Now, I’m well aware that having 47 million people who can’t afford medical care is a genuine social problem — although many of those millions are illegal immigrants, people between jobs and young folks who choose to go insurance-bare. I’m also aware that I can’t necessarily have everything I want, whether it’s a dozen pairs of Prada boots or a pacemaker at age 99. I know that Medicare is on the greased rails to a train wreck, and not just because of spiraling costs but because doctors are fleeing the system because they’re sick of below-cost reimbursements and crushing paperwork. There are ways to solve some of these problems: healthcare tax breaks, malpractice reform that would lower the cost of practicing medicine, efforts to make it easier to get cheap, high-deductible catastrophic coverage, steps to encourage fee-for-service arrangements of the kind that most people have with their dentists.
In short, as someone who’s not getting any younger, I’d like to be the one who makes the “difficult decision” as to whether I can afford — and thus really want — that hip replacement in my extreme old age. Sorry, President Obama, but I don’t want “society”– that is, government mucky-mucks — determining that I’ve got to go sit on an ice floe just because I’m old and kind of ugly, no matter how many fancy degrees in medicine or bioethics they might have.
Not having health insurance is not the same as not being able to afford health care. My community, like most large cities, has an excellent public hospital and a network of good community health centers. Because my clients are mostly indigent, I see their services up close, and I’m telling you, they get better health care than I do in many cases.
Insurance is, essentially, a socialized form of medicine: risk is aggregated and services dispensed according to need by large central bureacracies – (private companies in the U.S., the government in places like Canada. The essential problem is that medicine has become a business rather than a service; in a business, the consumer needs direct control and real choice. The plans Pres. Obama has for us will make a bad situation worse.
I’ll keep on saying it:
Government involvement in medicine, health care, and insurance should not increase one bit until they have proven their ability to improve on what they already do — Medicare, the VA, and Indian Affairs.
[b]Fix Medicare first.[/b] Then talk to me about how well you can run the rest of it.
She’s right.
It is more than possible that a ‘monolithic’ national health care law will result in government bureaucrats, regardless, of their credentials, making decisions that violate a patient’s rights.
Health care decisions should be made in the doctor’s office and be made bettween the patient and the practicioner. The doctor-client privelege of choice of medical care must not be tampered with by ‘progressive’ politicians.
The failures of Great Britain’s and Canada’s monolithic health care programs make this patently obvious.
As Charlotte Allen pointed out, there will always be people who cannot be reached/will not cooperate with whatever health care system that is available. What she is really pointing out is that there is a “diminishing point of return” for the expenditure of health care money by the government. That is, one additioanl unit of health care money might not serve to bring health care to one more person, Instead it might take five, ten, twenty or 100 additional units of money to reach that person.
We have homeless people who will not utilize shelters even when cold and hungry. What should we do here? A ‘progressive’ solution might be to force them to seek shelter and food by rounding them up against their will and placing them ‘hospitality’ shelters. A next step might be to evaluate their ‘worth’ to society and to evaluate their ‘cost’ to society. And what comes next? A utopian “final solution” for the homeless?
Ms. Allen, the ideologue, says “Sorry, President Obama, but I don’t want “society”– that is, government mucky-mucks — determining that I’ve got to go sit on an ice floe just because I’m old and kind of ugly, no matter how many fancy degrees in medicine or bioethics they might have.”
She would rather have us dependent on corporate mucky-mucks, all the insurance, pharmaceutical, health-aid, nursing-home, assisted living executives who have helped create the mess we’re in. Instead of rhetoric and the “solutions” touted by all her ideological buddies, she might expend her formidable intellectual powers to suggestions about how we might deal with her corporate allies who are all lined up and raring to go to make sure they get a piece of the pie. As for her assertion that many of the millions of uninsured are illegal immigrants, is she willing to actually provide figures? Or has she once again slipped into the ideological obsessions of her allies?
And cheap, low-cost catastrophic insurance with “high deductibles” would only be available to the rich –
Ms Allen and her allies are the Social Darwinists of our age – with reference to medical care, their advice to the poor, and especially the working poor, is “you die first”. Someday, newspapers and magazines, especially those interested in real-life problems, might want to ask real human beings why they do not have access to health care. Or why they can’t afford to pay $1000 a month for family insurance coverage, or $300 a month for two medications.
As for modeling a health-care system on the practices of dentistry, what a joke. Ask parents whose children have access to government-sponsored insurance for their kids about their success in getting minimal dental care for their children.
As always with ideologues of the left or right, it is difficult to have them live and solve problems in the real world. But when you make enough money to live in wealthy suburbs and design your own health insurance packages, why care for people who work hard, are paid little, and irritate the hell out of you because their plight disturbs your complacency?
And I never fail to be amused by the casual assertions that there is no health care problem; there are just people who don’t cooperate with the health care system. I will relay that information to those I know who in the past month alone decided not to deal with a medical problem because they had no insurance and could not risk the possibility their doctor would prescribe tests they could not afford. If people did not want to use the services provided them, there wouldn’t a problem. The issue is people who desire medical care and have no access to it. But why confuse the discussion with any consideration of reality?
Reply to #4.
So its always the big ‘evil’ corporations?
We should just leave this all in the hands of our kindly and competent politicians?
These politicians seem to be some sort of benign “dictatorship of the proletariat” to many universal healthcare advocates.
Kendall,
The problem with Obama’s health care reforms has nothing to do with medical care. It has to do with socialism.
To put it bluntly, if you have free bread, you have to have a bread line with rationing. It is the only way to be “fair”.
This society decided in the 60’s with Medicare and later with Medicaid that it wanted someone else to pay it’s medical bills. The problem with US medical care is that we have had 40 years of socialism WITHOUT the rationing. It is socialism, American style. That is why the costs have exploded.
Lack of approprate rationing is like walking into the store waving your daddy’s credit card around and asking the merchant what he has for sale, telling him money is no object and you will be back every day forever. Well, if I was that merchant, I would be sure to have “only the best” items for sale in my store every day. In fact, I would order the items on which I was assured the highest profit margins for my new customer with a deep pocket “sugar daddy” behind him. After just a few weeks, it would be amazing how expensive everything in my store would have become.
I’m forever amused to hear “conservatives” argue against “government takover” of healthcare. What they are saying is that they want whatever they want on society’s nickel.
Next post I’ll explain why any goverment insurance plan, and to a great degree any private plan, inevitably produces this sort of problem. Unless we are prepared to go back to only fee for service care, we have to have rationing.
I’ve had a great weekend and too tired to post much, but consider this: if we treated auto repair the same way we treat our healthcare, what do you think an oil change would cost your insurance company (after your copay of course)?
It’s not a matter of ideology or corporations, but simple economic reality. Government has steadily been annexing the healthcare field to the point that it today spends about fifty cents of every dollar spent on it. Has it gotten any cheaper? True, the technology has gotten much better, but so has the technology of the laptop I’m typing on right now. Why has the price of the laptop plummeted while the price of healthcare skyrocketed? Are the executives in tech industries more moral and altruistic than in healthcare?
We don’t have “insurance” in healthcare anymore, what we have is first-dollar pre-payment plans that are not purchased by those who use them. If we want to put burueaucrat in charge of rationing care (and that’s exactly what it is), then expect a lot of people to die and little control of costs. My solution would be to put 300 million cost-contrrollers on the street in the form of savvy consumers. We do it with computers, HDTVs and cell phone plans…there’s no reason we can’t do it with health care and insurance.
# 7 and #8,
Of course you are absolutely right. However, we decided 40 years ago not to take the course you propose. I’d be all for it. However, I think that the voters would throw out any polititian who proposed such a solution, or even took steps toward such a solution.
The next best thing would be to propose a “health care floor” concept, rather than “universal coverage”. In my model, we would simply acknowledge what already exists and say that there is no excuse for people to not get basic care. We would have community health centers where people could go for free and see a salaried NP or PA, overseen by an MD. There would be no marble on the floor, they would loose the right to sue and could only complain about medical quality, not how they were “treated”. The waits would be long, but everyone would be seen. Eventually. This would work alot like how we see patients on our medical mission trips. Everyone checks in at the beginning of the day and is seen in order of arrival.
Right now the indigent get their care in the ER. Sure, they get bills, but they are “judgement proof” since they don’t own anything. So, the hospital just has to write off the bill as uncollectable. For the working poor, they eventually take everything you own, then your medical care is essentially free, since the bills go unpaid and the ER can’t turn anyone away by law, so the way they ration care is by the waiting line, which is hours long. We have universal coverage already, but have a crazy way to “pay” for it.
Every year, hospitals get block grants to cover this unfunded care, and you and pay for it too through “cost shifting” onto our insurance.
Real tort reform and having people pay for a large part of their own care out of pocket would drive down costs, like it does in 2nd and 3rd world hospitals and medical clinics.
I’m afraid that most of what we do in medicine is required by the lawyers and not really demonstrated to prolong life or improve outcomes.
I’m not optimistic about Mr. Obama’s plan to control prices; not because it wouldn’t work (rationing always works to control costs–just say no, as it were), but because he won’t have the political courage to impliment such controls. The simplist way for him to create a permanent democrat majority is to just start sending out Medicare cards to the 50-65 y/o community. Sure, costs would go through the roof, but that won’t matter because these new addicts would always return to their new “pusher”, Obama, come election time.
I suppose they could just print some more money to pay the bills.
I don’t see the difference between your plan and Obama’s, honestly, Jack. Just try telling the American public you’re implementing a formalized two-tier system and wait for the howls of indignation.
No, either we take steps in the right direction or we don’t.
Anytime you send the bill to someone else there will be rationing. If not, then the cost becomes infinite as in the emergency room. Withour tort reform, the medical profession will not be guilty of rationing. There will be no tort reform since most of the Democrats are lawyers. Unless the thirteenth amendment is repealed, then you can’t force providers to provide for free or below cost. But this is what the people vote for and it is part of the judgment of God on our baby murdering society. There are answers to all this but those who have the answers are out of the loop. Enjoy.
Jeffersonian,
I think the difference is that Obama claims that he will meet our medical needs completely with his system. My pathetic idea is really just a return to the 1950’s model of charity care, where we try not to let people die in the streets from preventable medical illness.
It remains to be seen if Obama and Co. will try to outlaw private medical care. I assume that this will come later, as people find out that the private first tier system of payment offers better care. But that will only be a problem after the rationing is implemented. He won’t be able to ration and survive politically until after he has almost fully cornered the market with his heavily subsidized “public” option. After most everyone has dropped their private coverage, he or another administration can start the rationing.
Until then, I’m expecting a pretty generous “public” option in order to get the doctors and patients to play ball and drop their private coverage. When the inflation rate/taxes go up and economic growth stops, he can justify the draconian rationing and/or outlawing of private care.
I’m thinking the next 2 years are going to be great for the medical community-awash in borrowed money and little restraint required. After this will come the induced famine years.
The reason why I don’t think Obama will actually ration for a while is that he could start appropriate rationing right now in the areas of healthcare that the Feds control already. The fact that he won’t start with cost control in Medicare tells me that he won’t control costs in his “public” insurance option either, because it is politically impossible to say no to anyone. It’s true that Medicare weakly tries to control costs by capping physicians fees at 50 cents on the dollar or so, but they do this while still allowing inappropriate and unproved procedures to get paid for which suck the money out of the system for the important stuff like chronic disease management, etc.
That unneeded hip replacement could pay for alot of hypertension management! Oh, and I don’t think it is appropriate to fix hips on patients with terminal illness. We can give them good pain control. They will die of broken hip, or pneumonia or heart attack, etc. They need to be on hospice comfort care, not getting aggressive and futile medical procedures that don’t substantially prolong their lives and are very expensive.
The simple question that never gets asked, let alone answered: If I receive medical services, why should anybody be responsible for payment besides me?
There are a lot of aspects to be considered, to be sure. But we start from very many different assumptions, and never seem to settle the foundational issues before assigning blame and/or trying to fix “The System.” Of course, Healthcare is not a system at all, but an ecology. It’s not a deterministic automaton. You can’t “fix” it by imposing politically-motivated rules or establishing mechanistic levers to achieve a predetermined outcome: optimal health for all (“optimal” being defined as whatever it takes to make me feel good), at reasonable cost to consumers (“reasonable” being indexed to my ability to pay), with reasonable profit margins to all product and service providers (“reasonable” being defined by ability to satisfy principals/investors.) The government is not equipped (or intended) to solve even that minimal balanced equation of competing needs; add in employer/sponsor interests, legal and regulatory complications, political influence, and economic philosophies, and why would anybody think that a central gov’t plan could ever produce a better outcome than a free market and a compassionate charitable movement?
I should clarify: I’m not suggesting that there aren’t grave flaws in our current “ecology”. I meant to suggest that you can’t blame the current mess on the failure of free market forces, because what we have is not anything like a free market. Gov’t more often than not distorts the allocation of resources rather than makes it more efficient. To adapt a phrase from Pres. Reagan, “Gov’t influence on healthcare isn’t the solution, it’s the problem.”
Good points all, but to be fair, fee for services (your pay for what you use) is also a form of rationing. You don’t get what you can’t (or wont) pay for. You do without. Unfortunately it’s that willingness to do without that keeps the prices down. If a third party is going to pay my expenses then Jeffersonian is exactly right.
“Fee for services …..is also a form of rationing”. Hmmmm, I think that comes under ideology: looking for equal outcomes instead of equal opportunity.
And it is “the willingness to do without that keeps prices down”? No sir, it is a free market and bruising competition coupled with innovation that keeps prices down. To use an analogy from an earlier post, it was not declining demand that dropped laptop computer prices: it was demand coupled with aggressive competition.
Just imagine Wal-Mart jumping full bore into the medical services industry to give physical check ups. It would be with a med-tech and sophisticated technology and software. It would be cheap and you would pay for it and own the results. Take them to your personal doctor for analysis if anything was out of the norm.
For what this country spends on healthcare, there are armies of entreprenuers who would love to fight it out to grab a piece of that pie by providing the best services at the lowest costs.
Walmart and medical services are not the same sort of business. In a decent society, what Capn Jack Sparrow calls a “health care floor†is available to all without regard to ability to pay. If that’s not an agreed moral imperative, then arguing about ways and means is a waste.
Words #17,
My concept of a “medical floor” does not necessesarily imply that the government would/should provide this. Traditionally, religious orders and churches founded many of the great hospitals in this nation and around the world.
My ideal would be for the government to do this only up to a limited degree. As religious and private structures moved in to perform the services with greater efficiency and compassion, government need would “wither on the vine”, as Mr. Gingrich said a few years ago.
I agree with you that a decent society requires a “medical floor” of sorts, just as it requires a housing floor, etc. No one should die on the street due to lack of a place to stay. We are not India or Pakistan. A civilized society, because it is civilized, will have good people within it to rise up and provide such services, as ours does.
The problem with what has happened in America and the west in general is that in our desire to institutionalize poverty relief, we have politicized it and twisted the purpose away from relief toward winning elections.
16, no. It’s supply and demand and ability to pay. If I can’t afford to pay for an operation I don’t get it. That is a form of rationing. It’s rationing by price. It’s one reason I don’t have a Rolex.
Now if the doctor lowers his price to what I can afford the operation then I will have the operation. That is all I meant.
#18 Capn Jack Sparrow says:
The difference is that government is accountable for providing the service, and private organizations are not. If, say, a particular church provides free annual checkups for the uninsured for twenty years, and then decides that for whatever reason it can no longer do so — then that service disappears. Sure, it would be hoped that some other organization would step in to fill the gap, but there’s no guarantee that one would.
On the other hand if the government (local, state, federal, whatever) is providing this service, then there’s an accountability to the public involved. The public has a say in whether, and how, this service is provided; and since it’s provided for the public good, they are legitimately an interested party.
Put another way, perhaps the government agencies could indeed “wither on the vine” as private charities take over; but they also need to be able to un-wither promptly in case the private charity goes away.
I’m not saying this is a clear-cut reason for government providing the “medical floor” (housing floor, food floor, etc.), but it is an argument in favor of it. Perhaps the best solution is some kind of system where the government is a guarantor that a minimum level of service will be provided, and works with private organizations wherever possible to achieve that. But, of course, then you have government involvement again.
#20,
I would take issue with your idea that the government services are “accountable” to the public. In theory, yes, but in practice government tends to become a law unto itself. It hates competition with itself and tends to consume and destroy all structures which show up the innefficiency that is inherent to the political process.
Perhaps as you seem to be suggesting, there could be some sort of public/private partnership, much like the utility companies, where there are mandates given regarding universal coverage, but otherwise the business providing the service can do what it needs to do to get the job done.
Overall, however, if the bills are payed for without any rationing, then cost will simply rise proportionately to consume the available cash and then some. It’s just basic economics.
I would like a survey with each of the commentators responding as to who pays for their insurance coverage and how much out of pocket expense they pay. I’ll go first. I pay for my entire family’s plan. After considering deductibles it’s about $3,000 per month, more that twice my mortgage. It is a crushing expense. OK Words Matter, how about you go next?
#22 I pay for my family that is about $1300 per month before deductibles. I also pay health insurance for two employees, that is an additional $1000 per month. Last year I think my family paid about $4,800 out of pocket in medical expenses in addition to the insurance. So by my calculation I paid about $32,400 to support the current health care system last year.
#23 can empathize with my predicament. I have several ideas but I am more interested in yours. What should we do as small businesses?
#24,
Look up the Health Savings Account as an option.
I use an HSA for my family and pay several hundred dollars a month for catastrophic coverage ($10,000 deductable). We have been very blessed with good health, so not so much medical costs other than our premium. If we were to take a major hit, it would be painful, but full, low deductable coverage would be $1200-$1400/mo even for a healthy family. I figure that the deductable difference has already paid off for us, as we have been doing the HSA thing for years and I figure the 10’s of thousands of dollars we have saved make up for the extra risk of having a bad year at some point.
The HSA is a tax deuctable savings account linked to a high deductable major medical policy. I figure health care is alot like auto repairs. You just have to figure you are going to get hit one way or the other, so I’d rather be in control with the HSA rather than have the insurance company be in control.
Thanks JS I already have an HSA which was once a MSA. “I figure health care is a lot like auto repairs. You just have to figure you are going to get hit one way or the other, so I’d rather be in control with the HSA rather than have the insurance company be in control.”
Its actually a combination of Doctors, Insurance Companies, Lawyers, Pharmaceuticals etc and others who are paying the lobbyists who are pulling the strings. My premiums are rising around 25% per year.
I made up my mind yesterday that I was going to take ownership of this problem. I have a lot to say on this issue but I am really looking for comments so that I can get a reading from an unbiased point of view.
Health care, as with all consumer goods and services, is currently rationed and always will be. The only debate is the method of rationing. Most people believe the current system, rationing by insurance companies, drug companies, and health care providers with the goal of maximizing their profit, is not sustainable. I agree. That leaves only two choices, rationing through free market capitalism or some level of government involvement in the rationing process.
In a free market system it is survival of the wealthiest. If you can’t afford health care you do not get it. I reject the idea charities can adequately fill in the gaps. The ability of charities to help depends on the wealth of their community; thus charitable care will very tremendously depending on where you live. Those who would rely on charities should spend a year in Kolkata, formerly Calcutta. Despite Mother Teresa’s best efforts disease still spreads rapidly and people die in the streets daily from malnutrition and curable disease.
I appreciate Capn Jack’s belief we are a civilized society unlike India or Pakistan, but I think that is a little Pollyanna and somewhat insulting to Asians. Take a look at life in American cities from the mid to late 1800’s. A period of time during which we were decidedly more religious and decidedly more capitalist than we are today. We had 11 year old children and women working in sweat shop factories for barely enough money for food, and when you became too old or to sick to work you were left to your own devices; and yes, many, many people (particularly emigrants) died in the streets and in ghettos from lack of health care and food.
Also Word #17 you are correct. The Wallmart/computer argument does not work with health care. With all respect to Br Michael I can do without most consumer goods, but if I am diabetic I can’t do without insulin. If I have cancer I can’t do without cancer treatment. If I have clogged arteries I can’t do without a heart bypass. If I live under a free market health care system I will do whatever I have to obtain necessary care, especially if it is for my children; because if I fail, I, my children or both die. Life under a pure free market system becomes very cheap, which is why you can buy a kidney from a starving man India or a child servant from a starving family. Just as you could in Europe for most of its history and in America until the early 1900s, including the periods when church and government were essentially one.
Do I have the answer? No, but when it comes to health care, I believe pure free market principals are morally deficient and that in a civilized society some level of government involvement is necessary to prevent unnecessary death from illness and malnutrition.
I also cannot accept the idea that there is no good government sponsored health care. People in Sweden and France both express higher levels of satisfaction with their health care than Americans do today.
#27,
Good points all. Alot of the improvement in society’s standards, IMHO, has come from the good and very Christian desire to improve the lot of others. The spread of Christian ideas through the culture, as a result of the prominance of the gospel in 18th and 19th century England/America, is the very force that brought people to attempt government forced charity on others in the form of misguided “progressive” politics.
So, don’t get me wrong, I’m all for improving other’s lives. What I’m against is the political process and the obvious politicization of poverty that is destroying the Republic and the medical profession.
Sweden and France have populations that are used to rationing. If we are to have a “successful” socialized medical system, we will need rationing too. I’m very realistic about this-I think it’s going to happen, and Americans are going to be very unhappy with it.
However, the Democrat party will profit greatly by it, in fact they will may establish a generational hold on power because people will fear loosing their benefits, however meager, if they are voted out.
Thanks #27, I can tell that you get it. I have a general question. Why should my elected officials be entitled (entitlement) to relatively free health care and unlimited access and I have inferior health care which is incredibly expensive and very limited in terms of access?
My employer pays my health care premiums. If I had a family, I would be out several hundred dollars per month for them. I have a small co-pay for office visits and a more substantial cost for medications. As a matter of fact, I can’t afford a med right now, but it’s not a life-threatening situation, so I’m not complaining.
Regarding government run systems, I have known folks from Canada and New Zealand who very much liked their care. My mother got sick in Scotland and received excellent care. Her doctor was American and had moved to Scotland to get out of the medical rat race. I don’t buy all that Mitchell says (particularly dredging up 200 year old material), but it’s just as false to say no government intervention works. As I said in #1, my own community has an excellent system of public health services, county-run.
Perhaps as Americans, and Christians, we should address what really ails the United States including our health care, that being a materialism that never satisfies: we seem to forget that avarice is just as deadly a sin as lust.
For my money (literally), medical savings accounts would be far preferable to an insurance system for the general population. For those outside that system, public hospitals and clinics are an excellent alternative.
#30 You are dead on that the problem is materialism. No system will work with the state our nation is in. That’s why I’m pretty much resigned to the tyranny that we will get–and that we deserve.
#27 wrote: “In a free market system it is survival of the wealthiest. If you can’t afford health care you do not get it.”
Nothing, and I mean nothing, could be further from the truth of free markets. Price is not an absolute set by the seller in free markets. Price is the variable which equalizes supply and demand. If demand outstrips supply then price goes up. But when price goes up, new suppliers figure they can make a profit so they enter the fray. Now supply exceeds demand and in a free market that means that price will fall. Innovation plays a key role in that when everyone thinks supply and demand are in balance (and price is stable), some clever person figures out how to service more demand with the same amount of economic input (more efficiency). Short term they reap more profit, but eventually the innovation becomes widespread and the consumer wins with lower prices.
#17 said Wal Mart and medical services are two different thing–not so! In our area WalMart has an optical shop for eye exams and sell glasses and contacts. Prices are lower than the competition, hours are longer, and I judge the service to quite adequate.
My husband and I have paid for our own medical and disability insurance for many years. It’s not cheap by any means, but we do have a high deductible which makes the premiums much lower. My sister’s family has enormous health problems and expenditures every year. She complains loudly about her premiums, but I don’t know what the solution is for her, considering that they all go the doctor for costly procedures and tests year after year. Who should pay for that? Personally, I think most people who complain about not having insurance could probably afford some type of insurance that is not intended for maintenance-type coverage but only catastrophic coverage. I think the public mindset these days is that someone else should be taking care of them. This is a sad commentary of where we’ve come since the country was founded. Folks would rather have chrome wheels and a giant-screen TV than buy insurance. Not to mention the huge built-in costs due to malpractice premiums for doctors. I work in the court system and see many frivolous medical malpractice lawsuits. Juries want to award people in sad circumstances even if the medical providers have done nothing wrong; a fact which the plaintiffs’ bar is counting on. Many times the insurance companies settle, not because of any admitted liability but to avoid the sympathetic jury factor and the expenses of discovery and a trial. This needs to be addressed by congress, but I’m not holding my breath.
“With all respect to Br Michael I can do without most consumer goods, but if I am diabetic I can’t do without insulin.”
Actually you can. Just not very long. 27, restated my point: “Health care, as with all consumer goods and services, is currently rationed and always will be. The only debate is the method of rationing.”
Then do we step in and ease the harsh laws of pure economics and provide for those in need? Yes, we do. And we can argue endlessly over the means.
Nevertheless let us remember that as Christians, death is not the end, nor is it the worst that can happen to us. We are all going to die, but we are going to be resurrected with Christ. We have a lot of life in us.
As a Canadian, I find this whole discussion bizarre. Hiccups aside, the Canadian health care system works about as well as the one in France. I don’t have to get a 2nd mortgage in order to get hip surgery or heart surgery. Don’t listen to ideologues who tell you our system doesn’t work. The only big losers are big insurance.
#35, tell me more because this is not at all what we hear in the US.
#35
What percentage of healthcare received by Canadians is actually done in the US for cash??
Last time I checked it was about 35%. Granted, perhaps alot of that care did not really need to be done, but isn’t it hard to defend a system that merely outsources it’s dissatisfied customers while claiming to meet their needs?
#35 And don’t forget, the Canadian system is fundamentally different from Europe. In Canada, it is ILLEGAL to hire your doctor to see you outside of the much vaunted “single payer system”. In England and Europe, if the NHS lets you down, at least you can beg, borrow or steal some money and pay for the care that you think you need.
The complete loss of choice, even with one’s own money, is one of the reasons why the left in this country so admires the Canadian system over that of Europe. The left really does want to control other people with their own agendas. So far Obama has not proposed outlawing private medicine Canada-style, because the people would be even more afraid of him than they are already. He can outlaw private medicine later as a supposed cure for the “inequalities” that will arise as people pay his massive health tax and still have to pay their private doctors for what they want. Again, granted, if the rationing is set up correctly, perhaps much of what they choose to pay extra for will not really be medically necessary.
Personally, I’m not opposed to the loss of choice when one is spending taxpayer’s money. But to loose choice when I am spending my own money is, well, UnAmerican.
The idea Capn Jack might be to reinvent a system which really works. The private parties are too greedy to do it and have no incentive to do so. The system is not market driven and is controlled by special interests. I believe that the only way to stop this train wreck is through government intervention, slightly short of National Health Care. As much as I dislike government intervention, I believe the system is corrupt and must be changed.
Ross # 20 The difference is that government is accountable for providing the service, and private organizations are not. You think this is true? Look at our public school systems.
Our local paper had an interesting article by Susan Riggs, a Canadian, on the Canadian Health Care system. If you’d like to read it, it can be found at:
[url=http://www.tallahassee.com/apps/pbcs.dll/article?AID=2009906300305]Copy Canada’s health care? Not so fast!
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sorry about that, the link didn’t ’embed’.
Still, nobody wants to tackle the fundamental question I asked in #13: If I receive medical services, why should anybody be responsible for payment besides me?
We can keep moving the pieces around the game board all you like, but until you get to the core issues, you might as well be playing chess against a checkers opponent.
Don’t misunderstand me to say that I’m advocating an every-man-for-himself approach!
I can’t wait. As soon as all the doctors work for the government, then we all get to work like government employees! Enjoy.
Country Doc, until your profession takes responsibility for being a large part of the problem you can expect to eventually work for the government. To date I have seen mostly whining from physicians with very little effort put forth on solving the problem. Physicians have had more than a decade to be part of the solution and I have seen nothing substantial in the way of reforming the system from the private sector.
Lee, physicians have the answers to all these problems, but we are out of the loop. Organizations like the Association of American Physicians and Surgeons have been beating the drums for over fifty years and no one listens. We are few in numbers, and the percentage of the medical costs that goes to physicians is very small. Greedy or foolish patients and families are in the saddle and the lawyers are the terrorist. None of us can stand up to that, except by just withdrawing which is tracking the trajectory of TEO. No one in the legal profession is doing any thing to stop the corrupt court system. The Lawyer in Chief, BHO notified the AMA that he would oppose any tort reform. Of course he will. I no longer go to court as an expert because of the corruption. Today in our news paper was a big add for anyone who had a loved one who took Avandia–one of the best diabetes drug-to contact their office if they had had a stroke, heart attack, or death–all found with diabetes. They can get you some money. Maybe they can get that one off the market. That should lower medical costs. No, families and the lawyers are in controll. One nice thing about being a government worker is sovereign immunity. In our community no new doctors have come who were not salaried by our county hospital which has sovereign immunity. Nice.
Thanks Country Doc and I want you to know that I was not attacking you personally. Frankly my heart is with the GP not the specialist. I have become a victim of the system not a patient.
Having said that, I do not see any starving physicians. I think as a group the profession is the smartest on the planet but I see much greed and a sense of entitlement because of the difficulty of Medical School and day to day practice. etc.
This is the point I am trying to make. If for example a tax credit is given to Americans to buy private insurance all of the big three will begin competing for those dollars. It wont solve the problem.
I truly believe that is all of the big three would listen to folks like me we could avoid national health care. But it will not happen. I’m afraid that the solution is a political one and because healthcare is pushing me to great financial stress I have had enough.
BTW I have quit testifying as well, mostly due to tremendous disappointment over judges within our system.
Country Doc, two years ago our state enacted Tort reform. As the AMA requested we capped non-economic damages at 250k and required an affidavit from a physician agreeing malpractice was possible given the facts before a law suit could be filed. Several law makers tried to tack onto the bill a requirement that the malpractice insurers must lower rates as a result of the significant change. The insurance lobby killed that amendment and the law passed without it. To date there have been no decreases in malpractice insurance premiums for physicians.
In the process of debating tort reform we found out that the total of all medical malpractice payouts in the US in 2006 made up about 1.00% of health care spending. We were told that on the average a physician spends less than 4.00% of revenue on malpractice insurance. We also discovered that medical malpractice insurance is a very profitable product for insurance companies.
So given our experience here, I am highly suspicious of the claim that the problem with health care is greedy patients and the legal system. I think that more of a myth propagated by the malpractice insurance industry to keep their premiums and profits high.
“One nice thing about being a government worker is sovereign immunity. In our community no new doctors have come who were not salaried by our county hospital which has sovereign immunity. ”
Indeed. Three months ago, I traded private practice for working at a VA hospital. My life has improved astronomically. I no longer worry about being bancrupted by a dissafected patient for something I could not prevent and did not cause. I no longer work on weekends. My schedule is an extremely reasonable 50-55 hours a week, instead of the more than 80-100 hours a week I was working previously. Best of all, now that I no longer have to pay for daily fast food (I have time to cook now) daily after-after care/night care/weekend care for my child, malpractice insurance, etc I find that economically I have come out way ahead. I spent the first month going to bed at 8pm and sleeping all weekend. For the past two months I have not been tired at all, and have spent my evenings, and weekends gardening, and taking my kids swimming and fishing. I feel like I’m on vacation.
On the down side, since I was the last person seeing either medicaid or children in my 4 state area that includes 11 neurologists, these now go unseen except for their clinic nurse. Of the remaining neurologists, none see kids or medicaid, 9 refuse to see hospital consults, one is a hospitalist paid by his local hospital and only sees patients who are admitted. Thus, stroke care and head trauma services as well as intractable seizure care (not to mention pediatric neurology) have all largely disappeared from the 4 state area (about 500 miles in diameter) except for vets living close to the hospital, and for folks who can get to the hospital with a remaining neurologist quickly. Of the 11 neurologists in the area, I am paid by the VA so medicare doesn’t really count for me. The neurohospitalist is paid by his hospital so again medicare issues don’t matter. Of the remaining 9 neurologists two limit their practices to procedures only (sleep disorders for one, and electromyography for the other). Of the remaining seven, five have stopped seeing new medicare patients and are going to a cash only concierge practice. One is planning to leave. The last sees Medicare but I swear is so useless and passive aggressive, that he might as well not be there. I end up seeing most of the vets who go to him. His routine if somebody has a neurological problem is to say “Oh you have headaches/seizures/paralysis/whatever. I have done a CAT scan and you do not have an emergency. You should go to the Mayo Clinic (a thousand miles away and in a different state). I can’t help you.”
The bottom line is, that of the 11 neurologists who previously served this 500 mile cachement area, 3 are now lost to any traditional clinical practice, all are lost to the care of medicaid and children, 10 are lost to new medicare outpatients, eight are lost to hospitalized inpatients (including the uninsured who uses the hospital as their private clinic), and one is stupid and useless.
I am certain that the changes affecting neurology are similar to those affecting other specialties that have a high geriatric/pediatric/severely ill and poorly insured component.
The reason I am sure of this is that pediatric specialty care (usually on medicaid) which was previously extremely good, and easily accessed, disappeared (except for myself) five years ago. There are no pediatric specialists around here now. 10 years ago there were more than one hundred. I kept waiting and waiting for somebody to notice and do something. They prefered to let pediatric specialty care die, (and the patients with it). It saved money. Geriatric patients (usually on medicare) will go the same way with even less fuss.
However we will have no shortage of physicians taking care of carpal tunnels, sleep apnea, skin lesions, sports injuries, acne and cosmetic procedures. So it will all work out.
Clueless, good for you. I remember a while back when you were commenting, I got worried about you spinning out. I think I recommended a long vacation and getting in a better position. The lack of shortage areas you mention are limited and usually not messed with by the government/insurance companies–really concierge type practices. But with money running out this will also shrink. Sort of like the struggle that private/church school with tuition and the “free” schools given by the government. After taxes the average middle class couple can’t come up with the thousands of dollars tuition for each child. Basically, our nation has priced itself out of the market. Hence, the exodus to places like Costa Rico or Panama for medical care or retirement.
So that leaves VA, military, prison salried work like you have found. Primary care is going to hospitalist practice, but as nearly everyone is referring inpatients to the hospitalist they will become overloaded—already are, and the hospitals will realize they are loosing money paying them. So, good for you and don’t look back. You did all you could and this is what the people voted for.
Mitchell, I don’t know what state you are from, or why things have not changed there. In Mississippi, all the insurance companies except the state medical society insurance plan had left the state and no one could get the insurance no matter what they were willing to pay. The medical society could take no new customers. We lost 30% of our physicians who had to move and shut down the trauma services and things like neurosurgey. A coalition of the doctors and small businesses and patients who suffered for loss of care got a bill barely passed. Actually it was an act of God (another story) since the lawyers fought it tooth and nail. We got a $500,000 cap on non-actual damages like pain and suffering and also got court reform. Many states did likewise, but often their Supreme Courts dominated by trial lawyers would declare them “unconstitutional.” So by God’s grace we got judicial reform with several of those judges and lawyers in federal prison. The rest got religion.
Now as for the cost. Insurance companies returned, many new doctors have come back. They are trying to rebuild the trauma network—but this will take 20 years after the infrastructure was destroyed. My premiums are down 45% and we actually got a refund! Malpractice suits are only 10% what they were. But don’t forget, the premium cost is a small part of the cost of runaway torts. Hugh extra lab, xrays, hospitalizations, full court press on every patient, and the constant fear in the background. Every patient became a ticking bomb in the office. Being sued even if you know you were not wrong and there is little danger of loosing, still puts you through at least three years of hell, and untold hours of preperation, depositions, court time, and nights of tossing and turning. One of the principles of biology is that an organism withdraws from painful stimulation.
We were fortunate in our state to have exellent leadership and a great insurance non-profit company. I don’t know what the story is in your state. At any rate, I have vowed to have as little to do with the legal system as possible. I could write a book on the corruption I have seen as an expert witness.
Clueless, anyone who works 100 hours a week for an extended period of time will die. I am glad that you have found a better quality of life. My friends who are Docs work 50 – 60 hours a week and generally get 6 weeks of vacation per year. All of them enjoy lifestyles exceeding the upper middle class.
Good for them! They are smart and work hard. They are part of one of what I call the big three. That is, they are part of the Health care provider portion. Many, sales people in this sector make six figure incomes and more, medical coders make high five figure incomes. Hardware costs such as screws, hips etc are absurdly priced. It goes on and on. Lets not get started on pharmaceuticals.
So you say this is capitalism? No it’s not. There is an entire industry out there designed to pay this portion of the big three. It is called the insurance industry and there are so many rules, laws and greed affecting this portion of the big three that there is no way that market forces will work.
This is a true recent story in my family. My wife could not put off knee surgery any longer so we went to the orthopedic specialist. Total costs for 5 hours of out patient care and maybe 1.5 hours of surgery, around $30,000. Total cost without insurance $45,000.
When we were consulting with the Doc I asked him about what the procedure would cost he said he didn’t know. Of course he didn’t want to discuss the absurdity of the fee. In summary this is the portion of the big three problem that the AMA and your profession could address. Again, please do not take this at a personal level because I do not mean it that way.
“This is a true recent story in my family. My wife could not put off knee surgery any longer so we went to the orthopedic specialist. Total costs for 5 hours of out patient care and maybe 1.5 hours of surgery, around $30,000. Total cost without insurance $45,000. ”
The costs are huge. However your wife’s 30,000 is paying for the orthopedist to be on call anywhere from every other night to every 4th night for the emergency room where he will admit approximately 2-3 patients a night with various sorts of trauma who either have no insurance or who have medicaid which does not even pay for the costs of the supplies used, let alone physician time or hospital beds. Your wife is also paying for the illegal immigrant, for the medicare patient who overstays his DRG mandated 3-5 days following a broken hip, because he/she is 80 years old, frail and goes into congestive failure or becomes confused. Your orthopedist is not permitted to refuse to be on call. It is required by his hospital. There is a 50,000 dollar fine for refusing to come in, even if you are so tired you can barely stand without your head spinning. Failure to come in is ABANDONMENT AND PATIENT DUMPING. Your orthopedist is also not permitted to refuse the DRG mandated below cost payments by either medicare or medicaid. If he sees any medicaid or medicare he must see all and for the price that government dictates. Since private insurance negotiates with each hospital/doctors group to have a percent slightly above what medicare provides, it is necessary to have a ridiculously high “sticker price” since Medicare will pay 30% of this and medicaid will pay 10% of it, and in many parts of the country this will be the majority of the patients you see. It is not permitted for your orthopedist to say, Mr. X doesn’t have insurance, so I’m just going to have him pay what medicaid pays because this means that you are “FRAUDULENTLY” overbilling medicaid/medicare. Medicaid/Medicare is always supposed to get a percent of your best price and if you give Mr. X who has no insurance (but does have assets) free or reduced price care, then you are committing FRAUD AND ABUSE by not giving every medicaid/medicare patient free care also. Most of the “fraud and abuse” cases that Obama talks about is not physicians padding bills. It is about physicians feeling sorry for Ms. Parker who can’t afford 45,000 and cutting their fee to 4,000. That’s illegal. It is also illegal to get together with other physicians and jointly refuse to function under this Byzantine system. That is considered CONSPIRACY TO COMMIT FRAUD. Physicians have gone to jail for it. Patients and lawyers don’t care if physicians go to jail for cutting them a break on their care. Patients and lawyers also don’t care if physicians die on the 2am trip to the ER after 3 days without sleep. They only care if the sleep deprived orthopedist makes an error during surgery.
It is not possible for the AMA (who represents only 16% of physicians) or anybody else to address this problem because it is illegal for physicians to do anything other than lobby and whine. That they have been doing since the dawn of Medicare. We are not permitted to strike. (That is considered conspiracy). We are not permitted to do sick ins (also conspiracy). The only thing we can do is either limit our practices (eg drop medicaid/medicare or drop certain types of problems. In this regard, of the 5 neurosurgeons in the area, 4 have stopped operating on the brain, and the 5th plans to retire at the end of the year. The others do backs and necks and are talking about cutting back to carpal tunnels only). If anybody has an automobile accident and and has a subdural hematoma they will need to be flown to another state.
Our other options are to leave private practice, leave medicine, leave the country, (a couple of good friends are planning to move to New Zealand, and another has gone to Dubai), or to simply be passive aggressive. Now physicians are the last people in the world to be passive aggressive. No naturally passive aggressive person makes it through residency. However I suspect that the “I’m too stupid to be able to help you, you are going to need to go to ‘name that famous hospital’ is going to become the norm. The law requires that physicians see patients in the emergency room whether or not they are paid. No law can force a physician to be useful.
So be prepared, when you come to the emergency room with Obamacare and an obvious need for knee surgery to hear people say “Hmm. You have a really complex case. I don’t think I can help you. You should go to famous name hospital on the other side of the country. Maybe they can help you” Or Hmm. You are just too old and frail to have your hip fixed. I am not competant to fix the hip of somebody as old and frail as you. Have you considered “hospice”? Or “Hmm. You may benefit from knee surgery. Lose 80 pounds and get back to me. If you don’t lose 80 pounds in the next eight months, I will write that the patient is noncomplient with treatment, and poorly motivated for surgery and will drop you from further consideration.” Surgeons who do this will find that their numbers improve. Obviously one has better outcomes dealing with motivated skinny people than overweight undisciplined people. Politicians will find that costs drop like a stone under the new regime and will conclude that Obamacare is working wonders. They will order more of it.
And America will have gotten precisely the health care she deserves.
I will say to Lee what I would say to anyone in my own family who was uninsured and needed an expensive procedure: Shop surgeons and negotiate a cash price. If you don’t have the money saved and have to borrow (as you would for a car or having the house remodeled) that may be necessary also. Someone above mentioned, tongue in cheek, I believe, that he wouldn’t have to get a second mortgage to get a procedure. I immediately thought, I guess not – the taxpayers are paying for your procedure instead. Whatever happened to personal responsibility?
Clueless,
Glad to see you posting. You have been in my prayers.
Jim Elliott <>< North Georgia.
To #51 and #56
Thank you. I appreciate the charity on this board. I have not been posting for the past 3 months because I have been grateful (so unbelievably grateful and relieved) to be out of private practice, and somebody who made one of the few life boats off the Titanic of Medicine has no business opening her mouth to give anything but thanks. I am grateful to be where I am. I feel truly blessed. Undeservedly blessed.
I also have not been posting because I also truly feel ashamed to have left private practice. I am certain that people are going to die because of it. I have a horrible feeling that I know the names of some of the people who will die. I have not dared to go to confession because I sortof feel that I should confess cowardice, and lack of endurance, and (I dunno) maybe manslaughter by absence, and I know that there is no way I could make any priest understand how docs think. And it is pointless to go to confession and talk about missing an occasional sunday when there is this obvious glaring hole in your confessional life. And maybe the priest would have told me to go back to private practice. And I don’t know how I could possibly have lived more than a year at that pace. I just felt dizzy, and headachy and nauseated, and all my muscles hurt all the time, and my chest hurt too. And when the phone rang at night I felt I couldn’t breathe. I felt I couldn’t go on and that if I did not stop, I would die. (Oddly enough it didn’t seem to affect my clinical judgement. I was selected best neurologist in my telephone area code – by the physicians in the area- shortly before I left practice).
I feel a lot better now. In fact I feel fine now. But I am not proud of having run away. It was running away. And I do not know how I can explain or defend it. People are going to die because I am not there.
Clueless,
I’m proud of you for doing what you have done. You can always try some missionary medicine, where they don’t have so many lawyers, and you can still help people. I have done some of this in Jamaica, and it absolutely changes you for the better.
At some point it becomes necessary to simply allow consequences to fall where they will. Sometimes God does this to us, to cause us to realize just who we have become. It’s not the same as judgement–that’s when He finally gives up on us. But consequences are actually loving.
Your quitting private practice is allowing the consequences of people’s decisions to begin to bear upon them and their leaders. If consequences are not allowed now, they will be allowed later and be much worse. Doctors are the worlds greatest enablers—both of their patients and of the system that those patients have created through their foolish votes. We should have allowed the consequences to fall sooner–out kindness has enabled the broken system to expand further.
Clueless, I assure you that you did what God willed for you. The people you served would have soon been out of a doctor because you would have burned out and maybe died. You are not responsible for the people you left. We all will leave some day. God is responsible and not us. Francis Schaeffer once said that we must learn to bow twice: once to our fall into sin, and once to our humanese–we are finite. Being in the image of God, we have many of the characteristics of God such as love, creativity, compassion, etc. but we are not infinite like God and unlimited. So just because we can think or long for good things doesn’t mean we can do them or even should try. Only God can care for everyone. So you can pray for those left behind, but the Lord will have to see that they are taken care of, not you. He loves them more than us anyhow. Don’t let Satan accuse you or slander you. Now you can grow and thrive as the Lord wanted for you all along. Let the death and resurection of the Lord Jesus Christ take care or your sin and any guilt. He promised He would. I am glad for you. My prayers were answered.
#55 Alli B. Do you have insurance? Who pays for your insurance and how much do you pay? Do you have insurance?
God Bless you clueless. Sometimes we just need a break.
#48 Mitchell,
Your figure of 4% of revenue on malpractice insurance does not anywhere near reflect the actual cost to the system of what lawyers do. I would say that probably half the expensive imaging (MRI’s, CT’s Xrays, etc) that we do would not be done were it nor for the fear of being sued. Perhaps 75% of the referrals we do to specialists are for conditions that we primary care docs are perfectly capable of handling; and we all know what happens when you are sent to see “a specialist”. He orders even more tests, uses the newest meds and “buffs the chart” even further to avoid a lawsuit.
Since the main drivers of medical cost are the latest pharmaceuticals and expensive imaging, along with unneeded procedures done to satisfy lawyers, I would suggest that at least 50% of the cost of healthcare in this country is due to the constant fear from lawyers.
It’s not that lawyers are the worst people in the world. They are the people that get the phone call when someone wants money. There is a reason that American society has produced this class of people called lawyers with contingency plans and the ability to extort people just from the threat of suits. (Remember in England the looser pays the legal fees of both parties!!!) The reason our society produces these people is the same reason it produced Michael Jackson. We are corrupt, greedy and selfish. Lawyers are just taking advantage of this fact.
Real tort reform would solve most of the problem with health care inflation.
Lee,
I think you are partly right about the “big three” concept. However, these three are just reflections of our corrupt and decadent society that produced them.
Selfish people get taken advantage of by other selfish people. The insurance companies, the patients, many doctors and definately the politicians are among them.
It’s easy to criticize specialists for the money they make. I’ve seen plenty of patients get procedures they didn’t need after I was forced to refer them from fear of being sued or after a patient demand. However, remember that the specialist is just doing what he/she is trained to do–look under every rock for obscure but unlikely illnesses. In fact, the specialist is held to an even more unreasonable standard by the lawyers, so it’s no surprise that the more we refer, the more specialists we get and the more costs go up.
#54 Lee,
I would suggest that you research medical tourism. There are places in the world where you can get first rate medical procedures for 10-20% of US Lawyer-subsidy prices. For some insurances, that is less than the copay of the American version of medical care.
There is NO WAY that any payer system, be it government, employer, self pay, HSA, etc, can ever make up for such a disparity in costs as now exists between US healthcare and the rest of the world. That’s why Obamacare is doomed, as is our current system. He is just hoping to use the issue to get enough voters dependent on him for their “crust of bread” that perhaps he can forge a permant Democrat majority.
For some procedures, it would actually cost less for the insurance company to pay for your trip oversees than to finance our broken system here. Clueless in #53 has done a masterful job of pointing out why costs are so high.
Capn Jack more and more I believe this is a political problem. I hope this thread will continue until tomorrow. God Bless.
Clueless, as a non-doc I second everything Country Doc #59 said. Also, as a mother, I want to point out that there were primary patients who desperately needed you, and needed you to be in good mental condition, not in the frazzled state the private practice was causing. Those patients are your children, whom God has entrusted to you. Put those other patients on your prayer list as penance, if you want, but rejoice in God’s mercy for your mental healing and for your children.
Lee, I’ve paid for my own medical insurance for a couple of decades. I bought a disability policy too which was $150 a quarter when I was only making 19K a year 24 years ago when I was single and new in my career. It was hard to afford but very important to have. My husband and I have an MSA now which is about $500 a month but has a very high deductible. It’s basically a “catastrophic” policy.