Health Care Reform Gearing Up - Page 4

This doesn't make any sense at all.

Actually, other countries have come here and examined the VA's system to model or improve their own nationalized systems.

Yeah, but that's the VA...not the shining example of privatization that the right wing is holding up.

MediaOracle, the US has always had to deal with being a melting pot. I would argue we are more homogenized now then ever in our history.

The main issue we face politically, imo, is that it has gotten too easy to manipulate the uniformed or partially informed to shape agenda. If we could do more to inform people of the true pros and cons of topics such as this, we would be in a much better place. But, as of now, true journalism is at a real low so little effort is being made to truly inform and educate. Now you get AP stories that seem more like editorials then true information pieces.

Indeed.

I'm just a big believer in universal healthcare and like to point out whenervr I can that we have a system in our own country already in place that is an incredible blueprint.

Right. I hear all these horror stories from people about it, regardless, but considering that they have the biggest fucking healthcare burden to bear out there thanks to our current and past war efforts, the amount of homeless vets who still receive care, et cetera, they deserve more slack than they get. Not that this is any excuse for the conditions at, say, Walter Reed and so forth like we discovered a couple of years ago, but someone shouldn't be pissing and moaning about having to wait a few hours for a regular prescription.

One day people will learn that Walter Reed is NOT a VA hospital. One day.

Oops, my mistake. Carry on.

haha, wasn't really picking on you actually. What's funny is that people do use Walter Reed as an example of the VA not being good, but the irony is that it's an Army hospital not a VA one.

The critics of the VA know absolutely nothing about it, that's the funny (or sad) thing about it.

Why anyone would want a third party, like an insurance company, involved at all when it comes to one's health, is beyond me.

When you get sick you should be able to go to the hospital and get 100% free treatment no matter how serious a disease or length of time it lasts.

Now if you want better food, single room, faster treatment time (for some illness) then you can choose to pay a privately run hospital if you can afford it.

Your country should be able to figure it out.

Some of us already have that option, with private insurance. I think the problem is the ones that have it are not taking into consideration those that don't, and some might be doing that but they're afraid to change the one they have (which they might like).

My private health insurance is great, and I pay very little for it. But if I lost my job I'd be screwed. I guess some people don't want to consider the option of long unemployment or not being able to get a job at a large corporation with great benefits.

BTW - What is being proposed there will be a third party.

Exactly. NO ONE should have to be afraid of losing their job or having enough savings in the bank to afford possible treatment. It should be a birth given right to ANYONE, rich or poor.

And when I get sick I don't see public health care as a third party, cause the only people I deal with are the doctors in the hospital. It's not like they give you a bill and then you'll have to sign papers and forms to get a refund from the government. You don't see any of those things. You walk in, you get treated, and you go home. And it doesn't matter if it's a cut finger or a 1 year treatment of cancer with everything that's involved with that.

That's pretty much it for me with my private insurance. Most of the time you are asked to confirm your insurance information (in case it's changed) and the only annoyance (which is kind of minor) is that in my plan I always have to go to my primary care physician to get referred to a specialist.

But with a good health insurance, it's mostly painless for most routine stuff.

May I ask what you do for a living? Whatever it is what makes you feel like you own a portion of my life? Shouldn't I be given your services as birth given right? What makes your profession so special that I should have to pay you for your time/education/expertise? You are basically saying that you control my life because I should be forced to give my time freely to help you because of the profession I have chosen.

This is the thinking that Americans opposed to universal healthcare find horrifying. The fact that the state or another person owns anyone else and has a claim to their time/life is ridiculous.

And the even bigger problem with the American legislation is that they have seen the loopholes in European systems and have actively tried to close private hospital options down.

I actually would not be opposed to universal healthcare if there was the ability to own, run and/or seek treatment in a private hospital. I, like many of my colleagues, would simply opt right out of the public arena and begin care in private hospitals. However, American legislation has sought to make this illegal on both the provider and patient ends. Simple, unadulterated government intrusion into the private contracts of individuals.

Are you serious? I mean if this is an honest to God popular held opinion, then I understand why you'll never get a proper functioning system in the U.S.

No one fucking owns me, what are you talking about? If I don't like what I get for free at the public hospitals I have every right to visit a private hospital and pay for the treatment there.

I really don't think you have the faintest clue as to how these systems function elsewhere around the globe.

And what has my career to do with anything? I work as a graphic designer if you must know.

I'm going to preface this by saying that I found this over at Salon.com, so take that as you will. Anyway, thought some of the people here might be interested in reading it, since it's related to the discussion in this thread.

http://www.salon.com/news/feature/20...06/healthcare/

I am dead serious. I invested quite a bit of time and money in my degree and the returns on that degree are significantly reduced under a universal healthcare option.

So called free, universal or single payer healthcare drives up demand. My supply that I charge for is time. My supply becomes quickly used up as people with no disincentive to come in for treatment of minor problems, i.e. a cut finger, take up time that could be allocated to someone with a more serious malady. Increased utilization naturally calls for cost reduction through either cutting of fees or rationing of care.

I am therefore working twice as hard for what is now the same amount or even less in compensation. You have just laid claim to a portion of my life and are making a claim of ownership on me and my abilities because you believe healthcare is a birth given right.

Case in point the profession of Pediatric Orthopedist in the United States. There are so few MD's taking on the PedOrtho specialty because the clientele is almost exclusively Medicaid(our current poor people's insurance) patients. The reimbursement for the work and education investment is not a very good ROI and so the specialist profession is dwindling.

Case in point elderly patients under Medicare who pay absolutely no out of pocket expense have no disincentive to go to the doctor so everyday of the week their schedules revolve around which specialist they are visiting every day of the month. Utilization goes up, cost to the single payer goes up and therefore fees are slashed or costs are reigned in via rationing.

Extrapolate that across the board for the entire nation and you begin to see the problem opponents have with the idea.

So you don't get the sense that part of the problem in the US is that there are just too many people to service?

We may be more homogenized, but that doesn't mean we are getting along all that well.

I agree with you on this one. When a person on this board says he didn't watch the "Obama hour" in preference for reality television, it appears also to indicate the problem in America -- people not pay attention to these matters, listening only to what the pundits tell them, and then the media playing into this by not properly covering matters. Where are the debate shows? Where are the meetings where people can voice their opinions like sane people and not shout over and interrupt others with chanting? The media is having far too much fun sensationalizing this and creating Crank Cycles (love Stewart for that insight!). It's disgusting.

No, I don't think the problem is of scalability. We have more people than many countries, but we also have a bigger tax base and more wealth to draw from. You also make a point of the EU being separate countries, but we do function under a federated system, however I think it's better to pool resources on this on a national level rather than at the state level.

So no, I don't think that's the main problem.

I don't think you understand US culture very much btw.

Gee, it sure would suck to have to work harder at your job which you consciously trained for so that you could help people. That would be a fucking catastrophe.

Good points sir, My main fear is the same as yours, if the ROI is not very good we might just see a decline of some people going into medical school, then you'll get a decline in education and talent.

It's kind of simple, why work your ass off spending damn near a decade in school, working long and exhausting hours and be paid shit for it? Yes is he providing a great service helping people, but man, we all have bills to pay and I'm sure most of his are student loans.

I don't see how this would affect doctor pay. A bigger problem when it comes to that is the malpractice insurance and the like, not the "threat" of a public health system.

I'm not sure what you mean here -- how do I not understand it? I've spoken to many conservatives who desire small government, and they at the same time in some way indicate being distrustful of the people around them. They are also the same people who think everyone is responsible for him or her self, that societal factors like economic oppression do not dictate who a person is or what a person does. Thus they argue if a person cannot afford health care, that's their own fault because they are lazy and not working hard enough to earn it -- so why should they pay for lazy people. That seems to be rather common in a very vocal segment of the right wing of American culture.

No, the concept of "not trusting" government I believe is far more ingrained (and old) in US culture and you see aspects of it on the left and on the right. You see the "anti big government" conservatives (who only pay lip service to it) and the libertarians who can often be fanatical about it. But you also see "liberals" be against ideas like national IDs, health records, surveillance and other privacy related areas that don't want and trust the government with that much power.

You kind of provided a caricaturization of that concept of not trusting the government, but if you analyze it a bit further you see it goes beyond a single political ideology, and that while it can be bad in some instances in others it is good and positive cultural value. I don't think it's unique to Americans, but I do think it is cultural. You can tell, because other countries can be more ceremonial, and even reverential to government figures (and monarchic relics) which you don't really see much here.

That's what I meant.

First, let me urge all of the people posting in this thread to go and read this one over at Something Awful It's a long thread, but totally worth it. There are horror stories about the US system and golden stories about the Canadian system and other universal systems galore. If you can read that entire thread and still come away opposing universal health care, there's no hope for you.

I mean it. READ THAT GODDAMN THREAD.

Sometimes SA temporarily cuts off the ability to view threads for non-registered users, so try back in a few days if you can't see the thread.

Second, a couple of weeks ago I had a chance to talk to a fellow parent (Let's call him Ron) from my kid's pre-school who lived in Canada for the first 30 years of his life. While he had criticisms of the system, he still felt it was basically good. Ron has four brothers and sisters in law who are all practicing physicians in Canada. None of them want to see the Canadioan system changed. They are all well paid, work only 40 hours per week*, and get paid no matter how many patients they see.

*The 40 hours per week thing was eye-opening, especially in light of arguments made here that the system will be swamped if we get universal coverage. Here's his sister-in-laws's typical day:

-Strolls into work about with an armload of newspapers, magazines, and books. She'll need them to keep herself busy later.
-Starts seeing patients. Roughly 40% of her patients will cancel or no call/no show. There are no penalties for patients to do either, so it happens quite a bit.
-Due to the no shows, she will only do actual work for a little over 5 hours of her 8 hour shift. That's right, not only is she not swamped, she has time to fuck around on the net, read novels, and do crosswords.
-She gets paid a 6 figure salary no matter how many patients she sees. She doesn't deal with any billing paperwork at all.
-She and all of her brothers are aghast at suggestions that they should work harder or more hours. They didn't become doctors to work that hard!

Now, Ron meant this as a criticism of the system, in that there's no accountability for patients who no call/no show, and that doctors have little incentive to be anything other than competent, since they get paid either way. He believes that any new system in the US needs more accountability on both sides, and more incentives for doctors to be better, and I agree. But his story certainly seems to torpedo the notion that doctors under universal systems are so busy that they can't handle the load.

This is true, of course -- altho the liberals tend more to fear the consolidation of power into secrecy within small groups beyond the touch of representative democracy -- a la Bush and his executive orders -- while conservatives fear more the more massive, out in the open push into their lives -- from healthcare to gay marriage

It's like the liberals fear too few people have the power to change things, while the conservatives fear too many people changing things all around them.

...

The point still stands tho on the cultural war front that conservatives don't like the idea of having to take care of people they don't trust to do things they themselves believe they do -- such as work hard, live right, etc.

I think you've made some great points on why the US doesn't want the Canadian system. One of the issues with socialized medicinal systems is that there aren't enough doctors to see all patients. Especially if they're working 40 hours like you mentioned above. While this is great for the doctors it sucks for the patients waiting to see them. Personally, I don't think doctors should be dicking around on the net and reading papers at work. Thats for the rest of us damnit! In all seriousness, being a doctor is still a respected and revered profession and one of the reasons why is because they work so damn hard. Students at US Medical schools know they'll be busting their asses and working like dogs for at least the first 15 or so years of their careers. Hell, they have to just to make it through residency and to pay off student loans.

This may come as a massive shock to many on this board, but an issue a large percentage of Americans have is that they don't consider medical coverage a moral imperative or a given right. That may seem barbaric to outsiders but it is a very popular opinion ingrained in the American psyche.

Until something happens and they're stuck without coverage, paying massive bills. Then it's a travesty.

Also, I'm curious as to what percentage of that "large percentage" has medical coverage of some sort.

That's the part that maybe we don't have full agreement, I don't agree that it's (only or mainly) about secrecy within small groups. When people are against privacy encroaching measures, they just don't want government to have that much power over individuals. Many think it's because such information can be abused, but it's not out of some fear a secret cabal or the Illuminati is going to abuse that (I'm not saying these people are conspiracy theorists).

That's why the UK surveillance system is such anathema to people here in the US, left or right.

As for conservatives, that's the cultural value in the US of individualism and being able to take care of yourself and your won. They take it to the extreme of course, and in this case becomes selfish, but at its core that value does have its merits.

I think in this debate the problem is that those of us insured, that have no problems with our coverage are not thinking about those uninsured or those inadequately insured. Where the White House could do a better job communicating is in the area of better representation of the problem. Give a public face to the uninsured, and make sure as many people as possible understand that it could be them tomorrow.

I wonder tho...the idea of invasion of privacy...is it about the entirety of the government doing it? Or is it just a part of the government, the State, as depicted by a Big Brother type figurehead?

The interesting thing is, both sides fear fascism, just in different forms and on different issues. And both are about privacy, in some way -- the ability to choose to live one's own life as desired. For conservatives, they see this ability as being impinged upon when the government controls public programs and starts encroaching on traditional values. For liberals, they see this ability as being impinged upon when the government does not have enough programs in place to insure everyone has that ability.

So agreed -- both sides distrust government when they do not feel in control of it, and thus they fear those who do control it to some degree, meaning also the voters...but do conservatives fear individuals more regardless of who controls government because they see individuals as responsible for themselves and thus not controllable by the public mass? Because even when Bush was in power, conservatives would still fear and hate various groups around them.

Also -- I know conservatives who don't have insurance and still don't want the government in control of it even if it would help them to get insurance, because they don't trust the government.

I think it's a general mistrust of the government as a whole, and also politicians, bureaucrats, etc.

On the liberal side, that's not what I'm saying. An example of what I'm talking about is not distrusting the government because they don't provide enough programs as you say, but government accessing information that they feel should be private, misuse of that information or govt. with too much power abusing it.

[quote[So agreed -- both sides distrust government when they do not feel in control of it, and thus they fear those who do control it to some degree, meaning also the voters...[/quote]

I don't agree that most people extend this to the voters. You vote for somebody and ok, that's it, but they untrustworthy aspect of it is focused to government officials not the voters.

As for not trusting voters, I think that's a malady of both sides too. Just browse the presidential election thread, both sides would just accuse voters of being stupid, uniformed or prejudiced (of course, they are voting differently to me!).

I'm not sure about this but I think it's more about mistrusting a govt. that could become too powerful, not about individuals, even if your party is in power.

I guess I should fully disclose I work for the VA and my education is in Health Admin. This is in my wheelhouse, so I love discussing it.

The VA and civil DoD hospitals offer physician wages that are comparable to the private sector, plus they don't have to worry about doing billing, etc. and have panel size models so working more for less pay is not true. There are also a lot of methods in place to offer addition monetary and non-monetary incentives for hard to recruit positions. Plus there is the job security, it is extremely difficult to fire anyone due to the union factor, which would also keep wages up if we did nationalize.

There are a lot of quality and performance measures in place that are scutinized daily to make sure patients get the medical treatment they need and on a timely basis. Items like no shows, panel sizes, etc. are benchmarked. Panel sizes too big or small? You get jumped on. No-shows too high? You get jumped on. Patients not seen for certain types of appointments within a certain time frame? You get jumped on. It goes on and on. There are also a lot of outside review boards constantly keeping people on their toes as well. These measures are also updated and added to constantly so you have to keep putting a fresh eye things.

It is a bit micro-managy, but overall costs are lower, and patient satisfacion and overall quality is higher while dealing with a population of patients that has a lot more diverse health issues then the general population. This also done while dealing with all of the beauocratic rules and regulations of being a governement entity that make things so inefficient sometimes.

See, but I just got one story of one guy's extended family. I don't know if his sister-in-law was a GP or a specialist. I don't know if she's the only doctor in the practice/office. I don't know how typical her situation is. It's just anecdotal. And despite the perceived "abuses" that Ron saw in the system, he said he didn't want the Canadian system to change dramatically, just to build some accountability measures into it. And I don't have a problem with that, as I agree, doctors should be working and taking any overflow from surrounding offices instead of updating Facebook.

I can understand the argument that at the beginning, things will be crazy with people who could never afford health care before finally getting those long overdue checkups. After a year or two, I imagine things will settle down. The fact is that for almost everything else in our society, we have a public and private option.

Public Transportation: Take the bus if you're poor. Take a cab if you're rich.

Schools: Go to public school or Home School if you're poor or choose a private school if you're rich.

Books: Go to the library if you're poor, buy books at a book store if you're rich.

Drinking Water: Buy bottled water or use free tap water.

Health Care: Try your luck with private insurance, mortgage your house if you're uninsured or travel to an Asian country to get life saving surgery for the cost of one day's stay in a US hospital.

I honestly don't know what to say about opponents to bringing health care reform to the US other than to say you're ignorant and getting played big time. Until you experience health care in other countries, you'll really have no fucking idea how bad you're getting ripped off. It's obscene.

Ever see birds flying inside the closed halls of a hospital near people who just had brain surgery?

You might want to qualify that statement :-)

But I get your point of course ...

Yeah I might need to qualify it a little bit. My point still stands though. There are countries where you don't want to drink the tap water that have a more sensible health care system than ours though. That's pretty sad.

Honest question - how does the abortion angle come into play? I've already read a few articles stating that universal health care will include government covered abortion costs. Personally, that just makes sense to me as I consider it a medical issue. But at the public level, won't this make a lot of people go ape-shit? I think if a bill gets drafted that includes this it will become an even bigger lightning rod for fundies to rally against.

The Salon article posted earlier tackles that issue, but I'd like to read more about it. I think they said that money would come from your contributions not tax money, not clear on that ...

Not in the least. Nowhere did I say that US doctors would be broke and starving. Disingenuous comes into play when people don't stop to think about the decline in standard of living for US doctors under lowered fees due to cost control measures.

And when people are thinking about it and they take the line that doctors don't need to earn so much then very little room is left except to say that the person is displaying quite a bit of wealth envy and is trying to institute socialist systems wherein economic playing fields are leveled for all peoples. I believe this was once articulated as, "From each according to his abilities to each according to his needs."

While I do comprehend that there are legitimate disagreements on both sides please stop to take the time and walk through the logical progression of fears on opposition sides.

I oppose a single payer system but I also oppose the idea that insurance should cover routine office visits for check-ups and or commonly treated ailments. This is not what insurance is. Car insurance doesn't pay for my oil changes, new tires, new brakes or other similar maintenance items. It pays for catastrophic unforseen issues which is where health insurance should be restricted to.

1 point. Tap water isn't free, you pay a water bill to a water company unless you have a well.

All those things you mention aren't free. They're paid for from tax dollars of hard working Americans. The ones that AREN'T poor, since the poor don't pay taxes. Just like there is health care for the poor and elderly, which also happens to be paid for out of hard working American's paychecks.

Also, those countries you think are great. What do their taxes look like? How much does it cost to buy a pair of Levi jeans? What are their unemployment numbers? All of these things are related. Health care isn't free in other countries, it is paid for through some form of taxation or another.

ETA

The concern most Americans (the ones that work and or are out of the poverty bracket) have is about the COST of health care reform. Just look at the polls. We know that it is cheaper in other countries, no one doubts that. The concern is WHY is it so expensive here and what is going to address bringing those costs down. The OTHER concern is how to bring those without insurance into the mix without busting the bank or adopting an European style tax system, one that will hamper economic recovery or prosperity. As it stands now these concerns aren't being addressed in any of the bills being proposed and it leaves a sour taste in the majority of America (like I said, look at the polls).

Well we're not talking about cars right? And my oil change doesn't cost as much as it would cost to pay for my routine visit without insurance.

You're being a bit myopic, as the private insurance companies know here in the US, they want to pay for those routine visits so they don't have to pay for something else more expensive down the line. BTW I was reading that that was one of the good things about the US private system if you have insurance, that frequent visits are encouraged.

The insured and average citizen already pays for the poor's health care via already existing government programs or higher insurance premiums to pay hospitals who have extra costs from the indigenet care. When they say we spend $7400 per year per person on health care, it isn't just the people with insurance.

Cutting down the profit margin and encouring people to go for routine check-ups to catch and treat illnesses before they become catastrophic, which costs a whole lot more to take care of, and educating and encouraging people towards healthier lifestyles will cut costs.

A single payor or universal system also cuts a big chunk of administative costs by removing a lot of middle men from the equation. Reform will take quite a while to implement, so people in these jobs would have a lot of time to adjust and find new lines of work or retire out before the full transition. You won't see millions out of work overnight.

Short term you might see an increase in costs as things are implemented, but long term there would be massive savings of close to a trillion dollars annually before inflation. Taxes might go up, but insurance premiums, co-pays, etc. should go down.

Just to clarify:

We do NOT neccesarily have a tax based health care system over here. At least not in Germany. There is a whole variety of different systems but I´ll stick to the one I know.This is painted in veeeery broad strokes mind you. These technicalities are rather difficult for me to explain, so bear with me.

It basicly works like this: If you have a job, you and your employer both pay a certain amount (14.5%) of your income to health insurance. (Unless you consider that a tax...). But at the end of the day from all the money paid there is something like a pool of money created that pretty much is the money stock for the health care system. So it is a system that is based on the thought of solidarity. If you wanna call it socialism, go ahead. But I think that is a simplification for the dumb and greedy.

Doctors in France, England and Scandinavia are among the highest paid people in society. In my country our biggest problem is having enough doctors and a natural result of that is insane salaries. Example: a doctor who is called in at night to perform a simple alcohol test (blood sample in a small town with no hospital) will charge around 500 dollars per hour.

Well I guess I'll just never understand the mindset of many Americans who would rather pay a lot of money to an insurance company just because they don't trust the government. What exactly are you afraid of? Is it merely principle or are you scared of a complete system meltdown if you try and convert your system?

It's expensive here because private insurers are running their business for profit, not to contain cost. I don't have the data readily available, but if cost really is such an important factor, then there would be much more support for a single payer system which is easily more cost effective than anything involving a private insurer.

IMO this is more a kneejerk reaction of people who are afraid of change. If someone actually would provide actuarial data of the potential cost of insuring the poor vs. the actual expenditures of treating those same people in the ER instead of a free clinic, it would be easier to settle that argument.

Congressional Budget Office disagree's with that statement. According to them, this will cost about 1 trillion over 10 years and the way it is setup will be like a balloon mortgage where the trillion is the payments and at the end of that 10 years there will be huge costs that need to be addressed. Not to mention, it will still leave tens of millions of people uninsured.

Cry a river. Become a lawyer. Work harder. Do without. All of these are preferable to sacrificing the standard of living of those without access to medical care for the sake of yours.

And before you ask, I'm a professional too; an engineer.


No, they just want an adequate health care system. I know this because they say so. You seem to be making stuff up.

I don't believe anyone is forcing you to be a doctor, or to practice where you practice.

This sounds ideological.

Where is it written that your government owes you for all your hard work; that it should formulate policy around you getting what you think an adequate ROI? That's the market's job. The government's job is to ensure life, liberty, common good, etc.

I think it has to do from a general fear that "the goverment can't run anything".

As a canadian from ontario living in the south I had people stunned by the idea that our state (provincal) goverment runs alcohol. They think that means we have 4 forms of paperwork to get beer or something. They then state that "well they must be losing money from that then". I don't know why its so ingraned that the goverment in inept at running any buisness?