Health Care for Everyone

[Public'sTwin]

There is no free healthcare. For the money Canadians pay in taxes, private healthcare would probably be cheaper.

Just not American private healthcare.

Beyond this, I have little to add [that hasn't been said before], esp as the conversation appears now not to be concerned with principles, but pedantry.

 

[TomDrum]

This is a very interesting debate, especially from someone who works in health.

I think that too often people look at things in extremes (I do this too). In this case, it would appear that people are thinking a 100% government run health system or a 100% private system. I think there is room for both. I do like the way we do things here in Australia, but it is in no way perfect. We have a mixture of public and private health systems. However, the public hospitals are the only hospitals that will deal with major trauma and incredibly sick people. No matter what level of private insurance you have; if you are sick enough, you will be in a public hospital. However, private hospitals do manage a lot of non-emergency operations and other procedures as well less acute patients.

I think that the second we start to try and profit from health care, we enter dangerous territory. I can see that this is unavoidable in some cases, such as pharmaceutical companies, but the actual provision of care should not be provided at a for-profit basis. Private health insurance does that and it appears that insurance companies in the US are particularly good at excluding people and finding ways to not pay out on claims in order to profit. These organisations appear to have considerable influence on health professionals, which is very concerning.

Here, there is no real alternate motive to treating a sick person other than to make them better. The second you start to put money into the equation, it is natural for human greed to take over.

 

[Public'sTwin]

I think that the second we start to try and profit from health care, we enter dangerous territory. I can see that this is unavoidable in some cases, such as pharmaceutical companies, but the actual provision of care should not be provided at a for-profit basis.

I quote this for what I think is the single strongest moral objection to Private healthcare; if we're to suspend, for a moment, the axiomatic notion that all people are entitled to profit from their labour (Zzzz)†—regardless of what industry that 'labour' performs in—we may begin to have a discussion which really addresses the issue, and doesn't get entangled with the specificity of American or British or Canadian or Soviet Russian bureaucratic systems.

Private health insurance does that and it appears that insurance companies in the US are particularly good at excluding people and finding ways to not pay out on claims in order to profit. These organisations appear to have considerable influence on health professionals, which is very concerning. [...] The second you start to put money into the equation, it is natural for human greed to take over.

This point, to me, is secondary although nearly as important in a practical, policy-making context. If, hypothetically, we skip (A) and the debate centres on this—as, in particular with the US system of healthcare, it frequently does—there is good argument to be made over whether or not the symptom described above, (namely, that profit-motive corrupts the means and ends to which an insurance or medical company operates), is actually a symptom that is unavoidable and cannot be managed:

May it be regulated? Is regulation alone enough to combat that? Is there another, structural way to manage this behaviour, without requiring constant maintenance or interference? How may we implement these decisions, and, in reality, are they worth it (more benefit than harm) once these decisions are inevitably compromised by the stratification of decisive powers?

Here, there is no real alternate motive to treating a sick person other than to make them better.

† If we are not going to suspend this pre-supposition, the question must be brought from a rhetorical plane and into one where it is ready to be challenged and justified: are doctors—who have committed themselves to "do no harm"—really 'entitled to the fruit of their labour'? Is this notion even applicable to somebody who voluntarily provides what is almost universally-accepted an essential service?

Does the doctor's paycheque outweigh a patients' life? When a doctor is paid by the case, does he have the right to refuse help, when if on duty, the patient is unable to pay for the service? Of course, these questions are only using "doctor" and "patient" individually as means of producing digestible imagery: most of the answers are easily predicted; the application of these answers' conclusions on a systematic, structural level with global corporations is a far different problem altogether, and one that is only solved by an intimate knowledge—specificity, not ideology—of their operations, interactions, and multiple motivations and mechanics in far-reaching areas.

 

[Danoff]

I think that the second we start to try and profit from health care, we enter dangerous territory.

....

The second you start to put money into the equation, it is natural for human greed to take over.

You cannot take profit and money out of the equation, regardless of how much you really really want to. Nobody works for free, and you can't spend an infinite amount of resources trying to keep someone alive.

Regardless of anything else in this conversation, profit and money will always necessarily be a critical component of the healthcare discussion.

When a doctor is paid by the case, does he have the right to refuse help, when if on duty, the patient is unable to pay for the service?

Does your boss have a right to force you to work without pay? No.

 

[Public'sTwin]

When a doctor is paid by the case, does he have the right to refuse help, when if on duty, the patient is unable to pay for the service?

Does your boss have a right to force you to work without pay?

Of course, these questions are only using "doctor" and "patient" individually as means of producing digestible imagery: most of the answers are easily predicted; the application of these answers' conclusions on a systematic, structural level with global corporations is a far different problem altogether, and one that is only solved by an intimate knowledge—specificity, not ideology—of their operations, interactions, and multiple motivations and mechanics in far-reaching areas.

. . . No.

. . . but thanks for clearing that up.

 

[Joey D]

I think that the second we start to try and profit from health care, we enter dangerous territory. I can see that this is unavoidable in some cases, such as pharmaceutical companies, but the actual provision of care should not be provided at a for-profit basis. Private health insurance does that and it appears that insurance companies in the US are particularly good at excluding people and finding ways to not pay out on claims in order to profit. These organisations appear to have considerable influence on health professionals, which is very concerning.

Here, there is no real alternate motive to treating a sick person other than to make them better. The second you start to put money into the equation, it is natural for human greed to take over.

The hospital I currently work at is a non-profit institution then provides a substantial amount of charity care in the community to uninsured and under insured patients. We are not allowed to turn any patient away by our parent organization's mandate. When you take out whether someone can pay or not, you benefit the community.

I don't think for profit health institutions should exist to be honest and I agree with you, when bottom line profit is mixed with healthcare the patients will start to suffer. I've seen it happen when looking at cases between for profit hospitals and our own organization.

For profit hospitals tend to rank lower in quality, satisfaction and in core indicators then non profit organizations too. I just don't see the benefit for a for profit hospital when you look at it from an inside perspective.

Also one thing people often glance over when looking at healthcare reform is the benefits the community is getting from it. Look up meaningful use and tell me that's not a good thing, in the end everyone is paying less and getting a higher quality of care. If an institution can't meet the indicators with meaningful use, they lose out on funding and over time their accreditation which all but puts them out of business.

I don't support 100% government controlled healthcare, but I do support a reform to the healthcare system in America. It's very broken and if we aren't careful it will out price itself leaving those with no insurance unable to obtain anything. Even with charity care, there is only so much to go around.

 

[Danoff]

I quote this for what I think is the single strongest moral objection to Private healthcare; if we're to suspend, for a moment, the axiomatic notion that all people are entitled to profit from their labour (Zzzz)†—regardless of what industry that 'labour' performs in—we may begin to have a discussion which really addresses the issue, and doesn't get entangled with the specificity of American or British or Canadian or Soviet Russian bureaucratic systems.

I can understand why you'd want to say this... because if you ignore human rights, the solution to cannibalize a portion of society to suit a particular goal seems more palatable. I see no point in having a discussion where we ignore human rights for the sake of anything.

This point, to me, is secondary although nearly as important in a practical, policy-making context. If, hypothetically, we skip (A) and the debate centres on this—as, in particular with the US system of healthcare, it frequently does—there is good argument to be made over whether or not the symptom described above, (namely, that profit-motive corrupts the means and ends to which an insurance or medical company operates), is actually a symptom that is unavoidable and cannot be managed:

No profit-motive = no healthcare. It really is that simple. People don't work for free.

May it be regulated? Is regulation alone enough to combat that? Is there another, structural way to manage this behaviour, without requiring constant maintenance or interference? How may we implement these decisions, and, in reality, are they worth it (more benefit than harm) once these decisions are inevitably compromised by the stratification of decisive powers?

Government regulation almost always backfires as it gets bent to the interests of those who are more interested in the outcome - usually those who are willing to spend the most. Less regulation would be preferable.

† If we are not going to suspend this pre-supposition, the question must be brought from a rhetorical plane and into one where it is ready to be challenged and justified: are doctors—who have committed themselves to "do no harm"—really 'entitled to the fruit of their labour'? Is this notion even applicable to somebody who voluntarily provides what is almost universally-accepted an essential service?

Farmers provide an essential service. The guy who works at the water purification plant provides an essential service. Banana Republic provides and essential service. There are lots of essential services where we do not suddenly suspend human rights and claim that these people are not entitled to the fruits of their labors.

"Do no harm" does not mean "you're a slave". No matter how you slice it, you don't have the right to force anyone to work for your benefit (even if it's a doctor you want to force).

Does the doctor's paycheque outweigh a patients' life? When a doctor is paid by the case, does he have the right to refuse help, when if on duty, the patient is unable to pay for the service?

To say anything other than yes is to violate human rights. Who is going to be willing to become a doctor when they have no rights?

Of course, these questions are only using "doctor" and "patient" individually as means of producing digestible imagery: most of the answers are easily predicted; the application of these answers' conclusions on a systematic, structural level with global corporations is a far different problem altogether, and one that is only solved by an intimate knowledge—specificity, not ideology—of their operations, interactions, and multiple motivations and mechanics in far-reaching areas.

Pretending that the problem is complex changes nothing. It is not complex, by the way. Doctors are people too, they have rights. If we strip people of their rights when they become doctors, we will have no doctors. If we tell them they cannot make money, we will have no doctors.

I don't support 100% government controlled healthcare, but I do support a reform to the healthcare system in America. It's very broken and if we aren't careful it will out price itself leaving those with no insurance unable to obtain anything. Even with charity care, there is only so much to go around.

If fully agree with this. Very key steps need to be taken to address the problem with our healthcare system, and those steps are fairly obvious. First, though, before we can reform the system, we need a proper diagnosis for what is wrong with it.

The problem with the system is insulation of the patient from the cost. That's the bottom line. History has demonstrated time and again the "tragedy of the commons". Any time a service becomes "free", at point of sale, it becomes overrun and overused. The increased demand, especially when the demand is not linked with price, will result in rising prices. This is exactly the problem here in America. It is most visible when looking at the parts of our healthcare industry that are not covered by insurance. These areas of the industry are functioning fantastically, with dropping costs, no waiting, and increasing quality of service. Lasik surgery is a fantastic example.

When I go to the doctor I have no idea what the cost will be. The people serving me can't even tell me what the cost will be. My insurance company doesn't know what the cost will be. Nobody wants me to think about cost when I go to the doctor, and yet, if I don't think about cost, I'll spend thousands of dollars on services I don't really need... and this happens every day. I've tried time and again to figure out the price of the service being offered, and it's impossible. Doctors offices are simply not set up to do it

This can be fixed, but we need to acknowledge the problem and understand what is causing it (hint, the government is causing it).

 

[Danisfast]

So basically healthcare ran by the U.S. gov't is a bad idea. I'd also like to say you're one of the few people I've seen that talks politics and uses facts backed from respectable sites with actual statistics. I'd like to say thank you whether I like it or not you actually did some great fact checking.

You're welcome! I'd be more inclined to suggest, however, that in the light of the evidence I've got, the US should seek to have at least a major-majority state-funded health system. The US is the only developed nation to have such a large private sector, and aside from the fact that it's ineffective, the kinds of ethical and financial debates that the nation is mired in because of it are simply a thing of the past for the rest of us.

As I've indicated, I don't know where all the extra money is going, but it is clearly possible (with a comprehensive reform) to not only drastically improve the overall quality and coverage of the American health system, but to also cut costs. Over here, we have it 'costed' for as a separate tax (known as National Insurance Contributions), but you probably wouldn't even need that.

EDIT: I was always told that the NIC was for the NHS (by nursing professionals, too!) Actually, it is not for that purpose. Apologies for the error there.

 

[Public'sTwin]

I can understand why you'd want to say this... because if you ignore human rights, the solution to cannibalize a portion of society to suit a particular goal seems more palatable. I see no point in having a discussion where we ignore human rights for the sake of anything.

Actually, it was to allow for a more open debate—if we set aside that little categorical imperative of yours, we may have freer access to honest inquiry that isn't constantly stifled by the hyper-individualist categorical imperative you impose.

Perhaps I should have clarified: I did not mean suspend that right from all industries;

I meant, suspend that axiom, which is held to be true across all industries, only so far as it constitutes an un-validated presupposition which cannot be said to apply here.

No profit-motive = no healthcare. It really is that simple.

No, it isn't. This is true for companies and company-owners, who have their own operating costs, resources, and interests, and who operate in a private health economy.

A publicly-owned, operated, and regulated healthcare system does not simply vanish because it lacks beneficent capitalists who wish to serve the public, nor does it evaporate as a result of indirect income collection.

Yet, however you may attempt to reduce it to simplistic universalities, it is clear that I am talking about something else:

People don't work for free.

Although I thought I made this clear, I was not referring to individual actors; despite that, you seem to mix the two interchangeably as they remain convenient.

I am referring to the nature of a company—the morality of its enterprise—providing healthcare for profit.

This is quite different from a doctor, an individual agent who does not own or operate the service which populations depend upon, who has vastly different moral obligations, both in service to such a company as well as his patients, receiving a wage for that service, but who lacks the power to make gross demands on a scale far exceeding his own physical existence, as companies do.

(a) Government regulation almost always backfires as it gets bent to the interests of those who are more interested in the outcome—usually those who are willing to spend the most.

You illustrate here, rather well, the follies of mingling governmental and private agents.

There are fairly simple ways to avoid this, including the elimination of bidding wars for government contracts to private companies. When those interested in the outcome are the public—and not an individual or company who stands to materially gain at the expense of others from such an outcome—your irresolvable problem is suddenly manageable.

Additionally, just because governmental policy does not require the kind of transparency necessary to guard against this 'purchasing' behaviour, does not mean that the answers to problems, which may be ineffective or corrupted, are simply so because they originate from government organizations.

(b)Less regulation would be preferable.

However this relates to (A), I am unsure, as it plainly contradicts it.

Farmers provide an essential service.The guy who works at the water purification plant provides an essential service. Banana Republic provides an essential service. There are lots of essential services where we do not suddenly suspend human rights and claim that these people are not entitled to the fruits of their labors.

Let us look into the nature and definitions of an essential service, and add hospitals, as well as the military, to that list, then:

Essential services - Link
Work that is considered so important to the health, safety, or security of the public that workers who do it are not allowed to strike. Sometimes all workers in a sector, such as health care, are labelled “essential” and lose their right to strike.

Since it is almost always defined in economic terms, yet relating to public welfare, there are few resources to refer to.

However, we get a general understanding that industries—and in particular their manifestations at local levels—come be utterly depended upon for the health and security of the population.

The economic terms are indicative of its role, particularly since those who are most often affected by, in general, strikes within these industries are the public and the employees of said industries: if x party refuses to work (x service is suspended), then outcome y will happen, where the outcome "y" is exploited in these cases because of our dependence upon it being positively sustained.

Farmers, public water-works employees, clothing stores

"Y", in your examples, would ultimately lead to:

• famine
• drought
• embarrassment

And mine, a strike of hospitals/healthcare services and the military:

• death
• death/maybe less death

The military was appealed to mostly for the flambouyance; however, we know that hospitals and healthcare services provide not only life-sustaining services, as food, water, and ultimately, in some cases, the military do, but also life-saving services, for both long-term treatment, and emergencies.

The water-works, farming industry, and military do not.

Let's also look at the obvious repercussions, and not the ultimate "final" ones of these strikes, with some rather elementary, and actually quite pedestrian analyses:

Farms: food prices may go up, a delay in delivery, import and travel become necessary. Remember that I qualified all of these examples with the caveat that they occur at the local-level.
Water-works: water supplies run dry within 24 hours, and sanitation, cooking, and hydration becomes difficult as water much be purchased. Local supplies also run out. Import and travel also become necessary; prolonged periods likely lead to spread of disease.
GAP: People continue wearing existing clothes; in time, we possibly get over prudishness and ridiculous notions of body image.
Military: al-Qaeda, North Korea, Iran, northern Pakistan, the Taliban, FLQ, south American revolutionaries, students, Icelanders, China, the French, and Canadians immediately invade the city, burning it down and killing everybody. (But since the military was on strike, only half as many people die, since nobody fought back.)
Hospitals: emergencies go unresolved, some die; long-term patients and healthcare recipients suffer, a few possibly die; those receiving mental-health treatment lose support, with mostly unpredictable, though probably oft-benign results.

The suspension of availability of food, water, shelter, light, and fashion industries are coped with well, for short periods of time, or in moderation. People depend on them, for survival, certainly—but these are in no way emergencies (although homelessness, in certain cases, may qualify so) individually or at the local level, even though, if widespread, or for prolonged periods, they innevitably become one.

It is quite the contrary with healthcare services, and that is obvious. A hospital's services cannot be summarily withdrawn, either individually, or briefly, without seriously imposing on the welfare, the health—the life, which we all have a right to—of the population.

That you'd resort, if for reasons other than to make a trifle of the healthcare system, to such an analogy is utterly baffling.

"Do no harm" does not mean "you're a slave".

Actually, in colloquial terms, it very often does. Doctors' careers are rife and plenty with contractual obligations and necessities which, if breached, negate their status within the organization. In this sense, many doctors are slaves, and yet are so voluntarily.

However, as I'm well aware of your penchant for extremism, no, "do no harm" does not mean bound to white, cotton-farming slave-owners, nor did I ever in any place imply that.

In any event, where I wrote "doctors" and asked if they were entitled to the fruit of their labour, I took it for granted that (as I instructed you to) someone may understand it to refer instead to a generalized conception of an industry; additionally, the nature of essential services leaves the balance of power—patients are not, after all, consumers, they are victims—grossly balanced toward those who hold the skill and labour capital to aid, or not aid, those who come for assistance.

No matter how you slice it, you don't have the right to force anyone to work for your benefit (even if it's a doctor you want to force).

[Since I'm taking your objection to refer to individuals,] Irrelevant—I never argued this.

When a person goes through med-school, and does their understudy, and finally becomes a doctor, this person has already voluntarily made certain pacts and agreements between him, the legal statutes surrounding his profession, the patients and their family, the institute and values he represents, and the State; nobody forced his hand besides him when [he] wrote that signature. And as an extension of all the issues and necessities I've previously outlined,

Does the doctor's paycheque outweigh a patients' life? When a doctor is paid by the case, does he have the right to refuse help, when if on duty, the patient is unable to pay for the service?

To say anything other than yes is to violate human rights. Who is going to be willing to become a doctor when they have no rights?

then the answer, as the doctor has himself accepted it, is a clear "no"—because the doctor himself has pursued this profession and agreed to regard human life as more important than his paycheque. He has already agreed that his patients' lives are more valuable than the labour itself involved in saving them.

You already agree to the right to life—will you seriously challenge it with a conflicting claim to the right of one's fruit for their labour?

The answer to your question, "Who is going to be willing to become a doctor when they have [one less] right?" is thus already answered, and so too by the staff who continue to work in industries that lack the right-to-strike; however, [the presupposed answer to your question]'s absurdity may be highlighted by another, equally ridiculous question: Who is going to be willing to live when they don't have a right to life??

Your issue, then, of human rights—or, rather, mangling of them—in this regard, is absurd.

Pretending that the problem is complex changes nothing. It is not complex, by the way. Doctors are people too, they have rights. If we strip people of their rights when they become doctors, we will have no doctors. If we tell them they cannot make money, we will have no doctors.

Every single one of these statements rests on a presupposition contradictory to what I said: the problem is complex, because I'm not talking about doctors, although I may be entertaining your assertions related to them; doctors were never implied not to be people by me—the fact you simultaneously bring up their rights in this statement must mean that you are aware of the widespread ridicule imposed upon the notion "corporations are people, too [and therefore have similar entitlements]" and inverted my argument thus.

The final two points about doctors having "no rights" (where on earth was that ever a debatable element?) and thus having no doctors, and telling them they will not make any money, are entirely beyond my imagination as to how you could have possibly fabricated these ideas, although I do believe a suspension of mental-health services would be detrimental to understanding that.

—Greg

 

[Danoff]

Actually, it was to allow for a more open debate—if we set aside that little categorical imperative of yours, we may have freer access to honest inquiry that isn't constantly stifled by the hyper-individualist categorical imperative you impose.

Can't see what point there is in having a discussion that ignores human rights. Regardless of how much "freer" the conversation is.

No, it isn't. This is true for companies and company-owners, who have their own operating costs, resources, and interests, and who operate in a private health economy.

A publicly-owned, operated, and regulated healthcare system does not simply vanish because it lacks beneficent capitalists who wish to serve the public, nor does it evaporate as a result of indirect income collection.

It vanishes if nobody gets paid, public or private. Nobody will volunteer to be a doctor without compensation. You have to pay them regardless.

Although I thought I made this clear, I was not referring to individual actors; despite that, you seem to mix the two interchangeably as they remain convenient.

You seem to draw a line where there is none. Very often in healthcare, companies are owned by one or two doctors.

This is quite different from a doctor, an individual agent who does not own or operate the service which populations depend upon

See above.

You illustrate here, rather well, the follies of mingling governmental and private agents.

There are fairly simple ways to avoid this, including the elimination of bidding wars for government contracts to private companies. When those interested in the outcome are the public—and not an individual or company who stands to materially gain at the expense of others from such an outcome—your irresolvable problem is suddenly manageable.

...right. Elimination of bidding wars is only going to do one thing, drive up the cost. That's it. It won't get rid of companies getting their hand in law making, and it won't get rid of government creating unintended consequences. Just increased costs.

However this relates to (A), I am unsure, as it plainly contradicts it.

It most certainly does not. Regulation is an opportunity for corruption. The less control the government has on the market, the less opportunity there is for the government to misuse that control. Not only is it not a contradiction, it's not even arguable.

Farmers, public water-works employees, clothing stores

"Y", in your examples, would ultimately lead to:

• famine
• drought
• embarrassment

And mine, a strike of hospitals/healthcare services and the military:

• death
• death/maybe less death

The military was appealed to mostly for the flambouyance; however, we know that hospitals and healthcare services provide not only life-sustaining services, as food, water, and ultimately, in some cases, the military do, but also life-saving services, for both long-term treatment, and emergencies.

The water-works, farming industry, and military do not.

Let's also look at the obvious repercussions, and not the ultimate "final" ones of these strikes, with some rather elementary, and actually quite pedestrian analyses:

Farms: food prices may go up, a delay in delivery, import and travel become necessary. Remember that I qualified all of these examples with the caveat that they occur at the local-level.
Water-works: water supplies run dry within 24 hours, and sanitation, cooking, and hydration becomes difficult as water much be purchased. Local supplies also run out. Import and travel also become necessary; prolonged periods likely lead to spread of disease.
GAP: People continue wearing existing clothes; in time, we possibly get over prudishness and ridiculous notions of body image.
Military: al-Qaeda, North Korea, Iran, northern Pakistan, the Taliban, FLQ, south American revolutionaries, students, Icelanders, China, the French, and Canadians immediately invade the city, burning it down and killing everybody. (But since the military was on strike, only half as many people die, since nobody fought back.)
Hospitals: emergencies go unresolved, some die; long-term patients and healthcare recipients suffer, a few possibly die; those receiving mental-health treatment lose support, with mostly unpredictable, though probably oft-benign results.

The suspension of availability of food, water, shelter, light, and fashion industries are coped with well, for short periods of time, or in moderation. People depend on them, for survival, certainly—but these are in no way emergencies (although homelessness, in certain cases, may qualify so) individually or at the local level, even though, if widespread, or for prolonged periods, they innevitably become one.

It is quite the contrary with healthcare services, and that is obvious. A hospital's services cannot be summarily withdrawn, either individually, or briefly, without seriously imposing on the welfare, the health—the life, which we all have a right to—of the population.

Lack of water = death within days
Lack of food = death within weeks
Lack of clothing = death within hours
Lack of military = death within years
Lack of healthcare = death within decades

Obviously if you've just been stabbed, you're interested in healthcare first, water later. But for 99.99% of the population, the above holds.

Actually, in colloquial terms, it very often does.

No, it simply does not. "Do no harm" does not mean "you must work". It means do no harm. A doctor is not doing harm by not working. The idea is that he should not make things worse in an attempt to solve the problem, not that he is bound and beholden to anyone who has a need.

[Since I'm taking your objection to refer to individuals,] Irrelevant—I never argued this.

You still are, right here:

When a person goes through med-school, and does their understudy, and finally becomes a doctor, this person has already voluntarily made certain pacts and agreements between him, the legal statutes surrounding his profession, the patients and their family, the institute and values he represents, and the State; nobody forced his hand besides him when [he] wrote that signature. And as an extension of all the issues and necessities I've previously outlined,

then the answer, as the doctor has himself accepted it, is a clear "no"—because the doctor himself has pursued this profession and agreed to regard human life as more important than his paycheque. He has already agreed that his patients' lives are more valuable than the labour itself involved in saving them.

You can't force everyone of a given profession to agree to something and then claim that they do so voluntarily. But, if you want to stick to this - that doctors have no rights - you'll have no doctors. The more we push this notion on them, the fewer doctors we will have.

You already agree to the right to life—will you seriously challenge it with a conflicting claim to the right of one's fruit for their labour?

You do have a right to life - yours. You do not have a right to someone else's life. There is no conflict.

The answer to your question, "Who is going to be willing to become a doctor when they have [one less] right?" is thus already answered, and so too by the staff who continue to work in industries that lack the right-to-strike; however, [the presupposed answer to your question]'s absurdity may be highlighted by another, equally ridiculous question: Who is going to be willing to live when they don't have a right to life??

Some people hold their nose and enter the industry anyway yes, but lacking the right to strike is not likely to deter anyone - especially because they still have the right to quit... something I think they will do a lot of the more rights we take away from them.

The final two points about doctors having "no rights" (where on earth was that ever a debatable element?) and thus having no doctors, and telling them they will not make any money, are entirely beyond my imagination as to how you could have possibly fabricated these ideas, although I do believe a suspension of mental-health services would be detrimental to understanding that.

How about you take your thinly veiled insults elsewhere and have a civil discussion. Here is where you remove doctors rights.

A man is sick. A doctor is nearby. Doctor you must help him, even if you are not compensated!

This notion places one individual's need above another individuals rights. It removes the doctor of his freedom and places him a slave to the needs of others. In no other profession do we do this, and there are many other professions that we rely on for our lives. Why are doctors different? Because of the cultural desire to remove cost from healthcare decisions. We all want to pretend that our lives are worth an infinite amount of labor from everyone around us, but it simply is not so. The longer we try to divorce cost from the healthcare discussion, the longer we will continue down the road of increased healthcare costs and decreased access. This is an economic reality. Doesn't matter whether the healthcare is public or private.

 

[TomDrum]

The problem with the system is insulation of the patient from the cost. That's the bottom line. History has demonstrated time and again the "tragedy of the commons". Any time a service becomes "free", at point of sale, it becomes overrun and overused.

That is somewhat true. We have the same problem here where our services are struggling to cope with demand. However, this can be solved by redirecting money. Let me explain.

Here, if I want to see a GP (like a general physician in the US) I have to pay anywhere between $30 to $50. I could also present to the ED of my hospital and not pay anything. To some people $30 is a lot of money and it is unfair for us to expect them to make that choice. Another scenario is that after normal GP hours, the only option to seek treatment for non-life threatening things is to call for a locum doctor to visit which can cost a fairly substantial amount of money or present to an ED. Everybody is a human and has roughly the same body, but very few of us know how it works and how to fix it. It's not reasonable to expect most people to know the difference between what can wait and what can't.

Another issue is that our ambulance service does not have an intermediate receiving facility. You either stay at home or go to hospital. Some patients don't need my Level 1 trauma centre ED, yet they still need to be treated.

Finally, I think we need to clarify the 'profit' and money issue. I was not saying money should be taken out of the equation, I see a difference between profit and reimbursement. In my job, I am paid per hour, not for how many patients I move in a day or how fast I move them. I am being reimbursed for my time and level of qualification. I see the same for a doctor. The point here is that there is no other influence on pay aside from the number of hours worked. The second doctors can be provided with bonuses for discharging patients sooner or helping an insurance company avoid paying out a claim is the time we enter dangerous territory.

 

[TomDrum]

I thought I might throw this into the debate; the modern version of the Hippocratic Oath:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

 

[FoolKiller]

Yes, I have read the bill. It's a mess; the idea though (and thread topic) was originally to have healthcare for everyone (which is really the issue at hand here, hence the reason the NHS was brought into the debate in the first place by the American media, probably). Unfortunately, enough of America seemed so disapproving of the notion of state healthcare that Obama's administration had to water it down until he could at least cover most of those currently unprotected.

Sure you read it? Who is covering them? It forces individuals to buy insurance. It only grants coverage to those who can prove they cannot afford it. Not all those in the US without it cannot afford it. Some choose to not have it. Via Obama's plan, or any plan you would prefer, you force those people to pay into a system they don't wish to.

As for that report: yes, the tabloid may not be presenting the data in an unbiased, scientific manner, but those aren't warbled statistics cherry-picked to create an opinion, and you know it.

I am questioning the thoroughness of the study. Very often studies come out and say the same thing about how many people in the US suffer from conditions, die from them, and so on, and blame the healthcare system. The problem is that is not complete. We are a society that very often suffers from consumption. To ignore that fact and then blame the healthcare system when people die from diabetes related disease, heart disease, or lung disease while eating fried ice cream and enjoying their 50th cigarette that day is irresponsible at best or dishonest at worst.

If you want more facts, the WHO website has information outlining that not only does the US government already spend more of its budget on healthcare than the UK government does, but it also leaves out between 10% and 15% of its population.

The US government spends more per person: not even taking into account the private sectors, of which the US government holds approximately a half-and-half balance of the total expenditure. This is against the UK, which is more like 16.5% private. It's also generally no more effective: the last 'table', although over ten years ago, had actually ranked the US twice as many places below the UK (37th and 18th respectively).

So, then you should understand why people in the US don't want to trust these same guys to have full control. They waste more money with only a fraction of the responsibility than the UK. Why would you want those people in full control?

With people paying into private funds (or receiving medical as a part of their job/benefits), it makes me wonder actually, where is all the extra money going? It's either just a really inefficient system that leaks capital, or that dough is disappearing into someone's pockets.

Or both.

Well, we don't practice price controls, so R&D is more possible. Paying for an aspirin today helps pay for an HIV medicine tomorrow. You know, the way business works. If you limit companies to only charging cost you leave no room for growth. Personally, I enjoy working with a research hospital as I get the option to try new things that cost-controlled regions don't have access to. My current pulmonary conduit was experimental at the time it was put in. It was expected to last 7-10 years based on previous methods. I made it 17 before I needed something else done. I am now at 18 years with that same part. My personal health has deteriorated to the point that I need a transplant now, something we knew would be necessary since birth. But, due to all the wonderful medicines that have been developed in the last 20 years I am still living a full life with a heart that needs to be replaced. Why shouldn't I be willing to pay these people a profit? Not only is my current quality of life due to the profits my parents paid when I was a child and the profits I have been paying have gone toward working on artificial heart technology, that by the time my transplant wears out may be a long-term solution. Or, who knows, they may be able to make my own stem cells grow my own heart. That is where the money is going. Healthcare can and should cost more than just the expense of the care, especially if you want better care tomorrow.

The hospital I currently work at is a non-profit institution then provides a substantial amount of charity care in the community to uninsured and under insured patients. We are not allowed to turn any patient away by our parent organization's mandate. When you take out whether someone can pay or not, you benefit the community.

The hospital system that I have had all my cardiology work done through is also non-profit. But the doctors who work on me are not their staff, they are doctors who are private practice. The same doctors I see in offices in other buildings. The bills to my insurance are one for the hospital and one for the doctor's practice. Staff doctors work on the charity cases, but the guys with the most talent are working out of a private practice with contractual permission to work on their patients in the hospital.

It may be different in Michigan.

I don't think for profit health institutions should exist to be honest

Better doctors and better organized institutions shouldn't be rewarded for excelling over others in their field?

and I agree with you, when bottom line profit is mixed with healthcare the patients will start to suffer. I've seen it happen when looking at cases between for profit hospitals and our own organization.

For profit hospitals tend to rank lower in quality, satisfaction and in core indicators then non profit organizations too. I just don't see the benefit for a for profit hospital when you look at it from an inside perspective.

Yet, here in Louisville, the University of Louisville hospital is the one funded primarily by government. It is also the last hospital anyone in town wants to go to. I bet we can both find a laundry list of individual cases to prove our point. Do not forget that due to government intervention there is no cross-state insurance, thus no standard can be market forced across all states.

Also one thing people often glance over when looking at healthcare reform is the benefits the community is getting from it. Look up meaningful use and tell me that's not a good thing, in the end everyone is paying less and getting a higher quality of care. If an institution can't meet the indicators with meaningful use, they lose out on funding and over time their accreditation which all but puts them out of business.

I don't support 100% government controlled healthcare, but I do support a reform to the healthcare system in America. It's very broken and if we aren't careful it will out price itself leaving those with no insurance unable to obtain anything. Even with charity care, there is only so much to go around.

So, do you believe that the current reform plan is the way to go?



I have never said our current system doesn't need reforms, but no one wants seems to want to listen to ideas designed to create a fair system that asks for personal responsibility and true fairness. Instead, many prefer to complain about our system and then ask those that screwed it up to do more.

 

[livemusic]

The pursuit for profit is what drives the world forward, I don't see why it should be absent in healthcare. On the contrary, this is a vital area so profit should be even more present there.

Otherwise, shouldn't the food system be absent from profit? After all, food is more vital than healthcare, and capitalism has improved this area a lot over the last century.

 

[Keef]

Otherwise, shouldn't the food system be absent from profit?

No, no no nononononono. Healthcare is different. Don't even ask me to explain how it's different because I can't! But I know I'm right so there you have it.

 

[ROAD_DOGG33J]

Otherwise, shouldn't the food system be absent from profit? After all, food is more vital than healthcare, and capitalism has improved this area a lot over the last century.

You can pick which food you buy and evaluate your decision with a low amount of knowledge.

If a doctor recommended a procedure unless you know more than the doctor, you don't know if they're thinking in terms of profit or what's best for your health. If you go to get another opinion, you can still be unsure and wonder the same thing.

 

[Danoff]

You can pick which food you buy and evaluate your decision with a low amount of knowledge.

If a doctor recommended a procedure unless you know more than the doctor, you don't know if they're thinking in terms of profit or what's best for your health. If you go to get another opinion, you can still be unsure and wonder the same thing.

(same could be said of a mechanic, or the home repair guy, the plumber, electrician, lawyer, etc. etc.)

You should always get a second opinion.

Having been treated by both types of doctors - doctors who were interested in my health and doctors who were interested in over prescribing procedures for the sake of making money, I can say that it's strikingly obvious. Guess who got my business in the end? Guess who made more money off of me? The guy who kept me healthy without a bunch of unnecessary work.

We can make consumers out to be boneheads who can't figure out what's what. Or we can trust consumers to know their bodies, know when medication is working, and know when someone doesn't have their best interests in mind. Having been there, I can say that it's often easy, and it's a skill you need to have in all aspects of life.

Here's another angle. The guy who prescribes the unnecessary procedure in an effort to rack up the bill? He gets sued for malpractice. That's not something that happens to the mechanic who bills you $1000 for the work your car didn't need.

 

[FoolKiller]

You can pick which food you buy and evaluate your decision with a low amount of knowledge.

If a doctor recommended a procedure unless you know more than the doctor, you don't know if they're thinking in terms of profit or what's best for your health. If you go to get another opinion, you can still be unsure and wonder the same thing.

One could argue, and many do, that we are often lied to about what our food is in the name of profit. Unless you are well versed in all USDA and FDA regulations you cannot be sure you are buying what you think you are. When I changed my diet for low sodium and low sugar I had to learn a lot to be able to get the right stuff, and even then I have to read the fine print on packages very carefully. One example: Veggie burgers and turkey burgers are lower in cholesterol and fat and can be labeled healthy but they have four times the sodium as beef in order to not taste like dirt. There are also five different legally enforced sodium-based labels, two of which can sound good for a low sodium diet but not be. There is also two or three other ways that sodium can be advertised to sound healthy while not actually meaning anything more than there is less being used.

The same jumble of information and labeling can be used on any food category from organics to genetically modified to sugar content and even vitamin and nutrient content. I shouldn't have had to meet with a dietician and read whole books worth of info to make my diet work, but that is what had to happen.

I had three extra opinions on my need for a transplant months before I had that all figured out, and I still make the occasional dietary mistake.

And whether your doctor takes what appears to be the route best for your health or for money you should always get multiple opinions for big issues. For my doctors to say I needed a transplant meant I had to go to a new practice and different hospital. No reason not to trust them, but we were on the phone with Cleveland Clinic, University of Kentucky, and Minneapolis just to check.

Anytime treatment would mean complicated procedures always get multiple opinions. I would say the same thing under a non-profit system because all doctors are human and can be wrong, or perhaps they play it too safe or are too willing to try a risky procedure.

 

[ROAD_DOGG33J]

One could argue, and many do, that we are often lied to about what our food is in the name of profit. Unless you are well versed in all USDA and FDA regulations you cannot be sure you are buying what you think you are. When I changed my diet for low sodium and low sugar I had to learn a lot to be able to get the right stuff, and even then I have to read the fine print on packages very carefully. One example: Veggie burgers and turkey burgers are lower in cholesterol and fat and can be labeled healthy but they have four times the sodium as beef in order to not taste like dirt. There are also five different legally enforced sodium-based labels, two of which can sound good for a low sodium diet but not be. There is also two or three other ways that sodium can be advertised to sound healthy while not actually meaning anything more than there is less being used.

I was aware of the government misinforming the public about what's healthy and unhealthy. As far as I know, for most people cholesterol in food isn't that bad, so they can eat way above recommendations.

I shouldn't have had to meet with a dietician and read whole books worth of info to make my diet work, but that is what had to happen.

Just curious, what did you learn about the fats you are supposed to eat? Are you avoiding any?

 

[Joey D]

Better doctors and better organized institutions shouldn't be rewarded for excelling over others in their field?

There should be no need for better or worse. A patient should feel comfortable going to any institution knowing that they will get the best care they can. If a hospital is operating within 99% of all core indicators met, they shouldn't be rewarded. They are doing their job correctly.

By rewarding hospitals that are high in all indicators is like praising someone for stopping drugs, sure they are clean but they shouldn't have got there in the first place. You shouldn't reward someone or something for doing what they are supposed to do, however you should punish those who fall behind.

Yet, here in Louisville, the University of Louisville hospital is the one funded primarily by government. It is also the last hospital anyone in town wants to go to. I bet we can both find a laundry list of individual cases to prove our point. Do not forget that due to government intervention there is no cross-state insurance, thus no standard can be market forced across all states.

The overall data shows that not for profit hospitals rank better overall than for profit ones. There are always going to be exceptions to the rule. That was my point.

So, do you believe that the current reform plan is the way to go?

I have never said our current system doesn't need reforms, but no one wants seems to want to listen to ideas designed to create a fair system that asks for personal responsibility and true fairness. Instead, many prefer to complain about our system and then ask those that screwed it up to do more.

I believe the current reform has many good points, especially when it comes to meaningful use. I don't fully support the reform though because it could be much better and I think more of a properly run socialized medicine plan is the way to go, much like the way it is ran in Australia.

I don't blame the government all that much for the current state of the healthcare, I blame greed. I've gone to doctors for a 5 minute check up to get meds refilled and I end up paying $20 out of my own pocket with almost $300 being build to the insurance...that's what? $3,600 per hour for scribbling on a pad? There is no way medical care should cost that much. If medical facilities were put in check with how much they were charging patients, then insurance wouldn't have to pick up an enormous tab. I don't mind paying $20 for an office visit, but I'm sure my insurance company minds that they pay $300 and in the end it gets passed to me anyway with my premiums.

There are also the drug companies that charge outrageous prices for their drugs. My asthma medication costs me $75 a month and the insurance pays almost $600, seriously? There is no generic equivalent either so I have to buy the brand name. If I didn't have insurance I couldn't afford to keep myself alive, and sadly that's happening to quite a few people.

 

[FoolKiller]

I was aware of the government misinforming the public about what's healthy and unhealthy. As far as I know, for most people cholesterol in food isn't that bad, so they can eat way above recommendations.

Nothing definitive. The cholesterol itself has been previously shown to mostly pass unabsorbed, but studies also show that eating the foods with them correlates with increases in bad cholesterol. Personally, I think that if you step back and look at a larger picture we might find the foods with cholesterol
in them also have whatever it is that triggers the production of cholesterol in the body. We demonize the symptom but haven't found the true source. But that is just my base theory. Since poor life choices can be a determining factor in my transplant status I just eat what they tell me. I have three sheets of sample daily diets, seasoning substitutions, and daily allowed (or required) amounts of certain kinds of food stuck to my refrigerator.

You do not want to know how hard low sodium, low fat, low cholesterol with 85 grams of protein a day is. I got to where I throw handfuls of edamame into anything like salads, sauces or mixed vegetables. I would do a lot more fish but I am allergic to the most cheaper whitefishes, like cod. Fortunately, sustainability fears has increased the farm-raised catfish supply, but that is still a way off from being our main source of white fish for our fish sticks. For quick meals I have found very low sodium canned albacore tuna. It isn't labeled as approved by any green groups so I am probably eating turtle or killing off an eco-system somewhere, but oh well. Me or them, right?

Just curious, what did you learn about the fats you are supposed to eat? Are you avoiding any?

Red meat should be kept to only two or three servings a week. Eat Moar Chikin (white meat). Don't get me started on sodium content in chicken due to post-processing brine or broth injections. Purdue is the only non-organic brand I can buy in big grocery stores. And more fish. Avoid any added fats and primarily cook with olive oil. Extra virgin is preferred but has a low smoke point so many cooking options are limited there.

However, I will say this much. Something has to give to be palatable. Fat needs to be used as a flavor transfer in cooking, particularly when using low sodium. Salt makes your tastebuds more active, so when you take that away you need to pull the flavor through. I use plain old unsalted butter for sauteeing garlic and/or onion into most of my dishes. My blood is tested frequently and that has had no noticeable effect. Last test had everything perfectly where it should be. But when everything else is healthy it is probably an acceptable amount. I do have my doctors' permission to splurge every once and a while.

There should be no need for better or worse. A patient should feel comfortable going to any institution knowing that they will get the best care they can. If a hospital is operating within 99% of all core indicators met, they shouldn't be rewarded. They are doing their job correctly.

As a patient, if a hospital is just meeting core indicators they have done a piss poor job. I studied core indicators extensively and I can tell you right now that two hospitals that look the exact same statistically are not the same. You wouldn't say two cars with the exact same power, torque, etc. are the exact same. No. Sure they may both hug the road excellently, but then you get down to things like seat comfort, amenities, cost, and so forth and it is a night and day difference.

Physical health is the goal, but mental and emotional health are greatly affected by things not covered in the core indicators. A good doctor is one that keeps all his patients alive and in good health within his control. A great doctor is one that has his patient completely relaxed. He sends them into pre-op with a smile on their face. And after the procedure he makes them forget their discomfort. I know this because I have had equally qualified doctors, but one had a poor bedside manner and drab cream colored office walls while the other got into a UK vs Duke debate with me, and then before a procedure when I was explaining something and started with, "And while talking to my friends.." he interrupted me and said, "Wait, you have friends?" The man was about to defibrillate my heart after having me admitted to the hospital as an emergency and he had me laughing.

If Patch Adams were just a by the book doctor mainly concerned with core indicators no one would care. He'd be boring and he would scare children. Instead he is, literally, a clown who makes the children laugh.

Core indicators are for hospital administration who don't give to squirts about the patients, so long as they are healthy. It does not surprise me that your experience in this was preceded by "The hospital I currently work at..."

By rewarding hospitals that are high in all indicators is like praising someone for stopping drugs, sure they are clean but they shouldn't have got there in the first place. You shouldn't reward someone or something for doing what they are supposed to do, however you should punish those who fall behind.

You should also punish those with poor customer service, no matter their core indicators. That is why the choice of a private system is important to me.

The overall data shows that not for profit hospitals rank better overall than for profit ones. There are always going to be exceptions to the rule. That was my point.

As I previously pointed out, are the doctors hospital employees or working their with contractual agreements? I have a heart cath next week. It will be performed at the private, non-profit Kosair Children's Hospital, a member of the Children's Miracle Network. But the procedure will be performed by my private practice doctor. If I walked in to find a doctor I never met before was doing it because he was hospital staff I would walk out. How much of that data goes into those details? How many core indicators at non-profits are being met by private doctors not on the payroll?

I don't blame the government all that much for the current state of the healthcare, I blame greed. I've gone to doctors for a 5 minute check up to get meds refilled and I end up paying $20 out of my own pocket with almost $300 being build to the insurance...that's what? $3,600 per hour for scribbling on a pad? There is no way medical care should cost that much. If medical facilities were put in check with how much they were charging patients, then insurance wouldn't have to pick up an enormous tab. I don't mind paying $20 for an office visit, but I'm sure my insurance company minds that they pay $300 and in the end it gets passed to me anyway with my premiums.

Read your EOB next time and then try again. Your insurance isn't paying $300.

There are also the drug companies that charge outrageous prices for their drugs. My asthma medication costs me $75 a month and the insurance pays almost $600, seriously? There is no generic equivalent either so I have to buy the brand name. If I didn't have insurance I couldn't afford to keep myself alive, and sadly that's happening to quite a few people.

Do you seriously believe that anti-competition rules (such as cross-state insurance) put in place by governments have no effect on these things? Do you seriously believe that price controls on new drugs in other countries have no effect on these things? Do you seriously think that if you could buy health
insurance the way you buy any other insurance that it would be the same? Do you know if you could save money if you switched from Blue Cross Blue Shield of Michigan to HumanaOne Michigan Health or United Healthcare Great Lakes? Is there no personalized price comparison thing on their Web site? Do they need to worry about it with the way the laws are? Do you know why all three of those have Michigan, or some other regional nomenclature in their official local name? Do you know why I can't buy any of those?

You are right, greed plays a role and some politicians took their fair share of that. And we can see it playing a role in this new ponzi scheme, I mean healthcare reform bill.

 

[Joey D]

As a patient, if a hospital is just meeting core indicators they have done a piss poor job. I studied core indicators extensively and I can tell you right now that two hospitals that look the exact same statistically are not the same. You wouldn't say two cars with the exact same power, torque, etc. are the exact same. No. Sure they may both hug the road excellently, but then you get down to things like seat comfort, amenities, cost, and so forth and it is a night and day difference.

Physical health is the goal, but mental and emotional health are greatly affected by things not covered in the core indicators. A good doctor is one that keeps all his patients alive and in good health within his control. A great doctor is one that has his patient completely relaxed. He sends them into pre-op with a smile on their face. And after the procedure he makes them forget their discomfort. I know this because I have had equally qualified doctors, but one had a poor bedside manner and drab cream colored office walls while the other got into a UK vs Duke debate with me, and then before a procedure when I was explaining something and started with, "And while talking to my friends.." he interrupted me and said, "Wait, you have friends?" The man was about to defibrillate my heart after having me admitted to the hospital as an emergency and he had me laughing.

If Patch Adams were just a by the book doctor mainly concerned with core indicators no one would care. He'd be boring and he would scare children. Instead he is, literally, a clown who makes the children laugh.

Core indicators are for hospital administration who don't give to squirts about the patients, so long as they are healthy. It does not surprise me that your experience in this was preceded by "The hospital I currently work at..."

Customer service is measured and monitored extensively. The administration is also extremely involved in making sure that these indicators stay high and that they are well known among the community for advertising purposes. We have an entire department dedicated to this and to conduct on going training to assure the staff is at their best.

In my previous position I did a majority of my work with concerns around patient satisfaction and drawing conclusions from it, as well as looking for ways to implement more instantaneous feedback. So really you are preaching to someone that knows the ins and outs of this, it may be different in other states but since just about every patient is the same I doubt it. Everyone that ends up a hospital expects exceptional care, a caring staff and a speedy recovery.

And did you even look around for customer service ratings? I mean the HCAHPS includes all of the customer service data in it along with rating the actual care given. It pretty easy to find which hospitals have good all around indicators, although there is always a margin of error (which I know all to well).

You should also punish those with poor customer service, no matter their core indicators. That is why the choice of a private system is important to me.

They are punished by not having people return to the facility and losing out on revenue. Our organization is scared to death of that happening which is why we keep our customer service numbers up. Healthcare is the biggest industry in Southeast Michigan and there is no shortage on places to go to get healthy. If one hospital treats you poorly, there are 10 others that are ready to jump at your business by touting all sorts of data.

As I previously pointed out, are the doctors hospital employees or working their with contractual agreements? I have a heart cath next week. It will be performed at the private, non-profit Kosair Children's Hospital, a member of the Children's Miracle Network. But the procedure will be performed by my private practice doctor. If I walked in to find a doctor I never met before was doing it because he was hospital staff I would walk out. How much of that data goes into those details? How many core indicators at non-profits are being met by private doctors not on the payroll?

Both are considered. I can't go into the specifics (or maybe I can, I'm not about to tempt fate for the sake of an internet discussion). In short though we are able to breakdown data extensively, past that I don't know what I can and cannot say on the subject. If you don't want to believe me on it, it's alright.

Do you seriously believe that anti-competition rules (such as cross-state insurance) put in place by governments have no effect on these things? Do you seriously believe that price controls on new drugs in other countries have no effect on these things? Do you seriously think that if you could buy health insurance the way you buy any other insurance that it would be the same? Do you know if you could save money if you switched from Blue Cross Blue Shield of Michigan to HumanaOne Michigan Health or United Healthcare Great Lakes? Is there no personalized price comparison thing on their Web site? Do they need to worry about it with the way the laws are? Do you know why all three of those have Michigan, or some other regional nomenclature in their official local name? Do you know why I can't buy any of those?

I don't believe for a second if I could pick the insurance I wanted it would some how be cheaper or better. Car insurance is already a massive scam so I wouldn't even want to see what would happen to health insurance if it were ran that way. I believe I would end up paying more for a service that is worse then it is now with even more limited access.

I think healthcare needs to be controlled and regulated in order to keep it in check. Your health is important and if the care out prices itself, all it's going to do is make it so the lower end of society won't be able to afford anything and the charity care will run out. You'll end up having an unhealthier population as a whole. Most of the first world nations manage just fine on some form of socialized medicine so I see no reason why America can't follow suit. It's been shown to work so why not run with it? Oh that's right it's all about money instead of society.

 

[FoolKiller]

Customer service is measured and monitored extensively. The administration is also extremely involved in making sure that these indicators stay high and that they are well known among the community for advertising purposes. We have an entire department dedicated to this and to conduct on going training to assure the staff is at their best.

In my previous position I did a majority of my work with concerns around patient satisfaction and drawing conclusions from it, as well as looking for ways to implement more instantaneous feedback. So really you are preaching to someone that knows the ins and outs of this, it may be different in other states but since just about every patient is the same I doubt it. Everyone that ends up a hospital expects exceptional care, a caring staff and a speedy recovery.

And did you even look around for customer service ratings? I mean the HCAHPS includes all of the customer service data in it along with rating the actual care given. It pretty easy to find which hospitals have good all around indicators, although there is always a margin of error (which I know all to well).

They are punished by not having people return to the facility and losing out on revenue. Our organization is scared to death of that happening which is why we keep our customer service numbers up. Healthcare is the biggest industry in Southeast Michigan and there is no shortage on places to go to get healthy. If one hospital treats you poorly, there are 10 others that are ready to jump at your business by touting all sorts of data.

I combined the two responses for one important reason. They are all issues of a capitalistic, competitive system. Ever notice customer service at the DMV is bad? Where else will you go?

Both are considered. I can't go into the specifics (or maybe I can, I'm not about to tempt fate for the sake of an internet discussion). In short though we are able to breakdown data extensively, past that I don't know what I can and cannot say on the subject. If you don't want to believe me on it, it's alright.

I have participated, many times, in the surveys these are based on, so I know. But the surveys, at least in Kentucky, do not explain the differences to the patients. I know I have had times when I start meeting people on the team and I have trouble determining which ones are hospital staff and which are on my doctor's team. Especially when I meet them in the OR with "something to relax you" going into my arm. It is difficult enough so that now they have staff hand you cards with their names and jobs on them so you can identify them by name for the surveys.

I don't believe for a second if I could pick the insurance I wanted it would some how be cheaper or better. Car insurance is already a massive scam so I wouldn't even want to see what would happen to health insurance if it were ran that way. I believe I would end up paying more for a service that is worse then it is now with even more limited access.

You don't believe that anyone would come out with the better deal and undercut the status quo or offer something in a different way? AFLAC already did it with the way they handle supplemental insurance. You don't think there would be an AFLAC version of major medical to offer something different? No medical versions of the iPhone or Android to the status quo Blackberry? You ignore the history of business if you seriously believe that.

I think healthcare needs to be controlled and regulated in order to keep it in check. Your health is important and if the care out prices itself, all it's going to do is make it so the lower end of society won't be able to afford anything and the charity care will run out. You'll end up having an unhealthier population as a whole.

And if the price controls undercut R&D costs you get less options for care. But I guess it is fine to create a system where the newest and best stuff that a price controlled market wouldn't be able to afford is only available to the 5% who could afford to get the best of the supplemental private care and/or travel to where it is available. Just because you can regulate something doesn't make it cheaper. You can't control the actual costs of R&D without hindering it.

Most of the first world nations manage just fine on some form of socialized medicine so I see no reason why America can't follow suit. It's been shown to work so why not run with it? Oh that's right it's all about money instead of society.

I see reasons why we shouldn't follow suit, but if you think financial success means you owe someone something, and the government should force you to give it to them, you will disagree with me.

From a non-rich, patient point of view. I like choices. I like knowing that if something makes me unhappy I have hundreds of other choices in every city. I like knowing that my medical expenses are not a burden on anyone else and that I am taking 100% responsibility for myself and not mooching off anyone. I only wish the barriers that prevent my freedom to do that with insurance were removed.

 

[Joey D]

You don't believe that anyone would come out with the better deal and undercut the status quo or offer something in a different way? AFLAC already did it with the way they handle supplemental insurance. You don't think there would be an AFLAC version of major medical to offer something different? No medical versions of the iPhone or Android to the status quo Blackberry? You ignore the history of business if you seriously believe that.

Yes someone would come out with a budget system but I think the service it would provide would be awful, just like budget car insurance. You would think it's all good until you are hit with an unexpected bill the insurance didn't foot or didn't kick in what you were lead to believe.

My old car insurance company was famous for nicking me with charges that we some wild interpretation of my documents. I fought it and won most of the time but the headache of going through it was awful. It's bad with a car, but I think it would be even worse with your own health.

Plus I don't believe the health of our population should be reliant on whether or not you can afford insurance.

And if the price controls undercut R&D costs you get less options for care. But I guess it is fine to create a system where the newest and best stuff that a price controlled market wouldn't be able to afford is only available to the 5% who could afford to get the best of the supplemental private care and/or travel to where it is available. Just because you can regulate something doesn't make it cheaper. You can't control the actual costs of R&D without hindering it.

I don't see it cutting into R&D at all, the only thing I see is the company making slightly less profits. By limiting the cost of drugs the company would have to invest more of its profits into it's own company rather then lining the pockets of CEO's.

I see reasons why we shouldn't follow suit, but if you think financial success means you owe someone something, and the government should force you to give it to them, you will disagree with me.

I do disagree. I think having socialized medicine is the right thing for the common good. I'd rather invest my tax dollars into the health and well being of the US over a useless war in a third world nation.

From a non-rich, patient point of view. I like choices. I like knowing that if something makes me unhappy I have hundreds of other choices in every city. I like knowing that my medical expenses are not a burden on anyone else and that I am taking 100% responsibility for myself and not mooching off anyone. I only wish the barriers that prevent my freedom to do that with insurance were removed.

You are still relying on others for your care though, without people paying into the insurance company there wouldn't be any money for your care. You will be using more insurance money for you major heart procedures and follow up care than the guy who's paid in for years and have only ever had a cold.

I've stated why I think a socialized medicine system would be good for the US and I don't see it as being a burden to society. i believe we have a social responsibility to care for our fellow citizens. And as it is, I already pay money out of my cheque to go towards my insurance, it wouldn't really make any difference to me if that money was going to the employers health plan or the national health plan.

 

[MikeTheHockeyFan]

I've stated why I think a socialized medicine system would be good for the US and I don't see it as being a burden to society. i believe we have a social responsibility to care for our fellow citizens. And as it is, I already pay money out of my cheque to go towards my insurance, it wouldn't really make any difference to me if that money was going to the employers health plan or the national health plan.

This is where you lose a lot of people from the U.S. They have their gun, they have their nice acre and a half and a house with a paid-off mortgage, and they see socialized medicine as the government reaching into their pockets and taking what they earned to give it to some poor folks who were too lazy to work hard enough to be able to take care of themselves.

I believe we must judge the measure and resilience of a society by how it takes care of its less fortunate. The United States does a s**tty job of it with a legal system that disproportionately punishes the lower classes for small offences, and a prison system set up to institutionalize and beat the life out of them, slowly.

I guess Americans not in favour of socialized medicine just think that charitable giving or churches or something is going to take care of the less fortunate.

 

[Rich S]

I live near the Canadian border (albeit the MN/Ontario border) rather than a more heavily populated area.

Thunder bay is a larger city than Duluth, but the few times I've gone up there I have to say its not doing so well. All the Canadians are always coming down to the USA to do there shopping (shopping sucks in Canada I guess).

So I dont know....maybe socialism is not the way to go...

 

[Famine]

I don't believe for a second if I could pick the insurance I wanted it would some how be cheaper or better. Car insurance is already a massive scam so I wouldn't even want to see what would happen to health insurance if it were ran that way.

Car insurance is mandatory - a legal requirement if you want to run a car on the roads. This is why it can be run as an effective cartel, as you have to buy it from somewhere and the larger few companies run pretty much all of the market (as it is in the UK - almost all insurers are owned, or underwritten, by three companies). Health insurance is not (yet) mandatory - you don't have to have it if you want to run a body. This is why it has to be competitively priced and customer oriented.

Part of Obamalife is mandatory health insurance, from the public sector if you don't have private insurance. The way car insurance is run is a terrific argument against mandatory health insurance - with the only difference being that you can buy into the one-size-fits-none public option, run by the same people who run the FDA, the DMV and the IRS...

 

[Joey D]

Car insurance is mandatory - a legal requirement if you want to run a car on the roads. This is why it can be run as an effective cartel, as you have to buy it from somewhere and the larger few companies run pretty much all of the market (as it is in the UK - almost all insurers are owned, or underwritten, by three companies). Health insurance is not (yet) mandatory - you don't have to have it if you want to run a body. This is why it has to be competitively priced and customer oriented.

Part of Obamalife is mandatory health insurance, from the public sector if you don't have private insurance. The way car insurance is run is a terrific argument against mandatory health insurance - with the only difference being that you can buy into the one-size-fits-none public option, run by the same people who run the FDA, the DMV and the IRS...

I fully believe if you were able to pick your own insurance it would turn into exactly what car insurance is. The insurance lobbies would pressure lawmakers to enact laws mandating that everyone has some form of health insurance and they would make out like bandits. Smaller insurance companies would have no chance at making it into the market and your rates really wouldn't vary from company to company...much like car insurance is now.

I don't agree with what Obama's plan has become but I think with some modifications it could turn into something beneficial. Unlike many American members of GTP, I don't mind the government being involved with the country and its citizens. In fact I would rather my tax dollars go to helping out my fellow citizens and making the country a better place overall then fighting useless wars and handing out foreign aid like it's candy.

 

[Famine]

I fully believe if you were able to pick your own insurance it would turn into exactly what car insurance is.

You already have that - we already have that - and it isn't*.

Car insurance is a legal requirement for car owners (if they wish to drive on the public road) and the majority of insurers are run by or underwritten by the same three (or four) companies, resulting in industry-standardised prices and benefits - you have to buy it and there's no other option - a governmentally-sponsored cartel. Health insurance is not a legal requirement for body owners and, although the majority of insurers are run or underwritten by the same six or seven companies, there is no compulsion at all to make a purchase and there is no industry-standardised price system or benefit packages.

Make something a legal requirement and purchased from private companies and you make a cartel - that's car insurance right now. Make something a legal requirement and purchased from the state and you make a monopoly - that's driver licensing right now. Leave it optional and purchased from private companies and you have a free market - that's health insurance right now.


*I believe the commonest form of private health insurance in the US is provided by the employer and thus provided by the company the employer has chosen - of course you don't have to take your employer's health benefit package and you can buy your own. The UK isn't directly comparable as, typically, the only employers that offer private health benefit packages are private health providers (although you can get discounted cover through employee unions). But it remains that health insurance in both countries is optional and subject to competition and free market forces, whereas car insurance in both countries is mandatory (for drivers) and neither subject to competition nor free market forces due to the captive and legally enforced market.

The insurance lobbies would pressure lawmakers to enact laws mandating that everyone has some form of health insurance and they would make out like bandits.

That's exactly what Obama has planned for you.

 

[Joey D]

You already have that - we already have that - and it isn't*.

Car insurance is a legal requirement for car owners (if they wish to drive on the public road) and the majority of insurers are run by or underwritten by the same three (or four) companies, resulting in industry-standardised prices and benefits - you have to buy it and there's no other option - a governmentally-sponsored cartel. Health insurance is not a legal requirement for body owners and, although the majority of insurers are run or underwritten by the same six or seven companies, there is no compulsion at all to make a purchase and there is no industry-standardised price system or benefit packages.

Make something a legal requirement and purchased from private companies and you make a cartel - that's car insurance right now. Make something a legal requirement and purchased from the state and you make a monopoly - that's driver licensing right now. Leave it optional and purchased from private companies and you have a free market - that's health insurance right now.

What I'm saying is if we made it so it was easier for companies to sell health insurance you'd still end up with what car insurance is. Pretty much all the insurers in the US are underwritten too by a handful of companies too, I learned this while recently shopping for a new policy, so you get a pretty standard industry pricing for your given criteria.

The way I see it is that insurance companies would pressure the government to enact laws making health insurance compulsorily, even if you completely take Obama's Healthcare Reform out of the picture. Essentially I believe no matter what you do your are going to end up with the insurance companies winning in the end and the population losing unless there is some major change with the way we currently do things.

That's exactly what Obama has planned for you.

Which is the biggest thing I have against Obama's plan, it basically would make it so the insurance companies win. The only way I can see that the people would win is if we had a universal healthcare system.