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  1. #41  
    I hear you. However, I consider health to be a special issue. If someone deos not save for retirement, they deserve to die in poverty.

    But, when they are shivering in the cold, eating dog food, and they get sick, we still treat them when they go to the emergency room. My point is, we consider medical treatment to be a fundamental human right, but implement it in a horrible wasteful way.

    SS is a bad example of hand-holding. It comes from people contributing to the fund in their earning years. It's like forced saving for retirement. If we didn't do that and people frittered all their money on beer and cigarettes and riverboat gambling (like many blue-collar workers I know personally), imagine how badly off they'll be. Clerly, even with SS, their retirement won't be pretty.

    I have wandered all over the place in my posting. Back to the topic.. Universal health care is happening in US, just for old (Medicare) and poor (Medicaid) people. Both these are run by the Govt. but the services are offered by private doctors, hospitals, pharmacies. No one in our parent's or grandparents generation is asked to wait in long lines at a govt. hospital for care. Somehow, everyone gets their panties in a bunch when this is discussed for all.

    I understand the objections if we wouldn't allow augmentation by private insurance, but what if we allowed the rich to buy their own extra coverage?
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  2. #42  
    That's it. I have the last word on this !! (or maybe the west coast hasn't woken up yet :-)
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    Aloke
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  3. #43  
    Quote Originally Posted by NRG
    Here we go with the what 'ifs' again.
    Because I'm conservatively oriented, NRG, I do not automatically harbor the rabid resentment toward liberals as most liberals do toward conservatives, so I bear you no personal ill-will. However, you will be most disappointed when a government-controlled socialized medical plan becomes the rule of the land. Ask any physician what Uncle Sam has done for Medicare/medicaid, and you will unleash a wellspring of negativity and exasperation. Simply put, they can't manage health care for the elderly and poor already- just wait until the whole country has it inflicted upon them. If you have private insurance enjoy it (and hopefully you won't need it often) now. Just wait and see what the quality of your physician care as well as the second-rate quality of young minds entering medicine are like when the entreprenurial aspect of pay-for-service medicine is a figment of days gone by.
  4. #44  
    Quote Originally Posted by aprasad
    No one complains of service provided by Medicare, which controls costs very well.

    My choice would be to extend Medicare to all and allow the rich to add to the coverage through private insurance.
    No one complains? How about the physicians in this country. Those that are able either refuse to accept it or limit the number of patients they see with it because they loose money caring for medicare patients in most cases. Do I need to elaborate? Think: cost of education, cost of malpractice insurance. Work hours of 50 to 80 hours a week. Working nights , weekens and holidays. The constant interference caused by outrageous efforts that have to be made to keep incompliance with government regulations. Office staff. Unreimbursed procedures and treatments. Shall I go on? Don't take my word for it- ask a doctor you know.
  5. #45  
    Quote Originally Posted by Gasmeister
    Ask any physician what Uncle Sam has done for Medicare/medicaid, and you will unleash a wellspring of negativity and exasperation. Simply put, they can't manage health care for the elderly and poor already- just wait until the whole country has it inflicted upon them. If you have private insurance enjoy it (and hopefully you won't need it often) now. Just wait and see what the quality of your physician care as well as the second-rate quality of young minds entering medicine are like when the entreprenurial aspect of pay-for-service medicine is a figment of days gone by.
    I have talked to a couple of doctors about this. They seem to complain that in order to keep health costs down, they have very limited discretion on what kind of procedures that you can have done. I will give you a real life example: my son hurt his wrist at school in P.E. I took him to the doctor and they did an initial screening. The doctor didnt think it was broken but just to make sure, he ordered an xray. I had to leave that facility and travel to another hospital to have it done because of the limitation on our coverage. The Dr. was just as frustrated as I was. But the question is "who" is making that policy decision and why? Is it strictly because its easier to keep track of the costs if everyone goes to the same place to get an xray or is there a concern that Dr's will order procedures that may not be truly necessary? Im not sure...but I can tell you that I am glad I had some coverage, even if it was inconvenient.

    I see your point about the concerns of Dr's, but balance all of that against the working poor not having any medical coverage.

    There are some costs avoided by having health care for everyone...like preventive medicine/procedures. Many of those 'checkup' visits catch things before time compounds the danger/health/future costs on a system already taxed (i.e. people ending up having to use Emergency facilities for things that started out as routine and preventable like an infection.)

    As far as the argument that a national system will lower the overall quality of healthcare (especially for the people who can afford it) how about the idea of national healthcare with a supplement (in various amounts) available to those that can afford it.

    For example:

    National healthcare covers everyone.

    Secondary insurance is available to those that can afford and want that extra level of care/personal attention/procedure/etc.

    Isn't there a win/win there?
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  6. #46  
    Quote Originally Posted by Gasmeister
    No one complains? How about the physicians in this country. Those that are able either refuse to accept it or limit the number of patients they see with it because they loose money caring for medicare patients in most cases. Do I need to elaborate? Think: cost of education, cost of malpractice insurance. Work hours of 50 to 80 hours a week. Working nights , weekens and holidays. The constant interference caused by outrageous efforts that have to be made to keep incompliance with government regulations. Office staff. Unreimbursed procedures and treatments. Shall I go on? Don't take my word for it- ask a doctor you know.
    I have to admit: I haven't discussed this with doctors at any great length. Why don't doctors who don't like dealing with Medicare drop out and not see Medicare patients? My guess is that they do make money on them, albeit less than they do with patients on private plans. If more and more doctors drop Medicare, Medicare will have to raise payments.
    Clearly, such universal plan (which is augmented by private plans for those who can afford it) will have to come with significant tort reform and paperwork reduction. The overhead costs for such universal coverage is less in the countries that have it, from what I understand.
    --
    Aloke
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  7. #47  
    Timely (for this discussion) article in Newsweek:
    http://www.msnbc.msn.com/id/11434805/site/newsweek/

    "America's health-care "system" looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they're ill, they get—as the cliche goes—"the best health care in the world." The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

    To slip from the winners' circle into the losers' ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That's your lot if you lose your corporate job and can't afford a health policy of your own."
    ....
    --
    Aloke
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  8. #48  
    Quote Originally Posted by hoovs
    Great point. Along those same lines, we need to consider that when we make these comparisons many times we're comparing largely homogeneous European populations with the United States which is decidedly not homogeneous. When talking about health care we need to factor in that there are many different diseases and hereditary illnesses as well as cultural attitudes and practices that are brought into the US population from other countries.
    Eh, have you ever been to europe?
    Saying that it is more homogeneous than the US is a very bold statement..
    I'd say That the UK alone has more defersity than the US, let alone the rest of Europe..
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  9. #49  
    Quote Originally Posted by cardio
    I would rather have a system where I control the care I receive not one where a gov't agency decides my care regardless of my income level. If a person wants to pay for the care in Britain or Canada and the gov't says no, can they pay and receive the care? I do not know so I ask? If they can, does that not go against the policy of social medicine?
    Sure in theory I dont see why not, there is no law in making private medical care illegal..
    In reality people dont have the £££ to pay for it..
    Just like many people in the US dont have the $$$ to pay medical care themselfs.. And private medical insurance has limits and regulations too..

    This is a sad case for this person, but it doesnt mean that the system is flawed.
    It isnt perfect, but to make a perfect system you'd pay a fortune for it and that would make it imperfect again
    Reality is you if you pay a certain amount for medicare you cannot expect unlimited treatment.
    At least with the NHS people get the service for 'free' (paid from their taxes) which means everybody is covered.
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  10. #50  
    Quote Originally Posted by aprasad
    I understand the objections if we wouldn't allow augmentation by private insurance, but what if we allowed the rich to buy their own extra coverage?
    How could anybody expect it to be illegal for somebody to pay extra for extra treatment?

    In Switzerland, health insurances are private. However, the basic set of medical services (covering everything medically necessary and useful) is mandatory for everybody. It costs about 400 US$ per month for a family of four (2 adults, 2 children), or about US$ 150 per month for an adult. There is a competition between health insurances to offer the mandatory set of medical services (including medication) at the best price. In case somebody cannot afford the mandatory health insurance, the government pays a part or all of it, so 100% of the population is covered.

    Those who feel like it (and can afford it) get additional coverage (e.g. for single room and the like).
    “Reality is that which, when you stop believing in it, doesn't go away.” (Philip K. ****)
  11. #51  
    I am trying to avoid the Pavlovian scare that the Repubs/conservatives/rightwingers get by (falsely) labelling something as "Socialist". Medicare should be extended to all.

    I'd like to see the neocons try to abolish Medicare :-) if they hate Govt. involvement with anything and everything that's non-military ...
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  12. #52  
    Quote Originally Posted by aprasad
    I am trying to avoid the Pavlovian scare that the Repubs/conservatives/rightwingers get by (falsely) labelling something as "Socialist". Medicare should be extended to all.
    Ah you noticed that.. I guess they have an allergy for anything 'social'
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  13. #53  
    Quote Originally Posted by aprasad
    Medicare should be extended to all.

    I'd like to see the neocons try to abolish Medicare :-) if they hate Govt. involvement with anything and everything that's non-military ...
    Perhaps this is the solution, but any nationalized healthcare plan won't be as inclusive or "generous" as medicare. There's no way we could afford that. But be warned. This year alone, the federal government has given me a 6% PAY CUT in the form of reduced reimbursement for Medicare part b. Just wait until such a system exists for all payors; you'll be hard pressed to get a doctor to come to work for more than 40 hours/week or even consider going the extra mile, because along with nationalized healthcare will come massive malpractice reform (you can't have the mass of patients suing government employess right and left, which is what physicians and hospital administrators will become) and the incentive of the free market will be lost. Another gem in the crown of America will have been shattered.
  14. #54  
    Are you arguing against malpractice reform? I thought you'd welcome that ...

    If Medicare is such a bad deal, why not stop accepting Medicare patients and accept only those with private insurance? If enough doctors did that, the Govt will have to increase Medicare payments ... That's free market.

    What's your solution for extending health care coverage to ALL? Do you accept that as the goal of any civilized society?

    PS: I value your input, having learned that you are in the medical profession.
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  15. #55  
    QUOTE=aprasad]Are you arguing against malpractice reform? I thought you'd welcome that ...

    Not at all.. I'm suggesting it will be an inevitable part of healthcare reform. What physician would want to take a 30 to 60% paycut and still pay today's ridiculous malpractice premiums. The insurance cartel will fight this tooth and nail, but it will have to be part of any overall solution.

    If Medicare is such a bad deal, why not stop accepting Medicare patients and accept only those with private insurance? If enough doctors did that, the Govt will have to increase Medicare payments ... That's free market.

    Some of those that can stop or restrict their Medicare patient populations do. For many of us this is neither possible or ethical, and despite what you may believe, read, or hear, the vast majority of docs are not in it for the money but for the ability to help people while engaging in an intellectually stimulating profession. I have no choice in my payor mix; a full 40% of my practice is either Medicaid or what is euphemistically called "private pay" which in reality is "no pay", being the part of society with no insurance at all. So, yes, in many ways a global coverage would be a good thing in concept. i just have littel faith in the US government's ability to administer it in a way that is fair to providers.

    What's your solution for extending health care coverage to ALL? Do you accept that as the goal of any civilized society?

    Absolutely, but I am only forecasting that along with a universal coverage will come a dramatic and heretofore unrecognized change in the quality of care and the willingness of physicians to scarifice what they have traditionally in most specialties of medicine. I won't be missing my kids' ballgames, anniversary dinners, Christmas celebrations, etc. when I'm a government salaried healthcare worker.

    PS: I value your input, having learned that you are in the medical profession.[/QUOTE]
  16. #56  
    So, how would you extend universal health coverage to everyone?

    Do you think anything is broken and needs fixing?
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    #57  
    Quote Originally Posted by meyerweb
    It's an example, man. The POINT is that private health insurance companies make choices as to what drugs you can get paid for just like the British Government does. Some insurance companies will not longer cover drugs like Nexium because a similar drug, Prilosec, is available over the counter. Most insurance companies refuse to cover some of the new cancer treatments because they are "experimental."

    The POINT is that paying for health insurance doesn't guarantee you the right to whatever medical care you want. At best, it guarantees you the right to whatever health care the insurance company is willing to pay for. Just like the British system.

    If you don't like the British system because it makes your choices for you, and "rations" care, then you ought to be questioning our health insurance system, too. The only way YOU really get to choose exactly the health care you want is to pay for it out of your pocket. Any other way, and someone else is making at least some of those decisions for you.

    Get the point now?
    Skipped the first line did you. I said "while this may be true" which indicates I understand the point you are trying to make, however IMHO the example you use waters down the point. Comparing Viagra (for ED) to any cancer treatment (BTW viagra is also used in some cancer cocktails now) is not very accurate. You have the option to choose which insurance program to go with, you should review what the company covers and what they exclude and use that information to assist in your choice. When the gov't tells you what they cover and what they don't you do not have the choice. BIG difference.
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    #58  
    Quote Originally Posted by aprasad
    My health insurance routinely rejects drugs like Celebrex, even though I get stomach problems with other NSAIDS like Aleve and ibuprofen.
    Your provider should be able to get authorization once it is verified that NSAIDS show side effects (stomach problems)
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    #59  
    Quote Originally Posted by NRG
    Correct, a point I made earlier. Although, I was thinking more along the lines of heart meds and such, Cardio you are in drug sales, right?
    No not sales, provider
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    #60  
    Quote Originally Posted by Gasmeister
    No one complains? How about the physicians in this country. Those that are able either refuse to accept it or limit the number of patients they see with it because they loose money caring for medicare patients in most cases. Do I need to elaborate? Think: cost of education, cost of malpractice insurance. Work hours of 50 to 80 hours a week. Working nights , weekens and holidays. The constant interference caused by outrageous efforts that have to be made to keep incompliance with government regulations. Office staff. Unreimbursed procedures and treatments. Shall I go on? Don't take my word for it- ask a doctor you know.
    Only a 50-80 hour week, where do I sign up.
    Be at the hospital at 7:00-7:30 to see the ER visits from last night, round on the patients in the ICU, see patients on the units, a procedure or two, get to the clinic by 10:00-10:30, see around 15-20 patients, review procedures that were done during the day, provide diagnositic information on those procedures, file all appropriate paperwork (do not even get me started on workers comp paperwork), complete insurance forms, return to hospital see the ER patients and the patients that were admitted during the day. Now I get to review the messages that came in to the office during the day. Go home kiss the kids that went to bed at 8:00 PM, prepare for a lecture that I have been asked to give to the community center. Oh and as a patient, I bet you would like for me to keep current on the latest medications, procedures and treatment options so now I need to review the journals. Next time you see your doc, give em a hug.
    "If It Weren't For The United States Military"
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