Sicko

[jhcakilmer]

I know this movie has been out for some time now, but my wife and I just watched it last night, and as a future physician I felt that is was necessary, if not an obligation.

First off, let me just say I have always been a firm, and outspoken supporter of socialized medicine, as well as education. So this film did not really convince me, or change my mind in anyway.

I did feel that Moore's view was intentionally, and cynically pessimistic, but I think he made many valid, and important points about the failures of our healthcare system.

I could of done with less drama, and more facts. Like
50 million americans lack any healthcare (which is actually closer to 70 million), and 100-120 million have unusable healthcare, since their deductable is 5 grand, or more. Plus, 90,000 die every year due to medication errors, or that we spend more than 4 times what other western countries spend on healthcare.

It seemed more comparative, and less substantive, then his previous films, all of which I enjoyed.

In general, I think as Americans we tend to be complacent, and accept what is give to us, and I think that is incredibly unfortunate. Our country is so excessively wealth, and posses so many resources, I find it very difficult to imagine that we would have any problem funding these types of programs....but I'm sure someone may try to convince me otherwise. I think it's the management of the system that presents the challenge, but I think the UK, France, and Italy offer some excellent examples, and precepts.

I guess it comes down to the simple belief that healthcare is a "right" NOT a "privelage"! I worry that I may have a hard time staying employed, if I'm forced to reject a patient that doesn't have health insurance. My wife says we should just go to Canada, or the UK, but running away from a problem doesn't help change it!

[sspielman]

Since you will be a doctor, you will be in a great position to open up a free clinic! Why wait for the government?

[jhcakilmer]

Since you will be a doctor, you will be in a great position to open up a free clinic! Why wait for the government?

That would be great, but since I'm straddled with hundreds of thousands in debt, that will have to come later, plus why should a single individual or organization be forced to do that which should already be provided?

[SWorks4me]

That would be great, but since I'm straddled with hundreds of thousands in debt, that will have to come later, plus why should a single individual or organization be forced to do that which should already be provided?

Why should it be provided? How will people learn to take care of themselves if everything is just given to them?

Why stop with health care? Housing? Transportation?

this thread is going to get the big daddy padlock!

[sspielman]

That would be great, but since I'm straddled with hundreds of thousands in debt, that will have to come later, plus why should a single individual or organization be forced to do that which should already be provided?


oh yeah...you will be in debt.....certainly our government has never experienced anything like that...after all, why SHOULD an individual be asked to walk the walk when he can advocate that somebody ELSE pay for it!

[J.Greene]

I keep asking myself the question....should everyone, including the old, sick, smokers, diseased, homeless and poor be entitled to every POSSIBLE medical procedure now and in the future? And who shoud, pay for it? HOW do we pay for it? As the impossible turns into the possible re: medical advancements, costs go up exponentially. Socialized medicine sounds good on a few levels to me, but it is not as simple of a problem as Michael Moore pretends it to be. Keep in mind it's a form of wealth transfer, and this country's greatness was not created that way atmo.

And this is all I have to say before this gets locked.

JG

[majorpat]

penalties for "lifestyle" diseases. I'm not talking about a guy getting hit by a car, I'm talking about the super-size every day smoker who is surprised that he ends up with type 2 diabetes. Sure I want gummint involvement...I want them to penalize those who place themselves in these health predicaments. Just saying..

[jhcakilmer]

oh yeah...you will be in debt.....certainly our government has never experienced anything like that...after all, why SHOULD an individual be asked to walk the walk when he can advocate that somebody ELSE pay for it!


Of course I would expect to pay for it, and with a physicians earnings, I will be paying a lot. I don't mind, as long as I'm getting something for my money. Everyone should pay for it, that's the basis of a socialized system, right.

If patients don't have to worry about co-pays, prescription cost, and deductibles they can focus more on their health, and less on their bank account.

Anyway, what's wrong with everyone paying for something that is provided universally, we already have many examples.....
schools
libraries
postal system
City Municipals
etc

[jhcakilmer]

penalties for "lifestyle" diseases. I'm not talking about a guy getting hit by a car, I'm talking about the super-size every day smoker who is surprised that he ends up with type 2 diabetes. Sure I want gummint involvement...I want them to penalize those who place themselves in these health predicaments. Just saying..


Well, why not think in the opposite direction. Why not give incentives for living more healthy? Not only to the patients, but also to the physicians?

I don't think you can necessary penalize someone for living a certain way, that's kind of a basic hallmark of "freedom" and "liberty".

[R2D2]

Of course I would expect to pay for it, and with a physicians earnings, I will be paying a lot. I don't mind, as long as I'm getting something for my money. Everyone should pay for it, that's the basis of a socialized system, right.

If patients don't have to worry about co-pays, prescription cost, and deductibles they can focus more on their health, and less on their bank account.

Anyway, what's wrong with everyone paying for something that is provided universally, we already have many examples.....
schools
libraries
postal system
City Municipals
etc

Your forgot war.

[SWorks4me]

Well, why not think in the opposite direction. Why not give incentives for living more healthy? Not only to the patients, but also to the physicians?

I don't think you can necessary penalize someone for living a certain way, that's kind of a basic hallmark of "freedom" and "liberty".

So you want some bureaucrat telling how to live? What to eat? Where to live? (some cities have more pollution than others) When to go for testing?

Maybe they can tell you what websites to visit. Or what TV channels to watch. What radio stations to listen to.

When does it stop?

[BdaGhisallo]

Of the examples you cite as supporting your thesis that medical services should be communally provided, all can be said to be enjoyed by those paying for them. Everyone is a municipality will avail themselves of those services at some point or another in their lifetime. Why should one person have to pay for the health care of another individual when there is no possibility for them to garner any benefit from that expenditure?

As was already said, why stop at medicine. Why don't we all work for the government, and everyone can be paid a "living wage"? Then no one would be worse off than anyone else.

You may look longingly at Canadian health care, but talk to folks who live there and listen to the stories of rationing and loooong waits for treatment. Talk to folks in the UK who are given 13 months to live after a cancer diagnosis, and then booked to see the oncologist for their initial consulation in 15 months time. What about the british hospitals whose nurses have been told not to change the sheets between patients, but merely to turn them over!

Socialized medicine will lead to rationing and denial of care, just as it has done in every other country that has tried it. It's inevitable. You remove the consumer of the services from the action of directly paying for it ( if they actually pay for it at all after govt transfer payments) and it's a recipe for disaster.

If someone else was paying for your bikes and all your kit, how many high end custom bikes with Record or Dura Ace and Lightweight and Lew wheels might you get?

[norman neville]

Since you will be a doctor, you will be in a great position to open up a free clinic! Why wait for the government?

this is one backward azz country.

[norman neville]

Why should it be provided? How will people learn to take care of themselves if everything is just given to them?

Why stop with health care? Housing? Transportation?

this thread is going to get the big daddy padlock!

what's the matter with kc?

[jhcakilmer]

Why should it be provided? How will people learn to take care of themselves if everything is just given to them?

Why stop with health care? Housing? Transportation?

this thread is going to get the big daddy padlock!

We already pay taxes for healtcare (medicaid/medicare/VA), subsidized housing, and public transportation (subway/bus systems), etc.

Also, we're the only western country that doesn't have a socialized medical system.....so how does everyone else do it? Their currency, and ecconomy seem to be doing much better than ours. Their quality of life is just as high, if not higher then in the US, and life expectancy is longer.

[coylifut]

In general, I think as Americans we tend to be complacent, and accept what is give to us, and I think that is incredibly unfortunate.

of all the countries i've done business (and it's been a lot of countries), americans are the least understanding and accepting of government bureaucracy. The fact that Moore can fund and show his movies is proof.

not saying that there's not any problems, but americans are far from complacent. Especially Jack Brunk.

[SWorks4me]

what's the matter with kc?

OT

Nothing is the matter with KC...it's beautiful here the cost of living is low. It's centrally located, and the pace of life is whatever speed you want it to be.

[norman neville]

Of the examples you cite as supporting your thesis that medical services should be communally provided, all can be said to be enjoyed by those paying for them. Everyone is a municipality will avail themselves of those services at some point or another in their lifetime. Why should one person have to pay for the health care of another individual when there is no possibility for them to garner any benefit from that expenditure?

As was already said, why stop at medicine. Why don't we all work for the government, and everyone can be paid a "living wage"? Then no one would be worse off than anyone else.

You may look longingly at Canadian health care, but talk to folks who live there and listen to the stories of rationing and loooong waits for treatment. Talk to folks in the UK who are given 13 months to live after a cancer diagnosis, and then booked to see the oncologist for their initial consulation in 15 months time. What about the british hospitals whose nurses have been told not to change the sheets between patients, but merely to turn them over!

Socialized medicine will lead to rationing and denial of care, just as it has done in every other country that has tried it. It's inevitable. You remove the consumer of the services from the action of directly paying for it ( if they actually pay for it at all after govt transfer payments) and it's a recipe for disaster.

If someone else was paying for your bikes and all your kit, how many high end custom bikes with Record or Dura Ace and Lightweight and Lew wheels might you get?

there's so much wrong in this and with this.

this country is in a sad state when lies and nonsense fill the heads of folks who don't know any better. unfortunately for us in the us, and lots of other folks around the world, this soft-headed outlook causes unnecessary pain and suffering everyday.

[SWorks4me]

We already pay taxes for healtcare (medicaid/medicare/VA), subsidized housing, and public transportation (subway/bus systems), etc.

Also, we're the only western country that doesn't have a socialized medical system.....so how does everyone else do it? Their currency, and ecconomy seem to be doing much better than ours. Their quality of life is just as high, if not higher then in the US, and life expectancy is longer.


You are missing my point. But if you want to go live somewhere else...go.


"Mom! The other countries are jumping off the bridge...why can't I?!"

[jhcakilmer]

Of the examples you cite as supporting your thesis that medical services should be communally provided, all can be said to be enjoyed by those paying for them. Everyone is a municipality will avail themselves of those services at some point or another in their lifetime. Why should one person have to pay for the health care of another individual when there is no possibility for them to garner any benefit from that expenditure?

As was already said, why stop at medicine. Why don't we all work for the government, and everyone can be paid a "living wage"? Then no one would be worse off than anyone else.

You may look longingly at Canadian health care, but talk to folks who live there and listen to the stories of rationing and loooong waits for treatment. Talk to folks in the UK who are given 13 months to live after a cancer diagnosis, and then booked to see the oncologist for their initial consulation in 15 months time. What about the british hospitals whose nurses have been told not to change the sheets between patients, but merely to turn them over!

Socialized medicine will lead to rationing and denial of care, just as it has done in every other country that has tried it. It's inevitable. You remove the consumer of the services from the action of directly paying for it ( if they actually pay for it at all after govt transfer payments) and it's a recipe for disaster.

If someone else was paying for your bikes and all your kit, how many high end custom bikes with Record or Dura Ace and Lightweight and Lew wheels might you get?

Sorry, I can't rely on what is said without some sort of citation, or public knowledge. If you have opinions, that's fine, but to state something like this without proper evidence is just counter-productive to any discussion.

I'm also not saying that socialized medicine is not without it's problems, but just look at the data published by the WHO, or even JAMA, and you will see that other western countries are more healthy then us!

[norman neville]

I know this movie has been out for some time now, but my wife and I just watched it last night, and as a future physician I felt that is was necessary, if not an obligation.

First off, let me just say I have always been a firm, and outspoken supporter of socialized medicine, as well as education. So this film did not really convince me, or change my mind in anyway.

I did feel that Moore's view was intentionally, and cynically pessimistic, but I think he made many valid, and important points about the failures of our healthcare system.

I could of done with less drama, and more facts. Like
50 million americans lack any healthcare (which is actually closer to 70 million), and 100-120 million have unusable healthcare, since their deductable is 5 grand, or more. Plus, 90,000 die every year due to medication errors, or that we spend more than 4 times what other western countries spend on healthcare.

It seemed more comparative, and less substantive, then his previous films, all of which I enjoyed.

In general, I think as Americans we tend to be complacent, and accept what is give to us, and I think that is incredibly unfortunate. Our country is so excessively wealth, and posses so many resources, I find it very difficult to imagine that we would have any problem funding these types of programs....but I'm sure someone may try to convince me otherwise. I think it's the management of the system that presents the challenge, but I think the UK, France, and Italy offer some excellent examples, and precepts.

I guess it comes down to the simple belief that healthcare is a "right" NOT a "privelage"! I worry that I may have a hard time staying employed, if I'm forced to reject a patient that doesn't have health insurance. My wife says we should just go to Canada, or the UK, but running away from a problem doesn't help change it!

a thoughtful post. certainly the answer is complicated, but not impossible. in fact, the solution has been discovered over and over in most of what some folks would refer to with a snicker as the civilized world. the problem is that is in fact a political solution to a social problem. political solutions require courage, truth, analysis and action, all of which can be sorely lacking without a vibrant political culture. vibrant political cultures are smothered by money, propaganda and ignorance. any solution to a social problem will fail in such an environment. this is how we wind up with the mess of healthcare in this country and have willing victims ready to spew back the lies they've been told. this is how we wind up dissolving the nation chasing dreams of empire. and so it goes.

[jhcakilmer]

You are missing my point. But if you want to go live somewhere else...go.


"Mom! The other countries are jumping off the bridge...why can't I?!"

So what's your point?? You already pay for public services, why should healthcare be one of them?

[BdaGhisallo]

there's so much wrong in this and with this.

this country is in a sad state when lies and nonsense fill the heads of folks who don't know any better.

For my edification, can you please point out my lies and my nonsense? I ask that with the utmost respect. Can you point out a nationalised/socialized health care system that doesn't ration its services, whether it be overt or not?

[norman neville]

OT

Nothing is the matter with KC...it's beautiful here the cost of living is low. It's centrally located, and the pace of life is whatever speed you want it to be.

as you may know, what's the matter with kansas was a book about the evolution of a compliant, backward middle-american underclass culture, unwilling or unable to resist manipulation by the political class/ruling elite. oddly enough, at one time kansas was the center of a radical progressive populist movement aiming for the replacement of the ruling political class with actual democracy. sadly that grand tradition has been replaced by the cowed and ignorant population willling to suffer for someone else's enrichment. it's not just kansas of course, but in the context of your post, it made sense to ask with all due snark, what's the matter with kansas (city).

[zap]

That would be great, but since I'm straddled with hundreds of thousands in debt, that will have to come later, plus why should a single individual or organization be forced to do that which should already be provided?

Your contradicting yourself.

You want socialized medicine, but you as an individual don't want to pay your share?

I lived in Canada and my mom still lives up there. Scheduling an MRI in Canada can take up to a year. My mom is always amazed how quickly I can get something done. But I know I'm fortunate to have great health insurance.

Sad stories abound from both Canada and the US.

[jhcakilmer]

For my edification, can you please point out my lies and my nonsense? I ask that with the utmost respect. Can you point out a nationalised/socialized health care system that doesn't ration its services, whether it be overt or not?


I think norman was speaking with a little frustration. But as I posted where is the evidence for your assertions? I would say the evidence is overwhelming in favor of a socialized medical system......not saying it would be easy, infact I think it would be near impossible, but worth the effort, IMO.

Lets try and keep this discussion amicable, please!!!!

[jhcakilmer]

Your contradicting yourself.

You want socialized medicine, but you as an individual don't want to pay your share?

I lived in Canada and my mom still lives up there. Scheduling an MRI in Canada can take up to a year. My mom is always amazed how quickly I can get something done. But I know I'm fortunate to have great health insurance.

Sad stories abound from both Canada and the US.


How am I contradicting myself, I will be paying a lot of taxes with a physicians earnings, and I don't mind paying more.

I was just saying that I have a responsibility to paying off my educational debt, but if presented with the opportunity to open a free clinic, I will be more than willing!!

[norman neville]

For my edification, can you please point out my lies and my nonsense? I ask that with the utmost respect. Can you point out a nationalised/socialized health care system that doesn't ration its services, whether it be overt or not?

all healtcare systems ration their services. all of them. private or public. the us healthcare infrastructure rations care through denial of service or by demanding impossible fees. to contend that it is only public healthcare systems which ration care is vile lie.

the funding and support for a public healthcare infrastructure is a political function. without functioning democracy and accountable politics, the system is doomed to fail. britain's public health was dismantled by the government in order to enrich that governments masters, and the public suffered. canada closes hospitals or emergency rooms if the elected officials refuse to address the problems with lack of funding in order to enhance the insurance industry.

it is the height of foolishness to believe that the problems are impossible to solve or that the money is not in fact available. choices must be made, but political and economic choices are made every day by the us government which do nothing to aid the general public. until that government is held accountable by the majority of the citizens, progress is not possible.

[sg8357]

......

[jhcakilmer]

all healtcare systems ration their services. all of them. private or public. the us healthcare infrastructure rations care through denial of service or by demanding impossible fees. to contend that it is only public healthcare systems which ration care is vile lie.

the funding and support for a public healthcare infrastructure is a political function. without functioning democracy and accountable politics, the system is doomed to fail. britain's public health was dismantled by the government in order to enrich that governments masters, and the public suffered. canada closes hospitals or emergency rooms if the elected officials refuse to address the problems with lack of funding in order to enhance the insurance industry.

it is the height of foolishness to believe that the problems are impossible to solve or that the money is not in fact available. choices must be made, but political and economic choices are made every day by the us government which do nothing to aid the general public. until that government is held accountable by the majority of the citizens, progress is not possible.

+1

[Grant McLean]

Your contradicting yourself.

You want socialized medicine, but you as an individual don't want to pay your share?

I lived in Canada and my mom still lives up there. Scheduling an MRI in Canada can take up to a year. My mom is always amazed how quickly I can get something done. But I know I'm fortunate to have great health insurance.

Sad stories abound from both Canada and the US.


Depends on what the MRI is for.

As was pointed out, the Canadian system is about priorities and spending
the public money on the most important stuff first. It's triage.

If you're really sick, there is rapid service. Have a car accident, or a heart
attack, there is plenty of action. If you have a sore knee... back of the line.

My father had a heart attack when living in California, and his bill was $150,000.

As i posted elsewhere here, my coach broke his hip at a race in Trinidad.
He had to have surgury, there was not a option.
http://www.canadiancyclist.com/dailynews/October/10.30.074.44PM02.shtml
Having an operation in basically a 3rd world hospital is not your fist choice...


-g

[norman neville]

Depends on what the MRI is for.

As was pointed out, the Canadian system is about priorities and spending
the public money on the most important stuff first. It's triage.

If you're really sick, there is rapid service. Have a car accident, or a heart
attack, there is plenty of action. If you have a sore knee... back of the line.

My father had a heart attack when living in California, and his bill was $150,000.


-g

oblique to the inane arguement against 'socialized medicine' is the question of outcomes versus money spent. that surgery is certainly good for your surgeon, but what if the less expensive, less invasive treatment is as good or better for the patient but very very bad for the surgeon? lots of area there for an interesting investigation. lots of those horrible 'socialized medicine' hellholes have pretty good outcomes. they must be fools to have their 'socialized medicine'. blue cross'd do 'em some good.

[BdaGhisallo]

I am trying to be amicable. Surely we can have a reasoned debate without people taking it personally. I don't think asking for evidence of one's assertions amounts to not being amicable.

It's been awhile on the sheet issue but I did find this mention on a blog out of Aberdeen. I was mistaken in recalling that it was the nurses who were told - it was in fact the custodial staff.

http://www.microshaft.co.uk/2007_04_08_archive.html

"Cleaners at an NHS hospital have been told to turn over dirty bed sheets rather than use clean linen. Good Hope Hospital in Birmingham advised its staff to “top and tail” used sheets to cut the £500,000 annual laundry bill.

Posters instructing staff that this procedure would save 0.275 pence for every sheet re-used were pinned on cupboards and doors leading to the A&E and maternity departments. A health worker said that new patients were being given the same sheets as the previous occupant.

A hospital spokesman denied the practice. He said the posters had been issued three years ago but had since been removed. John Baron, Tory shadow health minister, described it as a concern given that MRSA was such a problem in hospitals. Good Hope recorded 36 cases from April last year to January."

As for the rationing in Canada, I have first hand experience from my in-laws. They live in Toronto, right downtown, and are very well to do. I have heard them many times remark how they have to wait unreasonable lengths of time for basic care. Only by having one of their best and oldest friends as the head of the Toronto area goverment medical administration, were they able to pull some strings and get some care in a reasonable time. Once he moved on from that position, they have taken to jetting down to the Lahey Clinic to get their checkups and any procedures done. There are towns in Ontario where there are no doctors to be had, because the rewards for practising there are not worth it. Some towns have reportedly had lotteries to award doctors appointments, and that is for checkups at a GP. My inlaws have some friends who retired and moved out of Toronto to a town that is about two hours outside Toronto. There are no doctors they can see there. They have to drive two hours each way for any little doctor visit, all the way back to Toronto.

Check out these BBC stories for tales of health care rationing in the UK. And I hardly think that the BBC would be shils for market capitalism.

http://news.bbc.co.uk/1/hi/health/249938.stm

http://news.bbc.co.uk/1/hi/health/189095.stm

http://news.scotsman.com/index.cfm?id=995812007

This is my favorite bit, from the second link:

"Professor Klein argues that Health Secretary Frank Dobson will only make himself "look foolish and undermine his credibility" if he continues to ban the word rationing from the ministerial vocabulary.

He writes that once the inevitability of rationing is finally accepted "we can get down to the serious business of discussing how to devise the appropriate mechanisms ... involved".

[thwart]

So you want some bureaucrat telling how to live? What to eat? Where to live? (some cities have more pollution than others) When to go for testing?

Opening this topic up on a website devoted to expensive bicycles takes a lot of guts (or a lack of good common sense).

Folks here have good health insurance... they have not had to feel the pain.

And so, big surprise---you'll get responses like the above.

Even in the Christmas season.

[davids]

So you want some bureaucrat telling how to live? What to eat? Where to live? (some cities have more pollution than others) When to go for testing?

Maybe they can tell you what websites to visit. Or what TV channels to watch. What radio stations to listen to.

When does it stop?
Ronald Reagan's great genius, atmo, is that he convinced large portions of this country's population that the government is the enemy. His success makes it very difficult to have any kind of rational dialog about topics like this with those who bought his storyline.

Rather than consider the potential value of a program (with real costs and real benefits) in a dispassionate manner, the kneejerk response is to rail about incompetent, corrupt governmental bureaucracy.

Please consider that it is the role of the government to provide services and benefits to the people that cannot be efficiently or effectively delivered in other manners. The interstate highway system, or the provision of radio/TV bandwidth are two (relatively) non-controversial examples of this.

Government can also step in to attempt to redress inequalities. Another poster made reference to "this country's greatness" not being created through wealth transfer. I disagree - This country's greatness has always been its ability to walk a line between personal freedom and social responsibility and justice.

I believe that government should play an important role in maintaining that balance. To that end, it is worth considering a system that would guarantee health care for all, even if it might entail sacrifices for those fortunate enough to have the means to buy the best health care possible.

I don't know what the answer is. But those of you who immediately condemn the idea, especially with specious or reductio ad absurdum arguments, may want to consider that reality is a lot more complicated than Ronald Reagan chose to portray.

[Grant McLean]

There are towns in Ontario where there are no doctors to be had, because the rewards for practising there are not worth it. Some towns have reportedly had lotteries to award doctors appointments, and that is for checkups at a GP. My inlaws have some friends who retired and moved out of Toronto to a town that is about two hours outside Toronto. There are no doctors they can see there. They have to drive two hours each way for any little doctor visit, all the way back to Toronto.


This has nothing to do with the public nature of Canada's heathcare system.
There are places in every country, in every system where threre aren't enough
doctors.

It's about urbanization. Doctors want to live in cities.

-g

[davids]

all healtcare systems ration their services. all of them. private or public. the us healthcare infrastructure rations care through denial of service or by demanding impossible fees. to contend that it is only public healthcare systems which ration care is vile lie.

the funding and support for a public healthcare infrastructure is a political function. without functioning democracy and accountable politics, the system is doomed to fail. britain's public health was dismantled by the government in order to enrich that governments masters, and the public suffered. canada closes hospitals or emergency rooms if the elected officials refuse to address the problems with lack of funding in order to enhance the insurance industry.

it is the height of foolishness to believe that the problems are impossible to solve or that the money is not in fact available. choices must be made, but political and economic choices are made every day by the us government which do nothing to aid the general public. until that government is held accountable by the majority of the citizens, progress is not possible.
Dude, if you keep writing things like this, and stop gratuitously insulting posters with whom you disagree, I may have to start taking you seriously.

[sspielman]

Ronald Reagan's great genius, atmo, is that he convinced large portions of this country's population that the government is the enemy. His success makes it very difficult to have any kind of rational dialog about topics like this with those who bought his storyline.

Rather than consider the potential value of a program (with real costs and real benefits) in a dispassionate manner, the kneejerk response is to rail about incompetent, corrupt governmental bureaucracy.

Please consider that it is the role of the government to provide services and benefits to the people that cannot be efficiently or effectively delivered in other manners. The interstate highway system, or the provision of radio/TV bandwidth are two (relatively) non-controversial examples of this.

Government can also step in to attempt to redress inequalities. Another poster made reference to "this country's greatness" not being created through wealth transfer. I disagree - This country's greatness has always been its ability to walk a line between personal freedom and social responsibility and justice.

I believe that government should play an important role in maintaining that balance. To that end, it is worth considering a system that would guarantee health care for all, even if it might entail sacrifices for those fortunate enough to have the means to buy the best health care possible.

I don't know what the answer is. But those of you who immediately condemn the idea, especially with specious or reductio ad absurdum arguments, may want to consider that reality is a lot more complicated than Ronald Reagan chose to portray.

In other words you are advocating a policy of "from each according to his ability....to each according to his need"..That was an idea posited by Karl Marx in 1875....and yet you consider Ronald Reagan a villain?

[davids]

In other words you are advocating a policy of "from each according to his ability....to each according to his need"..That was an idea posited by Karl Marx in 1875....and yet you consider Ronald Reagan a villain?Wow.

No.

First, I don't consider Ronald Reagan a villain. He was a mediocre actor and an exceptionally talented politician.

I believe, fiercely, in individual rights. Free speech, free association, freedom of belief. Free enterprise!

But we live in communities.

And I therefore also believe that government has a role in providing for the common good, and for those unable to provide for themselves. And I immediately acknowledge that individuals need to surrender a bit of personal freedom (e.g. pay taxes, get a driver's license, etc.) so that the government can fulfill those roles.

Like I said, this country's brilliance is in our ability to navigate that tension between individual freedom and the common weal. Both are moral imperatives.

And I even believe that a progressive tax code is a good idea...

I am happy to quibble over the details of how to operationalize all this. But if this makes me a Marxist in your eyes, I don't think we've got any way to have a civil dialog.

[zap]

How am I contradicting myself, I will be paying a lot of taxes with a physicians earnings, and I don't mind paying more.

I was just saying that I have a responsibility to paying off my educational debt, but if presented with the opportunity to open a free clinic, I will be more than willing!!

My apologies, it wasn't clear before.

Something to keep in mind is that more than likely your physicians earnings will be capped as they are in other countries while still paying higher taxes.

Grant, you are correct that priorities are set, but still, some of the critical care seems to take more time than what I'm at least used too. I have no first hand knowledge of some of these sad stories, just what I hear from my mom and her husband, both whom raise funds for a local hospital north of TO.

But I've heard good things from people I know in Montreal. They had nothing but timely, quality medical service.

[Fixed]

:beer: one thing all the bros can agree on is the future will be different than today
cheers imho daddy mommie they are playin mean

[jhcakilmer]

Wow.

No.

First, I don't consider Ronald Reagan a villain. He was a mediocre actor and an exceptionally talented politician.

I believe, fiercely, in individual rights. Free speech, free association, freedom of belief. Free enterprise!

But we live in communities.

And I therefore also believe that government has a role in providing for the common good, and for those unable to provide for themselves. And I immediately acknowledge that individuals need to surrender a bit of personal freedom (e.g. pay taxes, get a driver's license, etc.) so that the government can fulfill those roles.

Like I said, this country's brilliance is in our ability to navigate that tension between individual freedom and the common weal. Both are moral imperatives.

And I even believe that a progressive tax code is a good idea...

I am happy to quibble over the details of how to operationalize all this. But if this makes me a Marxist in your eyes, I don't think we've got any way to have a civil dialog.

Well said!!

But I would disagree that we are giving up freedom at any point, with any socialized system, simply because the government should be "of the people, and by the people" so the real control is at the polling booth in a true democratic society. If we do not like it, then we vote in a different system. I know it's theoretically flawed, but the underling principle is very powerful, and I believe more active in other countries.

[Grant McLean]

Grant, you are correct that priorities are set, but still, some of the critical care seems to take more time than what I'm at least used too. I have no first hand knowledge of some of these sad stories, just what I hear from my mom and her husband, both whom raise funds for a local hospital north of TO.

But I've heard good things from people I know in Montreal. They had nothing but timely, quality medical service.


I think one of the biggest health related issues for big cities in canada, is the ageing
population with cash to spend on health services. Right now, it's not legal for alternative
to public medical businesses to set up for profit clinics, which could very well help ease the
public system. As some point quite soon, it's going to be a big issue here in Canada.

Right now, our government prevents people from having access to private services,
and that doesn't sit well with many Canadians.

-g

[zap]

Grant, didn't Quebec pass legislation in the last year or two that allows for profit clinics?

[Fixed]

Opening this topic up on a website devoted to expensive bicycles takes a lot of guts (or a lack of good common sense).

Folks here have good health insurance... they have not had to feel the pain.

And so, big surprise---you'll get responses like the above.

Even in the Christmas season.


and then ther 's me bro i have a chronic illness I haven't been to the doc in 3 years cos i have to pay my wife and son go but i don't $4000 deductible,cheers

[Grant McLean]

Grant, didn't Quebec pass legislation in the last year or two that allows for profit clinics?

Yes, the provinces have different laws. There is lots of talk about Ontario
making major changes too, but none of this stuff is going to change overnight.

We have had a major budget surplus this year, and the gov't is cutting taxes,
and a lot of people wish they'd just spend it on healthcare...

-g

[scrubadub]

I thought I'd chime in here, having been part of a group that actually started a free clinic while in medical school.

Free clinics are a stop-gap band-aid measure. Starting a clinic is incredible complicated and difficult, not the least of which is getting adequate insurance coverage for practicing physicians. This is worsened by the fact that we were flooded with patients as soon as we opened. The largest part of our expenditures were on medication costs for chronic conditions such as high cholesterol, diabetes, and hypertension. In spite of large quantities of donated medications, medication assistance programs, and donated laboratory services, we found that our costs were spiraling out of control.

Despite all of these costs, plenty of studies have shown that primary care is still the most cost-effective method for providing health care. While the cost of statins and anti-hypertensives may seem high, so is the cost of a single patient presenting to the ED with an MI. In fact, the cost of a single day in the hospital far outweighs any outpatient visit and medication costs.

The truth is all of us are paying for the out-of-control health care in this control whether we recognize it or not. County budgets are being readjusted in order to cover public hospitals that are overwhelmed. A lot of money is being spent to cover EDs when many of the underlying problems could have been prevented if patients had been given adequate primary care.

There's a lot of people who blame poor healthcare on poor lifestyle decisions. Thats true to some extent. But we know from public health studies that poor health is also more complicated than that. Poor neighborhoods have less access to healthy foods because supermarkets send the worst of their produce to those stores. Poverty itself is a stressor on health.

One of the most surprising things I found when I was managing the clinic was that a large percentage of our patient population were middle-class Silicon Valley engineers who couldn't afford adequate insurance because companies were cutting back. I think the lesson here is that our health care issues are not just about the poor and illegal immigrants that everyone wants to blame. Health care access problems are starting to affect the middle-class as well.

In business, it seems to me that most people are comfortable with the idea that you have to spend money in order to save money. Investments in capital equipment and other such business expenses are often made in order to save money down the line. We may not want to spend money on helping a poor unemployed homeless illegal immigrant, but the truth is that if you don't, that person will cost you more down the line. It may be in healthcare costs, it may be in crime that the person commits, or the cost of police to keep the person from committing the crime. But you'll pay one way or another.

[SWorks4me]

Ronald Reagan's great genius, atmo, is that he convinced large portions of this country's population that the government is the enemy. His success makes it very difficult to have any kind of rational dialog about topics like this with those who bought his storyline.

Rather than consider the potential value of a program (with real costs and real benefits) in a dispassionate manner, the kneejerk response is to rail about incompetent, corrupt governmental bureaucracy.

Please consider that it is the role of the government to provide services and benefits to the people that cannot be efficiently or effectively delivered in other manners. The interstate highway system, or the provision of radio/TV bandwidth are two (relatively) non-controversial examples of this.

Government can also step in to attempt to redress inequalities. Another poster made reference to "this country's greatness" not being created through wealth transfer. I disagree - This country's greatness has always been its ability to walk a line between personal freedom and social responsibility and justice.

I believe that government should play an important role in maintaining that balance. To that end, it is worth considering a system that would guarantee health care for all, even if it might entail sacrifices for those fortunate enough to have the means to buy the best health care possible.

I don't know what the answer is. But those of you who immediately condemn the idea, especially with specious or reductio ad absurdum arguments, may want to consider that reality is a lot more complicated than Ronald Reagan chose to portray.


The mob is Rome....

feed a stray cat and see where that gets you...

attach any trite statement on it you wish, but the results have always been the same.

I was in elementary school when RR was in office, so he must have done an incredible job brain washing me.

Anyway--- I agree with you as far as saying that the gov't can play a role in leveling the playing field to a point. The problem is us. Humans. We want more as soon as we are given some. I am not out of line by saying as soon as you give certain individuals in government a foot hold in your personal lives, they will try to swing that door wide open given their first chance.

Oh, and what about my taxes going towards illegals...do we continue paying long term health care for them as well?

[Fixed]

I thought I'd chime in here, having been part of a group that actually started a free clinic while in medical school.

Free clinics are a stop-gap band-aid measure. Starting a clinic is incredible complicated and difficult, not the least of which is getting adequate insurance coverage for practicing physicians. This is worsened by the fact that we were flooded with patients as soon as we opened. The largest part of our expenditures were on medication costs for chronic conditions such as high cholesterol, diabetes, and hypertension. In spite of large quantities of donated medications, medication assistance programs, and donated laboratory services, we found that our costs were spiraling out of control.

Despite all of these costs, plenty of studies have shown that primary care is still the most cost-effective method for providing health care. While the cost of statins and anti-hypertensives may seem high, so is the cost of a single patient presenting to the ED with an MI. In fact, the cost of a single day in the hospital far outweighs any outpatient visit and medication costs.

The truth is all of us are paying for the out-of-control health care in this control whether we recognize it or not. County budgets are being readjusted in order to cover public hospitals that are overwhelmed. A lot of money is being spent to cover EDs when many of the underlying problems could have been prevented if patients had been given adequate primary care.

There's a lot of people who blame poor healthcare on poor lifestyle decisions. Thats true to some extent. But we know from public health studies that poor health is also more complicated than that. Poor neighborhoods have less access to healthy foods because supermarkets send the worst of their produce to those stores. Poverty itself is a stressor on health.

One of the most surprising things I found when I was managing the clinic was that a large percentage of our patient population were middle-class Silicon Valley engineers who couldn't afford adequate insurance because companies were cutting back. I think the lesson here is that our health care issues are not just about the poor and illegal immigrants that everyone wants to blame. Health care access problems are starting to affect the middle-class as well.

In business, it seems to me that most people are comfortable with the idea that you have to spend money in order to save money. Investments in capital equipment and other such business expenses are often made in order to save money down the line. We may not want to spend money on helping a poor unemployed homeless illegal immigrant, but the truth is that if you don't, that person will cost you more down the line. It may be in healthcare costs, it may be in crime that the person commits, or the cost of police to keep the person from committing the crime. But you'll pay one way or another.
nice imho

[Pete Serotta]

very good insight to many aspects of the problem. Thanks for sharing with us. Like most things in life, there is never a black and white answer.

One of the latest Business Week magazines had a very informative article on medical coverage, insurance, and how some companies such as GE are making money on the debt of the uninsured..


I thought I'd chime in here, having been part of a group that actually started a free clinic while in medical school.

Free clinics are a stop-gap band-aid measure. Starting a clinic is incredible complicated and difficult, not the least of which is getting adequate insurance coverage for practicing physicians. This is worsened by the fact that we were flooded with patients as soon as we opened. The largest part of our expenditures were on medication costs for chronic conditions such as high cholesterol, diabetes, and hypertension. In spite of large quantities of donated medications, medication assistance programs, and donated laboratory services, we found that our costs were spiraling out of control.

Despite all of these costs, plenty of studies have shown that primary care is still the most cost-effective method for providing health care. While the cost of statins and anti-hypertensives may seem high, so is the cost of a single patient presenting to the ED with an MI. In fact, the cost of a single day in the hospital far outweighs any outpatient visit and medication costs.

The truth is all of us are paying for the out-of-control health care in this control whether we recognize it or not. County budgets are being readjusted in order to cover public hospitals that are overwhelmed. A lot of money is being spent to cover EDs when many of the underlying problems could have been prevented if patients had been given adequate primary care.

There's a lot of people who blame poor healthcare on poor lifestyle decisions. Thats true to some extent. But we know from public health studies that poor health is also more complicated than that. Poor neighborhoods have less access to healthy foods because supermarkets send the worst of their produce to those stores. Poverty itself is a stressor on health.

One of the most surprising things I found when I was managing the clinic was that a large percentage of our patient population were middle-class Silicon Valley engineers who couldn't afford adequate insurance because companies were cutting back. I think the lesson here is that our health care issues are not just about the poor and illegal immigrants that everyone wants to blame. Health care access problems are starting to affect the middle-class as well.

In business, it seems to me that most people are comfortable with the idea that you have to spend money in order to save money. Investments in capital equipment and other such business expenses are often made in order to save money down the line. We may not want to spend money on helping a poor unemployed homeless illegal immigrant, but the truth is that if you don't, that person will cost you more down the line. It may be in healthcare costs, it may be in crime that the person commits, or the cost of police to keep the person from committing the crime. But you'll pay one way or another.

[jhcakilmer]

and then ther 's me bro i have a chronic illness I haven't been to the doc in 3 years cos i have to pay my wife and son go but i don't $4000 deductible,cheers


Fixed is a perfect example of one reason our system cost so much, people can't go due to financial restriction. Many people have chronic, but manageable illnesses, and don't get the basic care, until they get to advanced stage, and at this point the cost is exponentially more that what it would have cost to manage the illness with a PCP.

There is a huge cost difference between your family practitioner and the emergency room, or specialist. PCP are a bargain in the healthcare community, and worth their weight it Meivicis!!

[PoppaWheelie]

You may look longingly at Canadian health care, but talk to folks who live there and listen to the stories of rationing and loooong waits for treatment. Talk to folks in the UK who are given 13 months to live after a cancer diagnosis, and then booked to see the oncologist for their initial consulation in 15 months time. What about the british hospitals whose nurses have been told not to change the sheets between patients, but merely to turn them over!



Yeah, other forumites may have other thoughts on this, but being among those of us who have spent time under the Canadian system (lived there for 10 years, most of my family is still in Ontario) it ain't all that. Good for basic preventive care, but seems to fall apart a bit beyond this. As my folks get older they've resorted to coming to the US and paying out of pocket for what they feel is better care in some cases.

[norman neville]

Dude, if you keep writing things like this, and stop gratuitously insulting posters with whom you disagree, I may have to start taking you seriously.

bite me.

[norman neville]

Yeah, other forumites may have other thoughts on this, but being among those of us who have spent time under the Canadian system (lived there for 10 years, most of my family is still in Ontario) it ain't all that. Good for basic preventive care, but seems to fall apart a bit beyond this. As my folks get older they've resorted to coming to the US and paying out of pocket for what they feel is better care in some cases.

any system without proper funding will fall apart.

the canadian insurance industry (aka the us insurance in many cases) wants to collect premiums from those happy healthy and (relatively) wealthy canadians. it's hard to believe, but weasels inhabit the canadian political class as well, happy to take money and bone the population in general. funny, huh.

fwiw, many many people i know, well canadians, actually, would kill to keep their health system, and the way it's going, they figure they may have to.

[stevep]

bite me.

he was complementing you.
for the record.

[norman neville]

Anyway--- I agree with you as far as saying that the gov't can play a role in leveling the playing field to a point. The problem is us. Humans. We want more as soon as we are given some. I am not out of line by saying as soon as you give certain individuals in government a foot hold in your personal lives, they will try to swing that door wide open given their first chance.

Oh, and what about my taxes going towards illegals...do we continue paying long term health care for them as well?

single payer healthcare delivery is not GIVING anything to ANYONE.

healthcare is delivered as usual and the payer is the government. pay a tax, get a speeding ticket, work a job, buy something, and bingo, you've contributed to the governemnt money pool, the same one that would build a road, conquer a country, hire a judge, subsidize a 'private' school, pay hush money to a hooker or fund a hospital. contragulations. now, get that rash looked at.

[norman neville]

he was complementing you.
for the record.

uh, yeah. i know. irony or something. he gives me a break, and then i insult him, but it's not really an insult, more like a nod or tip of the cap.

bite me is meant with respect. if you're healthy, it's just good, clean fun!

[davids]

...contragulations...Ollie North? Is that you?





See? All in good fun.

...stevep has to watch out for me. his long-term financial health is based on my mental stability.

[norman neville]

Ollie North? Is that you?





See? All in good fun.

...stevep has to watch out for me. his long-term financial health is based on my mental stability.

YES YES!! it's me, ollie. i'm a hero! buy me a home security system, please! bad men want to tickle my dog!

[norman neville]

there have been some good posts regarding a complicated topic.

the question of demographics is another good one. the folks on this forum are waaayy more likely to have good access to care, insurance, whatever, than most folks. however, if the demographic of the uninsured shifts and begins to put pressure on our peer group, then the costs of the problem will explode and the solutions become expensive, impossible, painful. pick two and hope for the best.

[Avispa]

I saw the movie and for the most part, I liked it. But, I've learned to take most of these documentaries (right or left, lib and conserv) with a grain of salt! I was particularly skeptical about the stuff mentioned on Cuban hospitals.

My doubts were confirmed by many of my Cuban friends.... Including those that go to Cuba on a regular basis. The hospital and care shown in the movie is far from reality! The hospitals like that in Cuba are strictly for foreigners and they have to pay in US$ or Euros. No locals are allowed!

But, that doesn't mean that the entire film is screwed... The health care in this country surely leaves a lot to say, when you compare it to other places.

..A..

PS
Guys, don't forget to keep it civil! This is a bike forum... Thanks! ;)

[DukeHorn]

Thwart is exactly on point.

There are a number of folks here with $5,000 bikes and multiple homes that are complaining about bureaucracy and "everyone paying his fair share," while being totally oblivious of the fact that there are a number of everyday Americans that are suffering from poor health care.

And whether you want to blame the 12 year old kid for being "stupid" or "unfortunate" enough to be born poor, I don't know how you can argue that our system is working when said child dies from a cavity.

(In case you all forgot)

http://yourtotalhealth.ivillage.com/ada-death-from-untreated-cavities-senseless.html

Do some of you ever stop and think that you are placing the burden of being born to poor folks right on top of those kids? Using an analogy to another child phenomenom, that's like saying, "hey your dad is a sexual predator, you deserved to be abused."

[jhcakilmer]

Thwart is exactly on point.

There are a number of folks here with $5,000 bikes and multiple homes that are complaining about bureaucracy and "everyone paying his fair share," while being totally oblivious of the fact that there are a number of everyday Americans that are suffering from poor health care.

And whether you want to blame the 12 year old kid for being "stupid" or "unfortunate" enough to be born poor, I don't know how you can argue that our system is working when said child dies from a cavity.

(In case you all forgot)

http://yourtotalhealth.ivillage.com/ada-death-from-untreated-cavities-senseless.html

Do some of you ever stop and think that you are placing the burden of being born to poor folks right on top of those kids? Using an analogy to another child phenomenom, that's like saying, "hey your dad is a sexual predator, you deserved to be abused."


Okay, I think this a little off the deep end, but I think we get the point. I don't think (or maybe just wishful) that anyone on the forum thinks anything like this. We live in a very privileged society, that affords many luxuries, which I believe many people take for granted.

In general people can be quite uninformed, or missinformed, and still express opinions on many topics, for better or worse.

[J.Greene]

In general people can be quite uninformed, or missinformed, and still express opinions on many topics, for better or worse.

It's a complicated subject. It worries me that watching Sicko might qualify as being "informed".

JG

[Ahneida Ride]

Take a ride up to Canada and find out what our Northern brothers and
sisters think really about their health care. Long waits for urgent care.

Care must be administered when it is needed, not when it is politically expedient.

Our government can't even run Social Security ...
Now ... Imagine it running our health care. :eek:

[norman neville]

Take a ride up to Canada and find out what our Northern brothers and
sisters think really about their health care. Long waits for urgent care.

Care must be administered when it is needed, not when it is politically expedient.

Our government can't even run Social Security ...
Now ... Imagine it running our health care. :eek:

social security runs on a pretty lean margin. it certainly was wildly successful in its mission: to keep vast numbers of old folks who had been broken down by their life of labor from eating worms out of puddles in order to survive after they could no longer work. many if not all of the scary stories you hear about the collapse of the social security system come from people who have a massive, vested interest in the failure of the social security system. that scumbag greenspan advocated huge tax cuts because ss was in such rosy shape, and then used the resulting revenue shortfall as an excuse to dismantle the ss program. when he's hanging upside down from a lamp post choking on his junk, at least that will be a sliver of justice served.

[norman neville]

Take a ride up to Canada and find out what our Northern brothers and
sisters think really about their health care. Long waits for urgent care.

Care must be administered when it is needed, not when it is politically expedient.

Our government can't even run Social Security ...
Now ... Imagine it running our health care. :eek:

in a single payer system, the government doesn't run healthcare. it finances it. it depends on the rugged individualists in the market to run the system. now, if those free-thinking cowboys of management happen to be azz clowns, well then that makes for a bit o' trouble.

[Grant McLean]

Care must be administered when it is needed, not when it is politically expedient.


As a Canadian, I have no idea what this means.
Your doctor is the person who administers your care here.

-g

[jhcakilmer]

It's a complicated subject. It worries me that watching Sicko might qualify as being "informed".

JG


I absolutely agree! I think you need to know both sides. Someone only knowing one side is just as dangerous as some that is totally ignorant on the subject.

The US is a great country, with a lot of intelligent, and capable people. I believe we COULD have the best Health-care system in the world. But I believe strongly that the current capitalistic paradigm that currently exist is detrimental to our nations quality of health!

I'm not naive about the problems facing socialized medicine, I just don't know why people find it so difficult to accept in the US. They pay for so many other services via taxes, why not medical care?

Also, I'm not sure Canada is the best exam. They are a great country, but they have limited resources.....the US does not have this issue! Mismanagement and incompetence is our main issue.

[Bobbo]

That would be great, but since I'm straddled with hundreds of thousands in debt, that will have to come later, plus why should a single individual or organization be forced to do that which should already be provided?


That is but a small sacrifice that you should make, for the sake of the greater good of society. Come on, do you want to be part of the problem or part of the solution?

When do you anticipate your free clinic opening? I'll mark my calendar.

[Grant McLean]

Also, I'm not sure Canada is the best exam. They are a great country, but they have limited resources.....the US does not have this issue! Mismanagement and incompetence is our main issue.

Canada has plenty to spend, and is around what most countries are spending,
around 10% of GDP which is up from around 8% a few years ago.

The REAL issue is prevention, and then the management of aging.
Haven't I read about how much money is spent on the final few months of life?
All governments need to invest in the health of their people. A healthy population
should be the goal for every country. Anyone think that's where we're headed?
It's not like the money can't be spent when people are sick, but isn't the point
to prevent a lot of people from getting real sick in the first place?
So far, the medical establishment is not set up for this, and I think that's the
main point of Michael Moore's film.

-g

[andy mac]

having lived for years in europe, australia and the usa i have to say the US had the inferior health system (wait times and cost).

the alarmists need to park their inherited rhetoric, go travel, and see there are different and sometimes better ways to solve issues. if you think a centralized health 'care' system would lead to russia come visit sydney - it makes aspen look like idaho.

it does sadden me to see the richest country in the world with such shocking child fatality rates for instance. that's shameful.

these countries all have lower child fatality rates than the USA:


164 New Caledonia 6.1 8.7
165 Cyprus 5.9 6.9
166 Brunei 5.5 6.7
167 Channel Islands (Jersey and Guernsey) 5.2 6.2
168 Cuba 5.1 6.5
169 New Zealand 5.0 6.4
170 Portugal 5.0 6.6
171 Italy 5.0 6.1
172 Ireland 4.9 6.2
173 Canada 4.8 5.9
174 United Kingdom 4.8 6.0
175 Slovenia 4.8 6.4
176 Israel 4.7 5.7
177 Netherlands 4.7 5.9
178 Luxembourg 4.5 6.6
179 Australia 4.4 5.6
180 Austria 4.4 5.4
181 Denmark 4.4 5.8
182 Germany 4.3 5.4
183 Spain 4.2 5.3
184 France 4.2 5.2
185 Belgium 4.2 5.3
186 Korea, South 4.1 4.8
187 Switzerland 4.1 5.1
188 Czech Republic 3.8 4.8
189 Finland 3.7 4.7
190 Hong Kong 3.7 4.7
191 Norway 3.3 4.4
192 Sweden 3.2 4.0
193 Japan 3.2 4.2
194 Singapore 3.0 4.1
195 Iceland 2.9 3.9

[1centaur]

norman neville is right that all systems ration health care - it is not infinitely available.

He is not right when he views those who question nationalized health care as spewing vile lies. Nor were such people brainwashed by Reagan.

The simple, observable fact is that all rationing systems have obvious shortcomings, most of which have been discussed in this thread and not one of which is a vile lie. Human bureaucracies, whether for profit or not, grow increasingly incompetent as their size expands and decisions move farther from personal incentive. That is why Reagan viewed government as the enemy, and those with a few years under their belts should have observed for themselves how often government performs tasks less efficiently (using money from our pockets) than would a for-profit business. That is why people with money in their pockets resist government programs - it has nothing to do with being clueless, mean, apathetic, vile, etc.

For-profit health care is also a huge human bureaucracy where payment is made indirectly (through a variety of middlemen) and thus the incentive to be efficient is likewise reduced. Michael Moore (not the brightest nor most thoughtful documentarian in history) was right to point out how horrendous the care is for many WITH health insurance. Some conservatives think HSAs will solve the problem, but I think health care is too complex and people too fearful for that to lead to an optimum health outcome for most.

While a single-payer system is not technically about the government running the show, a single customer who writes the rules is effectively in control, so the practical difference is slight (there would be some profit potential but as we are seeing today, those who figure out how to make a good margin have CMS change the rules on them).

Inevitably, national health care in the US means worse health care for those who get good care now (not millionaires who can buy anything, but middle class and above who happen to have good insurance) and better care for those with bad or no plans. It's not surprising that the many millions with care they like would resist national health care. While it's nice to say we the voters can make sure the system is right, that's naive for two reasons. First, we the voters don't have the time, temperament, knowledge or inclination to make a complex bureaucracy right, as we can see from many government programs today (or even the war, if you wish to view it that way). We are beholden to those who choose to go into politics, and you know what that means. Second, increasingly the voting power/numbers is going to those who do not pay many dollars of income taxes and they are likely to take money from those who do pay taxes (by voting for expensive programs the "government" should pay for). It's like taxation without representation, but not technically so it can't be outlawed. A great question for a Democratic debate would be "at what marginal tax rate would you consider the next dollar of tax to be immoral for the everyday functions of government?"

Statistics on medical outcomes are all over the place so no point in debating them here. A recent study showed that if you normalized life expectancy for deaths from illness (since so many Americans die from accidents and murder), the US is better than lots of Western countries. Factor in our obesity rate and our life expectancy is stunningly better than anyone's. But that's still aggregate data, and health horror stories are being told every day, person by person.

We will end up with national health care and there will be horror stories to tell of rationing gone bad. Government will be inefficient and that will extract a toll on national wealth. In the end, that cost may be worth it, but that is NOT crystal clear, which is not a vile lie.

[chuckroast]

Well put, there are no easy answers. Common to both the single payer system and the current insurance system is the insulation of the true cost from the end user.

No one here has yet used the car insurance analogy but I've heard it many times. We all purchase our own car insurance, it is a very competitive industry. We don't use our car insurance for oil changes or even windshield cracks, only for catastrophic car ills.

If health insurance, and by extension health care, were purchased by us individually, what impact would competition have on the cost?

[Fixed]

"that scumbag greenspan advocated huge tax cuts because ss was in such rosy shape, and then used the resulting revenue shortfall as an excuse to dismantle the ss program. when he's hanging upside down from a lamp post choking on his junk, at least that will be a sliver of justice served."


why would he sell us down the river ?
cheers

[J.Greene]

If health insurance, and by extension health care, were purchased by us individually, what impact would competition have on the cost?

Chuck,

yo man stop thinking for yourself. These guys will eat you alive bra. Dont ya know the man is supposed to support you.

JG

[R2D2]

Wow ..........
This stuff is getting deep.
You got the Ayn Rand faction and the Karl Marx faction.
I guess I'm more of the Albert Camus faction.

[norman neville]

"that scumbag greenspan advocated huge tax cuts because ss was in such rosy shape, and then used the resulting revenue shortfall as an excuse to dismantle the ss program. when he's hanging upside down from a lamp post choking on his junk, at least that will be a sliver of justice served."


why would he sell us down the river ?
cheers

wall street week. 2%-10% of social security taxes is a huge windfall for the money boys. greenspan was a nutjob from way back, ayn rand acolyte and such; he had no business near any public institution since he despised them so. he wanted to see the government out and wall street in, managing the social security retirement fund for millions of hapless americans for huge profits. not that there would be any accountibilty of course. the profits from fees would be handed out long before somebody's grandpa started enjoying worms on regular basis.

[J.Greene]

he wanted to see the government out and wall street in, managing the social security retirement fund for millions of hapless americans for huge profits.

He actually is very very cautious about this. He's lectured many times on the inefficiency these cappital flows could cuase and how gov't interaction could cause problems.

But hey, don't let the facts get in the way of the truth.

JG

[norman neville]

norman neville is right that all systems ration health care - it is not infinitely available.

He is not right when he views those who question nationalized health care as spewing vile lies. Nor were such people brainwashed by Reagan.

The simple, observable fact is that all rationing systems have obvious shortcomings, most of which have been discussed in this thread and not one of which is a vile lie. Human bureaucracies, whether for profit or not, grow increasingly incompetent as their size expands and decisions move farther from personal incentive. That is why Reagan viewed government as the enemy, and those with a few years under their belts should have observed for themselves how often government performs tasks less efficiently (using money from our pockets) than would a for-profit business. That is why people with money in their pockets resist government programs - it has nothing to do with being clueless, mean, apathetic, vile, etc.

For-profit health care is also a huge human bureaucracy where payment is made indirectly (through a variety of middlemen) and thus the incentive to be efficient is likewise reduced. Michael Moore (not the brightest nor most thoughtful documentarian in history) was right to point out how horrendous the care is for many WITH health insurance. Some conservatives think HSAs will solve the problem, but I think health care is too complex and people too fearful for that to lead to an optimum health outcome for most.

While a single-payer system is not technically about the government running the show, a single customer who writes the rules is effectively in control, so the practical difference is slight (there would be some profit potential but as we are seeing today, those who figure out how to make a good margin have CMS change the rules on them).

Inevitably, national health care in the US means worse health care for those who get good care now (not millionaires who can buy anything, but middle class and above who happen to have good insurance) and better care for those with bad or no plans. It's not surprising that the many millions with care they like would resist national health care. While it's nice to say we the voters can make sure the system is right, that's naive for two reasons. First, we the voters don't have the time, temperament, knowledge or inclination to make a complex bureaucracy right, as we can see from many government programs today (or even the war, if you wish to view it that way). We are beholden to those who choose to go into politics, and you know what that means. Second, increasingly the voting power/numbers is going to those who do not pay many dollars of income taxes and they are likely to take money from those who do pay taxes (by voting for expensive programs the "government" should pay for). It's like taxation without representation, but not technically so it can't be outlawed. A great question for a Democratic debate would be "at what marginal tax rate would you consider the next dollar of tax to be immoral for the everyday functions of government?"

Statistics on medical outcomes are all over the place so no point in debating them here. A recent study showed that if you normalized life expectancy for deaths from illness (since so many Americans die from accidents and murder), the US is better than lots of Western countries. Factor in our obesity rate and our life expectancy is stunningly better than anyone's. But that's still aggregate data, and health horror stories are being told every day, person by person.

We will end up with national health care and there will be horror stories to tell of rationing gone bad. Government will be inefficient and that will extract a toll on national wealth. In the end, that cost may be worth it, but that is NOT crystal clear, which is not a vile lie.

the vile lies are the lies that private insurance as we have in this country doesn't ration care. many people don't understand that a $50 copay for a scrip is rationing. or the copay for a dr.'s visit after you pay a hundred bucks a week for insurance for your family.

to say that single-payer will result in a lower quality of care for the majority of americans qualifies as a vile lie. lie because you cannot prove it, and the evidence from the rest of the world says otherwise, and vile because it is a scare tactic meant to frighten people who don't know any better away from their own best interests.

and how exactly does anyone think that private businesses operate more efficiently than governent. medicare runs on much less money, i.e. more effieciently, and delivers better care than the private hmo's doing the same job, so that contention plays more like simplistic jargon than reasoned or factual argument. anyone who has ever worked in the private sector for around a day and a half and doesn't have their head firmly wedged can see that business in general is anything but a model of effiency and innovation.

any government agency or program can suck, and any business can be an enron. that doesn't alter the fact that single payer healthcare is the most efficient delivery system yet devised. any dittoheads that want to come up with a better one are welcome to be rugged individualists and pull themselves up by their bootstraps and do just that!

fearing more democracy is a symptom of many in the comfortable class. being used to getting your way and having all of the welfare money go to you and yours is quite empowering to the status quo. unfortunately, at some point you find yourself defending your own pile of crap in the empire of crap, and you never realize you were looking right at it when it turned from comfort to crap. or something like that.

[norman neville]

He actually is very very cautious about this. He's lectured many times on the inefficiency these cappital flows could cuase and how gov't interaction could cause problems.

But hey, don't let the facts get in the way of the truth.

JG

jeez, i'm glad you've followed what greenspan said with such attention. now look at what he DID. every action taken throughout his career has been in the interest of enriching his cohort with the wealth of and at the expense of the majority of americans. greenspan only got into governent because he was an incompetent money manager whose clients deserted him after he lost their investment. fortunately for him and unfortunately for everyone else, he landed a few sweet gigs in goverment that allowed him to pay back his clients and them some.

sure, he made important sounding speeches to end up in the public record, while saying very little of substance. however, an analysis of his actions and his record will show his true intentions. it's not a secret, but it does take a bit of effort to put it all together.

but hey, don't let a smart-sounding retort get in the way of the truth now.

[michael white]

the point is that we're paying for "it" already. If you don't believe that, go hang out in the lobby of any VA hospital for 3 minutes. Everyone there is "sicko" all right, it's preventable, and it's on your dime. That's what your tax dollars go for, vast vast networks of institutionalized disease, a broken system where millions of patients die a long, miserable and expensive death, and you pay for every last bit of it.

I've been to hospitals in Canada, and was blown away by how well they worked, as far as I could see. For the conservatives out there: suppose it could be shown to you that you personally would pay out less taxes for socialized medicine, than you do right now for the mess we have. Would it start to make sense to you then?

best,
mw

[norman neville]

the point is that we're paying for "it" already. If you don't believe that, go hang out in the lobby of any VA hospital for 3 minutes. Everyone there is "sicko" all right, it's preventable, and it's on your dime. That's what your tax dollars go for, vast vast networks of institutionalized disease, a broken system where millions of patients die a long, miserable and expensive death, and you pay for every last bit of it.

I've been to hospitals in Canada, and was blown away by how well they worked, as far as I could see. For the conservatives out there: suppose it could be shown to you that you personally would pay out less taxes for socialized medicine, than you do right now for the mess we have. Would it start to make sense to you then?

best,
mw

goodness, now you've given some headaches. you're a bad, bad man.

[J.Greene]

I Love your writing. You gots skillz.

JG

jeez, i'm glad you've followed what greenspan said with such attention. now look at what he DID. every action taken throughout his career has been in the interest of enriching his cohort with the wealth of and at the expense of the majority of americans. greenspan only got into governent because he was an incompetent money manager whose clients deserted him after he lost their investment. fortunately for him and unfortunately for everyone else, he landed a few sweet gigs in goverment that allowed him to pay back his clients and them some.

sure, he made important sounding speeches to end up in the public record, while saying very little of substance. however, an analysis of his actions and his record will show his true intentions. it's not a secret, but it does take a bit of effort to put it all together.

but hey, don't let a smart-sounding retort get in the way of the truth now.

[norman neville]

I Love your writing. You gots skillz.

JG

kiss kiss

[J.Greene]

kiss kiss

Don't get all like that. I'm dropping the combat for the night. I got to use what cleverness I have on the old lady later. See ya in the AM :)

JG

[justinf]

Shortcomings of the bloated existing for-profit healthcare system set aside for a moment:

History has shown where socialism in industry breeds a mediocre workforce over time. So, who's signing on for increased mediocrity in the healthcare field?

Capitalism does represent a natural selection for talent in most cases.

[scrubadub]

I don't know if capitalism is necessary any better than socialism. For that matter, like many things in life, it's hard to reduce anything to just an idea like capitalism or socialism. I don't really know what those terms mean anymore since everyone uses these terms haphazardly.

My sense is that the overall quality of health care professionals would not change regardless of capitalism or socialism. Plenty of other countries are more "socialistic" than we are, and have great doctors. We hardly have a pure capitalistic system at the moment anyway, since there is (rightly) so much government regulation regarding who can and cannot be qualified to be a physician or health care provider.

One of the difficulties in applying capitalism and market-based solutions to health care is that capitalism is dependent on consumers making informed decisions. I suspect most health economists would agree with me in saying that health care is not a good that the average consumer can understand easily, and that therefore an assymetrical information bias exists. Patients go to doctors just like they seek out a custom bike builder because no matter how much you read on the internet on textbooks, they lack the experience and skills to completely understand their health care situation. I can read all I want about fork rake, planing, brazing, and tubing selection. I still won't be e-richie, DKS, or TK.

This isn't to say that consumers shouldn't be involved in their decision-making. Quite the contrary, I think patients in general are better informed and better off because of it. For example, in my future field of training, surgery, there is a huge push to publish the performance of every surgeon. Pay-for-performance is the big thing when selecting and reimbursing hospitals and physicians. While there are inevitably going to be flaws and problems with such a system, I think it's an important step forward. Right now, when you go to a surgeon, all you know is their reputation and the institution they work at. Maybe a friend told you they were good. But how do you know that this really is true?

Sorry to get long-winded. One last thing: Insurance is designed to spread the risk of a rare event among a large group of individuals. The best kind of insurance is that which spreads the risk across the largest pool*. One of the advantages of a single-payer system is that you can pool the risk of individuals across an entire country's population. Single-payer does not necessarily mean the end of insurance companies, nor does it mean that every hospital becomes a government institution. That's certainly one extreme, but not the only situation. I'd argue that the best situation is one where we have a single-payer (the government) but multiple competing delivery organizations. I believe Germany has something similar in their social insurance program. Privatization and competition can and in fact should be part of any single-payer solution. However, I should point out that AFAIK Medicare is actually the most efficient bureaucracy for delivering health care, far more efficient than every other private/non-profit health care program. Sometimes big government isn't so bad.

*Not quite actually. Technically, if you the consumer want the best deal on insurance, you want to be in the largest healthiest pool you can be so as to minimize your subsidy of others. The question is whether you think it's acceptable to exclude "unhealthy" people. How will you define "unhealthy"? That's a slippery slope there...

[malcolm]

I've been a physician for a long time and infant mortality rates and the general state of out citizens health is not really an indicator of the quality of our health care, possibly of the way it is administered.
I've not seen or heard of any socialized system that actually works well if you are sick. Most are great if you are healthy and some are OK if you have an acute illness like and MI, but otherwise very lacking. I don't think you see many american physicians moving to Canada to practice but many are here in private practice as well as university settings.
I agree our system needs help but I don't think government is the answer. Part of the problem is we operate in an unrealistic environment where a physician is not expected to ever make a mistake and if one is made someone has to pay lots of money. Hospitials are also run by CEO's in the same manner as WalMart where customer satisfaction is the number one goal and when someone shows up in the E.D. demanding an MR or there lortab prescription and you don't provide it they complain and your satisfaction score drops along with your income. I remember when you could tell a patient something was inappropriate without reprecussions. If you truly want to socialize medicine we will have to get over the expectation that everyone gets instant cadillac care. Like Grant said if it isn't life threatening get to the back of the line and we haven't been tolerant of this concept thus far, especially when you factor in occasionally being wrong and that simple headache wound up being a tumor and you just waited 6 months for an MR and now it is unrescetable.
And as far as worring about our future young physician's taxes under government medicine they won't be so much. I work in the trenches everyday and I'm unwilling to do what I do with the responsibility I shoulder for one cent less than I currently make. Before anyone thinks I do nothing to help the poor or pay back for my good fortune let me explain how I'm paid. The E.D. where I work is fee for service, meaning we cover our salary and expenses from monies we collect for servicies rendered. Of our patient population about 25% does not pay for one reason of another, no insurance or they have exceeded their medicade benefits for emergency care, whatever the case we see them for free. I nor my partners have ever complained it is just the cost of doing business and if they need help you try and provide it. The only thing I do different for non paying patients is try and provide the cheapest meds possible to do the job if they are coming out of their pocket.
Last but not least if you want to see U.S. government medicine look at the VA, possibly the worst system on the planet.

[stackie]

Wow, here's a thread that really gets me going. I, too, am a physician.

A few points.

1. Malcolm is going to stop working soon. Medicare is a budget neutral program. The more people enroll in it and the more procedures become available, the less Medicare will pay for everything. I do not make enough caring for a Medicare patient to pay a gardener to mow my lawn. I'm serious about that. So, Malcolm, like every other physician will continue to take pay cuts until the go broke. Then, we will go to entirely socialized system, to try to pick up the pieces. Many physicians will get contractor's licenses and do something profitable.

2. You cannot insure medical care. It is like insuring food. The only way to make money insuring food would be to collect premiums and not give out food. That is how medical insurance works. You are going to get sick and need medical care. That's a fact. Insurance companies make money by collecting premiums and then cancelling policies that become too expensive, say when the patient gets cancer. Otherwise, they just cut the pay to physicians until the threaten to quit.

3. We will not solve the problem until a few things become clear and accepted in the USA. First, all medical care cannot be a right. Sure, 28 years old with a hot appendix? Yes, let's take that bugger out. You probably have a few more productive years in you. How about 90 yrs old with diabetes, hypertension, dementia, and severe peripheal vascular disease with a cold, dead leg? Do, we do a 9 hour arterial bypass operation? Do we do a 1 hour amputation? Do we just say, Gramps, it's been a good run? I believe that Britain essentially does not provide ICU care for the elderly, nor do they perform coronary bypasses, at least not on the government tab. I'd say that's a good start.

4. We need to have more physician extenders and cut the training to become a physician so that we don't waste so many productive years becoming a doc, then need to make money to catch up. Why not train high school students with great video game skills to take out gall bladders? Train them for six months. Have a center with 12 of them just pulling out gall bladders all day. Have one surgeon supervising them to get them out of trouble for the one time in a thousand that they need help. Same with FP's. Have nurse practictioners handle the colds, diarrhea, and eczema. Send patients on to physician when the nurse is puzzled.

If thats to radical for you, how about this. Britain trains docs in 5 years, because they don't waste time on a undergrad education. Why do I need to know Russian literature to practice medicine? History? Calculus? Art? That stuff is just fluff. Do you really give a rodent's hindquarters if your doc can tell a Monet from a Picasso? No, you just want them to fix you.

4. Finally, just remember, counting insurance premiums and copays as medical dollars spent, half of all health care dollars goes to insurance companies. That's CEO pay, profit, and admin. If you just put that back in the physician's hands we could take care of everyone. I work with an old time surgeon who did just that before Medicare was implemented. The guy who drove up from Pebble Beach in the Mercedes paid $10k for his bowel resection. The guy who took the bus from Seaside just never seemed to get a bill. That's just the way you did it in those days.

PS, here's a question for you. Who's the highest paid person in the operating room for a Total Hip Replacement?

1. Scrub tech
2. Orthopedic Surgeon
3. Anesthesiologist
4. Stryker equipment rep to open the plastic wrap on the implants.

You guessed it. Number 4. For all of you not quite there on the medical career plan, it's not to late. Go get a job with Stryker opening that implant.

How bout them grapes?

Jon

[sspielman]

Anyway, what's wrong with everyone paying for something that is provided universally, we already have many examples.....
schools
libraries
postal system
City Municipals
etc

*Please tell me that you are not using the public school system as an example of a government "success story"....you know the system where the results are inversely proportionate to the amount of our money that is spent on it....
* The Postal Service operates as a quasi-business and is self supporting by user fees...
* City municipals also operate as quasi businesses....but they are local-not federal-functions anyway...EXCEPT for Washington, DC...and everybody knows how the infrastructure of that cesspool is crumbling under federal management/oversight....

any other shining examples of liberal success that I can take apart?

[nick0137]

For the conservatives out there: suppose it could be shown to you that you personally would pay out less taxes for socialized medicine, than you do right now for the mess we have.

From here in the UK it's this that confuses most. Here, it's all quite simple. We have a government-run, taxpayer funded National Health Service. It's open to all, basically at nil cost (some things like prescriptions carry nominal charges for some), and it's the usual mixture for a state-provided service of excellent, good, ok and crap.

But we Serotta-owning types also pay for private health insurance so that we can get the "extras" - like expensive scans, or non-urgent surgery - that you can get on the NHS but which you will have to wait for. So, unless we are in an accident or urgently rushed to hospital, we and our wives and children will not use the NHS.

But we still pay for for the NHS. Not for what we can get out oft it on an individual level but what we as a society get out of it. It is so ingrained in our culture (but evidently not in the US) that we regard it as part of what binds society together - what in fact makes us a society. It's the price of civilisation. No more, no less.

[sspielman]

I've been a physician for a long time and infant mortality rates and the general state of out citizens health is not really an indicator of the quality of our health care, possibly of the way it is administered.
I've not seen or heard of any socialized system that actually works well if you are sick. Most are great if you are healthy and some are OK if you have an acute illness like and MI, but otherwise very lacking. I don't think you see many american physicians moving to Canada to practice but many are here in private practice as well as university settings.
I agree our system needs help but I don't think government is the answer. Part of the problem is we operate in an unrealistic environment where a physician is not expected to ever make a mistake and if one is made someone has to pay lots of money. Hospitials are also run by CEO's in the same manner as WalMart where customer satisfaction is the number one goal and when someone shows up in the E.D. demanding an MR or there lortab prescription and you don't provide it they complain and your satisfaction score drops along with your income. I remember when you could tell a patient something was inappropriate without reprecussions. If you truly want to socialize medicine we will have to get over the expectation that everyone gets instant cadillac care. Like Grant said if it isn't life threatening get to the back of the line and we haven't been tolerant of this concept thus far, especially when you factor in occasionally being wrong and that simple headache wound up being a tumor and you just waited 6 months for an MR and now it is unrescetable.
And as far as worring about our future young physician's taxes under government medicine they won't be so much. I work in the trenches everyday and I'm unwilling to do what I do with the responsibility I shoulder for one cent less than I currently make. Before anyone thinks I do nothing to help the poor or pay back for my good fortune let me explain how I'm paid. The E.D. where I work is fee for service, meaning we cover our salary and expenses from monies we collect for servicies rendered. Of our patient population about 25% does not pay for one reason of another, no insurance or they have exceeded their medicade benefits for emergency care, whatever the case we see them for free. I nor my partners have ever complained it is just the cost of doing business and if they need help you try and provide it. The only thing I do different for non paying patients is try and provide the cheapest meds possible to do the job if they are coming out of their pocket.
Last but not least if you want to see U.S. government medicine look at the VA, possibly the worst system on the planet.

Excellent points from a ground soldier...


How is it that I know that when socialised medicine is crammed down our throats that those elite polit bureau members running the nanny state that they will not seek the input of conscientious WORKING physicians like Malcolm?

[R2D2]

Of our patient population about 25% does not pay for one reason of another, no insurance or they have exceeded their medicade benefits for emergency care, whatever the case we see them for free.

Are you saying your hospital doesn't do "cost shifting"? Someone has to pay
for the "free" service. Usually it is quietly shifted to those who do pay.

[J.Greene]

Funny story, at least to me anyway.

My business partner a few years ago set up a lunch appt with a local physician for me. He needed some retirement planning help for his practice. This guy spent the first 1/2 of lunch talking about how his malpractice insurance was killing him while collecting from insurance companies was getting harder and harder. He hated that the care he could provide was suffering. He said he was thinking of moving to another state which is not uncommon for MD's that practice here. I felt so bad for the Doc I would have loaned the guy money if he'd have asked. Thankfully, the second half of lunch the conversation turned. He wanted to talk about his race horses and the sucess he has had that year with them.

I thought it was a funny glimpse into Human nature atmo.

JG

[Dekonick]

A simpleton view (mine)

Preventive medicine should be free - to a point. Offer a baseline that everyone is entitled to use - check-up, some medications, some surgical procedures - everything else should be private insurance or cash.

Just as it is not my responsibility to offer the homless a mansion in the Hollywood hills, the same is true of healthcare.

What should be free is healthcare that keeps the general population healthy. Immunizations, catching disease before it is advanced, etc...

Organ transplants, advanced prosthetics, Gucci medications, etc... is another matter. It is hard to draw a line, but you have to if you want a system that will work and be affordable. It used to be that having great health insurance was an incentive to work for a certain company - not a right.

I imagine a big lock is looming...

[Dekonick]

From here in the UK it's this that confuses most. Here, it's all quite simple. We have a government-run, taxpayer funded National Health Service. It's open to all, basically at nil cost (some things like prescriptions carry nominal charges for some), and it's the usual mixture for a state-provided service of excellent, good, ok and crap.

But we Serotta-owning types also pay for private health insurance so that we can get the "extras" - like expensive scans, or non-urgent surgery - that you can get on the NHS but which you will have to wait for. So, unless we are in an accident or urgently rushed to hospital, we and our wives and children will not use the NHS.

But we still pay for for the NHS. Not for what we can get out oft it on an individual level but what we as a society get out of it. It is so ingrained in our culture (but evidently not in the US) that we regard it as part of what binds society together - what in fact makes us a society. It's the price of
civilisation. No more, no less.

Yup - BASIC healthcare - BASIC.

[jhcakilmer]

*Please tell me that you are not using the public school system as an example of a government "success story"....you know the system where the results are inversely proportionate to the amount of our money that is spent on it....
* The Postal Service operates as a quasi-business and is self supporting by user fees...
* City municipals also operate as quasi businesses....but they are local-not federal-functions anyway...EXCEPT for Washington, DC...and everybody knows how the infrastructure of that cesspool is crumbling under federal management/oversight....

any other shining examples of liberal success that I can take apart?


I'm acutally quite satisfied with all the services stated above, are they perfect, no, but we are extremely lucky to have them, and like I already said we already pay for them out of taxes, so why not healthcare. Let me reiterate that the US is the only western country that is not socialized......what....do we just know something that everyone else doesn't, or are we just smarter?

No, we are a society that places a greater priority on capitalism and free market, rather then on the health of the people. Seems like some screwed up values!!!

I'm a product of public education from a small rural PA town, and I am very satisfied with my education! We didn't have a ton of resources, but most of the teachers had a desired to teach, and were excellent at their job! Also, the postal system works pretty well, and it's quite a bit cheaper to send something via USPS, than UPS or Fedex.....and they seem just as fast, and professional, atleast with my experiences. And finally, we just got 2' of snow, and I was pretty happy to see that our roads where plowed in a timely manner.

Overall I feel quite lucky to live in the US. But our healthcare system (look at the statics, and compare to other western countries) is not working, and if you don't have health, do other things like education really matter?

[andy mac]

From here in the UK it's this that confuses most. Here, it's all quite simple. We have a government-run, taxpayer funded National Health Service. It's open to all, basically at nil cost (some things like prescriptions carry nominal charges for some), and it's the usual mixture for a state-provided service of excellent, good, ok and crap.

But we Serotta-owning types also pay for private health insurance so that we can get the "extras" - like expensive scans, or non-urgent surgery - that you can get on the NHS but which you will have to wait for. So, unless we are in an accident or urgently rushed to hospital, we and our wives and children will not use the NHS.

But we still pay for for the NHS. Not for what we can get out oft it on an individual level but what we as a society get out of it. It is so ingrained in our culture (but evidently not in the US) that we regard it as part of what binds society together - what in fact makes us a society. It's the price of civilisation. No more, no less.

sounds like a kinda hybrid system like we have downunder.

forgive me for simplifying it but i believe australia, where i now reside, has a similar set up. everyone has basic 'care' then you are responsible for extras. there are tax breaks/incentives for taking on private insurance above and beyond the base level.

private insurance allows you a private room, the surgeon of your choice, elective operations and rebates for things like physio etc.

i love the usa for so many reasons, but i have to say the health systems in europe and australia where i have lived too, are better.

big picture, it's about health 'care' - not just industry that just so happens to deal in health. big difference...

:beer:

[jhcakilmer]

I've been a physician for a long time and infant mortality rates and the general state of out citizens health is not really an indicator of the quality of our health care, possibly of the way it is administered.
I've not seen or heard of any socialized system that actually works well if you are sick. Most are great if you are healthy and some are OK if you have an acute illness like and MI, but otherwise very lacking. I don't think you see many american physicians moving to Canada to practice but many are here in private practice as well as university settings.
I agree our system needs help but I don't think government is the answer. Part of the problem is we operate in an unrealistic environment where a physician is not expected to ever make a mistake and if one is made someone has to pay lots of money. Hospitials are also run by CEO's in the same manner as WalMart where customer satisfaction is the number one goal and when someone shows up in the E.D. demanding an MR or there lortab prescription and you don't provide it they complain and your satisfaction score drops along with your income. I remember when you could tell a patient something was inappropriate without reprecussions. If you truly want to socialize medicine we will have to get over the expectation that everyone gets instant cadillac care. Like Grant said if it isn't life threatening get to the back of the line and we haven't been tolerant of this concept thus far, especially when you factor in occasionally being wrong and that simple headache wound up being a tumor and you just waited 6 months for an MR and now it is unrescetable.
And as far as worring about our future young physician's taxes under government medicine they won't be so much. I work in the trenches everyday and I'm unwilling to do what I do with the responsibility I shoulder for one cent less than I currently make. Before anyone thinks I do nothing to help the poor or pay back for my good fortune let me explain how I'm paid. The E.D. where I work is fee for service, meaning we cover our salary and expenses from monies we collect for servicies rendered. Of our patient population about 25% does not pay for one reason of another, no insurance or they have exceeded their medicade benefits for emergency care, whatever the case we see them for free. I nor my partners have ever complained it is just the cost of doing business and if they need help you try and provide it. The only thing I do different for non paying patients is try and provide the cheapest meds possible to do the job if they are coming out of their pocket.
Last but not least if you want to see U.S. government medicine look at the VA, possibly the worst system on the planet.

Infant mortality, and general health are not good indicators of healthcare quality? what? So what are good indicators???? I'm really interested!!

Also wouldn't it be nice if all you had to do is worry about treating patients, and not the bottom line? Plus what statistics do you have on the VA system, or medicaid/medicare? What I've read is that the VA system runs reasonably efficienctly, and their cost/patient is less than the rest of the medical community. I don't mind being wrong, but I just like to see evidence.

Doesn't it seem plausible that we are stretched in to many directions....VA, medicare, medicaid, etc? Wouldn't a single universal healthcare system streamline things?

[Tom]

Not much of substance to add except for wild opinions here... and a challenge to some.

I happened to be working in data processing at a health insurance company when I met who became my wife. She was the head of internal audit. After that her career has included being one of six who did a PPO startup when a western NY company wanted to penetrate the local market. Then she has held finance positions in an HMO, managed care analyst for a private hospital, business manager for a full service medical lab and is now a contractor with DOH, looking at the restructure of state long term care. She's seen it from every side.

Trust me when I tell you our system is very, very broken.

Single payer? The hospital had an entire staff devoted to deciphering payer contracts, rates and rules. That's called unnecessary overhead, people.

You think you don't pay for the uninsured? Very funny. What do you think happens when the reimbursement rate (actual money that shows up for a bill) is something about 60%?

HSAs... I got one this year because in the long run it works out for me but I can afford to pay a lot up front. Not many people can say that.

Rationing? You got the money, you get your ration. You don't have the do re mi... pound salt.

And a challenge... to those that say "Well, open your free clinic..." Why don't you? Why don't you put your money where your mouth is?

Thought not. Until you do, you got nothing to say.

[davids]

*Please tell me that you are not using the public school system as an example of a government "success story"....you know the system where the results are inversely proportionate to the amount of our money that is spent on it....
* The Postal Service operates as a quasi-business and is self supporting by user fees...
* City municipals also operate as quasi businesses....but they are local-not federal-functions anyway...EXCEPT for Washington, DC...and everybody knows how the infrastructure of that cesspool is crumbling under federal management/oversight....

any other shining examples of liberal success that I can take apart?
Vitriolic rhetoric. No room for dialog here...

[Elefantino]

I smile at the irony and yet cringe at the reality when I read threads like this. Because otherwise (seemingly) rational minds can conjure up their own political bogeymen (on both sides) when discussing an issue that, at its core, is one of simple humanity.

No one should be without health care, period. What is the counter-argument to that … that some people should not receive health care? What, because they're a) poor, b) overweight, c) smokers, d) illegal immigrants, e) Republicans or f) Democrats? We should "let them die"?

When did a culture of caring, the culture that brought us out of the depression (spare me the anti-FDR screeds), the culture that begat the Peace Corps, suddenly turn into a culture of hate, where if you disagree you are vilified not for your beliefs but for something more base — for who you are?

C'mon, folks.

If you don't think our health care system is broken and you have not lived in another country where "socialized medicine" works, then I'm at a loss to understand your bona fides.

WWJD? And, for the record, he was a liberal.

[MilanoTom]

Infant mortality, and general health are not good indicators of healthcare quality? what? So what are good indicators???? I'm really interested!!

Also wouldn't it be nice if all you had to do is worry about treating patients, and not the bottom line? Plus what statistics do you have on the VA system, or medicaid/medicare? What I've read is that the VA system runs reasonably efficienctly, and their cost/patient is less than the rest of the medical community. I don't mind being wrong, but I just like to see evidence.

Doesn't it seem plausible that we are stretched in to many directions....VA, medicare, medicaid, etc? Wouldn't a single universal healthcare system streamline things?

Infant mortality and general health would only be good indicators of healthcare quality if adjusted for (in the case of infant mortality) the number of high-risk (as in young teen and drug addict/alcoholic) pregnancies and unhealthy lifestyles (as in obesity, to name one) in this country. I saw Mike Huckabee speak at a conference a couple of months ago, and while I'm far from being a Republican, he made a very good point. We as a population generally expect our health care system to fix us when we're sick, but we ignore the things we need to do to keep from getting sick.

One can't judge the quality of our healthcare system without paying some regard to what it has to work with. Far too many Americans have become undisciplined, irresponsible and/or lazy, and if staying or getting healthy requires the least bit of real effort, it's just too much bother.

A universal healthcare system sounds nice, but in practice, I doubt it would work. It wouldn't be long until the more wealthier among us, dissatisfied with wait times, started seeking care outside the usual channels, fragmenting the system and making it less than universal. At that point, the remainder would end up with whatever system the govenment had provided (and since the financially better-off didn't use it anyway, they'd make some level of effort to reduce funding levels). Then, the disparities that already exist in healthcare would be magnified even more.

I'm not making a value judgement, just making a reasonably educated guess.

Regards.
Tom

[Fixed]

bro maybe churchs should have an admission fee ..last rites $15000
cheers
compassion for those with less( sick and poor ) is a lesson we need to learn as
taught by the perfect teacher .
cheers imho

[Elefantino]

A universal healthcare system sounds nice, but in practice, I doubt it would work. It wouldn't be long until the more wealthier among us, dissatisfied with wait times, started seeking care outside the usual channels, fragmenting the system and making it less than universal. At that point, the remainder would end up with whatever system the govenment had provided (and since the financially better-off didn't use it anyway, they'd make some level of effort to reduce funding levels). Then, the disparities that already exist in healthcare would be magnified even more.
I think you're right, Tom, in that there would be a two- or multi-tiered system wherein the wealthy would receive better healthcare than the non-wealthy. But that's what we have now. I think any system wherein those who cannot afford health care (based on earnings minumums, if you like) still receiving some level of care is better than having one-fifth of the nation uninsured.

The Brits have a similar system and it works. Yes, there is inequity. But not abandonment.

I also would be willing to pay higher taxes to ensure health care for all. I have not sent and do not send my children to public schools, but I understand that paying property taxes affords an education to everyone who wishes it.

[Skrawny]

We actually have the best medicine in the world; we just are not very good at figuring out when to use it and when not to use it!

NB: I said the best "medicine" NOT the best "healthcare"

-s

[davids]

I smile at the irony and yet cringe at the reality when I read threads like this. Because otherwise (seemingly) rational minds can conjure up their own political bogeymen (on both sides) when discussing an issue that, at its core, is one of simple humanity.

No one should be without health care, period. What is the counter-argument to that … that some people should not receive health care? What, because they're a) poor, b) overweight, c) smokers, d) illegal immigrants, e) Republicans or f) Democrats? We should "let them die"?

When did a culture of caring, the culture that brought us out of the depression (spare me the anti-FDR screeds), the culture that begat the Peace Corps, suddenly turn into a culture of hate, where if you disagree you are vilified not for your beliefs but for something more base — for who you are?

C'mon, folks.

If you don't think our health care system is broken and you have not lived in another country where "socialized medicine" works, then I'm at a loss to understand your bona fides.

WWJD? And, for the record, he was a liberal.Their rhetoric says "personal freedom is value #1" and "government is evil". All the other conclusions follow from there. It appeals to people's most selfish impulses, and is served up cloaked in a combination of high-minded principle and righteous crusading.

It breaks my heart to see how successful it's been.

(And as best as I understand it, Jesus was way more than a liberal. He was a radical.)

[Len J]

Canada has plenty to spend, and is around what most countries are spending,
around 10% of GDP which is up from around 8% a few years ago.

The REAL issue is prevention, and then the management of aging.
Haven't I read about how much money is spent on the final few months of life?
All governments need to invest in the health of their people. A healthy population
should be the goal for every country. Anyone think that's where we're headed?
It's not like the money can't be spent when people are sick, but isn't the point
to prevent a lot of people from getting real sick in the first place?
So far, the medical establishment is not set up for this, and I think that's the
main point of Michael Moore's film.

-g

Bingo.

The biggest problem that needs to be addressed before we go to a coverage system that includes everyone is to accept that health care is a limited resource. Sure, politicially it will be decided how limited, but, it is still a limited resource.

Something like 50 to 60% of all health care dollars spent in the US are in the last 6 months of life. We need to make hard decisions about wether this money is spent effectivly or should be reallocated to cover basic health care for all. These are incredibly tough decisions and if it's my wife or loved one, I am going to hate some of the decisions, but they have to be confronted. Someone has to choose who gets what care and to what degree. The current disconnect is that everone unconsciously believes they and theirs is entitled to all care at all times..... no society can afford that.

We already make hard decisions about allocating l,imited organs for transplant..........we can do this.

But we need a dialog on exactly what care will be offered to everyone, and what care will be withheld and when.

The devil is in the details and this is one detail that has the potential to derail any solution.

Len

[J.Greene]

Very thoughtful post Len. What you describe is the issue we face.

JG


Bingo.

The biggest problem that needs to be addressed before we go to a coverage system that includes everyone is to accept that health care is a limited resource. Sure, politicially it will be decided how limited, but, it is still a limited resource.

Something like 50 to 60% of all health care dollars spent in the US are in the last 6 months of life. We need to make hard decisions about wether this money is spent effectivly or should be reallocated to cover basic health care for all. These are incredibly tough decisions and if it's my wife or loved one, I am going to hate some of the decisions, but they have to be confronted. Someone has to choose who gets what care and to what degree. The current disconnect is that everone unconsciously believes they and theirs is entitled to all care at all times..... no society can afford that.

We already make hard decisions about allocating l,imited organs for transplant..........we can do this.

But we need a dialog on exactly what care will be offered to everyone, and what care will be withheld and when.

The devil is in the details and this is one detail that has the potential to derail any solution.

Len

[Skrawny]

Something like 50 to 60% of all health care dollars spent in the US are in the last 6 months of life.

Therein lies the rub. People are sick before they die.

I challange anyone to tell me which is the first day of the last six months of someone's life.

The only person who is close to making an informed decision on that matter is the physician and, as Malcolm aptly stated, he/she is frequently trumped out of the decision.

-s

[malcolm]

Jhackilmer, those statistics are just that statistics many factors influence those numbers. Access to health care general wellness many other things. Our care is the best on the planet, but I still see many term mothers show up in the E.D. crowning without any pre natal care. Numerous drug addicts pregnant with no prenatal care. I suspect many cases in other countries go unreported and they may have less of the above than we do. There are many other factors if you think of them. So our care is quality but many social issues skew the numbers without changing anything to do with the actual quality of medicine. Costa Rica has a higher literacy rate than us. Do you think they are better educated as a whole?
The VA, I can't speak to the whole system, but I've worked and trained in and around it in three different states. The examples I can give you are anecdotal. Our VA has recently stopped most acute medical care and is a long term facility and psych hospital. The big regional VA is 50 miles away, they send all there sick patients to us acute or otherwise, many of whom I have to treat in the hall because we are already overburdened. The VA up the road always seems full and can't take them, yet it is OK for me to see them in the hallway. Then if one of our surgeons operates on one the VA doesn't want to pay because the big VA is up the street. Another problem in the VA is access. My wife is a radiologist at a big well known university hospital that also does radiology for the VA, and should a vet be treated there the care is excellent. Same surgeons, internists from the university hosp., except more resident driven. The problem is wading through the VA system to get there. The needless red tape is ridiculous. Just one example, from the E.D. if I want to transfer a patient to them it takes at least three phone calls and several faxes before I even get to talk to a doctor and usually not even then just a clerk will call back and say sorry full. I think most higher level care is at least OK, but it may take forever to access it and the gate keeper level VA care is atrocious. Our vets deserve much better.
Cost/loss shifting. Of course it takes place. Ever wonder why blue cross is so expensive. It just occurs above my/head. The 25% I mentioned come directly from my pocket. I don't control reimbursment except to make sure I document as well as possible to recover every penny I can from the people t that do pay.
I agree that the system is in deep trouble, but I don't think the government is the answer although I'm not sure what is. Physicians are certainly part of the problem although not in the manner the public thinks. Very few physicians are scam artists and medicare skimmers. We gave up control of health care. Physicians can no longer be as involved because the way reimbursment is you have to see considerably more volume to make the same relative income of 15-20 ago, that doesn't leave much time for hosp. mgt.. The CEO's that now run hospitals are trained in the same fashion as those that run nabisco or walmart. There is probably no other industry where the people that make the decisions and run the show have less understanding of there actual product than hospitals/medicine. Patient satisfaction concerns and I do think you should strive for patient satisfaction are destroying emergency medicine. The push to satisfy and have people seen quickly is changing they way we practice and it isn't doctor driven. If you choose to get your non emergent care in the ED then you know what you may just have to wait. Now we are forced to move everyone to a room as quickly as possible and this utilizes all our resources then when someone sick arrives they are difficult to treat because all the beds are full and all the nurses are taking care of the non emergent. Then the well complain they weren't treated quickly enough or didn't get there narcotics in a timely fashion and our satisfaction score drops and my nurses don't get raises and ultimately quit they we start over with a group of new grad nurses to start the cycle again.
Sorry for the rant but I'm working nights. I do think the system needs help. I have over a decade in the highest volume E.D. in my state and I'm done. I'm tired of people that have no idea of what we do changing my job or telling me how to better do it and thus far most changes have been for the worse. I love emergency medicine and have spent countless hours and holidays away from my family doing it and yes it would be nice just to worry about patient care and I hope for the young ones coming up that will happen

[Len J]

Therein lies the rub. People are sick before they die.

I challange anyone to tell me which is the first day of the last six months of someone's life.

The only person who is close to making an informed decision on that matter is the physician and, as Malcolm aptly stated, he/she is frequently trumped out of the decision.

-s

It's not an all or nothing proposition.

Extreme example was given further down the thread.

29 YO healthy with a hot appendix clearly you do the appendectomy

90 YO with hypertension, late stage alzheimers, bad heart, advanced prostate cancer adn a dead leg........do you do a 9 hour surgery, a 1 hour operation to remove his leg or just provide hospice care?


If the only thing we did was acknowledge that people are dying earlier and promote death with dignity, how many resources would be freed up to provide basic care for all?

As I said, tough decision.

The other thing that is being missed in this discussion is that this whole thing might not cost another dime......it might be nothing more than a reallocation of what we are currently spending......Innefficiencies in the current system include:

1.) Over allocation of resources to the dying
2.) Overallocation of resources to emergency care that should be provided by basic (cheaper) care
3.) Overallocation of resources to later stage care when primary basic care would be cheaper.......people waiting to get care until advanced stage in the ER, vs getting care up-front.
4.) Overallocation of resources to drug company profits through the inability to negotiate buying prices for gov't sponsored plans.
5.) Overallocation of resources to administration of so many plans. Go into a hospital billing department and see how many resources are consumed filling out many different submittal forms, getting a myraid of different types of pre-approvals from different plans...etc...etc. And don't forget the various profit takers within the current system. The Social Security Administration is one of the most efficient organizations in the world (as measured by a cost as a % of spending). May not like them but they are good at what they do.


And that's just a start.

Elefantino raised the important point..........how do we feel about the fact that 20 to 30% of the people in this country have no basic health care? The rest is just details.

Len

[davids]

Therein lies the rub. People are sick before they die.

I challange anyone to tell me which is the first day of the last six months of someone's life.

The only person who is close to making an informed decision on that matter is the physician and, as Malcolm aptly stated, he/she is frequently trumped out of the decision.

-s
Rather than think in terms of "the last six months", it's probably better to think of this as "end of life" care, and I think that's often easier to discern.

I've only had one personal experience with decision-making around this issue, and in the case of my father, my mother made the decision to suspend care when my dad's doctor (and I, for that matter) still wanted to "fight". It was a wrenching decision for all of us, but she was right. Once all but palliative care was withdrawn, he died in three days.

It was instructive for me to see that, in my fear and grief, I wasn't making a good decision. I hope that the next time I face this situation, I'll be able to analyze more clearly, and face death less fearfully.

p.s. The bill for the last month of my father's life, including two surgeries and four weeks of ICU and step-down care, was about $180,000. My mom paid a single $10 co-payment.

It's not an all or nothing proposition.

Extreme example was given further down the thread.

29 YO healthy with a hot appendix clearly you do the appendectomy

90 YO with hypertension, late stage alzheimers, bad heart, advanced prostate cancer adn a dead leg........do you do a 9 hour surgery, a 1 hour operation to remove his leg or just provide hospice care?

...

Elefantino raised the important point..........how do we feel about the fact that 20 to 30% of the people in this country have no basic health care? The rest is just details.

Len
Another example from my experience: My 95-year-old Grandmother began having heart arrhythmia. So, she was taken by ambulance to a local hospital and had a pacemaker installed. My dad: "Wow. I am so glad we caught that!" Two years later, when she was slowly dying in a level-3 nursing home, but her heart kept her from the rest she craved, my dad again: "You know, that pacemaker wasn't really such a good idea. We shouldn't have advised her to go through all that stress..."

Live and learn, huh?

And how do I feel about the fact that 20-30% have no health care? Like it's an effen moral abomination.

[malcolm]

One other thing before I quit. Publishing physician numbers or surgical outcomes. Be very careful. These are just numbers and like all statistics need to be viewed by someone that knows how to interpret them. I know a particular surgeon that may well be the most skilled person I've ever met and while I've not seen his numbers I suspect they are mediocre and likely becuse he operates on the sickest people in a tertiary university hospital setting. Is it fair to compare him to someone that dose elective procedures all day or just lap choles?

[Len J]

Rather than think in terms of "the last six months", it's probably better to think of this as "end of life" care, and I think that's often easier to discern.

I've only had one personal experience with decision-making around this issue, and in the case of my father, my mother made the decision to suspend care when my dad's doctor (and I, for that matter) still wanted to "fight". It was a wrenching decision for all of us, but she was right. Once all but palliative care was withdrawn, he died in three days.

It was instructive for me to see that, in my fear and grief, I wasn't making a good decision. I hope that the next time I face this situation, I'll be able to analyze more clearly, and face death less fearfully.

p.s. The bill for the last month of my father's life, including two surgeries and four weeks of ICU and step-down care, was about $180,000. My mom paid a single $10 co-payment.

Tough stuff.

I have a neicee who was born with a heart ailment that restricted oxygen to her brain for most of her gestation and the first 6 months of her life. At 6 months old, she was given a heart transplant. She is now 16 years old. She is also mentally around 6 or 7.

She is a wonderful child, we love her dearly. Were she born today, there is no way she would have been given the heart.

Having spent some time as a board representative on a hospitals transplant committee......I was staggered at the tough decisions that these incredibly empathetic people did on a daily basis. It showed me what is possible.

Len


W

[Pedro72]

We are not a wealthy nation anymore. Very little is produces in the US now. We have 9 trillion in national debt. Most people have thousands of dollars in credit card debt. I don't have answers to the healthcare crisis in this country but I just wanted to point this out.... Bottom line is we cannot afford to impliment a national health care system. How are we gonna pay for it?

[1centaur]

So, sounds like we have a consensus :)

Lower cost overall (which by necessity means lower cost to upper income people who buy health insurance and pay higher taxes now), since it's really for-profit middlemen who ramp up the cost of care.

A two-tier system of basic care paid for through a wonderfully efficient single-payer system and then the good stuff paid for privately.

Sounds good to me.

[sspielman]

I just wanted to point this out.... Bottom line is we cannot afford to impliment a national health care system. How are we gonna pay for it?

...And THAT is the reality that people are unable or unwilling to understand.....

[avalonracing]

We are not a wealthy nation anymore. Very little is produces in the US now. We have 9 trillion in national debt. Most people have thousands of dollars in credit card debt. I don't have answers to the healthcare crisis in this country but I just wanted to point this out.... Bottom line is we cannot afford to impliment a national health care system. How are we gonna pay for it?

Yeah, we don't have a trillion to spare. Unless it is to get the WMD's... uh, no, wait... I mean, liberate a nation... no wait... that's not it either... ummm, fight them over there before they come here. Yeah that's it! (for now). Yeah that's what we could do with money that could have been put into health care, education, science and humanity.

[sspielman]

Yeah, we don't have a trillion to spare. Unless it is to get the WMD's... uh, no, wait... I mean, liberate a nation... no wait... that's not it either... ummm, fight them over there before they come here. Yeah that's it! (for now). Yeah that's what we could do with money that could have been put into health care, education, science and humanity.


Duuude...It is arguments like these that are bad enough for people on one side or the other of the political spectrum....but as a populist/libertarian, I have to deal with BOTH sides driving me nuts!

[saab2000]

Isn't it ironic that a morbidly obese man makes a film about the health problems in society?

[sg8357]

[/QUOTE=Pedro72]
I just wanted to point this out.... Bottom line is we cannot afford to impliment a national health care system. How are we gonna pay for it? [/Quote]

...And THAT is the reality that people are unable or unwilling to understand.....

Aren't we already paying for it ?, the money you pay your insurance co.
The money your employer doesn't pay you, so he can give it to the insurance co.
Some of your existing Federal taxes for medicare/caid/s-chip etc.
State & Local taxes for the local charity hospital etc.

Scott G.
former medical billing software guy

[avalonracing]

Isn't it ironic that a morbidly obese man makes a film about the health problems in society?

Hey, give him a break... He's very hungry :D

[Len J]

We are not a wealthy nation anymore. Very little is produces in the US now. We have 9 trillion in national debt. Most people have thousands of dollars in credit card debt. I don't have answers to the healthcare crisis in this country but I just wanted to point this out.... Bottom line is we cannot afford to impliment a national health care system. How are we gonna pay for it?

See my post above......doesn't have to cost an additional dollar.

Len

[malcolm]

End of life care is an area where we don't do well at all. I'm confronted daily with the patient that is bed bound and hasn't had a lucid thought in years with feeding tubes and urinary catheters yet the family wants every thing done. Many people don't have the ability to decide when enough is enough and don't really understand when you explain the situation to them. They just think you don't want to help for what ever reason. It is unfair to the family and patient to place the entire burden of these decisions on them yet that is basically what happens and we subsequently let the old and chronically ill die one cell at a time over the course of many years. We've become so adept at treating simple infections and complications that these no longer end life. Remember pneumonia the elderly and debilitateds friend, not so much any more. We have created a situation where we say one thing then our actions say the opposite. End of life care is an example, amongst ourselves enough is enough and most physicians feel they know about where enough is then when we speak with the family and they clearly don't see things the way you do probably from lack of understanding you just say OK and do everything. Emergency care is the same way at meetings and in our literature overcrowding and overburdening is the hot topic and we talk about people that do have choices (family doctors, free or community clinics) yet still seek their non emergent care in the ED, because it is more convenient or they won't have a co-pay, yet when confronted with these people you can't tell them not to come because they will complain or write a letter and the hospital will not tolerate that. Part of an emergency physicians role is to educate people how to access care and that has been completely taken away from us. I see people every day that have 30-60 ED visits per year that are insured yet have no definable illness and have never been admitted to the hospital. What do you think that does to the cost of your premium? Our volume is over 80k visits/year and I know by name 10 or more patients I see a day before I even look at their chart and I'm not talking about people that I see frequently because they have some dred disease.
I think another issue facing medicine is 24 hour media/news. This has created an environment where everyone is paranoid over health concerns. Does anyone remember Bill Clinton on TV after his heart attack or angioplasty. He said his initial test were negative but he knew something was wrong and went back and they did a heart cath and found disease. This translates to the general public that you must have a heart cath and nothing else is good enough. I see 20 year olds that want an angiogram because they have chest pain nevermind the fact they have no risk factors. All the odd and statistically insignificant cases make the national news now. They guy that woke up normal after an eight year coma. They child that had a cold and died within minutes from meningitis so now every parent on the planet rushes their child to the ED as soon as they develop fever and now not only do they have a cold they have been exposed to every pathogen known to man. Constant media/pseudo news has robbed us of common sense.
I agree with much of what is said here and really hope positive changes can be made, but I don't think the road we are on is the one. I'm alo sorry for these rants it is really unlike me, but I'm in the middle of a seven day stretch of nights and haven't slept much. If anyone has a sharp instrument and would like to put me out of my and your misery I'll email my address.

[jhcakilmer]

I think this has been a reasonably productive thread, I am surprised by some, and have a new, slightly modified understanding of the issue that face socialized medicine in the US.

I do feel very strongly that we should at least have a basic primary care system that is provided to everyone. I think this is not only fair, but would greatly reduce the cost of the over system, and allow everyone the opportunity to at least have a basic health check. PCP are a relative bargain in our medical system, so I think this system could be established without much extra funding.

The majority of medical issues are relatively minor (if detected early), and can be effectively managed by the PC community!

I also would like to disclose that my family and I have been on medicaid for the past 5 years (during graduate and medical school) and I have felt extremely blessed. The system has worked very well for us. We have received top notch care, with all of the resources afforded to other patients. We had two children during this time, and our youngest has had many issues. He was hospitalized at 7 days old, and from my perspective he received the highest quality of care.

Thanks for all your input!!

[Your_Friend!]

Friends!


I Am _Glad_

To See That

Many Of You

Show Such

Thoughtfullness

And Compassion!


To Others Of You:

I Feel Sorry

That Your

"Let Them Pull

Themselves Up

By Their Own

Bootstraps"

Tough_Guy Mentalities

Appear So Hateful to

Everyone But

Yourselves!


This Is _Not_

The Wild West!




Love,
Y_F!

[davids]

http://www.myjgd.com/jgdi/Penguins_LovePenguins-lilpenguinshop-1515397.gif

[MilanoTom]

The below "A Day in the Life of Joe Conservative" (there's no by-line, unfortunately) is for all the previous posters who complained about "socialized medicine," Marxism, not wanting our country to turn into a "nanny state," and whatever else they parrot from their favorite talk radio right-wing shill. All I can add is that I wish I had written it myself:

Joe gets up at 6 a.m. and fills his coffeepot with water to prepare his morning coffee. The water is clean and good because some tree-hugging liberal fought for minimum water-quality standards. With his first swallow of water, he takes his daily medication. His medications are safe to take because some stupid commie liberal fought to ensure their safety and that they work as advertised.

All but $10 of his medications are paid for by his employer's medical plan because some liberal union workers fought their employers for paid medical insurance -- now Joe gets it, too.

He prepares his morning breakfast: bacon and eggs. Joe's bacon is safe to eat because some girly-man liberal fought for laws to regulate the meat packing industry.

In the morning shower, Joe reaches for his shampoo. His bottle is properly labeled with each ingredient and its amount in the total contents because some crybaby liberal fought for his right to know what he was putting on his body and how much it contained.

Joe dresses, walks outside and takes a deep breath. The air he breathes is clean because some environmentalist wacko liberal fought for the laws to stop industries from polluting our air.

He walks on the government-provided sidewalk to the subway station for his government-subsidized ride to work. It saves him considerable money in parking and transportation fees because some fancy-pants liberal fought for affordable public transportation, which gives everyone the opportunity to be a contributor.

Joe begins his work day. He has a good job with excellent pay, medical benefits, retirement, paid holidays and vacation because some lazy liberal union members fought and died for these working standards. Joe's employer pays these standards because Joe's employer doesn't want his employees to call the union.

If Joe is hurt on the job or becomes unemployed, he'll get a worker compensation or unemployment checks because some stupid liberal didn't think he should lose his home because of his temporary misfortune.

It is noontime and Joe needs to make a bank deposit so he can pay some bills. Joe's deposit is federally insured by the FSLIC because some godless liberal wanted to protect Joe's money from unscrupulous bankers who ruined the banking system before the Great Depression.

Joe has to pay his Fannie Mae-underwritten mortgage and his below-market federal student loan because some elitist liberal decided that Joe and the government would be better off if he was educated and earned more money over his lifetime. Joe also forgets that in addition to his federally subsidized student loans, he attended a state funded university.

Joe is home from work. He plans to visit his father this evening at his farm home in the country. He gets in his car for the drive. His car is among the safest in the world because some America-hating liberal fought for car safety standards to go along with the taxpayer funded roads.

He arrives at his boyhood home. His was the third generation to live in the house financed by Farmers' Home Administration because bankers didn't want to make rural loans.

The house didn't have electricity until some big-government liberal stuck his nose where it didn't belong and demanded rural electrification.

He is happy to see his father, who is now retired. His father lives on Social Security and a union pension because some wine-drinking, cheese-eating liberal made sure he could take care of himself so Joe wouldn't have to.

Joe gets back in his car for the ride home, and turns on a radio talk show. The radio host keeps saying that liberals are bad and conservatives are good. He doesn't mention that the beloved conservatives have fought against every protection and benefit Joe enjoys throughout his day. Joe agrees: "We don't need those big-government liberals ruining our lives! After all, I'm a self-made man who believes everyone should take care of themselves, just like I have."

[sspielman]

The below "A Day in the Life of Joe Conservative" (there's no by-line, unfortunately) is for all the previous posters who complained about "socialized medicine," Marxism, not wanting our country to turn into a "nanny state," and whatever else they parrot from their favorite talk radio right-wing shill. All I can add is that I wish I had written it myself:

Joe gets up at 6 a.m. and fills his coffeepot with water to prepare his morning coffee. The water is clean and good because some tree-hugging liberal fought for minimum water-quality standards. With his first swallow of water, he takes his daily medication. His medications are safe to take because some stupid commie liberal fought to ensure their safety and that they work as advertised.

All but $10 of his medications are paid for by his employer's medical plan because some liberal union workers fought their employers for paid medical insurance -- now Joe gets it, too.

He prepares his morning breakfast: bacon and eggs. Joe's bacon is safe to eat because some girly-man liberal fought for laws to regulate the meat packing industry.

In the morning shower, Joe reaches for his shampoo. His bottle is properly labeled with each ingredient and its amount in the total contents because some crybaby liberal fought for his right to know what he was putting on his body and how much it contained.

Joe dresses, walks outside and takes a deep breath. The air he breathes is clean because some environmentalist wacko liberal fought for the laws to stop industries from polluting our air.

He walks on the government-provided sidewalk to the subway station for his government-subsidized ride to work. It saves him considerable money in parking and transportation fees because some fancy-pants liberal fought for affordable public transportation, which gives everyone the opportunity to be a contributor.

Joe begins his work day. He has a good job with excellent pay, medical benefits, retirement, paid holidays and vacation because some lazy liberal union members fought and died for these working standards. Joe's employer pays these standards because Joe's employer doesn't want his employees to call the union.

If Joe is hurt on the job or becomes unemployed, he'll get a worker compensation or unemployment checks because some stupid liberal didn't think he should lose his home because of his temporary misfortune.

It is noontime and Joe needs to make a bank deposit so he can pay some bills. Joe's deposit is federally insured by the FSLIC because some godless liberal wanted to protect Joe's money from unscrupulous bankers who ruined the banking system before the Great Depression.

Joe has to pay his Fannie Mae-underwritten mortgage and his below-market federal student loan because some elitist liberal decided that Joe and the government would be better off if he was educated and earned more money over his lifetime. Joe also forgets that in addition to his federally subsidized student loans, he attended a state funded university.

Joe is home from work. He plans to visit his father this evening at his farm home in the country. He gets in his car for the drive. His car is among the safest in the world because some America-hating liberal fought for car safety standards to go along with the taxpayer funded roads.

He arrives at his boyhood home. His was the third generation to live in the house financed by Farmers' Home Administration because bankers didn't want to make rural loans.

The house didn't have electricity until some big-government liberal stuck his nose where it didn't belong and demanded rural electrification.

He is happy to see his father, who is now retired. His father lives on Social Security and a union pension because some wine-drinking, cheese-eating liberal made sure he could take care of himself so Joe wouldn't have to.

Joe gets back in his car for the ride home, and turns on a radio talk show. The radio host keeps saying that liberals are bad and conservatives are good. He doesn't mention that the beloved conservatives have fought against every protection and benefit Joe enjoys throughout his day. Joe agrees: "We don't need those big-government liberals ruining our lives! After all, I'm a self-made man who believes everyone should take care of themselves, just like I have."

ummmm..nevermind....

[cadence231]

Friends!


I Am _Glad_

To See That

Many Of You

Show Such

Thoughtfullness

And Compassion!


To Others Of You:

I Feel Sorry

That Your

"Let Them Pull

Themselves Up

By Their Own

Bootstraps"

Tough_Guy Mentalities

Appear So Hateful to

Everyone But

Yourselves!


This Is _Not_

The Wild West!




Love,
Y_F!

http://i103.photobucket.com/albums/m131/cadence220/insp_logic_preview.jpg

[avalonracing]

I assume that the liberals are resorting to fictional fantasy these days because they can't find any facts in their favour?

I think that his point was well made. Surely his story is supported as well as any story featured on the Faux News Network™

[andy mac]

Infant mortality and general health would only be good indicators of healthcare quality if adjusted for (in the case of infant mortality) the number of high-risk (as in young teen and drug addict/alcoholic) pregnancies and unhealthy lifestyles (as in obesity, to name one) in this country.
Regards.
Tom

you think that's only relevant to the usa? um, time for one of these.

http://travel.state.gov/passport/forms/ds11/ds11_842.html

[thwart]

Faux News Network™

Gets it. Atmo.

[jimcav]

How do we pay for it??
...And THAT is the reality that people are unable or unwilling to understand.....

we let folks in DC decide what is worth spending money on and what is not.
maybe someday we will hold some of the spenders accountable, but in many places over there now, fuel, weapons etc disappear from "secure" areas as soon as delivered. a corrupt society of warlords takes a huge cut of the cash and goods. In our health system, a huge portion of cash directed toward healthcare goes toward the system delivering the healthcare-which is not efficient, no more so than the salaries of the health care executives are justified.

I am personally amazed my gov't sees it as sensible to pay me a salary, and agree to pay me a pension the rest of my life, and give me (and my entire family) health care, when they could contract what i do to someone else at close to the same amount, and not pay them a pension or health benefit. I am grateful they do, but it makes no sense.

all you have to do is remember how the big sandwhich fast food advertising dried up after super-size me, and now all you see is the latest giant burger war of commercials--every chain has some massive double chedder bacon bomb or whatever they are pushing. a growing ageing, population getting fatter and fatter. Just today i learned they put fiberglass in chewing tobacco to cut the cheek and gum a little so nicotine is more potently absorbed in to the system.

no easy answer, but personal lifestyle needs to be a big part of the remedy--not simply who/how paying for the consequenses of our lifestyle happens.

[1centaur]

Just to be clear, the vitriol and personal attacks, the dismissal and the condescension, is HEAVILY weighted both in volume and in nature against the conservatives on this board. The conservatives tend to attack ideas and the liberals tend to attack the people who view the world a different way.

I am not saying this is universal (on either side) but anybody who doubts the balance should go through this entire thread and score each post as conservative, liberal or neither, and then rank the attacks on posters (their characters, their intellect, their compassion) on a scale of 1-10, 10 being pretty rude (yes, Faux News Network is equivalent to Commie New Network so it counts) and 0 being comments on arguments not on personal or presumed group qualities. Compare the scores. It won't be close.

However, I do agree with many here that the overall quality and tone of this thread has been much better than some others that divide upon idealogical lines. I credit prior moderator closures with some of that, but the sincerity and thoughtfulness of opinion helped too. The depressing thing for me is that the whole country will be going through the same debate over the next five years just to get where this thread got in a few days. We can all look forward to a raft of statistics and cost estimates that are wildly confusing and most likely wrong before the final decisions are made on the basis of political power, not consensus thinking. That's Washington for ya.

For the record, I believe in personal freedom and low taxes and earning what you have, and I believe that some form of preventative universal health care is better for our society than the current form of universal health care (emergency based) and it COULD be cheaper overall for a better outcome but nobody really knows.

[norman neville]

The conservatives tend to attack ideas and the liberals tend to attack the people who view the world a different way.



now THATS funny.

[Fixed]

liberals ... conservatives
which one wants this?
love and peace and goodwill towards all men
:beer: cheers imho happy holidays bro

[avalonracing]

I am not saying this is universal (on either side) but anybody who doubts the balance should go through this entire thread and score each post as conservative, liberal or neither, and then rank the attacks on posters (their characters, their intellect, their compassion) on a scale of 1-10, 10 being pretty rude (yes, Faux News Network is equivalent to Commie New Network so it counts) and 0 being comments on arguments not on personal or presumed group qualities. Compare the scores. It won't be close.


I would like to see it in an easy to understand graph, please. As an American citizen I only have time for graphs, sound bites and rhetoric.

[Skrawny]

I would like to see it in an easy to understand graph, please. As an American citizen I only have time for graphs, sound bites and rhetoric.

I think they covered it in an issue of USA Today that I got for free at an hotel. Maybe I still have it around here somewhere...

... let's see . . . um, it had a little cartoon doctor with a stethosocpe . . . it was just under the half-page article about Paris Hilton . . .
-s

[3chordwonder]

Agreed - unintended humor I'm sure, but gold nonetheless.

[sspielman]

Just to be clear, the vitriol and personal attacks, the dismissal and the condescension, is HEAVILY weighted both in volume and in nature against the conservatives on this board. The conservatives tend to attack ideas and the liberals tend to attack the people who view the world a different way.

I am not saying this is universal (on either side) but anybody who doubts the balance should go through this entire thread and score each post as conservative, liberal or neither, and then rank the attacks on posters (their characters, their intellect, their compassion) on a scale of 1-10, 10 being pretty rude (yes, Faux News Network is equivalent to Commie New Network so it counts) and 0 being comments on arguments not on personal or presumed group qualities. Compare the scores. It won't be close.

However, I do agree with many here that the overall quality and tone of this thread has been much better than some others that divide upon idealogical lines. I credit prior moderator closures with some of that, but the sincerity and thoughtfulness of opinion helped too. The depressing thing for me is that the whole country will be going through the same debate over the next five years just to get where this thread got in a few days. We can all look forward to a raft of statistics and cost estimates that are wildly confusing and most likely wrong before the final decisions are made on the basis of political power, not consensus thinking. That's Washington for ya.

For the record, I believe in personal freedom and low taxes and earning what you have, and I believe that some form of preventative universal health care is better for our society than the current form of universal health care (emergency based) and it COULD be cheaper overall for a better outcome but nobody really knows.

Thank you for another thoughtful post. I am agree with you on the nature of conservative vs. liberal attacks...and I think that it is a function of the items each seeks to control.....Conservatives seem morbidly concerned with controlling the behaviour of people...while the liberals are equally concerned at controlling the thoughts. This thread exhibits that abundantly. People more aligned with one philosophy or the other are offended by different aspects....a conservative (or libertarian!) feels that it is morally wrong for the government to take more of his dollars away to pay for somebody else's health care when he could spend those dollars on that of his own family...while a liberal feels that it is one's moral duty to pay whatever is asked by the government to make these programs possible...and will get offended by any opposition because it is a difference in THOUGHT and must be controlled....

[davids]

...a conservative (or libertarian!) feels that it is morally wrong for the government to take more of his dollars away to pay for somebody else's health care when he could spend those dollars on that of his own family...while a liberal feels that it is one's moral duty to pay whatever is asked by the government to make these programs possible...and will get offended by any opposition because it is a difference in THOUGHT and must be controlled....This analysis reflects a bias towards a particular philosophy.

You start by saying that both positions are "moral", but only (dis)credit the liberal position by characterizing it as thought control. Yet your statement could easily be re-phrased to paint conservatives or libertarians as the ones offended by incorrect thought.

Is your criticism of the liberal position based on the position itself, or on your perception that only the liberals see issues as one of thought-control?

...personally, I could care less what a person thinks. I only care about their actions, which can also be moral or immoral.

[jhcakilmer]

stated generalities are rarely accurate, and usually exposed innate biases (ironically tautological)........ ;)

[sspielman]

...there you go again.....

[jhcakilmer]

...there you go again.....

?

[Pete Serotta]

feel free to start another thread on the topic......