Universal Health Care

<div class='quotetop'>QUOTE(galaxee @ Aug 7 2007, 04:24 PM) [snapback]492007[/snapback]</div>

Out of curiosity, your experience was in a managed care (HMO, PPO, etc.) setting?

 

PPO, for both of us. no choice, that's what's offered to us so that's what we take.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 03:20 PM) [snapback]491999[/snapback]</div>

So, if I get cancer from all of the smog that is caused by pollution, I don't have a right to treatment unless I am rich enough?? If I contract bird flu from another person, or malaria, I don't have a right to live unless I can afford the treatment?? Healthcare is a right. Health is state of one's well being (and therefore can't be right). Education is a right. Wisdom is the state of one's knowledge of things (and therefore also can't be a right). So do you suggest that since health and wisdom aren't rights, that the means to acheive health (healthcare) and wisdom (education) are also not rights??

Your Founding fathers argument is useless in my opinion (especially considering that they believed that a right to own slaves was a part of a right to property), but you did mention right to life. Isn't healthcare in line of the right to Life??

And why with the crazy suggestions of Disneyland and McDonald's??? I don't think anyone mentioned those as rights, and to lump that with healthcare is quite demented.

So do you pay taxes?? Aren't taxes 'robbing' you of your work?? Do you feel any responsibility to the well being of society, to the education of all children, to the future of the environment??? I am earning my PhD in Environmental Engineering, and chances are that I will be compensated well. But I also have an obligation to make sure that others have the same chances I have had. I grew up in a middle class neighborhood, my parents grew up farmers; should I be destined to servitude unless my parents have the well being to buy me an education and keep me healthy??

I hope you know you are in the minority opinion to suggest that healthcare isn't a right.

 

<div class='quotetop'>QUOTE(galaxee @ Aug 7 2007, 04:35 PM) [snapback]492021[/snapback]</div>

The reason that I asked is because I think you are much more likely to see problems happen like the one you described when you are in a managed care setting. Your primary care physician acts as a "gatekeeper" and is sometime reluctant to refer you to a specialist because it actually costs them money.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 03:40 PM) [snapback]492029[/snapback]</div>

Yes, galaxee, you should have the money to afford private health insurance or directly afford the healthcare you need. If you don't have the money, then you got what your deserved! Or, we could have this system where the government pays you to get the heathcare you need, but by some magic stroke of 'market forces', the healthcare program you buy with government kickbacks won't act as gatekeeper.

 

<div class='quotetop'>QUOTE(MarkMN @ Aug 7 2007, 04:39 PM) [snapback]492028[/snapback]</div>

I don't mind being in the minority when I know that I am correct. Health care is not a right.

The real question you should be asking is can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is -- Yes, people can afford it. Where do you think the money is coming from right now to pay for it all ? Where does the government get its money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens' wealth, through taxation, deficit financing or the like.

It is sad, but some people can't afford medical care in the U.S. They are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off -- charity, not right. And such charity was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

But the fact is, you don't abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not you choose to call it a "right." To call it a "right" when the recipient did not earn it is merely changing the name, as it is charity nonetheless.

As with any good or service that is provided by some specific group, if you try to make its possession "by right", you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada.

 

<div class='quotetop'>QUOTE(Swanny1172 @ 2007 Aug 7, 01:55 PM) [snapback]492036[/snapback]</div>

If Canada's healthcare system has been 'destroyed', why are they listed 30th, and the US as 37th? Have you examined the political systems of all top 40 countries? Does political leaning have anything at all to do with where a country is ranked?

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 03:55 PM) [snapback]492036[/snapback]</div>

Healthcare is a right.

You need to get out of your McMansion more often. Most people couldn't afford a major surgery, treatment, or hospital stay if they needed it. Half of all personal bankruptcies are due to medical bills. Where do I think the money is coming to pay for it all?? The fact is that a lot of us in this country go without medical attention. Some of us don't need it, and some of us who do need it end up dieing because we can't afford the medical attention needed to keep us alive (or afford the diagnosis screenings to catch diseases in their earlier, treatable stages) or live with the pain and suffering. Those who do get medical attention pay their medical bills over years.

 

<div class='quotetop'>QUOTE(MarkMN @ Aug 7 2007, 05:23 PM) [snapback]492055[/snapback]</div>

Please show me some government document that says that health care is a right in the United States. Just because you say it is, does not make it so.

The Supreme Court has never recognized a constitutional basis for any welfare right, including the right to medical care. The Court recognizes that the concept of rights embodied in our legal system is the concept of liberty rights. Welfare rights are a product of later movements to expand the role of government beyond the original conception of its role. In our constitutional system, there is no requirement that the federal government provide health care. Health care entitlements, unlike fundamental rights like freedom of speech, have to be invented by legislators.

A right is a principle that specifies something which an individual should be free to have or do. A right is an entitlement, something you possess free and clear, something you can exercise without asking anyone else's permission. Because it is an entitlement, not a privilege or favor, we do not owe anyone else any gratitude for their recognition of our rights.

Health care does not grow on trees or fall from the sky. The assertion of a right to medical care does not guarantee that there is going to be any health care to distribute. Those of you that feel entitled to these rights demand, with air of moral righteousness, that everyone have access to this good. But a demand does not create anything. Health care has to be produced by someone, and paid for by someone. One of the major arguments offered by supporters of a right to health care is that health care is an essential need.

If I have such a right, some other person or group has the involuntary, unchosen obligation to provide it. I stress the word "involuntary." A right is an entitlement. If I have a right to medical care, then I am entitled to the time, the effort, the ability, the wealth, of whoever is going to be forced to provide that care. In other words, I own a piece of the taxpayers who subsidize me. I own a piece of the doctors who tend to me. The notion of a right to medical care goes far beyond any notion of charity. A doctor who waives his bill because I am indigent is offering a free gift; he retains his autonomy, and I owe him gratitude. But if I have a right to care, then he is merely giving me my due, and I owe him nothing.



<div class='quotetop'>QUOTE(hyo silver @ Aug 7 2007, 05:23 PM) [snapback]492054[/snapback]</div>

Thanks for making my point for me. Our healthcare system is ranked where it is due to government intervention and regulation. Before Medicare, Medicaid and the HMO bill, we had the greatest healthcare system in the world. The problems of our current system were caused by government. More government is not the solution. But we must oppose the expansion of government control in principle, by rejecting spurious claims of a "right" to health care, and insisting on our genuine rights to life, liberty, property, and the pursuit of happiness.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 04:58 PM) [snapback]492071[/snapback]</div>

I think your assertion is totally irrelevant .
The insurance industry has failed society.It is within the realm of government to rectify the problem.Its also economically feasible ,so lets get on with it.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 04:58 PM) [snapback]492071[/snapback]</div>

That is an interesting argument. You say that government involvement has caused our healthcare system to fall from #1 to #37 and that if we revert back completely to a free market system that we will go right back up to #1. (This is based on the WHO's ranking of world's health system).

However, have you noticed that all those countries ranked above the US have much more government involvement. Every western nation with a single-payer system of heathcare is ranked above us. I would take that to mean that MORE government intervention leads to better heathcare not LESS

Edit: (The countries ranked above us also pay less per person, about 1/2, and have longer life expectancy.)

Now I will wait for you and Dr. B to tell me the WHO's ranking is completely biased against the USA. B)

 

<div class='quotetop'>QUOTE(mojo @ Aug 7 2007, 06:31 PM) [snapback]492095[/snapback]</div>

Again, please show me something that says that healthcare is a right. Declaration of Independence? Nope. Constitution? Nope. Bill of Rights? Nope.

Government doesn't solve problems. It only creates new ones.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 04:40 PM) [snapback]492029[/snapback]</div>

so this is the way things should be? this is ideal? how does this type of thing do any good for our society whatsoever? forget the stress that we as individuals go through, and how we probably could have used a bit of counseling but (cough) couldn't afford it.

lost income due to unmanaged pain: many thousands over the year prior, which still involved minor pain.
lost taxes due to lost income: who knows.
potential income lost by employer: you know how much cut a tech gets out of the labor dollars billed?
total bills before insurance: i lost track a while ago, it seemed pointless to keep tabs after $50k...
insurance allowed amounts: more or less half that.
insurance payouts: that number minus the large percentage of our income that we paid out.

who loses:
-individuals
-employers (through lost productivity and later increased insurance costs)
-anyone who relies on people paying taxes
-insurance companies, who never lose, just recoup their costs in other ways. so they don't count.

who wins:
-doctors. sorta. nobody works for free, and yes we're providing them business. they have loans to pay off, etc. but to bill out $380 for a 10 minute consultation seems a bit absurd to me. $400something for the two-hour in-depth session, now that was worth the charge. we only paid about $110 of that but it was worth it, in comparison.
-hospitals. they gotta recoup the costs for all the deadbeats out there, so they don't really win either.


so some of us lose and some of us break even after losing from other aspects of this failing system. a system that harms the individual as such, for something that is well beyond their ability to control, is failing. i don't know enough about the system from an insider's POV, but i know how the average hard working middle class gets bent over...

 

<div class='quotetop'>QUOTE(galaxee @ Aug 7 2007, 08:08 PM) [snapback]492131[/snapback]</div>

Is this the way it should be? No.

Managed care, in my opinion, is one of the worst things that happened to the US healthcare system. HMO's and their bastard step-children, PPO's, are really a product of the government. The free-market had almost wiped them out. In 1970, the number of HMOs declined to less than 40. Paul Ellwood, often called the "father" of the HMO, began having discussions with what is today the U.S. Department of Health and Human Services that led to the enactment of the Health Maintenance Organization Act of 1973. This act had three main provisions:

1. Grants and loans were provided to plan, start, or expand an HMO
2. Certain state-imposed restrictions on HMOs were removed if the HMOs were federally certified
3. Employers with 25 or more employees were required to offer federally certified HMO options alongside indemnity upon request

My biggest problem with HMOs and PPOs is that they often shift some financial risk to providers through a system called capitation, where certain providers (usually primary care physicians) receive a fixed payment per member per month and in return provide certain services for free. Under this arrangement, the provider does not have the incentive to provide what they deem to be "unnecessary care", as he will not receive any additional payment for the care. Some plans offer a bonus to providers whose care meets a predetermined level of quality.

This is probably the exact trap you found yourself in. The PCP didn't want to refer you to a specialist, as it would have come out of his pocket. This is one of the primary complaints with managed care.

As I said, had the government not created the managed care market back in 1973, HMOs and PPOs would probably have ceased to exist, as the free market would have largely ignored them as it had for the previous five decades.



<div class='quotetop'>QUOTE(jhinton @ Aug 7 2007, 06:51 PM) [snapback]492098[/snapback]</div>

If our system is as bad as you say, then please explain to me why people from across the world continue to come to the US for their health care? That's right, there are people from the 36 countries that rank ahead of us in the WHO report who come to US to seek treatment in world-class hospitals like the Cleveland Clinic, the Mayo Clinic, Sloan-Kettering and Johns Hopkins.

Besides, if you want to see what "universal healthcare" would look like in the US, then you need to look no further than the Veteran's Administration. This is the agency that had an unexpected $1.3 billion shortfall in 2005 that put healthcare at risk. Last summer, they had a theft of 26.5 million veterans' personal data in what was the government's largest security breach. And, to top it all off, they awarded $3.8 million in bonuses to senior officials who were responsible for the agency's budget problems.

 

<div class='quotetop'>QUOTE(Swanny1172 @ Aug 7 2007, 08:29 PM) [snapback]492136[/snapback]</div>

Very well summarized. As a physician I would welcome free market forces into medicine and let me compete for your health care dollars the same way its done in every other marketplace.

I would favor several small changes that would probably have dramatic effect on our health care system:

1. change the tax laws to credit the individual for purchasing their own policies to cover what they want covered - stop state enforced mandates.
2. change medical malpractice to no-fault
3. allow insurance companies to compete across state lines and offer a wide variety of policies that are flexible and allow the individual to purchase the coverage they want to buy.

 

<div class='quotetop'>QUOTE(mojo @ Aug 7 2007, 06:31 PM) [snapback]492095[/snapback]</div>

completely wrong - the equation that was established for the insurance company by the government doomed it to fail. fix the equation - allow individuals to purchase their own health insurance policies directly from insurance companies (any insurance company, from any state) and let the individual claim the tax deduction. take the decision as to health insurance policy purchasing away from the employer.

and wrong again, it is not economically feasible - prove that statement. where is the govt going to get that money from?? they are already running a HUGE deficit, and there are tens of TRILLIONS of dollars of UNFUNDED liabilities they have in front of them already.

here is a compromise - let the State of Wisconsin which is on the cusp on enacting socialized universal care for all its citizens be the experiment. give them a few years and we will watch what happens. their initial plan already costs more than the state collects in taxes - not a good sign.

 

<div class='quotetop'>QUOTE(dbermanmd @ Aug 8 2007, 08:26 AM) [snapback]492321[/snapback]</div>

It WON'T be free. Why do you keep saying that? The flow of the money will change, but we still pay for it. Instead of insurance companies controlling the revenue stream (and milking out their huge cut), the government will, or at least a portion of it. There should still be co-pays (IMO) to deter abuse of the system. Doctors are not going to be paid like blue collar workers, that's just an insane worry. They'll probably have government protection to cap malpractice. The Mayo is visited by VERY WEALTHY people outside of the US and that example has NOTHING to do with the discussion.
BTW: My parents spent a large amount of money on my brother (who DID have good coverage) sending him to the Mayo when he was dying of cancer. In the end they couldn't help either and it was a big waste.

We have to get employers out of the business of providing insurance, its killing American competitiveness. Individuals cannot be trusted to carry proper health insurance. It's like auto insurance. If it was optional, only the wealthy would carry it. Poor people would go without, leaving a mess of litigation, hit and runs, etc, etc. This is what is happening in healthcare. Those who can't afford (Since coverage is a privelage, not a right) go without. And guess what? They still go to the emergency room, since they have no choice, and we ALL pay for it indirectly already in the form of higher costs at the hospital and increased rates. With a single payer system, we avoid that problem, we avoid spending millions on legal battles over denied claims and other insurance battles that are currently taking place, we get to negotiate drug costs better as a whole, instead of as individuals. We don't need to file complex paperwork any time we start or leave a job. Living cost during times of unemployment will be much easier for people to handle without the $1000+ cost of COBRA coverage. Hospitals don't have to track every insurance plan to know what is covered and what isn't. There are many good aspects of a one payer system, and some bad. Since we are late to the game, we can learn from the problems of other socialized systems and make it better.

 

<div class='quotetop'>QUOTE(Darwood @ Aug 8 2007, 09:58 AM) [snapback]492329[/snapback]</div>

yes and no

who will deterimine:
1. my salary and pay raises if any
2. who will pay my malpractice insurance
3. who will pay my staff and practice expenses
4. who will pay for my electronic medical records
5. who will pay me for night call and weekends
6. who will pay me for medical testing - recertification, etc
7. who will contribute to my retirement plan
8. who will pay my staff


and you make it sound like a govt run health care will be efficient and paperless - you are funny. I still like my compromise - let the State of Wisconsin run with it for a few years and lets see what happens.

 

<div class='quotetop'>QUOTE(dbermanmd @ Aug 8 2007, 09:34 AM) [snapback]492361[/snapback]</div>

Who pays for all of that it now? I don't see why any of the above will change. The hospitals and clinics should run just as they do now. But instead of sending claims all over the place to get payments from multple insurance companies, and then sending follow up bils to the patients for uncovered services, they send them to one place.

(1 state is not universal, they will still need to take out of network and deal with all the extra crap from multiple payers.) I agree that 1 state attempting this will have major problems.

What I want to know is what % of the money collected by the insurance companies actually make it through to the doctors like you, the nurses, etc. that actually do the work? 75%? more? less? Insurance companies have a monopolized cash cow here that takes AWAY from the money that should go to the doctors, hospitals, etc.

 

<div class='quotetop'>QUOTE(Darwood @ Aug 8 2007, 10:40 AM) [snapback]492363[/snapback]</div>

You still need to answer my question as to who determines physician salaries, etc.

And if you think one state will have problems, why not all 50??