Let's Talk About Health Care!

Off Topic Politics & World Issues
61

[quote]John S. wrote:
orion wrote:
John S. wrote:
orion wrote:
John S. wrote:
MaximusB wrote:
If you thought Emergency Rooms were busy now, it’s going to get worse I bet.

Look at Europe and Canada. They tell the story on socialized medicine. In canada There is a doctor shortage because of this, and in Europe well there is over a million people on a waiting list.

If the government wants to fix something they can regulate the cost any other option would fuck us over.

Price fixing!

Sweet!

What could possibly go wrong?

Not exactly price fixing but when there are obvious gouging taking place they can regulate that. There are plenty of examples of doctors popping in and saying a few things when a couple is having a baby delivered then charging them an ass ton of money. You can regulate that. But as far as saying something like you can only charge $20 for an x-ray then that is not right.

But if you have one than you will get the other.

There is simply too much money too be made to not expect this to be a highly politicized area.Naturally there will be waste and corruption like in any other government run area.

It seems to me that a lot of people ask the wrong question. Instead of asking “Why does the market not work in health services” they ask “Given that the market does not work in health services what can government do to help?”.

It seems to me that getting the market to work in this area should be the main concern but yet it is not.

And that is bad.

Because if I ever should have cancer I want the Samsung 8th generation OLED treatment and not the government provided black and white POS.

And I personally agree if I ever get sick I want the best technology and I will pay for it. But please understand that I in fact do not want the government messing with anything when it comes to health care I am simply saying that what I suggested would be the only non disastrous way for them to get involved.[/quote]

Since we both agree they cannot fix the market why not just have them NOT get involved in the first place?

Price fixing creates shortages of what ever service it is intended to fix. Tell a doctor how much he can charge for a “visit” and those doctors that cannot keep their costs down, due to their newly lost revenue, will go out of business and there will be less doctors – and then the government will come in and say, “gee, look, an other problem for us to solve that the market couldn’t handle.” The masses will fall for it and their “solution” will be socialized medicine, for sure.

I mean, really, that is how it has been happening for the last 4 decades with managed health care. The government creates a problem only so they can come in and fix a problem and thus government grows ever larger with the incentive to never really fix anything but rather keep making problems for them to fix. The ultimate solution to “job security” if you ask me.

62

[quote]LIFTICVSMAXIMVS wrote:
John S. wrote:
orion wrote:
John S. wrote:
orion wrote:
John S. wrote:
MaximusB wrote:
If you thought Emergency Rooms were busy now, it’s going to get worse I bet.

Look at Europe and Canada. They tell the story on socialized medicine. In canada There is a doctor shortage because of this, and in Europe well there is over a million people on a waiting list.

If the government wants to fix something they can regulate the cost any other option would fuck us over.

Price fixing!

Sweet!

What could possibly go wrong?

Not exactly price fixing but when there are obvious gouging taking place they can regulate that. There are plenty of examples of doctors popping in and saying a few things when a couple is having a baby delivered then charging them an ass ton of money. You can regulate that. But as far as saying something like you can only charge $20 for an x-ray then that is not right.

But if you have one than you will get the other.

There is simply too much money too be made to not expect this to be a highly politicized area.Naturally there will be waste and corruption like in any other government run area.

It seems to me that a lot of people ask the wrong question. Instead of asking “Why does the market not work in health services” they ask “Given that the market does not work in health services what can government do to help?”.

It seems to me that getting the market to work in this area should be the main concern but yet it is not.

And that is bad.

Because if I ever should have cancer I want the Samsung 8th generation OLED treatment and not the government provided black and white POS.

And I personally agree if I ever get sick I want the best technology and I will pay for it. But please understand that I in fact do not want the government messing with anything when it comes to health care I am simply saying that what I suggested would be the only non disastrous way for them to get involved.

Since we both agree they cannot fix the market why not just have them NOT get involved in the first place?

Price fixing creates shortages of what ever service it is intended to fix. Tell a doctor how much he can charge for a “visit” and those doctors that cannot keep their costs down, due to their newly lost revenue, will go out of business and there will be less doctors – and then the government will come in and say, “gee, look, an other problem for us to solve that the market couldn’t handle.” The masses will fall for it and their “solution” will be socialized medicine, for sure.

I mean, really, that is how it has been happening for the last 4 decades with managed health care. The government creates a problem only so they can come in and fix a problem and thus government grows ever larger with the incentive to never really fix anything but rather keep making problems for them to fix. The ultimate solution to “job security” if you ask me.[/quote]

Ive been thinking and you are right. I agree with everything you are saying.

63

Just a question…Does anybody realize that Universal Health in the way it is being forced today will cover illegal aliens?

64

[quote]Rockscar wrote:
Just a question…Does anybody realize that Universal Health in the way it is being forced today will cover illegal aliens?

[/quote]

Rock have you seen the legislation to end almost all benefits to illegals in Cali? If you haven’t here is the link…

http://www.taxpayerrevolution.org/

65

[quote]MaximusB wrote:
Rockscar wrote:
Just a question…Does anybody realize that Universal Health in the way it is being forced today will cover illegal aliens?

Rock have you seen the legislation to end almost all benefits to illegals in Cali? If you haven’t here is the link…
[/quote]

Yeah, and I think its great…but the Feds will pick up that mess downstream, California knows it, so it makes it easier to cut that out.

66

The problem with universal health care goes back to the social contract. The government exists for the protection of the people it serves. It does not exist to provide for the people it serves. No where in the Constitution is anyone guaranteed health care. I find it a bit sad that America today has done a 180 of America of the Revolution. They fought for less government control of their lives.

Today everybody wants the government to step in and tell everyone what to do: what health care to use, how much oil prices should be, that we should pray in school, that gays can’t get married, etc. Very few want to take issues into their own hands and as a result we’re trampling on the work of our Forefathers.

67

[quote]BBriere wrote:
The problem with universal health care goes back to the social contract. The government exists for the protection of the people it serves. It does not exist to provide for the people it serves. No where in the Constitution is anyone guaranteed health care. I find it a bit sad that America today has done a 180 of America of the Revolution. They fought for less government control of their lives.

Today everybody wants the government to step in and tell everyone what to do: what health care to use, how much oil prices should be, that we should pray in school, that gays can’t get married, etc. Very few want to take issues into their own hands and as a result we’re trampling on the work of our Forefathers.[/quote]

You deserve a Reagan Point!

68

[quote]engerland66 wrote:
DrSkeptix wrote:
engerland66 wrote:
I’m in med school at the moment, and to sum things up, a lot of my fellow students are thinking along these lines:

I’m graduating with $200k debt, why would I enter family medicine when I could stay on for a few more years and get to:

  • learn more about a particular specialty (aka…nearly master a part of the body…a big motivational factor for us geeky types)
  • perform procedures so that my day isn’t completely routine visits
  • and most importantly, make more money to pay off this debt and work less hours (on average)

Altruism brought a lot of us here, but to ignore the fact that healthcare is a business is foolish. Perhaps realigning incentives to reward those who choose to enter family medicine or other first-line fields is a way forward as the demand increases. But, the way things stand now, entering those fields doesn’t make a lot of sense for the majority of future doctrs.

Let’s also look at the other end of arc of a medical career.
About 75% of medical care is provided in private arrangements, outside of Universities and government Clinics.
Let’s suppose that a large number of docs, some with 25 or more years of experience are looking at the following:

  1. On Jan 1, 2010, the reimbursement on MediCare will be cut by 20% (Yes, this is a fact.)
  2. Some specialties will see a further cut of 8%, due to rotten survey of provider’s costs. Insurance tends to follow MediCare’s lead in cutting back on compensation.
  3. In my zipcode, for example, elderly women can no longer find gynecologists willing to take on new MediCare patients. Other specialties may follow.
  4. In some communities, there is a rising number of internal medicine docs who are contracting their practices; they have established themselves as “concierge” or “VIP” practices in which the patients pay a $1500 surcharge, just for the standard meticulous care that used to be provided as routine.
  5. There is a new specialty, “hospitalists,” because internists, who have abandoned the care of their patients in hospitals because compensation is so poor. Hospitalists, who do not care for the same patients outside the hospital, whose chief obligation to the hospital is to get MediCare patients out earlier, can save a medium sized community hospital $80 million per year. So there is economic drive to have disjointed care, and earlier discharges, all of questionable benefit.
  6. Now suppose that the tax rates are changed. We are not talking about just a 4% increase in the top marginal rate on the Federal Income tax. There will be a removal of the ceiling on MediCare tax (add 6 +%), increased self-employment and social security taxes, and many states will increase their state income taxes by the end of this year.

Ok.
Now suppose these doctors are faced with these pressures–and ObamaCare becomes law–why would experienced and highly productive professionals choose to work marginally harder ? WHy would I stay at work 3 hours longer for a sick older patient, when the effort is so poorly compensated? If the effort is taxed so high, how many producers will stay in the game, or cut back to go golfing?
If enough doctors so decide, can the collapse of MediCare, or even of standard medical insurance, be far off? It is hard to come up with replacements for well-trained and experienced workers.

(So, engerland, if you think that one “gains mastery” of a specialty, I can assure you that it takes more than 6 or 12 years of post-graduate medical training. It takes a lifetime. )

Society has jiggered the rules, and these rules now express how low it values experience, effort, and the individuation of care for our sick and elderly. Even professional altruism must have its limits, and I worry that a shrinking number of experienced docs will not be able to provide even the same level of care in the very near future.

Thanks for that insight. Do you think it is likely that more doctors are going to stop accepting medicare/medicaid once reimbursements drop even further?[/quote]

Yes. It is already happening.

Think of Medicare and Medicaid as marginal business. They pay at break-even or less and soon it will be a money loser.
An office welcomes that business if the place would be empty otherwise.
What is happening is the re-segregation of healthcare by economic status:

Docs in less affluent communities will see anyone to keep up the volume, but their capacity is limited.
Docs in more affluent communities–trust me, there are poor and middle-class folks who live in affluent areas–will not have the incentive to add to their schedules, and cut back on low-pay patients, especially when the government mandates further cuts as planned.
Overall, there will be a decline in producers and their services, and new physicians and specialists will find it harder to move to underserved areas, even in big cities.

69
  1. Doctors are not health illiterate, that is just a dumb statement. Do they not always understand exercise physiology, yeah, do they say dumb thinks like don’t deadlift/squat/free weights yeah. but being health illiterate is a big stretch
  2. One of the biggest problems with health care is overutilization for stupid stuff. you have the sniffles, well get some rest, drink fluids and eat properly. or learn how to apply a bandaid that small abrasion won’t hurt you- People need to realize that health insurance is INSURANCE, NOT a PAYMENT PLAN.
  3. Costs go up for lots of reasons. a) Insurance companies reimburse at different rates, so any provider will raise rates so that it meets or exceeds what the best paying insurance company will pay, They “write-off” more that way but it also maxes out reimbursement from insurance companies. b)Malpracice is atronomical because everyone who has a bad outcome (even if everything was done properly) expects to be compensated for their loss or is looking to make a quick buck. Yes Dr.'s mess up, yes bad things happen, but everytime someone dies in a hospital is not due to negligence or DR. error. Many more reasons but I digress.
  4. Free Health Care is an Illusion, someone pays, and in my opinion everyone should be paying for there health care. Giving health care to lower income people who won’t pay anything through taxes is a bad idea and is not fiscally possible in any real sense.
  5. We have a Health Crisis in this country, NOT a HealthCARE crisis. As a nation we consume 42% of the world’s pharmaceutical products, We rank 36th in health, Improved health is not a matter of getting more care, it is a matter of being healthier. Why would I want to pay into a health system that costs me the same or more than some obese, diabetic smoker who hasn’t done more than pick up his monthly check and block the isle at walmart in his motorized scooter/shopping cart. People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now

70

[quote]chiro1 wrote:

  1. Doctors are not health illiterate, that is just a dumb statement. Do they not always understand exercise physiology, yeah, do they say dumb thinks like don’t deadlift/squat/free weights yeah. but being health illiterate is a big stretch
  2. One of the biggest problems with health care is overutilization for stupid stuff. you have the sniffles, well get some rest, drink fluids and eat properly. or learn how to apply a bandaid that small abrasion won’t hurt you- People need to realize that health insurance is INSURANCE, NOT a PAYMENT PLAN.
  3. Costs go up for lots of reasons. a) Insurance companies reimburse at different rates, so any provider will raise rates so that it meets or exceeds what the best paying insurance company will pay, They “write-off” more that way but it also maxes out reimbursement from insurance companies. b)Malpracice is atronomical because everyone who has a bad outcome (even if everything was done properly) expects to be compensated for their loss or is looking to make a quick buck. Yes Dr.'s mess up, yes bad things happen, but everytime someone dies in a hospital is not due to negligence or DR. error. Many more reasons but I digress.
  4. Free Health Care is an Illusion, someone pays, and in my opinion everyone should be paying for there health care. Giving health care to lower income people who won’t pay anything through taxes is a bad idea and is not fiscally possible in any real sense.
  5. We have a Health Crisis in this country, NOT a HealthCARE crisis. As a nation we consume 42% of the world’s pharmaceutical products, We rank 36th in health, Improved health is not a matter of getting more care, it is a matter of being healthier. Why would I want to pay into a health system that costs me the same or more than some obese, diabetic smoker who hasn’t done more than pick up his monthly check and block the isle at walmart in his motorized scooter/shopping cart. People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now
[/quote]

No, by all means, you can keep posting here.

71

[quote]chiro1 wrote:

  1. Doctors are not health illiterate, that is just a dumb statement. Do they not always understand exercise physiology, yeah, do they say dumb thinks like don’t deadlift/squat/free weights yeah. but being health illiterate is a big stretch
  2. One of the biggest problems with health care is overutilization for stupid stuff. you have the sniffles, well get some rest, drink fluids and eat properly. or learn how to apply a bandaid that small abrasion won’t hurt you- People need to realize that health insurance is INSURANCE, NOT a PAYMENT PLAN.
  3. Costs go up for lots of reasons. a) Insurance companies reimburse at different rates, so any provider will raise rates so that it meets or exceeds what the best paying insurance company will pay, They “write-off” more that way but it also maxes out reimbursement from insurance companies. b)Malpracice is atronomical because everyone who has a bad outcome (even if everything was done properly) expects to be compensated for their loss or is looking to make a quick buck. Yes Dr.'s mess up, yes bad things happen, but everytime someone dies in a hospital is not due to negligence or DR. error. Many more reasons but I digress.
  4. Free Health Care is an Illusion, someone pays, and in my opinion everyone should be paying for there health care. Giving health care to lower income people who won’t pay anything through taxes is a bad idea and is not fiscally possible in any real sense.
  5. We have a Health Crisis in this country, NOT a HealthCARE crisis. As a nation we consume 42% of the world’s pharmaceutical products, We rank 36th in health, Improved health is not a matter of getting more care, it is a matter of being healthier. Why would I want to pay into a health system that costs me the same or more than some obese, diabetic smoker who hasn’t done more than pick up his monthly check and block the isle at walmart in his motorized scooter/shopping cart. People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now
[/quote]

very good post.

72

[quote]chiro1 wrote:

  1. Doctors are not health illiterate…

People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now
[/quote]

As much as I agree with most of what you say, I have to take exception to the quote. Here are 3 reasons why:

  1. We all get sick and die of something.
  2. If we don’t get sick and die of something, we will get sick and die of something else.

I agree that diabetes and obesity add to general mortality and to disease-specific morbidity, but even if every last Crispy-Creme franchise were turned into a Broccoli Boy, there will be, even for people “who take care of themselves,” heart disease, cancer, stroke and neurodegenerative disease. Oh, the percentages may shift a little here or there, but morbidity is unavoidable, even if we all don roller-skates and eat carrots as Streamline implies.

  1. Real prevention and early detection are expensive

When subjected to real objective measurement, life-style changes yield very little mortality benefit in practice. (I know marathon runners who will die of prostate cancer nevertheless.) Over time, even effective life-style changes have small benefits; if cigarettes disappeared tomorrow, ex-smokers would still have elevated risk of lung cancer for seven years, and the risks fall only substantially after 10 to 20 years.
Similarly, screening and testing–whether for lung disease, or heart disease, and certainly for cancer–is expensive, resource-intensive and of modest benefit if any, in terms of mortality. (The morbidity of treatment, I argue, is improved, but at great expense.)

Last, in 2011, we sill see the onslaught of 76 million new entrants to MediCare. Even among the most narcissistic, demanding, and self-absorbed baby boomers, real prevention is farcical. And they, too, will have to endure not only the indignity of illness, but of restricted providers and resources.

73

[quote]DrSkeptix wrote:
And they, too, will have to endure not only the indignity of illness, but of restricted providers and resources.[/quote]

Otherwise known as “begging a bureaucrat to save you while you are already down on your knees”.

From customer to petitioner, via the magic of government.

74

[quote]DrSkeptix wrote:
chiro1 wrote:

  1. Doctors are not health illiterate…

People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now

As much as I agree with most of what you say, I have to take exception to the quote. Here are 3 reasons why:

  1. We all get sick and die of something.
  2. If we don’t get sick and die of something, we will get sick and die of something else.

I agree that diabetes and obesity add to general mortality and to disease-specific morbidity, but even if every last Crispy-Creme franchise were turned into a Broccoli Boy, there will be, even for people “who take care of themselves,” heart disease, cancer, stroke and neurodegenerative disease. Oh, the percentages may shift a little here or there, but morbidity is unavoidable, even if we all don roller-skates and eat carrots as Streamline implies.

  1. Real prevention and early detection are expensive

When subjected to real objective measurement, life-style changes yield very little mortality benefit in practice. (I know marathon runners who will die of prostate cancer nevertheless.) Over time, even effective life-style changes have small benefits; if cigarettes disappeared tomorrow, ex-smokers would still have elevated risk of lung cancer for seven years, and the risks fall only substantially after 10 to 20 years.
Similarly, screening and testing–whether for lung disease, or heart disease, and certainly for cancer–is expensive, resource-intensive and of modest benefit if any, in terms of mortality. (The morbidity of treatment, I argue, is improved, but at great expense.)

Last, in 2011, we sill see the onslaught of 76 million new entrants to MediCare. Even among the most narcissistic, demanding, and self-absorbed baby boomers, real prevention is farcical. And they, too, will have to endure not only the indignity of illness, but of restricted providers and resources.[/quote]

Good dialogue, but i am not sure exactly where you are heading.
You state true prevention and early detection is expensive, and affects morbitiy but not mortality, I get that. But what conclusion do you come to from that information? Where does this leave healthcare? Do you do a cost-benefit analysis and just not treat people? only Select people? Certain criteria gets priority over others?

75

[quote]chiro1 wrote:
Good dialogue, but i am not sure exactly where you are heading.
You state true prevention and early detection is expensive, and affects morbitiy but not mortality, I get that. But what conclusion do you come to from that information? Where does this leave healthcare? Do you do a cost-benefit analysis and just not treat people? only Select people? Certain criteria gets priority over others?
[/quote]

I have a proven way that works time and time again for figuring out who gets treatment and who does not.

It’s completely fair and does not require any middle-men making decisions on anyone else’s behalf.

If you want the best treatment money can buy you must actually buy it…with your own money.

Problem solved.

76

HT, good thread and I appreciate you keeping your head cool. Try to ignore the junk that comes flying your way. I appreciate the insights.

77

[quote]chiro1 wrote:
DrSkeptix wrote:
chiro1 wrote:

  1. Doctors are not health illiterate…

People need to realize that they are responsible for there health, not the healthcare provider. Yes I understand that there are people with genetic disease and other unavoidable illnesses, they are truly a small percentage of the costs, most are from people who don’t take care of themselves.

rant over, for now

As much as I agree with most of what you say, I have to take exception to the quote. Here are 3 reasons why:

  1. We all get sick and die of something.
  2. If we don’t get sick and die of something, we will get sick and die of something else.

I agree that diabetes and obesity add to general mortality and to disease-specific morbidity, but even if every last Crispy-Creme franchise were turned into a Broccoli Boy, there will be, even for people “who take care of themselves,” heart disease, cancer, stroke and neurodegenerative disease. Oh, the percentages may shift a little here or there, but morbidity is unavoidable, even if we all don roller-skates and eat carrots as Streamline implies.

  1. Real prevention and early detection are expensive

When subjected to real objective measurement, life-style changes yield very little mortality benefit in practice. (I know marathon runners who will die of prostate cancer nevertheless.) Over time, even effective life-style changes have small benefits; if cigarettes disappeared tomorrow, ex-smokers would still have elevated risk of lung cancer for seven years, and the risks fall only substantially after 10 to 20 years.
Similarly, screening and testing–whether for lung disease, or heart disease, and certainly for cancer–is expensive, resource-intensive and of modest benefit if any, in terms of mortality. (The morbidity of treatment, I argue, is improved, but at great expense.)

Last, in 2011, we sill see the onslaught of 76 million new entrants to MediCare. Even among the most narcissistic, demanding, and self-absorbed baby boomers, real prevention is farcical. And they, too, will have to endure not only the indignity of illness, but of restricted providers and resources.

Good dialogue, but i am not sure exactly where you are heading.
You state true prevention and early detection is expensive, and affects morbitiy but not mortality, I get that. But what conclusion do you come to from that information? Where does this leave healthcare? Do you do a cost-benefit analysis and just not treat people? only Select people? Certain criteria gets priority over others?
[/quote]

I treat people, one at a time, but I do not make health-care policy…unfortunately.

My point: if one insists that something called “preventive medicine” works, than how much does it cost–in money, manpower or resources?
These calculations are done all the time. For example, how much does it cost to prevent one case of colon cancer? By colonoscopy? By virtual colonoscopy? By broccoli? WIll the screening cause morbidity or death?
Then,if it takes tests or “interventions,” that cost $25,000 to spare a year of life, is it worth it? $250,000? 2.5 million? Remember, if you are establishing policy, you cannot devalue cost-benefit anakysis to dodge the question, because there are also other competing medical or health care priorities.

The NICE of the NHI has explicitly and implicitly determine the value of a British life-year at about $30,000; they deny access to care that yields a (putative) benefit less than that. What is the value of an American life-year when resources are in higher demand? Are 76 million baby boomers going to understand when they cannot get everything to which they feel entitled?

78

[quote]LIFTICVSMAXIMVS wrote:
chiro1 wrote:

If you want the best treatment money can buy you must actually buy it…with your own money.

Problem solved.[/quote]

You cannot afford me.

79

[quote]DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
chiro1 wrote:

If you want the best treatment money can buy you must actually buy it…with your own money.

Problem solved.

You cannot afford me.[/quote]

I can afford 10 of you and all of your moms.

80

[quote]LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
chiro1 wrote:

If you want the best treatment money can buy you must actually buy it…with your own money.

Problem solved.

You cannot afford me.

I can afford 10 of you and all of your moms.[/quote]

And you are too irredeemably stupid to know why you are wrong.
But just as an exercise, why not look into the total charges for operative care of, say, colon cancer and 6 months of adjuvant chemotherapy, especially if you can not work.

Oh, that’s right… I forgot. You do not need verifiable facts, because all you need know is between your ears already.