The Future of US Healthcare

[SaintessHeart]

Originally Posted by iLney

Imagine in front of a facility, instead of 100 people, you have 10,000 people. Oh, and most cases are not that obvious. The most important part of the process is the self-diagnosing of the patient. If he doesn't go to see you, then there is nothing you can do.

Like what I pointed out, as a lifesaver, you do what you can.

You oversimplify the problem by believing that being socializing health care the only difference it makes to the current system is that instead of paying to get diagnosed for say, heart disease, a patient will have to pay nothing. That is not true. That patient, if not restricted by the cost, will also go to see other doctors trying to scan for unforeseen diseases. At this moment, we don't have enough doctors and people are proposing adding 100 times more workload to them? Ridiculous.

I never say anything about it. Either you misunderstand, or you are just pulling apart my argument and interpret each part in a way which is logically flawed. I reiterate : If you can do anything, you do what you can. Use everything within your ability to complete the task, but of course, don't let an irrational determination cloud your judgement.

And that is what advocates of universal health care are trying to do.

And they know it. They keep doing, sometimes they know they can't, sometimes they know they can, but they do whatever they can. I know this doesn't make alot of sense on its own, so put yourself in a difficult situation which involves the well-being of others and yourself, then let your instincts guide you.

You have a perfectly healthy looking guy who also think he's healthy going to see a practitioner. What will they talk about? Football? There are diseases that without careful scanning, there is no way even a doctor could tell, like you said. So let me ask you again, in the population of 300,000,000 people, using what methods would help pinpoint who needs what?

There is a reason why you CONSULT a general practitioner FIRST.

Besides, if that person THINKS he is physically and mentally healthy, he wouldn't have gone to the doctor in the first place.

_Doctor, my stomach hurts really bad, please see me.

=>No, I can't. It's required that you see a GP first.

_But the line is too long there.

=>What a shame!

That guy probably lived in a rural area or some third world country, or there must have been an outbreak. And besides, you are missing a few pieces of logic here :

1. Doctors don't run 1 man clinics. There is something called take a triage test, questionnaire and queue number if the illness is not obvious like multiple lacerations or hemorrhage signs.

2. The last line should be : Take a number and wait. Unless that doctor is a real asshole, he wouldn't turn away someone who needs a treatment. And it is in the International Quote Of Medical Ethics under Duties Of Physicians To Patients, Line 3 :

A PHYSICIAN SHALL owe his/her patients complete loyalty and all the scientific resources available to him/her.

Idealistically, he should treat the patient. Pragmatically, he should handle the more important cases first, followed by a first-come-first-served basis (usually conditions are aggravated or relieved by periods of time, so theoretically this shouldn't exist) to maintain fairness because under the same quote, same section, line 5 :

A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.

and under Duties of Physicians In General, Line 1 :

A PHYSICIAN SHALL always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.

In that case it is a stomachache so here is a quick-treat attempt :

1. Ask the patient

- to sit down, squat, or lie down to see if he feels any better.
- for previous activity and how long has he been feeling the pain.
- sharp and acute or chronic pain

2. Administer water at closest possible moment. It slightly decreases the chance of having serious effects of poisoning.

3. Look out for the following
- slurred speech
- facial expression
- marks of harm
- sensitivity to surrounding and level of conciousness
- obvious signs of illnesses (pale face indicating low blood pressure, sour breath indicating recent vomiting, etc)

All of these should not take more than 5 minutes. I was trained before to aid in large scale CBR emergencies, and this is pretty much I can remember.

Huh? A students spend 10 years to become a doctor not only because he loves humanity, you know. Generally, that doctor would cater the sick first because he will get paid more.

You need a license to practice medicine. Unless your government is corrupt, you won't get a license with just good grades because health ministries test for attitude too, mercenary behaviour is not accepted.

Check this list to see if your country is in it. If so, prior to be officially granted a license, they have to dictate an oath similar to this.

Once you take that, you will be BOUNDED not just by your local law, but by international law to adhere to the guidelines as stated. One step out, and you risk losing your license, freedom or even your life.

If everyone is perfect, you need no system.

Please tell me how you run a computer without software. Similarly, do me a favour and read / breathe before bashing any of my points so you wouldn't make sweeping statements like this. I don't think it is digress to discuss general philosophy, the Chaos Theory or Causes And Effects, so I will just leave that statement.

[Kamui4356]

Originally Posted by iLney

Imagine in front of a facility, instead of 100 people, you have 10,000 people. Oh, and most cases are not that obvious. The most important part of the process is the self-diagnosing of the patient. If he doesn't go to see you, then there is nothing you can do.

Sure, if a patient doesn't want to see a doctor, there's nothing you can do about it. However, there are lots of people who say have a pain in their knee, somehting that could be corrected at that point by just wearing a leg braces for a few weeks if they went to see the doctor, but don't because they can't afford to. Several months/years later the problem is worse, they can't even walk anymore and it now requires an operation to correct. Stuff liek that happens all the time.

You oversimplify the problem by believing that being socializing health care the only difference it makes to the current system is that instead of paying to get diagnosed for say, heart disease, a patient will have to pay nothing. That is not true. That patient, if not restricted by the cost, will also go to see other doctors trying to scan for unforeseen diseases. At this moment, we don't have enough doctors and people are proposing adding 100 times more workload to them? Ridiculous.

Scan for unforseen disease? Wait? Are you actually claiming it's rediculous to have a system that makes doctor's visits affordable so people can get regular check ups?

And that is what advocates of universal health care are trying to do.

No, advocates of universal healthcare are trying to make it so people have equal access to treatment. No one should be forced to forgo medical treatment because they can't afford it.

You have a perfectly healthy looking guy who also think he's healthy going to see a practitioner. What will they talk about? Football? There are diseases that without careful scanning, there is no way even a doctor could tell, like you said. So let me ask you again, in the population of 300,000,000 people, using what methods would help pinpoint who needs what?

It's called a check up. You go to the doctor, the doctor orders some lab work done, talks to you about your diet, exersize, any health issues specific to you, makes sure you're healthy, and then sends you on your way. You're talking like this is some rediculous thing when it's how medical treatment is supposed to work. Lots of times a disease is caught in an early stage because the person has regular check ups. Take cancer. Many types will show up in labs well before the person notices symptoms, and by the time they do it might be too late to treat. Even if it isn't, it'll probably require more intensive treatment. That's what a check up can do.

_Doctor, my stomach hurts really bad, please see me.

=>No, I can't. It's required that you see a GP first.

_But the line is too long there.

=>What a shame!

Actually you've just described how the system works now.

Huh? A students spend 10 years to become a doctor not only because he loves humanity, you know. Generally, that doctor would cater the sick first because he will get paid more.

Because doctors working under socialized medicine live in shacks forced to work grueling hours sometimes 72 hours straight... Oh wait, sorry that's how medical interns are treated under the current system. My mistake. Seriously though, doctors make out pretty well in nations with socialized medicine too.

Edit: I just remembered a quote I saw someone mention on another forum that sums up the difference betwene the two systems. Don't remember the exact quote so I'm paraphrasing here. "The difference between socialized medicine and private insurance? Under socalized medicine treatment is rationed by who needs it the most. Under private health care it's rationed by who can pay the most."

[Vexx]

Originally Posted by iLney

---Many absurd scenarios that make one wonder if he has bothered to study the situation at all---

You're really way over your head here. You don't seem to understand how our current medical system in the US works. You don't seem to grasp the concept of preventative care or that it is much cheaper than reactive care. You don't seem to grasp the quandary that the rest of the business sector is in because of the health insurance industry. You're spouting misinformation the insurance industry uses to derail the discussion. You don't even seem to understand how other systems really work. You really need to do some homework because you're basically blowing your credibility to shreds -- there *are* problems with various share-the-pain systems but you're using soundbite memes that simply don't hold up under examination (or they reflect short term conditions that haven't been true in decades).

Here's a real problem with a shared healthcare system: in the Japanese system, they have a shortage of gynecologists which has led to several deaths because the hospital claimed to have no room for them. Also, Japan apparently doesn't have a "You MUST take and render first aid" mandate that American hospital emergency rooms have. Those factors make it unwise to assert "that could happen here". Meanwhile, the vast majority of Japanese get good healthcare and quite a long life expectancy. Anecdotes are worthless except as edge indicators that some investigation is needed -- what is the overall situation for most people?
http://www.npr.org/templates/story/s...oryId=89626309 (positive)
http://en.wikipedia.org/wiki/Health_care_in_Japan (neutral)
http://www.bmj.com/cgi/content/extract/331/7518/648 (addresses the current problems with it)

Again, the current system in the US is seriously broken:
1) over 40 million Americans go without basic healthcare.
2) Those Americans with insurance are often left financially destroyed after a medical illness because of all the caveats in for-profit health insurance.
3) The insurance industry IS ALREADY standing between you and your doctor - it tells him what drugs he can prescribe you based on their "cheapest formulary of the month" rather than "most effective formulary". It tells her what treatments she can use based on maximization of their profits, not what is most effective for your health. It is maximizing profits by extracting from you, your employer, the doctor, and the hospital -- that money leaves the healthcare system.
4) Few insurance plans encourage preventative care ... they'd rather drive the car without an oil change and just pay for massive meltdowns "later" (or better yet, abandon the car after the small lifetime cap is reached).

So the question isn't "Should it be reformed?" but "HOW to reform it?" I'd be fine with requiring all health insurance be non-profit as a minimum -- that alone would keep billions of dollars *in* the system. However, it doesn't address healthcare for the many who are locked out of the system (though more of them might be able to afford it since money isn't being drained away).

[Xellos-_^]

Originally Posted by Xellos-_^

besides the insurance side, you can't really tackle healthcare cost without tackling the cost of education for Doctors. I see some talks in regard to the growing cost of Education for doctors but most still talk only about how much the insurance company gouging the public or Free market vs Social medicine.

Besides education cost there is also the growing problem of Malpractice Insurance. Is society willing to cap how much a doctor is liable for if he mess up and who is going to provide that insurance?

Originally Posted by Vexx

(we've moved this discussion to its own thread )
Agree totally with you that the cost of educating a doctor probably needs a deep scrutiny -- especially when they only get one semester of pharma and grow up to get most of their information from vendors rather than their fellow professional the pharmacist (still a lot of doctors with a bit much ego to confer with pharmacists who spend years learning which drugs work on what and don't mix these). The whole "become a doctor" seems more an initiation rite than a learning process -- and my experience is that a doctor's UNDERgraduate degree informs me much more as to whether the doctor has critical thinking skills or not. Doctors with hard science or engineering degrees just have a better mental toolkit for diagnosis and whole system treatment. My wife has been a pharmacist for almost 30 years and can pretty much nail on the dot a doctor's undergraduate degree based on professional conversations with him or her

I'm totally on board with tort reform along with reform of malpractice insurance protocols -- as long as the patient has some procedure of redress for grievances. Most tort reform measures have failed to provide such a process.

didn't realize this was. here is my and Vexx's response to it.

[iLney]

Obscene scenarios, how? Because you just can't believe our holy people would do such?

First off, prevention vs immediate treatment: of course, idiots would see that the former is much cheaper. That is, if you know what to prevent. Let me ask you this simple question: how the heck would you know? By what tools? Do you ever know of people who are perfectly healthy from the outside suddenly drop dead? To diagnose a problem to much more than just seeing a consultant. And let me add this, some people think they are healthy enough because it will cost them something to see a doctor otherwise. And no, I don't oppose people doing such; I oppose them doing it for free.

Secondly: over 40 millions people without health insurance! WoW, that's bad. But please tell me what else happen to those 40 millions. Mr. A got a cancer without insurance. That's sad, very sad. So.... 1/40,000,000. And? Have you ever wonder before there were insurance how people paid for their health care?

And yes, I agree with you: this system should be reformed. And I never said otherwise. The one difference between you and I is that while I am for an affordable system, that is, even immediate treatments are affordable, you are for a system that everyone should be covered by some godly means while the cost for health care remains the same. We are talking about treating, say several hundred thousands people, versus preventing for 300,000,000 people. Even if the cost of the latter is 1/10 of the former, the latter will cost much, much more. And I am not talking about the monetary cost but the capital cost. Surely, we don't want America to be one big hospital right?

If you look at it through a good old supply-demand model, it'll make much more sense. If the supply (health care services) remains the same, how can we lower the cost? By proposing universal health care, you are basically saying "by increasing the demand." Sure that'll work somehow because yes it can!

The obvious answer is to decrease the demand. Demand here not only include "real" demand- that is, treatment and prevention when it really matters- but also include "false" demand. We are currently provide leeway for a certain portion of the population who happens to vote a lot more and are more susceptible to those "falsehood," to use the services for free. I don't dare suggesting anything else. But just by looking at the economic model, it's the most reasonable thing to do.

PS: for those who brings up what a doctor is supposed to do, my reply to you is that I don't trust humanity. In Casablanca, some guys said something like "The only way those two can escape is by a miracle, and the Germans has outlawed miracles." In the end, the couple escaped! Restriction by the laws doesn't mean anything if there is no bidding hedonistic means.

[Kamui4356]

Originally Posted by iLney

Obscene scenarios, how? Because you just can't believe our holy people would do such?

No one said obscene. The problem is your scenerios make no sense and are missing the point entirely.

First off, prevention vs immediate treatment: of course, idiots would see that the former is much cheaper. That is, if you know what to prevent. Let me ask you this simple question: how the heck would you know? By what tools? Do you ever know of people who are perfectly healthy from the outside suddenly drop dead? To diagnose a problem to much more than just seeing a consultant. And let me add this, some people think they are healthy enough because it will cost them something to see a doctor otherwise. And no, I don't oppose people doing such; I oppose them doing it for free.

Are you just trolling? Seriously, do you not understand the concept of a check up? The whole idea is to go to the doctor so he can run some tests and make sure everything's normal. That's how you know if you're not symptomatic. Something get's found in one of the labs that the doctor runs during the regular check up, then the doctor looks into it to find out why that lab wasnt normal.

Secondly: over 40 millions people without health insurance! WoW, that's bad. But please tell me what else happen to those 40 millions. Mr. A got a cancer without insurance. That's sad, very sad. So.... 1/40,000,000. And? Have you ever wonder before there were insurance how people paid for their health care?

They didn't unless they were rich. As a result many many people died of preventable diseases, much like in many poor third world nations today.

And yes, I agree with you: this system should be reformed. And I never said otherwise. The one difference between you and I is that while I am for an affordable system, that is, even immediate treatments are affordable, you are for a system that everyone should be covered by some godly means while the cost for health care remains the same. We are talking about treating, say several hundred thousands people, versus preventing for 300,000,000 people. Even if the cost of the latter is 1/10 of the former, the latter will cost much, much more. And I am not talking about the monetary cost but the capital cost. Surely, we don't want America to be one big hospital right?

Except that it is cheaper in every 1st world nation that does it that way. Once again, the US pays more in healthcare per person than any other nation.

Also your numbers are seriously wrong there. Do you honestly believe only a few hundred thousand people in the US get sick each year?

If you look at it through a good old supply-demand model, it'll make much more sense. If the supply (health care services) remains the same, how can we lower the cost? By proposing universal health care, you are basically saying "by increasing the demand." Sure that'll work somehow because yes it can!

No. By promoting universal healthcare we're saying by taking care of the problem early when it only costs maybe a few hundred dollars, we're preventing the $50,000 operation they'll need later when the problem's gone untreated for years. People who get regular check ups tend to be much healthier than people who don't as well.

The obvious answer is to decrease the demand. Demand here not only include "real" demand- that is, treatment and prevention when it really matters- but also include "false" demand. We are currently provide leeway for a certain portion of the population who happens to vote a lot more and are more susceptible to those "falsehood," to use the services for free. I don't dare suggesting anything else. But just by looking at the economic model, it's the most reasonable thing to do.

So your answer to providing affordable healthcare is to stop people from being able to get healthcare until they're seriously ill?

PS: for those who brings up what a doctor is supposed to do, my reply to you is that I don't trust humanity. In Casablanca, some guys said something like "The only way those two can escape is by a miracle, and the Germans has outlawed miracles." In the end, the couple escaped! Restriction by the laws doesn't mean anything if there is no bidding hedonistic means.

What does this have to do with anything?

[iLney]

Originally Posted by Kamui4356

Are you just trolling? Seriously, do you not understand the concept of a check up? The whole idea is to go to the doctor so he can run some tests and make sure everything's normal. That's how you know if you're not symptomatic. Something get's found in one of the labs that the doctor runs during the regular check up, then the doctor looks into it to find out why that lab wasnt normal.

Do you know how to spell "cost?" C-O-S-T

They didn't unless they were rich. As a result many many people died of preventable diseases, much like in many poor third world nations today.

Oh really?!

Except that it is cheaper in every 1st world nation that does it that way. Once again, the US pays more in healthcare per person than any other nation.

Also your numbers are seriously wrong there. Do you honestly believe only a few hundred thousand people in the US get sick each year?

We are talking about reform right? What does it have anything to do with other nations?

Maybe I didn't make myself clear there. What I meant were seriously sick, say cancer or something like that.

No. By promoting universal healthcare we're saying by taking care of the problem early when it only costs maybe a few hundred dollars, we're preventing the $50,000 operation they'll need later when the problem's gone untreated for years. People who get regular check ups tend to be much healthier than people who don't as well.

I was talking about simply and demand. Simple as that. You void the cost and people will flood into clinics for check ups. Unless those check ups are not done by doctors, nurses nor require any medicine, I don't see how it will not suck up our resources. Ah, and you are assuming that the cost of check ups will remain the same even after the surge of new consumers. That is an absurd assumption.

So your answer to providing affordable healthcare is to stop people from being able to get healthcare until they're seriously ill?

A can have medical checks up for free; thus, he goes to see a doctor 3 times a week.

B must pay 500$ for a check up. Thus, he may go to a doctor once per 2 months.

What I'd like to see is both A and B pay ~75$ for a check up. It's their lives, they decide. Right now, B is seriously bound by the absurd cost because some venerable morons are using the service for free.

What does this have to do with anything?

It does. If you chance the system, people change.

[Vexx]

You do know that "free checkups" are a standard part of most dental plans? But you can only go at specified intervals? And that most HMOs have schedules for general exams based on your medical health and age?

You keep pulling these scenarios up that just don't match either the existing system or any other system.

[iLney]

When they say it's free, it doesn't mean it's free. Free dental check up is to scare the living out of a patient to milk him later. Or would you suggest that such check up costs no water, no electricity, no labor, no time, no nothing?!

Again, cost = capital cost. Monetary cost means little. "How much does this cost?" "20 bucks." <load 20$$.pdf and press "enter">. "Here your 20."

And those scenarios are from our glorious ...Care, ...Aid system.

[yezhanquan]

Er, there are hidden costs in anything. If you want to take into account every hidden cost, then we'll be talking until the cows come home and not go anywhere.

[Vexx]

@iLney: I shouldn't have called them "free checkups" but many packages encourage regular preventative "no problems just checking" checkups. They do this by not charging the patient a co-payment. Are you not aware of this?

You seem to be fairly unaware of the medical system and how it works as it exists right now. So unaware I'm wondering how old you are and whether you've actually worked for a business/corporation with benefits. I'd rather not pull the age card but you seem just totally unfamiliar with how the current system works.

[iLney]

I'm perfectly aware of that. Like I said, it is just a marketing gimmick. They will make it "free" as long as they can gain something back. Now, if they can't, it'll gonna "cost" something. Imagine instead of 10 patients a day, there are now 1,000 patients, 990 of whom just come for kick. Surely, the check up will also be free.

Let me state this again: if the current supply of health care remains the same, how can we lower the cost- in terms of capital across the whole system?

[Kamui4356]

Originally Posted by iLney

Do you know how to spell "cost?" C-O-S-T

Very good. You've proven you can spell. Now can you address my point too? Regular check ups will save money in the long run by catching more conditions early. Cost will come down because more people have access to healthcare.

Oh really?!

Are you going to at least attempt to counter that point or should I take that as a concession?

We are talking about reform right? What does it have anything to do with other nations?

You're claiming that such a system will raise the cost of healthcare. I'm pointing out that in nations with a healthcare system similiar to the one I'm arguing for, they pay less per person for medical coverage than the US for a system that is in many cases ranked higher than the US. This isn't something theoritical. This is a system that has been proven to work in the real world. Sure it'll have some problems, but the standard of care will increase.

Maybe I didn't make myself clear there. What I meant were seriously sick, say cancer or something like that.

Even if we take cancer alone, my point stands. The American Cancer Society estimates that in 2008, about 1,437,180 Americans will receive a new diagnosis of invasive cancer, and 565,650 Americans will die of this disease.1 These estimates do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers expected to be diagnosed this year. The National Cancer Institute (NCI) recently estimated that on January 1, 2005, 11.1 million Americans were alive with a history of invasive cancer.

According to the CDC, cancer along has more new cases per year than you accounted for in total.

I was talking about simply and demand. Simple as that. You void the cost and people will flood into clinics for check ups. Unless those check ups are not done by doctors, nurses nor require any medicine, I don't see how it will not suck up our resources. Ah, and you are assuming that the cost of check ups will remain the same even after the surge of new consumers. That is an absurd assumption.



A can have medical checks up for free; thus, he goes to see a doctor 3 times a week.

B must pay 500$ for a check up. Thus, he may go to a doctor once per 2 months.

What I'd like to see is both A and B pay ~75$ for a check up. It's their lives, they decide. Right now, B is seriously bound by the absurd cost because some venerable morons are using the service for free.

Why would people suddenly go to the doctor 3 times a week just because they dont' pay anything out of pocket? Unless they were hypocondriacs or something. That doesn't happen in any country with such a system, so why would it happen here? Further you seem to be neglecting to consider that to go to the doctor you need to make an appointment. Eventually that person is going to be marked as a troublemaker and find it harder to get an appointment than some other patient who only comes in if he's sick or for a regular check up every few months. Of course if that troublemaking patient does eventually get something actually wrong with him, he might not be taken seriously, but that would happen under either system. As for the cost of the check up, it'll be covered by taxes. It's "free" in the sense that you don't pay anything at the doctor's office, but the doctor still gets paid.

As for paying $75, that's the whole reason a lot of people don't go to the doctor to begin with. A lot of people are living paycheck to paycheck and simply can't afford that. Whether you realize it or not, you're basicly saying healthcare shouldn't be affordable. Rationing treatment by who can afford to pay is not an effective system.

It does. If you chance the system, people change.

That didn't have anything at all to do with a system or people changing as a result. It was a line in a movie meant to be poetic. Even if it was somehow relevant, it shouldn't be taken literally.

[iLney]

Originally Posted by Kamui4356

Very good. You've proven you can spell. Now can you address my point too? Regular check ups will save money in the long run by catching more conditions early. Cost will come down because more people have access to healthcare.

How long? It doesn't matter how much it will cost in the end, but if your initial proposal costs more than the current "hellish" system, I don't even dare to think how much it will cost.

Are you going to at least attempt to counter that point or should I take that as a concession?

I stated already: it was not true. There weren't enough doctors, the transportation system blew and the communication network was primitive. Yet, those "third world" people successfully built this empire while we are destroying it.

You're claiming that such a system will raise the cost of healthcare. I'm pointing out that in nations with a healthcare system similiar to the one I'm arguing for, they pay less per person for medical coverage than the US for a system that is in many cases ranked higher than the US. This isn't something theoritical. This is a system that has been proven to work in the real world. Sure it'll have some problems, but the standard of care will increase.

You don't understand. I am talking about the capital cost not momentary cost. If an operation costs an amount of capital equivalent to, say 40,000$, not matter what you do, this amount of capital must be spent EVEN IF you forcefully set the price tag to, say, 40$. Surely, the country you mention enjoys the same quality of life as our citizens and its economy must be also at top of the world.

Even if we take cancer alone, my point stands. The American Cancer Society estimates that in 2008, about 1,437,180 Americans will receive a new diagnosis of invasive cancer, and 565,650 Americans will die of this disease.1 These estimates do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers expected to be diagnosed this year. The National Cancer Institute (NCI) recently estimated that on January 1, 2005, 11.1 million Americans were alive with a history of invasive cancer.

According to the CDC, cancer along has more new cases per year than you accounted for in total.

Uhm, we are in 2009 and there are that many people "expected" to die in 2008?... That's really scary. I wonder if I were included.

Why would people suddenly go to the doctor 3 times a week just because they dont' pay anything out of pocket? Unless they were hypocondriacs or something. That doesn't happen in any country with such a system, so why would it happen here? Further you seem to be neglecting to consider that to go to the doctor you need to make an appointment. Eventually that person is going to be marked as a troublemaker and find it harder to get an appointment than some other patient who only comes in if he's sick or for a regular check up every few months. Of course if that troublemaking patient does eventually get something actually wrong with him, he might not be taken seriously, but that would happen under either system. As for the cost of the check up, it'll be covered by taxes. It's "free" in the sense that you don't pay anything at the doctor's office, but the doctor still gets paid.

Here is a new flash for you: the doctor won't care since he doesn't work for free. The government pays him to cater those people. Plus, there are always problems especially in the age of the particular group I mention.

As for paying $75, that's the whole reason a lot of people don't go to the doctor to begin with. A lot of people are living paycheck to paycheck and simply can't afford that. Whether you realize it or not, you're basicly saying healthcare shouldn't be affordable.

They don't go to the doctor because it costs way more than 75$ (a very low number) to get any meaningful result. Anything but a free check up is unaffordable?! My gosh, where are we living? Africa? Guess what, even if an operation cost 3,000$ instead of 30,000$, people wouldn't need insurances. And in the first place, it was so! This is what we get for trying to fix what is not broken.

That didn't have anything at all to do with a system or people changing as a result. It was a line in a movie meant to be poetic. Even if it was somehow relevant, it shouldn't be taken literally.

Of course, doctors and nurses will treat you as nicely even if their workload doubles while their pay is halved. Before you claim that it will not happen. Let me rephrase it again: if the current supply of health care remains the same, how can we lower the cost- in terms of capital across the whole system?

Rationing treatment by who can afford to pay is not an effective system.

Seriously?

Edit: well, an immoral system.... maybe just maybe (30%) but ineffective?

=>Giving free treatments to those who's gonna abuse them is a stupid system.

[Kamui4356]

Originally Posted by Vexx

And finally in US healthcare news:

(from NPR)
A recent Harvard study shows a dramatic increase in personal bankruptcy filings related to medical expenses in the last eight years.

In 2007, 62 percent of all personal bankruptcies were linked to medical bills. That's nearly 20 percent more than reported in 2001. And in most cases, those who sought bankruptcy protection had middle-class earnings; nearly 80 percent were covered by health insurance.
Medical expenses are causing more Americans to experience financial distress and insolvency. The rapidly rising bankruptcy numbers will probably add pressure to the national debate over health care reform.

That the majority of them had health insurance is the most sobering statistic there. It shows that even people with medical coverage either don't have enough, or end up getting dropped because they become too sick to work or the insurance companies find some excuse to deny claims they should cover or get rid of them, so they end up paying anyway. This should serve as a wake up call to Americans, but I suspect it won't change many people's minds on the issue.

[Vexx]

The level of denial of the healthcare issues from the status quo advocates seems to depend on whether they've known someone who was bankrupted that was the "right sort of person" (middle/uppermiddle, had insurance, etc) or not.

They ignore the statistics, they ignore the facts on the ground - they cling to ideological platitudes that ignore the buffaloes in the room -> that much of the money spent on healthcare leaves the system; that insurance cherry-picks their customers and culls; that most insurance companies do not want to pay for preventative care; that most policies have small lifetime caps and are tailored to minimize *their* cost while maximizing *their* profit (ya know... how corporations work) rather than a patient-centered optimization of cost/benefit; that the siphoning is crushing the patient, their employer, their doctors, the hospitals, the rest of the medical team; and that we *already* have non-medical bureaucrats who decide whether you get the healthcare the doctor recommends... ones who get paid more the less they spend on you rather than someone who reports to someone you elect.

(see link in News Stories concerning ballooning number of bankruptcies of Americans who were salaried middle class with health insurance - who were gamed into insolvency with one major illness by the insurance industry; cross quoted below )

Originally Posted by Vexx
And finally in US healthcare news:

(from NPR)
A recent Harvard study shows a dramatic increase in personal bankruptcy filings related to medical expenses in the last eight years.

In 2007, 62 percent of all personal bankruptcies were linked to medical bills. That's nearly 20 percent more than reported in 2001. And in most cases, those who sought bankruptcy protection had middle-class earnings; nearly 80 percent were covered by health insurance.
Medical expenses are causing more Americans to experience financial distress and insolvency. The rapidly rising bankruptcy numbers will probably add pressure to the national debate over health care reform.

Originally Posted by 4Tran

This deserves to be expanded upon. Here's a write up on the same study (empahsis mine):

http://www.cnn.com/2009/HEALTH/06/05...lls/index.html

Quote:
Medical bills prompt more than 60 percent of U.S. bankruptcies
By Theresa Tamkins

This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."

Woolhandler and her colleagues surveyed a random sample of 2,314 people who filed for bankruptcy in early 2007, looked at their court records, and then interviewed more than 1,000 of them. Health.com: Expert advice on getting health insurance and affordable care for chronic pain

They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.
It astonishes me that anyone can prefer this over a public system.

[4Tran]

The two things that perplex me the most about the mess of this debate in the US is twofold:

1. Public Health systems in many, many other countries have much better outcomes than the American system, so why are so many people adamant that the American government will be far less competent at this than their foreign counterparts? Do they also feel that the American military is also far less competent than their foreign counterparts?
   
2. Why is the fact that the U.S. already has public heath insurance in the form of Medicare and Medicaid so little touched upon? On the basis of these two systems, the American government already spends more per capita on health services than any other country in the world. So why isn't the debate more about how to make such systems as effective as possible rather than on knee-jerk reactions about how the very concept is wrong?

[Jinto]

Originally Posted by Vexx

"single payer health plan" seems to mean very different things to many people. The proposal here is that everyone signs onto a single non-profit insurance entity (the actual execution of the processing will probably be outsourced) that has the entire citizenry as its user pool rather than many tiny splinters and chunks of the population.

Thats quite similar to the german health care system then. Except... if you earn enough or have a private buisiness you can also opt out for the private health insurers in germany.

The problem with this system is, that the pharma lobby has a very easy play and can dictate prices like they want.
Because once a drug is allowed to be subscribed by the doctors, everyone has a right to get it (when needed). And if it is the only one of its or one of a few then prices suddenly explode for the drug.
The point is, the patient doesn't know how much the drug costs and he/she doesn't care because the insurer pays it.
But that is exactly the reason why there is no real competition in that market. The pharma industry knows too well that they can dictate the prices. And if one corporation raises the price for their drug, other corporations willingly raise prices for their equivalent drugs too.
That is the reason why the model was changed a little bit. Now patients have to pay for certain drugs themselves. Suddenly there was a real market with generics and all the stuff that makes those drugs cheaper.

Another meassure was that there were white lists handed out to the medics/docs. And if medic/doc doesn't have a good reason to subscribe the expensive drug he is forced to subscribe the white list drug (which is similar).
This meassure was neccessary because the pharma industry had bribed doctors to subscribe their expensive drugs instead of the cheaper drug from a competitor.

Even with all these meassures taken the german health care system is rather expensive. Just 30% cheaper then the US american system but still quite expensive.

[Vexx]

Originally Posted by 4Tran

The two things that perplex me the most about the mess of this debate in the US is twofold:

1. Public Health systems in many, many other countries have much better outcomes than the American system, so why are so many people adamant that the American government will be far less competent at this than their foreign counterparts? Do they also feel that the American military is also far less competent than their foreign counterparts?

The extent of LYING by stakeholders in the status quo is just staggering. We're actually having to import Canadians to explain how their system *actually* works because the misinformation and hate/fear is flying so thick. At the moment you can really tell which Senators are owned by the insurance industry.

I should point out the A.M.A. doesn't speak for all doctors and actually hasn't in decades. They just pretend to - the majority of doctors don't even belong to it anymore.

Why is the fact that the U.S. already has public heath insurance in the form of Medicare and Medicaid so little touched upon? On the basis of these two systems, the American government already spends more per capita on health services than any other country in the world. So why isn't the debate more about how to make such systems as effective as possible rather than on knee-jerk reactions about how the very concept is wrong?

Medicaid is a bit of a mess (mostly due to chronic underfunding and poor execution). Medicare is actually a raving success and is only creaking because of the absurd cap on the medicare income tax (only the first $100K of income is taxed).

Basically, the opposition is simply shouting scary myths loud enough that the simple fact that we spend more per capita and get less results, that we don't even cover a quarter of the population, that the rate of well-to-do people being bankrupted from the loopholes of coverage...

ahh... pbffffft. After a while you're not sure whether to be more appalled at the manipulators or the manipulated.

[Zippicus]

Originally Posted by Vexx

The extent of LYING by stakeholders in the status quo is just staggering. We're actually having to import Canadians to explain how their system *actually* works because the misinformation and hate/fear is flying so thick. At the moment you can really tell which Senators are owned by the insurance industry.

To be fair it's not just one side or the other that's lying their asses off, both sides are pretty much full of it. Both sides ignore at best, misrepresent at worst, the known problems with whatever solution they advocate. You can pretty much just insert any generic nefarious force at work behind any politicians decision, because none of them are looking out for you or me (well maybe one or two of them).