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DocLightning
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Single-Payer Healthcare

Tue Jan 13, 2009 10:27 pm

OK. So some ruminations from a physician-patient.

I am a strong proponent of a single national healthcare plan for one very important reason:

"I'm sorry, sir, but you are not covered under our plan."

I can't tell you HOW many times I've been told this by various health insurance companies. In fact, it is a common tactic to try to harass patients who use their benefits by falsely terminating their benefits, then apologizing for the mistake, etc. This keeps the most expensive patients away.

In a single, national healthcare plan, there is a single healthcare company. Perhaps you can buy additional, "luxury" insurance on top of the national plan (like they do in Spain) but THERE IS NO SUCH THING AS "NOT COVERED."

The problem is customer service. Having just dealt with a horrible battle with the CA Medical Board and dealt with them simply refusing to do their jobs and having no oversight and no accountability, I cringe to think of what a National Health Service could turn into given the Government's way of operating. I'll call it the NHS but remember that it's a theoretical AMERICAN organization, not the UK's NHS.

So here's a few ideas.

1) Privatize the whole system under a single operator, much like Canada does with their ATC. That will get rid of a lot of government red tape.

2) Appoint an elected official in charge of the system. His sole job is to ensure rapid and efficient care. If care suffers, he gets voted out.

3) Place rules about performance into the system and enforce them by rewarding patients who suffer from delays and poor care with monetary benefits taken from the paychecks of those who work for the National Health Service. So if I have to wait over the mandatory 60 day period to have a claim processed, then I get $500 from the NHS. And that $500 comes out of every single employee's paycheck (totalling maybe $0.001). The idea being that if they are routinely late, sluggish, and inefficient, they have to pay a lot of these awards and thus don't get paid.

But I dream of a day when no citizen or resident alien of the U.S. will just get told (as I just did on the phone) "I'm sorry, sir, but you aren't on our plan."
-Doc Lightning-

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Flighty
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RE: Single-Payer Healthcare

Tue Jan 13, 2009 10:43 pm



Quoting DocLightning (Thread starter):
If care suffers, he gets voted out.

And what about the 100 to 500 lieutenants under "him"? Would they be subject to review and termination? Generally in the government, people like that have job security. High level GS bureaucrats...

Your idea is a great one. Single payer health care is needed. It would save us money and we would be richer. No other country spends as much money on health care. We do because we're inefficient.

The issue is, like you say, it has to be a system designed to function efficiently and fairly. The current system we have now, should be thrown away. It is a disaster, and a complete failure IMO. We have the best doctors and hospitals, but we have the wrong system underneath. It costs more than double what the UK or Japan cost. We could take the Japanese system and have a giant amount of money for tax cuts or social programs, and never worry about health care coverage again.
 
lowrider
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 3:21 am

So you want to create a health care system with infinite demand, but limited resources? How do you prevent shortages and control costs? How do you control supplier costs without stiffling innovation? How do you ensure accountability of the single payer? Finally, why do you expect to get this out of the same government that brought you the IRS, Social Security, the current Medicare mess, and the Department of Education?
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PPVRA
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 5:46 am

I have a feeling you are talking about more expensive, non-routine care, so this Senate testimony might not go hand in hand with what you experienced this time, but I think it's a worthwhile read (it's a bit lengthy). The testimony is about a Doctor who opened a clinic in rural Tennessee mainly for the uninsured, and he does not accept any kind of insurance--private, government, or any hybrid creature in between. Straight up cash, which has allowed him to make major overhead cost cuts, among other things. He says his prices are cost-competitive with insurance co-pays.

At the very least it's a different perspective on the third-party/single-payer system and some points to consider.

[Edited 2009-01-13 22:11:01]
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ManuCH
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 7:04 am

I like the Swiss healthcare system, but I have no idea what it would mean to apply it in the US. We basically have many healthcare insurances offering the basic, mandatory insurance. This basic coverage, which has a law defining what the insurer has to pay, costs about $150/month. This way, everyone in this country (besides illegal immigrants) has basic coverage.

With basic coverage, you are treated when you are sick, and "sorry, you are not covered" doesn't exist.

Then there's extended coverage, where you can pay an additional $50 to $200/month, depending on what you want, for example for private hospital stay or alternative medicine. Everyone can pick what he wants.

The only current drawback is that about 2-3% of the people are not paying their basic coverage because they don't have enough money. In this case, their healthcare bills are paid by the state, in order to respect the principle that everyone has the right of being treated when they're sick.

Why wouldn't this work in the US? Is it because most people wouldn't want to pay a "social" monthly fee to cover other people's expenses? Is it because a hospital stay in the US is more expensive than in Switzerland?
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DocLightning
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 8:13 am



Quoting Lowrider (Reply 2):
So you want to create a health care system with infinite demand, but limited resources? How do you prevent shortages and control costs?

The demand is not infinite. It is finite. There are about 300 million Americans. There are ways to do this fairly and economically. We spend more money per capita on healthcare than any other country in the world and much of that is due to the inherent inefficiency of a system where people are uninsured.

Remember, EVERY SINGLE OTHER FIRST-WORLD COUNTRY HAS UNIVERSAL HEALTHCARE. There is nothing magical or special about the U.S. that makes this impossible here.

Quoting Lowrider (Reply 2):
How do you ensure accountability of the single payer?

I just said so. You establish standards of performance and start paying people less if they don't perform.

Quoting PPVRA (Reply 3):
He says his prices are cost-competitive with insurance co-pays.

That's great until you get a sinusitis and need a course of "AUGMENTIN." That's $200, even generic.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
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Flighty
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 9:26 am

LR that is all a good point. But I do not think today's healthcare system is a "market" system. Not in any respect. There isn't accountability today. If your health insurer makes a mistake, you could sue them... but basically they are your overlord. Can you choose a new insurance provider, usually the answer is no. Your job dictates your insurance provider, in most cases.

How do you control costs? You auction out services in a fair and non-corrupt way. It is done fairly well today in Medicare and the Veterans Administration system (but it could be done better). But also, you take the very sickest people, and let them die. That is what they do in the UK and Japan. Ultimately there are limits to medical science. Ugly limits and they cost a lot of money. At some point, it is not worth it for society to pay for knee surgery for a 91 year old woman etc. The human body breaks down, this is by definition a compromise and a capitulation, no matter what country you live in.

Everybody dies from illness or injury. Fundamentally, that has to be OK. Human reproduction is how we survive... not health care. Health care is nice but we cannot allow it to overpower the reasons we want to live or the ways in which we might pay for it. Ultimately it's a luxury, a nice thing, not a stone around our necks.

The bottom line is that general health care is really very cheap. Most countries have cheap systems that work fairly well. If you want premium, high tech care, it is available and there is a cashier's window who will accept your cash payment. This is the only way I see health care working out financially. Free basics for everybody, and then a cash market for luxury care.
 
lowrider
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 2:28 pm

Quoting DocLightning (Reply 5):
The demand is not infinite. It is finite. There are about 300 million Americans

How much medical care can each person consume, especially if the perceicved cost to the comsumer is zero?

Quoting DocLightning (Reply 5):
You establish standards of performance and start paying people less if they don't perform.

You have just stipulated a massive oversight and enforcement infrastructure, compounding your expenses and reducing your efficiency.

Quoting Flighty (Reply 6):
But I do not think today's healthcare system is a "market" system.

No, its not even close to one. Try to compare hourly rates to see a doctor, or lab fees. How is it the same product is priced differently depending on the consumer? Next time your doctor wants to order a lab, refuse to allow it until he tells you how much it costs. Because there is no transparency in pricing, there is little competition among service providers. Why must I submit a claim through insurance? I should be able to pay for simple items out of pocket if I so desire.

[Edited 2009-01-14 06:29:56]

[Edited 2009-01-14 06:30:15]
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 3:29 pm

Quoting DocLightning (Reply 5):

That's great until you get a sinusitis and need a course of "AUGMENTIN." That's $200, even generic.

At least you can prioritize where your help goes. Or limit what you get insurance for.

Another reason for U.S. health care being more expensive than other countries is because the U.S. does not have price controls on medicine. Price controls have a negative effect on research and development of new drugs, and for that, Europe should not get credit.

Quote:
Price controls seen as key to Europe's drug innovation lag

Pharmaceutical innovation is not only occurring faster in the United States than in Europe, but the gap is getting wider.

For those hoping that Europe might be redressing the imbalance in R&D innovation compared with the United States, two recent reports make gloomy reading. According to a competitiveness report published in November 2006 by the European Commission's high-level Pharmaceutical Forum, the US has established itself firmly as the key innovator in pharmaceuticals since 2000. "That dominant position continues to expand... a disproportionate share of pharmaceutical R&D is performed in the US," it laments.

http://www.nature.com/nrd/journal/v6/n4/full/nrd2293.html

The effects of a third party payer system goes beyond just the patient.

[Edited 2009-01-14 07:56:01]
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 4:26 pm



Quoting ManuCH (Reply 4):
offering the basic, mandatory insurance

I think that is what most European countries have. The "basic"package cover all serious health problems, the extra's are single rooms, dental care, alternative health care etc. People that somehow still are not insured (homeless etc) are taken care of by local instutions.

Mostly the systems are based on solidarity, healthy people willing to pay for those needing care. I have a feeling its hard to match making as much money as possible and taking best care of patients.
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 5:50 pm



Quoting Lowrider (Reply 7):
Why must I submit a claim through insurance? I should be able to pay for simple items out of pocket if I so desire.

Of course. Can't you do that? I (luckily) never use my insurance, I pay everything out of my pocket (because insurance only pays if I spend more than $2000/year for healthcare, which never applied so far - fingers crossed).
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lowrider
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 5:55 pm



Quoting ManuCH (Reply 10):
Can't you do that?

No, I cannot get past the waiting room without providing insurance information. When asked about direct billing, I was told that all bills were first submitted through the insurance company, and anything not covered would be forwarded to me.
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 7:46 pm



Quoting Lowrider (Reply 11):
No, I cannot get past the waiting room without providing insurance information. When asked about direct billing, I was told that all bills were first submitted through the insurance company

This is extremely strange. And what happens to all those who don't have insurance? OK, most of them probably wouldn't be able to pay, but what if a person who can afford it doesn't *want* insurance (as it's not mandatory in the US, if I understand this correctly)? Will they deny treatment?
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PPVRA
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 8:07 pm



Quoting ManuCH (Reply 12):

Page 2 of the link I provided on reply #3 might shed some light on what and why that happens.
"If goods do not cross borders, soldiers will" - Frederic Bastiat
 
Pyrex
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RE: Single-Payer Healthcare

Wed Jan 14, 2009 9:40 pm

The problem in the U.S. is that you already have what almost amounts to, in essence, a single-payer system but without all the costs that need to come associated with it. There is a huge "long-tail" in the distribution of medical costs, by the very nature of it. I don't remember the exact numbers but it is something like the sickest 2 or 3% of the population are responsible for 70% of medical costs. Since a lot of these sickest people are effectively shut out of the private insurance market because they are too sick, they end up on Medicare/Medicaid, who ends up being responsible for something like 50% of all healthcare expenditure in the U.S. So basically, Medicare/Medicaid do not receive premiums from healthy people to help cover unhealthy people (thus creating massive losses for them) while private insurers are able to charge high premiums from healthy people confident that they can always dump the sickest ones onto the government (thus reaping major profits).

Imagine an insurance company that only insures reckless, drunk drivers, or beach houses in the Florida coast, and you get Medicare/Medicaid, with the exception that they receive no premiums.
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aa757first
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 12:24 am



Quoting DocLightning (Thread starter):
1) Privatize the whole system under a single operator, much like Canada does with their ATC. That will get rid of a lot of government red tape.

A government run organization gets rid of government red tape?

Quoting DocLightning (Thread starter):
2) Appoint an elected official in charge of the system. His sole job is to ensure rapid and efficient care. If care suffers, he gets voted out.

People elect their Congressmen and Senators and look at their approval ratings. George Bush's approval ratings have been low for, what, three years?

Quoting ManuCH (Reply 4):

Why wouldn't this work in the US? Is it because most people wouldn't want to pay a "social" monthly fee to cover other people's expenses? Is it because a hospital stay in the US is more expensive than in Switzerland?

There's a whole host of reasons that, in a way, separates the US from other countries. For one, what do we do with the many illegal immigrants?

Quoting ManuCH (Reply 10):

Of course. Can't you do that? I (luckily) never use my insurance, I pay everything out of my pocket (because insurance only pays if I spend more than $2000/year for healthcare, which never applied so far - fingers crossed).

There are different ways of using health insurance in the US. One is somewhat like the system you're describing. It's called a high deductible health plan. A person has to pay for almost all of his or her health care out of pocket until they hit the deductible, which may be something like $3,000. Then, insurance kicks in and the person only pays for a certain percentage of care.

Other plans may not work like that. Many plans have "co-pays," which are fees that a patient pays to the doctor/facility and then the insurance company is billed for the difference (at an arranged rate). So for example, when a covered patient visit's a doctor, the insurance company pays for that after the patient gives the doctor $20. So the insurance companies are left paying for tiny little things that the average person can afford (say three doctors visits, a blood test and an antibiotic over the course of one year), which really adds up.

The high deductible system works like car insurance. If you need to change your headlight, your insurance company doesn't pay for it. If someone hits you when you're stopped at an intersection, the insurance company does pay for a new bumper. The latter system, which AFAIK is more popular and common, is the equivalent to car insurance paying for headlights and oil changes.
 
LH423
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 7:08 am



Quoting Aa757first (Reply 15):
People elect their Congressmen and Senators and look at their approval ratings. George Bush's approval ratings have been low for, what, three years?

Yes, but as the old adage goes, "All politics is local." Congress often has a low approval rating yet most people think THEIR politician does a good job. That's why we see so many career congressmen. They get sent back by constituents thinking that their congressman isn't part of the problem on the Hill.

As for Pres. Bush. Well, even with a healthy dose of revisionist history, I don't think Bush will be seen in the same light as Washington, Lincoln, Roosevelt, Kennedy, or Reagan. His low-approval ratings are do to a multitude of reasons.

That said, while I agree with the idea of a sort of elected ombudsman to oversee a national health care system, I worry that needing to be elected would politicise the office too much. Would the person in that office be working to make sure Americans have the best health care system possible or would he/she be worried about being reelected?

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DocLightning
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 8:32 am



Quoting Lowrider (Reply 7):
Next time your doctor wants to order a lab, refuse to allow it until he tells you how much it costs.

He doesn't know how much it costs because 1) nobody tells us that and 2) how much it costs depends on your insurance provider.

Quoting Lowrider (Reply 7):

How much medical care can each person consume, especially if the perceicved cost to the comsumer is zero?

This is why I'm a strong proponent of co-pays and policies that minimize freebies. If you have to shell out a bit of money to use an ambulance and you have to shell out a bit of money to go to the emergency room and you have to shell out a bit of money for other things, you are less likely to just use the system for the hell of it.

Quoting Lowrider (Reply 11):

No, I cannot get past the waiting room without providing insurance information.

That's a stupid doctor, then. He can get a lot more by billing you directly than by billing your insurance. Pick a different doctor.

Quoting PPVRA (Reply 8):

Another reason for U.S. health care being more expensive than other countries is because the U.S. does not have price controls on medicine.

Yes and no. Some things bewilder me. BACTRIM is a two-component antibiotic that has been around for a few decades. I just paid out-of-pocked for a 7-day course, US$15. A 7-day course of AUGMENTIN, another two-component antibiotic that has been around for a few decades, costs about $200. Why? I have no idea.
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lowrider
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 2:12 pm



Quoting DocLightning (Reply 17):
1) nobody tells us that and

How hard do you look? How often does the question cross your mind?

Quoting DocLightning (Reply 17):
2) how much it costs depends on your insurance provider.

And therein lies a large portion of the problem. As I have said in the past, we should demand transparent, market based pricing.

Quoting DocLightning (Reply 17):
If you have to shell out a bit of money to use an ambulance and you have to shell out a bit of money to go to the emergency room and you have to shell out a bit of money for other things, you are less likely to just use the system for the hell of it.

What is "a bit" and who decided how much that is? If you set the bar too high, isn't that the same as having people who are not covered? If it is too low than it is not a deterrent.

Quoting DocLightning (Reply 17):
That's a stupid doctor, then

Perhaps, but that is not my opinion of him. Seems to be a good guy, but the group he is a part of has certain policies.
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DocLightning
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 3:01 pm



Quoting Lowrider (Reply 18):

How hard do you look? How often does the question cross your mind?

Many times and the answer is always "We bill differently for it based on the insurance." It sounds like a simple question, I agree. But it appears to be one of those unanswerable ones. And that frustrates me as much as it frustrates you.

Quoting Lowrider (Reply 18):

What is "a bit" and who decided how much that is? If you set the bar too high, isn't that the same as having people who are not covered? If it is too low than it is not a deterrent.

Well, in my experience, the copay on an ambulance needs to be more than cab fare. People on Medicaid in the Bronx would come in by ambulance because the kid has a cold. Like, all the time. And because it was free to them, they'd just glibly abuse the system.

A $15 copay would not cripple anyone, but would cost more than a cab. That's just one example of how to get people to use the system appropriately.
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"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
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windy95
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 3:12 pm



Quoting DocLightning (Thread starter):
That will get rid of a lot of government red tape.



Quoting DocLightning (Thread starter):
Appoint an elected official in charge of the system



Quoting Flighty (Reply 1):
And what about the 100 to 500 lieutenants under "him"? Would they be subject to review and termination? Generally in the government, people like that have job security. High level GS bureaucrats...



Quoting Lowrider (Reply 2):
Finally, why do you expect to get this out of the same government that brought you the IRS, Social Security, the current Medicare mess, and the Department of Education?

It is not some form of healthcare that covers everyone or one that does not let people fall through the cracks that I disagree with. But the above mentioined quotes are why I would not ever support our Government controlling my healthcare. Our whole government sucks and is out of control with red tape and corrupted officials. Every system we have is a mess and Healhtcare would be no different. I do not trust our elected officials or the lifetime beuracrats for one second. I like your ideas a bit Doc and I like your passion but thinking of our government running this makes me want to go see my Doc for some blood pressure pills.
 
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RE: Single-Payer Healthcare

Thu Jan 15, 2009 7:29 pm



Quoting Windy95 (Reply 20):
Our whole government sucks and is out of control with red tape and corrupted officials. Every system we have is a mess and Healhtcare would be no different.

You've outlined a more intractable, systemic problem; a problem we share with you to a certain extent. Wouldn't it be nice if real electoral reform were possible, but unfortunately the guys and gals who have to implement the reform are the ones who do best exploiting the status quo.

Having said that, it's hard to envision a national health care system based on a 100% private sector model, and I'm unaware of any country that has gone that route. We've managed to produce (on average) better outcomes at lower cost (compared to the US) with a system that is run entirely by governments, with some private sector involvement at the clinical level. And we've done a reasonably good job keeping drug costs in check because the government controls it.

Bottom line -- you have to trust the government to do it right. Our system was established at a time when governments were generally given more respect than they are now. And I wonder, given the current distrust of government, if we would be able to create the system that now exists -- or would we wallow in the inefficiencies we see to the south and end up forever wrangling over the ideological divide.

I'm certainly grateful that it was done here, back when it was possible to do it (there was a war over it even then). I've benefitted personally from it and wouldn't swap places with Americans.
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MD11Engineer
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RE: Single-Payer Healthcare

Fri Jan 16, 2009 11:12 am

Here is an article (intended for ex-pats working in Germany) on how the Germany health insurance system works.

Quote:
Basic introduction

Health insurance is obligatory for everyone residing in Germany who is employed full-time by a company. The company pays half of the insurance contributions, the other half comes out of the employee's salary. The employee's half usually totals around 10% of their gross salary. When starting work with a company usually the employee won't have to worry too much about how the system works. The company will automatically sign them up with an insurance company and the contributions automatically deducted from the salary. Sometimes the employee may be asked if they have a preferred insurance company. It is recommended to simply go with one of the big names, like "AOK" or "TKK". They are all pretty similar.

Health insurance has been obligatory for everybody in Germany, including the self-employed, since 2007. Medical treatment can be hugely expensive.

There are two types of health insurance in Germany. These are the "public" and "private" systems. This system often causes considerable confusion. Full details are given below.

More: http://www.toytowngermany.com/wiki/Health_insurance


BTW, from my own experience, the system is pretty good, as are most European systems.
From my own experience (Ok, I'm rarely sick, but I had a few accidents in my life and also had an accute loss of hearing together with a tinnitus last summer), I never had to wait unduely long. Ok, once I had to wait for an hour or so in a hospital emergency room, where I went after an accident at work, where I thought I might have a broken ankle (turned out to be a bad sprain), because somebody else came in by ambulance with a life threatening condition and all emergency room staff had to take care of this patient first.

German hospitals usually provide state of the art treatment, as do the various GPs and specialists doctors all over the country. Treatment is all covered by the mentioned insurance schemes.

Jan
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canuckpaxguy
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RE: Single-Payer Healthcare

Sat Jan 17, 2009 12:47 am

Well, not to get too personal, but there's one hospital here in Canada that has saved my life on two occasions. Aside from prescriptions I needed after being released from the hospital, my total healthcare cost was C$50 in 1993 from a major trauma visit (to pay for the ambulance ride); and C$200 in 2008 for a rather serious cardiac procedure (Because I chose to get upgraded to a private room, the cost would have been $1000, but my private insurance through work paid 80%). I'm told that if I had been in the USA, without insurance, my two procedures combined would have run me nearly $200,000.

Damn right I'm happy to be Canadian!

There are some common misconceptions though about medicine in Canada:

  • * Sometimes patient wait-times are called "unreasonable" by some. The Canadian system treats patients in order of medical priority so you may be sitting in an emergency room with broken finger for hours.
  • * Depending on where you are in the country, you may have a great deal of difficulty finding a doctor who is taking patients. There's a lot more $$$ for doctors in Canada to practise south of the border.
  • * Dental visits are not covered by the state unless you are on welfare, and even then there are limitations. Same goes for prescription drugs. These are often covered by employer health plans where available.
  • * Elective surgery, in most cases, is not covered unless it is directly related to an essential treatment. (Although I did hear rumours about a gender-reassignment surgery getting paid for).


Overall, it's a good system, and one I've come to really appreciate. Sure, it has its querks, but we Canucks have no grounds for complaint.

G
 
aa757first
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RE: Single-Payer Healthcare

Sat Jan 17, 2009 4:29 am



Quoting Canuckpaxguy (Reply 23):
* Sometimes patient wait-times are called "unreasonable" by some. The Canadian system treats patients in order of medical priority so you may be sitting in an emergency room with broken finger for hours.

This is true in the US and I assume almost everywhere as its medical, not a way to manage things. Obviously, the most acute cases need to be treated before simple things like broken bones and minor illnesses.

In the US, places called Minute Clinic and similar "retail health centers" have developed as a much more convenient and cost effective way to treat minor problems that clog up ERs. Nurse practitioners and physician assistants staff these walk-in clinics and see only patients with very specific, minor illnesses. They'll try to bill insurance for you, but the prices are very low anyway. The US system does, like all systems, have flaws. One advantage it does have is innovation created by the free market.
 
canuckpaxguy
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RE: Single-Payer Healthcare

Sat Jan 17, 2009 4:43 am



Quoting Aa757first (Reply 24):
One advantage it does have is innovation created by the free market.

That's one very clear advantage over our system! In Ontario, we're just now piloting Physician Assistants. The concept is brand new.

I let you know how it turns out.
G
 
Dougloid
Posts: 7248
Joined: Tue Jul 05, 2005 2:44 am

RE: Single-Payer Healthcare

Sat Jan 17, 2009 5:04 am



Quoting DocLightning (Reply 5):
The demand is not infinite. It is finite. There are about 300 million Americans. There are ways to do this fairly and economically. We spend more money per capita on healthcare than any other country in the world and much of that is due to the inherent inefficiency of a system where people are uninsured.

Quite frankly Doc, your profession stands in the way when every person who graduates from a second rate medical school in Manila won't turn the key for less than a quarter million a year clear. Between that and the outrageous prices people are forced to pay for medicine in this country, that's what's driving the price. I daresay that if the Army trusts my son to go out and patch up wounded people and spend his afternoons ministering to local afghanis who walk miles to have their kids looked at and stitched up, he could do the same thing here.

What's needed is something along the lines of Mao's 'barefoot doctors' and get the price down to a level that's within our means, instead of sitting here trying to figure out ways to give more money to people who already make obscenely large salaries.

I'm sixty, and I've got no retirement. The biggest fear that I have is that some day in the next few years I'm going to get damned ill, and they're going to tell me the same thing they told you over the phone. Only difference is, it'll likely kill me.
If you believe in coincidence, you haven't looked close enough-Joe Leaphorn
 
cairo
Posts: 889
Joined: Mon Jun 06, 2005 2:41 pm

RE: Single-Payer Healthcare

Sat Jan 17, 2009 5:37 am



Quoting DocLightning (Reply 5):
EVERY SINGLE OTHER FIRST-WORLD COUNTRY HAS UNIVERSAL HEALTHCARE. There is nothing magical or special about the U.S. that makes this impossible here.

First of all, I agree with some kind of national universal healthcare. BUT,

These things work best in small countries, and, anecdotally speaking, seem to get worse and worse on a logarhithmic scale as the actual size and population of the country get bigger.

Between the NHS in the UK and America's current system - I know both - I'd rate them, in actual effect, about equal. In London you can't see a doctor today with anything less than a severed limb or cardiac arrest - you can see them in a few weeks; meanwhile, in most cases, you will either just suffer along in painful misery or get better on your own, "naturally". Those with money just pay to see a private doctor anytime they like. Otherwise, everyone gets equally bad service.

Just don't turn America into the NHS and don't make things worse for those of us (85%) who have good jobs and have always had health care insurance.

Cairo
 
Dougloid
Posts: 7248
Joined: Tue Jul 05, 2005 2:44 am

RE: Single-Payer Healthcare

Sat Jan 17, 2009 6:00 am



Quoting Cairo (Reply 27):
Just don't turn America into the NHS and don't make things worse for those of us (85%) who have good jobs and have always had health care insurance.

Look closely at the Massachusetts model. That may be where we end up.
If you believe in coincidence, you haven't looked close enough-Joe Leaphorn
 
dxing
Posts: 5859
Joined: Wed Nov 12, 2008 5:14 pm

RE: Single-Payer Healthcare

Sat Jan 17, 2009 6:43 am



Quoting DocLightning (Thread starter):
But I dream of a day when no citizen or resident alien of the U.S. will just get told (as I just did on the phone) "I'm sorry, sir, but you aren't on our plan."

So they can be told "I'm sorry sir, you're not in our records, it appears that we have listed as having died a year ago. I'm afraid you'll have to come down to the office with two forms of picture ID's to be reinstated". My father got that one from social security. My uncle got "I'm sorry sir but according to our records you aren't yet old enough to qualify for medicare". He was 72 at the time. Or my favorite, "Mr. DXing we show your home as being purchased for XXX thousand dollars and that is what we are basing your property tax on. If you have documentation to prove us wrong then please submit it." Of course my home didn't cost anywhere near that amount and it took me 3 months to get things straightened out. Yeah, I want the government in charge of my healthcare. Just what I need.
Warm winds blowing, heating blue skies, a road that goes forever, I'm going to Texas!
 
Flighty
Posts: 7860
Joined: Thu Apr 05, 2007 3:07 am

RE: Single-Payer Healthcare

Sat Jan 17, 2009 7:59 am



Quoting Cairo (Reply 27):
Just don't turn America into the NHS and don't make things worse for those of us (85%) who have good jobs and have always had health care insurance.

Americans could take 2 extra weeks off per year (as the Brits do) with all the productivity they saved (money) by switching to a Canadian type system. Maybe more like 3 extra weeks. Whether you see it or not, about $10k of your compensation is going to your health insurance, if you have a family and "real insurance." It costs about a grand a month for that insurance.
 
Arrow
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Joined: Wed Jun 19, 2002 7:44 am

RE: Single-Payer Healthcare

Sat Jan 17, 2009 5:08 pm



Quoting DXing (Reply 29):
Yeah, I want the government in charge of my healthcare. Just what I need.

The fallacy in this argument is that somehow, the private sector gets it better and doesn't perpetrate these kinds of bureaucratic nightmares. That's often the fallacy when using anecdotal evidence to push an argument in one direction or the other. I could cite a list of similar abuses committed on me and my family by a variety of private sector companies, from the phone company right up to my local mechanic. The answer to my anecdotal problems is not to nationalize those folks.

If you're going to make an intelligent choice between a nationalized versus a largely private health care system, you have to base it on costs, outcomes, and a whole host of other comparables. When you do that, the US style system rarely comes out on top. In particular, it fails miserably the test of universality. That's unforgivable in the richest nation on earth. DocLightning has some useful ideas on making it better, and since he's out there in the trenches, I put a lot of stock in what he says.
Never let the facts get in the way of a good story.
 
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DocLightning
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RE: Single-Payer Healthcare

Sat Jan 17, 2009 9:56 pm



Quoting Dougloid (Reply 26):

Quite frankly Doc, your profession stands in the way when every person who graduates from a second rate medical school in Manila won't turn the key for less than a quarter million a year clear. Between that and the outrageous prices people are forced to pay for medicine in this country, that's what's driving the price. I daresay that if the Army trusts my son to go out and patch up wounded people and spend his afternoons ministering to local afghanis who walk miles to have their kids looked at and stitched up, he could do the same thing here.

OK. My education cost a quarter of a million dollars.

How am I supposed to pay for that?

Make my education free and then we'll talk.

Oh, and your sun stitching up kids is all well and good. Does he know what to do when one comes with easy bruising and easy bleeding? Or the work-up for irregular menses? Or how to recognize signs of an androgen-secreting tumor?

Sorry, it's not that simple. It's like saying that any FSX geek can fly a real 744.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
canuckpaxguy
Posts: 1482
Joined: Sat Sep 06, 2003 2:31 pm

RE: Single-Payer Healthcare

Sat Jan 17, 2009 10:20 pm



Quoting DocLightning (Reply 32):
OK. My education cost a quarter of a million dollars. How am I supposed to pay for that? Make my education free and then we'll talk.

Whoa! Slow down kids!! Free health care? Free university tuition? Sounds like a communist society!!!  Wink (Just kidding!).

Medical schools are VERY expensive because university administrators know they can charge whatever they want for admission. Also, every medical school wants to be the best and isn't afraid of spending the money high priced equipment, technology or professors. Future doctors take on $250K in educational training because they know that they are quite likely going to be able to pay it off with their salaries post graduation.

Dougloid, I can see your point about doctors driving up costs with their high salaries, but at the end of the day, you can't blame someone for wanting a decent return on their $250K investment in training. But you also can't expect M*A*S*H style medical care, like what your son did for Afghanis, in modern USA or Canada. We wouldn't tolerate that level of care ourselves ... and with the malpractice suits Americans are reputed for, you can bet your ass the barefoot doctor style of medicine would go bankrupt toute-suite!

There are so many other problems with the system. You simply can't blame it solely on doctor's salaries.
G
 
ltbewr
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RE: Single-Payer Healthcare

Sat Jan 17, 2009 10:42 pm

There are a number of arguements against a government contolled or 'single payer' health care system. Many persons and providing institutions may not want to or cannot be part of or be forced to pay into such a system due to ethical and religious reasons - for example from being against abortion, birth control drugs, can't have transfusions and end of life decisions. No one wants any rationing of or delays in accessing a doctor or treatment yet you need to keep out potential abusers of the system. You need a system that encouages healthy lifestyles, not forces the healthy to subsidise those that won't try. Many would demand gold plated coverage for no or little cost, a wide range of care from mental health, dental, vision, nursing home care for the elderly and many prescription drugs subsidised, although in some ways it would be the right thing to do.

A 'single payer' system would have to allow persons to have private options of insurance at reasonable prices, would charge progressive rates of premiums and co-pays based on income and to some extent liquid assets (cash, stocks, bonds - not a primary residence or business property) with caps per year or quarter for such co-pays. That of course gets in to privacy issues, that one would have to disclose their income and assets to a government agency. Of course the rich would object to any progressive plan as they would say it is 'stealing' income from them, and limitning their ability to invest to make them richer or provide investments for employment to pay for the masses.

There are many issues to considering a single payer plan of health care, but most important is that it may make sure no one - adult or child - has to forgo needed care until possibly too late to save them or to preserve a reasonable quality of life.
 
dxing
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Joined: Wed Nov 12, 2008 5:14 pm

RE: Single-Payer Healthcare

Sun Jan 18, 2009 12:36 am



Quoting Arrow (Reply 31):
The fallacy in this argument is that somehow, the private sector gets it better and doesn't perpetrate these kinds of bureaucratic nightmares.

I have a choice of providers, if I don't like the one I have now for the reasons you listed above I can fire them and get another. If the government is the sole provider, I don't and I can't. There is a reason we don't allow monopolies in this country.

Quoting Arrow (Reply 31):
If you're going to make an intelligent choice between a nationalized versus a largely private health care system, you have to base it on costs, outcomes, and a whole host of other comparables.

Of course you didn't list "choice" in that list because once the government takes over there is none and of course as I have personally seen too many times to suit me, when choice is not available, more often than not neither is competency.
Warm winds blowing, heating blue skies, a road that goes forever, I'm going to Texas!
 
N801NW
Posts: 558
Joined: Mon Jul 12, 2004 8:56 am

RE: Single-Payer Healthcare

Sun Jan 18, 2009 1:18 am



Quoting DXing (Reply 35):
There is a reason we don't allow monopolies in this country.

Monopolies are not illegal, per se in the US. What is criminal is doing illegal things to maintain said monopoly.
 
Arrow
Posts: 2325
Joined: Wed Jun 19, 2002 7:44 am

RE: Single-Payer Healthcare

Sun Jan 18, 2009 2:09 am



Quoting DXing (Reply 35):
Of course you didn't list "choice" in that list because once the government takes over there is none

That's not true. I make all manner of choices in my health care, from which doctor I go to, which hospital I access, which pharmacy I buy my drugs from -- and so on. I've fired specialists and sought others to replace them. Government-run does not mean no choices.

Our single-payer system has lots of flaws that need fixing, but I wouldn't trade it for a 100% private sector solution. That's a path to bankruptcy.
Never let the facts get in the way of a good story.
 
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DocLightning
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RE: Single-Payer Healthcare

Sun Jan 18, 2009 3:09 am



Quoting DXing (Reply 35):
There is a reason we don't allow monopolies in this country.

The USPS. The Military. The FBI. The electric company (in most places). The phone company (in most places). The water. The roads. The garbage.

Healthcare is a basic service. It is absurd that you think that both transportation infrastructure and healthcare should be completely free-market. That's never worked well. Ever in history.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
Dougloid
Posts: 7248
Joined: Tue Jul 05, 2005 2:44 am

RE: Single-Payer Healthcare

Sun Jan 18, 2009 6:35 am



Quoting DocLightning (Reply 32):
OK. My education cost a quarter of a million dollars.

How am I supposed to pay for that?

Make my education free and then we'll talk.

Oh, and your sun stitching up kids is all well and good. Does he know what to do when one comes with easy bruising and easy bleeding? Or the work-up for irregular menses? Or how to recognize signs of an androgen-secreting tumor?

Sorry, it's not that simple. It's like saying that any FSX geek can fly a real 744.

First of all, Doc, you investing in your education is like anyone else investing in themselves or their business. If I invest in a dry cleaners, you don't owe me a living. So don't lay that trip on me. You're in a monopoly business that has managed to legalize extortion on a grand scale.

Ninety percent of the medical care people get is routine, and they do not need somebody with a quarter million dollar education to tell them they have a cold. So maybe what you need to be doing is referrals from barefoot doctors instead of demanding that everyone with the sniffles pay for your education.


And before you disrespect my son tell me when you have had to figure out how to clean blood and brains out of the inside of a humvee or get people medevaced under hostile fire.He has.
He's made his bones in the hardest school there is. Shame on you.

The people who came before you were not nearly as mercenary as your class of meat mechanics.. When I was a kid doctors didn't play golf on Wednesday, they made house calls for shutins. Do you do that? What are you giving back that you do not expect a huge payday from?

People did not need health insurance. In fact there was no such thing. Physicians charged reasonable prices for their services, and don't try to slough off the blame on trial lawyers. Doc Kolbay made house calls, the charge was about ten bucks, and we were better for it. When my old man nearly died from an allergic reaction to aspirin, Doc was there in about ten minutes in the sleepy little town I grew up in. In his 1950 Dodge with his bag. Saved my old man's skinny ass.

That was normality. It's how it was done. And parenthetically it also demonstrates what a good thing the GI Bill really was, because that's what financed his education.

Quoting Canuckpaxguy (Reply 33):
Dougloid, I can see your point about doctors driving up costs with their high salaries, but at the end of the day, you can't blame someone for wanting a decent return on their $250K investment in training. But you also can't expect M*A*S*H style medical care, like what your son did for Afghanis, in modern USA or Canada. We wouldn't tolerate that level of care ourselves ... and with the malpractice suits Americans are reputed for, you can bet your ass the barefoot doctor style of medicine would go bankrupt toute-suite!

There are so many other problems with the system. You simply can't blame it solely on doctor's salaries.

Canuck, with all due respect, people go into that line of work for the money. They go to medical school in Guadalajara and they think they're worth a quarter million a year to dispense pills and play golf on Wednesday, Lexus in the driveway and a nice McMansion in the burbs. They're holding us the rest of us at ransom and pointing the finger at the insurance companies, the trial lawyers, the patients who sue, the drug companies, everyone. And they've got the AMA, one of the most powerful lobbies in existence beating the drum at every opportunity.

Doc, when you figure out how to get needed medical care that doesn't bankrupt people let me know. See, you're in the same position as John Gotti-when we're sick and fucked up we have to pay the price you demand whatever that is-and where there's no alternative you and your friends will charge as high as you please, like a bunch of oil soaked petroleum barons from Dubai.

Did you take macroeconomics? Then you probably learned that when you're the only game in town you can charge exactly what you want and nobody's going to be able to do a thing about it.

Doc, my stepmother was in the same line of work as you aspire to. The only difference was that the good people of the Soviet Union paid for her training. There she was, crying the same blues you are, ten feet from the Steinway she bought with cash on the barrelhead.
If you believe in coincidence, you haven't looked close enough-Joe Leaphorn
 
dxing
Posts: 5859
Joined: Wed Nov 12, 2008 5:14 pm

RE: Single-Payer Healthcare

Sun Jan 18, 2009 5:39 pm



Quoting N801NW (Reply 36):
Monopolies are not illegal, per se in the US.

Yes they are.

Quoting Arrow (Reply 37):
Government-run does not mean no choices.

Government run means that no matter where you go the rules are going to be the same. You can shop around but the price is going to be the same. The quality is going to be the same, the problems are going to be the same.

Quoting Arrow (Reply 37):
Our single-payer system has lots of flaws that need fixing, but I wouldn't trade it for a 100% private sector solution. That's a path to bankruptcy.

And I would be the exact opposite.

Quoting DocLightning (Reply 38):
The USPS.

UPS, Fedex, any number of commercial transporters.

Quoting DocLightning (Reply 38):
The electric company

Here in Texas you have a choice of suppliers.

Quoting DocLightning (Reply 38):
The phone company

Cell and Internet phone service.

Quoting DocLightning (Reply 38):
The water. The roads. The garbage.

Water in many locations is a function of the County due to the nature of the service, not here in Texas. Roads are a necessity of the State although here in Texas the roads in my subdivision are owned by the subdivision and not the city so we pay for repair twice, through the subdivision dues and property taxes. Garbage depends on where you live. When we lived in apartments the management group hired a private contractor to take it away as does the subdivision we live in now. When we lived up north the City in which we lived took care of it so your examples while not wrong, are flawed and dependent on location.

Quoting DocLightning (Reply 38):
Healthcare is a basic service.

That you should be willing to pay for. If you are unable to pay due to being poor then there are already government programs to help.

Quoting DocLightning (Reply 38):
It is absurd that you think that both transportation infrastructure and healthcare should be completely free-market.

It is absurd that you would think that absolutely free healthcare with no limits is a basic right. Somewhere, some how, personal responsibility has to enter into your life.
Warm winds blowing, heating blue skies, a road that goes forever, I'm going to Texas!
 
PPVRA
Posts: 7878
Joined: Fri Nov 12, 2004 7:48 am

RE: Single-Payer Healthcare

Sun Jan 18, 2009 10:15 pm



Quoting DocLightning (Reply 17):
A 7-day course of AUGMENTIN, another two-component antibiotic that has been around for a few decades, costs about $200. Why? I have no idea.

Do you have any reason to believe this might be an expensive drug to manufacture? Expensive ingredients? Without going deeper into it I don't have an answer why it costs so much.


Quoting Arrow (Reply 21):

You've outlined a more intractable, systemic problem; a problem we share with you to a certain extent. Wouldn't it be nice if real electoral reform were possible, but unfortunately the guys and gals who have to implement the reform are the ones who do best exploiting the status quo.

Elected officials also come with problems, just like unelected bureaucrats. No need to look further than all our elected officials in bed with all kinds of big companies.

Quoting Dougloid (Reply 26):
Quite frankly Doc, your profession stands in the way when every person who graduates from a second rate medical school in Manila won't turn the key for less than a quarter million a year clear. Between that and the outrageous prices people are forced to pay for medicine in this country, that's what's driving the price. I daresay that if the Army trusts my son to go out and patch up wounded people and spend his afternoons ministering to local afghanis who walk miles to have their kids looked at and stitched up, he could do the same thing here.

What's needed is something along the lines of Mao's 'barefoot doctors' and get the price down to a level that's within our means, instead of sitting here trying to figure out ways to give more money to people who already make obscenely large salaries.

Doctors are highly protective of their profession. It's easy to understand why, but it's probably worth to consider whether we have gone too far in regulating the profession. Some of the posts above seem to indicate that and that some actions are being taken.

The supply of Doctors does matter, too.
"If goods do not cross borders, soldiers will" - Frederic Bastiat
 
N801NW
Posts: 558
Joined: Mon Jul 12, 2004 8:56 am

RE: Single-Payer Healthcare

Sun Jan 18, 2009 10:20 pm



Quoting DXing (Reply 40):
Quoting N801NW (Reply 36):
Monopolies are not illegal, per se in the US.

Yes they are.

To quote the Federal Trade Commission:

Quote:
A monopoly exists when one company controls a product or service in a market. If it’s because they offer consumers a better product at a better price, that’s not against the law. But a company that creates or maintains a monopoly by unreasonably excluding other companies, or by impairing other companies’ ability to compete against them, raises antitrust concerns.

Emphasis added.
 
dxing
Posts: 5859
Joined: Wed Nov 12, 2008 5:14 pm

RE: Single-Payer Healthcare

Sun Jan 18, 2009 11:41 pm



Quoting N801NW (Reply 42):
But a company that creates or maintains a monopoly by unreasonably excluding other companies, or by impairing other companies’ ability to compete against them, raises antitrust concerns.

Which is exactly what the government would doing by creating a single payer system. The only way a single payer system could be cost controlled is to make it a monopoly.
Warm winds blowing, heating blue skies, a road that goes forever, I'm going to Texas!
 
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DocLightning
Topic Author
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RE: Single-Payer Healthcare

Sun Jan 18, 2009 11:42 pm



Quoting DXing (Reply 40):

It is absurd that you would think that absolutely free healthcare with no limits is a basic right. Somewhere, some how, personal responsibility has to enter into your life.

Where did I say that? Quote it. Go for it. I'm waiting.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
N801NW
Posts: 558
Joined: Mon Jul 12, 2004 8:56 am

RE: Single-Payer Healthcare

Mon Jan 19, 2009 1:03 am



Quoting DXing (Reply 43):
Which is exactly what the government would doing by creating a single payer system. The only way a single payer system could be cost controlled is to make it a monopoly.

If a single payer system was implemented then it would most likely be monopoly. For example, in order to preserve universal access to mail, USPS has a legal monopoly on first class "letter mail." UPS and FX deliver parcels and courier pieces. They cannot deliver to mailboxes. I would presume the feds would insulate themselves from anti-trust legislation if they became everyone's health insurer.
 
dxing
Posts: 5859
Joined: Wed Nov 12, 2008 5:14 pm

RE: Single-Payer Healthcare

Mon Jan 19, 2009 1:04 am



Quoting DocLightning (Reply 44):
Where did I say that? Quote it. Go for it. I'm waiting.



Quoting DocLightning (Reply 38):
Healthcare is a basic service.

I guess that about covers that.

Quoting DocLightning (Reply 38):
It is absurd that you think that both transportation infrastructure and healthcare should be completely free-market.

Which you some how extrapolated from what I said about monopolies.
Warm winds blowing, heating blue skies, a road that goes forever, I'm going to Texas!
 
aa757first
Posts: 3140
Joined: Sun Aug 03, 2003 11:40 am

RE: Single-Payer Healthcare

Mon Jan 19, 2009 3:15 am



Quoting Dougloid (Reply 26):
Quite frankly Doc, your profession stands in the way when every person who graduates from a second rate medical school in Manila won't turn the key for less than a quarter million a year clear. Between that and the outrageous prices people are forced to pay for medicine in this country, that's what's driving the price. I daresay that if the Army trusts my son to go out and patch up wounded people and spend his afternoons ministering to local afghanis who walk miles to have their kids looked at and stitched up, he could do the same thing here.

Patching up wounded people is a lot different than treating them.

Quoting Dougloid (Reply 26):
What's needed is something along the lines of Mao's 'barefoot doctors' and get the price down to a level that's within our means, instead of sitting here trying to figure out ways to give more money to people who already make obscenely large salaries.

Well obviously the market decides how to compensates doctors. And I don't have any objection to the salaries they make, personally. An anesthesiologist goes into work everyday and stops a patient's breathing without killing them. I think that's a feat that is worth compensating.

Quoting LTBEWR (Reply 34):
You need a system that encouages healthy lifestyles, not forces the healthy to subsidise those that won't try.

That's part of the problem I foresee with single payer health care. What do we do with someone who smokes a pack a day? I don't really want to pay for their lack of discretion.

Quoting Dougloid (Reply 39):
Ninety percent of the medical care people get is routine, and they do not need somebody with a quarter million dollar education to tell them they have a cold. So maybe what you need to be doing is referrals from barefoot doctors instead of demanding that everyone with the sniffles pay for your education.

Ninety percent of the time, pilots take off, put the plane on auto pilot and land it. Every once in a while, both of a plane's engines go out and there's no way to get back to the airport. Pilots have an easy job ninety percent of time -- its the hard ten percent we train them for. Even if we assume doctors have an easy job ninety percent of the time (I disagree with that), we're paying them for that extraordinary ten percent of cases.

And now there are mid-level providers that get paid a lot less and do things like take care of colds. Nurse practitioners and physician assistants make anywhere from about $50,000 to about $80,000 and can treat patients with simple diseases.

Quoting Dougloid (Reply 39):
And before you disrespect my son tell me when you have had to figure out how to clean blood and brains out of the inside of a humvee or get people medevaced under hostile fire.He has.

It sounds like a challenging job, but the focus of the care is very different. Care in the field is basically A-B-C: keep the airway open, lungs breathing and heart beating. It tends (but not always is) to be more symptomatic. Care in the hospital, which a doctor is doing, is very long term. Of course, your son is also getting shot at when he does his job. That's pretty demanding, but the level of care he provides is still different than the level of a care a doctor provides.

Quoting Dougloid (Reply 39):
Doc Kolbay made house calls, the charge was about ten bucks, and we were better for it. When my old man nearly died from an allergic reaction to aspirin, Doc was there in about ten minutes in the sleepy little town I grew up in. In his 1950 Dodge with his bag. Saved my old man's skinny ass.

But medicine back then was different and we can't deny that. His patients probably weren't telling him that they would sue him directly to his face (not uncommon). On top of that, the medicine he practiced was arguably simpler. How many of his patients had HIV/AIDS, diabetes, asthma and depression with nine different prescription medications and three specialists?

Quoting Dougloid (Reply 39):
Canuck, with all due respect, people go into that line of work for the money. They go to medical school in Guadalajara and they think they're worth a quarter million a year to dispense pills and play golf on Wednesday, Lexus in the driveway and a nice McMansion in the burbs. They're holding us the rest of us at ransom and pointing the finger at the insurance companies, the trial lawyers, the patients who sue, the drug companies, everyone. And they've got the AMA, one of the most powerful lobbies in existence beating the drum at every opportunity.

What about working about eighty hours a week for four or five years with your instructors constantly asking you questions you don't know? What about taking continuing education, defending yourself against lawsuits in court, calling other doctors to talk about your patient's condition, getting phone calls from nurses and patients at 2:30 AM? Medicine is one of the most -- if not the most -- demanding professions in the world.

Interestingly enough, if we did a poll of people who were waiting in the ER after their husband or wife or child was in a serious car accident, I'm sure they'd say you couldn't pay doctors enough for what they're doing.
 
Dougloid
Posts: 7248
Joined: Tue Jul 05, 2005 2:44 am

RE: Single-Payer Healthcare

Mon Jan 19, 2009 6:15 am



Quoting Aa757first (Reply 47):
Well obviously the market decides how to compensates doctors.

Wrong. When you're the only game in town you get to charge whatever you like. And when it's something that people go without at their peril. the notion that the market sets the price is specious. There's simply no competitive product. It's a classic monopoly with all the trimmings.

Quoting Aa757first (Reply 47):
Interestingly enough, if we did a poll of people who were waiting in the ER after their husband or wife or child was in a serious car accident, I'm sure they'd say you couldn't pay doctors enough for what they're doing.

Your entire screed is a rationalization for the cold hard fact that they've got us by the balls good and hard and they're not interested in letting go or cutting any deals.

Quoting Aa757first (Reply 47):
It sounds like a challenging job, but the focus of the care is very different. Care in the field is basically A-B-C: keep the airway open, lungs breathing and heart beating. It tends (but not always is) to be more symptomatic. Care in the hospital, which a doctor is doing, is very long term. Of course, your son is also getting shot at when he does his job.

Whenever he goes out on patrol, his unit will stop somewhere and set up shop. The word gets around pretty quick and a lot of his work is doing the peace corps/medecin sans frontiers kinda thing-hearts and minds, y'know. They treat anyone until they're out of supplies. People will walk six or eight hours just to get looked at by a kid with a year's training and a year's experience in the field.

See, here's the deal. One day, some guy is going to be at the mosque Friday and the mullah will be bitching about the Americans this, and the Americans that, and this guy will say to himself "F**k that-they came into town, saved my kid brother's life and didn't even ask to be paid."

That's the reason for it.

the other reason for it is my kid got into the field because he wanted to help people-he's not getting rich in Uncle's service.

What we've got in this country is like the dollar sign that Jesse James the chopper man has tattooed on the palm of his hand that says "Pay up, sucker."

Quoting Aa757first (Reply 47):
What about working about eighty hours a week for four or five years with your instructors constantly asking you questions you don't know? What about taking continuing education, defending yourself against lawsuits in court, calling other doctors to talk about your patient's condition, getting phone calls from nurses and patients at 2:30 AM? Medicine is one of the most -- if not the most -- demanding professions in the world.

I never said it wasn't demanding. . What I'm objecting to is the sense of entitlement. That's unique and offensive.

Quoting Aa757first (Reply 47):
Ninety percent of the time, pilots take off, put the plane on auto pilot and land it. Every once in a while, both of a plane's engines go out and there's no way to get back to the airport. Pilots have an easy job ninety percent of time -- its the hard ten percent we train them for. Even if we assume doctors have an easy job ninety percent of the time (I disagree with that), we're paying them for that extraordinary ten percent of cases.

Most pilots don't get paid shit. Very few ever get that payday you're talking about. They do it because they love it and not because they think they're going to get fat off it, or that they deserve to get fat off it. Besides, we as civilians have options, because we can choose to take the train, drive our cars or take the Greyhound. Medicine and health care are not like that at all.

The analogy's flawed.

I wish you could have seen my stepmother the MD crying the same blues right next to the Steinway Grand she paid cash for. The bill was inside the lid.
If you believe in coincidence, you haven't looked close enough-Joe Leaphorn
 
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RE: Single-Payer Healthcare

Mon Jan 19, 2009 6:38 am



Quoting Dougloid (Reply 48):
Your entire screed is a rationalization for the cold hard fact that they've got us by the balls good and hard and they're not interested in letting go or cutting any deals.

Some do. Read the PDF link in reply #3. Why not every MD is doing this? I have no idea.

My opinion is that being an MD isn't just like "any other job". It's far more demanding, requires much more education to get there, etc. And yes, I think your son should also be get a high salary for doing what he's doing out there, because of the risk factor involved.

Mind you, I'm not one of those who believes that MDs are wizards who know everything, and that you have to listen to them as if what they say was the bible. My approach to MDs (unless I'm there almost dying, that is) is "I'm the customer, you're the provider, let's talk". It works pretty well, and a MD visit for me is always a little science lesson. Doesn't work with every MD, though  Smile

What I want to say is that medicine isn't one of those subjects you can learn online. You really have to be into it for years and years. And you have huge responsibilities, because people's lives are in your hands. Mistakes happen to MDs, too, but it's not the rule. They mostly save lives. And that's why they deserve a high salary. This doesn't mean MDs do their job because of the salary, but if I was an MD, I for sure wouldn't give away my high salary only because it's nice to do so...
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