private enterprise does? I recognize the force and appeal that universal coverage has, but it is purely an emotional one, and in fact, if implemented, it will limit the choice and autonomy of both providers and consumers, leaving everyone the less well off. If for no other reason, people should be suspicious of a plan in which politicians and bureaucrats take control of how we get healthcare, because of the unprecedented leverage and power it gives them to invade other aspects of our lives even loosely tied to health.

So, to the OP, I commend your reluctance to unthinkingly commit to sway of the crowd without good reason.

 

[Reimat]

It amazes me that despite a long history of failures, deception and inefficiency, for some reason beyond my comprehension, people still look to government to take control of the most important functions of society. Have we not learned that commands and mandates from a few elites fall short in nearly every case of meeting the needs of individuals the way private enterprise does? I recognize the force and appeal that universal coverage has, but it is purely an emotional one, and in fact, if implemented, it will limit the choice and autonomy of both providers and consumers, leaving everyone the less well off. If for no other reason, people should be suspicious of a plan in which politicians and bureaucrats take control of how we get healthcare, because of the unprecedented leverage and power it gives them to invade other aspects of our lives even loosely tied to health.

So, to the OP, I commend your reluctance to unthinkingly commit to sway of the crowd without good reason.

Again, requiring universal coverage does not necessarily mean central gov. needs to be in charge of administrating the system. Basically they already control the current system by controlling medicare/caid reimbursement rates.

I agree that more gov control probably isn't a good thing - but that is a different issue. Universal coverage means healthcare coverage for everyone in the US. Not more, not less.

Thus to say you disagree with universal healthcare means you think healthcare is a privilege, not a right. I think this is certainly an arguable issue, but details of how universal coverage would be implemented should be treated as a distinct issue.

 

[chicklett1]

To the OP, it sounds like your concerns stem from the fact that your school is very much in favor of a healthcare reform bill, but maybe you haven't been presented with enough information to feel like you can have an informed opinion on the matter.

I'd really encourage you to read up on it yourself, as at least in California, this legislative season is very likely to see some major changes in health care, and if you have a strong opinion about how things should go, you should get involved. You can find out more info about SB-840, which is Senator Sheila Kuehl's single-payer bill here http://www.csphr.org/sb840, including a summary and information about financing the changes. AMSA is strongly in favor of this bill. Currently, the governor and Representative Nunez also have proposals as well, although they are not as comprehensive.

I am personally a strong supporter of single payer health care, and this is why:
1. I do believe that health care is a basic human right and everyone should have access, regardless of their immigration status or ability to pay. I realize that not everyone agrees with me on this one, particularly when it comes to undocumented persons. I think it's just good public health policy to ensure that the entire population is covered. And if you think you're not currently paying substantial amounts for other peoples' healthcare, take note of the fact that 60% of all US health care dollars are spent by the US government, a.k.a. taxpayers. It is also the case that in the current system, many people who would want insurance simply cannot get it--because they can't afford it or because they have a pre-existing conditions. It seems unjust to me that the person most in need of health care (say, a diabetic or someone with a history of cancer) is the person who is denied coverage.

2. Single-Payer saves time & money. Currently about 30% of all healthcare spending is due to administrative costs created by for-profit HMOs. Compare this to the 4% administrative cost of Medicare--a single payer system. By having one organization handle all the administration of the health care system, that money could be spent on patient care, not to mention physician reimbursement.

3. Single-Payer promotes economic growth. People would not be tied to their jobs because of their health benefits or worry about being denied coverage due to pre-existing conditions when purchasing individual insurance. This encourages entrepreneurship and helps businesses remain competitive with companies in countries like Canada and the U.K. that don't have to pay for their employees' health insurance. When Starbucks spends more on health care than coffee, and General Motors spends more on health care than steel for cars, it's easy to see how it's bad for multinational companies trying to compete in the international arena.

4. America is doing something wrong. We spend double the amount of money per capita on health care than the average of all industrialized countries, yet we rank #37 in terms of health outcome (WHO data), and even worse when it comes to access. We are also one of the few industrialized nations that doesn't have a single-payer system. A publicly financed single payer system diminishes cost-shifting, provides greater bargaining power for drugs and medical devices, and eliminates tons and tons of physician time and expense in billing and paperwork.

5. Expanding coverage saves everyone money and improves outcome because people will have access to primary and preventative care. Everyone knows that the most expensive--not to mention inefficient place to get primary care is the ER, but this is where the overwhelming majority of uninsured individuals seek care, and usually after a delay. Since ERs can't refuse most of these patients, the tab often ends up getting picked up by the government (taxpayers).

 

[dilated]

By having one organization handle all the administration of the health care system, that money could be spend on patient care, not to mention physician reimbursement.

 

[achamess]

Again, requiring universal coverage does not necessarily mean central gov. needs to be in charge of administrating the system. Basically they already control the current system by controlling medicare/caid reimbursement rates.

Indeed, government intervention in medicine is already excessive, which is why it astonishes me that people want MORE government intervention. Government influence is the cause, not the cure of the so-called 'crisis'. I highly recommend Healthy Competition: What's Holding Back Health Care and How to Free It by Michael Cannon of the Cato Institute. They do a much better job pointing out how the involvement of gov. has led to the woes we now suffer. One point made in this work is that the tax exemption afforded to employers makes spending dollars on health coverage more attractive to employers than using that money elsewhere, say, in their employees paychecks. Accordingly, people likely receive more health coverage than they actually need, and then, not feeling directly the cost of the care they solicit, they feel no need to economize their use of a valuable resource. When it's your own money, you shop around for the best deal. When someone else foots the bill, what incentive do you have to look for the best value for your buck? What's more, the critical information provided by a price system that is not encumbered by corporational or government bias is not available to tell providers (physicians) which of their services is in highest demand and which is not. Thus, the prices of the services offered by providers are dictated almost arbitrarily by third-party payers and not by the most important thing, the consumer demand. Allowing the market to dictate the prices of services would surely lower costs as providers compete for consumer attention. It works that way everywhere else, why not in medicine?

I agree that more gov control probably isn't a good thing - but that is a different issue. Universal coverage means healthcare coverage for everyone in the US. Not more, not less.

Yes, that's very nice, but who pays for the universal coverage? There is something more, craftily concealed by the euphemism for this healthcare free-for-all; that is, somebody has to pay for it, and the only way to do that is through various forms of taxation. But if only that were the end of the line that wouldn't be do bad, but there has to be more. What is the extent of this so-called coverage? Who decides what services I get. Surely we cannot offer every medical service to every person whenever they desire it. And again, we run into the same problem as before - if someone else pays the bill - your neighbor, someone in the next state, someone across the country - people will have no incentive to be thrifty with this resource and will utilize it more than they would if paying out of pocket. Various studies have confirmed this, most notably the RAND health insurance experiment.

Thus to say you disagree with universal healthcare means you think healthcare is a privilege, not a right. I think this is certainly an arguable issue, but details of how universal coverage would be implemented should be treated as a distinct issue.

Healthcare cannot be called a right because people cannot claim a right that infringes on the rights of others. This is why I can have a right to free speech or a right to bear arms or a right to keep the fruits of my labor, but I cannot claim a right for healthcare, because that would encroach on the right of another to keep what he earns. Essentially, it costs nothing to others if I say what I would like or meet with whomever I'd like, but it necessarily costs another person, whether it be in time or money, when I demand that he pay for my broken leg or my heart surgery. So call it something else, privilege if you want, but healthcare cannot properly be called a right.

I know all this makes me sound like a scrooge and I will probably receive a tongue-lashing from someone who wants to call me a villain for wanting to deny healthcare to all, but the consequences of doing what is being suggested in our national discussion will certainly prove far worse than the troubles we deal with now. A wise man once said "The road to hell is paved in good intentions."

 

[sprinkibrio]

I'm asking this because at my school (in CA), they are totally pushing us to lobby for a new universal health care bill. I was a little upset, because nobody has taken the time to explain the specifics of the bill, or the pros and cons of it, just that as med students we should automatically be for it.

Personally, I'm a bit sceptical of any government run system. Public schools are a disaster, the US tax code is a massive string of red tape, and profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. I expressed my opinion and concerns to some of my classmates, including the fact that this system could lead to a tax increase and a cut in physician pay. I mean, yes we became doctors to help people, but it is a job at the end of the day, and any smart individual should always be concerned about the compensation recieved for work done.

It bothers me that so many physicians and students are for a universal health care plan, but yet they don't know/don't care about the details.

That's definitely a no for this semi-traditional school in Texas.

 

[Reimat]

Currently about 30% of all healthcare spending is due to administrative costs created by for-profit HMOs. Compare this to the 4% administrative cost of Medicare--a single payer system. By having one organization handle all the administration of the health care system, that money could be spend on patient care, not to mention physician reimbursement.

This is an important fact that still amazes me - that is the crazy overhead costs of insurance companies. I think there are many flaws in the VA system and with medicare, but the huge overhead cost difference clearly shows one area where money could be saved.

 

[Reimat]

When it's your own money, you shop around for the best deal. When someone else foots the bill, what incentive do you have to look for the best value for your buck? What's more, the critical information provided by a price system that is not encumbered by corporational or government bias is not available to tell providers (physicians) which of their services is in highest demand and which is not. Thus, the prices of the services offered by providers are dictated almost arbitrarily by third-party payers and not by the most important thing, the consumer demand. Allowing the market to dictate the prices of services would surely lower costs as providers compete for consumer attention. It works that way everywhere else, why not in medicine?

This point is good, and certainly has worked well for Whole Foods (who provides their employees with flex-med spending accounts.) And in theory, it is a good idea - in fact I used to be 100% for this sort of system. However, I believe there are many issues with implementation of such a system nationwide and that while a good thought, it probably isn't possible.

Yes, that's very nice, but who pays for the universal coverage? There is something more, craftily concealed by the euphemism for this healthcare free-for-all; that is, somebody has to pay for it, and the only way to do that is through various forms of taxation. But if only that were the end of the line that wouldn't be do bad, but there has to be more. What is the extent of this so-called coverage? Who decides what services I get. Surely we cannot offer every medical service to every person whenever they desire it. And again, we run into the same problem as before - if someone else pays the bill - your neighbor, someone in the next state, someone across the country - people will have no incentive to be thrifty with this resource and will utilize it more than they would if paying out of pocket. Various studies have confirmed this, most notably the RAND health insurance experiment.

Yes - if the country tries universal coverage with the government footing the bill to keep the current system, it will certainly fail in a matter of years. However, the flip side of the coin is not only that people consume services, but that doctors will create a need to fill their business needs. The US has ~70% specialists and ~30% PC docs, whereas most other equivalent nations have the opposite ratio. And if you look at how services are used it's more doctor dependent then patient dependent. In a free market system, I doubt there would be a need for >30% specialists because a people will not be willing to pay for what could often be considered "elective" procedures. A lot of docs will be out of jobs, but the good thing is that primary care doc salaries will rise.

I know all this makes me sound like a scrooge and I will probably receive a tongue-lashing from someone who wants to call me a villain for wanting to deny healthcare to all, but the consequences of doing what is being suggested in our national discussion will certainly prove far worse than the troubles we deal with now. A wise man once said "The road to hell is paved in good intentions."

No - I don't think there's anything wrong with worrying about the consequences of universal coverage. However, both ethically and practically I believe it is inevitable. How can a country that guarantees a K-12 education for it's citizens say that healthcare and access to a doctor is a privilege? Certainly people with more money should have the freedom to buy better healthcare for themselves if they choose, but everyone should get some healthcare. However, a free-market system will also lead to tiering of the medical profession - the docs who provide care at a premium (the minority) and those who provide care to everyone (the majority). Most doctors certainly don't want a completely free-market system, for example check out AMA's stance on covering the uninsured http://www.ama-assn.org/ama/pub/category/17712.html

The solution is going to be very very complex. But, I think it's good that a lot of people are taking interest in this issue.

 

[chicklett1]

Healthcare cannot be called a right because people cannot claim a right that infringes on the rights of others.
"

Ok, so I get your argument and I do see its merit, but at the same time, there is a clear precedent in America for social programs (keep in mind that a social program is one that everyone pays into and everyone benefits from while a welfare program is one that everyone pays into but only a subpopulation benefits from). All taxpayers pay for the public school system, the post office, the police and fire departments, etc. Even if you may be able to argue that these services are not rights per se, would you argue that having to support these social programs through taxes is an infringement of your rights and thus wrong?

 

[AZhopeful]

...
1. I do believe that health care is a basic human right and everyone should have access, regardless of their immigration status or ability to pay....

I think that this person's point about a single-payer system saving money is 'laughable' enough, as Dilated so eloquently pointed out. It's the part about healthcare being a right that gets me and I'll tell you why:

I wish everyone could get healthcare. What I understand, though, is that healthcare is a scarce resource and that it is economically IMPOSSIBLE to provide everyone with maximum health care(especially at the level people will demand if they don't have to pay commensurately for it). See how economics leaves that bad, but necessary, taste in your mouth? It has a habit of seeming brutal and inhumane with statements like the one I just made, but in reality it shows the constraints that we HAVE to work with. The truly humane thing is to acknowledge these constraints and do the best we can within them.

Folks, talking about how healthcare is an inalienable right for everyone is not going to get us anywhere. Whether it's a morally true statement is another debate; I'm just taking the economic perspective that that is an impossible world. That's the ECON perspective- not cruel or inhumane, just stating the facts.

I don't take pleasure in saying this. I'm a Christian and it pains me to realize that we can't take care of everybody with an endless supply of sterile fields and ICU beds. I just believe that the truly compassionate thing to do is to have the guts to admit the facts as economic study gives them to us(not an easy thing to do, especially in a representative democracy where a candidate would have to admit them), andwork to maximize use of the scarce resources we have. This probably means letting the market run its course, but this post is already too long to go into that.

 

[achamess]

Amen brother. Really well stated. I do not get any pleasure from saying that healthcare cannot be guaranteed to every person. I truly wish it could be, but for the reasons you have pointed out, it is not a matter of unwillingness, but rather impossibility. Acknowledging our constraints and trying to work within them is the only way to even attempt to bring sufficient care to meet demand - and as we know too well, there is far more demand than there is supply.

Slightly random question - Are you familiar with work of Milton Friedman? It's clear you have both respect for and understanding of economics, and I was wondering if he was one of the economists who influenced you.

 

[AZhopeful]

Random-sounding answer to your random question: I'm not even much of an economist, just your average jerk who took two semesters of economics in undergrad but I've never looked at the world quite the same since. It seems to me that economists are some of the only people lucid and scientific enough(as well as having enough testicular fortitude) to state the facts about some of our biggest social and financial issues.

As for Friedman, like I said I'm not a total econ expert but I think I fall in line for the most part with his line of thinking. I couldn't, for example, tell you what the difference between his Chicago School and the Austrian School of economics, just that they're both well-distanced from Keynesian economics and New Deal-type governing, which seems like what we keep falling into these days.

I just wish we could have a political system where a candidate could make the assertions that an economist would. Things like the impossibility of supplying healthcare to everyone, the consequences of a minimum wage(or any other price floor/ceiling). And ooh! how about the fact that insulating patients/consumers from true price even more than they already are(i.e. they pay their premiums and a small co-pay) just lowers the incentive to pursue preventive medicine. That is to say, if that visit to the ER doesn't cost me much more than low-fat food and an hour of exercise every day, then I don't have much incentive to keep myself out of the ER.

Don't take my word for it, though. Read some economics, or just think things through with common sense and I think you'd come to the same conclusions.

 

[Reimat]

Folks, talking about how healthcare is an inalienable right for everyone is not going to get us anywhere. Whether it's a morally true statement is another debate; I'm just taking the economic perspective that that is an impossible world. That's the ECON perspective- not cruel or inhumane, just stating the facts.

I don't understand this statement at all. Part of the big problem with our healthcare system is everyone DOES get healthcare treatment - most who can't afford it do so through the ER. Have you ever been in a big academic hospital? Many patients cannot pay for their care and yet they are cared for anyways. Most of these centers have it in their institutional statement that they will treat patients "without regard to their ability to pay."

The people who get screwed in the current system are the middle class. That is why there is a huge push for reform - it's the donut hole problem, the top and bottom are covered, but the middle is falling through the gaps.

 

[Reimat]

I don't understand this statement at all.

Ok, I do get what you are saying, but I think the econ perspective is more that care between all people will never be equal. And that I agree is a truth - there is no way that the very wealthy will ever receive care equivalent to that the poor receive.

 

[Percival]

I'm for mandatory health insurance. I'm certainly against tax-subsidized universal "free" health care.

Why on earth would I want to use my tax dollars (already for doctors probably in the 40% range) to pay for free health care for people who don't take care of themselves (obesity, drugs, alcohol, sex, etc etc)? This is what charities are for.

As future physicians, let's not advocate "free healthcare" (that we'll pay for), but more charitable giving. Have a free exam day once a month, or do some pro-bono surgeries if that's how you feel.

The government cannot run our entire health care system. It would be a logistical and bureaucratic nightmare. Do you really think Uncle Sam can make everyones' health care decsions? I agree that our system is broken, but this is not the way to fix it.

 

[dynx]

Who decides what services I get.

The government will. Which would make it the pinnical of humor if some democrat gets universal healthcare coverage passed and then a republican gets elected and refuses to fund abortions...Its not illegal, we just won't pay for it and we won't let you get insurance that will.

Ah if only.

 

[dynx]

And just to add...
Who decides? The governement, the same people that decided that Dialysis should be free. Why? because someone related to a senator was dying of renal failure...pretty medically sound reason. Now we're giving 92 y/o's HD to the cost of a 100,000 a year...pretty cost effective no? There probably aren't a **** load of infants and children we could care for with that money. Oh I forgot, you need more money? Just take it from taxes or cut payment, the rich and doctors are a small voting block and if we keep these walking corpses alive thier absentee ballots will easily push us to victory.
The same people that after mandating that Dialysis will be paid for has pushed for a "fistula first" initiative. Now you "should" (and by should I mean if you don't your quality control indicators are dragged down and you risk loss of payment) put in about 70% fistulas before using a synthetic graft. Why? Well fistulas are technically better access and they have a 70% fistula rate in Japan and we're the US we should be able to do just as good. Never mind that in japan the average age of a dialysis patient is half what it is in the US and they have healthy veins that can handle a fistula...this isn't medicine damn it, this is national pride we're talking about. So the government will pay you to put in failed fistula after failed fistula KNOWING they are not going to work (ask some vasc surgeons) but after 2009 is gonna start dinging you for putting a graft in that 95 yo who's gonna be dead in 2 years anyway after he sucks up more resources.
Actions by the government don't make sense...they are polititians, they do things for political reasons, to suspect otherwise is idiocy. Unfortunatly there are a lot of do-gooder idiots in medicine.

 

[achamess]

And just to add...
Actions by the government don't make sense...they are polititians, they do things for political reasons, to suspect otherwise is idiocy. Unfortunatly there are a lot of do-gooder idiots in medicine.

That's precisely it - people are motivated by the way they feel, not by what they must conclude if they look at the long list of failed attempts by government to do what the private sector already does. The feeling of sympathy, guilt, sadness and perhaps even genuine kindness forces them to say "at whatever cost, we must make sure nobody goes without medical attention." The cost to them does not matter because they do not see themselves being the one on whom the burden of payment lies - so long as it gets done, that's what counts. I can tell from the tone of your response, Dynx, that you are feeling the effects first hand of what happens when politicians get involved in what should be your and your patients' business. Perhaps if people could hear the discontent of doctors who are already constrained by bureaucracy in this age of managed care, then they would not be so quick to bury the dagger even harder into the backs of the people on whom we count to help us - the physicians.

 

[Raydeus]

I would be more than happy to move over to a Universal Healthcare System, perhaps, if medical school were free or at least much cheaper. Not sure how I'm gonna pay back all these loans if I won't be making much money when I graduate.

 

[Tired]

My school used to:

- encourage us to go into Primary Care and work in rural areas

- lobby for increased minority preference in University and med school admissions

- write letters to increase reimbursements from state Medicaid funds

- go to legislative hearings to expand coverage under Medicaid for low-income individuals

And I would just laugh, and laugh, and laugh, and then go get a beer.

Tired, MD
Orthopaedic Surgery Intern
Future Practitioner of Boutique, Cash-Only Medicine

 

[achamess]

It is telling that many medical students are supportive of a move to universal healthcare, while several of the residents who have chimed in seem to decry the idea. Could it be that they are already experiencing the extreme inefficiency of managed healthcare and so they realize that more of the same will not make their or their patients circumstances any better?

 

[medhacker]

Doesn't California already have like a $20 billion budget deficit? How are they going to pay for more healthcare entitlement without the money? And I would anticipate the illegal immigrant presence in CA to wreak havoc on any healthcare system over there.

Then maybe NAFTA should make economic repairs for the havoc it created on the local economy of those who are now immigrating as a consequence of it...

 

[Trismegistus4]

I'm for mandatory health insurance. I'm certainly against tax-subsidized universal "free" health care.

Why on earth would I want to use my tax dollars (already for doctors probably in the 40% range) to pay for free health care for people who don't take care of themselves (obesity, drugs, alcohol, sex, etc etc)? This is what charities are for.

As you may know, the response of those advocating it is that this governmental "health care" program would include lots of preventive care, education, community outreach, etc., which would "empower" people not to become obese, use drugs, get drunk, have risky sex, etc.

 

[mashnuts]

I can't believe I'm about to become a 4th year and I have absolutely no idea what the big fuss is.

What are the pros/cons of universal health care? (I'm not trying to be a smart@ss. I'm genuinely asking!)

 

[goodoldalky]

I think that this person's point about a single-payer system saving money is 'laughable' enough, as Dilated so eloquently pointed out. It's the part about healthcare being a right that gets me and I'll tell you why:

Speaking of single-payer systems, I would like to point out that we are already operating, practically, under nearly a single-payer system. 60% of all healthcare costs are already paid by the government. And, all of the payments made by private insurance companies are based on the government scale for medicare.

I believe that insurance-for-profit is going to have to be removed from the equation if healthcare is to be improved. The government is already footing too much of the bill and the funds that could be used for that stopgap are going to private insurance company coffers. On top of that, millions of dollars and thousands of hours are wasted every year dealing with private insurance companies and fighting over reimbursement. (Of every dollar a physician makes now, 30 cents goes to billing and accounting personnel who deal with these issues).

It will take some sort of standardized sysem where the private insurance company profits are used to bolster healthcare and not take advantage of it before things improve. Unfortunately, insurance companies, being one of the most powerful political lobbies, will be hard to axe.

Then again, I, like most medical students, don't have a very good idea what sorts of suggestions are out there. I don't understand the topic fully except that our system right now is broken and expensive. It is leading to decreased reimbursements for physicians (decreased conversion factor from $37.90 to $34(?) was luckily delayed), increased cost and decreased care to patients, and budget shortfalls for government.

 

[QofQuimica]

Thus to say you disagree with universal healthcare means you think healthcare is a privilege, not a right. I think this is certainly an arguable issue, but details of how universal coverage would be implemented should be treated as a distinct issue.

I have a really hard time with this notion of health care being a "right." I think it's a gross misuse of the word. Even leaving aside the issue of funding, it's not like health care grows on trees and we can just plant some more whenever we don't have enough. In order for a person to get health care, someone else has to provide it. If health care is a right, does that mean that we as physicians can be forced to provide health care because to not do so would be to violate someone else's right to health care? Does your "right" to health care supercede my "right" to get a full night's sleep, take vacations, hang out with my friends and family sometimes? Should the government (or society) be able to force more people to become nurses, PCPs, or whatever other health care workers are in short supply in order to provide all Americans with their right to health care?

Studies on this subject show that a very large portion of health care dollars are spent during the last few months of people's lives. In a way, we have become a victim of our own success: the fact that we *can* do so much to help people makes us believe that we *ought* to do that much in every scenario. We seem to operate on the assumption that it is each individual's "right" to use as much of the limited supply of health care as desired, even though that policy inevitably interferes with other people's "right" to health care. I don't think there is any good solution to the problem. Even having the government ration care instead of insurance companies doing it will entail someone making the decision to deny some health care to some people who could probably benefit from it.

 

[Omegadramon]

If physicians' salaries are to decrease in any new system, do you think physicians will be able to lobby for the government to subsidize the cost of medical school. It only seems fair.

 

[achamess]

I have a really hard time with this notion of health care being a "right." I think it's a gross misuse of the word. Even leaving aside the issue of funding, it's not like health care grows on trees and we can just plant some more whenever we don't have enough. In order for a person to get health care, someone else has to provide it. If health care is a right, does that mean that we as physicians can be forced to provide health care because to not do so would be to violate someone else's right to health care? Does your "right" to health care supercede my "right" to get a full night's sleep, take vacations, hang out with my friends and family sometimes? Should the government (or society) be able to force more people to become nurses, PCPs, or whatever other health care workers are in short supply in order to provide all Americans with their right to health care?

Studies on this subject show that a very large portion of health care dollars are spent during the last few months of people's lives. In a way, we have become a victim of our own success: the fact that we *can* do so much to help people makes us believe that we *ought* to do that much in every scenario. We seem to operate on the assumption that it is each individual's "right" to use as much of the limited supply of health care as desired, even though that policy inevitably interferes with other people's "right" to health care. I don't think there is any good solution to the problem. Even having the government ration care instead of insurance companies doing it will entail someone making the decision to deny some health care to some people who could probably benefit from it.

Well said Q. I've read many of your posts before, and most of them have thoughtful insights and astute observations - and this case is no different.

As I said a few posts back, something cannot be a legitimately be called a right if it infringes on the right of another person;that is, if it is at their expense that you get to claim a "right". That people can even begin to make the claim that healthcare is a right is good evidence of how much we take for granted our extreme prosperity and good fortune. More importantly, the things to which our rights lay claim, such as free speech, are in unlimited supply, and need to be, if everyone is granted that right and is free to use it at their discretion. Healthcare is not one of those things. It is a scare resource, one that requires the input of time and capital from other individuals for whom the opportunity cost of providing healthcare makes it almost harmful for them to continue doing so. Calling healthcare a right, then, is pretty ridiculous.

 

[Reimat]

I have a really hard time with this notion of health care being a "right." I think it's a gross misuse of the word. Even leaving aside the issue of funding, it's not like health care grows on trees and we can just plant some more whenever we don't have enough. In order for a person to get health care, someone else has to provide it. If health care is a right, does that mean that we as physicians can be forced to provide health care because to not do so would be to violate someone else's right to health care? Does your "right" to health care supercede my "right" to get a full night's sleep, take vacations, hang out with my friends and family sometimes? Should the government (or society) be able to force more people to become nurses, PCPs, or whatever other health care workers are in short supply in order to provide all Americans with their right to health care?

By right, I simply mean that the American people decide whether or not everyone should have equal access to some level of care. Take for example education. Should it be a right? That's a reasonable question. Have the American people decided that it will be a right for citizens to receive a K-12 education? Yes! Thus education is a right.

Obviously making healthcare a "right" does not mean you will lose your ability "to get a full night's sleep, take vacations" etc. Does the government force people to become teachers? Additionally, by choosing to become a MD, you are willfully agreeing to go through an internship and residency (knowing legal limits allow upto 80 hours of work a week with potential for lost sleep and vacations).

Anyways, in many situations you are legally obligated to care for patients - i.e. you can't dump ED patients on the streets just because you don't want to care for them anymore.

A right is not some universal law of nature - it's something people agree upon. Nor does granting healthcare as a right mean that doctors have to give up their freedoms/rights. Basically it'll result in a tiering of medicine where a minority of the best docs will serve those who can pay cash for their services and the majority of docs will live under gov regulation. That is, unless legislation is passed to prevent this from occuring. It's a freaking complicated issue.

 

[Reimat]

If physicians' salaries are to decrease in any new system, do you think physicians will be able to lobby for the government to subsidize the cost of medical school. It only seems fair.

I tend to think government subsidizing people to enter primary care is a great way to encourage more people to enter those specialties. Someone should acknowledge that a future radiologist shouldn't carry the same debt burden as a future peds doc.

 

[Crixivan]

If physicians' salaries are to decrease in any new system, do you think physicians will be able to lobby for the government to subsidize the cost of medical school. It only seems fair.

I've heard about some states that currently do this sort of thing, and the latest variation seems to be debt repayment if you sign up for the program later in medical school.

Since physicians' salaries are already decreasing in the current system, I think that the best solution is to go ahead and offer debt repayment post-residency for whatever specialty or area is underserved so that docs can make better decisions in real time. Uncle Sam could simply transfer your debt to a Ford Direct from whatever lender you have and then incremently forgive the payment as you meet the terms.

 

[QofQuimica]

By right, I simply mean that the American people decide that everyone should have equal access to some level of care. Take for example education. Should it be a right? That's a reasonable question. Have the American people decided that it will be a right for citizens to receive a K-12 education? Yes! Thus education is a right.

We may be arguing semantics here. I don't consider education to be a "right" either, although I understand your point. Actually, I would argue that both education and health care are "privileges" in the sense that we are fortunate to be living in a society that makes them available (to most of us, to some degree). I wouldn't be opposed to making preventive health care universal for children, analogous to your education example, even though it's hardly an ideal solution.

Obviously making healthcare a "right" does not mean you will lose your ability "to get a full night's sleep, take vacations" etc. Does the government force people to become teachers?

Interesting question. We do have a teacher shortage, and there are some schools (and teachers) that are clearly deficient and are not providing an adequate education to the students who attend them. We have an awful lot of uneducated and undereducated folks in this country. On the flip side, the rules for becoming a teacher really seem to have little to do with one's competency for teaching that subject. For example, although I have a PhD in chemistry and have taught college-level chemistry courses, at least some school districts do not consider me to be qualified to teach high school chemistry because I don't have an education background.

Additionally, by choosing to become a MD, you are willfully agreeing to go through an internship and residency (knowing legal limits allow upto 80 hours of work a week with potential for lost sleep and vacations).

Actually, I made no such agreement, and I'm under no obligation to do so. I can choose to finish my MD and never spend another day in the hospital, in which case the government will naturally refuse to provide me with a license to practice medicine. But there is no law saying that I must complete a residency just because I have attended medical school. In fact, I was considering not doing a residency for a while since my plan is to go into research, not clinical practice.

Anyways, in many situations you are legally obligated to care for patients - i.e. you can't dump ED patients on the streets just because you don't want to care for them anymore.

I think we both know that legal does not always equal moral. And patients do get dumped by hospitals. The interesting question is not whether it is legal to force people to leave the hospital before they are ready, but when and whether it is moral to do it. Again, we're coming back to this issue of rationing a limited resource.

 

[Green Chimneys]

I wouldn't be opposed to making preventive health care universal for children, analogous to your education example, even though it's hardly an ideal solution.

Already done: SCHIP. The bill to expand it and subsequent veto was a talking point this past year.

 

[Reimat]

I think we both know that legal does not always equal moral. And patients do get dumped by hospitals. The interesting question is not whether it is legal to force people to leave the hospital before they are ready, but when and whether it is moral to do it. Again, we're coming back to this issue of rationing a limited resource.

Yea - I think it's such an interesting issue. I just wonder how everything is going to work out...

 

[45408]

2. Single-Payer saves time & money. Currently about 30% of all healthcare spending is due to administrative costs created by for-profit HMOs. Compare this to the 4% administrative cost of Medicare--a single payer system. By having one organization handle all the administration of the health care system, that money could be spent on patient care, not to mention physician reimbursement.

Are you serious? Do you know how Medicare works and just why its administrative costs are so low? Obviously not, because it can't be compared so simply with an actual insurance company.

And I can assure you, the money will not be "better spent" on your salary.