# "universal healthcare"



## Harry96 (Aug 3, 2005)

I've avoided reading some threads here on topics like "universal healthcare" because my blood pressure can't take it.

I sent this link to some friends yesterday:

https://www.lewrockwell.com/rozeff/rozeff112.html

One wrote back tonight and we started talking about healthcare. Like me, he's against government healthcare. I started typing some problems that I saw with such a program, and every time I wrote one, I thought of another one. It came out pretty well, so I thought I'd share what I wrote for anyone who's interested.

Of course I realize that some will disagree, which is fine. But here's a preface to my comments for anyone who disagrees: I'll give you the benefit of the doubt and assume that all of my points are wrong and that "universal healthcare" would benefit me (which, of course, I don't believe). Even if that's true, if I don't want to be involved, what right do you have to force it on me, even if it really is for my own good? As law professor Butler Shaffer recently commented, "I wish to not be coerced. Why should I have to justify myself to anyone beyond that?" (I wonder if anyone will respond that anyone who wishes to not be coerced doesn't want to be a part of "society?")

I hope my thoughts are beneficial to someone.

*****

That's not the first real hospital bill from circa 50 years ago that I've seen that shows the average charge for a week's stay and surgery to be about $1,000 in today's dollars. That's a big chunk of change, but it's nothing that anyone couldn't manage, even without insurance and even if they had to carry it on a credit card for a few months. Today, thanks to government-imposed distortions, a week in the hospital could be literally 100 times that -- enough to bankrupt almost anyone without insurance.

Speaking of insurance, employer-provided health insurance is another government distortion. It started during WW2, when the government imposed wage and price controls, so employers had to figure out a different way to lure better workers. It's remained because of further distortions caused by the tax code and by government's regulations on the insurance industry driving up the price to where most people can't afford to pay the entire premiums on their own. In a free market, employers wouldn't pay for people's insurance any more than they'd pay for their shoes, haircuts or anything else; they pay you for the income you make for them through your work, then you buy whatever you want with it on your own time.

I believe this all started with medical licensing during the late 19th Century. This gets back to what I wrote the other day about a small ruling elite fleecing everyone else for their own benefit, while conning them into thinking it's for their own good. Medical licensing wasn't instituted to "protect" the public from things like quack doctors; it was instituted specifically to forcibly cartelize the medical profession, artificially restricting the supply to drive up the incomes of the people already in the business by making it much harder for others to enter and compete with them.

This illustrates the insidiousness of public schools and why they were such an important part of the Progressive package. People undergo a 12-year brainwashing (which is furthered for the rest of their lives, largely unwittingly, by the media, their parents and other authority figures that the underwent the same brainwashing) that government regulations are there to protect them, when they're really there largely because big business used its money and political connections to get the government to give it advantages -- at the expense of the average person -- that it couldn't get in the marketplace through voluntary transactions. Again, medical licensure is a major example, as are other medical regulations. It's easy to see how people would fall for that con in particular, because that industry deals in life and death.

An indication of the effectiveness of such campaigns is the call for "universal healthcare" as a "solution" to the distortions that government caused in the first place. That's so economically illiterate that it's unbelievable, and hardly anything makes my blood boil more. There are so many things wrong with it that I almost don't know where to start, but to name a few:

No one has a "right" to healthcare, because there's no such thing as a legitimate right to anything that someone else has to pay for. If that seems cruel, consider that, unless you have an immediately life-threatening injury, food is more important to life than healthcare. In countries that preached a "right" to "free" food, like the USSR, they had mass starvation. But, in a country like the U.S., where people are "exploited" by greedy businesses like food producers, supermarkets and restaurants, even the poorest people have more food than they can eat, and government is the only thing that keeps it from being even cheaper and more plentiful, through things like farm price supports (again, keeping a few in business at the financial expense of everyone else in the country). Also consider that charity hospitals and doctors doing free work for the poor existed here until about 50 years ago, when they were driven out by government regulations.

Governments have no resources of their own; they only have what they take by force from the private sector. And no matter how much they confiscate, there aren't enough resources in the world to provide "universal" access to anything, even if some government central planner has the best of intentions. Any resources used for one thing can't be used for something else, and there's no way to allocate resources to their most urgent uses, nor to reduce the waste of overproduction for less urgent uses to the minimum, without the pricing information that can only be provided by property owners in the market.

Plus, even the currently-estimated resources will turn out to be insufficient (even if they're accurate now, which they won't be, because government allocation of resources is inherently arbitrary), because demand for healthcare will soar when people perceive it to be "free."

All of this will create chaos -- there will be shortages of more urgently-needed healthcare resources at the same time there is massive waste of less urgently-needed healthcare resources. Some resources will be wasted that shouldn't even be in healthcare at all, at least not in the quantities that emerge, because many will demand frivolous, unnecessary medical treatments that they would do without if they had to pay for them themselves.

There are only two ways to ration resources: By highest bidder wins or by everyone waits in line. And, again, the inherent long waits for treatment will be exacerbated by the fact that demand for medical services will soar when people perceive them to be "free." This, coupled with the inherent inadequacy of government-controlled supply, will lead to chronic shortages. Many needing urgent treatment will die waiting in line. (Organ transplants are a perfect example of this; the government has made it illegal to sell organs, which means everyone waits in line and the market can't adjust the supply by offering people the financial incentive to sign their donor cards).

You won't decide what you need; some government bureaucrat will. Life and death will become politicized. If a bureaucrat denies your treatment, you will suffer or even die, have to go to the colossal inconvenience and expense of going overseas for treatment (add to that the legal risk if such action is illegal), or endure the danger of going to the black market.

That black market will flourish and will greatly foster crime, as well as disease and death from ill-trained black market practitioners.

In a free society, customers are cherished and courted by businesses to try and convince them to voluntarily spend their money for something that they perceive to be more valuable to them than the money they're relinquishing. In a forcibly socialist or collectivized society (or industry), anyone who needs or wants anything is seen and treated as a parasite who's using up limited resources.

Busybody regulations on people's personal lives and on business will probably explode (which is beginning already), because if "we" all pay for healthcare equally, then it becomes everyone's business what everyone else eats, drinks, smokes, whether they exercise, etc, because anyone who doesn't take care of themselves increases their potential of using more than their "fair share" of limited healthcare resources.

That attitude could potentially lead to a genocide against the elderly, handicapped, obese, etc, to stop them from disproportionately consuming limited medical resources (for the "good of society," of course.)

Is this really what you want?


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## hopkins_student (Jun 25, 2004)

I agree with pretty much everything you said. Unfortunately, many of your arguments are futile against people who support universal health care. You point out several instances where universal health care is bad for just about everyone, but many of your arguments are about economic waste and inefficiency. It's been my experience, debating with medical students who want to save the world and know ABSOLUTELY NOTHING about markets and economics, that these people, much like die hard environmentalists, believe there is nothing more important than universal health care and that there is no price too high.

However, from the financial perspective, I think there is only one question that has to be asked, to which I've never heard anyone provide an answer, satisfactory or not: At what cost of treatment would a government managed health care system decide that it is not worth treating someone? Insurance companies are able to answer this question by outlining levels of coverage, but I can't see any politician, bureaucrat, or humanitarian placing a value on human life, which is necessary for universal health care.

This leads me to where laws have to change. There is currently federal law that requires emergency departments to treat anyone regardless of their ability to pay. On the one hand, it is entirely unfair to the organization operating the ER and on the other hand we don't want people dying in the streets. At this point hospitals are aware that they are required to treat everyone and so it's up to them to make the decision whether or not to keep their emergency departments open. What is incredibly unfortunate is when emergency departments close, and this resource is not available to people who can or cannot pay. The only "fair" alternative I can imagine is legislation where ER departments would be forced to stabilize and then release patients who cannot afford treatment. Is this a solution that I'm satisfied with: no. Is it a solution that is better than what we've currently got: yes.


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## Harry96 (Aug 3, 2005)

hopkins_student said:


> I agree with pretty much everything you said. Unfortunately, many of your arguments are futile against people who support universal health care. You point out several instances where universal health care is bad for just about everyone, but many of your arguments are about economic waste and inefficiency. It's been my experience, debating with medical students who want to save the world and know ABSOLUTELY NOTHING about markets and economics, that these people, much like die hard environmentalists, believe there is nothing more important than universal health care and that there is no price too high.
> 
> However, from the financial perspective, I think there is only one question that has to be asked, to which I've never heard anyone provide an answer, satisfactory or not: At what cost of treatment would a government managed health care system decide that it is not worth treating someone? Insurance companies are able to answer this question by outlining levels of coverage, but I can't see any politician, bureaucrat, or humanitarian placing a value on human life, which is necessary for universal health care.
> 
> This leads me to where laws have to change. There is currently federal law that requires emergency departments to treat anyone regardless of their ability to pay. On the one hand, it is entirely unfair to the organization operating the ER and on the other hand we don't want people dying in the streets. At this point hospitals are aware that they are required to treat everyone and so it's up to them to make the decision whether or not to keep their emergency departments open. What is incredibly unfortunate is when emergency departments close, and this resource is not available to people who can or cannot pay. The only "fair" alternative I can imagine is legislation where ER departments would be forced to stabilize and then release patients who cannot afford treatment. Is this a solution that I'm satisfied with: no. Is it a solution that is better than what we've currently got: yes.


I probably can't prove this, but my suspicion is that most people who dogmatically cling to their "save the world" plans in the face of devastatingly conflicting evidence aren't really passionate about the cause they espouse; what they're really passionate about is running other people's lives, and the particular cause they latch onto is just a means to an end.

I can't name any examples off-hand, but I've read numerous times that many of the early hardcore environmentalists were former socialists. When socialism proved so devastatingly destructive to the material needs of people -- especially the poor whom the socialists claimed to be helping -- it fell out of favor. So the socialists became environmentalists and encouraged people to embrace the poverty caused by socialism, because the abundance of capitalism will kill the planet otherwise, a fate which, of course, can only be averted by giving the environmentalists power over everyone else's lives.

Ray Kurzweil and other experts on nanotechnology are predicting that it will make fossil fuels and all other polluting technologies obsolete, as well as cleaning up all existing pollution, within 20 years (the veracity of these predictions is another subject for another time). I believe it, and I've been predicting since I first learned about it that, if it happens, any of today's militant environmentalists who are still around won't go away; they'll just find some other cause to latch onto as an excuse to indulge their totalitarian, control-freak personalities.

(Incidentally, I'm not referring to regular people like you or me who make an effort to recycle or something; I'm referring to the hardcore nut-jobs who see humans as a blight on the earth; wish to return to a pre-Industrial, pre-technology society; believe in population control by any means necessary, etc.)

I don't think the answer to your question of how far a government-run healthcare system would let someone decline before cutting off their treatment can be known today, because it would depend on the political climate at the time. Politicians will be politicians; aside from being a pathological liar, the number one qualification for the job is to say and do whatever you think the majority wants in order to obtain power and keep it. As I mentioned earlier, if the climate was right, there might be a genocide like the Holocaust. In a milder climate, there might be a passive genocide, where people are just cut off from further treatment. If the climate demanded that people be kept alive at all costs, the politicians would steal whatever they had to steal to try to keep the system going and to keep the people from revolting against them.

The law requiring emergency rooms to admit anyone, even if they can't pay, reminds me of Ludwig Von Mises' comment that governments create their own reasons for existing, that most of the problems in the world that supposedly require government intervention wouldn't exist in the first place if there weren't governments around to cause them, and that one law, regulation or program creates all kinds of new problems in addition to making the original problem worse, so governments feed their own growth.

As I mentioned, the average charge in the U.S. for surgery and a week in the hospital 50 years ago was about $1,000 in today's dollars. To the best of my knowledge, there were no such laws then, and the reason is obvious: They weren't needed.

I can't imagine a hospital in a free society turning away a critically injured or ill person, even if they knew they can't pay; aside from human compassion and the role of churches and charities to help, such a hospital would get a bad reputation and invite a competitive edge from other hospitals: "If you need treatment and can't pay now, don't go to that heartless hospital across town; come to us. We'll work something out, no matter what your income."

Besides, without all of the government distortions, there'd be little chance that someone couldn't pay, unless they're crooked. If prices were what they were 50 years ago, even someone making minimum wage could pay off a $1,000 debt eventually. If they didn't have any credit cards or couldn't get a bank loan, I'm sure the hospital would work out a payment plan or something if they just explained their situation. In a free society, hospitals would have little reason to fear that someone wouldn't pay. Yes it would happen sometimes because the world isn't perfect and not everyone is honest, but it wouldn't be a major problem.

Governments run up the price of healthcare to the point that it can bankrupt anyone who needs it, then pass laws that prevent hospitals from turning anyone away who can't pay -- and they're able to convince the boobs that they just "protected" them from "greedy" hospitals! Unbelievable.


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## hopkins_student (Jun 25, 2004)

Excellent post.

To vent a frustration that's been building for a while, I'd say that the most irritating discussion I have encountered lately involves anger on the parts of my classmates that health insurance isn't cheap. It does not matter how many people you pool into your policy, fixed fees (say the cost of a yearly physical) are always going to be transmitted completely intact to the purchaser of the policy. There is no way to insure for a yearly visit for a physical that costs $150 with a plan that is going to be less than $150 dollars. And this is for the exact reason that you can't buy lunch insurance. If you're expected to eat lunch seven days a week at $8 dollars/day you cannot purchase an insurance plan to pay for your lunch for $50 dollars a week. My classmates cannot get accustomed to the idea that they cannot will things to be made affordable to people to whom they want them made affordable.

As much as I'd like Congress to be locked out of the buildling for the next hundred years, I wouldn't feel too badly about legislation, like medical savings accounts, that would encourage the return of insurance to what it was meant to be used for, unexpected events with high cost. People should not be purchasing policies to cover yearly physicals, they should be purchasing policies to cover catastrophic events that are financially crippling and have a low likelihood of occurrence.

Ok, now that that's off my chest I should go to bed...it's late.


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## Harry96 (Aug 3, 2005)

The total perversion of the concept of insurance is a very important point that I forgot to mention. As you say, it makes no sense for insurance to pay for routine, out-of-pocket expenses; insurance is intended to reimburse for catastrophic loss. The health insurance people have today is like having homeowner's insurance that pays for things like nails or window cleaner, or car insurance that pays for oil changes and gasoline. 

I've been at my present job for almost six years and I've been paying about $80 a month for health insurance that whole time. I've only been to the doctor twice during that time, both times for bronchitis; each time, the charge for the office visit before insurance was about $65, with another $100 or so for my prescriptions (which are also grossly inflated due to government regulations). Obviously it'd be a much better deal for me to not even have insurance and just pay for the occasional office visit out-of-pocket. The reason I still carry insurance is to avoid being ruined by a hospital stay in the event of some catastrophe, like being in a terrible car wreck or coming down with cancer.


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## MichaelS (Nov 14, 2005)

Talk about blood pressure!

The only thing I can say about the often maligned European Health Care is that they live longer than us in Europe. (Don't attribute this to diet. Have you seen what the English eat?) Is it really all that bad?

I'll shut up now.

MichaelS


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## Fogey (Aug 27, 2005)

Ha.

'It's too difficult so we'd better not do it, despite the tens of millions who critically need it'. 

Way to go, superman.

Do you really think that 1000usd medical bill is 'no problem' for anyone? If so, then you have a lot of explaining to do about your vast knowledge of economics and markets.


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## ksinc (May 30, 2005)

Great posts all.

However, it's the contradictions like the supposed infinite value of saving a life that bother me philosophically. 

Speaking strictly in economics, the NPV of saving an unborn child (IO-$0) vs their potential taxable earnings is far greater than paying (IO-$50,000) for some senior on SS/medicare to have a hip replacement and sit by the shuffleboard courts.

Are we deciding based on values or value?

JLP... brings up an excellent point. Even our $1,000s deductibles are too high for many based on their net savings and net worth. Sad how many working adults have negative or zero cashflows or networth because of lack of education on managing money. We see it often with over-leveraged homes after hurricanes here in Florida and $10-$20k deductibles. If 'univeral healthcare' is an answer, then so must be 'universal car insurance', 'universal property insurance', 'universal mortgage insurance', 'universal credit insurance', 'universal unemployment insurance', etc., etc.!


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## agnash (Jul 24, 2006)

*Forgive the length of this post*

As an introduction, I work for a Medicare Provder partner. For those not in the know, Medicare eligibles sign up with Medicare partners. Medicare makes a monthly payment to the partner for everone signed up with that partner. In return, Medicare is off of the hook for any medical bills incurred by the medicare eligible who signed up with the partner plan. Medicare eligibles sign up with the Medicare partners, because the partner offers to cover things that Medicare does not, or the partner offers lower co-pays, or both. The partner has a steady stream of revenue from Medicare, and has an incentive to try and keep patient costs down. Due to legal constraints, and the possibility of people choosing to leave the plan, there are only two ways to keep medical costs down: keep members healthy, and negotiate prices to providers.
Over the course of my employment, I have had the opportunity (and sometimes been required) to study the history of the Medicare program, and the general path of payments for the medical system overall. Any student of economics can point out what happens when more money chases the same level of goods and services, the price of those goods and services increases. Under normal market conditions, new providers would appear to take up some of the excess demand, but it takes longer to increase the supply of doctors than it does to pass a piece of legislation that increases the amount of money available to pay for their services. An excellent point was made earlier about employers using medical insurance benefits to pay people in a manner not subject to income tax. I would argue that Medicare has had an even greater impact of driving up the price of healthcare. According to the literature provided to me by the CMS, the Federal Government now accounts for about 2/3 of all medical spending in United States.
I must admit that this leaves me in somewhat of a quandry. I know what a terrible drain Medicare is on the financial health of this country. For a truly horrifying Halloween treat, skip watching Friday the 13th this year, and read the Congressional Budget Office report on the state of the nation's finances. That said, I also see every day the impact the current system has on the lives of people. Again according to CMS, most of the healthcare cost for anyone in the U.S. will come after retirement, and most of that will come in the last year of life. It is not just the cost of the doctors, but also for the medicine. Drug producers have a disproportionate interest in creating end of life therapies for the elderly, becuase they know there will be a market that can pay for those drugs. 
Hopkins Student pointed out the dilema of at what price do you deny coverage? We have discussed that topic in strategic meetings. The British have a system where they consider the amount of life added vs. the cost of adding that life. For instance, a 12 year old with a newly diagnosed kidney problem would get a transplant ahead of a 65 year old who had been on the waiting list longer. Our current system favors the 65 year old.


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## ksinc (May 30, 2005)

agnash said:


> The British have a system where they consider the amount of life added vs. the cost of adding that life. For instance, a 12 year old with a newly diagnosed kidney problem would get a transplant ahead of a 65 year old who had been on the waiting list longer. Our current system favors the 65 year old.


Yep. We have the AARP.


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## Fogey (Aug 27, 2005)

ksinc said:


> Great posts all.
> 
> However, it's the contradictions like the supposed infinite value of saving a life that bother me philosophically.
> 
> ...


Interesting point, whether one is deciding based on compassionate ethics or with the cold precision of an actuary. I wasn't referring to merely deductibles, however, but also to those who have no medical coverage whatever (something like 12 million completely uninsured children alone).

Your other examples of 'universal mortgage insurance' etc are straw men. Many conservatives claim that whilst they certainly don't favour an equal finish line for everyone (obviously - I don't either), they do favour an equal starting line. When a large proportion of your population is condemned to endure treatable maladies merely because they haven't the funds, how can they expected to overcome all of their other disadvantages to compete on fair terms?

This is even more dramatic an issue for the uninsured children. It is really inconceivable to me that a civilised nation in 2006, that can afford it so easily like the USA can, would repeatedly refuse to extend basic healthcare to all of its citizenry.


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## SGladwell (Dec 22, 2005)

hopkins_student said:


> I agree with pretty much everything you said. Unfortunately, many of your arguments are futile against people who support universal health care.


Indeed, because supporters of a civilized health care system believe in data over dogma. And those pesky data unambiguously show that societies with universal healthcare (or even subsegments within the American heathcare mess, such as the VA since it was modernized under Clinton) have generally superior societal outcomes at a significantly lower cost.

Yes some universal systems are better or worse than others. I think that the NHS, for example, is not the best model. (Though it is better than our mess.) But that's a tactical issue. On strategy, the choice is obvious to anyone who's bothered to look at the numbers before consulting their local AM radio guru.

Also, all of you people blathering on and on about how evil government regulation is, why don't you put your feet where your mouth is (oops, you're already doing that, but anyway) and move someplace where there effectively isn't any. I hear Rummy could use some new boots on the ground...


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## Harry96 (Aug 3, 2005)

JLPWCXIII said:


> Ha.
> 
> 'It's too difficult so we'd better not do it, despite the tens of millions who critically need it'.
> 
> ...


What I actually said was closer to, "It's impossible to do and tens of millions critically need for us not to do it, so we better not do it."

I did not say that a $1,000 medical bill is "no problem" for anyone. I said it's a manageable problem and a much, much smaller one than a $50,000 or $100,000 bill that's the result of government-imposed distortions, and that "universal healthcare" will extend such distortions further, plus create new ones. And the $1,000 bill was for someone without insurance. At the time of $1,000 hopsital bills, health insurance for a family of four or five people cost about $50 a month in today's dollars.

"Government has increased the cost of medical care by as much as 100-fold in two generations and made health insurance unaffordable for many people, so instead of repealing those policies, the government should now completely take over the entire healthcare and medical insurance industries."

Which one of us has some explaining to do about his vast knowledge of economics and markets?

Nice to hear from you again, JLPWCXIII. It's always nice to write a lengthy, thoughful post and have someone respond with a sarcastic four-sentence dismissive that distorts two of my points and completely ignores any of the others.

Way to go, Lex Luthor.


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## Fogey (Aug 27, 2005)

Harry96 said:


> "Government has increased the cost of medical care by as much as 100-fold in two generations and made health insurance unaffordable for many people, so instead of repealing those policies, the government should now completely take over the entire healthcare and medical insurance industries."


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## ksinc (May 30, 2005)

JLPWCXIII said:


> Your other examples of 'universal mortgage insurance' etc are straw men. Many conservatives claim that whilst they certainly don't favour an equal finish line for everyone (obviously - I don't either), they do favour an equal starting line. When a large proportion of your population is condemned to endure treatable maladies merely because they haven't the funds, how can they expected to overcome all of their other disadvantages to compete on fair terms?


You lost me here. How are they straw men? How is enduring losing your home or car simply because you don't have funds through no fault of your own (natural disaster) any different than a treatable malady? Or losing your job because an industry becomes obsolete or moves offshore?

Many people in my state simply can't get any property insurance. Is that any different morally than not having access to health insurance? My own company, State Farm, is charging me a 'carrier fee' of $68/year to underwrite with Colonial, most were simply dropped that didn't have multi-line policies. My premium went from $812, $939, $1,009. That's not 'just inflation' or appreciation of home values. ;-)


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## ksinc (May 30, 2005)

SGladwell said:


> Indeed, because supporters of a civilized health care system believe in data over dogma. And those pesky data unambiguously show that societies with universal healthcare (or even subsegments within the American heathcare mess, such as the VA since it was modernized under Clinton) have generally superior societal outcomes at a significantly lower cost.


Ok then, "Name that tune!"

Which country and unambiguous data are you specifically referring to that has superior outcomes to American healthcare at significantly lower cost?


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## oktagon (Mar 9, 2005)

Universal health care is one of th biggest evils in the modern political ideology. While from the first glance it appearas humane, allot of people forget, that in order of universal care to work everething must be brought to the lowest common denominator. That means that in order for the poor people to be able to get free care YOUR healthcare benefits must decline to mimic those of Canada or similar socialist country. Are you prepaired to take that? I am not. I would rather have good coverage for myself and my famil then care about others. I am really sorry that they have to die, but after all we are trying to conserve the world's resources aren't we? Exsessive poluplation growth is bad.


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## ksinc (May 30, 2005)

oktagon said:


> Universal health care is one of th biggest evils in the modern political ideology. While from the first glance it appearas humane, allot of people forget, that in order of universal care to work everething must be brought to the lowest common denominator. That means that in order for the poor people to be able to get free care YOUR healthcare benefits must decline to mimic those of Canada or similar socialist country. Are you prepaired to take that? I am not. I would rather have good coverage for myself and my famil then care about others. I am really sorry that they have to die, but after all we are trying to conserve the world's resources aren't we? Exsessive poluplation growth is bad.


Did you know that Russian Dr. Pavlov, of Pavlov's Dog's fame, was actually a vetenarian and his experiments were motivated by wanting to achieve the same level of healthcare for dogs as that of humans in Russia?

... It took a long time, but after 70 years of communism, they finally succeeded! ;-)


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## oktagon (Mar 9, 2005)

Pavlov was actually not medical doctor, but physiologist. Otherwise you are correct.


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## ksinc (May 30, 2005)

oktagon said:


> Pavlov was actually not medical doctor, but physiologist. Otherwise you are correct.


Pavlov received his medical degree on 19 December 1879 with honors. He was awarded a gold medal for his experimental work on the circulation and competed successfully for a postgraduate fellowship that would support him to do full-time research at the Medical-Chirurgical Academy for 4 years.

Pavlov caught the eye of Professor S. P. Botkin, the leading clinician of Saint Petersburg. Botkin was the doyen of the Russian school of scientific medicine that aimed to replace the authority of anecdotal clinical experience with medical science from controlled experiment. Botkin had converted a shed in the garden behind his clinic into a primitive laboratory for animal experiments. Botkin invited Pavlov to direct the animal laboratory. This is the kind of offer young physiologists dream of, and it worked perfectly for Pavlov. Botkin was supportive, and, because of his extensive teaching and clinical responsibilities, he left Pavlov alone. Botkin also taught Pavlov to search for the explanation of all physiological phenomena in the action of nerves. This strong form of nervism was Pavlov's working hypothesis for the rest of his life.

Botkin was primarily interested in testing potential drugs for effects on the heart and blood pressure. Thus Pavlov was doing pharmacological experiments with medical students and physicians attracted to Botkin's clinic. It was here that Pavlov first demonstrated the experimental tactics and administrative skill to lead a group of investigators in a variety of complementary experiments.

In addition to helping others, Pavlov got on with his own work for his doctoral dissertation "The Centrifugal Nerves of the Heart." Using pharmacological and anatomic methods, Pavlov suggested that in addition to the known neural control that accelerated or slowed the rhythm of the heart, cardiac nerves also affected the functional activity of cardiac muscle and the conduction system. Pavlov concluded "the work of the heart is governed by four centrifugal nerves with respective functions of slowing, accelerating, weakening, and intensifying" (9, p. 302). Although Pavlov's conclusion was wrong, the experimental work satisfied the requirements for his MD thesis that he received with honors.

https://ajpregu.physiology.org/cgi/content/full/279/3/R743


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## oktagon (Mar 9, 2005)

Perhaps I was mistaken. 

When I recieved my medical degree from Novosibirsk Military Medical Academy, Pavlov was not as much on the cussiculum as Botkin and Pirogov.


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## ksinc (May 30, 2005)

oktagon said:


> Perhaps I was mistaken.
> 
> When I recieved my medical degree from Novosibirsk Military Medical Academy, Pavlov was not as much on the cussiculum as Botkin and Pirogov.


I haven't been there, but I have been to the Pavlov Medical Institute and to the University of Saint Petersburg, in 1997.

You are of course correct that he was a physiologist.

This helps explain his view on the relationship of medicine and physiology.

After graduation, Tsion offered Pavlov an assistantship in his laboratory at the Medical-Chirurgical Academy. Pavlov accepted this and also matriculated as a third year medical student (1, p. 14). It is clear that Pavlov was not interested in the practice of medicine. He took courses in medicine to broaden his knowledge of physiology. His experience in medicine was formative. Not only did it give him an acquaintance with human physiology and current ideas of the pathophysiology of diseases, but it also encouraged him to be on the lookout for ways in which experimental progress in the laboratory could be transferred to the bedside and clinic. Pavlov was one of the new generation who saw physiology as the basic science of medicine.


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## oktagon (Mar 9, 2005)

Off course. Most of Pavlov's work did not in fact concentrate on pathophysiology, but in normal physiology of nutrition and digestion, as well as neurophysiology. He was one of the first scientists to use modern approach to link biockemical physiology with neurophysiology in jis famous experiments with fistulated dogs and goats. 
He has also peoposed a theory on the connection between precursor signals and secretory reaction which was in fact the basis of his works.


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## SGladwell (Dec 22, 2005)

ksinc said:


> Which country and unambiguous data are you specifically referring to that has superior outcomes to American healthcare at significantly lower cost?


Every other country in the Western world. Arguably Costa Rica, Chile, and (yes) Cuba, too. As for the data, feel free to look them up.


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## pt4u67 (Apr 27, 2006)

SGladwell said:


> Every other country in the Western world. Arguably Costa Rica, Chile, and (yes) Cuba, too. As for the data, feel free to look them up.


As a medical professional I have to ask how "outcomes" are defined.


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## ksinc (May 30, 2005)

SGladwell said:


> Every other country in the Western world. Arguably Costa Rica, Chile, and (yes) Cuba, too. As for the data, feel free to look them up.


Really? Every other country?

So, why can't you pick one, and why can't you just share your unambiguous data?

How about Cuba since it's easy.

Perhaps you read/listen to too much Paul Krugman and his unambiguous 'life expectancy' argument?

For the last several years, some critics of the American health care system have claimed that life expectancy is a good indicator of the quality of a country's health care system. If they are right, you should be indifferent about having your surgery in Cuba or in the United States because the two countries have the same life expectancy, 75.6 years. And you would have to say that the health care system of Barbados was nearly as good as that of the United States, since average life expectancy in Barbados (75.3 years) is almost the same. In fact, if general life expectancy is the right guide, you would probably want the surgery done in Costa Rica, since life expectancy there (76 years) is higher than in the United States.

Sound silly? Of course it is. And critics of the American health care system cite several other statistics that are also poor indicators of a health care system's quality. Let's see why.

Life Expectancy.
While a good health care system may, by intervention, extend the life of a small percentage of a population, it has very little to do with overall life spans. Life expectancy " in all but the least-developed countries " is primarily a result of genetic and social factors (e.g., lifestyle, environment, education, etc.) rather than the quality of medical care.
For example, Japan's average life expectancy (78.6 years) is one of the highest in the world, about three years higher than that in the U.S. If the three-year difference were the result of lower-quality health care in the United States, you would expect Japanese-Americans living in this country to experience shortened life spans. They don't. According to the National Asian Pacific Center on Aging, in 1980 (the latest numbers available) white Americans had an average life expectancy of 76.4 years, while Japanese-Americans had an average life expectancy of 79.7 years - just about the same three-year spread that exists between the populations of the two countries. Similarly, the California Department of Health reports that people of Asian or Pacific Island ethnic origin living in the state and using its health care system have a life expectancy 5.3 years longer (81.2 versus 75.9 years) than white Californians.

Critics of the American health care system who compare life expectancies are comparing apples and oranges. Of the industrialized countries with better life expectancies than the U.S., nearly all have overwhelmingly white populations of European descent. None have large black populations. Unfortunately, black Americans have more health problems and shorter life expectancy (70 years in 1991) than whites. The American population is a mixture of several ethnic groups - some with longer and some with shorter life spans than whites. Pointing to the average distorts the picture significantly.

Infant Mortality.
Critics claim that the second-best indicator of the quality of health care is infant mortality. However, the evidence shows that differences in infant mortality frequently reflect differences in genes, lifestyles and environments rather than in the quality of medical care. Data from the California Department of Health Services, for example, show that the average infant mortality rate was 8.6 deaths per 1,000 live births in the 1980s. But Americans of Japanese descent living in California had an infant mortality rate of 4.8 deaths per 1,000 live births through 1989 (the latest data available for these populations), while Chinese had 7.1 deaths, Filipinos 7.8 deaths, Hispanics 7.8 deaths, whites 7.7 deaths and blacks 18.0 deaths per 1,000 live births. Since individuals in the different groups often live in the same communities and use the same hospitals and physicians, the difference clearly is a result of something more than the health care system. The health care policy problem is that some ethnic, geographic and economic groups need better health care. Desegregating the numbers helps illuminate the target populations to whom better health care must be delivered. Using national averages to stigmatize systemwide quality is clearly unjustified.

Average Hospital Stay.
Some critics also claim that the amount of health care is greater (better) as hospital admissions and lengths of stay increase. By this standard, the United States is stingy. The average hospital stay in all developed countries is 12.9 days, compared to 6.4 days in the United States in 1992. In Japan, which spends far less per capita on health care than the United States, the average length of a hospital stay is 50 days, nearly eight times that of the United States.
However, less inpatient and more outpatient care has been a goal of U.S. health care policy for the past two decades. And most health economists regard shorter stays as a sign of hospital efficiency, not of the failure to provide needed care.

In many other countries, hospital stays are long because large numbers of patients use hospitals as nursing homes. Chronic patients, who really don't need to be in a hospital, fill about a fourth of all beds in England, Canada and New Zealand. In addition, recuperating patients are encouraged to remain hospitalized. Both groups of patients, who require little additional therapy, cost less to maintain than acute patients who need expensive treatment. Such patients, known as "bed blockers," help limit the costs of hospitals struggling under restrictive global budgets - budgets that ration care and cause long waits for hospital admission.

Primary Care Physicians. 
The U.S. is often criticized for having too many specialists and not enough primary care physicians. At the moment, medical school students choose to be specialists about 70 percent of the time, primary care doctors 30 percent. By law, the Clinton health care proposal would have changed that mix to 50 percent each, forcing another 20 percent of the young men and women entering medical school to practice primary care. But is there a shortage of primary care physicians? Not really. When was the last time you saw a waiting line outside a primary care clinic? Moreover, a recent survey by the American Medical Association found that if physicians who practice both specialized and primary medicine are combined with the 34 percent who practice primary care exclusively, about 47 percent of all physicians engage in some form of primary care - nearly reaching Clinton's target with no government interference.
There are shortages of primary care physicians in some rural and inner-city areas, but almost nowhere else. For example, a 1990 survey found that only 28 doctors serving a population of 1.7 million low-income people in New York's Harlem were qualified to provide primary care. The explanation for such shortages has little to do with the ratio of primary care physicians graduating from medical school. There simply isn't enough money in rural and inner-city areas to support such physicians. Rural areas may not have enough people to warrant having a physician close by, while Medicaid, the federal health insurance program for the poor, pays so little that very few physicians can afford to locate in inner-city areas with a preponderance of Medicaid patients.

Oh and here's some more:

Krugman's arguments are enticing. But they gloss over basic facts. Consider:

Americans tend to believe that we have the best health care system in the world. . . . But it isn't true. We spend far more per person on health care . . . yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.

Krugman's error here is a common one: assuming that universal health insurance and good health go hand-in-hand. 
But life is not so simple. Take infant mortality. According to the National Center for Health Statistics, Mexican-American and white babies in the United States have a lower infant mortality rate (about 6 in a thousand live births) than Native Americans (9) or blacks (14). Yet Mexican Americans also have the least access to health insurance of any of these groups. In fact, it's even more complicated: A study in the Journal of the American Medical Association suggests that Mexican-American babies are twice as likely to be born outside a hospital as babies of all other groups.

Infant mortality statistics--like life expectancy--reflect a mosaic of factors, such as diet, marital status, drug use, and cultural values. Dismissing American health care on the basis of such statistics is like declaring Cuban democracy stronger than America's based on voter turnout.

Krugman again:

Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills. . . . What do we get for all that money? Not much.

Actually, if we measure a health care system by how well it serves its sick citizens, American medicine excels. Comparing breast cancer statistics in Germany, Britain, France, Spain, Italy, and the United States, market analyst Datamonitor finds that 95 percent of American women are diagnosed in early stages (I or II). In contrast, a full 20 percent of European women are diagnosed in late stages. WHO data on five-year survival rates for various types of cancers bear this out. For leukemia the American survival rate is almost 50 percent; the European rate, just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. Say what you want about the problems of American health care, but for those stricken with disease, there's no better place to be than the United States.


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## Phinn (Apr 18, 2006)

Within a decade of its enactment, we can expect the financial solvency and quality of service of "universal health care" to closely resemble those of the Post Office, Medicare and Amtrak. 

If you are looking for another example of the economic outcomes of government-run programs, there is always the Big Dig.


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## Newton (Oct 6, 2006)

Coming from outside the USA, this is an interesting argument to read.

Most people in Australia and probably elsewhere regard the US health system as a joke. We cannot believe that you would tolerate it!

I am not a America basher so I will hold my tongue a little bit.

But to the erstwhile economist earlier in the thread, you have been distracted by theory and have actually missed the entire point of practising and studying economic theory/philosophy.

The point is this:

Economics is about overall societal prosperity. In effect, this means, it's about improving the conditions for the lowest tiers of the society.

Our goal is to provide living conditions that are as good as possible to the very last person. It's not about pure efficiency. Economics students very often forget this. They worship the model. But the model is a servant of the people.

Yes, even liberalised markets, which I also believe in as a framework.

Following through from this, if a society can afford it, they SHOULD provide healthcare to all who need it. Education and healthcare are two of the most basic and necessary services of government and unfortunately, your government provides neither. (College education funds, anyone?)

I went to hospital for a week earlier this year. If I had been forced to pay for it myself, I would have had to fork out three months of my own income. That does not include the expense from the CT and MRI scans.

I didn't pay one cent for those tests(directly.) Other testing, I paid 50% of the cost and the other half was subsidised. All Australians subsidise the healthcare system by paying 1.5% of their income to health, known as the Medicare levy. We're happy with this, because we know that if we fall ill - such as my case - that we will be ok. What a comforting guarantee.

America would be well-served by a similar system.


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## Newton (Oct 6, 2006)

ksinc said:


> In contrast, a full 20 percent of European women are diagnosed in late stages.


But you must look at causation.

As soon as I read this, my first reaction was that this must be about cultural taboos regarding seeing the doctor, pride, etc. Having lived with Americans and Europeans, I can say that Americans are far more likely (in my anecdotal experience) to see a doctor over a minor issue.

This seems good enough explanation for early diagnosis rates.


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## ksinc (May 30, 2005)

Newton said:


> Coming from outside the USA, this is an interesting argument to read.
> ...
> Most people in Australia and probably elsewhere regard the US health system as a joke. We cannot believe that you would tolerate it!
> ...
> America would be well-served by a similar system.


Well, I think most Americans appreciate your kind thoughts and sympathies.

Thank You, for your concern and we wish our Australian friends the very best as well.

It's tough being an American, but someone has to do it.


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## Fogey (Aug 27, 2005)

ksinc said:


> Well, I think most Americans appreciate your kind thoughts and sympathies.
> 
> Thank You, for your concern and we wish our Australian friends the very best as well.
> 
> It's tough being an American, but someone has to do it.


Meanwhile:


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## pt4u67 (Apr 27, 2006)

Newton said:


> Coming from outside the USA, this is an interesting argument to read.
> 
> Most people in Australia and probably elsewhere regard the US health system as a joke. We cannot believe that you would tolerate it!


I understand how you can feel this way however I can assure you its not a joke. We stay quite healthy for a nation of 300,000,000 people and counting. That it entails an out of pocket cost is true as opposed to Australia, Great Britain or other countries with socialized medicine however keep in mind that you levy a tax on your citizens for these costs so there really is an out of pocket cost. You say you pay a 1.5% tax to cover healthcare costs however that is quite a bit. Someone making $100K per annum pays $1500. I would also venture an educated guess that although a 1.5% tax is levied that does not account for the true cost.

I did a little experiment: I assumed that both my wife and I live in Australia and earn a similar income as we do now in the U.S. Our marginal rate in Australia would be 40% for every $1 over 75,000 of taxable income. In the U.S. it would be 28%. According to my calculations our income tax burden in Australia would be double what it is now. I'm not suggesting that every penny of that goes into healthcare but I'm sure a good chunk of that is allocated to your healthcare system. Add to that a 1.5% medicare levy and we're talking about a serious outlay of cash per individual. Those money's could be injected into the marketplace creating an economic boom allowing for private healthcare insurance and the privatization of the healthcare system.

And while Australia is not Canada please look at the following for an example of what a public healthcare system can turn into:

and


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## Fogey (Aug 27, 2005)

pt4u67 said:


> I understand how you can feel this way however I can assure you its not a joke. We stay quite healthy for a nation of 300,000,000 people and counting. That it entails an out of pocket cost is true as opposed to Australia, Great Britain or other countries with socialized medicine however keep in mind that you levy a tax on your citizens for these costs so there really is an out of pocket cost. You say you pay a 1.5% tax to cover healthcare costs however that is quite a bit. Someone making $100K per annum pays $1500. I would also venture an educated guess that although a 1.5% tax is levied that does not account for the true cost.
> 
> I did a little experiment: I assumed that both my wife and I live in Australia and earn a similar income as we do now in the U.S. Our marginal rate in Australia would be 40% for every $1 over 75,000 of taxable income. In the U.S. it would be 28%. According to my calculations our income tax burden in Australia would be double what it is now. I'm not suggesting that every penny of that goes into healthcare but I'm sure a good chunk of that is allocated to your healthcare system. Add to that a 1.5% medicare levy and we're talking about a serious outlay of cash per individual. Those money's could be injected into the marketplace creating an economic boom allowing for private healthcare insurance and the privatization of the healthcare system.
> 
> ...


What good is a theoretical 'economic boom' for poor people who cannot even get their children treated for asthma?


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> What good is a theoretical 'economic boom' for poor people who cannot even get their children treated for asthma?


Who are these children, or are you simply making a rhetorical argument? Is there an untreated asthma epidemic in Australia? I don't know but if you do could you please inform me.

An improving economy will be to the advantage of every citizen. The opportunity to purchase healthcare appropriate for a given family/citizen will greatly improve. For people that are truly destitute and cannot afford medications then the government can step in. That's the way it works here and for even nastier diseases.

Also keep in mind that we have a multitude of charitable organizations that are able to step in and provide for our lesser fortunate neighbors. That is the essence of civil society after all; neighbors caring for neighbors without everyone standing around waiting for the government to solve our problems.


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## ksinc (May 30, 2005)

JLPWCXIII said:


> Meanwhile:


You assume Insurance equals healthcare. Wrong, but thanks for playing.


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## ksinc (May 30, 2005)

JLPWCXIII said:


> What good is a theoretical 'economic boom' for poor people who cannot even get their children treated for asthma?


I like this. One guy says we go to the doctor too much, you say we don't we go enough.

Could we only argue one side of the issue? Thanks!

FTR they CAN get their children treated for asthma, but often they don't GO to the doctor.


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## Fogey (Aug 27, 2005)

pt4u67 said:


> Who are these children, or are you simply making a rhetorical argument? Is there an untreated asthma epidemic in Australia? I don't know but if you do could you please inform me.


 I thought you said, in essence, that you would propose dismantling the Australian healthcare system in favour of lower taxes. Sorry for misunderstanding.


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## Fogey (Aug 27, 2005)

ksinc said:


> You assume Insurance equals healthcare. Wrong, but thanks for playing.


I beg your pardon? Health insurance does not give one access to healthcare? When was this press conference?


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## Fogey (Aug 27, 2005)

ksinc said:


> FTR they CAN get their children treated for asthma, but often they don't GO to the doctor.


Perhaps because they cannot afford it? Do you realise that some people are, in fact, poor?


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> Perhaps because they cannot afford it? Do you realise that some people are, in fact, poor?


There aren't many places in this country, in fact none that I can think of, where children do not have access to at least some baseline of healthcare. I Chicago we have the Cook County Hospitals and they provide healthcare to the indigent population. Many charitable organizations will arrange for screenings and preventative medicine as well. Low cost drugs are available to those who cannot afford them through special state, federal as well as charitable and yes even drug company programs. The only catch however is that people need to access them and assume responsibility for their own healthcare.

And yes there are poor people in this country however our poor people are actually pretty well off. America is the only country I know where even poor people are fat.


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> I thought you said, in essence, that you would propose dismantling the Australian healthcare system in favour of lower taxes. Sorry for misunderstanding.


You assume that only one healthcare system can exist in Australia. I'm not Australian so far be it for me to suggest how they run their healthcare system. Even so, dismantling the current system in favor of another is not the same as abolishing it all together.


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## Phinn (Apr 18, 2006)

Newton said:


> Most people in Australia and probably elsewhere regard the US health system as a joke. We cannot believe that you would tolerate it!


I agree -- the US medical system is bad and getting worse. However, it does not follow that increasing the scope of government interference in the provision of such services will improve things.



> Economics is about overall societal prosperity. In effect, this means, it's about improving the conditions for the lowest tiers of the society.


This is a non-sequitur. First you say that economics is about overall prosperity, then you say it is about the prosperity of only one specific segment of the population. Which is it?



> Our goal is to provide living conditions that are as good as possible to the very last person. It's not about pure efficiency. Economics students very often forget this. They worship the model. But the model is a servant of the people.


No, YOUR goal may be to "provide living conditions that are as good as possible to the very last person," but that does not make it "our" goal. Only individuals can have goals, and each person's goals are defined by him alone. That is what freedom is -- the ability of everyone to define for himself what his goals are. More importantly, it includes the freedom to set ones own priorities from among competing goals.

I also dispute whether your goal, as stated, is in anyway meaningful.

A model is not "a servant of the people." No one is a servant of anyone, in my opinion, not unless you agree to become someone's servant. Plus, to the extent that a model is a useful analytical tool, it is not anyone's "servant." It is (if correct) an expression of scientific fact.

What you are proposing is that everyone should be COMPELLED BY FORCE to contribute toward YOUR goals. To the extent that anyone disagrees with you, you want them to be threatened with violence, and thrown in jail if they do not comply.

All government action is nothing but organized force. You should not congratulate yourself for being so quick to use this system of violence to make others work to achieve your objectives.



> if a society can afford it, they SHOULD provide healthcare to all who need it. Education and healthcare are two of the most basic and necessary services of government and unfortunately, your government provides neither. (College education funds, anyone?)


Societies do not afford anything. People own things, and what people own determines what they can afford.

There is nothing about education or healthcare that makes them "services of government." They are services, yes, but like every other service in the world, they are provided at a higher quality and lower cost in a free, private market than in any other way.



> I went to hospital for a week earlier this year. If I had been forced to pay for it myself, I would have had to fork out three months of my own income. That does not include the expense from the CT and MRI scans.


This is my point -- the REASON the costs are so high in the first place is that government interference has increased them.



> We're happy with this, because we know that if we fall ill - such as my case - that we will be ok. What a comforting guarantee.


"We" are not happy with anything. Only individuals are capable of being happy. Groups can be neither happy nor unhappy.



> America would be well-served by a similar system.


No, it wouldn't.


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## Fogey (Aug 27, 2005)

pt4u67 said:


> There aren't many places in this country, in fact none that I can think of, where children do not have access to at least some baseline of healthcare. I Chicago we have the Cook County Hospitals and they provide healthcare to the indigent population. Many charitable organizations will arrange for screenings and preventative medicine as well. Low cost drugs are available to those who cannot afford them through special state, federal as well as charitable and yes even drug company programs. The only catch however is that people need to access them and assume responsibility for their own healthcare.
> 
> And yes there are poor people in this country however our poor people are actually pretty well off. America is the only country I know where even poor people are fat.


So you can guarantee that every single person in America has access to decent healthcare? And not in the sense that they will be treated, and sent a bill that will financially ruin them.

And, do you think that being fat is indicative of good nutrition and healthcare?


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## Harry96 (Aug 3, 2005)

Newton said:


> Coming from outside the USA, this is an interesting argument to read.
> 
> Most people in Australia and probably elsewhere regard the US health system as a joke. We cannot believe that you would tolerate it!
> 
> ...


Welcome to the board, Newton.

I am also concerned about overall societal prosperity, which is why I want to see the destructive, wealth-depleting, murderous parasite of government to be minimized as much as possible. (As a note about that, an economist recently calcuated that, if taxes and regulations reduce GDP by the very, very modest estimate of 1%, adding 1% to the U.S. GDP just since 1959 would make the average income in the U.S. today about $68,000, with the worker keeping all of it; a still-modest 2% would make the average income in the U.S. today about $110,000 -- nearly four times the real average of $28,000 after taxes. When I read that, I thought, "Good thing the government is there to 'help' the poor." I'm sure I can find the article for anyone who's interested.)

A free society WILL provide healthcare to all who need it. Any need that a large number of people have is a market for someone to make a living providing a solution. And a free society would address the most basic concerns -- like food, clothing, shelter and medicine -- before moving on to other, less important consumer goods (which means when such consumer goods are widely available, that society is quite wealthy). Before anyone responds by pointing out the abundance of consumer goods in America while people go without health insurance, this is not anything close to a free society, despite what cretins like George W. Bush claim.

On that note, in terms of my original post, I don't know what people who compare the American sytem of today to that of other countries think they're proving; it seems to me that they're unwittingly reinforcing my point. If you think that we have a laissez-faire healthcare industry here, you couldn't be more wrong. Already over half of the dollars spent on healthcare in the U.S. are spent by government. I find it telling that no advocates of "universal" healthcare have even attempted to rebut any of my specific arguments, nor have they contended that systems in other countries are better than the extremely inexpensive system in the U.S. 50 years ago (which also wasn't free, but it was a lot closer than what we have here today), or than what a totally free, private system would provide.

I have to again go back to food, which is even more vital than healthcare. Everyone should make a note that the market here controls food production and distribution with some (but relatively little) meddling by governments, and even the poorest have more food than they can eat. There are no constant crises; no chronic shortages; no Stalinesque five-year plans to "fix" things; no Congressional hearings; none of the problems that we take for granted with anything in the public sector; the market just works its magic in the background and is there to provide things people want.

It should also be noted that healthcare is technology-driven, so one should wonder how it is that the prices of consumer electronics keep collapsing to a startling degree, while healthcare costs continue to soar. I guess people acting in their own self-interest are too stupid to understand that things like Ipods, PCs and plasma TVs are less important than healthcare, so we need a "planner" with a higher mind to come in and "run" things. Yes, such central planning is the reason healthcare is so expensive in the first place, but why should such trivial details bother the reformers who have further distortons to impose on us -- all for the "good" of "society;" or "the children" or (fill in your own blank)?

Also, has anyone considered in the midst of the wailing about how many people don't have health insurance (especially "the children!" my god, "the children!"), aside from the fact that insurance and healthcare are so expensive because of government distortions, that some people have decided that they don't want insurance because they have more urgent things on which to spend their money? Even if they're hurting themselves, what business is it of yours? Of course, the poor never make rational, deliberate decisions based on their available alternatives and resources; they're always "driven" to things by forces outside their control.

No child (or adult) has food insurance, or clothing insurance, or homelessness insurance. How come there's no wailing about that, since those things are even more vital than healthcare? Oh, sorry, I forgot that's a strawman argument (Phillip, perhaps you should look up the definition of "strawman;" contrary to what you seem to believe, the definition is not "a relevant, cogent rebuttal for which I have no response.")


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> So you can guarantee that every single person in America has access to decent healthcare? And not in the sense that they will be treated, and sent a bill that will financially ruin them.
> 
> And, do you think that being fat is indicative of good nutrition and healthcare?


What is "decent healthcare?" We don't have epidemics in this country. Childhood diseases that 100 years ago were a scourge are no longer really relavent. We have a public health care system that is second to none in identifying disease trends and getting the information to the public and healthcare professionals.

Does this mean that every single person in every instance will always get the care they need? Probably not. I would argue however that people to have "access" in the form of public aid and charitable organizations. People are also free to make choices. Health savings accounts and cafeteria plans are available from most employers. Most people in this country still get healthcare insurance through their employers and yes, even evil WalMart provides healthcare insurance for as low as $11/month for its employees. Access? Yes.


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## Fogey (Aug 27, 2005)

pt4u67 said:


> What is "decent healthcare?" We don't have epidemics in this country. Childhood diseases that 100 years ago were a scourge are no longer really relavent. We have a public health care system that is second to none in identifying disease trends and getting the information to the public and healthcare professionals.
> 
> Does this mean that every single person in every instance will always get the care they need? Probably not. I would argue however that people to have "access" in the form of public aid and charitable organizations. People are also free to make choices. Health savings accounts and cafeteria plans are available from most employers. Most people in this country still get healthcare insurance through their employers and yes, even evil WalMart provides healthcare insurance for as low as $11/month for its employees. Access? Yes.


But as you know we're not just talking about access...such as going to the Emergency Room for a cold, but having a system that meets all the needs from beginning to end of every citizen, regardless of ability to pay.


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> But as you know we're not just talking about access...such as going to the Emergency Room for a cold, but having a system that meets all the needs from beginning to end of every citizen, regardless of ability to pay.


A nationalized healthcare program does not provide this either. Are there not shortages and restrictions as such? I recall a study once that found that there are more MRI scanners in the city of San Diego than in the country of Canada. The system we have does meet all those need but it also asks that individuals take responsibility to make insurance available to themselves as well. There are a number of people who opt out of employer provided healthcare insurance because of the cost. This accounts for nearly 20% of all uninsured lives. And for those without employer provided benefits there are state benefits available.

At the risk of using anecdotal evidence allow me to speak of my personal experience. When I was in graduate school I was obligated to have healthcare insurance. I opted to shop for insurance myself rather than going with the schools preferred program. I found a policy paying $80/month in premiums for coverage. The coverage was bare minimum however I was (and still am relatively) young and therefore my healthcare needs were very different from someone older. My point however is that with a bit of research and smart consumerism many can obtain healthcare insurance appropriate for their needs.


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## Harry96 (Aug 3, 2005)

JLPWCXIII said:


> But as you know we're not just talking about access...such as going to the Emergency Room for a cold, but having a system that meets all the needs from beginning to end of every citizen, regardless of ability to pay.


Now THAT'S a strawman argument! You're absolutely right, the private sector can never live up to this impossible, absurd utopian fantasy. I concede. (Of course, governent can make this fantasy a reality, because it can wave a magic wand and make resources appear out of thin air that didn't exist previously, and/or grant omniscience to the people in charge to direct the resources that do exist exactly where they need to go.)


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## Harry96 (Aug 3, 2005)

Phinn said:


> I agree -- the US medical system is bad and getting worse. However, it does not follow that increasing the scope of government interference in the provision of such services will improve things.
> 
> This is a non-sequitur. First you say that economics is about overall prosperity, then you say it is about the prosperity of only one specific segment of the population. Which is it?
> 
> ...


Excellent post, Phinn. I don't feel quite so lonely with you here!


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## pt4u67 (Apr 27, 2006)

Harry96 said:


> Now THAT'S a strawman argument! You're absolutely right, the private sector can never live up to this impossible, absurd utopian fantasy. I concede. (Of course, governent can make this fantasy a reality, because it can wave a magic wand and make resources appear out of thin air that didn't exist previously, and/or grant omniscience to the people in charge to direct the resources that do exist exactly where they need to go.)


And how easy it is to achieve it when one is oppressively taxed!


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## Fogey (Aug 27, 2005)

Harry96 said:


> Now THAT'S a strawman argument! You're absolutely right, the private sector can never live up to this impossible, absurd utopian fantasy. I concede. (Of course, governent can make this fantasy a reality, because it can wave a magic wand and make resources appear out of thin air that didn't exist previously, and/or grant omniscience to the people in charge to direct the resources that do exist exactly where they need to go.)


Your vision of a better world is awesomely inspiring.


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## Harry96 (Aug 3, 2005)

JLPWCXIII said:


> Your vision of a better world is awesomely inspiring.


Don't you hate it when someone disrupts your worldview with facts?


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## Fogey (Aug 27, 2005)

Harry96 said:


> Don't you hate it when someone disrupts your worldview with facts?


I wouldn't know...it never happens.


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## Harry96 (Aug 3, 2005)

JLPWCXIII said:


> I wouldn't know...it never happens.


I'm glad you and I can agree on something.


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## Fogey (Aug 27, 2005)

Harry96 said:


> I'm glad you and I can agree on something.


Indeed :icon_smile:


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## ksinc (May 30, 2005)

JLPWCXIII said:


> I beg your pardon?


Of course, you are excused.



JLPWCXIII said:


> Health insurance does not give one access to healthcare?


No, I said they are not equal. People with insurance receive no, little, or bad healthcare all the time. Inversely, people without insurance receive excellent healthcare all the time.

You assume not having insurance equals not having healthcare. Insurance is only another 3rd-party payment system. Statistics on how many children do not have insurance is not an indicator of how many do or do not receive healthcare.



JLPWCXIII said:


> When was this press conference?


Around 230 years ago.


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## Fogey (Aug 27, 2005)

ksinc said:


> No, I said they are not equal. People with insurance receive no, little, or bad healthcare all the time. Inversely, people without insurance receive excellent healthcare all the time.


Ah - so you cancelled your health insurance, correct, so you could take advantage of the excellent healthcare that uninsured people enjoy?


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## ksinc (May 30, 2005)

JLPWCXIII said:


> Ah - so you cancelled your health insurance, correct, so you could take advantage of the excellent healthcare that uninsured people enjoy?


I haven't had health insurance since 1992.

Still, you miss the larger point as usual. Statistics about un-insured Americans do not absolutely mean they do not receive healthcare.

Your biased assumptions continue to be absolutely wrong.


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## Fogey (Aug 27, 2005)

ksinc said:


> I haven't had health insurance since 1992.


At least you are consistent. But what about all the others who are unable to find this 'excellent free healthcare'?


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## ksinc (May 30, 2005)

JLPWCXIII said:


> At least you are consistent. But what about all the others who are unable to find this 'excellent free healthcare'?


All what others?

Who said it was free?

You really don't read very well. I repeat AGAIN ...

Not having insurance does not imply one does not receive health care or pay for health care.

Insurance is only a 3rd party payment plan. Insurance is just one way most people pay for healthcare.

I said, I don't have insurance and I receive excellent healthcare.
I said, some people have insurance and still receive no, little, or bad healthcare.

There is usually a high correlation, but particularly with children not having insurance has little to do with receiving healthcare. Since this was the majority of your complaint you should feel better knowing you were absolutely wrong, again.


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## Newton (Oct 6, 2006)

pt4u67 said:


> Who are these children, or are you simply making a rhetorical argument? Is there an untreated asthma epidemic in Australia? I don't know but if you do could you please inform me.


His point was that even the poorest family in Australia can get asthma treatment for their kid at subsidised rates, while in a more liberalised economy such as America, they cannot.


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## ksinc (May 30, 2005)

Newton said:


> His point was that even the poorest family in Australia can get asthma treatment for their kid at subsidised rates, while in a more liberalised economy such as America, they cannot.


Correct. A poor family in America would probably get treatment for their asthmatic child for free or almost free.

Here's an example of how we do it

Please explain America to us further. It's very interesting ...


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## Fogey (Aug 27, 2005)

ksinc said:


> Correct. A poor family in America would probably get treatment for their asthmatic child for free or almost free.
> 
> Here's an example of how we do it
> 
> Please explain America to us further. It's very interesting ...


What do you think would happen to that place if they were flooded with thousands of uninsured people at once? Millions? Tens of millions? Does the idea of a centralised, rational system of universal healthcare contradict some clause in your core morality, or do you really think this inadequate, _ad hoc_ system is superior in delivering healthcare to everyone?


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## pt4u67 (Apr 27, 2006)

Newton said:


> His point was that even the poorest family in Australia can get asthma treatment for their kid at subsidised rates, while in a more liberalised economy such as America, they cannot.


Really? Where? Are you basing this on empirical evidence. I honestly have not heard of children with asthma dying because they did not have asthma medication available to them. Every state in the union has a public aid program through which poor families are able to obtain medicines for children. Even more precisely there are state program funded specifically for children's medicines. As well, typical asthma control medications (albuterol, etc.) are very inexpensive and affordable even without public aid.

Perhaps there are isolated cases where the machinery of the state grinds slowly and someone falls through the cracks however how much more so is that to be the case when the government controls healthcare access.

If someone wants to make an argument that the U.S. healthcare system is broken, fine. Let that person make the point not using platitudes but facts.


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## ksinc (May 30, 2005)

JLPWCXIII said:


> What do you think would happen to that place if they were flooded with thousands of uninsured people at once? Millions? Tens of millions?


My educated guess is: the same thing that would happen to any other clinic that was beseiged with thousands, millions, or tens of millions of customers regardless of it's management or their ability to pay.



JLPWCXIII said:


> Does the idea of a centralised, rational system of universal healthcare contradict some clause in your core morality, or do you really think this inadequate, _ad hoc_ system is superior in delivering healthcare to everyone?


My core morality in regards to government and solutions to problems is "do more of what works and less of what doesn't".

Centralized systems are simply an inadequate solution over the long term to have healthcare. The simplest of economic analysis prove this out. Time and again there are longer waits, shortages, and quality of care declines. It's the same with bread, housing, or health care.

In spite of hysterical claims to the contrary and sure some existing problems, the US market works. Competition and CHOICE works. The majority of the existing problems were actually introduced by people that are not following the rule I follow. Insurance companies - whether HMOs or Medicare/Medicaid and lawyers are largely to blame for the problems we do have, but make no mistake about it. If you were to get really sick, you want to be in America. Competition and free markets are the answer to most problems and America's generosity and kind hearts is the answer to the rest.

Look at how much we send to Africa/Aids in medical relief. What is any other country doing by % and $? Look at what Gates and Buffet and other Americans are doing on a host of health care issues from clean water to immunizations for poor people ALL OVER THE WORLD that your centralized systems can not and will not care for.

Take for example, INDIA. India is having a huge thriving market in offering surgeries to Americans at competitive prices. They are basically OUTDOING America with our own ideas, un-molested by lawyers and insurance companies. It drives free market, conservatives like myself nuts to see it. They have brand new, modern hospitals and equipment, are filled with American educated, English speaking doctors and include flight costs in their medical fees for surgeries.

See: Russia, Great Britain, Canada for the the long term, non-market health care experiments future ahead of the rest of the world and America if we succumb to cries for universal healthcare and centralized healthcare.

I find it really humorous that most of your questions are rhetorical and seem to be based on the assumption that Americans like myself must just be stupid and don't get it.

Do you think all the other golfers in the world wonder why Tiger is so stupid and messed up and not doing things the way they are doing them? No they are all trying to copy Tiger because he is #1. Why exactly should the US copy someone else? Because some idiot at the WHO can't read life expectancy results and draws the wrong conclusions? Because Paul Krugman says so? PK is a wacko.

You probably missed my post about going to Russia. What do you think the group I was with was doing over there? Learning how to build a health care system to Russian standards? Heck, you probably do.


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## Fogey (Aug 27, 2005)

ksinc said:


> In spite of hysterical claims to the contrary and sure some existing problems, the US market works. Competition and CHOICE works.


But not for everyone. When forty million people are left behind, that is a flaw in the system.


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## Karl89 (Feb 20, 2005)

Gents,

I like the MA plan, where private insurance is REQUIRED for everyone and if you can't afford it then the state pays your premiums. Clearly our system is a mess and the lack of primary care and preventative medicine in the US is a huge problem but I don't think a national healtcare system is the way to go.

Another problem is end of life costs, particularly if the person is being aggressively treated are tremendous. Life expentancy may have increased but quality of life, especially in the final years has not. Couple this with the huge problems we face with Social Security and underfunded private pension liabilities and a huge financial crisis looms.

The progress paradox strikes again.

Karl


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## ksinc (May 30, 2005)

JLPWCXIII said:


> But not for everyone. When forty million people are left behind, that is a flaw in the system.


If that were true, yes. It's not. So, what's your point?


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## Phinn (Apr 18, 2006)

> What do you think would happen to that place if they were flooded with thousands of uninsured people at once? Millions? Tens of millions?


I expect two things:

1. that place would not be able to service the demand.

2. Simultaneously, every medical provider that formerly served these thousands, millions or tens of millions of people will suddenly experience a sharp decline in the demand for their services.

(I expect the ratio of the magnitude of these two sets of phenomena to be about 1:1.)

As a result, the former providers will have to lower their prices in order to keep people coming through the door.

Now, if the various state governments would stop artificially restricting the number of medical providers that could practice medicine (they hold it far below the number of people who would be qualified), then things would be even better.


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## crs (Dec 30, 2004)

Hell has not frozen over, but I do look forward to Wayfarer's informed opinion on this thread when he returns from Hawaii.


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## pt4u67 (Apr 27, 2006)

JLPWCXIII said:


> But not for everyone. When forty million people are left behind, that is a flaw in the system.


That number refers to those not covered by private healthcare insurance. Medicaid/Medicare picks the others up.


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## Wayfarer (Mar 19, 2006)

*There's My Cue!*



crs said:


> Hell has not frozen over, but I do look forward to Wayfarer's informed opinion on this thread when he returns from Hawaii.


Hey guys.....so been in an earthquake lately? 

I've said this before about healthcare, I think we need a mixed system. A basic, and I do mean BASIC, universal coverage with third party payer system on top. It will never happen.

As you most know, I'm a Canadian that emigrated to the US, I'm a past health care practitioner that went and got an MPH and MBA and function as an exec in the field. I'll take the US for my healthcare over Canada.

Points:

1) Things got messed up with WWII and tax treatment of premiums (mentioned in thread already)
2) We have poor priorities as AARP and seniors vote, kids needing vaccinations do not. Somehow it is a person's god given right to get an ORIF when they're 95, totally demented, bed bound and on a PEG tube for feeding.....all at taxpayer expense.
3) To the interchange about people not seeking tx 'cause they can not afford it: a) EMTALA and b) as an example, when I was doing some public health work in Detroit, the city lost millions in funding as they could not get enough people to come out for free (as in zero, nadda, zilch cost) kiddie care. Many people are short sighted and idiots. We apparently can not legislate good decision making abilities.
4) The per capita spent argument is specious as countries like Canada simply allocate so much and then you just go without. My favorite was one time in Ontario several years ago when surgeries were all canceled in December as money was running short province wide. They would do emergency stuff but if your surgery could be put off, it was. I remember the official line of "there would be no undue suffering." I wondered, at the time, what suffering was due? I mean, back surgery is rarely emergent but it can sure make your life miserable.

More will come no doubt, I love this topic (as always).

So my position: mixed system, basic universal, private ontop, return insurance to things catastrophic relative to income (not office visits!), and get equal tax treatment for premiums thus severing the link between employment and private healthcare coverage.

Cheers!


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## zegnamtl (Apr 19, 2005)

So much for me staying out of the interchange.....

Wayfayer wrote:
So my position: mixed system, basic universal, private on top, return insurance to things catastrophic relative to income (not office visits!), and get equal tax treatment for premiums thus severing the link between employment and private health care coverage.

~~~~

As a subscriber to free (income tax based...nothing in life is free) universal health care in the great white north I have seen the glory and the short comings of the system.

I must agree with Wayfayer that a mixed system is the best and only viable solution over the long term.

Our system has been bogged down in abuse, top heavy waste and government mismanagement.

Not too long ago, my father went in for an X-ray complaining of a sore hip. He never left the hospital. 6 months in palliative care, he had generalized cancer and they did the best to make him comfortable until the end.

I never once considered what things would cost, never haggled with an HMO. The staff went above and beyond the call of duty and he had everything he needed to spend his last few months in the most reasonable comfort possible. There is not one sole on earth who can convince me that the service provided and paid for by the state run medical plan Medicare is not worth my tax dollars put in to the system.

When my eldest daughter was wiped out by an out of control skier who did not belong on the advanced trail he was attempting to ski, the orthopedic surgeon asked for an MRI. The wait list at the children's hospital would have been months as they only had one scanner at the time.

I have both private insurance and the state provided.
Off to a private clinic I went and in less than a week she was seen, the doctor and myself were faxed the results of the scan. The service was impeccable. Cost, $750.00. 

When I was seeing a specialist regarding a badly broken collar bone (several places) he was delayed by a lengthy visit to an elderly woman in the next booth. He told me that she has nothing wrong with her, she makes appointments with a few doctors and is in the hospital every few weeks seeing someone, she is lonely, bored and alone in this world. One of the top specialist sat with her for a half hour or so because she is bored? That would never be permitted under the tightly run private system in the US, no one would pay the bill!

I know a woman who gave her medical card to a friend in the US, so she could come here and have an operation to remove a cancerous ovary!
fraud of the first degree. One day, this will come back on her when she needs medical help and her file shows she has no ovary and there is in fact one to be found in its place!

I can spend hours getting a free blood test at the local hospital, or I can pay my GP 10 dollars plus my medical card and get them done in his office. I believe this to be a great choice, free up the clinic in the hospital for those who need it, I can go to my GP.

The future of medicare in Canada, and hopefully in the US, will be a balanced tightly run dual system that takes into account one's income, or lack of, so that those who are without will never be denied decent medical attention.

The greater concern here with private is that all the best doctors would jump ship and leave the public system reeling in the vacuum. So. Legislation was passed that a certain number of hours must be given to the public system, or you are cast out to fend solely on your own in a fully private system (which, contrary to popular believe, does exist her and has for many years, just not a huge scale).

We have a very liberal educational system here as well, but due to the heavy exodus of students after med school, they are now obliged to serve two years in the province before flight, or re pay some amount of which I have no idea how the numbers are derived, but the last student doctor I spoke with who was about to skip out on his contract was told he could buy out the two years duty for $200,000.00. He stayed and did ER duty and most likely gained more experience than he could have imagined, a young student fresh out of school spending two years in a busy ER.


There may be no god given right to medical attention, or perhaps not even a clause in our constitution that guarantees a surgeon at the end of your bed for life, but any decent human being would want to be sure that all of society has at least some basic care available to it, if for no other reason, it does protect your own life to certain degree when all those around you are health and not seeking to car jack you get enough money top pay a doctor's bill for their child or wife!

I do not feel empowered knowing I have the best of both world's at my finger tips and the next guy is left to fend for himself. I take pride in knowing that he has, at very least, what he needs to get through life and take care of his family.

Wayfarer, 
You are very right, a mixed system is the answer for the US.
We have a great system, but it has its short comings.
I hope the US can do this right and find the perfect balance of a mixed system, the entire nation will come out ahead in the long run.


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## ksinc (May 30, 2005)

zegnamtl said:


> I hope the US can do this right and find the perfect balance of a mixed system, the entire nation will come out ahead in the long run.


Amen. I'm sure that eventually we will. The markets and the people usually get things right (sooner or later) and that seems to be the balance.


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## pt4u67 (Apr 27, 2006)

zegnamtl said:


> I must agree with Wayfayer that a mixed system is the best and only viable solution over the long term...........I hope the US can do this right and find the perfect balance of a mixed system, the entire nation will come out ahead in the long run.


But don't we already have a defacto mixed system. We have private health insurance and the state (Medicaid) covers those who cannot afford it. For seniors this is not even a question as Medicare A,B and now D kick in automatically.


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## Wayfarer (Mar 19, 2006)

pt4u67 said:


> But don't we already have a defacto mixed system. We have private health insurance and the state (Medicaid) covers those who cannot afford it. For seniors this is not even a question as Medicare A,B and now D kick in automatically.


PT, we have various systems, but not as I have proposed. First, each government run one is selective i.e. old, poor, vet, and also they are comprehensive, not basic. They also create much duplication of services and overhead.

No, what I propose would stop discrimination against the able and eliminate duplication at various levels of government through a basic universal coverage at the Federal level. Again, it would be basic, not comprehensive, and also hopefully more rational.

Again, I know this will never happen, I am no fool. I understand the AARP will convince people it is their god given right to have a Triple A repaired even though they are 90, bed bound, totally demented and need a PEG for nourishment. I am of course not saying a person should not be able to get these services under this patient profile, I am merely suggesting the tax payers should not pay for it.


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## Fogey (Aug 27, 2005)

Wayfarer said:


> PT, we have various systems, but not as I have proposed. First, each government run one is selective i.e. old, poor, vet, and also they are comprehensive, not basic. They also create much duplication of services and overhead.
> 
> No, what I propose would stop discrimination against the able and eliminate duplication at various levels of government through a basic universal coverage at the Federal level. Again, it would be basic, not comprehensive, and also hopefully more rational.
> 
> Again, I know this will never happen, I am no fool. I understand the AARP will convince people it is their god given right to have a Triple A repaired even though they are 90, bed bound, totally demented and need a PEG for nourishment. I am of course not saying a person should not be able to get these services under this patient profile, I am merely suggesting the tax payers should not pay for it.


Why not make it both universal and comprehensive?


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## Wayfarer (Mar 19, 2006)

JLPWCXIII said:


> Why not make it both universal and comprehensive?


Why? You think the taxpayers should pay for lipo for fat housewives?


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## hopkins_student (Jun 25, 2004)

JLPWCXIII said:


> Why not make it both universal and comprehensive?


I'm convinced that once you go beyond basic coverage, which I assume would be limited to primary care visits and related medical, not surgical, therapy you lose the positive externality that justifies the economic burden.


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## pt4u67 (Apr 27, 2006)

The problem with allowing the government to play too large a role is that eventually, as in all cases involving the government, costs begin to creep up. Once the camel's nose is in the tent there's really no stopping it. Taxes will eventually rise to cover expenditures. A lack of free market competition will stifle innovation and efficiency (yes I believe that for all its problems we still have a highly efficient healthcare system). Special levies will be enacted to cover short term cost run ups however will never be repealed. 

Then there is the corruption question. If government controls access and costs then it also controls the funding. Imagine what a cash cow this would be and how lathered up petty congressmen will get at the thought of channeling all those funds to there contractor pals to build healthcare centers, hospitals and whatever else there districts likely don't need. Don't beleive me? Take Cook County Illinois as a microcosm of what a nationalized healthcare system will look like. Tremendous overhead, inefficient care, cronyism and duplication of services such as each Cook County hospital having its own PR staff and legal staff. 

Allowing the free market to work its charm is the best way to ensure that there is equity in the healthcare field. Will everyone be happy? Probably not. But its certainly better and more equitable than the alternative.


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## Phinn (Apr 18, 2006)

> Why not make it both universal and comprehensive?


Because doing so always causes the quality of the good in question to decline while also causing the costs to increase.

Eventually, this produces a near-total collapse of the industry and a crisis that, unfortunately, prompts some people to redouble the level of governmental control that caused the crisis in the first place.

See, e.g., banking (nationalized monetary system), railroads (nationalized passenger transportation and heavy regulation of everything else), road construction (astronomical costs, poor quality -- see Big Dig), insurance (heavily regulated at the state level, with state-run "insurers of last resort" increasing their market share every year, as sort of a slow-motion take-over), etc.


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## Wayfarer (Mar 19, 2006)

There are positive externalities to be gained from a basic universal coverage and I would like to see those captured. As well, we can offer humane treatment to ease suffering when palliation is called for and palliative care is 99.9% very inexpensive care (we are talking a month of palliation for the cost of one night in the ICU type ratios). Also, certain public health concerns would best be addressed through this basic policy, at 7:50 on a Monday morning the only one popping to mind is "herd immunity".

Regards

P.S. JLP, still anxious to hear if you think lipo for overweight trophy wives should be paid for by the taxpayers.


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## Phinn (Apr 18, 2006)

> JLP, still anxious to hear if you think lipo for overweight trophy wives should be paid for by the taxpayers.


It's a trick question, JLP -- trophy wives, by definition, aren't overweight. :icon_smile_big:

On a more serious note, Wayfarer, I'm curious -- why do you think that any intervention in the medical services industry is even necessary?


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## Wayfarer (Mar 19, 2006)

Phinn said:


> It's a trick question, JLP -- trophy wives, by definition, aren't overweight. :icon_smile_big:
> 
> On a more serious note, Wayfarer, I'm curious -- why do you think that any intervention in the medical services industry is even necessary?


Again Phinn, the positive externalities to be gained as well as a modicum of basic human compassion.

By making it basic, we would remove much of the burden on the tax payer for end of life care, for instance. Trust me, if Sonny had to pay for Mom's 25k hospital stay, her third one this year, when she is totally demented and bed bound, Mom's suffering would end alot sooner and the tax burden would be a lot lower. We could reallocate towards those that can still experience quality of life and/or be productive members of society. Really, when one does not know their name and sits in their own filth on a daily basis, I fail to see why tax payers should foot the bill for expensive interventionary tertiary treatment when low cost, humane palliative treatment is available.

Certain aspects of healthcare are public goods, just like education, IMO. I think we should capture the positive externalities of these and help steer people into more realistic outcomes.

P.S. Still waiting for JLP...good point Phinn...let's go back to my original statement of just plain old "fat housewives"!


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## Fogey (Aug 27, 2005)

Wayfarer said:


> Again Phinn, the positive externalities to be gained as well as a modicum of basic human compassion.
> 
> By making it basic, we would remove much of the burden on the tax payer for end of life care, for instance. Trust me, if Sonny had to pay for Mom's 25k hospital stay, her third one this year, when she is totally demented and bed bound, Mom's suffering would end alot sooner and the tax burden would be a lot lower. We could reallocate towards those that can still experience quality of life and/or be productive members of society. Really, when one does not know their name and sits in their own filth on a daily basis, I fail to see why tax payers should foot the bill for expensive interventionary tertiary treatment when low cost, humane palliative treatment is available.
> 
> ...


This is absurd - so you favour euthanasia for poor elderly people?

There is no point attacking your housewife strawman. Liposuction is fine if it's related to healthcare.


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## Wayfarer (Mar 19, 2006)

JLPWCXIII said:


> This is absurd - so you favour euthanasia for poor elderly people?
> 
> There is no point attacking your housewife strawman. Liposuction is fine if it's related to healthcare.


Only a very shallow mind or one totally uneducated in regards to healthcare would equate palliation with euthanasia. I assume then that hospice is also some form of euthanasia? Your time away has not improved your rhetoric it would seem.

Also, I am sitting on the edge of my seat for this one....could you give me a run down of what conditions would require lipo that are "related to healthcare" other than vanity ones?

Not a good effort on your part, I expect better logical fallacies from you JLP!

Cheers

Edit: Oh, forgot to squash your use of the term "poor elderly". No, this policy would go for *all* people regardless of age and net worth. Also, please spend some time with families making end of life decisions. Even relatively wealthy ones make decisions where preservation of the estate is a major variable in the equation. Are you then for having the poor that pay taxes support wealthy folks?

Also, you did not answer my question in the least. Give an affirmative argument as to why a universal policy should be comprehensive.


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## Fogey (Aug 27, 2005)

Wayfarer said:


> Trust me, if Sonny had to pay for Mom's 25k hospital stay, her third one this year, when she is totally demented and bed bound, Mom's suffering would end alot sooner and the tax burden would be a lot lower.


.....


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## Fogey (Aug 27, 2005)

Wayfarer said:


> Also, I am sitting on the edge of my seat for this one....could you give me a run down of what conditions would require lipo that are "related to healthcare" other than vanity ones?


That would be for her medical team to decide, of course.


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## Wayfarer (Mar 19, 2006)

JLPWCXIII said:


> Wayfarer said:
> 
> 
> > Also, I am sitting on the edge of my seat for this one....could you give me a run down of what conditions would require lipo that are "related to healthcare" other than vanity ones?
> ...


I am sorry, that is not an answer. You sir need to answer as you made a proposition concerning it. Please, flex your vast knowledge on the subject. As to your quote without any text, yes, if that is what you are fixating on, you do indeed have either a very shallow mind or one totally uneducated in the realm of healthcare.

Also, still waiting for that affirmative argument...oh wait! You've been gone and I forgot. You merely make little harpoon-like non sequitors and logical fallacies, you do not actually present cogent, affirmative positions. I remember now and shall adjust my expectations of conversations with you accordingly.

Cheers

Edit: I just finished a conversation with a patient and family and it made me think of this. JLP, please relate to us how many patients/families you have had to inform that they or their loved one are terminal or how many conversations have you had with a patient/family that palliation might be a better alternative than interventional tx or even that the point has been reached where palliation might be a more valid modality than interventionalism? I think it is *very* pertinent to the conversation at this point one's first hand experience, or one is merely an armchair quarterback. I mean, I would stipulate that I have no experience being dissolute minor royalty and would probably give some strong credence to what someone in that line of work might have to say on the subject.


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## Fogey (Aug 27, 2005)

You've lowered the level of discourse beneath that which is worthy of a measured response. I'll give you an opportunity to try again.


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## Wayfarer (Mar 19, 2006)

JLPWCXIII said:


> You've lowered the level of discourse beneath that which is worthy of a measured response. I'll give you an opportunity to try again.


That is the slickest way to say, "I can't win so I'm taking all my marbles and going home!" that I have ever read.

If you wish to put the thread back on track, merely respond with an actual answer. A good start will be a cogent argument in the affirmative for comprehensive universal healthcare. Or a run down of the lipo reasons.

Cheers


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## zegnamtl (Apr 19, 2005)

Wayfarer,

What would you consider to be required within "universal care"?

To the best of my knowledge,
Lipo and the likes are totally private and pay per use here as they should be. Plastic surgery is fully covered if, as the result of an work accident, car crash etc you are disfigured.


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## Wayfarer (Mar 19, 2006)

zegnamtl said:


> Wayfarer,
> 
> What would you consider to be required within "universal care"?
> 
> ...


"Universal" simply means that all legal residents of the country have said policy. The lipo line of inquiry came from the "comprehensive" side of this thread. As you just pointed out, even Quebec's provincial policy does not cover that, hence your healthcare is not "comprehensive", meaning there are medical procedures one must pay privately for, or pay for better treatment, for example, cataract surgery in Ontario. While OHIP will cover the operation, you can pay for better inserts....I know, I just dropped $1300 CDN for my mother to have the upgrade 

As an aside, I'd have my plastic surgery somewhere other than Quebec zeg. The last I read, MRSA was a crisis in surgery suites there. The last thing I'd want was to get MRSA from plastic surgery.


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## zegnamtl (Apr 19, 2005)

Wayfarer said:


> ....I know, I just dropped $1300 CDN for my mother to have the upgrade ........


The debate rages here about what should and should not be included in universal coverage, hence the question. To date, I find the balance struck here seems about fair. Dental cleanings for children was cut back to one a year (from two) which I think was rather short sighted.

There is a "newish" state run prescription drug plan in effect, since I am not eligible, I have no idea how it is working out yet, but as I understand it, the user pays a small flat fee for his prescription and the state picks up the balance. Everyone must have private insurance or subscribe to the state run system.
It appears to be a good thing for those who may not have been able to afford their meds.

I hope all has gone well for mom with her eye surgery.


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