It’s always nice to see the President take a principled stand on something. The man formerly known as “43,” and now perhaps better named “29” for his record–breaking approval rating, is promising to battle any expansion of government health insurance for children – and not because he hates children or refuses to cough up the funds. No, this is a battle over principle: private health care vs. government-provided health care. Speaking in Cleveland this week, Bush boldly asserted:
I strongly object to the government providing incentives for people to leave private medicine, private health care to the public sector. And I think it's wrong and I think it's a mistake. And therefore, I will resist Congress's attempt … to federalize medicine…In my judgment that would be -- it would lead to not better medicine, but worse medicine. It would lead to not more innovation, but less innovation.
Now you don’t have to have seen “Sicko” to know that if there is one area of human endeavor where private enterprise doesn’t work, it’s health care. Consider the private, profit-making, insurance industry that Bush is so determined to defend. What “innovations” has it produced? The deductible, the co-pay, and the pre-existing condition are the only ones that leap to mind. In general, the great accomplishment of the private health insurance industry has been to overturn the very meaning of “insurance,” which is risk-sharing: We all put in some money, though only some of us will need to draw on the common pool by using expensive health care. And the insurance companies have overturned it by refusing to insure the people who need care the most – those who are already, or are likely to become, sick.
I once tried to explain to a Norwegian woman why it was so hard for me to find health insurance. I’d had breast cancer, I told her, and she looked at me blankly. “But then you really need insurance, right?” Of course, and that’s why I couldn’t have it.
This is not because health insurance executives are meaner than other people, although I do not rule that out. It’s just that they’re running a business, the purpose of which is not to make people healthy, but to make money, and they do very well at that. Once, many years ago, I complained to the left-wing economist Paul Sweezey that America had no real health system. “We have a system all right,” responded, “it’s just a system for doing something else.” A system, as he might have put it today, for extracting money from the vulnerable and putting it into the pockets of the rich.
But let’s not just pick on the insurance companies, though I wouldn’t mind doing that-- with a specially designed sharp instrument, over a period of years. Sunday’s Los Angeles Times featured a particularly lurid case of medical profiteering in the form of one Dr. Prem Reddy, who owns eight hospitals in Southern California. I do not begrudge any physician a comfortable lifestyle – good doctoring is hard work – but Dr. Reddy dwells in a 15,000 square foot mansion featuring gold-plated toilets and keeps a second home, valued at more than $9 million, in Beverly Hills, as well as a $1.4 million helicopter for commuting.
The secret behind his $300 million fortune? For one thing, he rejects the standard hospital practice of making contracts with insurance companies because he feels that these contracts unduly limit his reimbursements. (In a battle between Aetna and Reddy, it would be hard to know which side to cheer for.) In addition, he’s suspended much-needed services such as chemotherapy, a birthing center and mental health care as insufficiently profitable. And his hospitals are infamous for refusing to treat uninsured patients, like a patient with kidney failure and a 16-month-old baby with a burn.
But Dr. Reddy-- who is, incidentally a high-powered Republican donor – has a principled reason for his piratical practices. “Patients,” the Los Angeles Times reports him saying, “may simply deserve only the amount of care they can afford.” He dismisses as “an entitlement mentality” the idea that everyone should be getting the same high quality health care. This is Bush’s vaunted principle of “private medicine” at its nastiest: You don’t get what you need, only what you can pay for.
If government insurance for children (S-CHIP) isn’t expanded to all the families that need it, there is no question but that some children will die – painfully perhaps and certainly unnecessarily. But at least they will have died for a principle.
As I finish reading this, feeling painfully frustrated and disheveled due to the fact I too, am uninsured along with my unisured children. You see, I make too much money for any government program ( $ 32,000 yearly) but I cannot afford to pay $800 a month for a family plan with a $2000 deductible. So, we try not to get sick, or injured, or even think about getting prevenative care. Unfortunately, my daughter fell on her ankle a few years ago, and now she is constant pain and can only wear certain shoes( she just turned 16) So who knows what that injury will be like when she is thirty. Needless to say on her Christmas list last year all she wanted was "Health Insurance"! That my friends is the honest to God's TRUTH!
But unbeknown to my daughter, the really sad issue is that even if we had it now, her injury would be "Pre-Exsisting" and she couldnt get treatment anyway. Why should I break her heart too? Her Ankle was enough. Have we as a Nation had enough? My story is one of many, so we need to make a stand!!! We are not living but merely exsisting!! Thank you Barabra for all your work. Sincerely, Stacy
Posted by: Stacy Smallwood | July 12, 2007 at 11:37 AM
Hard to know where to begin with this one, given that our health care system is such a cluster. Whether insured or not, no one should have to sell their soul in order to pay a big medical bill.For the smaller stuff, wouldn't we all like to see a system of low cost clinics - perhaps staffed by nurses and PAs rather than expensive MD's - that could take care of day-to-day matters and minor emergencies at a cost that most everyone can afford: $10 or $20 bucks.
But with all the technological advances, and the ability to keep people alive longer and longer, we are definitely going to have to make some hard decisions about who gets what. Care is, of course, already being rationed informally - and, in some cases explicitly by the crud you wrote about, "Dr" Reddy. But it will no doubt get worse as the "staying alive" technology improves.
I shudder to think of the rich Boomers all hitting the "market" for new organs at the same time, and trying to justify why the 85 year old Boomer who can "afford" the new heart is more deserving than some poor schlub who's only 25 but doesn't have the scratch. That's when it will truly get ugly.
(I'm a Boomer, but I sure hope I have the grace to say "enough", or give the younger folks a chance, when the time comes.)
Posted by: Maureen Rogers | July 12, 2007 at 11:55 AM
I didn't have health insurance when I was raising my children and we were very lucky that our needs were few. I went over 20 years without seeing a doctor even once. Most people would not be able to do that.
Posted by: Maya's Granny | July 12, 2007 at 11:55 AM
The LA Times article, “Hospital Group Rejects System…”, by Daniel Costello dated July 8, 2007 is full of distortions that portray me in a very negative light to sensationalize a story. Many statements I made during interviews with Mr. Costello were misrepresented in the article and were taken totally out of context. As a practicing physician for over 30 years, I take serious offense to Costello’s gross assertion that I stated “that patients may simply deserve only the amount of care they can afford.” This is preposterous and I was simply misquoted. It is my firm belief and strong conviction that every patient deserves care based on the nature and severity of illness and should not be based on financial status. The statement comparing the need for healthcare services to other essential needs was completely erroneous. Prime Healthcare Services and I stand by the belief that healthcare is a basic human right. This philosophy has guided our operations and business practice of more uninsured patients being seen in our emergency departments and more charity care provided in our hospitals, compared to both for-profit and not-for-profit competitors. I am especially troubled because thousands of patients and employees of Prime Healthcare Services’ hospitals may be deeply hurt by this inaccurate, biased, and sensationalistic article. Prime Healthcare Services and I will continue to provide excellent patient care and will meet the goals and needs of our patients, the local communities, and the State of California.
Prem Reddy, MD, FACC, FCCP
Chairman of the Board
Prime Healthcare Services, Inc.
Posted by: Prem Reddy, MD, FACC, FCCP | July 12, 2007 at 12:08 PM
I live in Cleveland, and was outraged when I heard a snippet of Bush's speech on the local news, in which he said that people need to take more responsibility for their health, and that a good way to start is by people using health care savings accounts. Yes, I agree, that there are things people can and should do to lower their health care costs - eat healthier, exercise, don't smoke or drink, etc., however, not all health problems are avoidable, and the average person (especially here in Cleveland, one of the poorest cities in the nation) simply does not have hundreds of dollars a month lying around to sock into a health care account, whether the account is tax-free or not. And having employer-sponsored health insurance is no panacea either. I slipped and fell on a patch of ice here in Cleveland back in February, and broke my right wrist. I have medical insurance through my employer, but still ended up with nearly $1,000 in bills that my insurance would not cover for various reasons. I am very blessed to have an employer that covers the full cost of my medical insurance premiums, but the copays, deductibles, poor prescription coverage, and other exclusions, mean that every time me, my husband or my children need medical care, that I end up with a mountain of bills, leaving me perpetually in debt to hospitals and doctors. Several years ago I quit my job to stay home with my daughter who had developed asthma and was in and out of the hospital. I carried the family medical insurance through my job and so I lost my coverage when I quit. The cheapest family medical insurance plan (and a lousy one at that) my husband's employer offered was over $500 a month, which we had no hope of affording without two incomes. My diabetic husband went without insurance for month, unable to afford his medication, and I watched my daughter's asthma worsen until I was finally able to get her onto our state's Medicaid program. My husband and I made "too much money" to qualify for Medicaid ourselves. Clearly, our health care system in the U.S. is broken. Private medical insurance is increasingly unaffordable for employers, too difficult and expensive for workers without employer sponsored coverage to get, and for those with private insurance, still does not provide an adequate safety net. Yet, Bush thinks all will be fine if Americans start being responsible and start socking all their extra dollars into health care savings accounts. For someone who makes $600,000 a year (not to mention all the wealth from his family's oil company ties), and access to the best healthcare in the world for free, of course that looks like a solution. Bush is clueless and out of touch with reality. If he had given his health care speech in Cleveland in front of the average, working-class people of this city, instead of a carefully staged group of executives, he would have been booed right out of the room.
Posted by: Laura | July 12, 2007 at 01:14 PM
Doctors are allowed to "own" 9 hospitals ?
Sounds like Dr. Wealthy is adept at defending his position on a regular basis. Hot air is what it is.
I smell a rat.
Posted by: Curly Earl | July 12, 2007 at 01:15 PM
Dr. Reddy is rich and has all those flashy possessions. Does his profession as a healer not fulfill him to the extent that he could be happy living in more modest circumstances? Why does he need so many things? And what is the truth about qualifying for treatment with his health services?
I think Ms. Ehrenreich has got it right. This is a doctor who has seen the enormous profits to be made off the sick, and is helping himself instead of letting the insurance companies get the big bucks.
That's called "greed." Now those who think greed is good will of course admire Dr. Reddy.
Posted by: Hattie | July 12, 2007 at 01:15 PM
Dr. Reddy: It is unfortunate that you and your words may have been taken out of context, but it is obvious from your comment here and in the larger picture that you have no idea what a great many in the U.S. face in terms of health care challenges. If you sold just one of those homes, and put it where it counts, you would make a world of a difference. Better yet, network in the world that you are privileged in and come up with a group of people who actually want to provide health care to those who can't even come close to having a safety net. Oh wait even better, get politcally involved on their behalf. You have the type of money that speaks volumes.
Posted by: meow | July 12, 2007 at 08:46 PM
From an outsider’s point of view, it is often hard to understand why anyone (i.e., the millions and millions of insured Americans) would want private medical insurance. The coverage of this topic usually mentions the greed of insurance agencies, the doctors’ over-inflated sense of the level monetary recompense they deserve for their services, the unfortunate people who can’t afford insurance, those that have insurance but are not compensated because of some bureaucratic loophole, and those, like you, who wish to be insured but are refused because of some unfortunate pre-existing condition. I’ve always questioned why the, presumably, millions and millions of satisfied patients, who receive good health services for reasonable prices from dependable companies, are not heard.
Then, Stacy Smallwood writes how she is expected to pay $800 a month for a family plan with a $2000 deductible on $32,000 annual income. By my humble calculations, she is expected to pay 30% of her salary for the possibility of major health difficulties occurring sometime in the future. Yes, only for the possibility, because with $2000 deductible that policy does not include preventive medicine (e.g., pap tests) or lingering flu symptoms that just won’t go away.
If there are no millions and millions of satisfied patients out there, why aren’t you all out in the streets demonstrating? All developed countries, other than the States, feel that everyone has the right to good health and education: not just children and the disadvantaged, though certainly the children and disadvantaged.
Social medicine is not free. Everyone pays what they can pay (in Germany approximately 10-12% of our salary, unless you are rich and then you pay much less, but still more than an average earner). No one is getting handouts here. We pay into a system that costs far less than yours does and we get more out of it. We can go to visit our general practitioners any time we are feeling sick. We can go to specialist any time we require either preventative tests (e.g., mammography, stress ECG, ultrasounds) or diagnosing for acute illnesses. That is what a modern medicine system should offer their citizens. All their citizens.
Posted by: lilalia | July 12, 2007 at 11:32 PM
Lilalia, Americans are 'sheeple'. They do not complain because they follow their 'air headed' leaders who they trust because they are in a 'leadership' position. Reagan, who said the Berlin Wall should come down against the wishes of the so called 'elites' in foreign policy, was the only U.S. president in my lifetime to have a brain. Americans fear smart people so they elect buffoons. Understand this, and you understand the USA.
Posted by: barbsright | July 13, 2007 at 01:06 AM
Some things just aren't meant to be for profit. Healthcare is one of them.
Posted by: gaby | July 13, 2007 at 01:15 PM
Please! Let's stop saying "government provided", and start saying "publicly provided". Government officials aren't out moonlighting to pay the bills---it's OUR MONEY!
Big Daddy is a parasite, not a patron.
Posted by: Tina | July 13, 2007 at 01:38 PM
Let me preface my comments by stating that I would welcome a single payer health care system that provided government immunity for providers (similar to that extended to firefighters or police), though when it occurs, I will probably retire and retrain as a school teacher.
Last year I took a new position as a neurologist in private practice, but made the mistake of agreeing to see children with medicaid on the same terms as other patients. However medicaid does not pay office overhead, let alone physician salaries. Since government mandates, and legal liabilties make the usual office overhead about 120,000/year (not counting physician salaries) this required that I increase the number of patients I saw. I did so, however I was not willing to see a new patient in less than 45 minutes or a follow up in less than 15 minutes, so my office times reflected this. (I took no breaks, and did not eat lunch). I worked 8-5 on the above schedule (and spent another 2 hours a day on unreimbursed telephone calls). I also spent every other evening and weekend at my hospital (where I was required to take call without expectation of payment - most ER visits are not reimbursed, due to the high volume of illegal alients and other insured) However, despite working over one hundred hours a week, and seeing my children for only snatches of time every other weekend I found myself making only about 50,000 after paying my staff. This is not an inconsiderable salary, however it does not go very far when one has to pay for night time child care coverage, and student loans.
I was therefore reluctantly forced to limit the number of medicaid patients I see. I now have 3 slots a week for new patients, which is more than any other neurologist in this area. This means that it takes 6 months for a medicaid patient to get in to see me, while blue cross patients can usually get an appointment in 2-3 weeks.
I believe that physicians should see the poor. But let us call medicaid and governement provided care what it is: Charity provided by the physician, with a minimal but less than cost token payment.
Posted by: shari | July 14, 2007 at 12:54 PM
Reddy is successful because he has henchmen like Mark Bell to do his bidding. Mark Bell is the director for “EMA” a group of ER doctor own by Mark Bell and Irv Edwards. These group of doctors will do anything Reddy says or else they will loose the contracts at his hospitals. Reddy’s specific instructions are to admit all insured patients for expensive work ups and up code the diagnosis to fleece medicare and insurers more than full price. People who protest this fraud are fired or buried in lawsuits which usually settles. Reddy is a smart business man, because these doctors are the real ones commiting the frauds, but
Reddy is well insulated and protected. He could say, “I’ve never told them that.” Mark Bell sold out his patients and dignity to make a lot of money for Reddy.
Posted by: JD | July 15, 2007 at 12:36 AM
Reddy is successful because he has henchmen like Mark Bell to do his bidding. Mark Bell is the director for “EMA” a group of ER doctor own by Mark Bell and Irv Edwards. These group of doctors will do anything Reddy says or else they will loose the contracts at his hospitals. Reddy’s specific instructions are to admit all insured patients for expensive work ups and up code the diagnosis to fleece medicare and insurers more than full price. People who protest this fraud are fired or buried in lawsuits which usually settles. Reddy is a smart business man, because these doctors are the real ones commiting the frauds, but
Reddy is well insulated and protected. He could say, “I’ve never told them that.” Mark Bell sold out his patients and dignity to make a lot of money for Reddy.
Posted by: AK | July 15, 2007 at 12:40 AM
1. Cancel HMO 2.Forbids the ED from transferring insured patients to other hospitals. 4. Admit these patients for expensive workups and overinflated prices. 5. Up code the diagnoses to charge Medicare and insurers fradulantly. 6. Do very minimal screening and tests on noninsured patients and throw them out the ED. Any physicians or workers who protest will be fired or buried in lawsuits, which usually settles. 7 Reddy ingratiates himself with the politicians with his filthy money. See his personal website.
Posted by: Reddy Business model | July 15, 2007 at 12:49 AM
"Sheeple"...I'll have to remember that one. It fits?
Why is it that viewers of a TV show were able to rally themselves to send 50,000 pounds of nuts to a network to protest cancellation of a program, but won't make themselves heard on the subject of affordable, accessible healthcare?
Though I do believe that times are changing.
As for Dr. Shari something is off. Her attitude reflects that of a lot of younger physicians who seem not to understand how tough it is for some folks.
I'm aware of one physician in his first year of private practice declaing to his staff: "If they don't have health insurance, they must have money" He then proceeds to order numerous and, maybe, unnecessary tests the patients can't afford. His attitude has had a very negative effect on the office patient load.
Posted by: Solo | July 15, 2007 at 04:30 AM
I wanted to chime in to say how much I appreciated this read. I can only wish that the thousands of undecided citizens would read this rather than watch Sicko. The point is NOT that Americans need to rethink their attitudes towards socialism in general or Castro in particular. (Moore has an unfortunate habit of making an excellent point, and then adding some politically poisonous frosting to his argument.)
As you say, the real point is that health care is one area where private enterprise does not work. And without getting all theoretical about it, it is for the same reason that private enterprise would be a poor way to provide fire fighting services.
One error that must be avoided this time around, though... We must not go after the Dr. Reddys. If publicly provided health care works (Thank you, Tina, for an important distinction), then private, elitist alternatives should only be a minimal threat. Further, by not trying to outlaw the competition, as happened last time, we avoid a lot of the fear that comes from taking away at least the idea of choice.
As Moore's movie made clear -- and from what I understand, this is the pure truth in France and mostly the truth in Britain and Canada -- once in place, very few people would ever want to go back.
Posted by: Don Bemont | July 15, 2007 at 06:33 AM
When HSAs (Healthcare Savings Accounts) were introduced, in President G. W. Bush’s first term I believe, I wondered who HSAs were for. After all, anyone with a job that provided a decent health care benefit would not have the prerequisite employer’s HDHP (high deductible health plan), they would have a low- or no-deductible plan, right? Then I learned what the HSA “incentive” really means and who it is for:
At the beginning of 2007, employees of Deere & Company (the John Deere farm and heavy equipment manufacturing firm) found themselves in the HSA wonderland. Some didn’t find out until they stopped at the financial checkout desk upon leaving their health care clinic. These employees expected to make a nominal co-payment and said to the clinic staffer, “I have insurance through John Deere.” “Yes, you do," the staffer replied, “and you now have a $4,800 deductible on your family plan.” The employee makes his payment arrangements and walks away stunned.
Deere employees woke up this year to a monthly premium of $225 per month, or $2,700 per year, for family coverage under their new health plan (not bad as today’s employee benefits go), but the company has replaced their former health care plan with an HDHP plus an HSA. The employee’s HSA is, of course, designed to give him a “tax break” to help cover his new deductible, which is $4,400 to 4,800 per year! Under the new plan, prescription co-pays are $10 to $30 per prescription in addition to the premium and the deductible. So, depending on the medical issue, and given a few ongoing prescriptions for the family, the employee could face out-of-pocket costs of up to $8,000. (Some other “details” in the plan could push the annual out-of-pocket to $10,000.) One estimate is that Deere’s new HDHP + HSA arrangement amounts to at least a 4% pay cut for the employees. That estimate of the effective pay cut certainly assumes that you remain very healthy.
Now I know what the President’s HSAs are all about: paving the way for corporations to shed the burden of health care benefits, and allowing them to do so before we have the universal health care system that must replace employment-based benefits. If this profitable major corporation is doing this to its employees, will the rest of employers be far behind?
Posted by: Actuarily Unsound | July 15, 2007 at 07:04 AM
Barbara writes:
“Now you don’t have to have seen “Sicko” to know that if there is one area of human endeavor where private enterprise doesn’t work, it’s health care.”
It is astounding that Americans will believe that in Cuba, a poor dictatorship locked 50 years in the past, modern medical care is available to all. One only needs to consider that Castro is near death because treatment of his intestinal problem was botched. Really botched.
At that point you know the Cubans are no better at medical care than they are at car manufacturing, energy production, agricultural production, housing construction and maintaining a free society. Why would anyone believe any statement from the Cuban government other than one noting the hardships Cubans must endure while their moronic socialist experiment fails?
By the way, whom is Fidel going to sue for malpractice? Not that it matters in his case. Does anyone know the fate of the doctors who bungled his surgery? Alive? Dead? Harvesting sugar cane?
If the dictator of Cuba can’t get decent medical care, who in Cuba can? A truer picture of medical treatment in the island prison would include mention of the need for families to bring their own sheets to hospitals where relatives are admitted.
Barbara writes:
“Consider the private, profit-making, insurance industry that Bush is so determined to defend. What “innovations” has it produced?”
No segment of the insurance industry produces “innovations.” However, many insurance companies advise their clients on ways to improve performance and reduce the errors that lead to payouts for mistakes. They investigate practices and procedures that offer better outcomes.
She writes:
“In general, the great accomplishment of the private health insurance industry has been to overturn the very meaning of “insurance,” which is risk-sharing:”
Nonsense. This concept may hold for life insurance or property & casualty insurance, but not health insurance. There is no cap or limit on what maladies can behalf the rapidly increasing number of US citizens. There is no cap or limit on the potential costs of “unlimited” care.
Life insurance (an odd name for a financial product that is redeemed at death) pays a fixed amount at the death of the insured. Property & casualty insurance also pays an agreed-upon amount following various impairments or calamities affecting the properties.
In other words, pay-out limits are set. However, if an insured party wants higher limits, the insured party must pay higher premiums. Meanwhile, people with bad driving records pay higher premiums to insure themselves behind the wheel. This arrangement seems to satisfy most observers.
Life insurers know with 100% certainty that every insured party will die. The risk faced by life insurers is predicting how long the insured party will live. However, no matter when that party dies, the pay-out is the same.
With medical issues, who the heck knows what will happen or when problems will arise. First, the nature, extent and occurrence of medical problems is unknown and knowable. Second, the medical world is innovative. Thus, more and more problems become treatable every year.
In short, there’s no end to the arrival of new treatments for an expanding list of medical maladies. Costs will continue to soar as a result.
Barbara writes:
“We all put in some money, though only some of us will need to draw on the common pool by using expensive health care.”
More nonsense. There are so few people who see a doctor only the day they’re born and the day they die that they don’t count.
She writes:
“And the insurance companies have overturned it by refusing to insure the people who need care the most – those who are already, or are likely to become, sick.”
This is an area in need of improvement. But let’s face it, a person with a bad driving record pays more for insurance, for obvious reasons. Does anyone object? No.
Barbara writes:
“I once tried to explain to a Norwegian woman why it was so hard for me to find health insurance. I’d had breast cancer, I told her, and she looked at me blankly. “But then you really need insurance, right?” Of course, and that’s why I couldn’t have it.”
Norway is a welfare state of 4.5 million people, about half the population of NY City. It has fully exploited its oil and gas reserves to generate cash. It created a massive investment pool with the money that rolls in from international energy sales. If the US were to exploit its energy reserves as Norway has, we would have much of the funding needed to provide the level of healthcare critics expect. But wacky green politicians have stopped energy companies from exploiting our entire base of energy reserves. At least 80 billion barrels of oil lies under protrected territory, and its thus off limits. Brilliant.
However, the one country in the world that is truly resistant to welfare-state practices like those in Norway is the US. No matter how much press healthcare receives, support for universal healthcare is minimal. Healthcare reform has had no impact on presidential elections in the past.
She writes:
“This is not because health insurance executives are meaner than other people, although I do not rule that out. It’s just that they’re running a business, the purpose of which is not to make people healthy, but to make money, and they do very well at that.”
The healthcare insurance industry shows a net profit margin of less than 10%. The number is unimpressive. In contrast, Microsoft enjoys a net profit margin of almost 25%.
She writes:
“Sunday’s Los Angeles Times featured a particularly lurid case of medical profiteering in the form of one Dr. Prem Reddy, who owns eight hospitals in Southern California.”
Every hospital has an owner. So what if he owns eight, ten or 50.
She writes:
“The secret behind his $300 million fortune? For one thing, he rejects the standard hospital practice of making contracts with insurance companies because he feels that these contracts unduly limit his reimbursements.”
Think what you want, but there’s no indication he’s committed any crimes. Moreover, there’s no evidence his patients are dissatisfied. Those two points count for a lot.
She writes:
“In addition, he’s suspended much-needed services such as chemotherapy, a birthing center and mental health care as insufficiently profitable.”
Even thought this statement is inaccurate, what of it? He’s not obliged to lose money. Frankly, doctors all over the country are steering clear of OB-GYN work because the lawsuits are so punitive and malpractice insurance for that specialty is so high.
She claims:
“And his hospitals are infamous for refusing to treat uninsured patients, like a patient with kidney failure and a 16-month-old baby with a burn.”
Oh. Infamous. I see. Which hospitals are FAMOUS for treating uninsured patients?
She writes:
“If government insurance for children (S-CHIP) isn’t expanded to all the families that need it, there is no question but that some children will die – painfully perhaps and certainly unnecessarily. But at least they will have died for a principle.”
New York City pays out about $500 million a year to settle liability claims against the city. The single largest chunk results from medial malpractice suits filed against doctors working for the state.
There is great lunacy in believing the state can operate a vast medical system that would meet the needs of the 300 million people who live in the US.
Take the public school system in NY City. It attempts to educate 1.1 million students. Teachers and administrators are all college graduates. Many have masters’ degrees. Some Ph.Ds. Nevertheless, no one – inside the school system or out – would claim the system is good. People who know the statistics know the NY City system is doing a poor job of educating a large minority of students.
If healthcare outcomes were similar to education outcomes, the nation would truly suffer. Is there any reason to believe that doctors will make fewer mistakes if they work for the state? They will make more mistakes because they will have less accountability. That's the hallmark of all bueaucracies. No accountability.
Thus, some big questions need answering.
Why would doctors embrace a universal healthcare program? If Medicaid indicates what is to come, a pay cut for doctors is in the offing.
Why would voters agree to add 45 million uninsured people to the rolls of those receiving healthcare benefits if the cost of their care was distributed among those who already pay for their own healthcare as well as making their tax-payer contributions to Medicaid expenditures?
What would happen to malpractice awards? How high would they go?
Who would qualify for the insanely generous benefits many people believe they should receive? Would illegal aliens get coverage? If an illegal alien female gave birth in the US, thereby creating a new US citizen, would the illegal-alien parents also enjoy the healthcare rights of the new infant citizen who cannot be deported?
Posted by: chris | July 15, 2007 at 09:55 AM
Well now, I can imagine that if you added up all the related tuition and fee costs earned by the educational system from every single person who wishes to have a medical career, this would come to a consider amount of booty. To make these costs attractive to the participants (students) there has to be a golden carrot at the end of the stick, um?
And in the great historic tradition, once something like the medical industry has become so firmly entrenched in profiteering (that's how we got our railroads) then you have something so obviously difficult to budge.
Of course it makes perfect sense to those in other civilized lands - to remove health care from the vicious profiteering corporate model, but America will bellow its individuality with great disdain.
That this is so firmly entrenched in the minds of even those who are hurt by how we do things - is obvious.
Is it time for a change?
(I'm not old enough to know exactly how the average worker was affected by this issue 30 or 40 years ago...) but my gut response is this:
If the corporate and political bellowing about our "modern" global love-fest is to be believed, well then, I'd say it's time to observe and follow how other "civilized" nations in the West do things...(better)
Posted by: JP Merzetti | July 15, 2007 at 11:24 AM
This issue is complicated. I'm low income with no insurance but I also have no dependents and no debt. My visits to the doctor are few and far between and I pay cash when I do go. This is not the best way to do it I know and yet I'm one of the luckier ones. There are people in my situation that aren't healthy and do have uninsured dependent children.
Posted by: Chris S. | July 15, 2007 at 11:26 AM
"Solo" thinks I don't understand how tough it is for some folks. He's probably correct.
However I suspect Solo does not understand how tough it is for me either.
All jobs offer varing amounts of hassle, appreciation and money, and consume time, money (upfront costs) and energies.
Physicians today graduate between 150,000 and 200,000 dollars in debt. That needs to be paid. Due to malpractice and due to government requirements about medical record keeping, most non-VA offices spend approximately 120,000 per physician in support staff costs. Somebody has to be paid to type the notes, answer the phone, deal with dozens of different insurers, and make sure that the tens of thousands of rules are followed.
Thus, before you see your first patient on your first day of work you have already commited to a debt of 270,000 to 370,000 before you earn anything. If you decide to work at a free clinic one day a week (as I used to do) then that debt will grow.
If you choose (like Dr Reddy) to see only insured patients you can usually pay off your debts in about 10 years and have a salary in the 300,000 range.
If you choose (as I used to) to see all comers, then your practice will rapidly become all Medicaid and uninsured as there are plenty of folks who will gladly see a physician for free (the person above who has not yet obtained medical care for his child for example) but who will not do so if they have to pay. When this happened you will end up losing money and will either go out of business or will choose to run a mill, seeing patients at 10 minutes a pop.
I managed to make 50,000 because I was still seeing some insured patients, however the long waits necessitated by the rush of the uninsured and Medicaid drove the insured patients to physicians (like Dr. Reddy) who did not have a 3 month waiting list.
By deliberately maintaining some time in my schedule for medicaid and uninsured, but by seeing insured patients on a preferential basis, I have reduced my waiting time for folks who actually bring in revenue to 1-2 weeks, while increasing the waiting time for what is essentially charity care to 6 months. I make more than I did (though a good deal less than I could).
However, this does not change the fact that while I now make enough money to pay my student loans and to see my kids through college, I am still working 12 hour days, and I am still on call for free, and don't get to see my kids. Physicians are not paid for being on call to the ER, where most patients are uninsured or have medicaid.
Further, currently anybody could sue me and confiscate my salary and my kids college money even if I didn't do anything wrong. This happens all the time, because physicians are attractive deep pockets.
For all of these reasons, my plan is to work as hard as I can for the next period in order to become debt free, and to ensure that my kids college tuition is there for them, and to then go be a high school science teacher.
Because then, I would have the time, and time is also important.
I would also be much less likely to be sued by the patients whom I see for free (Emergency rooms generate more lawsuits) and safety is also important.
Frankly most physicians I know who are over the age of 50 plan to leave medicine in the next five years for precisely these reasons.
I could leave it a lot sooner if I behaved like Dr. Reddy. I'm not willing to do that. However I'm also not willing to bancrupt myself and my children in order to be an unpaid public service for the poor, or for those who chooose to spend their disposable income on something other than medical insurance.
What salary do you think is appropriate, for a physician to receive who works 12 hours a day, and gets very little sleep every third night, and every third weekend due to unpaid care?
Posted by: shari | July 15, 2007 at 11:39 AM
The proposed salary that folks offer should include consideration of repayment of the 100,000 to 200,000 student debt, the hours, and the fact that everything you worked hard for could be taken away at any moment by a drunk driver who comes into the ER with a head injury, and decides to sue you because he feels that the consequences of his head injury would have been less severe if you had gotten to the Emergency room 10 minutes faster.
So, lets hear it? Whats a fair price for a physician? Because I know that I can make about 37,000 working as a high schol teacher. Should I switch, I will enjoy equal benefits to those that I enjoy as a physician, and I will work less than 8 hours a day, and I will not have call or weekends or liability.
And I will still be doing an important job, that I will enjoy doing. And I do enjoy medicine. However I am pretty sure that I will enjoy teaching, which is why I am studying the subject.
Posted by: shari | July 15, 2007 at 11:47 AM
shari asks:
"So, lets hear it? Whats a fair price for a physician?"
What's so tough about estimating a fair wage? What do other professionals with similars levels of education and responsibility earn?
New attorneys from good schools who join major law firms START at about $150,000 a year. They often work 80 hours a week or 4,000 hours a year. Thus, on an hourly basis, they're earning $37.50.
But there are no competent legal practitioners who charge less than $150 an hour.
Entry level Investment bankers earn similar amounts, but their pay rises sharply every year, easily hitting $500,000 before the worker turns 30.
Psychiatrists charge $100 or more an hour.
There's no reason a physician with a year's experience should earn less than $100 an hour.
I don't mean billing $100 an hour. I mean earning $100 an hour.
HOwever, an entrepreneurial doctor, like Reddy, is likely to earn far more.
Posted by: chris | July 15, 2007 at 12:21 PM
Since restructuring my practice, I estimate my hourly wage at approximately 35/hour. This puts me in the upper third of my specialty, rather than in the lower 10%.
What is the hourly wage of the folks who post on this board? If they believe that physicians should work for free (in the ER or elsewhere) do they believe that everybody should be forced to spend approximately 30% of their time engaging in charity work (compulsory work at soup kitchens or cleaning up slum dwellings for example)?
Or is it only physicians who should be forced to work for free (as they are, in ERs)?
Posted by: shari | July 15, 2007 at 12:36 PM
Posters of hourly wages should include their "start up costs". For example, my teenager who is a lifeguard at the local pool has an hourly wage of 6.50 but had a start up cost of about 50 dollars (compared to a physician start up cost of over 200,000 dollars). She paid 35 dollars for the course, 12 dollars for a drug screen and 5 dollars for a t-shirt.
So. Lets hear it beginning with Barbara Ehrenreich.
What is your hourly wage?
How much do you pay for your office staff, rent, liability and the minimal education necessary to get your job?
What percent of your time is spent working at your usual trade for free (for example since you are a journalist, what percent of the revenues of your writing projects are given entirely to charity (for which you take no tax write off). Physicians, remember, can't write off their time.
Please notice, that I am not calling "charity" the vocational work that most Americans do because we enjoy it. I too volunteer to flip pancakes at my local church, teach bible study, and in the past I enjoyed tutoring local kids for free. I hope to do more of that when I am no longer a physician, and am a teacher with more time to call my own.
Posted by: shari | July 15, 2007 at 01:15 PM
Back up a minute: why, in this most prosperous and wonderful country, should anyone graduate with $100,000 to $200,000 worth of debt? There's no excuse for that.
Posted by: buena | July 15, 2007 at 01:44 PM
www.ama-assn.org/ama/pub/category/5349.html
As the above link will tell you, the average educational debt for the class of 2006 was 130,571
72% of graduates of US medical schools carry educational debt of at least 100,000
This debt is largely used to offset uncompensated care (read medicaid and uninsured) at hospitals in the university system. It is NOT paid to faculty.
I personally volunteer to teach medical students. They shadow me in clinic and on the ward. They are NOT useful, but they do keep me sharp. Last year, I was paid a total of 1,500 dollars for this work, as well as to give them two lectures. It is meant to be a token. Everyone who teaches medical students does so because we love medicine. My real salary comes from the patients I see.
Posted by: shari | July 15, 2007 at 02:04 PM
After spending over 20 years working in the business side of healthcare services, I'm very familiar with "docs" and their problems and attitudes.
It's insane that anyone attempting to obtain a higher education is now saddled with enormous debt. It's not only the high income professions like doctors and lawyers that are graduating owning tens (or hundreds) of thousands of dollars.
The paperwork and regulation load is a real burden, but one that can be managed, especially in a group practice.
We live in a culture in which run-a-way capitalism has changed the nature of our society. It's it the extreme manifestation of the "me" generation and "rugged individualism" myth.
As for ER docs not getting paid that may apply to residents, but not those "hired guns" who work in ER under contract. Which since most of these "lease a doc" companies don't contract with insurance companies the doc fee is billed at the highest rate with each "service" (history, exam, procedure) charged separately.
Years ago it would have been possible, if she was willing, for Dr. Shari to pay off her debt by working in a rural or low income area. Remember the TV show Northern Exposure? Unfortunately, most of those opportunities no longer exist.
We are begining to see more and more physician groups publicly sponsoring universal health care. They understand as do the physicians who are part of Doctors without Borders and similar groups that healthcare is a basic human right, not a resource to be apportioned among the rich.
Posted by: Solo | July 16, 2007 at 04:57 AM
I'm a neurologist. Federal regulations require that anybody who comes to the ER receive whatever care the hospital can provide, regardless of legal status or ability to pay. Everybody needs to be screened, even if they are using the ER in order to avoid an office visit (which would cost them).
Thus, if the ER physician says you need to come in and evaluate the patient, one needs to do this. To fail to do this, results in an automatic 50,000 dollar fine that is not picked up by malpractice insurance.
It doesn't matter that you are the only physician on call, and you had no sleep the night before.
It doesn't matter that it's your own child has been punched in the eye by the neighborhood bully and wants her mommy there to hold her while she cries.
You have to go in anyway.
Although hospitals do pay their ER physicians, and their hospitalists, the don't pay their consultants. Consultants bill whatever insurance or lack of insurance the patient carries. Mostly, due to the high number of illegal immigrants, none of whom carry health insurance, it is lack of insurance.
In my last practice there were two neurologists and we were on every other night. I left, and the remaining neurologist is now on every night (She has already handed in her resignation). I am currently in a practice with three neurologists and we are on every third night. We usually get 2 new patients each night for which we need to go in, and 5 phone calls spaced about every two hours during the wee hours of the morning. This is not paid for.
I believe that a national health system could work, but only if physicians had amnesty, like police officers and fire fighters. Regulation will also need to be slashed, because if you can't raise prices, then you need to cut costs.
Finally, while it may be true that "health care is a basic human right" so is sleep, and the right to have some time to spend with one's family.
We should have some rights too.
If my time can be confiscated by the state, then so should everybody's time. If physician's times can be confiscated by the state because health care is a "right" then journalists times should be confiscated by the state. Let Barbara Ehrenreich (who has not yet posted her hourly compensation) as well as all journalists, free lance writers, and other literate persons be forced under a 50,000 dollar penalty, to spend every third evening and weekend in the local elementary school tutoring underpriveledged kids in writing. After all an education is a "basic human right". Why should the children of the poor have less access to education than the children of the wealthy? Education is a basic human right, not to be apportioned among the rich. Yet few inner city children can write well. Wealthy parents do not send their kids to the NY city schools.
Let every lawyer be forced to spend every third weekend, and every evening preparing legal defenses for those unable to pay. Let them be fined 50,000 dollars each time they refuse to work for free, whether or not their child has a soccer game, whether or not their child is ill, whether or not they themselves are ill.
After all "justice" is a basic human right. Why should justice be apportioned among the wealthy? We should all have public defenders, and the lawyers should be enslaved to provide this free of charge.
Every right assumes a responsibility to pay for it.
So lets hear it Solo:
What is your hourly compensation, how much time do you spend taking care of the underpriveledged for free, and what are/were your start up costs?
What right have you to tell me that I should operate (flawlessly lest I get sued) on 5 hours sleep, and forgo most weekend activities with my children, so that you can indulge your "right" to whatever medical care you think you nee
Posted by: shari | July 16, 2007 at 07:27 AM
Unfortunately, you appear to have chosen the wrong profession. You are obviously angry, overwhelmed,and burnt out.
Would you grant amnesty to the Dr. Swango(s) of the profession?
Of course, their should be provisions that only GROSS negligence or similar disgregard for the health and life of the patient should put a doctor's license / income in jeopardy.
I agree that all professions should provide some pro bono services.
And, when you start talking about responsibilities attached to rights, you're preaching to the choir.
However, I respectively suggest that you examine the reasons why you became a physician. From what you write it my be your vocation but it's not your calling.
Posted by: Solo | July 16, 2007 at 07:51 AM
If a policeman commits murder he goes to jail. He does not get sued.
Similarly if a physician deliberately kills a patient he should go to jail. If he accidently kills a person due to incompetance he should lose his licence.
However the tort system is in place to enrich lawyers.
Police officers who fail to protect people because they arrived late to a domestic disturbance aren't sued for malpractice. Doctors are. Lawyers don't go into jails to learn if a criminal was roughed up so that that criminal can sue for pain and suffering.
As to my vocation, I've been a neurologist for 20 years. I have five separate specialty board certifications and 30 papers. But I didn't try to combine it with children when I was younger, and the hours in neurology have approximately tripled, while the compensation has dropped. You are right. I can't do it any more, but I am torn. When I retire, the only person in 300 miles who sees medicaid kids will be gone.
When I leave, somebody will die.
But at least my own kids will have their mother back. That's important too. I now know three collegues who have had children who commited suicide.
I wont let that happen to my kids. I can be a good teacher.
So. what is your hourly compensation, and what pro bono services do you provide?
Posted by: shari | July 16, 2007 at 08:05 AM
Wow.
I've been checking the archived comments for this site - intriguing discussions and debates.
Monica - if you are still reading this blog - would you happen to sympathize with the Christian Reconstructionists? I am getting that impression from reading your entries.
Barbara - I'm quite the devoted fan, having devoured both of you recent books (N&D, B&S) in a single manic evening of intense reading. Keep on keeping on!
WW
Posted by: WW | July 16, 2007 at 08:16 AM
Shari - The american system is brutally inefficient. The fact that medicaid pays so poorly is because they don't want doctors supporting medicaid. With greater societal input into training doctors and caring for the population, you wouldn't have such a horror story.
That's not to say that Canadian or British doctors don't have a complaint or two. They're not forced, however, to sell their soul to feed their children and pay off their student loans at the same time.
Universal health care is NOT as sloppy, inefficient, and hard on doctors and patients as Medicaid. That's exactly the point.
Posted by: Arwen | July 16, 2007 at 08:57 AM
Universal health care works in Canada and the UK because it is understood that patients can't get everything they want. If they go to an ER in the UK with a stroke they will be seen, but they wont receive clot busters in the 3 hour window. There is a neurologist shortage in both UK and Canada and therefore if the service is unavailable, it will not be provided, and people understand that you can't sue because something is not available.
Similarly, in the US if you need IV-IG for inflammatory neuropathy you will get it, whether or not you can pay. In the UK you won't. There is a list of procedures and therapies that are permitted and those that are not. There is explicit rationing.
Personally I favor explicit rationing. I think it is better than rationing by hassle factor which is the kind of rationing that happens in the US. However the American people have not been willing to accept limitations on care, and the American legal system, backs up their "right" to whatever care they want by law suits freely scattered.
I too favor universal health care. However the care delivered will not be as good as the care delivered now, and waiting lists for all people will become similar to waiting lists for medicaid now.
Since folks don't wish to hear this, they will not vote for politicians who tell them this, and instead prefer to believe that the lack of accessible health care is due to "greedy doctors" and "fraud and abuse".
By the way, I had a collegue who just paid about 100,000 to medicare for "fraud and abuse". His "fraud" consisted of letting patients who did not have health insurance pay only 10 dollars or simply writing it off. That's not allowed under federal guidelines. You can't have different payments for folks who can't pay. All you can do is to refuse to see them.
Shari
Posted by: shari | July 16, 2007 at 09:26 AM
Universal health care works in Canada and the UK because it is understood that patients can't get everything they want. If they go to an ER in the UK with a stroke they will be seen, but they wont receive clot busters in the 3 hour window. There is a neurologist shortage in both UK and Canada and therefore if the service is unavailable, it will not be provided, and people understand that you can't sue because something is not available.
Similarly, in the US if you need IV-IG for inflammatory neuropathy you will get it, whether or not you can pay. In the UK you won't. There is a list of procedures and therapies that are permitted and those that are not. There is explicit rationing.
Personally I favor explicit rationing. I think it is better than rationing by hassle factor which is the kind of rationing that happens in the US. However the American people have not been willing to accept limitations on care, and the American legal system, backs up their "right" to whatever care they want by law suits freely scattered.
I too favor universal health care. However the care delivered will not be as good as the care delivered now, and waiting lists for all people will become similar to waiting lists for medicaid now.
Since folks don't wish to hear this, they will not vote for politicians who tell them this, and instead prefer to believe that the lack of accessible health care is due to "greedy doctors" and "fraud and abuse".
By the way, I had a collegue who just paid about 100,000 to medicare for "fraud and abuse". His "fraud" consisted of letting patients who did not have health insurance pay only 10 dollars or simply writing it off. That's not allowed under federal guidelines. You can't have different payments for folks who can't pay. All you can do is to refuse to see them.
Shari
Posted by: shari | July 16, 2007 at 09:27 AM
Universal health care works in Canada and the UK because it is understood that patients can't get everything they want. If they go to an ER in the UK with a stroke they will be seen, but they wont receive clot busters in the 3 hour window. There is a neurologist shortage in both UK and Canada and therefore if the service is unavailable, it will not be provided, and people understand that you can't sue because something is not available.
Similarly, in the US if you need IV-IG for inflammatory neuropathy you will get it, whether or not you can pay. In the UK you won't. There is a list of procedures and therapies that are permitted and those that are not. There is explicit rationing.
Personally I favor explicit rationing. I think it is better than rationing by hassle factor which is the kind of rationing that happens in the US. However the American people have not been willing to accept limitations on care, and the American legal system, backs up their "right" to whatever care they want by law suits freely scattered.
I too favor universal health care. However the care delivered will not be as good as the care delivered now, and waiting lists for all people will become similar to waiting lists for medicaid now.
Since folks don't wish to hear this, they will not vote for politicians who tell them this, and instead prefer to believe that the lack of accessible health care is due to "greedy doctors" and "fraud and abuse".
By the way, I had a collegue who just paid about 100,000 to medicare for "fraud and abuse". His "fraud" consisted of letting patients who did not have health insurance pay only 10 dollars or simply writing it off. That's not allowed under federal guidelines. You can't have different payments for folks who can't pay. All you can do is to refuse to see them.
Shari
Posted by: shari | July 16, 2007 at 09:28 AM
dunno how that happened. sorry for the multiple posts
Posted by: shari | July 16, 2007 at 09:29 AM
Shari's posts bring up an interesting point. To what degree is the "debtor" model for education -- particularly for health care professionals -- screwing up health care in this country? When clinicians routinely start out their careers an eighth or a quarter million in the hole, before they ever earn a dime, of course it's going to impact the quality of care. No question about it.
The entire debtor model for education, IMHO, needs to be junked, and in particular nurses and doctors should be able to be trained for free or close to it. You can be your own lawyer if need be. You can't be your own doctor or nurse.
Posted by: Promentalbackwash | July 16, 2007 at 10:33 AM
Everybody else pays for their education and is in debt. Why should we pay for Dr. Reddy's education? If college is free will that mean that taxes will be raised on people who didn't go to college?
Posted by: stacy | July 16, 2007 at 11:07 AM
Everybody else pays for their education and is in debt. Why should we pay for Dr. Reddy's education? If college is free will that mean that taxes will be raised on people who didn't go to college?
Posted by: stacy | July 16, 2007 at 11:12 AM
Presumably. College and medical school is free in much of Europe, and taxes are more than double what they in the US. "Free medicine" is expensive.
Posted by: shari | July 16, 2007 at 11:16 AM
That's exactly what I mean, Stacy. No one should have to go into serious debt in order to get an education. The amount of debt people carry from that in this country is absolutely ridiculous.
Posted by: Promentalbackwash | July 16, 2007 at 01:09 PM
If college is free, (as it is in some countries) then somebody needs to pay for it. That usually means either increased taxes (Europe's taxes average 70% of income for the middle class) or printing money. Printing money causes runaway inflation (see Zimbabwe or Argentina).
If students (as in France) were paid to study and had free schooling, then somebody has to pay for it. In France this is achieved by high taxes on the nonliterate population (many of whom are islamic immigrants).
What I see is that everybody in the US is hurting and has noticed a gigantic drop in their standard of living. The reason for this is because the US government has been inflating the money supply by running up the national debt to pay for both her wars and for the Great Society programs. Thus, the value of the dollar now buys only about 10% of what it used to. The reason that this has not shown up in the official inflation index is that the official inflation index excludes energy, food, health care, and education. The dollar has been debased since Nixon took us off the gold standard (and had previously been debased when FDR confiscated gold and devalued the dollar then.
This will only get worse as the boomers retire, as the US government will be forced to print even more money to pay for their promised benefits. However the solution to this problem does not seem to be to be promising more benefits. The solution, would seem to be reducing debt, by living within our means.
As for solving the problem of medicine by making education free, don't make me laugh. The ONLY reason most residents remain in medicine is because they realize they can't do anything else until they pay off their student loan. They have to work the insane hours because if they switched and tried to get that "50,000 dollar a year public relations job" that Barbara was going after they would find themselves lucky to get a 20,000 dollar a job working at Office Depot. Then, that 150,000 dollar student loan would bancrupt them.
Similarly truck drivers (most of whom are independant) are now required to work about 120 hours a week in order to make 40,000. The reason they do so is to pay off their trucks.
It is debt that is killing our generation, and debt is what is tying people to jobs that have turned pretty horrible.
This includes not just our own debts, for student loans, mortgages or toys, but the debts our government took on to pay for the things we said we wanted.
Possibly we should consider doing without? When my grandfather developed crippling arthritis, he told me once "well, the doctors said there was an operation that might help, but I don't think so. Anyway there was your father in college."
It used to be that people didn't expect to retire.
Personally, my goal is to be free of all debt (including mortgage debt) in 3 years, and to have my kids college funds paid up. Then I plan to leave medicine, get a very much lower paying job, and live cheaply, maintaining my health insurance for as long as my kids are dependant on me. After that, I will probably give up my health insurance, but plan to die if I get ill. After all, by that time it wont matter what happens to me, the kids would be on their feet, and will be debt free.
That is the way my grandfather thought of money. He was right.
Shari
Posted by: shari | July 16, 2007 at 07:38 PM
Dennis Kucinich has proposed universal health care - no more profit for insurance companies.
Posted by: mel | July 17, 2007 at 06:12 AM
Generally, the opportunity for profit usually attracts entrepreneurs. As increasing numbers of them exploit it, and apply technology to production, the product or service become commodified and its price drops due to competition.
Obviously, this has not happened to medical care. That implies that profit per se is not the problem.
Posted by: Anarcissie | July 17, 2007 at 06:22 AM
shari: '... The ONLY reason most residents remain in medicine is because they realize they can't do anything else until they pay off their student loan. ...'
This doesn't explain why the residents got into medicine in the first place, if it was going to burden them with crippling debt. Same for the truck drivers.
Posted by: Anarcissie | July 17, 2007 at 06:30 AM
Residents get into medicine for the same reason that I went into medicine.
The subject was fascinating, medicine used to be both prestigious as well as an opportunity to do good, and we expected to pay off our costs relatively quickly.
For the most part, once we were accepted, we were never told about the debt. There were three thousand forms to sign and we signed them. We were also told that once we graduated it would be no problem paying off the debt. This is the reason that many undergraduates pay big bucks for college. They are not carefully instructed in what the alternatives are. In point of fact, both in time and in money I would have done better had I taken the price of my education (much less in those days) and bought a laundromat with it. I have suggested this career option to my kids, but right now one wishes to be a teacher, and the other is considering being a vet.
Why do most people get into debt? Because they believe that the money they spend, whether on a truck or on a career will be returned with a premium. It is the same reason that some folks get into debt to buy stocks.
However I think it is a mistake. I will be paying in cash once I pay off my mortgage, and I will be encouraging my children to do likewise.
Posted by: shari | July 17, 2007 at 07:19 AM
The reason that prices have not dropped in medicine is that we don't have a free market in medicine.
There are some segments of medicine that are profitable and are in fact being commodified. Urgent care is one of them, and increasingly physician extenders, and nurses are being trained to provide it on a cash on the barrel system. I imagine that the price of the routine ear infection will drop sharply, and that there will in time be as many cahs only-urgent care centers on each street as there are chiropractitioners. Chiropractitioners also enjoy a free market with people willing to pay cash on the barrel.
However serious medicine, when you have a stroke, when you have multiple sclerosis, when you have breast cancer is expensive. There are drugs that cost money, nursing care that costs money, and it requires frequent physician visits, not a single one. Since insurance is tied to work in this country, when somebody gets a serious illness like cancer, they become unable to work, and are likely to lose their health insurance immediately thereafter. If they qualify for disability (rare, and late) they will get medicaid. Otherwise they will be uninsured. Since Medicaid does not pay for costs, their care is subsidized by the folks who do have insurance. This drives up their costs, and drives down physician profits.
This is why Dr. Reddy does not wish to have a chemo center. All cancer centers (like trauma centers and burn centers) lose money. That money comes from patients who have more profitable diseases (like heart disease)that are likely to allow them to keep working, and hold on to their insurance.
Posted by: shari | July 17, 2007 at 07:29 AM
As to universal health care with no more insurance companies I think that will be a good thing in general, at least for young people with straightforward diseases. Appendectomies, broken bones, coronary artery diseases and hypertension should be covered nicely under Dennis Kucinich's plans, as should urgent care (urinary tract infections, STDs and ear infections),
Universal health insurance will also be cost effective, because it will let people who can work and pay taxes, get back to working and paying taxes.
What it will not do, and has not done in those countries where it has been tried is to take care of frail people with complex illnesses. The Netherlands is a case in point. Euthanasia is not only legal, but is expected. Not only are preemature infants, or infants with neurological illnesses euthanized at birth (paradoxically improving their child mortality statistics since we call any death after birth death, while death in the first few months in the Netherlands is not considered child mortality but fetal death, and is uncounted). Similarly older individuals do not get much in the way of chemotherapy or surgery as they do here. What they do get is the opportunity to "die with dignity". The Netherlands has euthanized not only older people with heart disease and strokes, but also people who are depressed, people who were "distraught over facial scarring" and on one occasion, a healthy 70 year old was euthanized because he was living a "pointless existence". Euthanasia in Holland does NOT require patient consent, and in 20% of cases no consent is obtained either from patient or family.
http://www.euthanasia.com/index.html
I suspect we will have universal health care in the US, and that euthanasia will follow of necessity. I am not afraid to die, and will be ready to die once I have provided for my children. However I am not prepared to kill, and since neurologists will undoubtedly be a part of the brave new world that will be brought on us, this is another reason that I wish to be out of medicine in 5 years.
Posted by: shari | July 17, 2007 at 08:15 AM
shari, you wrote:
"I suspect we will have universal health care in the US, and that euthanasia will follow of necessity."
Neither universal healthcare nor euthanasia will survive the legislative process.
Despite the claims appearing here, the country is so divided on healthcare issues that there is no chance for the emergence of a national program.
First, as we all know, a national healthcare bureaucracy would become a mammoth entity within which factions and fiefdoms would arise. Costs would spiral while results declined.
Rationing of care would have huge political fallout.
First, the federal government is not going to provide abortions. Let the rock fights begin!
Second, the federal government is not going to engage in euthanasia. More rock fights.
The experiences of other governments and nations may have some instructive value. But the healthcare experiences of countries with populations smaller than New York City don't tell us much.
Religious leaders and religious voters will oppose abortion and euthanasia.
Meanwhile, the issue of driving the profit margin out of healthcare will disappear when it becomes plain that a federal healthcare bureaucracy employs a vast army of people who perform no useful tasks.
The healthcare bureaucracy would soon become the largest and most voracious consumer of taxpayer funds ever known. And there would be no one to stop it from expanding until it bankrupted the nation. It would become a warehouse for people with limited skills. Pushing paper, maintaining records, losing files, mismanaging data, attending meetings, arranging seminars, squandering money on consultants, documenting the activities of employees, issuing quality-control reports, etc.
A review of the Departments of Education in every state in the union shows how bureaucracies become unaccountable behemoths that are forever short of sufficient capital for success.
Politicians fear a healthcare bureaucracy because its existence would destroy too many political careers.
Meanwhile, voters would hate it as well. Why? Because to survive the legislative process, its structure would require so many compromises that absolutely no one see it as a victory. But everyone would see it as bad, because it would demonstrate the adage of too many cooks spoiling the broth.
Universal healthcare died one death already when Hillary took her crack at it a dozen years ago. Little has changed since then. It may seem that people are yapping about it again. But it is clear there is no unity among those who are driving this public discussion.
Posted by: chris | July 17, 2007 at 09:29 AM
Our country is losing a war, cannot educate its children, cannot rescue a drowned city, and cannot improve the health of its citizens. Meanwhile everyone gripes about taxes. Maybe it's time to pay a 70% rate. On payroll, capital gains, corpo profits, inheritance, etc. I'm for it.
Posted by: Tom | July 17, 2007 at 09:35 AM
Tom, you wrote:
"Our country is losing a war, cannot educate its children, cannot rescue a drowned city, and cannot improve the health of its citizens."
Your comment is largely false. The US enjoys arguably the best education system in the world. The system has many problems, but it is faced with more challenges than any other system in the world.
If, like in Japan, everyone in the US spoke the same language, our education problems would largely disappear. But there is little hope for declaring English our official national language and conducting all public education in our mother tongue.
In any case, the problems that exist within our education system exist mainly because our public education system is a government bureaucracy. That means funneling more money into it won't improve it.
Next, New Orleans is a city that sits below sea level. No responsible lender will finance the construction of new buildings sitting below sea level and below the water level of the Mississippi and Lake Ponchatrain.
Additionally, it is the bueaucracy of the federal and state funding process that has kept the city mired in muck.
Here in NY City, the World Trade Center site is still no more than a big hole in the ground almost six years after 9/11. Again, this is a demonstration of government bureaucratic logjams. Meanwhile, Larry Silverstein, the leaseholder on the World Trade Center before 9/11 has already completed a new 52-story building to replace World Trade Center Tower 7. It is open for business and it is a beauty. That's private enterprise at work. His new building would have been finished sooner had he not been locked in disputes with the government over liability issues.
Thus, New Orleans will probably never see significant reconstruction in the Lower Ninth Ward unless all buildings are up on stilts and safely above flood levels.
Why would any lender finance any rebuilding in one of the country's most likely sites for catastrophe?
As for managing the military, that's one job I will leave to the federal government. Meanwhile, there is a cost for doing nothing, as many people would like.
The cost of 9/11 itself was well over $100 billion. It took only a few hours for a handful of muslim terrorists to inflict over $100 billion in damages.
How many days like that can we withstand? Answer. Not many. Thus, doing nothing is not an option.
You wrote:
"Meanwhile everyone gripes about taxes. Maybe it's time to pay a 70% rate. On payroll, capital gains, corpo profits, inheritance, etc. I'm for it."
Ahhh, the height of liberal illogic. It goes like this: If an expensive program or practice is a failure, the best solution is to spend even more money while failing to achieve goals that the free-market would solve without government intrusion.
Posted by: chris | July 17, 2007 at 10:17 AM
The health care math is simple. We in the developed world have a high-skill, high-tech, health care model which, when it works the way it should works well (I do have plenty of issues with the system but this is neither the time nor place). Health care is provided by teams of highly educated, committed professionals, often using sophisticated scientific devices and state of the art medications and therapy modalities. This is expensive but is worth the cost because it does work. Many of us do live longer and better (the reason that more of us don't has at least as much to do with distribution as it does with current limitations). At the same time we have powerful social forces pressing to keep health care costs down. The costs of using this system would put health care out of reach for all but the wealthiest citizens. Between these two economic forces, the steadily increasing cost of quality care and the need to keep prices affordable there is simply no room for profit. Health care has to be provided without the add-ons of maximum return for investors and the monstrous "compensations" awarded to corporate CEO's these days (yet another issue for another day), and it needs to be provided universally. The only way to do this is through a single payer system operated by the government.
Posted by: Ron | July 17, 2007 at 10:22 AM
I'll vote for John Edwards - he has a plan for universal health care that WILL work.
Posted by: bpb | July 17, 2007 at 11:24 AM
http://www.huffingtonpost.com/rj-eskow/the-john-edwards-health-p_b_40573.html
John Edwards freely admits that his plan will cost a great deal more than the present system, and will include taxes for healthy people who currently decline health insurance because (they are healthy).
I do not see the current uninsured agreeing to pay health insurance premiums to support the plan.
However I do note that the wealthy (like JOhn Edwards) will be able to opt into a private system so that he can go to Dr. Reddy's hospitals.
The plan would probably work, however it would be most expensive for the current uninsured.
Posted by: shari | July 17, 2007 at 11:46 AM
John Edwards plan will not do anything about either the complex scheme of insurance plans or about the liability crisis, and therefore costs will rise, and providers will continue to leave medicine, or to at least leave the less lucrative aspects of medicine.
But trial lawyers such as John Edwards should be pretty happy with the outcome.
Posted by: shari | July 17, 2007 at 12:11 PM
When I was working at Target I did not have health insurance because the employee contribution was $50 a week. On a $200 weekly pay check my health was forced to take a back seat. One day I got sick. It was a BAD cold that got worse. I got an ear infection in both ears. I was in such massive pain that I went to the E.R. and I waited for about 2 hr. and was never even taken in side the E.R. in instead some one who was not a doctor looked in my ears and then came back to me 2 hr later with 3 prescriptions. At the time I thought that by treating me in the waiting room meant that the bill was going to be low. I was wrong. Total cost was $300. (not counting the cost of the prescriptions.) That comes out to $100 for 3 slips of paper.
Posted by: Justin K. | July 17, 2007 at 01:32 PM
I think universal health care in the US will work once you take and eliminate the fat greedy overlords who stand to benefit the most.
Swallow your pride. Use the French sytem as a model, admit it works so much better than your pitiful greedmonger based broken down model, and implement it.
I cannot believe you fools let it deteriorate to the point that people are losing their lives unnecessarly.
Face the facts US citizens.You are being outlived by the populations of the G-8 nations, by many years. How's that for quality of life ? You could have an extra 5 thrown in, if you fix things now.
I thought the Chinese had no regard for human life.
Posted by: Larry in Lethbridge | July 17, 2007 at 01:38 PM
Your mistake was going to an ER. You'd have done better going to an Urgent care where you'd probably have had a 50 dollar bill.
Your high ER bill paid for the illegal immigrant who gave a false social security number, the patients with medicaid who paid less than cost, and the patient with medicare who had a complex illness which cost more than the "DRG" reimbursement set by the government. The ER is not permitted to charge you less than the full cost because you are uninsured, that is considered "Medicaid fraud" since if they wrote off your charge they would be billing medicaid more than you were billed, and medicaid is supposed to get the lowest price. The government is very eager to stamp out medicaid and medicare fraud and therefore actively goes after providers who don't charge uninsured patients.
Since more than half of the patients who go to the ER don't pay the full cost of their visits, that leave both the self pay and the privately insured paying the bills.
In parts of the country, where there is a high number of illegal immigrants, more than 80% of ER patients don't pay their bills.
Posted by: shari | July 17, 2007 at 01:45 PM
http://fn.bmj.com/cgi/reprint/89/1/F2.pdf
Regarding the wonderful health care of France and the other G-8 nations, most of these nations permit passive euthanasia (witholding food and water from "useless eaters" such as disabled infants, and the elderly) and France recently joined the Netherlands and Belgium in permitting active euthanasia (deliberate use of drugs to end life).
http://news.bbc.co.uk/2/low/europe/665372.stm
Euthanasia of the disabled actually improves the health care ratings of the G-8 nations. If you remove preemie infants (which are counted as live births in the US, but who have a high child mortality) and call them "fetal deaths" or "after birth abortions" which is what live preemies are called in France or the Netherlands, then when despite the best efforts of physicians the baby dies, this will greatly reduce societal life expectancy in the US (by the 75 years or so that that child would have lived had he been healthy), while falsely improving life expectancy in the G8 countries.
Similarly, since bumping off a disabled Dutch 70 year old with a mild stroke will only reduce his expected life expectancy by about 5 years. Euthanasia (whether active or passive) of older adults will not noticeably decrease life expectancy rates.
But Larry in Lethbridge is right. Here in the filthy greedmonger based health care system, people are dying "unnecessarily". In the glorious G-8, they can die in the service of the state.
Posted by: shari | July 17, 2007 at 02:31 PM
http://fn.bmj.com/cgi/reprint/89/1/F2.pdf
Regarding the wonderful health care of France and the other G-8 nations, most of these nations permit passive euthanasia (witholding food and water from "useless eaters" such as disabled infants, and the elderly) and France recently joined the Netherlands and Belgium in permitting active euthanasia (deliberate use of drugs to end life).
http://news.bbc.co.uk/2/low/europe/665372.stm
Euthanasia of the disabled actually improves the health care ratings of the G-8 nations. If you remove preemie infants (which are counted as live births in the US, but who have a high child mortality) and call them "fetal deaths" or "after birth abortions" which is what live preemies are called in France or the Netherlands, then when despite the best efforts of physicians the baby dies, this will greatly reduce societal life expectancy in the US (by the 75 years or so that that child would have lived had he been healthy), while falsely improving life expectancy in the G8 countries.
Similarly, since bumping off a disabled Dutch 70 year old with a mild stroke will only reduce his expected life expectancy by about 5 years. Euthanasia (whether active or passive) of older adults will not noticeably decrease life expectancy rates.
But Larry in Lethbridge is right. Here in the filthy greedmonger based health care system, people are dying "unnecessarily". In the glorious G-8, they can die in the service of the state.
Posted by: shari | July 17, 2007 at 02:39 PM
Figure the BBC to pull apart the French system. They have been feuding since Norman/Saxon times and the Beeb needs to fill time slots to entertain the folks down at the pub afterall.
Your argument about Youth in Asia is just plain ignorant and without merit.
I doubt whether you have even travelled outside the USA, maybe even your state, by the sounds of it.
Lifespan is lifespan. Pickup your scientific research there, Dr. Shari and then come back and report your findings then.
Your statement might be the most ignorant thing I have read on the Internet in weeks.
btw, Belgium and the Netherland are not yet in the G-8 in case you thought they were.
Posted by: Larry In Lethbridge | July 17, 2007 at 05:41 PM
I was born in DC, spent 8 years living in Europe, and then returned to DC from 3rd grade through fellowship.
I lived 2 years in Holland, 2 in England and the rest scattered in Sri Lanka, India and France. My father was a diplomat in Belgium, and I visited him often.
In point of fact the issues regarding the european experiment with euthanasia are well documented.
A google search on "euthanasia, Europe" will find this for you.
I offer the following piece which is a reasonable summary:
From:
http://www.nationalreview.com/comment/smith200312230101.asp
December 23, 2003, 1:01 a.m.
Continent Death
Euthanasia in Europe.
By Wesley J. Smith
Too many people think with their hearts instead of their brains. Wanting the world to suit their desires, when faced with hard truths to the contrary, they refuse to face facts they don’t want to believe. This common human failing has a name: self-delusion.
Self-delusion is rampant in the euthanasia movement. Most proponents recognize that it is inherently dangerous to legalize killing. But they desperately want to believe that they can control the grim reaper. Thus, they continue to peddle the nonsense that "guidelines will protect against abuse" despite overwhelming empirical evidence to the contrary.
Euthanasia has been around long enough and practiced sufficiently enough for us to detect a pattern. Killing is sold to the public as a last resort justified only in cases where nothing else can be done to alleviate suffering. But once the reaper is allowed through the door, the categories of killable people expand steadily toward the acceptance of death on demand.
The classic example is the Netherlands, where doctors have been allowed to euthanize patients since 1973. Dutch death regulations require that euthanasia be strictly limited to the sickest patients, for whom nothing but extermination will alleviate overwhelming suffering — a concept in Dutch law known as force majeur. But once mercy killing was redefined as being good in a few cases rather than being bad in all circumstances, it didn’t take long for the protective guidelines to be viewed widely as impediments to be overcome instead of important protections to be obeyed.
Thus, supposedly ironclad protections against abuse — such as the doctrine of force mejeur and the stipulation that patient give multiple requests for euthanasia — quickly ceased meaningfully to constrain mercy killing. As a consequence, Dutch doctors now legally kill terminally ill people who ask for it, chronically ill people who ask for it, disabled people who ask for it, and depressed people who ask for it.
Euthanasia has also entered the pediatric wards, where eugenic infanticide has become common even though babies cannot ask to be killed. According to a 1997 study published in the British medical journal The Lancet, approximately 8 percent of all Dutch infant deaths result from lethal injections. The babies deemed killable are often disabled and thus are thought not to have a "livable life." The practice has become so common that 45 percent of neonatologists and 31 percent of pediatricians who responded to Lancet surveys had killed babies.
It gets worse: Repeated studies sponsored by the Dutch government have found that doctors kill approximately 1,000 patients each year who have not asked for euthanasia. This is not only a violation of every guideline, but an act that Dutch law considers murder. Nonvoluntary euthanasia has become so common that it even has a name: "Termination without request or consent."
Despite this carnage, Dutch doctors are very rarely prosecuted for such crimes, and the few that are brought to court are usually exonerated. Moreover, even if a doctor is found guilty, he or she is almost never punished in any meaningful way, nor does the murderer face discipline by the Dutch Medical Society. For example, in 2001, a doctor was convicted of murdering an 84-year-old patient who had not asked to be killed. Prosecutors demanded a nine-month suspended probation (!), yet even this brush — it can’t even be called a slap — on the wrist was rejected by the trial judge who refused to impose any punishment. Not to worry. The appellate court decided to get tough: It imposed a one-week suspended sentence on the doctor for murder.
Even such praising with faint damnation isn’t enough for the Dutch Medical Association. As a result of this and the handful of other non-punished murder convictions of doctors who engaged in termination without request or consent, the organization is lobbying to legalize non-voluntary euthanasia. Along these same lines — and demonstrating that the culture of death recognizes no limits — the day after the Dutch formally legalized euthanasia, the country’s minister of health advocated the provision of suicide pills to the elderly who do not qualify for killing under Dutch law.
Lest we think the Dutch experience is a fluke, let us now turn our attention to Belgium. Only one year ago the Belgians legalized Dutch-style euthanasia under "strict" guidelines. As with the Netherlands, once unfettered, the euthanasia culture quickly began to swallow Belgium whole. Moreover, the slide down the slope has occurred at a greatly accelerated pace. It took decades for the Dutch euthanasia to reach the current morass. But Belgian euthanasia went off the rails from day one: The very first reported killing — that of a man with multiple sclerosis — violated the legal guidelines (not that anything was done about it). Moreover, while 203 people were officially recognized as having been euthanized in Belgium during the first year of legal practice, most euthanasia deaths were not reported (a violation of the law). The actual toll is probably closer to 1,000.
And Belgian euthanasia advocates have already begun agitating to expand the categories of killable people. A just-completed forum attended by hundreds of Belgian doctors and euthanasia enthusiasts advocated that minors be allowed to request euthanasia, as well as people with degenerative conditions, such as Alzheimer’s, who are not imminently dying. Not only that, but the chairman of the conference wants to force doctors to participate in killing patients, even if they are morally opposed. If he gets his way, the law will soon require doctors who oppose euthanasia to refer patients who want to be killed to a colleague willing to do the deed. So much for choice.
The Swiss have also unleashed the culture of death into their midst. Rather than authorizing doctors to commit euthanasia, however, Swiss law instead permits private suicide facilitation. As a result, Switzerland has become a destination for "suicide tourists" who travel there not to ski, but to receive a poison cocktail.
A private group that goes by the name "Dignitas" facilitates most Swiss assisted suicides. Its founder, lawyer Ludwig Minelli, recently told the Swiss press that he will not restrict Dignitas’s dark work to providing services to the dying. Indeed, the report said Minelli believes that "severe depression can be irreversible and that he is justified" in helping "the mentally ill" to die. Along these lines, a Swiss doctor is being investigated for possible prosecution for the double suicide of French twins with schizophrenia. That may sound like a serious effort to crack down on abuse, but remember, once euthanasia is legitimized, such talk is often cheap. If the Dutch experience is any indication, even if the suicide doctor is convicted, he will not be meaningfully punished.
Despite this history, euthanasia advocates here and abroad still cling irrationally to the hubristic and foolish notion that they are competent to administer death. They remind one of Dr. Frankenstein, who, in the name of benefiting humankind, unleashed a terrible monster.
Posted by: shari | July 17, 2007 at 06:04 PM
And in this article, 2,000 French Doctors and Nurses Petition for Legalized Euthanasia saying that they have ALREADY “helped patients die” illegally
http://www.lifesite.net/ldn/2007/mar/07030905.html
By Gudrun Schultz
PARIS, France, March 9, 2007 – More than 2000 French medical professionals have issued a petition calling for laws to permit active euthanasia, saying they already engage in the practice when a patient’s life becomes “intolerable” due to “physical and psychological suffering.”
"Because disease was certain to defeat medical procedures, because in spite of treatment, physical and psychological suffering had rendered the life of a patient intolerable, we medical staff, have consciously helped patients to die with decency," the petition reads.
The declaration was signed by 2,134 medical professionals and published Thursday in the weekly Nouvel Observateur, Reuters reported yesterday.
Alex Schadenberg, executive director of the Euthanasia Prevention Coalition in Canada, questioned whether the signers of the petition were actually involved in euthanasia or whether they were simply involved in allowing death to occur by ending aggressive medical treatment.
“Often people become confused by language and definitions,” Schadenberg told LifeSiteNews.com in an email commentary.
He also questioned the comment claiming euthanasia is frequently practiced by French doctors, pointing out that a study last year in the UK proved that the actual number of clandestine euthanasia deaths in their country was much less than the pro-euthanasia people have stated.
“There seems to be a push to legalize euthanasia and assisted suicide based on the argument that it is happening already,” Schadenberg said. “Studies have proven that this is not the case. The other fact is that some people are intentionally breaking the law in order to create pressure to change the law. These cases are actually rare compared to the total number of people who receive end-of-life care.”
The petition comes as a trial opens for a French doctor and nurse accused of committing euthanasia in August, 2003. The doctors call for the charges against the pair to be dropped, and demand a new law that would allow active euthanasia, modeled on the laws operating in Belgium, Switzerland and the Netherlands.
With France facing an election in just a few weeks, euthanasia has become a campaign issue for presidential candidates. Contender Ségolène Royal has promised to legalize euthanasia if elected, while frontrunner Nicolas Sarkozy, a Catholic, has presented himself as a pro-family candidate with policies more in line with the Church.
Posted by: shari | July 17, 2007 at 06:16 PM
shari: 'The reason that prices have not dropped in medicine is that we don't have a free market in medicine.
There are some segments of medicine that are profitable and are in fact being commodified. Urgent care is one of them....'
I haven't noticed a drop in prices, but it is difficult to tell, because we have some very strong inflation going on but it affects different areas of the economy to different degrees and is being carefull concealed by the government. $100 in 2007 is as nothing compared to $100 in 2000, if one is dealing with real estate, stock, collectibles, energy, and a number of other things, whereas it still buys about the same amount of unskilled labor.
But, incredibly, real estate and energy aren't counted in computing inflation.
My main point, though, was that profit (in a "free market" situation) can't be the cause of rising medical care prices for the Adam-Smithian reasons I gave, so that removing profit can't be expected to solve or mitigate the problem by itself.
Posted by: Anarcissie | July 17, 2007 at 06:34 PM
chris: '.... As for managing the military, that's one job I will leave to the federal government. Meanwhile, there is a cost for doing nothing, as many people would like.
The cost of 9/11 itself was well over $100 billion. It took only a few hours for a handful of muslim terrorists to inflict over $100 billion in damages.
How many days like that can we withstand? Answer. Not many. Thus, doing nothing is not an option.
You wrote:
"Meanwhile everyone gripes about taxes. Maybe it's time to pay a 70% rate. On payroll, capital gains, corpo profits, inheritance, etc. I'm for it."
Ahhh, the height of liberal illogic. It goes like this: If an expensive program or practice is a failure, the best solution is to spend even more money while failing to achieve goals that the free-market would solve without government intrusion.'
There's something of a contradiction in what you're saying, isn't there? 9/11 occurred after enormous amounts of wealth were expended over a period of many years on 'national security' -- very broadly defined to include not only defense but the imperialism and manipulation which have been elements in American state policy since the beginning of the 20th century and became dominant, indeed, exclusive during World War II. As the cops and banker of the world, the U.S. naturally draws a lot of unwelcome attention. Maybe this sort of thing -- heroically and single-handedly invading places like Afghanistan, Iraq, Somalia, Bosnia, Kosovo, Vietnam, etc. etc. etc., to straighten them out isn't such a good policy after all.
It seems to me you could apply your suspicion of government expenditure to militarism and imperialism as well. You don't have to become a liberal -- check out Ron Paul.
And now, back to our subject....
Posted by: Anarcissie | July 17, 2007 at 06:49 PM
Larry in Lethbridge thinks that "life span is lifespan" Doubtless he also thinks that "employment is employment" and congradulates Dubya on having created so many sucky jobs in the last 6 years.
For those of you who actually are capable of understanding numbers, I enclose the numbers for late fetal death (after 28 weeks) for the US and selected european countries
From: www.oecd.org
3rd trimester death (not related to abortion) per 1000 live births
US: 3.3
Canada: 3.3
Netherlands 4.7
Belgium: 4.9
UK 5.3
France: 4.6
Gosh all those 3rd trimester "miscarriages" in France home of wonderful preventive care.
And yet life expectancy is better once you manage to get out of the French creche.
France: 79.4
Belgium 78.1
Netherlands: 78.6
UK: 78.5
US: 77.2
Canada: 79.7
But we know that statistics never lie. Inflation is really only 2%, unemployment is at an all time high, and we are all living in paradise.
Posted by: shari | July 17, 2007 at 07:05 PM
--"Patients,” the Los Angeles Times reports [Reddy] saying, “may simply deserve only the amount of care they can afford.”
It's a good thing the good doctor owns hospitals: if he keeps spouting this kind of Nazi/eugenicist bull sh*t, he's going to need them. Vive la revolution! :)
Posted by: Tom M. | July 17, 2007 at 09:43 PM
Update: I just saw the good doctor's rebuttal to the LA Times, in which he asserts, "It is my firm belief and strong conviction that every patient deserves care based on the nature and severity of illness and should not be based on financial status."
Good for him--if he means it. But if so, why is he giving money to Republicans, who believe it's only right that the rich should be *healthier* than the poor--the blessing of an elitist, callous, Calvinist God?
Of course, here in Gekkoland, this Master Racism is a shocking reality. Not so in other developed nations, where decency and a commitment to civilization prevail.
Posted by: Tom M. | July 17, 2007 at 10:02 PM
Exactly what does all this nonsense about euthanasia have to do with the fact that the US healthcare system has gone horribly wrong Dr.Shari ?
That is the topic right ?
Maybe we can save your insight for the day when we discuss infanticide or killing my Grandma
Posted by: Larry In Lethbridge | July 18, 2007 at 06:59 AM
The reason we are discussing European infanticide and european murder of the elderly and disabled NOW is because that is how Europe pays of "universal health care". Dead people are a lot cheaper than sick people, and disabled infants, and the elderly don't pay taxes.
When universal health care comes to the US, euthanasia will follow.
But at that point I will no longer be a physician.
Posted by: shari | July 18, 2007 at 07:53 AM
As for "Nazi/eugenist bullsh#t" isn't that exactly what is happening in the wonderful socialist meccas of the Netherlands?
From:
http://www.internationaltaskforce.org/fctholl.htm
The Netherlands doesn't need to worry about the US problems of ADD or bipolar illness in teens:
* Some Dutch doctors provide "self-help programs" for adolescents to end their lives. (26)
No forced call for general practitioners taking care of frail oldsters:
* General practitioners wishing to admit elderly patients to hospitals have sometimes been advised to give the patients lethal injections instead. (27)
Lower costs!
* Cost containment is one of the main aims of Dutch health care policy. (28)
And fewer people on disability:
* Euthanasia has been administered to people with diabetes, rheumatism, multiple sclerosis, AIDS, bronchitis, and accident victims. (30)
And a terrorised population that is unlikely to sue:
* In 1993, the Dutch senior citizens' group, the Protestant Christian Elderly Society, surveyed 2,066 seniors on general health care issues. The Survey did not address the euthanasia issue in any way, yet ten percent of the elderly respondents clearly indicated that, because of the Dutch euthanasia policy, they are afraid that their lives could be terminated without their request. According to the Elderly Society director, Hans Homans. "They are afraid that at a certain moment, on the basis of age, a treatment will be considered no longer economically viable, and an early end to their lives will be made." (32)
Posted by: shari | July 18, 2007 at 08:20 AM
But we don't wish to beat on the Netherlands. Or France.
England also kills her ill.
http://www.lifenews.com/bio1280.html
In 2004, some 2000 deaths in England were from INvoluntary euthanasia (killing the patient without consent) and about another 1000 from Voluntary euthanasia (killing the patient with consent).
That was about 6% of all deaths in the UK.
That was about as many as the number of people dying of cancer in the UK, and almost as high as the number of people dying of stroke in the UK.
And just think, a cocktail of euthanasia drugs costs only 50 dollars, while chemotherapy for breast cancer or other treatable cancers can run into hundreds of thousands of dollars.
But Hey! Everybody has equal access to lethal injection. Free health care is so wonderful.
Posted by: shari | July 18, 2007 at 09:41 AM
Regarding Anarcisse's comments on medicine not becoming commodified:
As I noted, some aspects (the profitable ones) of medicine has been commodified. Walmart now offers 4 dollar prescriptions for a host of cheap generics. Walmart and CVS offer nurse led urgent cares that have a flat fee of 40 dollars. These do NOT accept insurance and will ONLY take care of ear infections, urinary tract infections, and bronchitis. (These are the quickest and most profitable aspects of medicine, unlike taking care of complex patients who need chronic care or who are on multiple medications.
However prices are hindered by the fact that under a insurance based system it is unprofitable to offer certain lines of service. For example, one could do telephone/internet/video consults, but this would not be paid for under insurance. Only face to face consults are paid for. Thus a physician could not simply put up an 800 number for folks who wish to get a quick medication refill or other relatively easy follow up and be paid for it. We either force the patient to come in for everything, or we offer telephone follow up free. Personally I hire a nurse to take telephone calls, and she does med refils free (to the patient) over the phone. If they want to speak to me personally, then they come in. If they are constantly calling the nurse, it is assumed that telephone service isn't working, and they come in.
An 800 number (paid for like other services) or paid for internet would be cheaper but since the patient has insurance, this cannot be offered.
I used to offer free email access to my patients, but my hospital pointed out that it increases liability, is not reimbursed, and is against the hospital policies. Thus I no longer do this.
In a Health savings account system, it might be possible to offer email follow up at a fraction of the cost of an office follow up. However that would only be true because the patient would bear the entire cost. As long as third parties bear the cost, "commodification" will be impossible.
Posted by: shari | July 18, 2007 at 10:29 AM
Shari - there's more to you than meets the eye. Not sure which planet you're living on.
Yes, taxes would have to go up. SO? At least something worthwhile would be the result instead of pouring more and more $$ into the stupid war. As for Edwards and the reference to "trial lawyer," I'm thankful there is someone to look out for the person that gets butchered by incomptents and facility machinery.
Posted by: belinda | July 18, 2007 at 10:49 AM
oops - I meant to say "faulty" equipment. That's what happens when you type and talk on the phone at work at the same time.
Posted by: belinda | July 18, 2007 at 10:51 AM
I was being facetious when I referred to Shari as Dr.
Do harbour ill will towards the Dutch medical system ? Where you stripped of your license in that country if indeed you are a physician?
Without getting you all worked up again, did you ever consider that some of these patients who are "euthanized" do so with consent and their society has allowed this mentality to be accepted ?
Before you label all Dutch doctors murderers, did you want to open the forum up to quality of life ?
Posted by: Larry In Lethbridge | July 18, 2007 at 11:06 AM
In the English study about 1/3 of the patients gave consent, the rest were euthanized without consent. In the Remeniyk study on the Netherlands about the same number 30% gave consent, the others were involuntarily euthanized.
I guess their society has allowed this mentality to be accepted. Is that a good thing? Is it a good idea to pay 70% in taxes in order to be certain that once your ability to pay taxes no longer outweighed your cost to society that you will get a lethal injection?
Why do you think free care is so wonderful that you are willing to accept euthanasia?
And if you are in love with euthanasia, why should physicians do this? It is not necessary to be a doctor to kill people. (And yes, I'm a physician in good standing, and thus far have never been sued, let alone lost my license)
If you want to live in a society where grandma gets bumped off once she develops breast cancer, and the little kid with downs gets offed in the NICU, why pay doctors to do this? Why not simply hire contractors to terminate people? They are cheaper.
Posted by: shari | July 18, 2007 at 11:41 AM
Malpractice is much lower in Europe. If there are "incompetants and faulty machinery" one can simply terminate one's mistakes.
Much cheaper.
But less fun for trial lawyers.
Posted by: shari | July 18, 2007 at 11:42 AM
This is getting me upset, so this will be my last post on this blog.
I don't label all Dutch physicians murderers.
However I do call any physician who euthanizes a patient a murderer, liar, oathbreaker, and traitor to his patients and to his profession.
Have a happy life once the socialized utopia you all envision comes in. Unlike Chris, I believe it is unstoppable. But I will not be part of it. There are some things worth dying for, and not being a murderer is one of them.
Bye.
Posted by: shari | July 18, 2007 at 11:57 AM
I think Dr.Shari has been writing herself some scripts. or tipping a few back.
Sounded like female version of Larry David. Quack Quack !
Posted by: Larry in Lethbridge | July 18, 2007 at 12:40 PM
The stuff about euthanasia seems like a red herring. It is not particularly connected with Single Payer (or any other payment arrangement).
Posted by: Anarcissie | July 18, 2007 at 09:11 PM
The commentary here may be sharp and insightful, at least in a theoretical way.
But the fact remains that the US is not sufficiently socialist to adopt a Universal Healthcare program.
The lack of socialist sensibilities is evident by the absence of vast federal programs aimed at meeting broad societal needs. Moreover, every federal program that does exist is either a failure or close to one.
Most important, however, is the fact that there will never be agreement on what a national health plan would offer.
Meanwhile, no matter what anyone claims or wishes, a national health bureaucracy would sponge up more money than the most cynical critics would estimate.
Furthermore, the US, with its current rules for citizenship -- a child born on US soil is a citizen, even if his parents are in the country illegally -- would become the maternity ward for the world if the US were to adopt Universal Healthcare.
We can't afford a gold-plated program for honest citizens. It's beyond rationality to believe we can care for every person who sneaks into the country and has a child here.
As always, our politicians will argue healthcare to death, but no plan will emerge.
Posted by: chris | July 18, 2007 at 10:00 PM
Well, the President's point would be stronger if Europe and Canada did not exist.
In Catalonia (my country), for instance, there is a public system run by private companies that manage it with efficiency criteria. At the same time, there is are many private hospitals and health related companies for those who want a faster or more personal service.
I agree with the republicans in the fact that money has to be made from health to grant innovation and efficiency, only that it is only moral to do so when the basic health needs of every other citizen are covered.
Thanks,
Marc
www.catalunyafastforward.blogspot.com
Posted by: Marc | July 19, 2007 at 04:46 AM
Where Are the Innovators in Health Care?
By REGINA E. HERZLINGER
No sector of our economy is more in need of innovation than health care, yet its many regulations handcuff entrepreneurs. A consumer-driven health-care system will unlock these shackles to bring about a much-needed entrepreneurial revolution.
Health care's $2.2 trillion of costs (17% of GDP), breaks the backs of U.S. firms that compete with companies in countries spending, at most, 12% of GDP on health care.
Yet, despite this torrent of cash, more than 40 million Americans lack health insurance, mostly because they cannot afford it. Although some claim we have the world's best health-care system, where are the quality outcome metrics to back this up? Don't try that one on the loved ones of the 300,000 people killed by hospital "medical errors" in the past few years.
In almost every sector of our economy, brilliant, effective innovators have forced sluggish U.S. industries to become more productive. Sam Walton's exquisitely detailed supply chain management, coupled with his daring decision to locate Wal-Marts in rural areas, kick-started the boom in retailing, while Bill Gates, Steve Jobs and Michael Dell drove productivity in the IT sector.
These entrepreneurs, and so many others, have fundamentally improved our economy by making goods and services better, cheaper and more accessible.
But can you name any innovators in our bloated, inefficient health-care system? While there is innovation in the medical technology and health-insurance sectors, when it comes to health services, the 800-pound gorilla of our system, entrepreneurs are nowhere to be found. And their absence has enabled the status quo providers to get fat and sloppy.
One analysis showed that hospital activities accounted for $400 billion of the excessive costs of U.S. health care while all too many quality measures have worsened. Patients learn -- sometimes the hard way -- to bring along an assertive, intelligent loved one to protect them during a hospital stay.
Entrepreneurs avoid health-care delivery because status quo providers, abetted by legislators and insurance companies, have made it virtually impossible for them to succeed. Unlike any other U.S. industry, consumers do not set prices, yet they provide all the money through taxes for government programs and foregone salaries for employer-provided benefits. A third party -- a government or an insurance company -- not only sets the prices but goes so far as to specify procedures and even the kinds of patients to be covered.
Lately, payers are even telling doctors how to practice medicine -- and those who follow their recipes get paid more. The recipes are devised through an innovation-killing "peer review" process. The history of medicine is filled with shameful stories of "peers" who used their powers to suppress innovations: Judah Folkman, the brilliant scientist whose anti-angiogenesis theory forms the basis for many important new cancer drugs, for example, had difficulty obtaining peer-reviewed government research funds for nearly a decade.
Third parties' lock-hold on reimbursement punishes innovators. When the Duke University Medical Center's innovative new program for people with congestive heart failure so substantially improved patients' health that hospital visits and usage plummeted, the perverse nature of the payment system meant Duke couldn't benefit from saving its patients' money -- nearly $8,000 per person.
In only one year, the program had reduced costs by 40%, yielding the kind of do-good returns that would normally earn kudos from Wall Street and Main Street. But, because the third parties pay providers only for treating sick people, they penalize innovators who make people healthy.
Non-market based payment is but one of many barriers to innovation that plague the health-care industry. Insurance entrepreneurs who confront mandated benefits and "community pricing" can neither design nor price their innovations. Technology entrepreneurs must clear massive hurdles before securing the "coding" and "coverage" decisions that open the door to reimbursement. And health-service entrepreneurs must comply with tens of thousands of pages of regulations.
Time and again the regulatory status quo blocks entrepreneurship. Consider the round-the-clock coverage, offered by Washington's Dr. Garrison Bliss, that will be available to middle-class and uninsured people at a price of only $70 a month. Attempts by insurers to characterize Dr. Bliss as an insurance company -- with the attendant massive capital reserves and regulatory hurdles -- have required his small start-up to hire a full-time lobbyist.
No wonder the 20 or so doctors enrolled in my class "Innovating in Health Care" at Harvard Business School are ruefully driven to earn MBAs once they realize they can innovate in medicine better as an entrepreneur than as a doctor.
Luckily there is a solution, but there is only one: consumer-driven health care. Let's take back our $2.2 trillion from the entrepreneur-suppressing status quo and allow consumers to reward those entrepreneurs who lower costs by improving health. With us in charge, not only would Duke University Medical Center have flourished, but other entrepreneurs would introduce similar cost-reducing programs for the other chronic diseases, like diabetes, and disabilities like bad backs, that account for nearly $1.8 trillion of expenses.
Until we control our own health- care system, the entrepreneurs who could reform it -- and make our lives better -- will continue to look elsewhere for opportunities. Who can blame them?
Ms. Herzlinger is a professor at Harvard Business School, a senior fellow at the Manhattan Institute and the author of "Who Killed Health Care?" (McGraw Hill, 2007).
Posted by: chris | July 19, 2007 at 06:03 AM
I will say one thing.This topic has certainly brought about some very good discussions and has given many us a different perspective that we might not ordinarily get to hear.
Perhaps a person of Barbara's importance might take and compile this and present it to other channels, so many of these sage comments can be further considered.
Keep discussing this till your blue in the face though.
If you don't fix this system soon, you are going to have riots in the streets and a carnage like you have never seen before.
Time to drop "theUSA best nation in the world routine"
and realize your own people are needlessly dying and living shorter lives because you are such a freakin greedy country.
You idiots are loathed worldwide becuase of you place money ahead of people's lives.
Why doesn't this gasbag Chris offer some solutionsrather than snip away at others.Dude, you obviously are smart.Use it to help others you wanker.
Posted by: Larry in Lethbridge | July 19, 2007 at 07:20 AM
Whew -- this thread does go a long ways towards explaining why, despite all the advantages of universal health coverage, it will be so difficult to achieve.
Like most well-meaning people I know, I am concerned about physicians' well-being, I am concerned about bureaucratic bloat, I am concerned about the ethics of euthanasia, I am concerned about... Well, you get the drift.
But we Americans have come to allow tangential matters to overwhelm central issues, probably because well-heeled opponents decide a diversion is more effective than an honest, straight forward attack.
Most Western countries manage to provide public health care to all. It is not perfect, it does not solve every problem of mankind, but by most accounts it works pretty well for both the society and for the vast majority of the individuals.
Under the current system, a very significant percentage of people have no health insurance, and a vast number of people with health insurance find that it simply will not pay when serious disease actually strikes. Millions upon millions of those individuals who suffer, even die, as a result, are children who were utterly blameless in the matter. Further, the societal costs are extremely high, not just morally, but financially. None of this is sly rhetoric -- not clever semantics or selective use of statistics, etc.
As to the opposition... I will grant that, depending on details, reform might have some impact on physician finances, and I am sorry that doctors feel threatened by this. However, as this thread points out, two giant issues impinge upon compensation of doctors: 1) educational costs, and 2) the cost of treating uninsured and underinsured patients. Universal health coverage is likely to help with the second issue. However, that is not the main goal, any more than school reform is about helping teachers or court reform is about helping lawyers. I am not anti doctor, lawyer, or teacher (I am a teacher), it's just that I am in favor of improving health services, schools, and courts.
I will also grant that universal health care will have some impact on the euthanasia debate. However, those waters are so muddy that I cannot be optimistic about any reasonable national discussion. Use the word euthanasia and most people conjure up an image of the vet giving their dog a shot. However, in discussion of human health care, the term has come to mean many things to many people... making me really want the details on those horror stories from Europe. Was euthanasia without consent a shot given to a supposedly useless grandma who "probably would die eventually anyway"? Or was this the turning off of life support for a long comatose patient, for whom no next-of-kin could be found? I am suspicious that a very, very high portion of those depressing statistics had their roots in the latter sort of cases.
And before you argue that ANY euthanasia is wrong, it is a slippery slope, etc... Do keep in mind that we already have euthanasia under the present system. When an insurance company will not pay for an expensive, necessary medical treatment that will not otherwise be provided (Moore cannot always be trusted, but I can vouch for his cancer treatment stories), this is highly similar to cases of euthanasia that are being counted as horrifying RESULTS of universal coverage.
If we are being really truthful here, we already do many of the things that are held up as foreign abuses. I have had the misfortune of watching three family members die in the past five years, and, in every case, there were conversations instigated by health professionals regarded the speeding up or slowing down of the death process -- one such conversation only meant to change the outcome by a few hours, but the other two involving weeks or months.
So we are going to hold up universal health care to prevent this from happening? Honestly, I question the motives of those who use this extremely difficult issue to impede universal health care.
Finally, as to bureaucratic waste, this is not an idle objection. But keep in mind the current level of waste. If you have not been involved in the final months of life for an insured person under the current system, you really need to talk to someone who has been there. The nightmare of paperwork back and forth between various insurers, health care providers, and the patient is not to be believed. If you think this sort of thing is only "wasteful" if it is conducted by government bureaucracy, you are deluding yourself.
Posted by: Don Bemont | July 19, 2007 at 07:25 AM
Don Bermont writes:
"I am not anti doctor, lawyer, or teacher (I am a teacher), it's just that I am in favor of improving health services, schools, and courts."
Teachers in NY City have gold-plated healthcare. Everything is covered. Forever. The school budget -- and its healthcare expenditures -- is a good place to start when looking for a basis for the cost of a national healthcare program.
He writes:
"I will also grant that universal health care will have some impact on the euthanasia debate. However, those waters are so muddy that I cannot be optimistic about any reasonable national discussion. Use the word euthanasia and most people conjure up an image of the vet giving their dog a shot."
The practice of euthanasia is part of US medicine. But, it isn't offered as a medical strategy. Dr. Kevorkian was recently released from jail, and he says he has no plans to resume his former profession of suicide assistant.
However, doctors, patients and their families seem to have developed strategies for allowing life to end well before all technical sustainers of life have been exhausted.
Feeding tubes are removed. Life support systems shut off. Patients often sign Do Not Resuscitate orders.
We may not have reached the point of encouraging people to say goodby to life with the same nonchalance of checking out of a hotel. But many people do decide to let life end well before reaching the limits of medical technology.
However, we do not have a legislated national policy for the rules of the end game.
Posted by: chris | July 19, 2007 at 08:37 AM
chris: '... As always, our politicians will argue healthcare to death, but no plan will emerge.'
There is already a plan. Those who have an interest in keeping things the way they are plan to do so.
I am inclined to believe "shari" and Ms. Herzlinger in spite of some of the odd things they have said: I think the mainspring of the current plan is regulation, rather than profit. (Since, as I said, large profits would draw entrepreneurs into the system who would tend to compete and lower prices.) What profits there are emerge from playing games with the regulatory system, rather than from producing a more desirable product. However, we are mostly in fact-free, ideological mode here so I can't go much further with this.
It surprises me, for example, that there are no user-owned cooperative HMOs. But I don't know what specific laws or regulations prevent them from existing.
Posted by: Anarcissie | July 19, 2007 at 08:41 AM
Larry in Lethbridge writes:
"You idiots are loathed worldwide becuase of you place money ahead of people's lives."
Loathed? By whom? Oh yeah. Those muslims who advertize their desire to kill us. Yeah, that's loathing.
How are those muslim countries managing their healthcare? They account for at least a billion of Earth's inhabitants.
How about China and India? Is everyone their getting top-notch care? Or is there some inequity in the availability of healthcare?
North Korea? Cuba? Every African nation?
Is there any country in South America or Central America to which patients head when they need medical treatment?
By the way, if you want to discuss unrest among residents, look no farther than Norway, the social welfare state that taxes its residents out the wazoo for everything.
In yesterday's news was an article showing Norwegians hate -- their word -- hate their taxation level, which is confiscatory by any measure. However, Norwegian leadership is at least smart enough to fully exploit its oil and gas reserves to maximize revenue coming to the Norwegian treasury.
Norwegians have the good sense to fully exploit the natural resource gift Nature placed in their hands.
The US has the same option. Even though full exploitation of natural resource reserves would go far to cover the bills of a broad healthcare plan, millions of Americans believe trees and animals deserve more consideration than humans.
Posted by: chris | July 19, 2007 at 08:59 AM
Anarcissie, you wrote:
"There is already a plan. Those who have an interest in keeping things the way they are plan to do so."
Correction. There are many "plans". None implemented however.
The status quo is not a "plan".
Meanwhile, as I said, no politician will risk his/her future by making Universal Healthcare the centerpiece of his/her campaign.
Note that Hillary, not Bill, ran with that ball in the Clinton years. Even Bill didn't want to tie himself too closely the issue. For that found a willing virgin to sacrifice.
Posted by: chris | July 19, 2007 at 09:05 AM
What about the health care in CHina, India, Cuba, African nations ? Of course it is nowhere near that of the USA, but the USA has more resources available to it than any other country in the world. You should be shameful you are allowing the complete erosion of your system.
Listen Chris, I am all for
for capitalism, but sometimes you need to change things up.It is not socialism if you adopt a universal health care system.
You can argue here all you want and quote volumes from every source around, but your broken down pitiful healthcare system needs massive change that only a universal model can bring to it effectively.
Oh,it's not only the Muslims that "loathe" the USA. It might be a form of jealousy, I don't know, but you aren't really endearing the world yet.
Posted by: Larry in Lethbridge | July 19, 2007 at 10:06 AM
Chris, a person with a terminal disease who is judged by his or her doctor to be of sound mind can be prescribed a lethal dose of a drug for the purpose of committing suicide in Oregon. Is this medical strategy? Your call. There have been several cases concerning Oregon's assisted suicide law that have reached the Supreme Court.
A follow-up study on people who were prescribed the lethal dose revealed that a minority of the people actually took the drug at the time of death, and even fewer took it in sufficient quantity to cause death. It seems that some terminally ill people wanted the security blanket of being able to end their lives if the pain got to be too bad.
Posted by: paperpusher666 | July 19, 2007 at 01:13 PM
Chris, why isn't the status quo a plan? It might not be a good plan, but it is a plan nevertheless.
Were I to break it down to its elements, the plan would run something like:
1. Make it difficult for people with pre-existing conditions to obtain individual coverage
2. Push as much of the cost of obtaining group health insurance onto the employee as possible.
3. Restrict preventive care for people in publicly funded insurance plans so that short-term cost goals can be met.
4. Restrict or outlaw needle exchange and condom distribution plans (not insurance, but decent harm reduction steps)
I could go on, but others doubtless will on my behalf.
Posted by: paperpusher666 | July 19, 2007 at 01:19 PM
Larry in LeftBridge writes:
"Listen Chris, I am all for capitalism, but sometimes you need to change things up."
Our healthcare system needs improvements, but no one has envisioned a new program that will receive the support of voters. The US has shown repeatedly that it isn't quick to embrace socialist solutions to issues of great importance to the nation.
You wrote:
"It is not socialism if you adopt a universal health care system."
Oh. A national health system supported by taxpayers isn't a socialist idea? Really? That's not a socialist idea? Whaddayaknow?
Lefty Larry says:
"...your broken down pitiful healthcare system needs massive change that only a universal model can bring to it effectively."
ONLY a universal plan will work? I see. What would America get with this plan? What would America have to give -- in costs and in the rationing of care -- to get it?
Lefty Larry wrote:
"Oh,it's not only the Muslims that "loathe" the USA. It might be a form of jealousy, I don't know, but you aren't really endearing the world yet."
I am a big supporter of immigration to the US. But we've got a problem in that department. So many people in the world loathe the US that we can not accomodate all the immigrants desperate to move here, which is remarkable with respect to the loathing America endures. Moreover, there are at least 12 million people who loathe the US so deeply that they entered the country illegally.
It is a shame that so many loathe the US so heartily. When I ride the subway from my home in Brooklyn, I hear the loathing when other passengers speak. Though they are speaking Russian, Spanish, French, Hebrew, German, African languages I can't name, Chinese, and Korean, Arabic, Persian, Hindi and other languages, I know they are expressing their loathing of the US.
However, it's seldom I hear someone with an English accent. Irish, yes, but not English.
Posted by: chris | July 19, 2007 at 05:13 PM
paperpusher666, you wrote:
"Chris, a person with a terminal disease who is judged by his or her doctor to be of sound mind can be prescribed a lethal dose of a drug for the purpose of committing suicide in Oregon. Is this medical strategy?
Two points. One, this practice is permitted in Oregon, a state. A state whose leading cash crop is marijuana. It's okay with me if Oregon permits medically assisted suicide. But Oregon is one state. A liberal state. This makes my point. The people of Oregon may be on the right track. But they are alone among states.
I think a majority of voters in this country believe drug use/abuse is a medical issue rather than a criminal issue. Our current generation of adults occupying elective offices across the entire country grew up around widespread drug use.
Nevertheless, no recreational drugs have been legalized. Or decriminalized. Our courts are clogged with drug cases. In other words, we pay lip service to liberal ideas, but we don't legislate them. Too bad.
If the nation can't decriminalize pot, do you think the nation can agree on medically assisted suicide or euthanasia or abortion or the limits of medical treatment for individuals? Not likely.
Second, yes, I do think the Oregon rule on medically assisted suicides amounts to a "plan" -- for that small portion of human medical needs. But dealing with death is only one aspect of a national health plan.
Posted by: chris | July 19, 2007 at 05:23 PM
paperpusher666, you also wrote:
"Chris, why isn't the status quo a plan? It might not be a good plan, but it is a plan nevertheless."
It isn't a plan. Why? Because it is a hodge-podge of efforts undertaken over many years that have brought us to where we are. But the system we have was not presented as a "plan" in its entirety. It evolved by fits and starts with no system-wide goal in mind.
That's not a plan. It's a haphazard Rube Goldberg contraption that manages to perform many tasks with difficult maneuvers.
Posted by: chris | July 19, 2007 at 05:31 PM
Due to a horrible marriage to an irresponsible individual, I was saddled into an early adulthood of poverty and so were my three children. My first child was born in an outdated ER room at the end of the hospital, with little staff attention. Although I insisted on well child care at all times for my children, I could not keep consistent records of their immunizations and such as many of the doctors offices I visited would hold the records in lieu of payment I couldn't afford.
Also, due to my then husband's behavior, I obtained two STD's, for which I had to receive treatment out of state and which frankly, I would have never known about had I not gone for a gyno check-up on a whim.
I nearly died of pneumonia while pregnant with my second child as I did not want to call the doctor and wrack up more bills; a routine monthly gyno visit had my in the hospital that afternoon and also my one year son on medication that very day as well for breathing problems. I was on a five day IV of Keflex. Who knows what the cost of that was.
After struggling to bring my ex around to be responsible, I gave up and divorced him. I started working to support my family and found that on my low income jobs health insurance ate up nearly one quarter of my meager paycheck, supplanting needed funds for basic living necessities such as food, lights, heat, rent and transportation to work. Forget about the costs for the children's needs, I usually had to beg for that through charity or they had to go without.
Finally I gave up on that too as my inability to afford daycare or after school care had my children wondering the streets. I quit, went on state aid and enrolled in college. I got on Medicaid and for the first time my children had a thorough (not half-assed) checkup. It was found that my oldest daughter was so near sighted that she couldn't see more than thirty feet in front of her and had a wondering eye condition and needed glasses (hence her complaint of headaches all the time) and my son had a hernia that needed immediate fixing that, when I was insured, was 'not a problem' and could not be operated on without my ponying up $2,000 in cash to the 'approved' HMO. The doc said lack of an operation could have serious emergency consequences and it was performed without delay.
Also, while on the 'system' I had a bad toothache and since medicaid does not cover dental for adults accept for extractions and I never had dental in the private industry, my teeth were not in good shape. Although I was in serious pain and had to go to the ER for needed pain killers, I had to get a spot with the one and only dentist in my area of the state who sees medicaid patients. During that time, prior to receiving anesthesia, I got a nice lecture on how I was a deadbeat because of an unpaid bill for emergency treatment I had received by him ten years earlier (tooth broken due to an assault). He proceeded to inform me that Medicaid only pays one third of his costs, etc., etc. I had about $50 to live on for that month, what could I do to alleviate his pain? Nothing!
The American culture is riddled with Puritan guilt tripping and classism and the healthcare industry shows its true effects.
Presently my children are grown and on their own and on their way to college, of course fearful of the huge college debt. I never did finish school due to my obligations for the children, but I too, have debt and worse yet, debt without a title -- or a high income/status job either.
I am currently self employed and work day and nights, have no spare time and oftentimes deal with customers who attempt to cheat me, will not pay or threaten to sue. My liability insurance costs are very high as well as my worker's comp and taxation costs. My requirement for specialized equipment is also high. But unlike the medical profession, I don't have an entire culture to backup my insistence on inflated wages, nor does my industry have any organization to protect entrance into my field to qualified candidates (although I wish it did).
But I still take responsibility for my choice and suck it up. I enjoy being self employed and wouldn't trade it any minute for a boring 'secure' job. I also don't expect everyone else to feel pity for me, nor do I expect that persons should unnecessarily suffer because I think I should earn a high wage. Sorry, Shari, you don't get my sympathy.
I know someone who is in the hospital administration field, is as numb as a post and has more money than even most docs. She makes her money by rationalizing the value of or lack of value of people's lives.
That is not justice, its criminal.
Posted by: kate | July 19, 2007 at 06:15 PM