Health Care Reform

I live in the States and have been a consumer of the US health care system for close to 30 years now. My father is a doctor in Toronto (where I was born), moved there prior to the socialization of medicine there because it was considered a good place to start a new practice. I still have an OHIP card that I could use if I ever was ill in Ontario and have used received medical attention when in Canada during visits over the last few decades. I only bring up these personal facts because they are relevant in the fact that I know a little bit about health care in the States and Canada.

First, the system of medical services in Toronto has gotten a little better over the last few years. If you want an MRI, it does not take months to get a reservation; it can be done in weeks. They now have more than two MRI machines in the city, which was not the case not that long ago (when it would take months or a year to get a reservation). Nevertheless, my dad has advised patients to make the drive to NY and get an MRI there when it needs to be done sooner. I needed an MRI a couple years ago for a non-critical reason (a shoulder that had given me pain on and off for close to 10 years that I never had a satisfactory diagnosis of); I was able to get an appointment within the week, and the only reason it took so long to get it was due to my schedule. I had to go into a hospital in Toronto when I was very ill for a diagnosis. The only reason I did not have to spend all day waiting behind the folks with sniffles was that my father was on staff at the hospital. The lessons I learned from the admittedly, highly anecdotal encounters, is that there are waits in Canada, they are getting better but they are still significant, and it leads to corruption where if you know someone, you can jump ahead in line.

Second, if you introduce a public option, although it will not immediately supplant/replace private insurance, that is only a matter of time. The government has an inherent advantage if it competes with the private sector as it can set up the rules and regulations in certain ways, has greater market power with being able to enroll more customers, and does not need to worry about profit/loss like a rational company needs to. For example, look at the USPS: profit and losses is not a concern to it and it usually is in the red. It does not operate like a rational business. Of course, UPS and FedEx can't directly compete with it because the rules state that only the USPS can put things in a mailbox. However, if it could, would they find it worthwhile to send regular mail if it were unprofitable? I could probably come up with a better example of where the government has competed and killed of a private option (this being an example of government not allowing a private option).

Third, you may say, OK, I don't care if the government eventually takes over health care as long as people are covered. But here is the issue as I see it: once you make medicine a public good, then medical decision will become politicized. Want your health care to cover your birth control or abortion? Well that depends on who is enacting the policies (for those not paying close attention, the house version of health care will seriously limit the ability for health care insurance to cover abortions if they receive any federal subsidies, which will be a huge chunk). Want to be able to use a treatment that was derived from stem cell research -- well that may also be foreclosed based on political, not medical, decisions. Who knows what the next few decades of medical research will be politicized?

Now this is not to say that there will be "death panels" deciding who lives and who dies. That all along was a red herring and never really part of the proposals. However, there can be no denying that when the government controls the funding of things, then that control will in turn be politicized. For people who are pro-choice, think about this: if health care passes that restricts abortion under a democrat President and Congress, what will happen if a more conservative government comes in?

Fourth, if you cut down on the profits that doctors and pharma can make, that will have a huge impact on the quality of health care. As another poster mentioned, the US heavily subsidizes pharmaceutical costs for the rest of the world. You can think this is a good or bad thing, but that is the way it is. If the US moves its system to be more in-line with how the rest of the world pays for medicine, the profits will be severely cut. Again, you can put your own value judgment on whether that's good or bad; however, keep in mind that basic economics teaches that if an industry, such as pharmaceuticals, is not profitable, there will be less investment and consequently, less R&D.

This is similar to the market for doctors. I would guess most people become doctors because they want to help others and the salary is a secondary consideration. But there is a huge investment in terms of years and money, as well as opportunity costs, to become a doctor, and the salaries are reduced, this will disincentive people from making that choice. After doctors' abilities to earn a living they expected was reduced in Canada, there was what was known as a "brain drain" where a sizable number of doctors would just emigrate to the States (this article, which I just picked at random from a google search, shows that in the 90's, it was 30% of the output of Canada's medical schools. There are probably many other articles and studies with comprehensive stats that back this up). The US may not suffer a "brain drain" with no alternatives for doctors to move to, but it will probably push those students who would have gone into medicine into engineering or other fields.

I agree that there are problems with the health care system here. I just don't find any of the current proposals to be tenable and will lead to much worse issues including the politicization of medicine, potential rationing of medicine, decline in quality and speed, etc.

 

People contribute their money to the risk pool run by an insurance company voluntarily. If you don't pay no one shows up with guns to enslave/imprison you or kill you should you resist their theft. Maybe I'm nuts but that matters to me.

What is most shocking to me though is that you trust the government more than private corporations and say the government faces violent revolt while a company faces shareholder revolt. What about the fact that you can just quit shopping somewhere? Do you not think companies care about that? Private companies face losing their businesses and often their shirts. I'll tell you when they stop caring about that: when they receive money from the government and thus don't care about their customers.

Politicians merely face not being re-elected which inflicts on them such horrible burdens as lifetime pension/retirement and high paying speaking engagements and cocktail parties.

 

I see where this is coming from. Do you also feel you should be able to opt out of taxes that pay for roads, the military, schools, and welfare? Also, I think the last time the U.S. government killed someone over not paying their taxes was when the non-taxpayer shot back.

In the case of grocery stores, people might have the ability to just shop elsewhere. But do you know how hard it is to switch providers? If you've got any pre-existing condition, you're pretty much fucked. I feel this is akin to saying that a pharmacist can refuse to fill a prescription he doesn't want to, because the prescription-holder can just go elsewhere. Things aren't always that simple.

And yes, I do trust the government more than private companies. Private companies were A-OK with child labor, private companies were A-OK with having their workers work for 18 hours for pennies (hey, the worker can just quit and get hired somewhere else, right?), private companies were A-OK with selling chalk-and-water as "milk", private companies were A-OK with selling contaminated meat to unwitting customers. You know who stepped in and made rules so private companies can't do that shit anymore and get away with it*? The government.

Not being re-elected is kinda a big deal for some people. Also keep in mind that if a politician is found criminally negligent or just plain evil, they can go to prison. Sure, it's generally not federal-pound-me-in-the-ass-prison normally, but it is prison. Also, one thing to keep in mind is that the government has both politicians and bureaucrats. Politicians would be about as involved in the running of the healthcare system as they are in the running of the FBI or USDA or the Post Office. Bureaucrats are not fantastically paid, IIRC the best pay possible for a normal bureaucrat is the same as a colonel in the military. Not terrible pay, but not extravagant.

 

Of course. What kind of person would I be if I thought other people should be forced to pay for things I want? Or to rephrase, why should I be forced to pay for things other people want like healthcare?

Shooting is a perfectly reasonable response when someone is trying to rob you or falsely imprison you, by the way.

A pharmacist should be forced to fill your prescription? What about his rights to do what he wishes with his own things/business? Your example was terrible.

You're serious about that point about bureaucrats pay? And you think it's good that bureaucrats run things? And you used the example of the FBI and USDA and Post Office?

CBS story.

And yeah I know how high the risk is for politicians for go to jail. It just happens all the time. There's no way a politician would use his government power to avoid prosecution by other government employees he likely had a hand in appointing. That just never happens.

 

I hope this isn't getting off-topic, but I think it's central to any debate about society and government. Delete away if you disagree!

The first thing you said in the edit is just gibberish. So I'm being robbed to buy some guy in Africa I've never met food or for a military base in Japan so I should just accept anything politicians want to do to me. Ridiculous.

To say someone is entitled to food, clothing, shelter, and healthcare is nothing less than saying there are no human rights. Quick example: If you are entitled to healthcare then a doctor must provide it whether he wishes to or can afford it or not and if he refuses he is imprisoned or killed. This is nothing less than slavery. To accept this is to accept in principle anything the government (or the voters) wants. I don't accept that.

 

The doctor is getting paid. That's hardly slavery. You are making very little sense other than its clear you believe you should have some kind of "right" to do whatever you want and keep all the money you earn (without acknowledging that its the government that keeps roving bands of pirates from just taking 100% of your earnings and then anally raping you) and you think the government should not exist.

You should try reading some Hobbes (the philosopher, not the comic strip w/ Calvin).

 

My company (I work for Anthem corporate) has loads of documents detailing not only the company stance on all this, but detailed case studies showing what will happen to member premiums in all our states. There's also our letter to Congress, responses to White House blogs, and other shit I don't feel like looking at right now.

I'm pretty sure it's all public knowledge, so I'd be happy to share with anyone. It's all PDF files so I can't copy and paste. I would summarize, but there's simply way too much to know where to begin.

 

Take from this what you will, but my experience with Canadian health care

Or go to BC or Quebec, where there are privatized clinics.

A year or so ago, I torsioned a testicle, it all seemed to heal fine, but about 3 months after, I started getting bad abdominal pain and was worried it was some sort of complication from the tacks they put in, or some such. When I hurt myself the first time, the hospital trip was fast, efficient and they were great. The doctors and nurses did their job fast, efficiently, and I didn't wait. They had to call in the Ultrasound Doctor, Urologist, and an anesthesiologist Saturday evening to get my diagnosed and into surgery to make sure I didn't loose my testicle. They all were friendly and did a great job.

The follow-up I tried to do was awful, the urologist who did the surgery couldn't (wouldn't) see me without a referral from my family doctor, which I don't have since they are impossible to find in Calgary. He said he might be able to fit me in a month or so. No good when I worried about my nuts.

Luckily I was going back to Montreal to visist my parents in a week in a half, and they have private clinics.

Call my parents G.P. Friday morning, got an appointment Friday at noon. She found nothing wrong, so she called down to get me an ultrasound. Lo and behold they can fit me in 30 minutes, on the ground floor of the same building. Ultrasounds done.

Total bill. $160 and some peace of mind when nothing was found wrong, compared to them doing nothing in Alberta.

Take from this what you will, but I do like the social health care. It was good not to have to worry when I first hurt myself not to have to worry about the cost of the trip, but as was said, the non-emergency stuff is hell to try and get done.

At least for the emergency procedures, they are on the ball, and do very good work. I'm all for public health care with private clinics for those willing to pay, or with jobs that offer extra medical insurance.

A few funny things about Canada health care.

My Dad, who is of the age where he is told to get a colonoscopy once a year, is told Calgary has an 18 month waiting list for on. In Quebec, he can get one in less than a week.

A friend of our family, who has had breast cancer, is supposed to get a mammogram (is that the right procedure?) once a year. 18 month waiting list. She flies to the States to get them done.

Another friend is a family doctor. His family doctor just retired, now he is unable to find a doctor for himself, and his family, since he prefers not to be his own family's doctor. He's had people try and bribe him into taking them on as patients since it is so hard to find family doctor. Kind of ridiculous, eh?

 

Who cares if he's getting paid? Isn't the force involved the important part? You have taken away his free will (life, liberty, property, pursuit of happiness) even if you pay him.

You read about the concept of negative rights and maybe I'll read Hobbes.

The Wikipedia article on it isn't bad.

I think this is important because all talk about government policies boil down to this crucial point.

 

Have any of you actually read the health care reform bill? It's actually pretty damned scary. Every one in the US will be required to purchase (Through the government) health insurance. My income for the past 4 years is $0. I've lived off of what I earned when I was younger so I'm better off then most with an income of nothing, but still my income is nothing. How the blue fuck is a person with an income of nothing supposed to buy health insurance?

The alternative to not having health insurance is a fine. Once again, if you have no money for health insurance, how are you going to pay the fine?

Then they arrest you and you get free health insurance. A person that was just minding their own business just became a drain on society. That's a brilliant plan.

 

a) To all you folk in the US, something is fucking wrong when medical bills are the main cause of personal bankruptcy in your fair land. Furthermore, a doctor telling the spouse of a terminally ill patient to divorce them so you don't get raped by insurance companies is some brutally fucked up shit. Some reform is required, something that can contain costs and ensure treatment for all. Your country needs to stop being so uselessly retarded, for fucks sake.

b) I live in Australia and we have a system of Medicare which covers everyone. People can also take out private health insurance if they so desire - there are also tax benefits for doing so.

When I was 19 I dislocated a disc and vertebrae in my neck in a sporting accident. I was taken to hospital, cut open, fixed up, stared at the ceiling in my room for a week, told by the doctor that the extent of my injury meant I should have been paralysed from the neck down, ate some terrible food and then sent on my merry old way. I didn't receive a bill at all. I do not know what would have happened to me if I'd been in the US uninsured, or if my insurance company had refused to cover me. Actually, I do know what would have happened to me. Severe financial anal rape.

I do not mind paying that little extra in taxes today to allow for Medicare because the program has a social utility above and beyond my own personal needs and, as someone who directly benefited from its existence, I'd be a despicable fucking hypocrite if I thought it was fundamentally evil.

 

You're taking an extreme side on this and I can appreciate that, but it does make a difference that he's getting paid. There isn't force involved because that's the profession he chose. That choice comes with rules. One of the rules is that you have to treat patients and if you refuse, there will be consequences. The Doc can quit at any time, but while he's working, he needs to follow the rules. He has free will, his life, liberty, pursuit of happiness. We all have to pay for things (through taxes) we might not want to pay for, or think we don't need. Maybe the guy who rides the bicycle everywhere he goes doesn't think his taxes should go to paying for roads, either. He doesn't have a car, so why is he paying? But unless he is totally self sufficient, he needs those roads for the delivery of food and medicine and all sorts of other things he does rely on. The big picture gets very important in situations like these.

Focus: Re-read what DrinksOnTheHouse wrote and the quoted pieces by Savage Henry. Anything else I wrote would be "me too-isms". Having worked as an EMS provider for a while in the past, I see where S.H. is coming from. Heath Care isn't great in our country right now and there needs to be change, however, I'm not comfortable with the suggested changes our government is currently offering.

 

The problem is that you are already a drain on society (nothing personal). Because when you get hit by a car or accidentally shoot your face off while drinking, they are going to come and take you to a hospital, which is going to treat you and then have to eat the cost of the treatment since you have no insurance.

Additionally, if you're income is actually nothing, you should have medicaid, so you shouldn't have to worry about it.

Right. I think I missed the part where any particular doctor is obligated to treat any particular person, although if they work for some hospital I suspect the hospital probably has a policy that says they will treat anyone with insurance. I think I'm missing the part where because the government is requiring health insurance (or in many cases giving it away if you qualify) we've somehow taken away the free will of doctors.

 

That was just an example of the principle. The government requiring health insurance does take away lots of peoples' free will and property though. Like your free will not to pitch in for some guy that lives 2000 miles away insurance to have insurance. Or not buy insurance. Or not pay a fine or go to jail if you don't buy insurance.

 

You wouldn't get "fined", but you would be penalized via a surtax on your income.

Source.

In theory, if your income is $0, then any surtax made against you would equal.... $0.

 

yes, you've succinctly summed up the concept of taxation. The government requiring seat belts also takes away your free will. Somehow the republic has been able to survive.

Really I think what you're saying is you don't want to pay for other people's health care (I'm assuming you have insurance, so you'd be a payor rather than a beneficiary of the system). And thats fine, its really the underlying subtext of the whole debate.

Its just trying to wrap in this whole horrible sounding infringement on your free will dogma thats really just an unrealistic load of crap.

 

Here is our health care problem summarized in one graph.



Over the past fifty years, we have had a tremendous disconnect between the American consumer and their purchase decisions related to health care. In the 1960's, about half of all purchases - drugs, doctors, services - were paid out of the consumer's pocket. Health care was paid not by insurance, not by the government, but by after-tax dollars paid by you and me. Today that number has plummeted down to around 10%.

Are we so far from the shady groves of reason now that we can't see how this would lead to a huge increase in health care costs? Anytime you have a disruption in supply and demand - anytime prices become irrelevant because the consumer doesn't pay the full cost - you are going to have a bad mix of products and excessively high prices. If Homer Simpson walks into a buffet, pays a lump sum and then gets to eat whatever the hell he wants, he is not only going to over-eat, but he is going to particularly over-eat those items that were more costly as he isn't charged for them. As Homer would say, "ALL YOU CAN EAT? THE JOKES ON THEM!" The same thing is happening to health care.

If you want to control health care costs, you have to put the decision making power back into the hands of the consumer. Nothing in the current health care bill will be doing this.

 

You trust the government more than a business? I agree that the government has a responsibility to the people, but I think they have already failed in that responsibility. I'm not seeing a very bloody revolt over the nearly $40,000 that every man woman and child in the country owes toward the national debt. The government, obviously, doesn't really care a whole lot about losing money. Why would a government run health care system be any different?

Cost aside, I think the bigger issue at hand is what the role of the federal government actually is. Nobody is going to complain about roads, fire and police, military, shit like that. But the entitlement programs and the like are where the debate lies. Some people, like our aptly named Crazy Wolf here, believe that the government can solve all our problems (more so than a greedy, evil business anyway). Some people have no problem allowing the government to confiscate a huge chunk of our property (usually in the form of money) to provide us with some level of security. Some people would rather have a cradle to the grave society where the government provides for us, and any meaningful notion of individuality is given away with our income (upwards of 40% for the average person after all taxes are accounted for). The government can only give to somebody if it takes from somebody else. When government starts providing a lot, that means they are taking a lot too. I would argue that we provide too much already.

When it comes to a large, government funded, taxpayer subsidized health care system, I don't want any part of that. Someone said that 60% of medical costs is administrative. That's in the private sector (that's not really all that private). If you think that the government can actually do this more efficiently, then you're living on a completely different world. The government has never done anything efficiently as far as I can tell. Also, whatever they say this will cost, I'll multiply it by 10 and be closer to the real cost than the government. That's just the way it works when government runs things.

Before I go on a huge rant here, I will say this: Something absolutely needs to be done. And I'm smart enough to know that I'm too stupid to know how to do that. I know TORT reform would be a good step. Also, allowing insurance companies to sell across state lines would help reduce price through competition. But more than anything, the cost of health care has to be brought back to the individual instead of filtered through insurance companies the way it's done now. Savage Henry's post spoke about this better than I ever could. Perhaps the most important thing though, is that people need to be more self reliant rather than expecting someone else to solve their problems. Government should be there as a safety net for the very extreme circumstances that citizens find themselves in. Nothing more, nothing less.

 

I don't have medicaid because pure and simple I don't want anyone to foot my bill. I also don't get food stamps or any other government handout. If I can't take care of myself, I'd rather be dead. If I get sick, I die. It's that simple.

I think you may want to amend your statement that I am already a drain on society to I might one day be a drain on society. And then think real hard that someday almost anyone, even you, could be a drain on society.