Healthcare deserves its own thread

[bobblehead]

This author says it better than I can: (though long)
============================================

Blame Congress for HMOs
by Twila Brase
Published in Ideas on Liberty
by the Foundation for Economic Education
February 2001





Only 27 years ago, congressional Republicans and Democrats agreed that American patients should gently but firmly be forced into managed care. That patients do not know this fact is evidenced by public outrage directed at health maintenance organizations (HMOs) instead of Congress.

Although members of Congress have managed to keep the public in the dark by joining in the clamor against HMOs, legislative history puts the responsibility and blame squarely in their collective lap.

The proliferation of managed-care organizations (MCOs) in general, and HMOs in particular, resulted from the 1965 enactment of Medicare for the elderly and Medicaid for the poor. Literally overnight, on July 1, 1966, millions of Americans lost all financial responsibility for their health-care decisions.

Offering "free care" led to predictable results. Because Congress placed no restrictions on benefits and removed all sense of cost-consciousness, health-care use and medical costs skyrocketed. Congressional testimony reveals that between 1965 and 1971, physician fees increased 7 percent and hospital charges jumped 13 percent, while the Consumer Price Index rose only 5.3 percent. The nation's health-care bill, which was only $39 billion in 1965, increased to $75 billion in 1971.1 Patients had found the fount of unlimited care, and doctors and hospitals had discovered a pot of gold.

This stampede to the doctor's office, through the U.S. Treasury, sent Congress into a panic. It had unlocked the health-care appetite of millions, and the results were disastrous. While fiscal prudence demanded a hasty retreat, Congress opted instead for deception.

Limited by a noninterference promise attached to Medicare law--enacted in response to concerns that government health care would permit rationing--Congress and federal officials had to be creative. Although Medicare officials could not deny services outright, they could shift financial risk to doctors and hospitals, thereby influencing decision-making at the bedside.

Beginning in 1971, Congress began to restrict reimbursements. They authorized the economic stabilization program to limit price increases; the Relative Value Resource Based System (RVRBS) to cut physician payments; Diagnostic-Related Groups (DRGs) to limit hospitals payments; and most recently, the Prospective Payment System (PPS) to offer fixed prepayments to hospitals, nursing homes, and home health agencies for anticipated services regardless of costs incurred. In effect, Congress initiated managed care.

National Health-Care Agenda Advances
Advocates of universal coverage saw this financial crisis as an opportunity to advance national health care through the fledgling HMO. Legislation encouraging members of the public to enter HMOs, where individual control over health-care decisions was weakened, would likely make the transition to a national health-care system, where control is centralized at the federal level, less noticeable and less traumatic. By 1971, the administration had authorized $8.4 million for policy studies to examine alternative health insurance plans for designing a "national health insurance plan."2

Senator Edward M. Kennedy, a longtime advocate of national health care, proceeded to hold three months of extensive hearings in 1971 on what was termed the "Health Care Crisis in America." Following those hearings, he held a series of hearings "on the whole question of HMO's."

Introducing the HMO hearings, Kennedy said,"We need legislation which reorganizes the system to guarantee a sufficient volume of high quality medical care, distributed equitably across the country and available at reasonable cost to every American. It is going to take a drastic overhaul of our entire way of doing business in the health-care field in order to solve the financing and organizational aspects of our health crisis. One aspect of that solution is the creation of comprehensive systems of health-care delivery."3

In 1972, President Richard M. Nixon heralded his desire for the HMO in a speech to Congress: "the Health Maintenance Organization concept is such a central feature of my National Health Strategy."4 The administration had already authorized,without specific legislative authority, $26 million for 110 HMO projects.5 That same year, the U.S. Senate passed a $5.2 billion bill permitting the establishment of HMOs "to improve the nation's health-care delivery system by encouraging prepaid comprehensive health-care programs."6

But when the House of Representatives refused to concur, it was left to the 93rd Congress to pass the HMO Act in 1973. Just before a voice vote passed the bill in the House, U.S. Representative Harley O. Staggers, Sr., of West Virginia said,"I rise in support of the conference report which will stimulate development of health maintenance organizations. . . . I think that this new system will be successful and give us exciting and constructive alternatives to our existing programs of delivering better health services to Americans."7

In the Senate, Kennedy, author of the HMO Act, also encouraged its passage: "I have strongly advocated passage of legislation to assist the development of health maintenance organizations as a viable and competitive alternative to fee-for-service practice. . . . This bill represents the first initiative by the Federal Government which attempts to come to grips directly with the problems of fragmentation and disorganization in the health care industry. . . . I believe that the HMO is the best idea put forth so far for containing costs and improving the organization and the delivery of health-care services."8 In a roll call vote, only Senator Herman Talmadge voted against the bill.

On December 29, 1973, President Nixon signed the HMO Act of 1973 into law.

As patients have since discovered,the HMO--staffed by physicians employed by and beholden to corporations--was not much of a Christmas present or an insurance product. It promises coverage but often denies access. The HMO, like other prepaid MCOs, requires enrollees to pay in advance for a long list of routine and major medical benefits, whether the health-care services are needed, wanted, or ever used. The HMOs are then allowed to manage care--withhold access to dollars and service--through definitions of medical necessity, restrictive drug formularies, and HMO-approved clinical guidelines. As a result, HMOs can keep millions of dollars from premium-paying patients.

HMO Barriers Eliminated
Congress's plan to save its members' political skins and national agendas relied on employer-sponsored coverage and taxpayer subsidies to HMOs. The planners' long-range goal was to place Medicare and Medicaid recipients into managed care where HMO managers, instead of Congress, could ration care and the government's financial liability could be limited through capitation (a fixed payment per enrollee per month regardless of the expense incurred by the HMO).

To accomplish this goal, public officials had to ensure that HMOs developed the size and stability necessary to take on the financial risks of capitated government health-care programs. This required that HMOs capture a significant portion of the private insurance market. Once Medicare and Medicaid recipients began to enroll in HMOs, the organizations would have the flexibility to pool their resources, redistribute private premium dollars, and ration care across their patient populations.

Using the HMO Act of 1973, Congress eliminated three major barriers to HMO growth, as clarified by U.S. Representative Claude Pepper of Florida: "First, HMO's are expensive to start; second, restrictive State laws often make the operation of HMO's illegal; and, third, HMO's cannot compete effectively in employer health benefit plans with existing private insurance programs. The third factor occurs because HMO premiums are often greater than those for an insurance plan." 9

To bring the privately insured into HMOs, Congress forced employers with 25 or more employees to offer HMOs as an option--a law that remained in effect until 1995. Congress then provided a total of $375 million in federal subsidies to fund planning and start-up expenses, and to lower the cost of HMO premiums. This allowed HMOs to undercut the premium prices of their insurance competitors and gain significant market share.

In addition, the federal law pre-empted state laws, that prohibited physicians from receiving payments for not providing care. In other words, payments to physicians by HMOs for certain behavior (fewer admissions to hospitals, rationing care, prescribing cheaper medicines) were now legal.

The combined strategy of subsidies, federal power, and new legal requirements worked like a charm. Employees searching for the lowest priced comprehensive insurance policy flowed into HMOs, bringing their dollars with them. According to the Health Resources Services Administration (HRSA), the percentage of working Americans with private insurance enrolled in managed care rose from 29 percent in 1988 to over 50 percent in 1997. In 1999, 181.4 million people were enrolled in managed-care plans.

Once HMOs were filled with the privately insured, Congress moved to add the publicly subsidized. Medicaid Section 1115 waivers allowed states to herd Medicaid recipients into HMOs, and Medicare+Choice was offered to the elderly. By June 1998, over 53 percent of Medicaid recipients were enrolled in managed-care plans, according to HRSA. In addition, about 15 percent of the 39 million Medicare recipients were in HMOs in 2000.10

HMOs Serve Public-Health Agenda
Despite the public outcry against HMOs, federal support for managed care has not waned. In August 1998, HRSA announced the creation of a Center for Managed Care to provide "leadership, coordination, and advancement of managed care systems . . . [and to] develop working relationships with the private managed care industry to assure mutual areas of cooperation."11

The move to managed care has been strongly supported by public-health officials who anticipate that public-private partnerships will provide funding for public-health infrastructure and initiatives, along with access to the medical records of private patients.12 The fact that health care is now organized in large groups by companies that hold millions of patient records and control literally hundreds of millions of health-care dollars has allowed unprecedented relationships to form between governments and health plans.

For example, Minnesota's HMOs, MCOs, and nonprofit insurers are required by law to fund public-health initiatives approved by the Minnesota Department of Health, the state regulator for managed care plans. The Blue Cross-Blue Shield tobacco lawsuit, which brought billions of dollars into state and health-plan coffers, is just one example of the you-scratch-my-back-I'll-scratch-yours initiatives. Yet this hidden tax, which further limits funds available for medical care, remains virtually unknown to enrollees.

Federal officials, eager to keep HMOs in business, have even been willing to violate federal law. In August 1998, a federal court chided the U.S. Department of Health and Human Services for renewing HMO contracts that violate their own Medicare regulations.13

The Ruse of Patient Protection
Truth be told, HMOs allowed politicians to promise access to comprehensive health-care services without actually delivering them. Because treatment decisions could not be linked directly to Congress, HMOs provided the perfect cover for its plans to contain costs nationwide through health-care rationing. Now that citizens are angry with managed (rationed) care, the responsible parties in Congress, Senator Kennedy in particular, return with legislation ostensibly to protect patients from the HMOs they instituted.

At worst, such offers are an obfuscation designed to entrench federal control over health care through the HMOs. At best, they are deceptive placation. Congress has no desire to eliminate managed care, and federal regulation of HMOs and other managed-care corporations will not protect patients from rationing. Even the U.S. Supreme Court acknowledged in its June 12, 2000, Pegram v. Herdrich decision that to survive financially as Congress intended, HMOs must give physicians incentives to ration treatment.

Real patient protection flows from patient control. Only when patients hold health-care dollars in their own hands will they experience the protection and power inherent in purchasing their own insurance policies, making cost-conscious health-care decisions, and inciting cost-reducing competition for their cash.

What could be so bad about that? A lot, it seems. Public officials worry privately that patients with power may not choose managed-care plans, eventually destabilizing the HMOs Congress is so dependent on for cost containment and national health-care initiatives. Witness congressional constraints on individually owned, tax-free medical savings accounts and the reluctance to break up employer-sponsored coverage by providing federal tax breaks to individuals. Unless citizens wise up to Congress's unabashed but unadvertised support for managed care, it appears unlikely that real patient power will rise readily to the top of its agenda.


1. John D. Twiname, Administrator, Office of Health, Cost of Living Council, testimony before the House Subcommittee on Public Health and Environment, Hospital Cost Controls, December 19, 1973, p. 3.

2. "OEO Transfer for Policy Research," a document included in the U.S. House of Representatives hearing on Oversight of HEW Health Programs, Subcommittee on Public Health and Environment of the Committee on Interstate and Foreign Commerce, March 1, 1973, p. 20.

3. Senator Edward M. Kennedy (Mass.), "Physicians Training Facilities and Health Maintenance Organizations," hearing, U.S. Senate, Subcommittee on Health of the Committee on Labor and Public Welfare. p. 2.

4. President Richard M. Nixon, "Health Care: Requests for Action on Three Programs," March 2, 1972, message to Congress on health care, Congressional Quarterly Almanac 1972 (Washington, D.C.: Congressional Quarterly Books, 1972), p. 43A.

5. U.S. Representative Harley O. Staggers, Sr. (W.Va.), speech on the floor of the U.S. House of Representatives, Congressional Record, September 12, 1973, p. 29354.

6. "Senate Passes Health Maintenance Organization Bill," Congressional Quarterly Almanac 1972, p. 769.

7. Representative Harley O. Staggers, Sr., speech on floor of the U.S. House of Representatives Congressional Record, December 18, 1973, p. 42229.

8. Senator Edward M. Kennedy, speech on the floor of the U.S. Senate, Congressional Record, December 19, 1973, p. 42505.

9. Representative Claude Pepper (Fla.), speech on floor of the U.S. House of Representatives, Congressional Record, September 12, 1973, p. 29353.

10. Laure McGinley and Ron Winslow, "Major HMOs to Quit Medicare Markets," Wall Street Journal, June 30, 2000.

11. The Federal Register, August 26, 1998.

12. "Public Health and Managed Care: Data Sharing for Common Goals," National Center for Chronic Disease Prevention and Health Promotion, Chronic Disease Notes & Reports, Spring/Summer 1997.

13. "Medicare patients have right to appeal HMO refusals, court says," New York Times, August 14, 1998.



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


Twila Brase, R.N., a public health nurse, is president of the Citizens' Council on Health Care in St. Paul, Minnesota.

© Foundation for Economic Education

[texaspackerbacker]

Let me state the case for the status quo.

We have the greatest quality of health care of any country in the world. We have an excellent degree of personal choice--that word liberals love so much on other issues. And virtually NOBODY that needs vital health care fails to get that care. Care is also easily available and convenient in almost every case. We also have the best research, etc. on medications, procedures, etc. of any country in the world.

What exactly are the proponents of "change" offering us that somehow improves on what we already have? I'll leave that to the libs to make their case about that.

[mraynrand]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

[bobblehead]

I believe there is room for improvement, but it lies in rolling back the gov't intervention, not increasing it.

In my Utopia, we would all carry disastor policies with 5-10k deductibles while funding a personal health savings acct that is tax free from the time we start earning wages. Any care that is not "significant" in cost we would actually look for doctors, practitioners, radiologists, whatever it is we need who are competant, then make a cost benefit analysis as to what we need. If we were struck with costs that push over our deductible the policy would kick in, the policy that we researched and chose to cover us in times of need. I would also pass legislation saying you can't be denied for pre-existing conditions as long as you have maintained a policy with no more than a 30 day gap at any time.

Call me crazy!

[MJZiggy]

I believe there is room for improvement, but it lies in rolling back the gov't intervention, not increasing it.

In my Utopia, we would all carry disastor policies with 5-10k deductibles while funding a personal health savings acct that is tax free from the time we start earning wages. Any care that is not "significant" in cost we would actually look for doctors, practitioners, radiologists, whatever it is we need who are competant, then make a cost benefit analysis as to what we need. If we were struck with costs that push over our deductible the policy would kick in, the policy that we researched and chose to cover us in times of need. I would also pass legislation saying you can't be denied for pre-existing conditions as long as you have maintained a policy with no more than a 30 day gap at any time.

Call me crazy!

Ok, you're crazy. Ok, you're really not, but while your idea is sound, you base it on the premise that everyone in the workforce is competent to do the type of cost analysis to their needs and related research. And there are many in this country (and not just lower class) who would be wiped out by a 10K deductible. And who's managing this health savings account and what happens if you have a catastrophic injury early in life and don't have enough in your account to cover it? btw, isn't your pre-existing condition policy already in place?

And Tex, I will need some proof that we have the best healthcare in the world, because from what I recall reading, there are countries in Europe doing better than we are in infant mortality and longevity etc. Show me the numbers, please.

[Scott Campbell]

........you base it on the premise that everyone in the workforce is competent to do the type of cost analysis to their needs and related research.



Isn't it sad that there is a presumption of incompetence when it comes to American's ability to take care of themselves.

[MJZiggy]

Most Americans are perfectly capable of doing it. (as some people on this forum are perfectly willing to do serious research to back up their point) Others are capable of doing it but are lazy about doing it thoroughly (as many people on this forum will sometimes tell you they know what they're saying but are too lazy to look it up for you) But do you really want Tank responsible for researching his own physicians, radiologists and managing his own health care account?

And if you'd had the text conversation I had this week--someone had lost his phone so I tried texting the last girl he had gotten a message from and she was too stupid to comprehend that someone had found this dude's phone and wanted her to tell him how to retrieve it. She is not competent to choose dinner ingredients much less health care options.

[Scott Campbell]

But do you really want Tank responsible for researching his own physicians, radiologists and managing his own health care account?


I suppose this will sound heartless, but Tank is the poster child for Darwin's theory. If his brain surgeon selection turns out to be a poor man's Bill Schroeder of the medical world, then so be it.

[MJZiggy]

:lol: :lol:

[texaspackerbacker]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

M.A.R. I don't know much about your posting history, but based on your screen name, I'm going to leap to the assumption that you are one of the good guys, and that your post above is mostly sarcasm.

I will just point out that in effect, health care is treated like a right now in that anybody who really needs it gets it--even if they can't afford it. And I don't say that as if it's a bad thing. Bobblehead would probably say it's a streak of liberalism in me, but I figure no America should go without needed care. The thing is, right now that is all kind of informally done--people show up and get treated, and the system absorbs the cost--which means in a round about way, the "haves" pay for it in the form of higher costs.

The libs want to formalize that situation--and to do so at HUGE taxpayer cost, and to do so also with the sacrifice of our freedom of choice and flexibility of care.

Ziggy, is it REALLY your position that the government should make health care decisions FOR people because a few like Tank can't do it adequately for themselves? That seems pretty extreme.

Bobblehead, I understand that you want to turn back the clock to improve the situation. That would take us back to to a time when there was a very slight amount of greater freedom, but a significant number who actually DID fall through the cracks and not get care. IMO, today's situation--HMOs, etc. really is better than 30 or so years ago.

If it ain't broke--and it ain't, don't fix it--in either direction.

[MJZiggy]

No, Tex, it's not my position that the government should make healthcare decisions for me. I was merely pointing out a consideration to Bobble's idea. Playing devil's advocate is how ideas get refined and improved upon. I don't think the government should make decisions for us, I just think that we should have access to coverage. I don't think poor people should have to wait until their medical problems become life threatening emergencies before they have access to the health care that could have prevented the emergency in the first place.

[3irty1]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

M.A.R. I don't know much about your posting history, but based on your screen name, I'm going to leap to the assumption that you are one of the good guys, and that your post above is mostly sarcasm.

I will just point out that in effect, health care is treated like a right now in that anybody who really needs it gets it--even if they can't afford it. And I don't say that as if it's a bad thing. Bobblehead would probably say it's a streak of liberalism in me, but I figure no America should go without needed care. The thing is, right now that is all kind of informally done--people show up and get treated, and the system absorbs the cost--which means in a round about way, the "haves" pay for it in the form of higher costs.

The libs want to formalize that situation--and to do so at HUGE taxpayer cost, and to do so also with the sacrifice of our freedom of choice and flexibility of care.

Ziggy, is it REALLY your position that the government should make health care decisions FOR people because a few like Tank can't do it adequately for themselves? That seems pretty extreme.

Bobblehead, I understand that you want to turn back the clock to improve the situation. That would take us back to to a time when there was a very slight amount of greater freedom, but a significant number who actually DID fall through the cracks and not get care. IMO, today's situation--HMOs, etc. really is better than 30 or so years ago.

If it ain't broke--and it ain't, don't fix it--in either direction.

I totally agree. Health care is available for everyone and even though it burdens the people who can pay for it, its a good system and its the right way to do things in this country. When it comes to health care, its necessary to take care of even those who can't take care of themselves, not because we're such nice guys but because its unacceptable to abandon those who had an accident, and fell through the cracks of the system.

There are however many ways to bring down costs starting with drug companies. In the last 20 years you've seen prescription drugs turn into a pill made in a factory that is marketed directly to customers (with like a billion commercials I might ad). What happened to the days of sending pharmacies the ingredients and having your prescription made for you? It won't be a colorful pretty pill but it will get the job done. Pharmacists don't go through all that schooling and make all that money to sell you a bottle full of pills, these people are a resource that is used less and less.

[Freak Out]

Ask some small business owners how they like the system.

[Harlan Huckleby]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

M.A.R. I don't know much about your posting history, but based on your screen name, I'm going to leap to the assumption that you are one of the good guys, and that your post above is mostly sarcasm.


The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

[bobblehead]

Most Americans are perfectly capable of doing it. (as some people on this forum are perfectly willing to do serious research to back up their point) Others are capable of doing it but are lazy about doing it thoroughly (as many people on this forum will sometimes tell you they know what they're saying but are too lazy to look it up for you) But do you really want Tank responsible for researching his own physicians, radiologists and managing his own health care account?

And if you'd had the text conversation I had this week--someone had lost his phone so I tried texting the last girl he had gotten a message from and she was too stupid to comprehend that someone had found this dude's phone and wanted her to tell him how to retrieve it. She is not competent to choose dinner ingredients much less health care options.

Here's the deal. First off, When medicare D popped up I tried to help my mom, but the time I had while home and the amount of paper involved were a nightmare. Guess what. There was a specialist in my hometown (population 15k) who for $50 looked over my mothers situation, and made very sound recommendations...also answered every question I had. Markets emerge where there is demand.

Second, so because some people are too dumb or lazy to do it the entire country should hand healthcare over to the federal gov't or an HMO....I can't believe that is actually your arguement, but it sounds like it is.

[bobblehead]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

M.A.R. I don't know much about your posting history, but based on your screen name, I'm going to leap to the assumption that you are one of the good guys, and that your post above is mostly sarcasm.


The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

That is not an arguement.

[Harlan Huckleby]

Health care is available for everyone and even though it burdens the people who can pay for it, its a good system and its the right way to do things in this country

No, health care is not available for everyone. Although it is true if you have a bone sticking-out, an emergency room won't refuse you. There are a lot of other services that are needed to keep a person healthy.

Under our current system, the only way for private insurance companies to survive is to reject coverage to people who are likely to get sick. There are all sorts of barriers that keep 50 million people out of the system - too poor to afford it, uninsurable, not falling into any of the categories for medicare.

[Harlan Huckleby]

The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

That is not an arguement.

It doesn't prove anything, but it should give you pause.

Did you watch the documentary on public TV that compared in detail health care sytems around the world?

[bobblehead]

Ok, you're crazy. Ok, you're really not, but while your idea is sound, you base it on the premise that everyone in the workforce is competent to do the type of cost analysis to their needs and related research. And there are many in this country (and not just lower class) who would be wiped out by a 10K deductible. And who's managing this health savings account and what happens if you have a catastrophic injury early in life and don't have enough in your account to cover it? btw, isn't your pre-existing condition policy already in place?

And Tex, I will need some proof that we have the best healthcare in the world, because from what I recall reading, there are countries in Europe doing better than we are in infant mortality and longevity etc. Show me the numbers, please.

Now on to another point. I would say that infant mortality and longevity could be attributed to a lot of things (mccdonalds for one). That isn't to say I discount it, but it alone isn't enough to convince me. I would like to know a bit about the EU's requirement for regular physicals and routine care...I am all for incorporating that if we can.

As far as getting wiped out by the 10k, that is true, young people would pay a bit more for a 5k deductible, probably even 2k deductibles would be available. If someone got their acct. wiped out though, yes, they would be stuck paying off the debt slowly through said acct. (all tax free) and that would be tough, but guess what....life is tough sometimes. No system is perfect, and I would be arrogant to shoot for it.

With this acct, the most you could get stuck for would be your deductible minus your present acct. If you suffered such catastrophe that you would be incapacitated and unable to work ever with ongoing huge bills...ok, that is where the gov't SHOULD step in and take care of someone (after said person hits the max payable by his insurance policy). That would be extremely rare though, and could happen in ANY system.

The pre-existing condition is for group plans only, try and get your own plan if you had a serious condition 11 years ago. Also it is usually only exempt in the HMO part of a plan, the PPO's can exclude based on pre-existing I THINK...correct me if I'm wrong. I want to take the cost of insurance away from the employer...I believe that will get reflected in wages. I want to increase competition amongst insurers and medical providers...this will get reflected in costs and efficiencies.

Lets keep the debate going...civilly, I like molding ideas.

[bobblehead]

The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

That is not an arguement.

It doesn't prove anything, but it should give you pause.

Did you watch the documentary on public TV that compared in detail health care sytems around the world?

No, but if you give me a title, or some way to access it I would like to see it. The main reason I reject national health care is because our gov't has shown very little competence in running anything.

[bobblehead]

Health care is available for everyone and even though it burdens the people who can pay for it, its a good system and its the right way to do things in this country

No, health care is not available for everyone. Although it is true if you have a bone sticking-out, an emergency room won't refuse you. There are a lot of other services that are needed to keep a person healthy.

Under our current system, the only way for private insurance companies to survive is to reject coverage to people who are likely to get sick. There are all sorts of barriers that keep 50 million people out of the system - too poor to afford it, uninsurable, not falling into any of the categories for medicare.

But MedicAID will cover most of those.

[Harlan Huckleby]

Health care is available for everyone and even though it burdens the people who can pay for it, its a good system and its the right way to do things in this country

No, health care is not available for everyone. Although it is true if you have a bone sticking-out, an emergency room won't refuse you. There are a lot of other services that are needed to keep a person healthy.

Under our current system, the only way for private insurance companies to survive is to reject coverage to people who are likely to get sick. There are all sorts of barriers that keep 50 million people out of the system - too poor to afford it, uninsurable, not falling into any of the categories for medicare.
But MedicAID will cover most of those.

No, this is a false rumor that republicans are fond of repeating. The safety net that you think exists is not there. ( I unfortunately had to learn about these realities first-hand once.) Medicaid is federally funded, administered by the states. They cover very narrow categories, in particular their definition of "disabled" describes very few people.

http://dhfs.wisconsin.gov/medicaid/

[Harlan Huckleby]

The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

That is not an arguement.

It doesn't prove anything, but it should give you pause.

Did you watch the documentary on public TV that compared in detail health care sytems around the world?

No, but if you give me a title, or some way to access it I would like to see it. The main reason I reject national health care is because our gov't has shown very little competence in running anything.

http://www-c.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

you can watch it online

[Harlan Huckleby]

The main reason I reject national health care is because our gov't has shown very little competence in running anything.

The interesting thing about that documentary is that it shows EVERY system has problems. Every approach has to constantly evolve and improve. You have to start by looking at the experiences and changes other countries made.

[texaspackerbacker]

No, Tex, it's not my position that the government should make healthcare decisions for me. I was merely pointing out a consideration to Bobble's idea. Playing devil's advocate is how ideas get refined and improved upon. I don't think the government should make decisions for us, I just think that we should have access to coverage. I don't think poor people should have to wait until their medical problems become life threatening emergencies before they have access to the health care that could have prevented the emergency in the first place.

What you said, Ziggy, and what Harlan said above is the real crux of the problem.

While any treatment indisputably necessary gets done even for people with no money or insurance, there are a lot of other lesser things that are more than just elective procedures, but that wouldn't be provided to those who can't afford them.

However, to provide that sort of coverage to everybody, we would have to sacrifice the choice, availability and convenience, and probably quality of research for EVERYBODY, as well as hit up the taxpayers for a HUGE additional amount of cost.

Obviously many of the liberal persuasion think that kind of sacrifice for the huge majority is justified to provide the kind of non-emergency care now not provided for those who can't afford it.

I still say, the status quo is the best way to go, and the negatives of those pushing "change" in the system greatly outweigh the good side.

[MJZiggy]

However, to provide that sort of coverage to everybody, we would have to sacrifice the choice, availability and convenience, and probably quality of research for EVERYBODY....

Why?

[PackFan#1]

I concur with and concede to Harlan's argument regarding the subject of this thread. :idea:

[texaspackerbacker]

However, to provide that sort of coverage to everybody, we would have to sacrifice the choice, availability and convenience, and probably quality of research for EVERYBODY....

Why?

Why? How about the law of supply and demand?

When I was in the army, I was part of the closest thing this country has had to socialized medicine/Hillary care/Obama care/whatever. Everybody got treated for free. And suddenly, a helluva lot of people decided that a helluva lot more things needed medical attention than on the outside where it wasn't free. A kid has the sniffles? Let's take him and sit around the minor illnnesses clinic for a few hours so a doctor can see him--which usually ended up being a physician's assistant--that said, "take him home, give him plenty of liquids, and in a couple of days, he'll stop sniffling" assuming he didn't catch something worse waiting in line for treatment.

If you want a more general case, check out Canada, Britain, etc., and the mess they have.

[digitaldean]

Just viewed the PBS Frontline episode on this.

My perspective on health care has changed greatly since 1994 when Billary tried to pass it through Congress. My wife was diagnosed with MS. The treatments alone cost $1800-$2000 per month. I have seen far too many friends run to the point of bankruptcy because of drug costs and hospital bills.

I am prefacing this as saying I am on the whole conservative. But, we are at a point in our country that reform is needed on all fronts.

The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.

[MJZiggy]

However, to provide that sort of coverage to everybody, we would have to sacrifice the choice, availability and convenience, and probably quality of research for EVERYBODY....

Why?

Why? How about the law of supply and demand?

When I was in the army, I was part of the closest thing this country has had to socialized medicine/Hillary care/Obama care/whatever. Everybody got treated for free. And suddenly, a helluva lot of people decided that a helluva lot more things needed medical attention than on the outside where it wasn't free. A kid has the sniffles? Let's take him and sit around the minor illnnesses clinic for a few hours so a doctor can see him--which usually ended up being a physician's assistant--that said, "take him home, give him plenty of liquids, and in a couple of days, he'll stop sniffling" assuming he didn't catch something worse waiting in line for treatment.

If you want a more general case, check out Canada, Britain, etc., and the mess they have.

Why does the law of supply and demand limit our choices, availability or convenience? I would think it would give us greater choice and convenience as the government is a very reliable client. By the way, these days civilians take their kids to the doctor for the very same sniffles.

[bobblehead]

read my original post where i copied someones article. That is why the current system is hurting, because gov't got involved in the first place. As for your MRI, you could have shopped around and gotten it done for around 500 if you negotiated and pointed out your insurance would only pay 400. I'm risking looking like an ass, but you went right where you were told and got an MRI without looking into it at all didn't you.

[Scott Campbell]

Just viewed the PBS Frontline episode on this.

My perspective on health care has changed greatly since 1994 when Billary tried to pass it through Congress. My wife was diagnosed with MS. The treatments alone cost $1800-$2000 per month. I have seen far too many friends run to the point of bankruptcy because of drug costs and hospital bills.

I am prefacing this as saying I am on the whole conservative. But, we are at a point in our country that reform is needed on all fronts.

The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.


I'm starting to lean your way. Mandatory portability would my first priority. But what I really want to see happen is that health care get paid for more equally by everybody. I perceive much of the Left wanting to pull their typical shennanigans and get somebody else to pay for theirs - typically those they define as the "rich". By definition this typically includes anybody making $5 a year more than themselves and up.

[MJZiggy]

Well, Scott, right now you're paying for indigent care 100% (as am I) you may as well get something out of it too.

[mraynrand]

Tex, you are so behind the times. Don't you know that Health care is a basic human right? That a college education is the birthright of every American. And that the rich (anyone earning 75K or more) are going to provide it? Wake up man! You seem like a fuddy duddy trapped in some sort of "Little House on the Prairie" time-warp, where Americans are God fearing self-reliant individualists. Those days are over.

M.A.R. I don't know much about your posting history, but based on your screen name, I'm going to leap to the assumption that you are one of the good guys, and that your post above is mostly sarcasm.


The United States is the only developed country in the world that has resisted providing health care to all its citizens, and you guys act like it is some wild-eyed notion.

That's just lame. Again, everyone can get healthcare and the U.S. spends more than any meaningful comparable country on healthcare. The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities. Of the 45 million uninsured, many can afford health care, many are illegals, and many others are elgible for existing programs. The critical problems in health care are 1) third party payer systems don't make people responsible in any meaningful way for economizing. If you can get virtually low or no co-pay why should you limit visits or expensive alternatives - 2) high tech care is assumed to be better - resulting in patients asking for the cadillac care version (like an expensive new artificial hip or knee for example when all that's needed is a standard version). Companies prey on this mentality and push the new stuff even if it's no better - certainly they push all sorts of things that have never been demonstrated to be better and they resist studies that demonstrate otherwise. 3) coverage for all sorts of things that would seem to be excessive or non-standard 4) End of life expenses that are out of this world - in many cases people spend more in the last two weeks of life than throughout their entire life. As difficult as it seems, people have to make choices that recognize their mortality. Everyone dies. Physicians should prevent death when it's in their power. Individuals and their families have to be responsibly told what is excessive and have a sense when to let go. I'm certainly not advocating the direction of Europe, with physicians essentially deciding when to Euthanize, but rather that people have to come to grips with their own mortality.

Most everyone can afford healthcare. The U.S. has by far the greatest healthcare system in the world. It can take care of people who truly cannot afford care, just so long as those who can pay, do so, and there is some rational use of resources

Ziggy, the mortality figures have nothing to do with quality of care - they have more to do with what is considered infant mortality. U.S. figures include neonatal.

Econ 101 - any time you subsidize something, the quality drops and costs go up. Ask yourselves this - if Government provides healthcare for 'free', what incentive do you have to govern your use of it? If government provides healthcare, then they must control it's distribution. Since it's 'free of charge', demand will exceed supply, and thus supply must be rationed. Who will ration it, and how? How will government prevent the 'rich' and/or people who place a premium on health care from seeking out higher quality health care, or from spending more on health care they choose to receive. What if physicians don't want to work for government wages, or the people who are intelligent enough decide not to train as physicians. Will government put a gun to their heads and force them to train as physicians. At some point they must if health care is to remain 'free' and to remain 'a basic human right.' If you think this sounds absurd, it's already happening. The costs are rising so fast that medicare and medicaid cannot reimburse so physicians are quitting and hospitals are recruiting from overseas - bringing in more poorly trained physicians. What is happening to our BASIC HUMAN RIGHTS?? Funny, I went out for walk in the woods and nowhere did I see healthcare growing on trees. I would have expected it, if it were a basic human right.

[Scott Campbell]

The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities.



The whole post was great, but that's the point I liked best.

[PackFan#1]

That's just lame. Again, everyone can get healthcare and the U.S. spends more than any meaningful comparable country on healthcare. The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities. Of the 45 million uninsured, many can afford health care, many are illegals, and many others are elgible for existing programs. The critical problems in health care are 1) third party payer systems don't make people responsible in any meaningful way for economizing. If you can get virtually low or no co-pay why should you limit visits or expensive alternatives - 2) high tech care is assumed to be better - resulting in patients asking for the cadillac care version (like an expensive new artificial hip or knee for example when all that's needed is a standard version). Companies prey on this mentality and push the new stuff even if it's no better - certainly they push all sorts of things that have never been demonstrated to be better and they resist studies that demonstrate otherwise. 3) coverage for all sorts of things that would seem to be excessive or non-standard 4) End of life expenses that are out of this world - in many cases people spend more in the last two weeks of life than throughout their entire life. As difficult as it seems, people have to make choices that recognize their mortality. Everyone dies. Physicians should prevent death when it's in their power. Individuals and their families have to be responsibly told what is excessive and have a sense when to let go. I'm certainly not advocating the direction of Europe, with physicians essentially deciding when to Euthanize, but rather that people have to come to grips with their own mortality.

Most everyone can afford healthcare. The U.S. has by far the greatest healthcare system in the world. It can take care of people who truly cannot afford care, just so long as those who can pay, do so, and there is some rational use of resources

Ziggy, the mortality figures have nothing to do with quality of care - they have more to do with what is considered infant mortality. U.S. figures include neonatal.

Econ 101 - any time you subsidize something, the quality drops and costs go up. Ask yourselves this - if Government provides healthcare for 'free', what incentive do you have to govern your use of it? If government provides healthcare, then they must control it's distribution. Since it's 'free of charge', demand will exceed supply, and thus supply must be rationed. Who will ration it, and how? How will government prevent the 'rich' and/or people who place a premium on health care from seeking out higher quality health care, or from spending more on health care they choose to receive. What if physicians don't want to work for government wages, or the people who are intelligent enough decide not to train as physicians. Will government put a gun to their heads and force them to train as physicians. At some point they must if health care is to remain 'free' and to remain 'a basic human right.' If you think this sounds absurd, it's already happening. The costs are rising so fast that medicare and medicaid cannot reimburse so physicians are quitting and hospitals are recruiting from overseas - bringing in more poorly trained physicians. What is happening to our BASIC HUMAN RIGHTS?? Funny, I went out for walk in the woods and nowhere did I see healthcare growing on trees. I would have expected it, if it were a basic human right.

To translate the above post: We don't give a fuck about people who can't afford health care. Let them die. And people with genetic diseases? They are "responsible" for their diseases, not the person or persons that passed on the diseases to them, so since they were "irresponsible" to began with, let them die. Hey, humans are merely animals with a big brain (those that are "irresponsible" have smaller than average brains). Survival of the fittest is the law of nature.

[Freak Out]

The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities.



The whole post was great, but that's the point I liked best.

I'm entitled to have my tax dollars spent wisely.

[Scott Campbell]

The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities.



The whole post was great, but that's the point I liked best.

I'm entitled to have my tax dollars spent wisely.


No arguments here.

[bobblehead]

To translate the above post: We don't give a fuck about people who can't afford health care. Let them die. And people with genetic diseases? They are "responsible" for their diseases, not the person or persons that passed on the diseases to them, so since they were "irresponsible" to began with, let them die. Hey, humans are merely animals with a big brain (those that are "irresponsible" have smaller than average brains). Survival of the fittest is the law of nature.

As usual pack, you have a very unique ability to read things that aren't there and you further the debate through civil well thought out discourse.

[bobblehead]

Well, Scott, right now you're paying for indigent care 100% (as am I) you may as well get something out of it too.

This is a very bad path to go down. First, its fundamentally wrong (especially if you agree to it for this reason and then they decide means testing is required to keep costs down).

Second, allowing gov't to REALLY mess it up in an attempt to get mine has been a long standing inhiibitor of progress in this country already.

[bobblehead]

Health care is available for everyone and even though it burdens the people who can pay for it, its a good system and its the right way to do things in this country

No, health care is not available for everyone. Although it is true if you have a bone sticking-out, an emergency room won't refuse you. There are a lot of other services that are needed to keep a person healthy.

Under our current system, the only way for private insurance companies to survive is to reject coverage to people who are likely to get sick. There are all sorts of barriers that keep 50 million people out of the system - too poor to afford it, uninsurable, not falling into any of the categories for medicare.
But MedicAID will cover most of those.

No, this is a false rumor that republicans are fond of repeating. The safety net that you think exists is not there. ( I unfortunately had to learn about these realities first-hand once.) Medicaid is federally funded, administered by the states. They cover very narrow categories, in particular their definition of "disabled" describes very few people.

http://dhfs.wisconsin.gov/medicaid/

1) I'm a libertarian who votes republican out of lesser of 2 evils.
2) ok, most was an overstatement, but a lot of those truly in need will be covered by medicaid.
3) After reading that gov't website and getting a headache I'm more convinced than ever I don't want them in charge of my healthcare.


4) I have't watched the video yet as I hate watching things longer than 2 minutes on a computer, but I will at some point.

[bobblehead]

Ok, I sucked it up and watched the first chapter, Great Britian....you can't deny the reporter is giving us his biased perspective starting out by saying our healthcare is a mess and in big trouble.

He also states that UK people have "no bills" for healthcare as though higher taxes aren't bills....he later admits "much higher taxes".

He and the times reporter also talk about elective procedures...you know, hip replacements and heart surgeries. Yea, I guess you can always put those off. Good news though, now with the conservatives taking over wait lines for these things have been cut from 18 months down to 6 months because they finally are spending more money on the system...ooops, isn't that like costs going up? Oh yea, they also reduced wait times by forcing hospitals to compete for business...sounds free marketish. And best of all, the crappy hospitals that no one is choosing now that they can choose are protesting the new policy.

This was from a liberal prospective no less.

They did make some positive points, on how doctors get a bonus for keeping patients healthy, I like that. It makes doctors work a bit harder on preventive medicine and screenings. Some patients were so diligent about their health that they came in twice a week according to the doctor interviewed.

Sorry, but after seeing the UK one I'm not overly impressed. He also didn't address the issue of innovative medicine/techniques which is my main issue.

Oh, forgot the best part of all, the doctor in the interview, you know, Mr. Preventive medicine. He was complaining about having a heart attack right here in Las Vegas and being brought to county where the care was great, but it was really expensive. I guess his bonus for keeping patients healthy is shot huh.

[PackFan#1]

Ok, I sucked it up and watched

Next, go check out Michael Moore's unbiased "Sicko."

http://upload.wikimedia.org/wikipedia/en/thumb/0/04/Sickoposter.jpg/406px-Sickoposter.jpg

[Harlan Huckleby]

4) I have't watched the video yet as I hate watching things longer than 2 minutes on a computer, but I will at some point.

I agree. It will be replayed on PBS sometime. The whole thing is well worth watching. Its a little dry, they go through about 5 countries, but damn was it eye-opening.

Regarding the biases in the documentary: Frontline often is pretty awful. But I was extremely impressed in the thorough report they did this time, which is probably due to the integrity of the individual who made this film. Of course their bias is that our system needs repair, but they didn't sugar-coat the problems that other approaches have encountered.

[Harlan Huckleby]

Ok, I sucked it up and watched

Next, go check out "Sicko."

I like Michael Moore as an entertainer, but don't take him seriously as a documentary maker, he plays fast and loose with the facts.

However, I've heard that "Sicko" is his best work as a real documentary, that he has done an honest job. I've been meaning to check it out.

[PackFan#1]

However, I've heard that "Sicko" is his best work as a real documentary, that he has done an honest job. I've been meaning to check it out.

Great film. Accurate. You should definitely check it out. (those right wing idiots like to describe the film as "liberal bias", but that's why they're narrow-minded idiots.)

[texaspackerbacker]

However, to provide that sort of coverage to everybody, we would have to sacrifice the choice, availability and convenience, and probably quality of research for EVERYBODY....

Why?

Why? How about the law of supply and demand?

When I was in the army, I was part of the closest thing this country has had to socialized medicine/Hillary care/Obama care/whatever. Everybody got treated for free. And suddenly, a helluva lot of people decided that a helluva lot more things needed medical attention than on the outside where it wasn't free. A kid has the sniffles? Let's take him and sit around the minor illnnesses clinic for a few hours so a doctor can see him--which usually ended up being a physician's assistant--that said, "take him home, give him plenty of liquids, and in a couple of days, he'll stop sniffling" assuming he didn't catch something worse waiting in line for treatment.

If you want a more general case, check out Canada, Britain, etc., and the mess they have.

Why does the law of supply and demand limit our choices, availability or convenience? I would think it would give us greater choice and convenience as the government is a very reliable client. By the way, these days civilians take their kids to the doctor for the very same sniffles.

I guess I didn't spell it out clearly enough. There simply aren't enough health care providers or facilities to handle everybody without massive traffic jams. That's the supply side. The demand side comes in when, as I described, people just somehow seem to decide that every little hangnail and sniffle needs the attention of a professional--when that professional attention is free of charge.
----------------------------------------------------------------------------------
The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.
_________________
-digital dean
---------------------------------------------------------------------------------

This is moderate and reasonable enough that I and many conservatives could probably go for it. I think you would have a problem with the Hillary and Obama types, though, as this falls WAY SHORT of the government takeover they have in mind.

The only thing I would add to what you posted would be some kind of a safeguard--how I don't know--against people clogging the system for silly crap that doesn't even need attention. Maybe a minimal copay of $10 or even only $5 would discourage that sort of thing.

Let's hear what some of the less extreme libs on this--Harlan, Ziggy, etc.. Would it be good enough for you? Or not?

[MJZiggy]

I thought I agreed with it when DD posted it. I agree on tort reform for ALL types of lawsuits, not just medical malpractice, I think as a country we've taken litigious to an art form and it needs to stop.
Portability is very important; Making sure everyone gets a basic form of coverage is key--especially children (and the distinction between basic and beyond is noted and agreed with as well)
And yes, they do need to stop selling drugs to doctors. Their offices are plastered with posters and pens and all manner of junk put out by drug companies in an attempt to make us think that their drugs are going to bring us utopia somehow.

There has to be a way to keep a free market system and make sure those who need medical care can get it.

[bobblehead]

Ok, I sucked it up and watched

Next, go check out Michael Moore's unbiased "Sicko."



Dude........Are you trying to lose all semblence of credibility or are you making a joke?

[bobblehead]

However, I've heard that "Sicko" is his best work as a real documentary, that he has done an honest job. I've been meaning to check it out.

Great film. Accurate. You should definitely check it out. (those right wing idiots like to describe the film as "liberal bias", but that's why they're narrow-minded idiots.)

You mean those right wing idiots that reject the notion that 9/11 was an inside job?

If you want to further your cause you're going to have to learn to tone down the rhetoric. Its very hard to take you seriously the way you go about it. What are you, like 20 years old and in college still learning the attack mechanism of the leftt?

[bobblehead]

I thought I agreed with it when DD posted it. I agree on tort reform for ALL types of lawsuits, not just medical malpractice, I think as a country we've taken litigious to an art form and it needs to stop.
Portability is very important; Making sure everyone gets a basic form of coverage is key--especially children (and the distinction between basic and beyond is noted and agreed with as well)
And yes, they do need to stop selling drugs to doctors. Their offices are plastered with posters and pens and all manner of junk put out by drug companies in an attempt to make us think that their drugs are going to bring us utopia somehow.

There has to be a way to keep a free market system and make sure those who need medical care can get it.

I hear ya. The drug advertising is getting tiresome. Portability is huge, I actually think simply saying that the employee sponsored group plans should never be able to drop you when you quit and have to charge exactly what they charge said company would go a long way just by itself.

I disagree on tort reform. I hate to say it, but we need professional juries that can comprehend the facts of a case. I have no problem with a gazillion dollar judgement agains ford because they made a cost benefit analysis on pintos exploding when rearended. It is simply a case of making sure they realize the cost side of that equation isn't worth the risk. Now, a doctor that did his god honest best and made a misdiagnosis that was within the realm of reasonability getting zapped with that judgement...no, i don't like that. Or suing a tobacco company cuz smoking was dangerous....it says so right on the frickin pack.

[PackFan#1]

Ok, I sucked it up and watched

Next, go check out Michael Moore's unbiased "Sicko."



Dude........Are you trying to lose all semblence of credibility or are you making a joke?

I am serious. You should definitely check out the film. It will broaden up your narrow mind a bit.

[Patler]

And yes, they do need to stop selling drugs to doctors. Their offices are plastered with posters and pens and all manner of junk put out by drug companies in an attempt to make us think that their drugs are going to bring us utopia somehow.

I don't mind it in the Drs. offices so much; but why do prescription drugs advertise so much on television and radio? Clearly they want us to go to our Drs. and request (demand) certain treatments. The whole idea of very, very frequent advertising of prescription drugs to the general population seems ridiculous to me.

And people wonder why we are a drug-driven society!

[mraynrand]

That's just lame. Again, everyone can get healthcare and the U.S. spends more than any meaningful comparable country on healthcare. The critical point is that we've become a country that thinks in terms of entitlements rather than in terms of responsibilities. Of the 45 million uninsured, many can afford health care, many are illegals, and many others are elgible for existing programs. The critical problems in health care are 1) third party payer systems don't make people responsible in any meaningful way for economizing. If you can get virtually low or no co-pay why should you limit visits or expensive alternatives - 2) high tech care is assumed to be better - resulting in patients asking for the cadillac care version (like an expensive new artificial hip or knee for example when all that's needed is a standard version). Companies prey on this mentality and push the new stuff even if it's no better - certainly they push all sorts of things that have never been demonstrated to be better and they resist studies that demonstrate otherwise. 3) coverage for all sorts of things that would seem to be excessive or non-standard 4) End of life expenses that are out of this world - in many cases people spend more in the last two weeks of life than throughout their entire life. As difficult as it seems, people have to make choices that recognize their mortality. Everyone dies. Physicians should prevent death when it's in their power. Individuals and their families have to be responsibly told what is excessive and have a sense when to let go. I'm certainly not advocating the direction of Europe, with physicians essentially deciding when to Euthanize, but rather that people have to come to grips with their own mortality.

Most everyone can afford healthcare. The U.S. has by far the greatest healthcare system in the world. It can take care of people who truly cannot afford care, just so long as those who can pay, do so, and there is some rational use of resources

Ziggy, the mortality figures have nothing to do with quality of care - they have more to do with what is considered infant mortality. U.S. figures include neonatal.

Econ 101 - any time you subsidize something, the quality drops and costs go up. Ask yourselves this - if Government provides healthcare for 'free', what incentive do you have to govern your use of it? If government provides healthcare, then they must control it's distribution. Since it's 'free of charge', demand will exceed supply, and thus supply must be rationed. Who will ration it, and how? How will government prevent the 'rich' and/or people who place a premium on health care from seeking out higher quality health care, or from spending more on health care they choose to receive. What if physicians don't want to work for government wages, or the people who are intelligent enough decide not to train as physicians. Will government put a gun to their heads and force them to train as physicians. At some point they must if health care is to remain 'free' and to remain 'a basic human right.' If you think this sounds absurd, it's already happening. The costs are rising so fast that medicare and medicaid cannot reimburse so physicians are quitting and hospitals are recruiting from overseas - bringing in more poorly trained physicians. What is happening to our BASIC HUMAN RIGHTS?? Funny, I went out for walk in the woods and nowhere did I see healthcare growing on trees. I would have expected it, if it were a basic human right.

To translate the above post: We don't give a fuck about people who can't afford health care. Let them die. And people with genetic diseases? They are "responsible" for their diseases, not the person or persons that passed on the diseases to them, so since they were "irresponsible" to began with, let them die. Hey, humans are merely animals with a big brain (those that are "irresponsible" have smaller than average brains). Survival of the fittest is the law of nature.
------------------------



You're so full of $hit, it's a wonder you can find enough time off the toilet to post anything. My post is simple: healthcare has multiple areas of problems, starting with the insane notion that it is some sort of basic human right that exists independent of human beings who work their asses off to train as physicians, scientists, engineers, etc. to learn how to treat patients, generate medicines, and produce instruments that are required to fix injured and sick people (Do MRI machines grown on trees? Do blood pressure medicines self sort to 99.99% purity and migrate into plastic bottles all on their own, does a human being spontaneously aquire the skill and judgment to understand human anatomy and physiology so as to make a differential diagnosis?).

The second point is that people in general should be responsible enough to get health care insurance since most can afford it. Third, is that government and unions should get the hell out of the business as much as possible, because they institute or codify insane requirements that drive up costs and because they eliminate competition.

Finally, nowhere in my post did I suggest that providing health care to those who can't afford it is not a proper objective. If you actually knew anything other than leftist propaganda (like 'Sicko') you'd know that there are thousands of people receiving top quality care (in many cases better than what they can get a private hospitals) at county hospitals and emergency rooms around the nation. Some county institutes provide well over 200 million dollars per year of free health care, and often that figure doesn't even include physician billing, which is often waived to the tune of 2,3,6 times the physician's salary. I challenge you to look into the kind of care the indigent receive at medical centers like Harborview in Seattle, Denver General, MetroHealth in Cleveland. The care is so far better than what the average poor shmuck living in a socialist hell like Cuba gets that the Cubans may just as well use rattles and chanting. But gullible fools like you will believe what a propagandist like Moore tells you, instead of thinking for yourself and researching the issue on your own - why? Because for what ever reason - indoctrination in public schools, or by the leftists media, etc. you choose to believe the historically disproven rhetoric that socialism and more government control is better, even though you'll turn around in the next instance and rail on government for screwing everything up. You're waiting for the next ruler to give you your bread and circuses and tell you that everything will be OK once all the ill-gotten monies are taken from corrupt capitalists and put back into your pocket in the form of "Free" health care.
----------------
For people who can think for themselves, the goal is to reduce health care costs by making responsible consumers, increasing competition so that companies can't gouge, and by reducing government and union involvement (for the obvious reason that government and large unions typically #uck up virtually everything they touch). Do these things, and the indigent people who really need free health care will never have to worry, and we won't have to worry as a society how to pay for it.

[mraynrand]

And yes, they do need to stop selling drugs to doctors. Their offices are plastered with posters and pens and all manner of junk put out by drug companies in an attempt to make us think that their drugs are going to bring us utopia somehow.

I don't mind it in the Drs. offices so much; but why do prescription drugs advertise so much on television and radio? Clearly they want us to go to our Drs. and request (demand) certain treatments. The whole idea of very, very frequent advertising of prescription drugs to the general population seems ridiculous to me.

And people wonder why we are a drug-driven society!

Yes, they are trying to push their products on you, like any other industry. Fortunately, Patler, you are a smart guy and you can seek out the relevant information and/or judge your physician to see whether he or she is just a pill pusher or a legitimate doc. Just like any industry, there will be docs that are trying to make money on the cheap, or who take short cuts to knowledge and will just accept what the drug companies tell them about medication x. Possible solutions include more government regulation or more awareness from the consumer. Which do you think will work better? From my perspective, I cringe at the thought of more regulation - it's bad enough that some pencil neck in an HMO office somewhere is trying to micromanage physicians - imagine some governmental clerk from HHS (Health and Human Services) in Washington D.C. trying to determine whether your prescription is legit given his/her education in public policy.

[Patler]

Yes, they are trying to push their products on you, like any other industry. Fortunately, Patler, you are a smart guy and you can seek out the relevant information and/or judge your physician to see whether he or she is just a pill pusher or a legitimate doc. Just like any industry, there will be docs that are trying to make money on the cheap, or who take short cuts to knowledge and will just accept what the drug companies tell them about medication x. Possible solutions include more government regulation or more awareness from the consumer. Which do you think will work better? From my perspective, I cringe at the thought of more regulation - it's bad enough that some pencil neck in an HMO office somewhere is trying to micromanage physicians - imagine some governmental clerk from HHS (Health and Human Services) in Washington D.C. trying to determine whether your prescription is legit given his/her education in public policy.

I'm not one for more government regulation in anything. I can't think of a single activity that I think needs more government control.

As you said, there will always be the occasional Dr. who wants his kickback, or is too lazy to stay current. Every profession has members who are not very "professional", and the medical profession is not an exception. Perhaps naively, I tend to think this will be only a small problem.

If you are suggesting that prescription drug advertising is a good way for individuals to become knowledgeable about the drugs their physicians might supply, I disagree. All it does is make people aware of what is offered, it does nothing to help them evaluate their physician. Unfortunately, most people will relate more to the one they remember, be it from advertising frequency, advertising cleverness so as to be memorable, or the spokesman used. None of these are relevant to the efficacy of the treatment in any circumstance.

Perhaps I misunderstood your point?

[Scott Campbell]

And yes, they do need to stop selling drugs to doctors. Their offices are plastered with posters and pens and all manner of junk put out by drug companies in an attempt to make us think that their drugs are going to bring us utopia somehow.

I don't mind it in the Drs. offices so much; but why do prescription drugs advertise so much on television and radio? Clearly they want us to go to our Drs. and request (demand) certain treatments. The whole idea of very, very frequent advertising of prescription drugs to the general population seems ridiculous to me.

And people wonder why we are a drug-driven society!


I'm a little tired of hearing about consulting your physician if your erection lasts longer 4 hour during prime time tv.

[Patler]

I'm a little tired of hearing about consulting your physician if your erection lasts longer 4 hour during prime time tv.

That has always confused me. I take no drugs. Should I still be consulting my physician when that happens??? :lol:

[Scott Campbell]

I'm a little tired of hearing about consulting your physician if your erection lasts longer 4 hour during prime time tv.

That has always confused me. I take no drugs. Should I still be consulting my physician when that happens??? :lol:



Call your Doctor???

I'm calling a press conference if that happens.

[mraynrand]

Yes, they are trying to push their products on you, like any other industry. Fortunately, Patler, you are a smart guy and you can seek out the relevant information and/or judge your physician to see whether he or she is just a pill pusher or a legitimate doc. Just like any industry, there will be docs that are trying to make money on the cheap, or who take short cuts to knowledge and will just accept what the drug companies tell them about medication x. Possible solutions include more government regulation or more awareness from the consumer. Which do you think will work better? From my perspective, I cringe at the thought of more regulation - it's bad enough that some pencil neck in an HMO office somewhere is trying to micromanage physicians - imagine some governmental clerk from HHS (Health and Human Services) in Washington D.C. trying to determine whether your prescription is legit given his/her education in public policy.

I'm not one for more government regulation in anything. I can't think of a single activity that I think needs more government control.

As you said, there will always be the occasional Dr. who wants his kickback, or is too lazy to stay current. Every profession has members who are not very "professional", and the medical profession is not an exception. Perhaps naively, I tend to think this will be only a small problem.

If you are suggesting that prescription drug advertising is a good way for individuals to become knowledgeable about the drugs their physicians might supply, I disagree. All it does is make people aware of what is offered, it does nothing to help them evaluate their physician. Unfortunately, most people will relate more to the one they remember, be it from advertising frequency, advertising cleverness so as to be memorable, or the spokesman used. None of these are relevant to the efficacy of the treatment in any circumstance.

Perhaps I misunderstood your point?

You were just a bit off. I agree that commercials tend to not be informative. They are in fact, deliberately manipulative. But they aren't going away. I just hope folks can determine for themselves, for the most part, when they are being scammed. I know that I won't try Avocor, because even though I want my hair back, I don't want it to be green and have to comb it funny. I'm tired of that bearded guy who keeps selling the amazing putty that can pull a semi and the Oxi-cleaner that will remove all colored stains from my carpet, yet not change the dye AT ALL, but I bought 400 of those amazing shami thingies instead of spending hundreds for paper towels. But that's not all, act now and WE'LL DOUBLE YOUR ORDER!

sorry, I lost it there. help me.

[Scott Campbell]

sorry, I lost it there. help me.



Tivo.

[bobblehead]

I'm a little tired of hearing about consulting your physician if your erection lasts longer 4 hour during prime time tv.

That has always confused me. I take no drugs. Should I still be consulting my physician when that happens??? :lol:



Call your Doctor???

I'm calling a press conference if that happens.

Hell with the press, I'm kicking the wife outta the house and calling 4-5 of my ex's

[bobblehead]

Ok, I sucked it up and watched

Next, go check out Michael Moore's unbiased "Sicko."



Dude........Are you trying to lose all semblence of credibility or are you making a joke?

I am serious. You should definitely check out the film. It will broaden up your narrow mind a bit.

I'll let it slide. I watched farenheight 911, was sickened by about 6 facts being wrong in the first 15 minutes, still watched it all though. See the problem with Moore, and people who run around calling consevatives "narrowminded" and "idiots" is they lose all credibility. Moore may have made about 5-6 good points in 911, he may have made more in sicko, but I'll never know because in order to hear his good points I gotta put up with being belittled and demeaned, and then sift thru the propagandist bullshit.

I actually watched inconveniant truth too. When I watched it I said he should have stopped after the graph...the last 2/3 of the movie was a glorified bush bashing. Then I found out the truth on his graph. While it was neat and all, it didn't point out that thruout the graph co2 levels TRAILED the temperature hikes during the times when glaciers were melting. That little fact he never pointed out pretty much shoots his entire theory in the foot, and when I found it out, I could no longer take anything he says credibly, not that I took him too seriously when he kept spouting his propaganda the whole time anyway.

http://www.sitewave.net/news/s49p1835.htm

from the link:
==================

Even if every example of the current impact of CO2 driven temperature rise could be disproved, one stunning visual from the movie remains to haunt the viewer with doubts. Gore shows us two lines - one plotting temperature over the past six hundred and fifty thousand years, the other plotting atmospheric carbon dioxide. They appear to rise and fall with a synchronicity that would be the envy of many an aquatic acrobat. If temperature and carbon dioxide really have shown such a strong correlation over the centuries, isn't it still probable that CO2 drives temperature? This is possible, of course, provided that the CO2 rises coincide with or slightly predate the rises in temperature. Correlation is sensitive, but not specific - it can pick up a whole range of possible causes, but cannot prove causation. On the other hand, as we have all learned by now, if a sensitive test is negative, it can rule out a potential cause. Lack of correlation rules out proximate causation. Is CO2 inducing this global fever?

Probably not.

That is, not if you trust the ice core records that Gore speaks so highly of in his Oscar-winning Powerpoint presentation. The Antarctic melting during the third glacial termination (210-225 thousand years ago) show that the CO2 rise lagged behind the temperature increase by about 800 years. An article by Fischer in Science reported a lag of 400-1000 years during all three glacial interglacial transitions on record. A later analysis using argon - which has been shown to correlate with temperature as well as the standard oxygen isotopes and would be less prone to inaccuracies in timing - confirmed the previously reported findings. That kind of a lag is easy to miss in charts covering hundreds of millennia, but it is hard to dismiss as insignificant on a practical level. The Fischer article states that the generally observed correlation between CO2 and temperature rise and fall is "connected to a climate-driven net transfer of carbon from the ocean to the atmosphere". In other words, the ocean acts as an enormous organism that exhales carbon dioxide during warming periods of earth's history, and absorbs it during periods of cooling. Caillon et al report that "this confirms that CO2 is not the forcing [that is, the causative factor] that initially drives the climatic system during a deglaciation". (Caillon, N. et al, Science 14 March 2003: Vol. 299. no. 5613, pp. 1728 - 1731; Fischer, H et al, Science 12 March 1999: Vol. 283. no. 5408, pp. 1712 - 1714).
====================================

Now that you have hopefully read this is your narrow mind broadened up a bit, or is al gore still being sincere?

[PackFan#1]

I'll let it slide. I watched farenheight 911, was sickened by about 6 facts being wrong in the first 15 minutes, still watched it all though. See the problem with Moore, and people who run around calling consevatives "narrowminded" and "idiots" is they lose all credibility. Moore may have made about 5-6 good points in 911, he may have made more in sicko, but I'll never know because in order to hear his good points I gotta put up with being belittled and demeaned, and then sift thru the propagandist bullshit.

I actually watched inconveniant truth too. When I watched it I said he should have stopped after the graph...the last 2/3 of the movie was a glorified bush bashing. Then I found out the truth on his graph. While it was neat and all, it didn't point out that thruout the graph co2 levels TRAILED the temperature hikes during the times when glaciers were melting. That little fact he never pointed out pretty much shoots his entire theory in the foot, and when I found it out, I could no longer take anything he says credibly, not that I took him too seriously when he kept spouting his propaganda the whole time anyway.


Anytime a liberal expose a truth, conservatives seek to discredit it by calling it propaganda. Conservatives have always been in favor of obliterating truths. An ignorant society is easier to exploit than a well informed one.

What is propaganda? Fox News!

[texaspackerbacker]

Just viewed the PBS Frontline episode on this.

My perspective on health care has changed greatly since 1994 when Billary tried to pass it through Congress. My wife was diagnosed with MS. The treatments alone cost $1800-$2000 per month. I have seen far too many friends run to the point of bankruptcy because of drug costs and hospital bills.

I am prefacing this as saying I am on the whole conservative. But, we are at a point in our country that reform is needed on all fronts.

The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.

This is an EXCELLENT plan here by Digitaldean. I like it --from the conservative side; Ziggy likes it--representing the fairly reasonable portion of the left. I doubt that Obama or Hillary or other big time Dems would go for it, as they are out to socialize the whole shibang in a massive government takeover. However, this is something that would be good for people, and equally important, sellable to people.

[Scott Campbell]

Anytime a liberal expose a truth, conservatives seek to discredit it by calling it propaganda. Conservatives have always been in favor of obliterating truths. An ignorant society is easier to exploit than a well informed one.

What is propaganda? Fox News!



Hmmmmmm.


Hmmmmmm.


You wouldn't happen to be an "Extreme" Liberal - would you?

[bobblehead]

I'll let it slide. I watched farenheight 911, was sickened by about 6 facts being wrong in the first 15 minutes, still watched it all though. See the problem with Moore, and people who run around calling consevatives "narrowminded" and "idiots" is they lose all credibility. Moore may have made about 5-6 good points in 911, he may have made more in sicko, but I'll never know because in order to hear his good points I gotta put up with being belittled and demeaned, and then sift thru the propagandist bullshit.

I actually watched inconveniant truth too. When I watched it I said he should have stopped after the graph...the last 2/3 of the movie was a glorified bush bashing. Then I found out the truth on his graph. While it was neat and all, it didn't point out that thruout the graph co2 levels TRAILED the temperature hikes during the times when glaciers were melting. That little fact he never pointed out pretty much shoots his entire theory in the foot, and when I found it out, I could no longer take anything he says credibly, not that I took him too seriously when he kept spouting his propaganda the whole time anyway.


Anytime a liberal expose a truth, conservatives seek to discredit it by calling it propaganda. Conservatives have always been in favor of obliterating truths. An ignorant society is easier to exploit than a well informed one.

What is propaganda? Fox News!

Interesting, living proof of your own point...did you read the piece on global warming?? He didn't expose a truth, he TOLD A LIE. CO2 emmissions trailed global warming, not vice versa.

I just told you I watched 911, I watched an inconveniant truth, and you dismiss me as ignorant. Did you watch farenHYPE 911?? Do you ever watch fox news?

Again, I know it is easier to call me names and be irrational, but lets debate the facts. I don't know many people who would call Moore unbiased. What would you say if I told you that Rush Limbaugh is unbiased and makes great presentations?

I really wish I could drag liberals like you into an intellectual argument so you would have to confront facts instead of calling conservatives names and race baiting.

[bobblehead]

Just viewed the PBS Frontline episode on this.

My perspective on health care has changed greatly since 1994 when Billary tried to pass it through Congress. My wife was diagnosed with MS. The treatments alone cost $1800-$2000 per month. I have seen far too many friends run to the point of bankruptcy because of drug costs and hospital bills.

I am prefacing this as saying I am on the whole conservative. But, we are at a point in our country that reform is needed on all fronts.

The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.

This is an EXCELLENT plan here by Digitaldean. I like it --from the conservative side; Ziggy likes it--representing the fairly reasonable portion of the left. I doubt that Obama or Hillary or other big time Dems would go for it, as they are out to socialize the whole shibang in a massive government takeover. However, this is something that would be good for people, and equally important, sellable to people.

I agree, this is a very good post. I think the solutions I put on my "utopia" post would solve a lot of this. I think tort reform needs to be a lot different than capping verdicts, but reform is in order.

[bobblehead]

I guess pointing out that al gore is pretty much full of it is a thread killer.

[MJZiggy]

I thought it was cause we all agreed on something for a change. I think it blew everyone's mind... :whaa:

[bobblehead]

I thought it was cause we all agreed on something for a change. I think it blew everyone's mind... :whaa:

LOL, that probably is true too.

[PackFan#1]

Conservative don't want free universal health care because, in their narrow-minded, egoistic view of the world, they think it would pave the way for communism.

Guess what? France, Britain, Canada, among others, provide free universal care and they're not turning into unions of soviet social republics!

Conservatives are all about me, and not we. Hey, I am Bob Dole and I'm getting paid millions by drug and health insurance companies, so who gives a fuck about those who cannot afford health treatment? Conservatism should change its motto to this: finding pleasure in other people's pain; only in America!

I quote the scientist Peter Kropotkin (don't agree with some of his anarchist ideas): "In the practice of mutual aid, which we can retrace to the earliest beginnings of evolution, we thus find the positive and undoubted origin of our ethical conceptions; and we can affirm that in the ethical progress of man, mutual support not mutual struggle – has had the leading part."

[Scott Campbell]

Tank?

[bobblehead]

yea, I shoulda looked at the total number of posts and realized it, I never respond to that chain yanker, so whether it is him or not, I guess I'll stop responding to this one.

[texaspackerbacker]

Tank?

I think you've got something there, Scott.

I will respond to him, though, as he has shown more testicular fortitude in his posts--albeit thoroughly wrongheaded--than most of the rest of the gonadally challenged leftists.

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

[GrnBay007]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Tell us about a "perfect plan".

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Tell us about a "perfect plan".

Hmm. I could respond next week (meeting with CFO of large west coast health system tomorrow and headed to Austin for a bachelor party this weekend). It won't be simple to understand but what is these days.

[bobblehead]

Its worth reading, yea, some is worth skipping, but if you read mainly the posts where we actually address the issue (I'm guilty of sidetracking too) its not all bad. I would like to hear your input.

[texaspackerbacker]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Framing the discussion that way MUST MEAN that favor the status quo or damn close to it, as "delivery" of care in this country is second to none in quality, convenience, and choice. The cost to most of us "haves" is tolerable, while the "have nots" basically still get the treatment they need even if they can't pay.

What do you think of Digitaldean's fairly moderate fine tuning of the system discussed above, Fosco?

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Framing the discussion that way MUST MEAN that favor the status quo or damn close to it, as "delivery" of care in this country is second to none in quality, convenience, and choice. The cost to most of us "haves" is tolerable, while the "have nots" basically still get the treatment they need even if they can't pay.

What do you think of Digitaldean's fairly moderate fine tuning of the system discussed above, Fosco?

Only have a minute.

I'm not saying patient liability as cost.

Cost in terms of charges/liability to the provider/hospital. Tons of unnecessary waste/tests to cover a doc's trail. All of that gets passed to you guessed it - us (whether it's higher cost of goods by companys to pay for hc or actual hc related costs, taxes, etc.).


The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.

Agree on #1. But it's slight - I used to think this was a bigger problem. True that MD's pay a shit ton for malpractice insurance and that likely gets passed on - but the cost of profees is very small % of total (and most outrageous claims are never paid).

Not sure what he means by portability (#2) (go anywhere you want) - like generous PPO or CARE?

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I'm typically against gov't regulation in most forms (i'm a libertarian). Drug costs are a bit wild -- and it's tough because patents don't seem to be protecting cheap knockoffs and foreign market influence (i.e., a drug mfg would typically make money on US and then rest of the world -- the rest of the world and cheaper knockoffs mean higher initial/long-term cost for the US). If there's no incentive ($) for companies to make better drugs b/c of regulation, be prepared for a stagnant quality of life (or a better one if the access/availability of drugs were in question).

Now the 'charges' that facilities give you for an MRI and reimbursement by your insurance... I've got lots to say and no time. My current client is one of cheapest in the country and they still have about a 40% cost/charge ratio (i.e., charge $1K for an MKI that costs them $400). But they discount your charges usually at b/w 50-75% (so the $1K becomes $500 or $750, which insurance pays 80-90% and leaves you with like $100 +/-). In competitive areas, providers jack up prices and force insurance to pay --- IN ORDER TO PAY FOR THE UNINSURED. Gotta make money somewhere (Surgery/Radiology for insured is the key).

Watch for more regulation though - requirements for nonprofits to provide a certain amount of charity to maintain tax status and 'maybe' price transparency (meaning you could price shop for that $2K MRI and find the best deal).

[hoosier]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

[texaspackerbacker]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

[hoosier]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Nobody's talking about forcing anyone into anything, except maybe you, who invented that claim out of thin air and tried to make it stick. My position is that everyone should have the RIGHT to affordable preventive care.

The argument that because "there aren't enough providers to go around" we should be satisfied with a situation in which almost 40% of Americans are uninsured or underinsured, is completely full of holes. You of all people should know that the demand creates the supply: if there are patients, doctors will follow.

"The horrors of waiting": have you ever sat in an ER at a busy time waiting to be seen for something non life threatening? If not, you have no idea what true horror is.

[Tyrone Bigguns]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Preventative care dubious in its value. That has to be the funniest thing you've ever said.

Yep, Docs love to see you when you are fat, high cholesterol, out of shape, poor diet, and your symptoms are out of control. :roll:

Perhaps you don't understand the concept of an ER...it stands for Emergency Room...as we only want to see you because it is an EMERGENCY. They don't want to see you because your kid has the sniffles.

And, they certainly don't want to see ANY emergencies..they would much rather prefer that you saw them before it became an emergency..so, they can prescribe care/drugs/etc...or schedule surgery.

[texaspackerbacker]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

As for preventative crap, here again, you fulfill your sick leftist intrusive government-loving stereotype. Your nutrition Nazis want to tell people what they can and can't/should and shouldn't eat? Yeah right! The sick thing is, if your side gets in power, we could end up with exactly that--another quantum leap size grab at OUR freedom--in that and a helluva lot of other areas.

[Tyrone Bigguns]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

As for preventative crap, here again, you fulfill your sick leftist intrusive government-loving stereotype. Your nutrition Nazis want to tell people what they can and can't/should and shouldn't eat? Yeah right! The sick thing is, if your side gets in power, we could end up with exactly that--another quantum leap size grab at OUR freedom--in that and a helluva lot of other areas.

WHo is complaining about the poor using the ER? The doctors..my friend. Taxpayers..who have to pay for it.

You like to say we all can get adequate care..going to the ER isn't adequate care.

As for nutrition..nice strawman. Who said anything about enforcing it by the gov't? Your doc tells you what to do..you make the choice.

As for you...i wish you would continue to eat poorly, etc...the quicker you shuffle of this mortal coil, the better.

[bobblehead]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Nobody's talking about forcing anyone into anything, except maybe you, who invented that claim out of thin air and tried to make it stick. My position is that everyone should have the RIGHT to affordable preventive care.

The argument that because "there aren't enough providers to go around" we should be satisfied with a situation in which almost 40% of Americans are uninsured or underinsured, is completely full of holes. You of all people should know that the demand creates the supply: if there are patients, doctors will follow.

"The horrors of waiting": have you ever sat in an ER at a busy time waiting to be seen for something non life threatening? If not, you have no idea what true horror is.
I think what badger said was that you can get pretty much any care including preventive if you go to the ER, with no questions asked about finance.

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

And tyrone, since tex isn't complaining about poor using the ER, it doesn't really refute his points. Quite the opposite, he is advocating it.

And lastly, tex, the patriot act was the worst "quantum leap size grab at OUR freedom" that I can recall, so its both sides on that one.....oh look tyrone, I disagreed with tex AGAIN.

[hoosier]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

[Fosco33]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

Only partly true. There are definitely people w/ the means/ability to pay for hc that use ERs because they're too lazy to get a primary MD or they can't stand waiting one day to get their service (or use an urgent care clinic, etc.).

AND there are some alternatives to ERs for people that don't have the means. I did 2 days of work last year pro bono for St. Johns Well Child center in/near Compton (feature this past week in WSJ). Really no requirement to pay anything and all state/federally funded - and about 90% undocumented aliens.

I've implemented processes to screen/triage then discuss finances and possibly defer care for non-urgent/emergent cases - result - ER volumes remain slightly less (meaning urgent ppl get served faster) and a push to scheduled care.

It all goes back to what many of us here have said - where did responsibility for average US (or long-term 'residents') go?

[hoosier]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

[hoosier]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

Only partly true. There are definitely people w/ the means/ability to pay for hc that use ERs because they're too lazy to get a primary MD or they can't stand waiting one day to get their service (or use an urgent care clinic, etc.).

AND there are some alternatives to ERs for people that don't have the means. I did 2 days of work last year pro bono for St. Johns Well Child center in/near Compton (feature this past week in WSJ). Really no requirement to pay anything and all state/federally funded - and about 90% undocumented aliens.

I've implemented processes to screen/triage then discuss finances and possibly defer care for non-urgent/emergent cases - result - ER volumes remain slightly less (meaning urgent ppl get served faster) and a push to scheduled care.

It all goes back to what many of us here have said - where did responsibility for average US (or long-term 'residents') go?

Responsibility, or lack of it, is undoubtedly part of the problem of using ER as primary. But 35% of Americans reportedly uninsured or underinsured is scandalous, and that's not a problem that personal responsibility or volunteerism (as important as they are) can solve alone.

[bobblehead]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

And again you have proven that you don't read most of my posts and only grab one line outta one post. Have I not complained over and over about how much of the problems we have now are because gov't got involved with the HMO bill?? Haven't I said doctors are getting crushed under legions of paperwork and regulatory burden NOW? Haven't I complained that doctors are being turned into nothing more than employees of HMO's? Didn't I point out that a doctor can make like 180 on an emergency appendectomy but the hospital makes 17grand?

I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.

You are really good at ripping me when I make points of economics, but I haven't heard you offer up ONE idea on this. If you aren't advocating national health care, what are you talking about? In this post you almost sound like an advocate for the current situation. Dude, sack up and make a point or arguement, and get rid of the hard on you have for me.

If you read my posts, you will see I am not a fan of the current medical situation, but I make valid points about how the gov't getting involved has deteriorated our care and now they are using the problems they created to argue that they should be in charge of the whole damn thing. Please, tell me where you stand, I am curious. You state that caps would have already destroyed the system (implying they are just fine) then in the very next sentence you use ty saying the professionals are complaining the loudest about current problems....you don't think that sort of disproves your first statement? You ask if I am thinking about what I type, do you READ what you type??

Now go back, read the thread from the beginning and show me where I am advocating the current system...never, so using medical professionals screaming about the current system as some sort of admonishment to me is just assinine.

My point again....the current system is hurting due to the HMO act of 1973 that has regulated and pushed doctors into a situation where they are merely employees with little hope of working outside the network. This is in effect capping their payments to what the hospitals and HMO's want to give them. This is causing a shortage of doctors damaging the system further. It is also limiting competition...the very thing needed to be called capitalist. since capitalism was created in 1965 by milton freidman the act in 1973....relax I'm just kidding.

[Fosco33]

Responsibility, or lack of it, is undoubtedly part of the problem of using ER as primary. But 35% of Americans reportedly uninsured or underinsured is scandalous, and that's not a problem that personal responsibility or volunteerism (as important as they are) can solve alone.

45M uninsured, 25M underinsured - population of 301M = 26%

The current definition of underinsured uses varying rules - like spending 10% of income on hc - or having deductibles of 5% of income (some due to outlier cases by year and some due to high deductible plans).

Of the uninsured - 41% many are between 19 and 34 - when young people are not covered by parents or the State (usually) and don't get jobs (that come with insurance). Part of being responsible is getting a job.

21% are under 18 and could be eligible for most state/local coverage. Some of these are poor kids with ignorant/lazy parents that don't apply for Medicaid. Part of being a responsible parent.

Also - 28% of uninsured are in 300%+ FPL brackets - and not 'poor' and could afford employer provided insurance - their choice/responsibility.

And lastely - 21% of uninsured are not US citizens! And even then there are programs like CMS 1011 that provide coverage - and again EMTALA that provides ER service without questions.

You can't double count the above stats - but it clearly shows there is a small window of opportunity for society to further assist on insurance coverage. Young people without insurance (not kids) don't use much/any hc and the outliers are often covered by charity. And those that are uninsured may get charity (typically 3-5% of hospitals gross charges are written off to charity).

It's a 'problem' by definition only in my book. Many of the solutions go back to responsibility.

[texaspackerbacker]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

How exactly is what you are saying any different from what you just quoted me saying? Yeah, it's an act of desperation; Yeah, it's inefficient. I just said that. However, it is a way for poor and uninsured people to get health care.

I suppose some doctors complain about it--it makes more work for them. Generally, however, if they work in an ER, they are on salary, so it's not a matter of they, themselves, not getting paid. Taxpayers are NOT complaining. Why would they? They aren't paying the bills of these poor or uninsured. The hospitals eat the cost--or more accurately, figure it into the rates charged the rest of us--kinda like shoplifting in a store, where other customers pay in the form of higher prices.

My point is that as bad/inefficient/whatever as this is, it beats any alternative I've heard--most notably, the ridiculous government takeover of the whole system suggested by Obama, Hillary, and others. Paying slightly more to "informally" take care of the poor and uninsured is much more tolerable than the loss of freedom, convenience, and quality, and horrendously high cost to taxpayers that goes with these socialized medicine alternatives.

[LEWCWA]

Its past your bedtime Tex!!

[texaspackerbacker]

Its past your bedtime Tex!!

Nah. I can sleep all day if I want to.

Next thing the libs will be legislating when bedtime is.

[Tyrone Bigguns]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.



I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.



So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

[texaspackerbacker]

We are already doing that, Tyrone--in large numbers from places like the Philippines, India, Korea, and the Caribbean.

I commend you for not spewing the usual liberal whine about "brain drain" and America exploiting other countries that way.

[bobblehead]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.



I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.



So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

You gotta take my quote in context(all of it), I don't have a problem with importing qualified professionals in and of itself...but when we are doing it because we have damaged our medical profession with capped payments and diminished earnings due to gov't intervention I think it is a valid point.

We messed up the system, so we are trying to import cheap labor to sustain it. I would think you lefties who are all about bashing companies for going after cheap labor would be on my side on this one. What would you say if GM imported laborers to bust the union??

Don't make silly statements about the free market working except when I don't like it...I'll say it again...HEALTH CARE IS NOT A FREE MARKET INSTITUTION. It hasn't been since the HMO's continually gained power, or since medicare started trying to control costs for that matter. It was in my quote, you know, the part you didn't include.

Did YOU even read what I wrote, I clearly said its not free market in its present form and you go right on with implicating me for just the opposite....man, I know why tex starts calling names. (although for your convenience, you chopped off that portion of my quote as then you wouldn't be able to try and twist my words and arguement.)

Last point, I am not in any way shape or form advocating "propping up" wages, I am for letting the FREE MARKET set them. I am against artificially DEFLATING them. Again, read my post, understand it, then respond to my actual points, not the straw man points you set up.

[bobblehead]

So? What is wrong with importing docs. If they are qualified i see no problem.


I guess I can play it your way too.

Who said its wrong? I didn't say its wrong.

[texaspackerbacker]

I almost let this slip by unchallenged, Bobblehead.
-----------------------------------------------------------
And lastly, tex, the patriot act was the worst "quantum leap size grab at OUR freedom" that I can recall, so its both sides on that one.....oh look tyrone, I disagreed with tex AGAIN.
------------------------------------------------------------
First of all, the Patriot Act probably deserves it's own thread too. I'll leave that for one of you detractors of it to start one, though.

Bobblehead, have YOU lost any freedom because of the Patriot Act? I sure as hell haven't. The ONLY people who have had freedom or rights curtailed by the Patriot Act are the terrorist enemies who are actively trying to destroy this country and kill our people.

Do YOU communicate with known terrorist numbers, addresses, or emails outside the country? If not, then the provision about moniitoring that kind of communications doesn't effect you.

Are YOU one of the non-citizen terrorists locked up in Guantanamo? No? Then the depriving to them of OUR rights of due process, Habeus Corpus, etc., and well as various kinds of harsh treatment--which still falls WAY SHORT of the traditional definition of torture--has NO negative effect on you. On the contrary, it just might have the very positive effect of saving your life from the acts of terror past, present, and future that are prevented.

Does the various other forms of enhanced security deprive YOU of any rights and freedoms? Yeah, the right to not have to wait in line, be searched, go through metal detectors, bring liquids onto planes. I'm sure that's all there in the Constitution somewhere.

The point is, hell no, we normal Americans have NOT lost any rights and freedoms as a result of the Patriot Act--even liberals and libertarians have lost no rights and freedoms.

This is in contrast to the Obama, Hillary, and other Dem/lib advocated health care programs which would drastically reduce freedom of choice for medical providers, as well as greatly curtailing convenience and availability of health care of all kinds. Yeah, I suppose there is nothing in the Constitution about that stuff either.

[Tyrone Bigguns]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.



I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.



So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

You gotta take my quote in context(all of it), I don't have a problem with importing qualified professionals in and of itself...but when we are doing it because we have damaged our medical profession with capped payments and diminished earnings due to gov't intervention I think it is a valid point.

We messed up the system, so we are trying to import cheap labor to sustain it. I would think you lefties who are all about bashing companies for going after cheap labor would be on my side on this one. What would you say if GM imported laborers to bust the union??

Don't make silly statements about the free market working except when I don't like it...I'll say it again...HEALTH CARE IS NOT A FREE MARKET INSTITUTION. It hasn't been since the HMO's continually gained power, or since medicare started trying to control costs for that matter. It was in my quote, you know, the part you didn't include.

Did YOU even read what I wrote, I clearly said its not free market in its present form and you go right on with implicating me for just the opposite....man, I know why tex starts calling names. (although for your convenience, you chopped off that portion of my quote as then you wouldn't be able to try and twist my words and arguement.)

Last point, I am not in any way shape or form advocating "propping up" wages, I am for letting the FREE MARKET set them. I am against artificially DEFLATING them. Again, read my post, understand it, then respond to my actual points, not the straw man points you set up.

Who cares why we import them...i certainly don't. If it lowers costs..that is the point.

I dont' think it is a valid point, sorry.

Free market: Agreed. So, then let's move on and get doctors anyway we can. Is there some sort of benefit to the PATIENT, INSURANCE COMPANIES, OR HOSPITALS if they all come from their native country...i don't see it.

The point would be is that HMOs aren't going anywhere. Are they? If you are against them..great, but Pancho Villa...you think you can take those windmills? Yikes.

Free market: it is as free as any other. Plenty of docs don't have to be in HMOs..one, that is their choice..two, they can choose a field where they can do elective work..ie, plastic surgery.

Or they can just make a free market choice..hang out a shingle...and see who comes a calling. nothing stopping you and the rest of the revolution from patronizing them..is there?

If they are good docs...and your health is important..i think you'll go to them if the other docs aren't as good. If you don't..then you are telling the us that healthcare isnt' that important.

For me, this is a strawman. And, once expectations are lowered...there still will be docs. That is the nature of choice. Those with a calling to serve their fellow man will still become docs, those who want a very nice living will still become docs...and those who became docs because of the high pay..they will move on to other professions...and be happy..and create glorious new things for our civilization..who knows what is being denied us because of the high pay for docs. (see, it is so great being Tex!!).

GM: When the conservs make that stand..i'll be glad to address it. But, you and i both know that the owners care about the bottom dollar. And, i have constantly heard how unions ruin things. If you wanna play devil's advocate..then you wanna dance with the devil..and you gotta start admitting that perhaps the almighty dollar isn't the sole criteria.

And, the fact is that...that companies do it all the time.

Companies hire illegals all day long to save money....yet, i hear most of the blame from conservs at the illegal...rarely at the business owner who knowingly does it.

The gov't sets prices in many areas...they won't pay more than X amount for things in the defense industry...and, like i pointed out before...i certainly don't see those companies struggling, lacking employees, etc.

To single out this field..when we have tariffs, subsidies, etc. for other industries strikes me as disengenous.

I'm all for the free market. Yet, i rarely see it practiced. And, it is conservs who don't fight to change it. Remind me when McCain comes out against corn subsidies/ethanol.

[bobblehead]

Tyrone:

1) I don't care if they import them...you missed the entire point. They fixed prices and are forced to import cheap labor now.

2) you may accpet it, I choose to point out the flaws and offer solutions.

3) It is not as free as any other, not even close. Not sure how you can draw that conclusion.

4) Yes, there is something stopping them from hanging out a shingle. Patients are locked into managed care situations and a doctor under the current system will be hard pressed to make money without playing ball.

5) Yes, they will move on to other professions. Not sure on your point. My point is that if the free market forces them to other professions, fine, if its HMO caps and a closed system, not so fine.

6) I have constantly said its the companies fault for our illegal situation. If I were in mexico I would try to sneak over here too, no question. It is up to us to make them come the right way, not them. Blaming the illegals for trying to better their life is just stupid.

7) When the gov't fixes prices in defense they are the buyer. Its not called fixing the price, its called the demand factor...when an HMO fixes the price for a service and the person getting the service has no input, it is very different. Also when you have taken competition out of the market it changes the parameters. Basically we are at a point now where the HMO's are the only buyers left (well, not quite, but you get the point), but the demand is there.

And finally I am fighting to change it, it is you who said...."The point would be is that HMOs aren't going anywhere. Are they? If you are against them..great, but Pancho Villa...you think you can take those windmills? Yikes"

[bobblehead]

Tex-

How will you feel in 2009 when Barrack Obama has the power to listen in on any phone calls he wants without a warrant?

[Tyrone Bigguns]

Tex-

How will you feel in 2009 when Barrack Obama has the power to listen in on any phone calls he wants without a warrant?

LOL

[texaspackerbacker]

Tex-

How will you feel in 2009 when Barrack Obama has the power to listen in on any phone calls he wants without a warrant?

Three things about that:

First, I'm confident the American people will not allow an Obama presidency.

Second, I don't have anything to hide. Anybody that wants to get bored to death listening to my phone calls, etc. is welcome to.

Third and most important, you are mis-characterizing the whole situation. The monitoring is ONLY COMMUNICATIONS TO AND FROM KNOWN TERRORIST SOURCES, AND ONLY THEN IF THAT TERRORIST SOURCE IS OUTSIDE OF THE COUNTRY. i don't recall the last time I talked to any of them. How about you?

How did this get in the health care thread?

[Freak Out]

Just another example....

http://www.npr.org/templates/story/story.php?storyId=92067101

[bobblehead]

Just another example....

http://www.npr.org/templates/story/story.php?storyId=92067101

Interesting article, she is apalled that americans have to wait or pay on their own, yet she had to pay for the drug she needed on her own while the HSA dragged their feet in approving it.

Again, this article is the crux of my arguement against nationalized care. We propped up their system by our free market creating a drug and eventually making it cheap enough for them to use. I like innovation. Its good.

edit: One more thing, life expectancy is in no way a good measure of the effectiveness of health care. So many things contribute to that.

[Tyrone Bigguns]

Just another example....

http://www.npr.org/templates/story/story.php?storyId=92067101

Add in anorexia to that as well. Thank god the courts are changing things.

Hmm, insurance only pays for 30 days of inpatient treatment..voila..30 days later and you are cured. :roll: