medGadget and Mark Steyn against Single Payor

And, Mark Steyn let them reprint part of his latest book , “America Alone” on their site; an Exclusive!.  But first Dr. O is on a tear:

Recently, Gov. Schwarzenegger announced his plan to provide universal coverage for health care and declared a war on physicians. We were shocked and appalled to learn that the Governator actually wants to penalize us, clinical providers, with a 2% gross revenue tax that will hit MDs with high operating costs especially hard. His action comes at a time when we are already experiencing unprecedented levels of loss of economic liberties and an ever increasing regulation of our profession.

Even more alarming is the acceptance with which this plan, and others like it, are supported by many of our fellow physicians, politicians and the media. Supporters of universal health care–i.e. socialized medicine–would have us believe that countries like Canada and Sweden provide superior care under their government controlled system. Furthermore, they would like to shame us for being ‘the only advanced country without universal health care.’ Yet, where does the world come for its health care? America. Where did Italy’s richest politician go to have his pacemaker installed? Ohio. When confronted with examples like this, supporters of universal coverage don’t deny the quality of care America provides but argue ours is a broken system that only provides quality care for the privileged. They would have us believe that socialized systems provide an optimal level of care, available ‘for free’ to the masses, yet they refuse to acknowledge the very real, very significant problems plaguing these systems. …

I love a good rant, and that qualifies.  Read it all.

Then comes the denouement, the Mark Steyn quote: however you feel about Single Payor (and it looks like the time to choose-up sides is coming) there’s a point to be had here:


Euro-Canadian socialized health care is, in essence, subsidized by American taxpayers: since the end of World War Two, Washington has assumed the defense costs of its allies, thereby freeing up those countries to spend their tax revenues on lavish social programs. But, if America follows the Hutton plan and “joins the world,” it will reduce its defense expenditures to Euro-Canadian levels. So the next time a tsunami hits Sri-Lanka or Indonesia there will be no carrier groups to divert and save lives. So more people will die, waiting the weeks and weeks it took the sleepytime gals at the United Nations to arrive. Were America to “join the world,” it would have to reduce its funding of the UN and other wold bodies to European levels. And it might have to scale back its domestic agencies so that they’re no longer able to serve in effect as international ones. Which will be tough when some kid in some village on the other side of the world comes down with some weird illness no one’s seen before and they want to FedEx the test tube to the Centers for Disease Control in Atlanta to figure out what’s going on. Indeed, even relatively advanced societies admired by the likes of Will Hutton take it as routine that the CDC is a kind of Health Ministry of last resort. …

I am not about to say American healthcare is substandard.  I will certainly agree it is fantastically expensive for those who can pay and terrifically slow for those who cannot; this is not the same as unobtainable, as there is a safety net in virtually every county in America (your county hospital).  OTOH, I work in a private ED that accepts everyone without regard for insurance, status or legality and gives each the same level of care.  They get admitted or discharged on their medical merits, period. 

American healthcare is very American, in that it’s terrifically accommodating, has astounding abilities and also unfortunately is subject to the ”I want it now and I’ll pay for it later (sucker)” mentality, and socialism in a country with no barriers to insist on More, Now scares the hell out of me.

So, count me out on Socialized Medicine / Single Payor.


Comments

  1. There has to be a shift in mentality in the average citizen before there can be positive change in the grand scale – have to work from the ground up.

  2. John J. Coupal says:

    Mark Steyn has the ability to make a politically incorrect subject even funnier – and more scary (which it really is) – to the average person.

    I plan to buy a copy of “America Alone” ASAP.

  3. Ditto, brother.

    Flea

  4. If socialized medicine takes hold, will doctors become government employees?

  5. Here’s the problem Grunt. You guys have been somewhat successful in convincing the public that the current system sucks. They bought it – you’re terribly wronged. So they predictably assume you want an alternative. Yet, with the exception of malpractice damage caps, you haven’t offered an alternative, at least in any legislature.

    So some people have started to come up with alternatives, and now you’re bitching about them. Eventually, the public is going to just conclude that you guys are just whiners, and do this without your input.

    So where are your solutions?

  6. I think the flaw with the logic here is the tying together of socialized medicine with the single payor proposal. These are two DIFFERENT systems, and thus can not be compared. Canada has socialized medicine, and clearly that will not work here for a number of reasons, so this example is not a good parallel for single payor proposals.

    Under a single payor system, the $150 BILLION dollars saved in excess administrative costs would be applied to actual health care.

    Further, it would be good for small business, because small businesses could attract and retain qualified individuals that previously were forced to work for large companies if they wanted health care.

    In terms of choice, access, and availability, single payor coverage does not decrease any of these things, and only makes things better.

    Under a single payor system, a set rate is reimbursed per procedure / visit type. Physicians are still allowed to charge whatever they wish and consumers may choose whether they wish to see a provider whose fee is covered entirely, or a more expensive provider and the consumer will have to pay the difference.

    The plan will also improve public safety and health by allowing people to have access to primary care physicians instead of relying on county emergency departments for things like blood pressure medication refills.

    Of course the plan is imperfect, and there are flaws, but it certainly seems like an improvement on what we currently have.

  7. CJD,Alternatives have been proposed (I think Bush’s HSA idea is the right general direction, but another squandered opportunity…). There will always be a demand for more services when those getting the service aren’t the ones paying for them. I’m not allergic to the Mass. experiment (the Romney plan), and think that’s the best short-term solution.

    Derrick, I cannot for the life of me figure out how having one big payor won’t mean socalized medicine. Oh, they’ll work really hard to call it something else, but in the end, if a) one procedure pays $X, b) there’s ony one payor who pays $X and that’s it, exactly how do physicians and hospitals charge more? They won’t be able to. Yes, there will initially be less red tape, but don’t for a second mistake efficiency with either quality or service. Every example of socialized medicine I’ve heard of has some forms of rationing, either through timed waits or caps on numbers, etc.

    Also, we have a big version of single-payor now, and it’s been instructive to follow what happens when the big checkbook says ‘jump’. CMS (Medicare) decreed that everyone who is admitted with a diagnosis of pneumonia needs to have a blood culture and antibiotics within 4 hours of the diagnosis. That seems reasonable, but their carrot has a stick, and if you don’t meet those goals enough you don’t get paid.

    So, both places I work decided they were going to get paid for the work they do, and set the internal rule at 2 hours for BC and abx. In a busy ED, that means, functionally, that we’ve all been very strongly encouraged to just order a dose of antibiotics and a bc for everyone that could be even remotely pneumonia.

    And, that’s bad medicine driven by a well-meaning but poorly thought-out policy (the law of the unintended result). Blood culture studies show they’re not helpful in the vast, vast majority of cases, but now everyone gets one, and millions of people are getting a dose of antibiotics they may not need. One big single payor says ‘play or else’ and it has already caused some system distortion.

    I don’t have a perfect, real-world answer, but I know that socialized medicine is the wrong answer to a tough question.

  8. HSAs aren’t an alternative – they were a small step for those with disposable income. Don’t get me wrong, they were a good idea, but they do nothing to solve the problems you guys are always complaining about – the way you’re paid and the way it impacts your patient relationship.

    Universal healthcare is what’s going to happen unless someone figures out a way to make the delivery of healthcare more market oriented and those who do a better job of that delivery get compensated more.

  9. The Grand Wazoo says:

    Fine, I’ll be happy to be a government worker! Please, let me have weekends off and all government holidays off – i.e. Martin Luther King’s birthday off, etc. and oh yes, evenings off! If my patients want me, I’ll tell them that the office is closed at 4:30, like every other government office. No more calls at two in the morning, ’cause I’ll leave a message on the answering machine stating that the office is now closed and will only reopen in the morning and no, you can’t leave a message on the answering machine because nobody will respond to it.

  10. Very oversimplified comparisons:

    Socialized healthcare – single payer: Providers are employees of the government, and subject to practice regulations imposed by the government

    Universal healthcare – single payer (not insurance): providers are employed as they are now – practice groups, employees of organizations, independent contractors, etc. Reimbursement of health services is administered by the government (e.g. Medicare). Regulations on practice are imposed via reimbursement requirements.

    Universal health insurance: mandates insurance coverage and purchase by all covered lives. May or may not be single payer. Continues to use for-profit insurance model (same administraqtive layers of paperwork and expenses). Puts onus of obtaining coverage on purchaser – either individual or employer.

  11. Canada does NOT have socialized healthcare. We have universal healthcare. Doctors are NOT government employees.

  12. N=1, that’s not right. Try my definition:

    http://www.grahamazon.com/2003/09/nhs-isnt-nhi/

  13. I think that’s an artificial distinction; if everyone in your profession gets paid by one source, you’re their defacto employee.

  14. That’s not true, GD–the single-payer doesn’t tell the doctor how to practice.

  15. That’s not true, GD—the single-payer doesn’t tell the doctor how to practice.

    What?

    Of course they do, Graham… when they’re writing your paycheck and/or deciding what services are worth, they’re driving the train. Ask any american physician about the impact (on length of stay, for instance) by CMS’s use of DRGs, denial of payment, and the upcoming P4P system.

    The power of the purse is everything in healthcare. Remember the old axiom: “He who has the Gold, makes the Rules”

  16. sultan of swage says:

    Someone wise once told me: when you constantly and increasingly take from the “haves” to give more and more to the “have nots” you eventually-by either force or choice-run out of “haves.” Is Arnie going to give us 2% of his career’s gross revenue so that we can continue to “enjoy” Hollywood’s latest offerings? Why is it again that providers are going to be taxed for the care they give Californians? This makes sense why? What am I missing? If I am understanding this correctly, the idea is to charge providers for providing EMTALA-mandated care (and its concomittant liability)? Couple this with the aforementioned problems with anticipated increased regulatory hassles and expenses, as well as the inevitable diminishing reimbursements and the situation looks grim…

  17. The truth is you guys are whiners. In fact, you whine more than any group of people I have ever seen. CJD is right about this. You don’t like things the way they are, yet you don’t want changes. HSA won’t work except for a small percentage.

    In honesty, I have been reading medical blogs since early 2004. The one I have the most respect for is Dr. Flea. he doesn’t just moan and bitch, he fights the system. He walks the walk by standing up for what he believes in. Most important he knows what he believes in, most of you just bitch without even knowing what exactly it is you want to have happen.

  18. Ed, PharmD says:

    How about this…

    Everyone must purchase private insurance.
    Insurance is not employer based.
    Govt subsidizes the poor on a sliding scale so that everyone can afford to buy private insurance.
    Govt mandates the minimum level of care that an insurer must cover.

    This plan guarantees universal access to health care. It also guarantees optimal quality (and quality improvement) by leaving the free market relatively unfettered. It does not seek to control costs but instead views premium health insurance as a consumer product that some may choose to buy.

  19. CJD, MJL,

    Apparently you have never noted the whining of trial lawyers when the subject of tort reform and a dysfunctional legal system comes up.

  20. Jerry, thanks for illustrating the problem. You’re once again whining about something that has little to do with the fundamental change you’re about to undergo if you don’t wake up and offer an alternative to single-payer or universal healthcare. If those are provided by the govt., we’ll likely to go a workers comp style no fault system anyway so tort “reform” will be a dead issue.

    But by all means, continue to go to bat for the insurance and pharmaceutical industry about something you have a meager understanding of while your own industry, which you have extensive knowledge of, undergoes a radical change which will effect how you practice, how you get paid, and how much you make.

    Are the deck chairs straight?

  21. CJD’s never happy unless every comment thread eventually devolves into a ‘debate’ with him.

    So, CJD, instead of whining about our very real concern that in the rush to do something we’ll just be government employees, I’d like to hear your plan.

  22. Yohan Stern says:

    I agree, the government has no place taking over the medical industry, however the industry in it’s current state acts like an oligopoly. Hospitals need to be more competitive, they need to make prices transparent and drop the ridiculous chargemaster system. They need to make their true costs known as well as their negotiations with insurance providers. Increasing the supply of doctors by lowering the artificially high barrier of entry wouldn’t hurt either. You don’t need 10 years of training to be a radiologist for example. Give someone technical training in a professional schoo l for 2 years and you knock MRI prices down from $3000 to $300. We can’t deny the fact thaat medical spending has increased from 5% to 15% of the GDP in 50 years. As long as government entitlement programs guarantee payments at any prices this trend will continue.

  23. “CJD’s never happy unless every comment thread eventually devolves into a ‘debate’ with him. ”

    It always turns personal with you when you’re at a loss for words, doesn’t it Grunt? Too bad.

    As for my proposal, I don’t have one, and I’ve studied it and thought about it as much as anyone outside the system who has another job not related to it can. But I can’t figure out how to replace the 50% of healthcare costs already paid for by the government. Where does that money come from?

    That’s why I keep asking those of you who will be most affected by it what your proposal is, instead of always telling us what you’re against. So far, no luck. You guys only seem to get excited about tort reform, and that’s of no real benefit to you, just your insurers. So I think we’re going to see a big change in the next 4 years, both in terms of how healthcare is delivered, and how its providers are compensated and perhaps more tellingly for you, regulated. If you don’t start focusing, you’re not going to have much of a say in that.

  24. sultan of swage says:

    CJD and MJL,

    You are both either miserably misinformed or intentionally argumentative if you believe that 1) we fight the insurance industry’s battles for them out of ignorance towards the issue of the current liability dilemma, 2) we are unmotivated to pursue any meaningful policy shift outside the blogsphere, and are content to just “whine” as we aligned the “deck chairs”, 3) we do not actively practice in a field that promises to never compromise care for the sake of any third party consideration-ever, 4) we do not have a large and active collective voice that speaks for the interests of our patients (like you) as well as ourselves and the medical community in general, 5) the purpose of this and other industry-specific blogs wasn’t to provide a sounding board for frustrations, questions, and ideas, as well as potential solutions.

    Please do not paint with such a broad brush, y’all. These posts do not tell the whole story but are just pieces of minds…

  25. There are a few issues with regard to making services Universal that seem to be flying under the radar here. One issue is how much say the Government would begin to have in our lives (as patients)in a single payer system. Can they tell us not to smoke, not to drink, not to eat at McDonalds? or can they withdraw care when we want fruitless (by agency standards) efforts on our family’s behalf?

    The closest model that I can come up with for the single payer proposal in this Nation is education. We have had a government run educational system in this country for 100+ years and we still have 25% of our primary schools as private institutions and we lag behind nearly every industrialized nation in math and science.
    I do not see how we can have anything but a multi-tiered system, in which government offers a skeleton service for all and individuals are left to make the choice to invest in something better for their families.

  26. sultan of swage says:

    +1 to trenchdoc.

    The provision of basic, preventative, and emergency services to all should not be widely derided, as some of the previous posts have suggested doctors are doing. In truth, I believe our hearts are in the right place.

    We must keep in mind the inevitable buracracy and the very real potential for regulations on the practice of medicine that pose an unacceptable risk to so many patients. Do you want every decision made for you as a patient to necessarily come from guideline.gov? For every case? An extreme example, to be sure, but what society can deny the very real pitfalls other countries are experiencing with their single-payor systems? Until we have an entire body of medical practice based 100% on evidence-based proofs we will always practice as both the proverbial artist and scientist. We all do our best.

    All of us praise progress and many of us eagerly attempt to hasten its pace. But most of the detractors of the single-payor, governmental-subsidized, one-size-fits-all system see it as regressive in many ways and progressive only inasmuch as it is “doing something.”

  27. Ahhhh… I needed my CJD fix. Aren’t you the guy who, at the very start of this thread stated:

    Eventually, the public is going to just conclude that you guys are just whiners

    Then you smugly whip out this little bit of sanctimony:

    It always turns personal with you when you’re at a loss for words, doesn’t it Grunt? Too bad.

    Errmm…. who was it who started out with the personal attacks?

    *crickets*

  28. NewGuy, I believe name calling is allowable for CJD since opening statements are not evidentiary, LMAO!

  29. Some of you need to work on your reading comprehension. I didn’t call anone any name. I said that is what the public WILL conclude if all physicians ever do is complain about the present system and proposed alternatives, yet offer no solutions. That’s not a personal attack.

    “1) we fight the insurance industry’s battles for them out of ignorance towards the issue of the current liability dilemma,”

    Well, at least you acknowledge who really benefits. The first step is acknowledgment.

    “we are unmotivated to pursue any meaningful policy shift outside the blogsphere, and are content to just “whine” as we aligned the “deck chairs”,”

    So where are these legislative proposals that are alternatives to single payer/universal healthcare that you are introducing? Or your lobbyists are introducing? Got a House or Senate Bill No. that is an alternative that the AMA is pushing the public to back?

    “we do not have a large and active collective voice that speaks for the interests of our patients ”

    You don’t. I’m sure you’re well intentioned, but when the rubber meets the road, the only thing you have been truly politically engaged on is capping the damages of the legitimately injured. That is what you’re handing out literature to your patients for. That is what you’re putting out “crisis” maps for. That is what the vast majority of your editorials are about. Those are the bills before the federal and state legislatures that you’re wearing your white coats and holding signs in front of capitols for.

    Your actions speak louder than your words. And I for one, as a patient and a taxpayer, wish that were not the case. I wish the people with the most intimate understanding of our healthcare system would give the rest of us an alternative.

    There are 28 posts here and not one of them offers us a proposal to our current or the proposed systems for delivery and funding of healthcare. But I bet you could all write 20 pages on the benefits of tort reforms and spew statistics until Tuesday. Doesn’t that trouble you a bit, considering that universal healthcare will have a far more profound impact on your daily work/life than whether your insurer has to pay $250,000 in noneconomic damages if you make a mistake?

  30. CJD,
    a new low, even by your reasonably lax standards. By taking several points (hint: the sentence content prior to the numbers actually has something to do with what follows the little “)” thingy) out of context, you have made a dumb series of cheap rhetorical points without actually making a point; anyone who can read can see that it’s not what the writer meant. I had to read your comment three times to see if you were kidding. Apparently not.

    Now, who has a reading comprehension problem? Not the one who has to deliberately misrepresent the comment content to gin up a response so laughable. I mean: really, terrible performance.

    By the way, tort caps are your addition to this comment thread. No commenter has brought them up except you, and then just to, yes, whine about getting beaten in state legislatures on just that topic. Thanks for bringing your pet peeve in.

    Thanks also for accusing us of whining because we’re not certain we have the perfect solution, for not being able to provide a solution of your own when asked directly, for ignoring the solution I agreed with in the seventh comment in this thread and then accusing us of whining and not having any ideas, and finally of, again, trying to make this all about you. By the way, I intentionally avoided all the troublesome “)” entries because you obviously cannot follow them.

    So, the sultan of swage certainly deserves an apology for how you’re tried to take bad advantage of his superior punctuation skills, and the rest of the readers certainly deserve better from you.

    And, once again a comment thread get hijacked down the CJD hole. I should have known better.

  31. I’m sure I don’t have an anwer either; but my thinking is colored by the sight, in my large clinic, of two floors in a rented building, entirely full of people in cubicles handling insurance paperwork. Add to that the fact that the many insurance companies undoubtedly have similar floors upon floors, to a higher power. So, accepting that “single payor” is a fuzzy term, it seems to me that if there were only one agency with which to deal, it would save enormous amounts of money robbed from healthcare delivery. I don’t see that as socialized medicine. Medicare, for all its faults, does not make us its employees, even if it makes us jump through hoops. But at least its only one set of hoops, as opposed to a gazillion people holding hoops of different sizes and changes. Plans which facilitate access to private insurance only further the costs of having countless insurers taking their cuts. And Bush’s plan to provide tax breaks for the poor to help buy insurance is laughable: tax breaks to people at the minimum rate have little impact on their abiltiy to pay. It’s a ludicrisly (sp?) off-point way of addressing the problem. And along the way, the public will have to alter its expectations if we really are to get a handle on costs: not everything for everyone. Maybe not private rooms with TVs for everyone. Maybe not asking for a couple more days in the hospital because the kids are having a party and can’t get them till Monday….

  32. I agree with trenchy’s point (multi-tiered system) and Sid’s point (not everything for everyone). I don’t have a problem with “free” government insurance for the (truly) disabled, the ultra-poor, the injured, and the children. The nature of ED work dictates that we are going to take care of those in true need without first swiping their credit card. We might as well get paid something for doing so.

    The sticking point is trying to convince “entitled” Americans that the government doesn’t necessarily have to pay for their liver transplant or bypass surgery, and that they might have to get their medical care at the government (teaching) hospital instead of the private one. They might have to settle for clonidine instead of Avapro. Macrobid instead of Levaquin. And forget about Zofran. Separate and unequal. Another sticking point is the elderly. They will let go of their Medicare benefits when we pry them from their cold dead fingers, and they have a really powerful lobby.

    So change is not forthcoming.

  33. So Grunt, still no solutions? Just complaints? Welcome to European style healthcare!

    Again, read closer. The Sultan said that physicians are advocating for an alternative. I’ve merely asked where I can read that alternative that you embrace. Still silence.

    But by all means, make it about me if that’s what you need to do.

  34. CJD,

    Are you really so poor at reading? Several doctors above have given insight their alternative or “vision” of what we see that would be feasible. Maybe try reading Scalpels post right before yours.

    Universal or “single payer” would not be too expensive for basic skeleton medical care (vaccines, emergency care, generic drugs for chronic conditions might be examples)

    However society can’t afford Viagra, gastric bypass surgery, liver transplants, dialysis, lifelong AIDS treatment, futile end of life care for everyone. If you want those things you need to pay for it.

    Some type of two-teired type of system that provides the cheap basics but also allows for the American way of personal choice in a free market to purchase extra that they want — I think many physicians agree from our perspective is what will be required.

    One big problem. Society and politicians don’t have the stomach for it. In Iraq there is maybe 3 main factions that can’t seem to agree. With healthcare there will be a million different factions feeling entitled that their provision is provided on the “First tier” of care.

    Bush tried touting this type of much needed approach with social security. It is needed, yet flopped miserably do to irrational fear from AARP faction

    Someone needs to be given the power to decide what belongs on the first tier. Give me the power and I will do it.

    Universal First tier (examples)
    -generic drugs
    -vaccines
    -evidence proven preventive and primary care strategies
    -emergency care

    Second tier (you pay for your own plan to cover provisions)
    -brand name drugs
    -penile implants
    -dialysis
    -transplants
    -ICU care for 93 y/o grandma that prolongs her life (torture?) another month.
    -fertility treatments

    The soobering problem though is that everyones list would be different. So we try to give everything to everyone and it is very very expensive.

  35. Not to interrupt – but (shove) go sit in your corners and catch yer breaths for awhile.

    It might interest this fine professional community to learn that HR 676 (National Health Insurance Plan) has been reintroduced and referred to the Energy and Commerce, Ways and Means and the Natural Resources Committees. It has 45 sponsors, and the list is rapidly growing. Go to the Physicians for a National Health Plan website or the Healthcare Now websites, or read this post and click on the links from there.

  36. I just have to comment on HSA’s… It’s not good – our hospital already offers it, and I didn’t take the bait, thank goodness!! I mean – it’s great for the small percentage who don’t need much. HMOs are also great for that small percentage who don’t need much, but the HSA puts the cost right back on the consumer. Say I set a moderate amount in my HSA – I bet whatever I could afford to set aside for a year would be blown within a month on my medical costs… Sick people, poor people, and middle class people cannot afford HSAs!!

  37. Carrie,

    Neither can the taxpayer.

  38. Grunt, I am curious what your proposed solution to the healthcare problem is. I hear your objections to single payer, and they sound quite valid – but is the current system better? Of course, if I had it my way – we would just spend all of the money we managed to find for Iraq on ourselves and the problem would be solved.

  39. Jerry – Who says that sick people, middle class people, and a lot of poor people aren’t taxpayers? Or do you mean that the HSA account will hurt the taxpayer as a taxpayer by hiking taxes to pay for the fallout of this program? To be honest, I dont’ know a lot about Bush’s HSA plan but rather just about the HSA plan offered at the hospital…and I think if this is what everybody was required to do, end of story, then it would be a bad thing… Yes, people should be held accountable for their use of the health care system, but what’s a person to do who gets sick? I mean – are we going to blame people for getting cancer and say that they still have to be held accountable…”if you didn’t have the money to afford your chemo treatments, then you should have thought about that BEFORE you got cancer!” That’s how absurd it is to me!

    Last year I had to pay over $2000 all the sudden in back taxes because my university had neglected to report our scholarships for nursing school as taxable income. They also put mine all in one year instead of splitting it between ’04 and ’05 as they should have. So then the university sent us a letter last year saying that they forgot to submit our scholarships, but they have submitted them now, so they have personally hired a CPA who will deal with this issue and then they’ll reimburse us for penalties and interest. Oh how kind of them… So I’m in my first full-time job and having to file for taxes as a full time employee for the first time ever, and I already have marks against me and suddenly owe over $2000 that I don’t have right now, as I didn’t expect this! My dad does my taxes – so I had no idea that there was a problem in 2004 – and neither did he. We didn’t realize the scholarship would be taxable income. I definitely consider myself a taxpayer! Haha…

  40. Carrie,

    The point is that there has to be limits at some point. Not everyone can be Bill Gates. If someone had some rare expensive disease but could be kept alive for 10 billion dollars a year do we do that to the detriment of the population as a whole. That is exagerated of course, but we have to grapple with those types of questions. A dialysis patient will cost 60K a year, HIV may cost 1 million over a lifetime.

    Sorry about the taxes. Yeah they suck. No, I am not a CPA. But we certainly will pay much more if health care becomes completely socialized and everyone wants everything covered.

  41. I think it will end up being tiered – I wrote my gigantic response on England and their system in the other post above this one, but I still stand by that. When I was over in England in September, I saw a system working smoothly – for my friend who has a ton of health issues and who also is a middle class citizen. I got to see the system in a very interesting way – staying with Helen firsthand and having both of us have a lot of medical stuff going on – we’ve talked about our experiences from the standpoint of money, insurance, and so on – and I’m a lot younger than Helen and have already forked over way more money and to an extent at times had my own health things exasperated due to inability to buy certain meds or stress of dealing with bankruptcy and things like that.

    I agree that there has to be a limit – everyone can’t have everything, and that’s not what I’m asking for. But I work very hard and have a sizeable chunk of my paycheck paying for my blue cross insurance. I have personally chosen the best plan out of 5 offered. I pay more into it because I need that coverage – I can’t afford to live otherwise. If we had a national health system, it would help me, but I would still keep my private insurance if it was all set up the way it is in England. There, you’ve got a basic system that covers everybody. But if you want or need more than that, then you can still pay for private insurance. But at least nobody goes without completely – and I think that’s important. If Katrina taught us anything, it showed us that while we focus our interests globally, people at home are suffering with no way out. I just think that before we go helping everybody else in the world with our money, resources and power, then we should first look domestically and help our own citizens. If that means the rest of the world doesn’t get as much, then so be it. People who live here should be a priority – and then what’s left can be used to help others around the globe – but many live in a 3rd world country within our own borders because they can’t afford to do better. It’s ridiculous to be a nation of such resources and to have this dichotomy.

    I also think that if we were to do some sort of setup of a NHS, then the GP would need to pick up a much broader role. This was attempted with HMOs and referrals, but it failed miserably for the most part. Some of the costs are cut by GPs in the UK managing much more than they manage here – and also people can’t just go to a specialist in the UK without a referral from their GP. Here in the US, if somebody decides they want to go to a specialist, no matter if their GP could treat the problem adequately or not, then they can go if they have insurance without referrals or can afford to pay for a specialist. Well – a lot of money gets burned up that way. Specialists should be consultants, leaving GPs to truly treat a lot broader base. I saw this in action with my new internal medicine doctor. When I had my synovitis and she suspected that I had RA or Lupus, she ran all the bloodwork and gave me a steroid taper to get the flare down and THEN had me make an appt with the rheumatologist, whom she recommended. She sent a letter ahead to the rheumy with a summary of my history, as well. That way, at my first appt with the rheumy, she didn’t have to order all the baseline tests and wait for them to come back before treating me. That allowed us to move into a plan of action much more quickly. That’s the way it should be done, ideally.

    I know a universal health plan is going to increase taxes – but if we looked more closely at things we are spending on now, then perhaps we could also reprioritize to an extent, too. I already pay 25% of my paycheck to taxes…because I have Philadelphia city wage tax, which is extremely high. So I wouldn’t be the first to want anymore t o go by the wayside in taxes, but I still think that nobody in this country should go without some form of basic coverage. (Not all the bells and whistles and top docs and all that – but some basic coverage which covers generic drugs and preventive care and a few other things…)

    Take care,
    Carrie :)

  42. sultan of swage says:

    Some interesting statements from Carrie.

    As you likely know, (last I checked) we have a GP shortage in this country, with more and more medical students choosing specialties over the last several years. By increasing the role and responsibilities of the GP and limiting the role of the specialists, you would need to reverse this trend and likely have to subsidize a number of new GPs through debt relief, loan repayment, more residencies, something. Or I suppose the government could just mandate an increase in the number of medical students who must go into a GP training program; but that may not be the best way you attract bright, ambitious, dedicated minds to that career path. Of course, by radically changing health policy and delivery we could potentially obviate some specialties altogether, I suppose, but at the detriment of what we all agree is expert care. The body of medical knowledge cannot be sufficiently known in the 21st century by one GP, IMHO. Are specialist overused? Perhaps, but by people who have chosen to prioritize their health by purchasing insurance. And the specialist’s patient is usually pretty happy when their health benefits from his/her advanced knowledge of a disease.

    The idea of health care entitlement for the very poor, elderly, and children is settled for me, professionally speaking. This entitlement disappears for the very wealthy, as it should as they have benefitted from the economic opportunities afforded by this country and therefore have more to lose should those opportunities be extinguished. Many wealthy persons worked extraordinarily hard to get where they are, regardless, and should not be vilified if they want to seek different or (what they perceive as) better care than that which is broadly available and are willing to pay for it, though. The most leftist policymakers could never deny that healthcare is a commodity that always will be disproportionately allocated but we can still afford to provide the basic services that would ensure some coverage for everyone regardless.

    I agree with the concept of a tiered system. But at the same time I also believe that it should not be unreasonable to expect those who can contribute something to their healthcare to do just that. Healthcare or food is not the question I am referring to but, say, healthcare or new jeans is. Healthcare or water bill? No. Healthcare or new CD? Yes. Healthcare or new rims for my car? Yes.
    Already, a lot of us work in a group where the billing companies make efforts to work with uninsured patients to help avoid stacking up ER visit bills, often settling the account for pennies on the dollar. The idea of an HSA was to help out the person’s use of our healthcare system back into their hands, making them more responsible for their expenses. But I have found-as a former occupant of 1 Poverty Place, Apt C-insurance is an expensive luxury in a lot of people’s minds, and these are people that insurance companies have no incentive to reach out to due to the economics of their business models. To avoid a single-payor eventuality this must be rectified. Otherwise, insurance remains a benefit for only the rich and healthcare subsequently becomes a right for those who cannot afford it or chose to not prioritize it. And that it what is most frustrating in this whole dicussion: people have to be responsible for there own well-being, as much as they are capable of. But the ideal system would also keep options open for those who already do. A tiered system could accomplish this but would be derided as morally suspect.

  43. The funny thing is, were I concerned only for myself, I’d be all over some Single Payor plan. See, I work in an ED, and roughly 40% of my work goes uncompensated. I don’t want anyone to shed a tear for me; as Ron White says, I told you that story to tell you this one:

    I personally would make out like a bandit for the first 3 to 5 years of single payor. Suddenly, I wouldn’t be giving away my work, I’d collect a decent amount on virtually every bill, and life would be good. And I think that’s the wrong answer, still.

    Because, in America, Land of the Free and Home of the Brave, that system would break the bank. And then, when the bill arrives and the world sobers up, the realization would come: holy hell, we have to pay for this!

    Today, marginal tax rates are at the lowest they’ve been in decades, but that won’t last long when everyone is covered for everything. Oh, and my ED will be stuffed, with paying patients.

    Then, well, read the part about the hair cutters.

  44. You are right gruntdoc. I am only currentl able to collect 30-33% of the dollar billed for services. Give me a few years of full payment and I will retire from this whole mess and discussion.

  45. “Because, in America, Land of the Free and Home of the Brave, that system would break the bank. And then, when the bill arrives and the world sobers up, the realization would come: holy hell, we have to pay for this!

    Today, marginal tax rates are at the lowest they’ve been in decades, but that won’t last long when everyone is covered for everything.”

    You Texans have already broken the bank for our government already. Taxes are going up no matter what in the next administration to pay for the fiscal debacle of the last 8 years. It won’t matter who is elected. Right now the govt. already pays 50% of all healthcare, and thanks to the prescription drug benefit (the first step in Republicans’ embrace of universal healthcare) and the Gulf War II vets getting ready to hit the VAs, those numbers are only going up.

  46. Yeah CJD, it is all Bush’s fault. along with AIDS, global warming, 911 and Islamic fundamentalism, Katrina, the Saints losing to the Bears, obesity, inevitable Avian Flu, tort caps. Your life must be miserable because of him.

  47. Ok, if you say so.