# Universal Healthcare: for or against and why?



## hopkins_student (Jun 25, 2004)

I know this has been done over at SF, but I don't recall it here. What do you think and why?


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## Fogey (Aug 27, 2005)

Maybe not for the whole universe, but at least for all human beings on Earth or in its orbit.


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## crazyquik (Jun 8, 2005)

Government provided health care.

Well we already have government health care, if you join the military. 

When a crack dealer gets shot and goes to the hospital for it, who pays for that, his insurance I suppose or me and you? And those millions of illegal immigrants who non-the-less are depleating the social safety nets in place for our citizens. But I digress... 

A 'right' is a person action that is unhindered by government intrusion. It's a limitation on government power. Your exercising of free speech, gun ownership, chosing your own religion, being safe in your person and privacy, etc do not require me to give up anything or materially deprive me. 

Governments create nothing, they merely redistribute resources and provide incentives for certain behaivors. The government providing health care means that the resources for it are taken from one person, and given to another. Since there is essentially an unlimited demand for free stuff (either here, or just across the border...), but a limited supply, this poses a serious problem. Why stop at giving all citizens free health care, why not anyone in the Western hemisphere who can walk across our border!

In elementary school we learned to keep our hands to ourselves. Too bad most people forgot that. 



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Beware of showroom sales-fever reasoning: i.e., "for $20 . . ." Once you're home, how little you paid is forgotten; how good you look in it is all that matters.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by crazyquik_
> 
> Government provided health care.
> 
> ...


Let me take a wild guess: You are a native-born American with healthcare?


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## tmlewis (Aug 7, 2005)

Against. Healthcare is a service that is beyond the obligation of our government which should exist in a minimal form.

What I really can't stand is when guilt-stricken liberals try to justify their support of universal healthcare by calling it a right. Rights are things like the freedom to speech or the right to liberty. A right is not something that requires the labor of another. That was called slavery and we did away with it two centuries ago.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by tmlewis_
> 
> Against. Healthcare is a service that is beyond the obligation of our government which should exist in a minimal form.
> 
> What I really can't stand is when guilt-stricken liberals try to justify their support of universal healthcare by calling it a right. Rights are things like the freedom to speech or the right to liberty. A right is not something that requires the labor of another. That was called slavery and we did away with it two centuries ago.


 Have not your rights called for the labour of others to defend and die for them?

Are you also against government standards for meat safety, or those which forbid child labour in coal mines? Where is the 'minimum' at which you draw the line? (If you support government-regulated meat safety and a ban on children working in coal-mines, thank a liberal. If you enjoy free speech, thank a liberal. And so forth.)


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## tmlewis (Aug 7, 2005)

> quote:_Originally posted by JLPWCXIII_
> Have not your rights called for the labour of others to defend and die for them?
> 
> Are you also against government standards for meat safety, or those which forbid child labour in coal mines? Where is the 'minimum' at which you draw the line? (If you support government-regulated meat safety and a ban on children working in coal-mines, thank a liberal. If you enjoy free speech, thank a liberal. And so forth.)


No, my rights have never required the labor of others for defense. Others have volunteered to defend my and their own rights, a service for which I am very thankful.

As far as the children in coal mines and meat safety the idea that I have a liberal to thank is as ridiculous as calling me a liberal. In the time period in which those regulations were passed I agree they were passed by people considered liberals for their time. That does not hold true for the present day however. If I were in that time I too would probably be considered a liberal. To call them liberals now is as ridiculous as calling me one.


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## Fogey (Aug 27, 2005)

> quote:
> No, my rights have never required the labor of others for defense.


 Are you familiar with the notion that the Universe didn't pop into existence when you were born?



> quote:Others have *volunteered* to defend my and their own rights, a service for which I am very thankful.


 I'll venture to presume that you are an American. Let's take a brief refresher of military conscription (mandatory, as opposed to volountary service) in the United States:

-First known draft in 1812, during the war by the same name.

-In 1863, a draft instituted by US President Lincoln precipitated the infamous New York Draft Riots. The Confederacy adopted one as well.

-Military conscription reared its head again in 1917, when the US began to enter the Great War (about 2,800,000 people were involountarily inducted to labour for your rights).

-The draft was revived again in preparation for the second World War (in 1940, note - well before the Pearl Harbour 'surprise' attacks). More than 10,000,000 were conscripted.

-Again, during the Korean War.

-Again, during the Vietnam War.


> quote:
> As far as the children in coal mines and meat safety the idea that I have a liberal to thank is as ridiculous as calling me a liberal. In the time period in which those regulations were passed I agree they were passed by people considered liberals for their time.


 Not just 'considered' liberals. They _were _liberals.



> quote: That does not hold true for the present day however. If I were in that time I too would probably be considered a liberal.


 That would depend on whether you took a time machine, or the natural birth-route as the legitimate liberals of the period did. It is impossible to know what you would have done then. What we _do_ know, however, is that you are not a liberal now, and that you are opposing progressive proposals on the same basis that the conservatives of the Progressive Era opposed meat-safety regulations and a ban on children working in dangerous industrial jobs.


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## rtaylor61 (Jul 25, 2005)

> quote:_Originally posted by tmlewis_
> 
> 
> 
> ...


What? If you are living here in the USA, every right and freedom you have was and is being defended by folks who have either died or are willing to die so that you have that right. Maybe you are in a position to provide for yourself and your family all that you need. Good for you. But in today's world, many cannot. The first time I ever visited this forum, I was amazed at what folks talked about spending for a shirt, pair of shoes, a suit. Yet, in the Grooming forum, I find that many of these same "gentlemen" aren't educated enough to shave! Yet they worry about the gray in their hair or beard. You say


> quote:"No, my rights have never required the labor of others for defense. Others have volunteered to defend my and their own rights, a service for which I am very thankful."


 Read that a few times and explain where "others" weren't giving labor for your defense.

You are correct. Healthcare is a service. But if you or someone you loved were in danger of loss of life or limb, and you had neither the funds or wherewithall to provide for healthcare, your tune would change. I don't know that "social" medicine is the cure, but until everyone can afford decent healthcare, lot's of folks are going to keep on dying.

Randy

"I won't be wronged. I won't be insulted. I won't be laid a-hand on. I don't do these things to other people, and I require the same from them." J. B. Books


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## hopkins_student (Jun 25, 2004)

I'm not going to agree with tmlewis's statement, because it has its flaws, and I would never want to suggest that other Americans have not made the ultimate sacrifice so that we can enjoy the freedoms we have. However, people serving in the armed forces are paid, it is not forced, uncompensated labor. In the case of the draft, it is forced, but at least compensated.

Food and water are more vital items than healthcare for human survival, should the government condemn and take possession of all farms, grocery stores, and water providers so that we can be sure these are supplied equally? As soon as the government begins providing services like healthcare to everyone regardless of need, where would you choose to draw the line?


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## tmlewis (Aug 7, 2005)

> quote:
> Let's take a brief refresher of military conscription (mandatory, as opposed to volountary service) in the United States:
> 
> -First known draft in 1812, during the war by the same name.
> ...


Your condescending implication that I was not aware of the draft is completely unnecessary.

Under the draft people face mandatory military service as you were so kind to remind me. But let's look at who this benefits. A military draft does not serve just me, it serves the entire nation including the draftee. This is very different from a "right to healthcare" that would require the entire country to subsidize healthcare for one person. This is an extremely important difference. A right is common, something we all share. Healthcare is the matter of a single person. Now if the draft existed to ensure just my right to freedom and no one else's that would be wrong.



> quote: Not just 'considered' liberals. They _were _liberals.


Exactly as I said. Liberals for their time.



> quote:What we _do_ know, however, is that you are not a liberal now, and that you are opposing progressive proposals on the same basis that the conservatives of the Progressive Era opposed meat-safety regulations and a ban on children working in dangerous industrial jobs.


In your original statement you tried to frame my opinion as wrong because commonly accepted regulations of the present day were enacted by historical liberals. Your attempt at discrediting my arguement by saying that liberals did all these great things in the past holds no merit in discrediting the ideas of present day conservatives. This was the point I was trying to make clear by saying that many present day conservatives hold views in line with the liberals of the past that you put up on a pedestal.

You've ignored this simple point. Instead you continue to try to write off my opinion by drawing a connection to conservatives opposing meat regulations in the Progressive Era in order to imply that the conservative position on the modern day issue of universal healthcare must also be inherently flawed.

I fully expect you to come back and claim that I'm mischaracterizing your statement becuase it is clearly logically unsound but if you read what you wrote that's what it says.


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## tmlewis (Aug 7, 2005)

> quote:_Originally posted by hopkins_student_
> 
> I would never want to suggest that other Americans have not made the ultimate sacrifice so that we can enjoy the freedoms we have.


Neither would I and I'm a little hurt people have interpreted my words this way. It's really my mistake though. When I said "my rights have never required the labor of others for defense." what I really meant was "my rights _as an individual_ have never required the _forced_ labor of others for defense." The sentence that followed about slavery indicated what I meant but it's my own fault for not including "forced".

As I said in my post above people have made sacrifices but those are not made just for me, they are made for the nation as a whole. Forced military service for the nation is the defense of a right, the right to freedom. Forced medical service and subsidization for an individual is not a right. When a soldier repels an enemy of the nation he is performing a service, even if it is involuntary, for the good of the entire nation. This service is not performed for the good of any one single person. With universal healthcare when the nation funds an operation and a doctor is required to perform it this is all for the benefit of an individual. It does not benefit the common good.

It is because of this distinction that healthcare is not a right.


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## Patrick06790 (Apr 10, 2005)

Back to health care -

I suspect the combination of greed - from lawsuit-happy attorneys and insurance companies - inept government meddling and the explosion of prescription meds is to blame for the current mess.

In the small towns I cover, the biggest item in the town budget is the schools, and the biggest item in the Board of Education budget is the health insurance for the teachers and staff. nTowns have to choose between keeping teachers and fixing potholes.

I pay a whopping amount into my health plan, but I only go to a doctor if I'm on fire. A routine physical from a country GP cost me, after my insurance, $75. Chump change to some; two weeks' grocery money to me.

Something's got to give in this patchwork, jury-rigged system. I have a hard time believing a massive Federal program is the answer, however.

The only time the Feds are efficient is when your taxes are a little askew. Then they act with bewildering swiftness.


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## Horace (Jan 7, 2004)

H.S.: does this debate come up in medical school? What say your colleagues?


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## crazyquik (Jun 8, 2005)

> quote:_Originally posted by rtaylor61_
> 
> 
> 
> ...


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## crazyquik (Jun 8, 2005)

> quote:_Originally posted by JLPWCXIII_
> 
> Let me take a wild guess: You are a native-born American with healthcare?


Yes. A native born American with health care. I work all week, go to church on Sunday, have no frivilous debt and a high savings rate, live below my means, and pay all my bills on time. I realize this lifestyle is entirely anthema to the 21st century. It's much more common that you see a low or a negative (!) savings rate, tens of thousands of personal debt spent on consumable goods instead of durable goods, people taking lavish vacations and having weddings that take longer to pay for than thier marriages last, etc.

Everyone I personally know (not a representative sample, I'm sure) who complains that they can't afford health care, all have a cell phone to thier ear half the time and over 100 channels of cable TV and often TiVO. I've ran the numbers. They can _afford_ health care, they just choose not to.


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## Briguy (Aug 29, 2005)

Totally against. I spent several years working for a medical devices manufacturer. What I saw convinced me that a national health type scheme consistantly results in the delivery of inferior health care. 

We sold three different generations of products in all of our lines: ancient (30+ years old technology); old (15-20 years old technology) and state-of-the-art. 

Asia and Africa purchased mostly the ancient stuff. Western Europe mostly old technology, with small sales of the newest technology to government systems. Private systems in Europe purchased mostly the latest technology. Canada, some ancient, mostly old, very little latest. US & Switzerland, all newest technology. 

Most companies in Europe provide private healthcare insurance to their professional employees. Basically, anyone with the means to be in the private systems seemed to do so. This, in my mind, represents the collective opinion of government funded healthcare; thanks, but no thanks. Even when its available, those with the means choose to pay for the superior outcomes and best available technology available in the private system.


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## crazyquik (Jun 8, 2005)

While watching the PM debates before the British election, someone questioned why the nurses union of the National Health Services used a private health care provider. If this is true, then it's certainly telling about the desirability of socialized health care.


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## Briguy (Aug 29, 2005)

One of the things I did when I worked for a medical device manufacturer was to make go/no go analysis for new product R&D and production. The development cost of medical device (and pharma is even worse) is staggering. We must be able to earn a profit consistent with our costs and risks. Without the massive profits available in the US, most of the products we developed would not be developed. Often, 80% of the profit generated by a new product came from the US. Take that away, and R&D efforts stop. 

In my view, all of the countries with government run systems, which always include price controls, are getting a free ride off of the US system. US healthcare consumers are effectively paying for the R&D that creates the products that are sold at cut rate prices to government run healthcare systems, even if those systems don't buy those goods until they become second or third tier technologies. The products exist because US consumers paid for the R&D necessary for their development.

Any government that wants to run a free healthcare system should, in my opinion, partially fund the R&D efforts necessary for the development of new drugs and technologies. Only then would they have both a moral and economic claim on those resources at below-market prices.


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## shoelovingSwede (Jul 28, 2005)

Any takes on the Swedish model?

My entire family is in the public healthcare system here in Sweden, I am the black sheep (mathematical modeling towards finance) so I have some comments on public versus private:

1: we have a small fee (30USD) when you actively search healtcare, so to weed out some of the headaches, but no medical care after that cost (some meds cost some but no more then say 200 USD in a year).

Some observations: the healthcare is somewhat slow moving, due to the fact that there is not competition between hospitals. But when is comes to crucial healthcare, there is no stopping and asking for insurance!

the some of Sweden's medical cost/ capita is actually less then in the US do to economics of scale I suppose ( you know the level of everyoneâ€™s healthcare and can plan for it) . As well that there are not so many that wants their piece of the pie, insurance, lawyers, doctorâ€™s insurance and so forth.

It is not an easy deal and as usual you neither system is without flaws.

JJ


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## Fareau (Mar 8, 2004)

I have voiced my support for a national health care system in the other forum on more than one occasion. The ensuing debate that emerges whenever this topic is brought up is often overly polemical, and the fervor of support for either side teeters on religious zealotry. Since this forum is a pleasant diversion for me, when it starts getting cantankerous I generally opt out of the discussion. I get enough of that in my day to day...

I will say that I am a physician and I have worked both in Europe and the United States. Within the United States, I have worked in county hospitals, private hospitals, and the VA system; I like to convince myself that I have some perspective, but I'm sure that my position is as rooted in sentiment as everyone else's. Regardless, it's hard to make a relatively convincing argument without writing a long, boring treatise on the subject.

Privatized medicine seems to be governed strictly by the profit motive and I think that that often distracts from what should be (at least in my mind) the utlimate goal, which is the provision of optimal health-care. I think that it is erroneous to conclude that patients will select the doctors who provide superlative care and that the marketplace will ensure standards of practice; despite the internet, most patients are completely uninformed consumers who really don't have any idea what metric to use in judging a clinician. And when illness strikes, people don't have the luxury of time to do much comparison shopping. I think that many physicians will attest to the frustrations of dealing with third party insurers who sometimes have no interest in paying for what is right for the patient. Additionally, the cost of health-care continues to rise with the advent of new diagnostic and therapeutic modalities, and I think that the capacity for individuals and insurers to accommodate (or contain) this rise is unlikely to happen under the current system in this country. 

I am a fairly patriotic person, and in today's world, I have a stronger sense of being part of an American community. I am not particularly comfortable with the thought that we have fellow Americans who are financially ruined on a daily basis by the cost of their health-care (assuming that they even have access to comprehensive care). I find that many of these people who are medically marginalized are often people who have done nothing to deserve it (eg through poor fiscal habits, poor health habits, etc.). I don't think our current system is equitable in the distribution of health resources, but this is particularly where sentiment creeps in regarding what a society should optimally provide its members. The person who commented that the technology available in other countries with nationalized care is dated and antiquated is speaking strictly about his own company's sales (I think, right?); I dare say that many technological advances are being developed in Europe and are then making their way to the States. But this is mildly less germane since the technology is really not an issue if it limited to a select advantage group.

There is too much to say, and I have written too much as it is. We all subscribe to the democratic process, and if Americans want privatized medicine, so be it. Perhaps in some debatable way it is best for the individual, but I don't think it is best for society. So, from this individual physician's view, I vote for a national health care system in this country. Hopefully we can avoid the polemics since, to some extent, I am interested in hearing other opinions.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Horace_
> 
> H.S.: does this debate come up in medical school? What say your colleagues?


Yes it does. We've debated it on and off in our class about Professionalism and there are split opinions. However, now that more students have spent time at the LA County Hospital talking with patients, not all by any means, but a lot, who have no desire to take common sense care of themselves or follow the advice of their physicians about taking medication and controlling their food intake, some students have come 180 degrees from supporting universal healthcare to being angered by its mere suggestion. To my knowledge nobody has changed viewpoints in the opposite direction.


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## SGladwell (Dec 22, 2005)

Without going too much into my own position on this topic, though I will say that having lived as an adult under several different systems has made me unambiguously in favor of universal single-payer healthcare, I think it might be useful to post an exchange that I only recently discovered between two of America's preÃ«minent public thinkers, Adam Gopnik and Malcolm Gladwell, that took place in 2000 under the auspices of the Washington Monthly.

Malcolm Gladwell has since then reversed his position, first in this New Yorker article

And more recently in his blog:
https://gladwell.typepad.com/gladwellcom/2006/02/gladwell_v_gopn.html
and
https://gladwell.typepad.com/gladwellcom/2006/02/gladwell_v_gopn_1.html


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## Briguy (Aug 29, 2005)

I believe my experience in the medical device industry applies, at the very least, to the entire device industry. No profit=no new products.

To be fair, both our French and German businesses, which were independent companies before we bought them, had developed best in class products in their niches (internal and external fixation and forged implant products, and spine fixation). However, they made most of their profits in the US. Take away the US profits and the companies would not have developed many of the products they developed.

Even if expensive, and potentially not available to everyone due to their cost, these high-cost products will eventually drop in price as newer technology supercedes them, and thus become widely available. Once again, take away the profits, the products never exist, and are not available to trickle down. 

The president of our Italian business told me, in response to my asking why, if the public system was so poor, the government didn't just get rid of it and go 100% private, that even a poor system with long waits and old technology was still needed, as it provided a safety net for the poor, the young, students, etc. 

For the US, I don't think the issue of national healthcare is the right issue. I think the creation of a safety net available for those without access to private insurance is both politically doable and practically addresses this gap in the US system.


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## Acct2000 (Sep 24, 2005)

We need our present system to change. Right now, I am reviewing our company's annual health insurance renewal. Egad!!

However, I don't think a government system is the answer. The government does little if anything efficiently and hamstrings ingenuity with exhaustive regulations. I see the government system as only making things worse.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by hopkins_student_
> 
> I know this has been done over at SF, but I don't recall it here. What do you think and why?


For government paid universal health insurance, ambivalent on government provided health care (there is a difference).

Government paid universal health insurace - pretty much what France has. The government pays the insurance, the doctors operate privately. Essentially, you have price negotiation between the between two essentially equal bodies - the medical professionals and the government insurers. The French suck at a lot of things, but they have a great health care system, much better than ours. And private add-on insurance and payments for specialized add-on care can be permitted.

Government provided health care - closer to what the UK and Canada have, I believe. These have two problems. First, I'll rather have the government deal with the payment and financing of treatment rather than the medical treatments itself. Second, UK and Canada run their programs on the cheap. Something at like 30 to 40% of the expense of our system. Simply taking their system up an expense proportion of 50 to 60% of the USA medical expenditures might fix up a lot of problems.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by hopkins_student_
> 
> Food and water are more vital items than healthcare for human survival, should the government condemn and take possession of all farms, grocery stores, and water providers so that we can be sure these are supplied equally? As soon as the government begins providing services like healthcare to everyone regardless of need, where would you choose to draw the line?


Easy place to draw the line - Is there a problem?

We really don't really have a food and water supply/shortage issue in the USA. Especially with water - there are many places such as public restrooms where you can get "free water". But we do have a medical supply problem - 16 percent of the country, and not the poorest, but the working lower-middle class, don't get any medical supply.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by forsbergacct2000_
> 
> We need our present system to change. Right now, I am reviewing our company's annual health insurance renewal. Egad!!
> 
> However, I don't think a government system is the answer. The government does little if anything efficiently and hamstrings ingenuity with exhaustive regulations. I see the government system as only making things worse.


government can be very efficient. i'll give you two clear examples.

1) social security is ridiculuously efficient. you might dislike the idea, but it works exactly as it should, and no private system can provide the same stability for that price....

2) medicare is more efficient (less than 2% of the medicare tax goes to bureaucracy) than any HMO or traditional health care plan (typically 10-25% of the premiums) on the market today. it's even more impressive, when you consider that many HMO's and health care plans copy medicare's decisions with regard to new treatments -meaning that medicare's bureacracy does work for private health care plans - and medicare pays more for treatment.


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## 16128 (Feb 8, 2005)

> quote:_Originally posted by NoVaguy_
> 
> Government paid universal health insurace - pretty much what France has. The government pays the insurance, the doctors operate privately. Essentially, you have price negotiation between the between two essentially equal bodies - the medical professionals and the government insurers. The French suck at a lot of things, but they have a great health care system, much better than ours. And private add-on insurance and payments for specialized add-on care can be permitted.


I have not heard a lot of complaints about French care.

I wonder if medical lawsuits are restricted/capped there, as well?

From experiencing both the UK and US systems, people have a choice between being underserved by having longer waits for tests and surgery and some unavailable care in a socialized system OR being overcharged and underinsured in a totally private system.


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## Wimsey (Jan 28, 2006)

I am in favor of universal healthcare, in principle. I say "in principle" because I think that it would be easy to get universal healthcare wrong, and bad "universal healthcare" could be worse - much worse - than what we have now.

I don't think that the English system is in any way a model that would work in the US...but I think that the French system works well; I've lived in Germany and used the German system, too; it also works quite well. (The fact that some countries have well-functioning systems doesn't mean that they can just be copied of course.)

Aside from providing healthcare for the 40 million or so Americans without insurance (some of whom, I'm sure, have chosen not to buy any), a universal system would also make American businesses more competitive and would make US workers more secure - if they lose their jobs, their family won't suddenly be without healthcare.

So put me in the "for" column, with the caveat that I'm not in favor of *any* universal healthcare scheme.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by SGladwell_
> 
> Without going too much into my own position on this topic, though I will say that having lived as an adult under several different systems has made me unambiguously in favor of universal single-payer healthcare, I think it might be useful to post an exchange that I only recently discovered between two of America's preÃ«minent public thinkers, Adam Gopnik and Malcolm Gladwell, that took place in 2000 under the auspices of the Washington Monthly.
> 
> ...


Great articles, thank-you! Are you related to Malcolm Gladwell?


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## hopkins_student (Jun 25, 2004)

To expand on my previous statement, a lot of people I go to school with would not choose to go into medicine if they were to essentially become government employees. I think you'd lose a lot of good people, which would only result in a lower quality of health care.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by hopkins_student_
> 
> To expand on my previous statement, a lot of people I go to school with would not choose to go into medicine if they were to essentially become government employees. I think you'd lose a lot of good people, which would only result in a lower quality of health care.


I support, as have others on the thread, the system that France has - for all nations that can afford it. With enough planning and thoughtfulness, every nation could improve the way its medical services are distributed, and obviously* it's important that every nation do so.

*not so obviously for some.


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## Doctor Damage (Feb 18, 2005)

> quote:_Originally posted by hopkins_student_
> 
> To expand on my previous statement, a lot of people I go to school with would not choose to go into medicine if they were to essentially become government employees. I think you'd lose a lot of good people, which would only result in a lower quality of health care.


You mean they didn't go into medicine to help people? Or do some sort of Christian duty? It's all about the money?



> quote:_Originally posted by NoVaguy_
> Government provided health care - closer to what the UK and Canada have, I believe. These have two problems. First, I'll rather have the government deal with the payment and financing of treatment rather than the medical treatments itself. Second, UK and Canada run their programs on the cheap. Something at like 30 to 40% of the expense of our system. Simply taking their system up an expense proportion of 50 to 60% of the USA medical expenditures might fix up a lot of problems.


Regarding Canada, an old friend of mine (and policy keener) explained to me that Canada does not have a system of socialized health care, but rather a system of socialized health insurance. A key difference, if his description is true. The system is so complex, however, that I doubt if anyone actually knows what it is or isn't.

'Wait times' have become the latest topic _du jour_ up here, but as my mom (a former nurse) says, anyone who really needs medical procedures right away gets them right away.

DocD


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Doctor Damage_
> 'Wait times' have become the latest topic _du jour_ up here, but as my mom (a former nurse) says, anyone who really needs medical procedures right away gets them right away.
> DocD


Of course, for 16% of America*, the wait time is essentially infinite for most services.**

*The 40+ million American citizens without health insurance.

**At least until it becomes a very expensive emergency procedure. For which our insurance and government ends up picking the tab. This is a big part of the reason why universal health insurance/programs tend to so much more affordable - it results in a lot of people getting quicker, and thus cheaper care.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by NoVaguy_
> 
> 
> 
> ...


 Not to mention that with cheap, preventative care, many of those expensive procedures would not be inevitable.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Doctor Damage_
> 
> 
> 
> ...


Well, considering we're going to end up with over $160,000 of loans for tuition, not including living expenses, followed by up to seven years of sub-minimum wage pay as residents, something has to pay those loans. The salaries of physicians in most countries with universal health care plans are not going to get the job done.


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## Concordia (Sep 30, 2004)

> quote:_Originally posted by hopkins_student_
> 
> To expand on my previous statement, a lot of people I go to school with would not choose to go into medicine if they were to essentially become government employees. I think you'd lose a lot of good people, which would only result in a lower quality of health care.


One of the reason my father got out of medicine is that he foresaw a day when all doctors would be low-level employees of insurance companies. Not to discourage your ardor...


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## Fareau (Mar 8, 2004)

There seems to be a rather false perception that physicians working in nationalized health care systems are simply government employees who make a pittance. This is, for the large part, incorrect; many are very handsomely compensated for their services, and they certainly are not cogs within some bureaucratic machine. Do they make as much as some of the high-fliers within the American private sector? No, they don't. But, if the impetus to become a physician is money, there are better career choices which offer more substantial remuneration. Medicine will always be a highly esteemed profession and will always attract intelligent people, regardless of the pay.

Wimsey: I agree with you. Erecting just any type of universal coverage is not the answer. It would have to be well planned (no easy task).

NoVaguy: Government managed universal health insurance may be a more feasible option for the U.S. I, too, have been generally impressed with some aspects of the French system. I like to think we could do it better in this country.


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## globetrotter (Dec 30, 2004)

two conflicting comments:

the israeli system is a universal insurance, managed by the government. basically, everybody gets good healthcare for a small monthly fee, with all employment contracts have to include by law. if you are unemployed, retired, in the military or a full time student the government covers you. doctors are very poorly paid - to the extent that in the high tech company that I worked, there were fully licensed doctors who had left medicine to work as tech support people to make more money. care is pretty good, but very impersonal. and you end up with a situation that anybody who can afford to tries to supplement the system with add on cash upgrades. 

the flip side of that is that you literally have nobody who falls between the cracks, kids get a good start, and you don't have to freak out when you are unemployed.


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## SGladwell (Dec 22, 2005)

> quote:Great articles, thank-you! Are you related to Malcolm Gladwell?


Unfortunately, no.

Also unfortunate is the perception of certain avaricious members of the American medical community that it's their God-given right to a virtually unlimited income.


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## Preston (Aug 8, 2003)

> quote:_Originally posted by SGladwell_Also unfortunate is the perception of certain avaricious members of the American medical community that it's their God-given right to a virtually unlimited income.


How is it that you know this? How do you define "virtually unlimited"? What should be the limit? How do you know they are avaricious?


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## Mr. Knightly (Sep 1, 2005)

Health care as an employment benefit is the big problem. 

- There is no incentive for people to take care of themselves
- You have no insurance between jobs

My insurance benefits got slashed because 4 people got gastric bypass surgery, which doubled the total health care expense that our insurer had to pay. The risk of insuring employees of our company was upgraded significantly and the only way for the company to afford the insurance was to cut benefits.

Why not get rid of insurance as a benefit and just pay employees more? Young people would be much less expensive to insure so they would be able to save the extra and let it collect interest, which would more than offset the increased cost of healthcare when they're older. Plus, if they knew that they'd eventually have to pay for their own healthcare, they'd be more likely to eat healthy and go for a jog now and then.

Costly thy habit as thy purse can buy,
But not express'd in fancy; rich, not gaudy;
For the apparel oft proclaims the man.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by SGladwell_
> Also unfortunate is the perception of certain avaricious members of the American medical community that it's their God-given right to a virtually unlimited income.


That's the biggest load of crap I've ever heard. Assuming you're not already a government employee, I take it you're not opposed to the idea of becoming a government employee if a bunch of half-wits decided your services should be provided to everyone for free?


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Mr. Knightly_
> 
> Why not get rid of insurance as a benefit and just pay employees more? Young people would be much less expensive to insure so they would be able to save the extra and let it collect interest, which would more than offset the increased cost of healthcare when they're older. Plus, if they knew that they'd eventually have to pay for their own healthcare, they'd be more likely to eat healthy and go for a jog now and then.


While I agree with you on principle, I think it would probably result in fewer insured people. As has already been pointed out, there are plenty of people who could afford it, but choose not to in favor of purchasing luxury items.


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## Concordia (Sep 30, 2004)

> quote:_Originally posted by Mr. Knightly_
> 
> Why not get rid of insurance as a benefit and just pay employees more? Young people would be much less expensive to insure so they would be able to save the extra and let it collect interest, which would more than offset the increased cost of healthcare when they're older. Plus, if they knew that they'd eventually have to pay for their own healthcare, they'd be more likely to eat healthy and go for a jog now and then.


Nice concept, but not helpful at the macro level. IMO, there needs to be some form of insurance that covers everyone for some minimum of service-- no ducking out if you happen to be healthy this year, no kicking out the certifiably unhealthy. It is not a question of rights, but merely sensible policy.

Shouldn't preclude a private market for those who want/need a different level of service, but the current regime which discourages routine health care and then dumps the uninsured into emergency rooms when it's often too late is very wasteful.

And those who would object to government setting of prices, be aware that this is pretty much what insurance companies do today.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


Wow, someone certainly took offense at a comment I made about people in the profession I know personally. 

Also, your argument is sadly typical of the hysterical hyperbole that always froths to the surface in any debate about civilizing America's health care system. Doctors working under single-payer health care systems hardly work "for free". Admittedly I don't know what the case is in North Korea, but even in Cuba doctors don't work "for free". (Also, as an aside Cuba's medical establishment is probably the most public spirited on Earth, training doctors from all over the world and sending their own expects to alleviate suffering in the forgotten corners of the globe. Say whatever you want about the rest of Castro's regime, but their health care policies have been a boon to the world.)

Do you actually _know_ any doctors who work in countries with universal health care? If you did, you would know that doctors all over the world are well compensated for the services they provide. Doctors fall into the elite strata of every society in the world. That high level of compensation, I might add, is far easier to stomach when you don't have several layers of bookies taking their cut from the medical dollar. That happens in America's highly inefficient private insurance market but does not in American or European government health care sectors.

Moreover, as has been already mentioned prices for many medical services in America are for all intents and purposes set by the government as well, given that insurance companies tend to follow Medica**'s lead. Except in the case of people who are too rich/young for government health care and too poor/sick to purchase insurance when their companies do not provide it. I see it as an outrageous scandal that the working poor are charged about 3x more for medical care than the company that picks up the tab on my behalf would. You, presumably, do not.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Mr. Knightly_
> 
> Health care as an employment benefit is the big problem.


Also, making health care an employment benefit effectively restricts the labor market. Some people who normally take chances with their employment (or even go off on their own and start their own business) won't because of the lack of insurance.

I'm one of those people, btw. I've generally passed up opportunities I normally might have taken but for the lack of insurance issue. I think, in my 30+ years, I've only been uninsured for maybe 1 or 2 weeks.... maybe even not at all (I've never really quite figure out what happens during those periods when you switch jobs - I think I'm covered by Cobra crap, but who knows...)


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## Harris (Jan 30, 2006)

I appreciate all that's been written: such-and-such system works for said reason, such-and-such system doesn't work for said reason, such-and-such system could work if such-and-such was different, such-and-such system could be tweaked to perform more efficiently, such-and-such system...

...and on and on. Most of the discussion thus far has centered on the systems that are already in place, and why (or why not) they work well (or do not). Very pragmatic. Very "See how it works now? Terrible, ain't it?"

I'm going to take a slightly different approach--a more deontological/Kantian approach toward the question of which sort of system is relatively (more or less) moral than others. And instead of being hyper practical, I'm going to dare to be theological: divine justice demands a safety net--the sort that would provide free-of-charge health care to all persons, especially the poor. In fact, I'll go a step further: God is pissed about the rich having access to all the (good) health care they can afford (a lot) while the poor go without.

Heeding what others have said about the flaws in both systems--and certainly any system is susceptible to abuse and/or corruption--it seems to me that a principled position demands a utopian scenario: that is, if both systems were equally free of abuse and/or corruption, which would be preferred? Preferred not by humans, but by the God who reveals himself through that radical messiah who expressed no small amount of favoritism toward the poor and the weak.

You Kantians among us must get where I'm going. Think in terms of categorical imperatives: not what presently works or does not presently work, but what _should_ be made to work well...and why.

-Harris


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## Fareau (Mar 8, 2004)

I don't agree that people would be less inclined to take care of themselves under a nationalized program. The incentive remains the same, regardless of the system: the hope for a longer, happier, healthier life. At the present time, the current system has not effectively dissuaded people from the various habits which have lead to increases in obesity and its comorbid states (diabetes, hypertension, hyperlipidemia). This is a very potential epidemic that has not been staved by placing any portion of the financial burden on the individuals (at least as far as I can discern).

The decline in smoking in this country was through public education, not from people suddenly being racked with fear of health care costs. We can see that smoking rates in western Europe are on the decline through heightened public awareness, and some legislative actions (restrictions on public smoking). It has been my experience that people don't clean up their lives simply to avoid expenditures; they do it because they fear the calamities that might ensue from bad habits. People who are going to smoke, drink in excess, use drugs, eat indiscriminately, and be non-compliant with medications will do so regardless of the system of health-care delivery.

I agree with the opposing side on one crucial point: adoption of a universal system of coverage would have to be contingent upon maintenance of an acceptable standard of practice. It would be folly to replace the current system with some pale shadow that provides inadequate care to everyone.


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## manton (Jul 26, 2003)

I just want to see if any genuine, self-professed Kantians declare themselves.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by Fareau_
> 
> I don't agree that people would be less inclined to take care of themselves under a nationalized program. The incentive remains the same, regardless of the system: the hope for a longer, happier, healthier life. At the present time, the current system has not effectively dissuaded people from the various habits which have lead to increases in obesity and its comorbid states (diabetes, hypertension, hyperlipidemia). This is a very potential epidemic that has not been staved by placing any portion of the financial burden on the individuals (at least as far as I can discern).
> 
> ...


"Acceptable standard of practice." Do you mean you would hope that doctors and nurses and researchers continue to provide quality service?

I should hope so too. And it seems like a doctor (or doctor-to-be) wouldn't want to admit that under a socialized health care system, the quality would be less. Isn't that the same as saying: "Look, we like the big profits; it's what makes us rich. And if there was no hope of making big profits, we wouldn't give as much of a damn"?

Perhaps it is the same. If so, shame on...


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## Fogey (Aug 27, 2005)

Hm. Judging by these new responses on page two, I suppose I'm a half-witted Kantian [}]


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## Fareau (Mar 8, 2004)

Harris, your'e Kantian approach to this is intriguing, but a little too cerebral for me. Describing an "acceptable standard of practice" is a slippery slope, but what I meant was that accessibility to diagnostics, specialists, etc. would be provided for in a timely fashion, which is one of the big concerns of detractors of the universal model; I am largely responding to concerns about the frightening delays in services described by other posters.

Let me reitterate that I am a keen proponent of universal care, in the event that my position is not clear..


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Harris_
> I should hope so too. And it seems like a doctor (or doctor-to-be) wouldn't want to admit that under a socialized health care system, the quality would be less. Isn't that the same as saying: "Look, we like the big profits; it's what makes us rich. And if there was no hope of making big profits, we wouldn't give as much of a damn"?
> 
> Perhaps it is the same. If so, shame on...


The quality wouldn't suffer due to lack of effort, but because many of those most "equipped" for medicine would choose other professions.


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## Harris (Jan 30, 2006)

For what it's worth: Deontological ethics (Greek Deon meaning obligation) maintains that moral/ethical decisions should be made as one reflects upon one's _*duties*_ to/toward others. Think a priori.

The working idea is that we should live according to eternal (duty-based) principles that do not (and should not be allowed to) change as a result of a change in situation/circumstances. The end does not justify the means to the end; rather, the principle (based upon duty toward another/others) is what defines moral/ethical behavior.

The simplified version: The Golden Rule.

I wouldn't expect that many citizens of the oh-so utilitarian USA would want to think and act in terms of a deolontogical/Kantian approach. Surely must seem weird. So saturated with Millians and Benthamites, as we are. (Sigh).

-Harris


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


You mean profession in which they could make lots of money, right?


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## manton (Jul 26, 2003)

Hey now. Americans are Lockeans. If anything. Jefferson said "Aristotle, Cicero, Locke, Sidney." Not bad.


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## Fareau (Mar 8, 2004)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


There are far more lucrative career choices than medicine. I am not entitled to tell people what to do with their lives (perhaps when I become a despotic leader, but that day will have to wait), but I would strongly discourage people from choosing medicine for the money. It is a bad, bad reason for choosing this path in life. I don't believe that people who are looking for the most financial reward are the "most equipped" for a career in medicine. Expand a little on your premise.


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## Preston (Aug 8, 2003)

> quote:_Originally posted by Harris_I should hope so too. And it seems like a doctor (or doctor-to-be) wouldn't want to admit that under a socialized health care system, the quality would be less. Isn't that the same as saying: "Look, we like the big profits; it's what makes us rich. And if there was no hope of making big profits, we wouldn't give as much of a damn"?
> 
> Perhaps it is the same. If so, shame on...


 No, I think it means, "Look, I just spent 10+ years in college, amassing $150K in students loans. I'm going to have to pay at least $90K/yr in liability insurance premiums, and another $100+K for office/medical equipment to get my practice STARTED... Oh yeah, and hire a receptionist and nurse for another $80K/yr (min)... oh Yeah, and pay another $50K/yr rent on my office. Oh yeah, and I'm going to be on call practically 24/7 for the first few years of my practice. Oh yeah, and oftimes, the very LIFE of your loved ones will be in my hands, which can be a little stressful. I don't think it is unrealistic for me to want to make enough to make as much NET income as a unionized manual laborer - approx $100K/yr, to begin with. Maybe by the time I'm 40, the school loans and medical equipment will be paid off.

Some docs make high 6 and 7-figure annual incomes. They are in the miniscule minority. But I don't begrudge them their just rewards either. Frankly, I don't want my brain surgery going to the lowest bidder.

If someone is NOT afforded the ability to make a decent living for himself and his family, after investing so much into the career, then he should not be "shamed" for leaving the field to pursue another career. There are a lot of occupations in which our bright young minds can succeed. Why discourage Medicine as an option. Next time I'm admitted to my local ER, I PRAY I'm attended by the A students.


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## Harris (Jan 30, 2006)

manton, we're awash in empricism. Yes, we Yanks. No doubt.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by Preston_
> 
> 
> 
> ...


How about this? How about the doctors who have worked their asses off be rewarded in a way that correlates with the amount of intelligence, time, energy, and hard work they've invested? Yes, indeed. I agree entirely.

Why couldn't that "reward" be paid by the government? Why can't the check be written and signed by Uncle Sam?

Or, more accurately, by means of a progressive income tax?


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## manton (Jul 26, 2003)

> quote:_Originally posted by Harris_
> 
> manton, we're awash in empricism. Yes, we Yanks. No doubt.


What could be more trad than to get back the thought of the Founding? Much better than Mill & co.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by manton_
> 
> 
> 
> ...


"...get back the thought of the Founding..."

"Much better than Mill & co."

Explain.


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## hopkins_student (Jun 25, 2004)

Preston got it right.


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## Fareau (Mar 8, 2004)

> quote:_Originally posted by Harris_
> 
> 
> 
> ...


I was expecting this topic to devolve into the usual college food-fight, and you two are playing philosophical footsies under the table.


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## Preston (Aug 8, 2003)

> quote:_Originally posted by Harris_
> How about this? How about the doctors who have worked their asses off be rewarded in a way that correlates with the amount of intelligence, time, energy, and hard work they've invested? Yes, indeed. I agree entirely.
> 
> Why couldn't that "reward" be paid by the government? Why can't the check be written and signed by Uncle Sam?
> ...


Well, I'm relieved that you want to see them compensated commensurate with their quals. Unfortunately, the government is not exactly known for paying well. In fact, isn't it the law of the govt bidding process to grant contracts to the lowest bidder? I'm asking. I honestly don't know. But that is my perception.


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## Harris (Jan 30, 2006)

I'll check back later with this discussion. Should be interesting. In the meantime, I encourage any/all to read a wee bit of William Temple--good Christian Socialist that he was--on the subject of moral obligations and/or duties. Good stuff. There might even be something to enlighten the rich on why they/we are obligated/duty-bound to spread the wealth and create safety net. 

Cheerio, chaps.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> Preston got it right.


Before I go...Preston got what right? That all the talented doctors-to-be would enter other professions.

You underestimate your colleagues and future colleagues in your vocation, my friend.

I know lots of doctors. Mostly surgeons. They do what they do because they enjoy using the gifts they've been given and cannot imagine doing much of anything else. _For them, what they do is a calling._

So how about this: don't generalize your own sentiments in such a way that it reflects all doctors and/or doctors-to-be. If some people want to become doctors for the $, fine. But not all do. And there's no evidence to confirm/verify that even a slight majority do.

Cheers, then.


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## Fareau (Mar 8, 2004)

> quote:_Originally posted by Preston_
> 
> 
> 
> ...


Don't you remember all of those news stories about the government paying for $500 toilet seats, and $50 nails/screws?


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## Preston (Aug 8, 2003)

> quote:_Originally posted by Fareau_
> Don't you remember all of those news stories about the government paying for $500 toilet seats, and $50 nails/screws?


Black ops [:0]


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Preston_
> I'm going to have to pay at least $90K/yr in liability insurance premiums...


If the AMA were more agressive in policing their members, the malpractice insurance premiums would a lot less. But the AMA doesn't believe in de-certifying bad doctors, so the rest of you are going to pay more in premiums.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Preston_
> Well, I'm relieved that you want to see them compensated commensurate with their quals. Unfortunately, the government is not exactly known for paying well. In fact, isn't it the law of the govt bidding process to grant contracts to the lowest bidder? I'm asking. I honestly don't know. But that is my perception.


No, no, no, no. Bidders usually have to be qualified...  Of course, the qualifications depend on what you're doing. It's one thing if you're supplying paper clips, another if you're the food contractor at a prison, and quite something else if you're in weapons building.

Otherwise, I would be out there, bidding 3 million dollars to build an aircraft carrier in my bathroom. And of course, you could count on me, because I said so!


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## hopkins_student (Jun 25, 2004)

Harris,

Your surgeon friends would not be in the business if it were a financial burden to them. Burden is the only word to describe the financial situation that my colleagues and I would face if we were to become government employees upon completing our training. I don't expect to become phenomenally wealthy from a career in medicine, but I expect my sacrifices to be compensated. My figure about $160,000 in loans is tuition for medical school only. Imagine loans from four years of private undergrad and the living expenses during undergrad and medical school; for some people, that will easily reach $500,000.

As for your comment about why shouldn't doctors' salaries be paid by the government, my only answer to you is that that is not what our government was created to do. We have become the most successful country in the world by allowing private enterprise to operate and provide goods to the market, I can't imagine why anybody would seek to emulate less economically successful systems of government.

And by the way, your evidence of your friends who would work as physicians regardless of the pay is every bit as anecdotal as mine. Your anecdotal evidence is probably less credible, because your friends are in a position where they have probably paid their loans off, whereas my fellow students and I would not be that fortunate if we were to start under a universal system. The stakes are a lot lower for them.
So how about this: Get off your high horse.

Cheers, then!


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> Harris,
> 
> ...


You don't have a clue.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> Harris,
> 
> ...


By the way, hopkins student, your question borders on trivial. And maybe you know it. It's just a matter of time--decades?--until the U.S. healthcare system is run and regulated by the government. Maybe you wouldn't have raised the question initially unless you kinda-sorta already know this (deep down in the gut), eh?

Good luck with your loans.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Harris_
> You don't have a clue.


Good response.

I don't see universal health care as inevitable. I think that the majority of people, those who either provide their own insurance or have sought employment that offers private insurance as a benefit, will resist the idea of turning over the decisions about their medical care to the government. It is in their best interest, and most people know that.


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## Doctor Damage (Feb 18, 2005)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


Hopkins, try to ignore those short replies. Anyway, just from a practical standpoint, the way the US economy (and heck, ours too) is shifting, there won't be many jobs left which offer health benefits or insurance. So at some point, probably pretty soon, there will be a big mass of people without any health insurance other than what they can afford to buy privately, and I think the pressure will be strong for some sort of gov't run health insurance scheme.

DocD


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## Harris (Jan 30, 2006)

Fine, then, hopkins student. But God's eyes are upon all of us, and perhaps especially upon those who continue to enjoy great wealth while a lot of people--including the elderly and little kids--go without. It's not a "high horse", but rather attention paid to a noble principle. 

I don't know you, but I feel sorry for you. Truly. I pity anybody who's so wrapped up in his own trials and ambitions that he's forgotten about the less fortunate.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by Doctor Damage_
> 
> 
> 
> ...


*Correct.*


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## hopkins_student (Jun 25, 2004)

I'm glad you finally exposed the emotion that drives you: envy. It is clear from your posts that you envy those who are financially successful, and that the only way to comfort yourself is proclaim publicly that the wealthy are less moral than you.

edit:
This was not a serious reply, merely an effort to show how truly ridiculous it is to make character judgements about people you don't know on internet fora.


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## Fareau (Mar 8, 2004)

It's a pity that the subject can't be discussed with civility (and in some cases, humility). There were some interesting points being made.


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## hopkins_student (Jun 25, 2004)

I would like to continue the debate, and I apologize to the forum for responding to Harris's attacks on my character and motives. Please, let the debate continue.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by hopkins_student_
> 
> Harris,
> 
> Your surgeon friends would not be in the business if it were a financial burden to them. Burden is the only word to describe the financial situation that my colleagues and I would face if we were to become government employees upon completing our training.


Again, you argue nonsensically that doctors would not be compensated well for their services under a universal healthcare system. Doctors will do well regardless, as they should, and will likely make about what they do now, rates for most things being set de facto by the government already. In addition, the most greedy of them may well be driven out of the system. That would also have benefits to public health, as doctors too relentlessly focused on their own pocketbooks are those likely to take shortcuts that could impact their patients.

In truth, the people who will suffer economically under universal healthcare are not doctors but the layers of bureaucracy in the insurance industry, which has somehow managed to eclipse the government in that regard by a staggering amount. And for a true-blue capitalist, that's a perfectly reasonable outcome: somebody (or some institution) does their job inefficiently, they are creative destructioned out of it. That it is government that has thoroughly cleaned the clock of private industry in the healthcare industry is delightful to someone like me who likes to see fundamentalists' sacred cows gored.

But more to the point, which is that universal healthcare is a _moral_ issue rather than a _financial_ one, do you not think that it is unconscionable that the people wedged between the top of the safety-net and the bottom of a reasonable comfort level, i.e. those too young and/or wealthy to qualify for Medicaid/Medicare but who do not get healthcare from their employers and for whatever reason (wanting to eat, owning a start-up business or struggling family farm, having a preÃ«xisting condition that means no individual policy-writer will touch them, or whatever) has to pay about 3x as much for medical services as the institutions funding your and my coverage pay when we have the same treatments. Note that I'm not arguing about me. My job provides me with a high quality healthcare package. I'm arguing that we have a system with severe moral failings, that must be addressed.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by SGladwell_
> 
> 
> 
> ...


Well stated.


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## Doctor Damage (Feb 18, 2005)

How did God etc. get involved in this debate? Surely we can agree that helping others is a Good Thing, without recourse to a deity.

DocD


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by SGladwell_
> 
> 
> 
> ...


My argument is not entirely non-sensical. Although I can't reproduce these documents, perhaps someone else knows where to find these statistics, we were shown figures on the average incomes of physicians in Canada and the UK. In Canada, the average was somewhere near $60,000, and in the UK I believe it was somewhere around $90,000. Now, I do not want this to devolve again into a discussion about the _profits_ of physicians, but rather about the compensation relative to the investment in education and loss of revenue generating years.

I take no joy in knowing that there are people that are uninsured who have limited access to health care. That does not mean that the government should step in and solve the problem. My personal philosophy is that it is the role of our government to be fair rather than compassionate; compassion is too subjective to be tackled by the government. I find it interesting that you chose to describe universal health care as a "moral" issue. Many proponents of universal health care, typically on the political left, are the first to proclaim that it is not the place of the government to legislate morality. The libertarian in me tends to agree with them.


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## Harris (Jan 30, 2006)

> quote:_Originally posted by Doctor Damage_
> 
> How did God etc. get involved in this debate? Surely we can agree that helping others is a Good Thing, without recourse to a deity.
> 
> DocD


God became involved when God declared that He had an interest in the welfare of the poor and the weak. Maybe we can all agree that helping others is a good thing. I should hope so. But when I read others' words that the government has no obligation or duty to provide for the needs of the less fortunate, then suddenly I'm fine with involving God. As it turns out, the Judeo-Christian God doesn't mind being involved. You can refuse such "recourse" if you'd like, but as a Christian believer I have a right to call upon my tradition as I reflect upon certain moral arguments. -Harris


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


You speak of the libertarian in you. Which philosophers, authors, writers, etc. have you read to inspire your libertarianism?


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## hopkins_student (Jun 25, 2004)

My beliefs were not shaped by writers that I sought to emulate, but from what I personally believe to be the maximum acceptable amount of intervention in the lives of individuals. Why does it really matter what I did or did not read that led me to my beliefs?


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## Harris (Jan 30, 2006)

> quote:_Originally posted by hopkins_student_
> 
> My beliefs were not shaped by writers that I sought to emulate, but from what I personally believe to be the maximum acceptable amount of intervention in the lives of individuals. Why does it really matter what I did or did not read that led me to my beliefs?


What you "personally believe"? You mean to say that there isn't one single writer or thinker or wit or philosopher who has inspired the libertarian in you?

It matters because I'm curious about how well informed your thoughts are.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by hopkins_student_
> 
> My argument is not entirely non-sensical. Although I can't reproduce these documents, perhaps someone else knows where to find these statistics, we were shown figures on the average incomes of physicians in Canada and the UK. In Canada, the average was somewhere near $60,000, and in the UK I believe it was somewhere around $90,000.


Let's assume your numbers are correct. That means a two-doctor household in the UK is earning an average of $180k a year, or a doctor-teacher household is earning about $140 a year. Except to the extraordinarily jaded, that is not bad money.. Second, I assume you are aware that no British, Canadian, German, Swedish, etc. doctor is going to come out of school with $160k of debt. Most probably won't have any, because of the way their university systems are funded.

As for loss of revenue-generating years...as a doctorate-holding academic with over two decades of education under my belt I can't help but laugh at such idiocy. Everything isn't about money. If you want to maximize your revenue-generating capacity from the get-go, become a management consultant or investment banker. Could I have made a million more dollars in this century than I ended up making. Quite likely. But so what? I'm not demanding that people pay me $400k a year because I _decided_ to do what I do. If you want to do something that requires more education, take the appropriate hit. People make such choices because they love to do something. If you want it both ways, don't complain if the system is biased against you!



> quote:_Originally posted by hopkins_student_I take no joy in knowing that there are people that are uninsured who have limited access to health care. That does not mean that the government should step in and solve the problem. My personal philosophy is that it is the role of our government to be fair rather than compassionate


I'm inclined to agree with that philosophy. Universal healthcare is a moral issue because it is a matter of fundamental fairness in society. Compassion is in the individual healing, not the creation of institutions that allow people to be healed without worrying that it will ruin them financially. That's just fairness. I'm appalled that you think it's FAIR for someone who falls through the cracks of the current insurance system will have to pay triple what would be paid on your or my behalf in order to receive the same medical treatment. That is the status quo today. If that is fair, what is unfair exactly?



> quote:_Originally posted by hopkins_student_Many proponents of universal health care, typically on the political left, are the first to proclaim that it is not the place of the government to legislate morality. The libertarian in me tends to agree with them.


First, the first major proponent and institutor of a universal healthcare system was not someone on the political left, it was Prince Otto von Bismarck. Unlike the Know Nothings who have run the American right in the past 50 years, Bismarck was smart enough to realize that a mass population freed from worry about something random striking them down forever was a population that would take more risks and be more productive. His education policies stemmed from the same pragmatic streak, namely that educated masses were more suited to the kinds of work demanded of the time than uneducated serfs were. If anything, both planks are far more relevant in 2006 than they were in 1883.

Second, you are (willfully?) misrepresenting of the leftist point of view, though that's irrelevant as I'm more of a p.o.'ed moderate than a dyed-in-the-wool leftist. (Though I guess being to the left of Torquemada makes one a "leftist" in today's America.) A fair statement of the leftist view is that a moral society should work together to address broad society problems, such as healthcare, elderly care, crime, poverty, and so on. By contrast, the classic leftist position on individual rights is that society has no right to command an adult to hold religious beliefs or be compelled into any sort of religious activity, exercise sovereignty over a woman's body, dictate what kinds of consensual arrangements between consenting adults should have legal standing, and so on. The failure of the libertarians to understand the difference between the social contract and individual rights is what damns their movement to the radical fringes of oh so put upon white middle class kids.


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## manton (Jul 26, 2003)

> quote:_Originally posted by Harris_
> 
> "...get back the thought of the Founding..."
> 
> ...


The Founders believed that man's moral and political status stemmed from human nature, which they understood in terms that were at once classical and modern. They did not fully agree with the classics on the primacy of duties, nor with the moderns on the primacy of rights, but believed that man was defined by both his rights and his duties and that neither were more important than the other, and indeed that neither could exist without the other. Certainly they did not subscribe to vulgar utilitarianism (which in any case had not yet been forumlated in modern terms) but spoke of the importance of obligation and sacrifice.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Harris_
> It matters because I'm curious about how well informed your thoughts are.


That's enough of subtly belittling my intelligence. Please refrain from personal attacks, no matter how masked or implied they may be.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by SGladwell_
> 
> 
> 
> ...


Based on your first paragraph am I to assume that you would also want to overhaul the education system in the US so that physicians may not finish their training with $500,000 in loans? If not, then what is the point of comparing US physicians making $180,000 to British, Canadian, etc. physicians making the same amount. While $180,000 is not much for a pair of married surgeons by today's standards, I agree that it is still enough to live on, without debt. Pile on $500,000 in loans ($1 million for a pair of surgeons) and it becomes a lot less to live on.

As far as people making choices to do what they do understanding the limits on earning potential, I completely agree. I'm just asking that the government not be my limiting factor. The government has not imposed maximum amount of money that you as an academic can make, that is up to the labor supply market of academicians to decide, but in a universal system earnings would be restricted by the government. The restriction stems from the limits on time and the pay for procedures. You can only perform so many procedures, and if the government limits the cost on the procedures, they limit the earning potential. Often times, with today's system, the limit is placed by insurance companies, but doctor's have a choice whether or not they will deal with specific insurance companies. They do not have that choice with the government in a universal system.

You and I have different definitions of fairness, and we're not going to reconcile that. Fairness, in my opinion, is equal access for those that have either provided insurance for themselves, sought jobs to acquire insurance, or have the funds to cover the costs of their care, regardless of race, gender, religion, etc. This does not apply to children. Children cannot help if their parents are screw ups, and I believe children should have nearly unrestricted access to medical care, regardless of ability to pay.

Since you characterized the leadership of the conservative movement in the US as "Know Nothings", I'm finished responding to your post.


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## Wimsey (Jan 28, 2006)

> quote:_Originally posted by hopkins_student_
> 
> [snip]
> Based on your first paragraph am I to assume that you would also want to overhaul the education system in the US so that physicians may not finish their training with $500,000 in loans? If not, then what is the point of comparing US physicians making $180,000 to British, Canadian, etc. physicians making the same amount. While $180,000 is not much for a pair of married surgeons by today's standards, I agree that it is still enough to live on, without debt. Pile on $500,000 in loans ($1 million for a pair of surgeons) and it becomes a lot less to live on.
> ...


Where does the "$500,000 in loans" figure come from? The med school in my state charges tuition of $20,000/yr in tuition (living expenses n/a), and the average overall med school indebtedness seems to be about $120,000.


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## Preston (Aug 8, 2003)

Just two random thoughts...

1) Since when has the government run ANYTHING more effeciently than the private sector?

2) I think at the very least that the government should make available to self-employed and un-employed the same insurance plans that are available to government employees - especially Congress.


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## Pressfan (Aug 6, 2003)

As I am writing this, there is a made for TV movie on CBC about Tommy Douglas, the leader of the first elected socialist government in North America who also instituted the first universal medicare program in North America. Here's a link to the site: www.cbc.ca/television/behindthescenes_tommydouglas.html

For more details on his life:
www.cbc.ca/greatest/top_ten/nominee/douglas-tommy.html

It is interesting to note that the doctors in Saskatchewan did not embrace the imposition of a universal healthcare system, but rather launched a strike in opposition to it. However, in Canada at least, the federal government continued this momentum and soon there was a national health care program. While constantly debated, I cannot imagine any politician campaigning to dismantle the program.

It is also fascinating to consider that Mr. Douglas was a Baptist minister. Sometimes change comes from the most unexpected places.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by Wimsey_
> Where does the "$500,000 in loans" figure come from? The med school in my state charges tuition of $20,000/yr in tuition (living expenses n/a), and the average overall med school indebtedness seems to be about $120,000.


It was a realistic maximum that a student attending private institutions for both undergrad and medical school could expect to borrow if he or she did not have any parental support. The USC Financial Aid office has determined that the bare minimum a student can get by on per year is about $68,000. That's approximately $250,000 for four years of medical school. For undergrad school, the financial aid office at Hopkins advised about the same for four years of school. I'm sure this is typical for most private schools.


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## Fogey (Aug 27, 2005)

> quote:_Originally posted by hopkins_student_
> 
> 
> 
> ...


 Mr Student,

What think you of the three fact-laden articles that SGladwell so kindly posted on page one of this thread?


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Preston_
> 
> Just two random thoughts...
> 
> ...


1) I did answer this above. Medicare and Social Security are more efficient than any comparable private systems. In general, I've come to the conclusion that the more universal the program, the better the government operates...

2) Ted Kennedy (and/or John Kerry) tried to do this, I believe, although it never made it out of committee. You 2 guesses as to which party stopped them, and the first guess doesn't count.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by hopkins_student_
> It was a realistic maximum that a student attending private institutions for both undergrad and medical school could expect to borrow if he or she did not have any parental support.


Of course, one makes the _choice_ to attend a high-end private or out-of-state institution in a city with a high cost of living. It is a choice I well understand, having chosen highly-ranked private institutions so for both undergraduate and graduate work, though the latter came with a modest stipend appended rather than tuition. However, the fact that one makes that choice does not mean that society needs to suffer for one's choice by denying health to those not fortunate enough to be able to make such a choice.

I think you'll agree that we as society should not be held hostage by the choices made by a few over-indulged kids. It's not...what's that word again?.,. fair.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by Preston_
> 
> Just two random thoughts...
> 
> 1) Since when has the government run ANYTHING more effeciently than the private sector?


There are mounds of data on the comparative inefficiency of the private insurance sector in the US compared to the US government healthcare programs if you'd care to crawl out of your ideological bubble and learn something. Google is your friend.

And that, hopkins_student, is my beef with the Know Nothing American right in a sentence. They don't bother to learn anything. If the data are contrary to their position, as happens rather more often than not these days, then they just scream "bias" and retreat to the certitude of their ideological extremism. Or dig their heads in the sand and pretend that the data don't exist as in the case of Preston's "random thought" above.


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## Horace (Jan 7, 2004)

> quote:_Originally posted by Harris_
> _For them, what they do is a calling._


This is a good point and one that is difficult to square with considerations of the market offered by others.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by SGladwell_
> However, the fact that one makes that choice does not mean that society needs to suffer for one's choice by denying health to those not fortunate enough to be able to make such a choice.


And my argument is exactly the same. Society should not suffer by reduced quality of health care because others have made choices that preclude them from purchasing health insurance.

Just curious, how do you respond to my resistance to the idea of the government essentially capping physician salaries? I understand you think doctors make enough as it is, which is fair, but do you honestly not find any problem with the idea of the government telling an entire profession how much money they can make?


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by SGladwell_
> 
> 
> 
> ...


So it sounds like you would rather be treated by kids that can afford to attend high tuition schools, rather than the best that were accepted at that school. Is this correct?

I feel like now you're grasping at straws.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by JLPWCXIII_
> 
> 
> 
> ...


I'll get back you tomorrow or the next day, I'm in the process of sifting through them as I find time.


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## hopkins_student (Jun 25, 2004)

> quote:_Originally posted by JLPWCXIII_
> Mr Student,
> 
> What think you of the three fact-laden articles that SGladwell so kindly posted on page one of this thread?


Alright, I just stayed up later than I should reading those articles, and all I can really say is that I agree with the pre-transformation Gladwell. He made a lot of good points in that debate and I liked what he had to say. The fact that he has since changed his mind doesn't make his statements any less valid, he's just experienced a change in values.

I think what I liked most about what he said, or at least identified with the most, was that the health care system in the United States is truly cutting edge. It's focused on treating conditions that other systems are not able to deal with. In short, it's more focused on the really interesting cases than the other systems.

I know a lot of attention in this conversation has been paid by myself, as well as others, to physician compensation. In my responses to some statements, I may not have been specific enough when discussing my position on physician salaries so that it seemed as though that is my only concernn. That really couldn't be farther from the truth. The truth is that I'm concerned about a system in which I might be paying for the rest of my life for the privilege to treat patients. I think that is a bad system in which you will only find the children of the wealthy practicing medicine. The truth is also that I'm hoping to go into a subspecialty (pediatric neurosurgery) that pays substantially less than its parent specialty (neurosurgery). The reason I'm hoping to go into pediatric neurosurgery is because that's where the really cool, cutting edge stuff is happening. There's more money to be made in dermatology and radiology, and those doctors work much better hours, but I'd rather kill myself than pop zits and look at pictures all day (not to be rude to any dermatologists or radiologists on the board, I realize that's not all they do, but it just doesn't interest me at all).

I agree with the old Gladwell that the United States is in a unique position to make strides in research that benefit not only Americans, but the rest of the world. I think this is something special in which we should all take great pride.


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## globetrotter (Dec 30, 2004)

I have several personal friends who are doctors in Israel and Canada, places where there is universal healthcare. it is very hard for a doctor to be in the upper middle class in either place. and, in both places, doctors very often find themselves bending the system to make a good living - working vacations in the US to make extra money, sometimes taking gifts that ammount to bribes from patients. 

Although a doctor can live much better than, say, a taxi driver, in both places, HS has a point that an investment of years of study should allow one to live pretty well, and I am not sure that a 90-100K ceiling is fair at all.


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## J. Homely (Feb 7, 2006)

Health care is not a 'right', and people should take much greater responsibility for their own health than they do currently, but I don't understand how a civilized human being can begrudge a guarantee of basic health care to those who are unable to afford it.

Reasonable people can discuss how to administer the health care system with the highest level of effciency at the lowest possible cost. We can debate what level of care can reasonably be guaranteed for the uninsured. We can discuss what responsibilities the beneficiaries should have in order to earn coverage. But I don't understand how we can reasonably refuse to take on collective responsibility to care for people who are unable to afford basic care.


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## Doctor Damage (Feb 18, 2005)

I am somewhat concerned about the comments on Canadian docs being paid low wages. Although I know no doctors personally, they do seem to be doing quite well, as they own all the big houses in town, vintage Porsche's, etc. And remember, Canadian wages are lower on average than in the US, so therefore one might expect Canadian docs to be earning on average less than US docs.

Anyway, I'm pretty sure they do well, since up here beat cops with only a few years under their belts can earn over $100G a year with overtime pay! No joke!

DocD


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## jeansguy (Jul 29, 2003)

As a Canadian, I do believe in basic Universal Halth Care. I don't think it should cover dental, birth conrol, abortion, basic prescriptions, etc.

Nor do I think it should be the only option. I firmly believe in a co-existing public and private health care system. In addition, I do believe in User fees before going to see a Doctor, whether that be $5 or $50.

www.thegenuineman.com


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## NewYorkBuck (May 6, 2004)

The major shift in health care needed is not if the govt should run it. (You want to screw something up royally, you just give it to the govt.) The major shift needed is the medical community needs to focus on keeping people healthy rather than only treating the sick. Since the medical profession is wealthier when there are more sick people than healthy people on the street, I dont see this change implemented any time soon.


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## Fareau (Mar 8, 2004)

I don't think that the government would necessarily "screw things up". There are already various U.S. governmental agencies in healthcare that are pretty impressive. The National Institute of Health is a center of research excellence and provides a level of specialist care that is singular in scope and quality; it also provides funding to various research groups across the country in a very organized and efficient manner. The VA system is also an impressive healthcare system; despite the bad rap is often gets, VA patients on average seem to be meeting blood pressure, lipid, and blood sugar goals better than patients at other large American institutions/systems.


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## SGladwell (Dec 22, 2005)

> quote:_Originally posted by NewYorkBuck_
> 
> The major shift in health care needed is not if the govt should run it. (You want to screw something up royally, you just give it to the govt.)


In parentheses is the extremist/fundamentalist view. In this case, it does not correlate at all with reality. What the extremists need to realize is that government, like anything else, is a tool with good aspects and bad aspects. In this case, government has a proven record of delivering medical care with far less bureaucracy than private industry.

Another great article on healthcare that was published recently may be found here: https://www.nybooks.com/articles/18802


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## NewYorkBuck (May 6, 2004)

> quote:In parentheses is the extremist/fundamentalist view. In this case, it does not correlate at all with reality. What the extremists need to realize is that government, like anything else, is a tool with good aspects and bad aspects.


Really? Its my contention that the govt taking over 50% of my income is quite "extremist". IMO, govt is far too intrusive on almost every level, and gets only moreso every year. The only reason more are not up in arms over it is because it is because they are typically smart enough to make it a slow bleed. Eg - the first income tax levied I believe was 4%. That is "reality". I agree that govt has its place, but that place has been FAR FAR overstepped. For me, it is just an issue of freedom over my own life. I would just assume be responsible for myself than to delegate that responsibility to the government. I truly believe the framers would roll over in their graves if they saw the current state of the federal govt.

I often chuckle when I hear people go on about the wonders of the government, and then ask them a few question to find what they really believe. Eg - if your wife was going into a critical surgury - who would you want doing the surgury - a private doctor or doctor appointed by the government? What if you had to send a package that your job depended on? Would you send it a) FedEx, b) UPS, or C) US Post Office? Hmmm.

The reason I say that the govt screws up most of its projects is because they have no competition, have no incentive to control costs, have no incentive to increase efficiency, and have no incentive to create customer satisfaction. This system is simply removing all of the forces that typically deliver and create value. That is the "reality" of this situation.



> quote:In this case, government has a proven record of delivering medical care with far less bureaucracy than private industry.


Yes, Medicare and Medicaid have been just paradigms of efficiency, cost control, and value.....


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by NewYorkBuck_
> Really? Its my contention that the govt taking over 50% of my income is quite "extremist".


If you're paying 50% of your income in federal taxes, you probably screwed up the math. Get an accountant, or a better one if you already have one. The typcial high average, including income, social security, and medicare taxes, is in the mid- to high-20's.



> quote:
> I often chuckle when I hear people go on about the wonders of the government, and then ask them a few question to find what they really believe. Eg - if your wife was going into a critical surgury - who would you want doing the surgury - a private doctor or doctor appointed by the government?


Government paid health insurance does not have to equal government 
And of course, your argument was clever in that it doesn't include option three - which is: not going to the doctor and dying, the only option for over 40 million working Americans.

But since you asked - the most safest and most effective hospital system in the country today is the VA hospital system. If I had to, I'll trust them more than the local virginia hospital (Inova Alexandria).



> quote:
> What if you had to send a package that your job depended on? Would you send it a) FedEx, b) UPS, or C) US Post Office? Hmmm.


US Post Office. I ship everything by the USPS, and I've never had a problem.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by jeansguy_
> 
> As a Canadian, I do believe in basic Universal Halth Care. I don't think it should cover dental, birth conrol, abortion, basic prescriptions, etc.


It should cover dental health (but not cosmetic dentistry). Good teeth are more critical to your health than you might think, especially as a preventive measure. People with bad teeth end up eating a lot of processed food, because they can't eat harder fruits and vegetables, and that leads to significant health problems down the line due to bad nutrition.

As for basic prescriptions (and even non-basic prescriptions - I'm not even clear what the distinction would be), I'm at a loss why one would think that shouldn't be included.


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## gmac (Aug 13, 2005)

> quote:_Originally posted by NewYorkBuck_
> 
> I often chuckle when I hear people go on about the wonders of the government, and then ask them a few question to find what they really believe. Eg - if your wife was going into a critical surgury - who would you want doing the surgury - a private doctor or doctor appointed by the government? What if you had to send a package that your job depended on? Would you send it a) FedEx, b) UPS, or C) US Post Office? Hmmm.


You hear people going on about the wonders of government? What circles are you moving in? Because I have never in my life heard anyone "go on about the wonders of government".

Some people complain less than others, some feel that certain roles are better performed by the state than by monopoly and profit seeking multinational corporations and some are willing to cede more of their income to the common good, but nobody talks about the "wonders of government".

In fact, the only case I can think of where a governmental agency is worshipped is the US military, which right-wingers seem to believe can do no wrong and should be funded to infinity.

And your naive belief in the efficiency of the private sector makes me think you have never actually worked in it.

------------------


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## Preston (Aug 8, 2003)

> quote:_Originally posted by NoVaguy_
> 
> 
> 
> ...


Perhaps if one has a home-based business, mortgage interest and children to write off, it could be in the mid-high 20s.

Otherwise, the maximum tax rate is: 
35.0%. Add to that approx 
7.7% for state income tax
6.0% for payroll taxes
*48.7% income tax * (except for the rare municipalities that charge a city income tax, which would of course make this figure higher.

Then out of ones AFTER-TAX income, he must pay an additional...
3.0% property tax rate
7.0% sales tax
14.0% gasoline taxes (in addition to sales tax)
11.0% hotel taxes (in addition to sales tax)
??.0% excise taxes
??.0% alcohol taxes
??.0% tobacco taxes
??.0% airline taxes
etc, etc, etc.

It's not tough to believe that we pay 50% of our income in taxes.


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## NoVaguy (Oct 15, 2004)

> quote:_Originally posted by Preston_
> 
> 
> 
> ...


You're mixing a couple of numbers that shouldn't get mixed - for one, it is mathematically impossible to pay 41% between social security and federal income tax. First, Federal income tax is progressive - and the top rate of 35% starts at about 330K for singles. Second, The social security tax is capped at 95K or thereabouts - everything pass the cap is not exposed to the tax. And third, you didn't even bother to account for standard deductions - which can cut off another 5 to 6% if you're making about 100K, and a bigger percent if you're making less. Those are three massive miscalculations that account for a huge error in your predictions. And any two is enough to push you below 40% and probably below 30%.


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## Preston (Aug 8, 2003)

OK, fine. So take the 35% + 7% state and in many places, another 2-3 local income tax. That's 44-45%. Then add 7% sales tax to darned near everything that is purchased with AFTER-tax dollars. See the others I mentioned as well. If you are in the upper income brackets in this country, then it is very feasible that you are paying 50% of your income to taxes of one kind or another. Oh yeah, and I didn't mention toll taxes. Yes, if one is clever, he can find a deduction here and there. 

But still - even if it were just 40% at the end of the day.. FORTY PERCENT!!???? Are you kidding me? Do you really think this is what the founders intended? How much is enough?


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## pinchi22 (Sep 30, 2004)

> quoteoctors fall into the elite strata of every society in the world.


True, morally speaking at least since Hipocretes. In universal single payer systems such as Spain, IÂ´ve visited MDs who live in small apartments, drive modest cars and live a decidedly middle to upper-middle class lifestyle. Only private MDs with elite clientele can affored McMansions.

The technology situation is changing. I know at two cases of patients in semi-public systems in Europe who have had silicon-titanium vertebrea replacements. One is an American who told me the technology doesnÂ´t yet exist in the


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## NewYorkBuck (May 6, 2004)

> quote:If you're paying 50% of your income in federal taxes, you probably screwed up the math. Get an accountant, or a better one if you already have one. The typcial high average, including income, social security, and medicare taxes, is in the mid- to high-20's.


See the many posts on this after mine. With federal, state, city, social security, sales, property, excise, etc, etc, etc, etc - it is painfully easy to pay 50%+ in taxes. Just quoting income tax rates doesn't nearly cover all the stealing the gov't does.



> quote:but nobody talks about the "wonders of government".


Please provide evidence of this claim. To accomplish this, you must survey every living person. Let me know when you are done.



> quote:US Post Office. I ship everything by the USPS, and I've never had a problem


The timing of this is actually quite funny for me. I just bought a Huntsman jacket on ebay. The seller sent it via the US Post Office. First attempt - was delivered to the wrong address. Second attempt - showed "delivery confirmed" on March 7th. Nothing was delivered. Going to the post office only resulted in blank stares (as is usually the case when an institution does not care about customer service). Finally yesterday, a mailman showed up yesterday with the jacket and about a weeks worth of back mail. Asking how this happened and how the package was marked "delivered" a week earlier only resulted in more blank stares. Conversely, I have sent and received hundreds of packages via Fed Ex. Never a problem. Not once. But if you like the post office, by all means keep using them. No skin off my nose.


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## Fogey (Aug 27, 2005)

> quote:
> The timing of this is actually quite funny for me. I just bought a Huntsman jacket on ebay. The seller sent it via the US Post Office. First attempt - was delivered to the wrong address. Second attempt - showed "delivery confirmed" on March 7th. Nothing was delivered. Going to the post office only resulted in blank stares (as is usually the case when an institution does not care about customer service). Finally yesterday, a mailman showed up yesterday with the jacket and about a weeks worth of back mail. Asking how this happened and how the package was marked "delivered" a week earlier only resulted in more blank stares. Conversely, I have sent and received hundreds of packages via Fed Ex. Never a problem. Not once. But if you like the post office, by all means keep using them. No skin off my nose.


 Oh wonderful - just what the Interchange needs: an escalating exchange based entirely upon anecdotes.


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## J. Homely (Feb 7, 2006)

> quote:_Originally posted by NewYorkBuck_
> 
> The timing of this is actually quite funny for me. I just bought a Huntsman jacket on ebay. The seller sent it via the US Post Office. First attempt - was delivered to the wrong address. Second attempt - showed "delivery confirmed" on March 7th. Nothing was delivered. Going to the post office only resulted in blank stares (as is usually the case when an institution does not care about customer service). Finally yesterday, a mailman showed up yesterday with the jacket and about a weeks worth of back mail. Asking how this happened and how the package was marked "delivered" a week earlier only resulted in more blank stares. Conversely, I have sent and received hundreds of packages via Fed Ex. Never a problem. Not once. But if you like the post office, by all means keep using them. No skin off my nose.


Well, that bad experience certainly doesn't invalidate the millions of pieces of mail that are delivered without a problem each year. Which is not to suggest that USPS is a model of efficiency by any means, but with a letter-delivery charge of about 40 cents vs. $4.00, I think we have to be somewhat reasonable about our expectations.


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## NewYorkBuck (May 6, 2004)

> quote:Well, that bad experience certainly doesn't invalidate the millions of pieces of mail that are delivered without a problem each year.


No - it doesnt, but the timing of the discussion I believe warranted its mention. However, that is not the first time that I have had problems with the post office, in fact, it is to the point where I hold my breath whenever I do anything with them other than send a letter. Perhaps the most frustrating thing about dealing with them when there is problems is the clear lack of concern and accountability.

Also, a nit, but its not quite fair to compare the letter rate at the post office to the package rate elsewhere.


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## J. Homely (Feb 7, 2006)

> quote:_Originally posted by NewYorkBuck_
> 
> 
> 
> ...


FedEx's website offers an dizzying assortment of delivery options, so I may have read the wrong chart, but I believe the comparison is 'regular letter delivery' to 'regular letter delivery' -- but correct me on the rate if I'm wrong. But let's say it's only $1 -- charging $1 vs. 39 cents allows you to hire much better personnel, put more sophisticated tracking and delivery systems in place, etc.

So, of course, you get what you pay for; bringing things back to the topic at hand, it's useless to debate universal HC until we resolve what level of coverage and what level of quality we should expect. I wouldn't think much of myself if I wasn't willing to pay a little more to ensure that an uninsured woman could get breast cancer surgery. You're going to have to do a little work, though to convince me to help pay for her holistic gurus suspiciously expensive exotic treatment, or her reconstructive surgery. But we've got to start somewhere.


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## NewYorkBuck (May 6, 2004)

> quote:it's useless to debate universal HC until we resolve what level of coverage and what level of quality we should expect. I wouldn't think much of myself if I wasn't willing to pay a little more to ensure that an uninsured woman could get breast cancer surgery. You're going to have to do a little work, though to convince me to help pay for her holistic gurus suspiciously expensive exotic treatment, or her reconstructive surgery. But we've got to start somewhere.


Nice post.....


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## gmac (Aug 13, 2005)

> quote:_Originally posted by NewYorkBuck_
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Au contraire. You made the original claim, let's see you back it up with one single individual. Until then it is just a further example of you using anectodal (I'm being kind here, made up would probably be morte accurate) evidence to back up your specious claims.

The USPS is rubbish because you say they are. Taxes are over 50% because you say it to be so. Etc, etc, etc.......

Until you learn to back up your arguments with something better than your imagination then your comments here will continue to be treated as a joke.

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## NewYorkBuck (May 6, 2004)

> quote:Au contraire. You made the original claim, let's see you back it up with one single individual.


The government is wonderful!

Your turn.....


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## gmac (Aug 13, 2005)

> quote:_Originally posted by NewYorkBuck_
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So you have this conversation about government in your own head?

How do you react when the other side of your personality tells you that you are wrong? Does that make you angry? Or are you able to debate the other fellow in your head, produce facts to show him the error of your ways?

How many of you are in there? Do you all go out for drinks after?

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## J. Homely (Feb 7, 2006)

Is it reasonable to pay for psychotherapy for the uninsured? You could probably make a more convincing argument for that than for purely medical ailments. Infectious diseases aside, most medical ailments only jeopardize the individual. But people with serious mental/emotional issues can be a terrible burden on society at large.


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## I_Should_Be_Working (Jun 23, 2005)

Whenever I hear of support for more government takeover, I ask the following questions:

Would you buy a computer, or car, or food at a restaurant made by the govt?

What does the govt. typically offer regarding customer satisfaction and support?

Who sets the budget for govt entities, and how transparent is their funding?

How can you elect out of a govt. program?

Be very, very careful when you ask for the govt. to come into your life. They rarely leave.

The truth is, most folks are simply looking for something for nothing, or something greatly reduced. If you don't believe the government could run a chain of restaurants well, then how could they run health care.


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## gmac (Aug 13, 2005)

> quote:_Originally posted by I_Should_Be_Working_
> 
> Whenever I hear of support for more government takeover, I ask the following questions:
> 
> ...


Reading this I presume you feel that the US military is a poorly run and ineffective organization that would ideally be farmed out to the private sector?

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## I_Should_Be_Working (Jun 23, 2005)

> quote:_Originally posted by gmac_
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You didn't answer the question. Also, remember, you are comparing national defense with individual service. These two are hardly comparable. Also, many do demonstrate the military, as an organization, not its combat capability, does not operate well. Procurements are routinely prioritized for politics, not military readiness or service needs.


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## J. Homely (Feb 7, 2006)

> quote:_Originally posted by I_Should_Be_Working_
> 
> Whenever I hear of support for more government takeover, I ask the following questions:
> 
> ...


I doubt many people specifically want "government takeover" of healthcare, they just want some way to ensure that the uninsured are reasonably well cared for.


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## gmac (Aug 13, 2005)

> quote:_Originally posted by I_Should_Be_Working_
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I'm not sure what your question is?

You seem to believe that an organization incapable of managing a restaraunt, healthcare or any other major or menial service should be entrusted with protecting your freedom, your very life?

How does that work?

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## Doctor Damage (Feb 18, 2005)

> quote:_Originally posted by J. Homely_
> 
> I doubt many people specifically want "government takeover" of healthcare, they just want some way to ensure that the uninsured are reasonably well cared for.


Those are wise words, JH.



> quote:_Originally posted by gmac_
> 
> You seem to believe that an organization incapable of managing a restaraunt, healthcare or any other major or menial service should be entrusted with protecting your freedom, your very life?


And those are fun words! I will quote you gmac, as I am sure the universe will give me the chance to use that phrase in real life!

DocD


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## I_Should_Be_Working (Jun 23, 2005)

> quote:_Originally posted by gmac_
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No, I'm saying they are not responsive to individual needs and service. There is little accountability, poor oversight of spending, and no control over the bureacracy that results. The military would also do a very poor job of handling individual service. These are large, bloated organizations manipulated regularly by politicians. Surely you can recognize the difference.

By the way, what's the average wait time for surgery in Canada, lately?


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## gmac (Aug 13, 2005)

Depends on the surgery. Sure, for some procedures there are horrific waits but emergency surgery is delived promptly. I wouldn't use the current Canadian health system as an ideal case study.

So you are saying that the government (or the state as that iswhat we are really talking about) is the _ideal _model for delivering some services, not for others, and it depends on the consumer of those services as to whether the state performs satisfactorily?

But what difference would that make? You are either efficient or you are not, you either have a large bureaucracy or you don't. You either perform or you don't. I don't see why the consumer should affect that?

What is your opinion of medical care within the miltary? Should that be outsourced as you don't seem to think that an organisation such as the military can care for individuals?

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## 16128 (Feb 8, 2005)

> quote:_Originally posted by gmac_
> 
> What is your opinion of medical care within the miltary? Should that be outsourced as you don't seem to think that an organisation such as the military can care for individuals?


I can answer this, because I use military medical care (my employer is rather pleased about that.)

Care within the military is very good, however, look at the client base - the military and their families are mostly young, healthy (pre-existing conditions preclude joining the military and you can be tossed out for having asthma), part of a culture which exercises frequently and illicit drug use is rare.

During wartime, many of the doctors and PAs deployed are reservists. I believe that anyone with needs such as use of a radiology facility for cancer treatment is referred to a private provider. Veterans receive treatment through the VA system, which is run separately.

So it's a good system for young, healthy people, but you can't replicate it exactly for the entire civilian populace without making many changes.


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## gmac (Aug 13, 2005)

> quote:_Originally posted by VS_
> 
> So it's a good system for young, healthy people, but you can't replicate it exactly for the entire civilian populace without making many changes.


I'm not suggesting that.

The point I am making is that the miltary, an organ of the state, is able to deliver outstanding medical care.

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## I_Should_Be_Working (Jun 23, 2005)

> quote:_Originally posted by gmac_
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Please refer to those relying upon Veterans Administration hospitals. Outside of active duty care, which, by its nature, is wholly different then general population health care, the government has a difficult time managing programs. My basic point is this, when business goes bad, there are those who can and will intervene. When the government goes bad, it seldom reforms and changes at any pace as witnessed with the private sector.


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## SGladwell (Dec 22, 2005)

Turns out the anti-health crowd has been wildly underestimating the compensation of doctors in government-run system such as the NHS, and the rest of us have been too intellectually lazy to challenge them.

From the Bagehot column in this week's Economist:
"With its indiscriminate largesse, the government has succeeded in making even family doctors unpopular, as they pocket Â£150,000-a-year ($262,000) salaries while reducing the hours their surgeries are open to patients."

That's a far cry from the 5-figure salaries that have been mentioned here.


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## Wayfarer (Mar 19, 2006)

> quote:_Originally posted by SGladwell_
> 
> Turns out the anti-health crowd


The "anti-health crowd"? Really gentlemen, this thread has been anything but convivial. First, men of good will can simply disagree and still be men of good will. There is no reason to cast such aspersions on each other. Second, is this really a binary subject i.e. national/socialized/universal healthcare for all or a totally free market? I submit it is not and most Western countries do not have a pure system of either. Even Canada allows some private pay i.e. I just paid for my mother to have her cataracts done in Ontario and even the US has a textbook socialized system of healthcare, namely the VA.

Possibly we should search for the hybrid system that allows society the greatest amount of positive externalities but still fosters personal responsibility? I fear this topic is such a hot button however, that data driven, humane, and fair policies might never happen.

Warmest regards


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