# The US Needs Universal Healthcare



## Wayfarer (Mar 19, 2006)

The US has almost every type of system there is for funding healthcare. We have single payer (like Canada) in Medicare and Medicaid, we have socialism in the VA system, we have third party reimbursement, and we have fee for service. Somehow, the US seems to reap the drawbacks of every system but the benefits of none.

What the US needs is universal health care. Get rid of Medicare, Medicaid, the VA and all other government programs. Create a basic universal policy, a ground floor of coverage for all that legally reside in the US. This universal policy should be big on prevention, screening, health promotion, and personal responsibility and light on tertiary or acute care settings. 

It should have limits. Meaning, if you weigh 500 lbs, smoke 3 packs a day, well you just do not get your hospitalization covered for acute intervention when you have a COPD exacerbation or NIDDM flare up. What you will be given is a choice of paying for your stay, either personally or through a third party policy, or hospice care. This is one example that jumps to mind, do not fixate on the example but rather take the spirit of the policy from it.

Normal "insurance" policies would build on the base, and we also need tax reform so paying your insurance is not tied to your job, you can get the same tax favored status for your premiums by privately shopping for the risk pool that best suits your needs.

I think this will lead to healthier people, lower costs in both taxes and premiums, and more sound policy decisions. However, I think this will never happen as the right will gasp, "socialized medicine", which this is not, and the left will scream, "who are you to decide what gets paid for by the government and what doesn't?".

Warmest regards


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## gmac (Aug 13, 2005)

I like it!

One thing is a bit unclear - are these premiums being paid to HMO style organizations who administer the system?

Or to government in some form which then administers the system?

Because I think that is where the idealogical lines will be drawn once you get everyone to agree on universal health care in principle.

Personally, I favour a mixed model with government resposnible for primary care and preventative measures while the private sector is able to offer insurance paid benefits such as swanky hospitals, quicker access to non critical procedures, etc.


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## Wayfarer (Mar 19, 2006)

gmac said:


> I like it!
> 
> One thing is a bit unclear - are these premiums being paid to HMO style organizations who administer the system?
> 
> ...


Premiums will be paid to HMO, PPO, ect. types of organizations. When it comes to HMOs, do not throw the baby out with the bath water, so to speak. They helped foster "small area studies" way back when, in the late 70s and early 80s. Questions of "best practices" came up, such as finding the best front line antibiotic for a given bug. Or discharging elderly people fast when pnumonia was stabilized. Why fast d/c? Because most mortality was from secondary respiratory infections and guess what the best place to catch those are? Hospitals. So HMOs did have other aspects about them than the currently perceived cheapness.

I think organizing things like I outlined above will save money in both efficiencies, investment in population health, and eliminate the many layers of paperwork and redundancy within the US system. Competition will continue to foster advancement through fee for service and third party payers in the private market.

I think it is a superior idea.

Warmest regards


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## hopkins_student (Jun 25, 2004)

If there's going to be any reform in this direction on the national front, I think we should at least first try to do something like they did/are doing in Massachusetts. It is my understanding that they have taken an approach to health insurance much like car insurance, that you have to have at least a minimum level of it, provided for yourself, not through a system organized and supported by the government.


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## Intrepid (Feb 20, 2005)

*Universal Health Care*

Both of the posts above have good points.

The subject is a fairly complicated one, but a bi partisan solution would seem to be possible.

There are some things that we do know, that may help in coming up with the best answer.

The Commonwealth of Mass recently enacted a plan for their state. In doing the research to uncover the reason for those with no coverage, they found that 40% of the uninsured in Mass were uninsured by choice.

Essentially, young, healthy people with good incomes, that wanted to spend the money for other things. These uninsured knew that if they became critically ill, they could always go to an emergency room.In every state, it is illegal for any emergency room to turn down an ill person, regardless of their ability to pay.

There are many in the US, who use emergency rooms as their primary care physician.Thus, huge lines in emergency rooms, with many true emergencies not receiving proper treatment.

gmac makes a good point about the possibility of a combination system. The single payer system in Canada, has resulted in shortages, rationing, incredible waits for all but emergency surgery, and a flow to the US for those that can afford to flee the system. Thus, putting the poor at a tremendous disadvantage.

The Unfunded mandates in the US, have made much of the private system totally impractical. EG, "guaranteed standard issue" means that you can postpone purchase of health insurance until you are critically ill, and then apply, with the law dictating that any carrier must cover your illness. This is known as adverse selection, and no system will operate where adverse selection is operative.

EG in the US, flood insurance is a product of the federal Govt. If you live on the water, you buy it. If you live in Denver, you don't. The system is an dismal failure.

Many states have mandated that any insurance sold in their state must cover everything from chiropractic care (special interert lobby at work),
to literally EVERY illness listed in the manual of American Psychiatry.

I'll bet that any four of us, picked at random, could come up with a fairly decent solution. However, we wouldn't care about satisfying special interests, or getting reelected. Therein may lie some of the problem.


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## Karl89 (Feb 20, 2005)

Wayfayer,

As long as such a system was based on private health insurance (the government could pay the policy premiums for the poor) and there were no price controls I have no problem with it in theory. One thing the government should be doing more of in regard to national health is acting as a bully pulpit - getting people to eat better, excercise and generally promote early screening. And there should be no McDonald's or Pizza Huts that serve as a the cafeteria for a public schools - that is disgraceful!

Karl

P.S. This should also coincide with serious medical malpractice reform. Far too many doctors are being forced out of practice by the legal enviroment in medicine.


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## Wayfarer (Mar 19, 2006)

hopkins_student said:


> If there's going to be any reform in this direction on the national front, I think we should at least first try to do something like they did/are doing in Massachusetts. It is my understanding that they have taken an approach to health insurance much like car insurance, that you have to have at least a minimum level of it, provided for yourself, not through a system organized and supported by the government.


First, is that how it works there? Somehow that does not ring true.

Second. No. Universal basic policy. Kids cannot pay for a minimum level of healthcare and I want them immunized. I want pregnant hookers to get pre-natal care. I want people with MDR-TB off the street whether they can pay for it or not. I want free needle exchanges to limit disease spread in IVDA populations.

Warmest regards


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## Wayfarer (Mar 19, 2006)

I agree with some posts above and you guys are on my wavelength. 

I am trying to merge two points: basic health care is a public good and competition makes things better. Thus my basic universal policy to complete the public good part and then private additional policies to foster competition in other areas than the basics. 

I agree about the adverse selection. I think a couple of strategies can be employed. First, again, revise the tax code to individuals can get favorable tax treatment for premiums and sever that employer/health insurance link. Next, make policies truly long term, like life insurance. How do you sell life insurance to a 25 year old? Because he/she locks their rates in. Same with health care. Maybe not a lock, but length on the policy will affect future premiums. Lastly, let risk reflect premium. A fit 25 year old should pay less than a 500# one that smokes, drinks, eats badly, and is a couch potato. Use acturial tables more.

I agree about the "bully pulpit", I call that "health education". There is a theory in public health that socialization affects health and we need to employ that. 

Sorry work calls...but I think many of us are in at least partial agreement.

Warmest regards


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## odoreater (Feb 27, 2005)

The other day I heard about a program that the federal government is running where they create guidelines for restaurants so that restaurants serve healthier food. Hearing about this story made me sick to my stomach because the federal government has no business getting involved in this area. Where in the constitution does it say that one of the enumerated powers of the US federal government is to lecture us about proper diet? If we hadn't let the federal government become the monolith that it is it would have been possible for states to take care of problems such as health insurance. With the federal government in charge, any universal healthcare program will be filled with pork and will be a failure. Just look at what the feds did with Medicare part d. What a disgrace.


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## hopkins_student (Jun 25, 2004)

Wayfarer said:


> Second. No.


Good thing you're willing to consider compromise.


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## hopkins_student (Jun 25, 2004)

Odoreater, this may be the first time I've ever agreed with you.


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## odoreater (Feb 27, 2005)

hopkins_student said:


> Odoreater, this may be the first time I've ever agreed with you.


I think we've agreed on sartorial matters in the past, if not political ones.


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## msh14 (Nov 11, 2005)

Wayfarer said:


> It should have limits. Meaning, if you weigh 500 lbs, smoke 3 packs a day, well you just do not get your hospitalization covered for acute intervention when you have a COPD exacerbation or NIDDM flare up. What you will be given is a choice of paying for your stay, either personally or through a third party policy, or hospice care. This is one example that jumps to mind, do not fixate on the example but rather take the spirit of the policy from it.


So much easier said than done...splitting hairs over the limits would kill any legislation.

Edit: and without limits the legislation couldn't pass either.


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## Wayfarer (Mar 19, 2006)

msh14 said:


> So much easier said than done...splitting hairs over the limits would kill any legislation.
> 
> Edit: and without limits the legislation couldn't pass either.


I agree the devil will be in the details, but I do not think the case of the 500# COPDer, non-compliant NIDDM person is a hair split. Either shape up, pay up, or we make you very comfortable on the way out.

Warmest regards


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## Wayfarer (Mar 19, 2006)

Wayfarer said:


> Second. No.





hopkins_student said:


> Good thing you're willing to consider compromise.


In regards to universality, what is there to compromise? It is a binary situation. It either is or is not. Negotiations could be had, for instance, on what and what not to cover, but the basic premise of universal coverage is an "either/or" situation.

Further, it is my firm belief that the ethic of "compromise" is what got the US this fragmented, multi-layered, inefficient, inhumane system we have now. Medicare was nothing but a compromise (I mean, you go to John Hopkins, they have a great school of public health, read some history on the Medicare program) and you are going to tell me that is a good system? DRGs, RUGs, and now Medicare D.....

Warmest regards


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## Doctor Damage (Feb 18, 2005)

Intrepid said:


> ...The single payer system in Canada, has resulted in shortages, rationing, incredible waits for all but emergency surgery, and a flow to the US for those that can afford to flee the system. Thus, putting the poor at a tremendous disadvantage...


That, I think, is an over-simplification, and almost universally negative. There are + and - to each system, but too often the failures are the result of political meddling, rather than anything inherently(sp) wrong with the system itself. Everyone up here loves to trot out stories about their favourite 80-year-old aunt who didn't get treatment fast enough and thus didn't live to see 150. Of course, no-one is quite willing to accept the fact that people die, and old people die more readily than young people, and their favourite aunt probably wouldn't have lived for more than a few more years anyway. Will changes to the system free up more money for better allocation? Will that solve one problem only to create a new one? Will the waste and mis-management quickly reappear?

One thing is sure in my mind: the 'baby boomer' generation will use their political clout to make sure they're well covered, leaving my generation and younger to make do with some sort of heavily privatized system, which I expect will be much more expensive on an individual out-of-pocket basis (after all, there's money to be made!).


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## Wayfarer (Mar 19, 2006)

DD, you hit on a couple of key points. I agree, Boomers, if left unchecked, are going to screw us that come after. I am Gen X and I figure we will get the worst of it.

Second, people dying. Yes, somehow, in America, no one is allowed to die, and if someone dies, then someone else is "at fault" for it. Do not get me going on this. Listen, does Aunt Fran, 95 years old, totally bed ridden, totally lacking mentation due to Altz. Dz., on a PEG (a permanent type of feeding tube) tube...she rolls out of bed ('cause the Feds will not let you use side rails anymore) and breaks a hip. Do I think the tax payers should pay for her ORIF? (hip repair). No, I think Aunt Fran gets a morphine drip, her PEG tube pulled, and is made comfortable. Unless someone wants to pay out of pocket that is. Even then, I have an ethical problem with a person like Aunt Fran getting a PEG as I think it is prolonging her misery and basically torturing her. Needless to say, under my proposed system, the payment portion will be fixed.

Warmest regards


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## 16128 (Feb 8, 2005)

odoreater said:


> The other day I heard about a program that the federal government is running where they create guidelines for restaurants so that restaurants serve healthier food. Hearing about this story made me sick to my stomach because the federal government has no business getting involved in this area. Where in the constitution does it say that one of the enumerated powers of the US federal government is to lecture us about proper diet? If we hadn't let the federal government become the monolith that it is it would have been possible for states to take care of problems such as health insurance. With the federal government in charge, any universal healthcare program will be filled with pork and will be a failure. Just look at what the feds did with Medicare part d. What a disgrace.


Why isn't it the individual's responsibility to ensure that they take basic good care of their own health, eat properly, etc? Isn't a goal of "not feeling horrible" enough to get people to eat fruit and move around a little?

Good grief... it's amazing that the human race has survived as long as it has without governments telling us how many pieces of bread are in the daily food pyramid.


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## I_Should_Be_Working (Jun 23, 2005)

Wayfarer said:


> DD, you hit on a couple of key points. I agree, Boomers, if left unchecked, are going to screw us that come after. I am Gen X and I figure we will get the worst of it.
> 
> Second, people dying. Yes, somehow, in America, no one is allowed to die, and if someone dies, then someone else is "at fault" for it. Do not get me going on this. Listen, does Aunt Fran, 95 years old, totally bed ridden, totally lacking mentation due to Altz. Dz., on a PEG (a permanent type of feeding tube) tube...she rolls out of bed ('cause the Feds will not let you use side rails anymore) and breaks a hip. Do I think the tax payers should pay for her ORIF? (hip repair). No, I think Aunt Fran gets a morphine drip, her PEG tube pulled, and is made comfortable. Unless someone wants to pay out of pocket that is. Even then, I have an ethical problem with a person like Aunt Fran getting a PEG as I think it is prolonging her misery and basically torturing her. Needless to say, under my proposed system, the payment portion will be fixed.
> 
> Warmest regards


Send Aunt Fran on a - what was it - Soma holiday like in "Brave New World".

Jokes aside, I agree we need creative solutions to health care. Though I truly fear handing it over to the government given what politicians do with such programs. Once they have power over something, we surrender a little more of our personal sovereignty over to the rent seekers. Social security should be taken away from direct control of the Congress. I just as soon hand it over to Microsoft.


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## Intrepid (Feb 20, 2005)

*Good Discussion*

A couple of posts indicate that there should be a form of health care for the poor. Fair enough, it doesn't seem possible to disagree , in a civilized society.

In the US, we have such a plan, and is called Medicaid.

True, it doesn't cover all of the uninsured. However, as Mass found when they implemented their plan, 40% of those without coverage were young, healthy, financially able to pay premiums, but chose not to.

Mass is planning to force those into the system, like auto insurance.Make it
mandatory.


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## Intrepid (Feb 20, 2005)

*No Argument*



Doctor Damage said:


> That, I think, is an over-simplification, and almost universally negative. There are + and - to each system, but too often the failures are the result of political meddling, rather than anything inherently(sp) wrong with the system itself. Everyone up here loves to trot out stories about their favourite 80-year-old aunt who didn't get treatment fast enough and thus didn't live to see 150. Of course, no-one is quite willing to accept the fact that people die, and old people die more readily than young people, and their favourite aunt probably wouldn't have lived for more than a few more years anyway. Will changes to the system free up more money for better allocation? Will that solve one problem only to create a new one? Will the waste and mis-management quickly reappear?
> 
> One thing is sure in my mind: the 'baby boomer' generation will use their political clout to make sure they're well covered, leaving my generation and younger to make do with some sort of heavily privatized system, which I expect will be much more expensive on an individual out-of-pocket basis (after all, there's money to be made!).


Your points are valid, Dr D.
Political meddling is impossible to avoid, however, and is a part of every health plan disaster that has occured. Someone mentioned Medicare Part D (Rx). If you started out to design something that is destined for failure, you would come up with Medicare part D.

The single payer plan failures don't involve 90 year old people, totally. They involve a lot of people in their 50s that could live normal lives with a knee or hip replacement. If these people are sentneced to years in a wheel chair, that simply puts a burden on the poor that can't afford to escape the system.


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## odoreater (Feb 27, 2005)

VS said:


> Why isn't it the individual's responsibility to ensure that they take basic good care of their own health, eat properly, etc? Isn't a goal of "not feeling horrible" enough to get people to eat fruit and move around a little?
> 
> Good grief... it's amazing that the human race has survived as long as it has without governments telling us how many pieces of bread are in the daily food pyramid.


I agree with what you're saying. All I was saying in my post is that as a matter of constitutional jurisprudence and law, I believe that if any government should have jurisdiction over this subject matter it should be the state government - not the federal government. Of course, the main responsibility should be on individuals.


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## Wayfarer (Mar 19, 2006)

*I agree but...*



odoreater said:


> All I was saying in my post is that as a matter of constitutional jurisprudence and law, I believe that if any government should have jurisdiction over this subject matter it should be the state government - not the federal government. Of course, the main responsibility should be on individuals.


The thing is, that ship has already sailed. Medicare set the precident in a Federally funded, single payer system for health care. FYI too, it is not just for those over 65. It covers ESRD too (end stage renal disease) and I believe, but am not 100% sure, if you are officially disabled for over two years. So falling back to the enumerated powers, just on the face of it, does not fly. Further, Medicaid, the States run single payer system for the poor and indigent, is funded mainly by the Feds, so of course they have large input into what each State's Medicaid covers. I am not saying whether that is right or wrong, I am merely describing what is.

EDIT: Forgot to mention the many federal laws that govern healthcare, from OBRA laws to EMTALA (Emergency Medical Treatment and Active Labor Act)...that is the act several people have alluded to, saying ERs must treat.

Warmest regards


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## DukeGrad (Dec 28, 2003)

Gentlemen,

I come from a medical care healthy job, the military and its retirement; to this terrible mess.
First, what do us Boomers have to do with this, stop blaming us, lol.
This is political, and everyone has an opinion. I see too many poor people, without healthcare, who need it. My vote, they need the care.
I see many people who are obese, have lung disease and so on. They also deserve healthcare.
I look at these people, in the same light as my rich patients with insurance.
Wayfarer, did you mean COBRA? Also, not just end stage renal disease, but a great deal of them are coverred, if you are disabled.By Medicare.

Odoreater, I like your ideas, but we need to focus forward, health promote our next generation, and move on.
I dont blame people for a poor lifestyle, either smoke, or eating, or drinking.
There are people behind these disease processes, so it becomes very hard to sort of punish these people, just my opinion.

Gentlemen, have a nice day


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## bwep (Apr 17, 2005)

Jimmy

So nice to read your posts! I am going to stay out of this one, though I do like the opinions of making people more accountable for their health and actions both from their pockets and their lifestyles. As a medical professional, I can see all of the arguments. I chose a specialty and really a subspecialty that is devoted to treating patients who have disease processes tha for the most part they did not bring onto themselves. I like it that way. I treat all comers, insured, medicaid, uninsured/self-pay/insured de Mexico (ie aliens w/o coverage) and ask no questions. I treat everyone the exact same and make sure that I do not know who has coverage, who does not have coverage, and what kind of coverage so as not to subjectively affect the delivery of care. Sure I eat alot on the expenses and I am open to some significant liability. I just assume that it will all work out in the end. I get to do what I love doing. I do better than I did as a resident. I put food on the table... I just cannot stand the fact that while my costs have increased and my reimbursements have fallen, I see other professions where this is simply not tolerated or accepted. I do not want to sound as if I am whining or complaining since I just wrote that I take care of all comers and that is my choice and that I went into medicine and my respective specialty and that was my choice. I just find it interesting that in business when costs rise, one charges more. In law, when costs rises, charges go up and the barristors would never think of collecting less. 

Bottom line, I have no clue to an answer which is why I originally wrote that I did not want to chime in. I love what I do. I make a tangible difference to society. I can provide for my family. Life is good!


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## Wayfarer (Mar 19, 2006)

DukeGrad said:


> Gentlemen,
> 
> Wayfarer, did you mean COBRA? Also, not just end stage renal disease, but a great deal of them are coverred, if you are disabled.By Medicare.


I meant OBRA as in Omnibus Reconciliation Act, particularly 1987 and 1996 BBA. These contain Federal regulations which dictate the parameters within which all health care facilities that participate in Medicare must function under. Not to be confused with COBRA or COBRA insurance which allows people to have continuation of health insurance post-employment. COBRA stands for Consolidated Omnibus Reconciliation Act which was the piece of legislation creating this continuing insurance.

As I said, I suspected Medicare covered those officially disabled for more than two years, just was not 100% sure at the time of posting and did not want to make the statement I was sure. As we both stated, ESRD is a covered benefit.

Is not giving acute treatment interventions for the 90th exacerbation of COPD by a 500# patient, with 100 pack years, that is also an uncontrolled NIDDM punishment? I do not think so. I think it would be punishment if we offered no treatment, only the treatment modality can be that of compassion and companionship vs. interventionalism.

I think by this time people can discern I am more than passingly familiar with healthcare.

Warmest regards

Edit: The only reason I made that last statement is I was trying to convey, I've actually given this much thought, both from a practical and philosophical/ethical point of view.


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## Dr James Ryan (Feb 8, 2006)

Universal health coverage in the USA. What a disaster... Im glad I'll be long dead before this scheme ever comes into fruition... 
The last thing a nation waning in economic power needs to do is bury itself under more entitlements. And why do we want to remove more personal choices in the last free country in the developed world? The USA is the only place in the world I'd want to be if I were to take seriously ill. Coincidentally it's the only place left without universal care. It's scary how many people think this is a good idea...


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## Wayfarer (Mar 19, 2006)

I want to restate one thing: I am not for a soup to nuts universal policy. Surely, if you are this far into reading this thread, you *must* realize this.

Now, I want to ask one question: do people get medical treatment in the US if they have no health insurance or are they left to die 100% unaided?

Warmest regards


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## Doctor Damage (Feb 18, 2005)

Wayfarer said:


> ...Now, I want to ask one question: do people get medical treatment in the US if they have no health insurance or are they left to die 100% unaided?...


There is an article in a recent TIME magazine (yes, not the most reliable publication) which follows the experiences of several people in just that circumstance. I haven't read the article yet, but there was one man who had no health insurance and couldn't afford the $60G+ needed for his heart surgery, so he went to a special clinic in India (with US-trained doctors) and got cut up there for about $10G. He is apparently fine, although his doctors in the US recommended against it. Let me say again I have not read the article and know nothing about the particulars of this case, I just thought it was an intriguing situation.


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## DukeGrad (Dec 28, 2003)

Gentlemen

Wayfarer,

Thank you. In answer to your question. I believe anybody should get medical care, even without insurance. This is just my opinion. Do not want to start a war here.
Again, there is more people in this country that have no insurance. That are not obese, have COPD or renal disease.
We have a high number of younger, working poor that can not afford it.
We have a number of poor, across the spectrum.
Young couples, middle aged people, who lost their jobs, and working poor.
I believe all should have medical care.
Again, my feelings about the matter,

Have nice day gentlemen


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## Martinis at 8 (Apr 14, 2006)

Healthcare cost issues tend to go away when risky behavior is eliminated. Examples: obesity, habitual smoking, habitual drinking, irresponsible driving. These are the main cost drivers, along with frivolous lawsuits.

So, why should I have to pay for the risky behavior of others through some socialized taxation scheme, or pseudo-taxation scheme known as insurance premiums?

Outlaw insurance for medical coverage, and other socialized tax schemes, and frivolous lawsuits, to include class action suits, and then watch the cost of healthcare drop through the floor. Problem solved.

Maybe this will enable doctors to make house calls again, like when I was a kid, and health costs were nothing. It can be like that again.

M8


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## Wayfarer (Mar 19, 2006)

*An important concept...*

I would like to interject an important concept to the talk at this point, as I see various labels being applied to "insurance". It was something drilled into me by one of the very first "healthcare economists" in the world. This gentleman did extensive work for WHO and is an expert in this field. His name is Ron Vogel and I was lucky enough to have him as a professor in one of my graduate programs.

Insurance is to guard against events that are disasterous, relative to income. Think about that statement and ask yourself if we follow that premise in regards to healthcare in the US.

I would also like to tell a story about medical history. At one time, surgeons were the least honoured physicians. They were also often the poorest physicians. Pediatricians were the most prestigious of physicians are one time, and often the wealthiest. Is it that way today or is it the inverse? Also, if you think it is in the inverse, what chain of events do you feel led to today's situation?

Warmest regards


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## Intrepid (Feb 20, 2005)

*Prepayin Predictable Expenses*



Wayfarer said:


> I would like to interject an important concept to the talk at this point, as I see various labels being applied to "insurance". It was something drilled into me by one of the very first "healthcare economists" in the world. This gentleman did extensive work for WHO and is an expert in this field. His name is Ron Vogel and I was lucky enough to have him as a professor in one of my graduate programs.
> 
> Insurance is to guard against events that are disasterous, relative to income. Think about that statement and ask yourself if we follow that premise in regards to healthcare in the US.
> 
> ...


One textbook description of insurance is the subsitiution of a small predictable expense, for the possibility of a huge unexpected insurance.

Most people don't understand this and they expect "insurance" to cover the small expenses, like innoculations, that are predictable. (Some people mistakenly think that they have "dental insurance". What they have is coverage for small predictable expenses, with a limit of about $2,000 per year. That is not insurance, but simply a way of prepaying small predictable ewpenses. Need a $4.000 implant, not covered.)

This brought about the concept of "medical savings accounts". A type of bank account that can be used for the predictable expenses, say $2,000, that allows the individual to cover the small predictable expenses, with the motivation that the unused portion can be carrried over.

Superimposed on the MSA, is true insurance, in the form of major medical coverage that protects against the unexpected cost of catastrophic illness.

This is true insurance. Those that want big government, do all they can to fight the concept. They want the public to look to the government for all health care, thus creating another block of those that consider themselver victims, with no hope, except for a large bureaucratic federal system.

It is often a useful exercise to think of all of the things that big government does very well. If you think that that list is a long one, then a single payor system of federally administered health care will fit in with the rest of the things on that list.


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## Wayfarer (Mar 19, 2006)

Intrepid, that is exactly right. Then co-pays were developed to prevent over utilization, mainly from work done by the RAND institute. Suddenly, a $5.00 co-pay for an office visit was "evil" according to leftists. AARP, a rotten, incestuous organization I could go on about, created "insurance" to cover the co-pays!

One reason I am for a basic, *basic*, universal policies is knowing that we, as a population, change insurance carriers approximately once every two years. Savings in healthy lifestyle promotion takes years to accrue. So then, why would a publically traded corporation, answering to Wall St. quarter by quarter, invest a large part of revenues back into health promotion? It does not make economic sense to the health care companies. Therefore, this is exactly the type of public good government should invest in. Also, as with all investments, if a return is not reaped, the investment must be liquidated...hospice or comfort care is very humane and very cost effective...or the non-compliant person is always free to pay for things out of pocket or have an insurance policy willing to pay for their non-compliance.

Warmest regards


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## burnedandfrozen (Mar 11, 2004)

*Universal Healthcare*

I always thought universal healthcare was just another way of saying "government controlled healthcare". The thought of the government having a hand in healthcare just scares the daylights out of me. With all the incompetence, waste, and corruption that goes on with other government programs, medical care is the last thing I'd want to see the government get into.
On the other hand something has to be done about those uninsured folks who use the emergency rooms for non emergency issues. Here in LA it's no secret that many emergency rooms have been shut down due to not enough money coming in to cover costs. Illegal immigration opponents site this as one of the problems that has occured due to the massive influx of low skilled people coming into the country. Whatever the case, from what I've heard about universal healthcare in countries like Sweden, it's far from being a solution. At least it just creates another set of problems in place of the ones it solves.
I also have to chime in about the government sticking its nose into school cafeterias and such. Kids aren't fat because of school lunches. They're fat because after school they come home and stuff their faces with Ding Dongs, Doritos, frozen pizzas ect while they sit for hours and play their xbox. I blame the parents for this. I mean really, is it too hard to take the twinkie out of the kids hand and tell him/her to go out and ride their bike or walk the dog?
Do we really need the government stepping in to control what we choose to eat? If so then I fear all is lost.


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## SGladwell (Dec 22, 2005)

odoreater said:


> With the federal government in charge, any universal healthcare program will be filled with pork and will be a failure.


Considering that the healthcare programs the government currently runs (Medicare/Medicaid and the VA system) are *vastly more efficient and less clogged with bureaucracy* than the bizarre, psychotic morass the rest of us are stuck with, I think your fears are unfounded. Most of the anti-health folks - and with the data currently available, there's no other reasonable way to characterize Luddite behavior like opposing universal health care except as anti-health - either through ignorance or ideological blinders fail to realize that the most efficient healthcare delivery systems in the United States (just like in the rest of the world) are *government run.*



odoreater said:


> Just look at what the feds did with Medicare part d. What a disgrace.


On the assumption that "Medicare part d" is really the Big Pharma subsidy that the GOP duplicitously sold as a prescription drug benefit, the obvious retort is that no healthcare reform is possible in this country until we get more competent and reasonable elected officials in the House, Senate, and White House. That will take at least two election cycles, but hopefully no more. So hope you don't get sick in the half-decade (minimum) before help is on the way!


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## Doctor Damage (Feb 18, 2005)

Whenever I get myself worked up about how I'm being screwed by the government, I remind myself that at least with the government I can go out and gather political support and/or funds and lobby or pressure for change. No such option exists when I'm being screwed by my insurance company or some other large corporation: I could take my business elsewhere, but in Canada at least, monopoly capitalism has found its home and the next company would just screw me the same as the first.


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## Wayfarer (Mar 19, 2006)

*Careful here...*



SGladwell said:


> Considering that the healthcare programs the government currently runs (Medicare/Medicaid and the VA system) are *vastly more efficient and less clogged with bureaucracy* than the bizarre, psychotic morass the rest of us are stuck with, I think your fears are unfounded.


Careful, there are a couple of points to consider. For instance, go take a poll of Vets and see what wait times can be like for certain things, ditto Medicaid. Also, Medicare and Medicaid reap many benefits on the backs of the private system, something better known as "cost shifting". My organization, at every occassion, loses money on every single damn Medicaid person we serve. Why do we take them? We are forced to. How do we compensate? Charging more for private pay/fee for service and insurance. Medicare can be just the same, if they have some outlier drug for instance, say Amphotericin B (which REALLY used to eat my lunch, I have not costed it lately), my organization can easily lose money there too. What the public must realize is Medicare works under DRGs and RUGs, depending on level of care, and these set either my diagnosis global revenue or my ppd (per patient day) revenues. If my cost of care exceeds my per diem by 2k, too bad, the organization eats it.

Lastly, efficiencies are not what they seem as oversight is less in Medicare in terms if quality control, appeals, claims adjudication, etc. plus they have a much larger service pool, meaning simply the numerator will inherently be smaller and the denominator inherently bigger, thus creating a ratio that leads to some spurious conclusions.

It takes an expert to wade through this crap, and it is duplicated at each level of government. More reasons to simply, remove the duplication involved in having several goverment bureaucracies, and pay fairly so costs are not shifted but rather accurately reflected. Aunt Fran, described above, should not have her ORIF make it cost you more to have your kid's tonsills out!

Warmest regards


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## MDSuits (Jan 28, 2006)

*Universal Health Care?*

What should be done with 12 million illegal immigrants?


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## Wayfarer (Mar 19, 2006)

MDSuits said:


> What should be done with 12 million illegal immigrants?


Are you talking under the current system or my proposed system? What do you think should be done with them under the current system?

Warmest regards


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## hopkins_student (Jun 25, 2004)

Wayfarer said:


> I would also like to tell a story about medical history. At one time, surgeons were the least honoured physicians. They were also often the poorest physicians. Pediatricians were the most prestigious of physicians are one time, and often the wealthiest. Is it that way today or is it the inverse? *Also, if you think it is in the inverse, what chain of events do you feel led to today's situation?*
> 
> Warmest regards


Some combination of:
Scientific and technical advances so that now people survive most surgeries.
Increased post graduate training of surgeons to 6+ years vs. 3 years for peds.
Increased competition for surgical residencies.
Actually training surgeons as physicians rather than finding the nearest butcher, carpenter, or fool who was willing to cut on someone without anesthesia and calling him a surgeon.


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## hopkins_student (Jun 25, 2004)

Intrepid said:


> One textbook description of insurance is the subsitiution of a small predictable expense, for the possibility of a huge unexpected insurance.
> 
> Most people don't understand this and they expect "insurance" to cover the small expenses, like innoculations, that are predictable. (Some people mistakenly think that they have "dental insurance". What they have is coverage for small predictable expenses, with a limit of about $2,000 per year. That is not insurance, but simply a way of prepaying small predictable ewpenses. Need a $4.000 implant, not covered.)
> 
> ...


Great post Intrepid. I think MSAs are one of the only things that can pull us out of the healtcare nightmare we're in while also maintaining the highest standards of care.


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## Wayfarer (Mar 19, 2006)

Wayfarer said:


> Originally Posted by Wayfarer
> I would also like to tell a story about medical history. At one time, surgeons were the least honoured physicians. They were also often the poorest physicians. Pediatricians were the most prestigious of physicians are one time, and often the wealthiest. Is it that way today or is it the inverse? Also, if you think it is in the inverse, what chain of events do you feel led to today's situation?





hopkins_student said:


> Some combination of:
> Scientific and technical advances so that now people survive most surgeries.
> Increased post graduate training of surgeons to 6+ years vs. 3 years for peds.
> Increased competition for surgical residencies.
> Actually training surgeons as physicians rather than finding the nearest butcher, carpenter, or fool who was willing to cut on someone without anesthesia and calling him a surgeon.


Actually, all wrong. In fact, some of your points are putting the cart before the horse, so to speak. For instance, why is there an increased competition for surgical residencies? The answer of course lies in my question, namely due to the increase in compensation and prestige for surgeons. The increase in prestige and money caused the increase in competition for those residencies, not the other way around. Trust me, if pediatrics started to pay far more than surgery, the competition would be in the pediatric slots, not the surgery ones. You really should take advantage of that fine school of public health and look into why. I will give you one hint: economics.

Warmest results


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## hopkins_student (Jun 25, 2004)

Actually, the more I think about it, the more universal health care seems inevitable. I believe genetic screening is probably going to require a shift to publicly provided health insurance because health insurance companies will be out of business. Genetic screening will do a lot to indicate who is and who is not at risk for diseases that are very costly to treat. Individuals without a predisposition to these costly diseases will be less likely to seek health insurance, and those with a predisposition will be very likely to seek insurance. The insurance companies won't need to perform genetic screening on their potential clients, because they'll have a pretty good idea that if they're interested in health insurance there must be some condition that they're worried about. Individuals with no risk won't seek insurance, so insurance companies won't collect premiums from customers for whom they would have no cost. The loss of these customers that are essentially pure profit would force insurance companies to raise premiums to the point that most will be unable to afford them.

Does anyone see a way for insurance companies to survive in a world where genetic screening offers a reliable predictive value for many inherited diseases?


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## Wayfarer (Mar 19, 2006)

hopkins_student said:


> Actually, the more I think about it, the more universal health care seems inevitable. I believe genetic screening is probably going to require a shift to publicly provided health insurance because health insurance companies will be out of business. Genetic screening will do a lot to indicate who is and who is not at risk for diseases that are very costly to treat. Individuals without a predisposition to these costly diseases will be less likely to seek health insurance, and those with a predisposition will be very likely to seek insurance. The insurance companies won't need to perform genetic screening on their potential clients, because they'll have a pretty good idea that if they're interested in health insurance there must be some condition that they're worried about. Individuals with no risk won't seek insurance, so insurance companies won't collect premiums from customers for whom they would have no cost. The loss of these customers that are essentially pure profit would force insurance companies to raise premiums to the point that most will be unable to afford them.
> 
> Does anyone see a way for insurance companies to survive in a world where genetic screening offers a reliable predictive value for many inherited diseases?


Logical fallacy, false dichotomy. Car accidents would require health care. Sports injuries. Skin cancer, for instance, has a high PAR to sun exposure. I beleive lung cancer has a 90% PAR to smoking, if memory serves. It might help adjust risk pools, but even someone genetically "perfect" will no doubt require health care at some point.

Warmest regards


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## hopkins_student (Jun 25, 2004)

Wayfarer said:


> Logical fallacy, false dichotomy. Car accidents would require health care. Sports injuries. Skin cancer, for instance, has a high PAR to sun exposure. I beleive lung cancer has a 90% PAR to smoking, if memory serves. It might help adjust risk pools, but even someone genetically "perfect" will no doubt require health care at some point.
> 
> Warmest regards


It is true that they will still require health care, but it will still shift their demand for health *insurance* down, and make it a much lower priority for consumption when they know their risks are car accidents and sports injuries rather than car accidents, sports injuries, cancer, diabetes, etc. We can only assume that the rate at which those who are genetically "perfect" sustain injuries from car accidents and athletic events will remain unchanged after their genetic screening, and because they are now aware of their genetic advantage, the probability of using their insurance, which they will take into account at the time of purchase of their insurance will no longer be the same as the population as a whole, and so an insurance policy is less valuable to them. 
Insurance companies would be forced to offer accident only coverage to the genetically "perfect", which is reasonable, but the result is that high risk individuals would face premiums so high that an average earner would have a difficult time paying the premium.


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## bwep (Apr 17, 2005)

Wayfarer

Your assumptions about medical vs surgical subspecialties are only partly correct. I do not disagree that money has stimulated the role reversal, but there are a number of other things that are taken into account to demonstrate why the discrepency in wage occurs. It starts with post graduate training. Sub-specialisty (including medical spcialties) training programs are longer and much more rigorous than general counterparts. Simple internists, family practitioners and pediatricians spend 3 years in training, do NOT have the same on-call demands, and are generally less competitive (which came first the chicken or the egg is a matter of debate). It continues after training as well. In general, surgical specialists assume greater liability for the nature of what they do. They generally (and I know this may not be a widely accepted premise, but I bet it is true) work longer hours. They do not work in shifts. There are plenty of reasons why my salary is greater than the pediatricians. This is not bragging or complaining. Yes, I thought about salary and prestige when I decided to go down my chosen path, but it was not the only thing. Well baby checks, having an office only based practice (that is what most pediatricians family practitioners and internists do), handing out medicines was not for me. I needed additional stimulation. I needed a specialty that was advancing in front of me, that would allow me to have a tangible impact on outcome, that few could do, and required advanced learning beyond the scope of mediacl school. It was my decision to spend over 8 years in training, to join a specialty that doesn't stop at 500pm or start after 600am, to join a specialty with medical liabilty of 100+K per year, but has higher reimbursement and may come with some inherent respect. 

So, back to the original point. Yes, I think money has a lot to do with why some spcialties do better financially than other, but it is not that simple....


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## Wayfarer (Mar 19, 2006)

bwep,

But why was the money there? I am playing out more and more clues here so I might as well give the Reader's Digest version of the answer.

The answer is two fold, one still with us, one not really a factor any more.

Part One: think back to the 19th century US. Mainly agrarian, still a frontier land. Children were needed to work your land, apprentice in your trade, etc. So children were literally a family's wealth. Hence, the person that took care of them would have prestige. The Industrial Revolution and modern society have rather turned children into a liability vs. an asset, so that is why Part One went away, decreasing ped's prestige.

Part Two: Money. Most families could afford a doctor's visit. Think 1850 thru WWI. Peds could line up office visits all day long, six days a week and make money hand over fist, as an office visit was not catastrophic relative to income. Now, could most people afford expensive operations? No, of course not, that was an event that was catastrophic relative to income. It was surgeons that helped create insurance pools so people could afford them! Once the mechanism was there to allow demand to be driven, viola, the road to today's paradigm was set.

I simplified the evolution slightly, but really not much. Damn, guess I paid attention to a class at some point during my MPH program, lol.

Do not think I am mitigating the factors hopkins and bwep mentioned, I am surgeons' biggest defenders. People often call them "overpaid" and "arrogant", but I point out that if I have to chose between the guy that says, "I might be able to save him" vs. the guy that says, "STAND BACK! I CAN SAVE THAT MAN'S LIFE!" I am picking #2. It takes a certain something to stick your hands into a living person's body. Also, I believe people deserve a decent ROI on their time and money investment. However, the evolution described above is pretty accurate.

My next prediction, and it's not rocket science, is that any practitioner that specializes in geriatrics, everything from anesthesia to pharmacy, is about to become a millionare. Demand will be fueled not only through consumer need, but from oversight need. For instance, every single SNF patient in the US needs a *monthly* review of their medications by a pharmacist. This is just one example of compliance driven demand. With the first Boomers turning 61 this year, imagine the demand about to be fueled by governmental compliance alone.

Time to step off my lectern, I wasn't planning on lecturing until I retired 

Warmest regards


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## bwep (Apr 17, 2005)

Wayfarer

My many thanks. It tends to get subjective and personal for me. 

B


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## Gurdon (Feb 7, 2005)

odoreater said:


> I agree with what you're saying. All I was saying in my post is that as a matter of constitutional jurisprudence and law, I believe that if any government should have jurisdiction over this subject matter it should be the state government - not the federal government. Of course, the main responsibility should be on individuals.


I think it is not worth arguing about whether states or the federal government handle health care, but rather to come up with a workable program. There are models of already up-and-running systems.

Having enjoyed quite good care at Kaiser Permanente for 56 of my 60 years, I have experienced the rare circumstance of not worrying about getting good medical care. Cost is not an issue. It works.

It isn't rocket science. I think medical staff should be well paid. Eliminate the profit motive for corporations and insurance companies.

Regards,
Gurdon


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## jessiereal24 (Oct 24, 2014)

I agree with the above post. Aside from the benefits you could get, I believe that every person need to have health care even though you are healthy because you will never know when you and your family will get sick. Furthermore, a network of health care trades, sites that essentially serve as online areas for health insurance created under the Affordable Care act, is intended to be online by fall of 2013. The states are supposed to create them, but those that don't will get a federal one pushed to them.


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## Pentheos (Jun 30, 2008)

jessiereal24 said:


> I agree with the above post. Aside from the benefits you could get, I believe that every person need to have health care even though you are healthy because you will never know when you and your family will get sick. Furthermore, a network of health care trades, sites that essentially serve as online areas for health insurance created under the Affordable Care act, is intended to be online by fall of 2013. The states are supposed to create them, but those that don't will get a federal one pushed to them.


Eight EIGHT (8) year necro? You win one (1) universal health insurance.

Content-wise, "is intended to be online" a year ago smacks of something...not sure what.


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