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January 7, 2009 3:28 pm PST

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I agree completely, and it’s not often that I say that. Please send this article to Obama et al!

Comment by Margaret on 11/22/08 at 12:54 pm

You’re kidding, right?  America’s most successful and popular social program is Social Security?  Anyone with a TV during the last 20 years will quickly agree that your entire argument for universal healthcare lost credibility as soon as you made that statement. Also, if indeed Obama’s mother was struggling with her insurance during her last days, sadly it was because private insurance companies follow the leads set by Medicare when it comes to reimbursement and coverage. Few people outside of the medical world know this. We should proceed with this universal concept with extreme skepticism and the utmost caution.

Comment by eric on 11/22/08 at 2:31 pm

If you like going to the Post Office, you’ll love government mandated medical care.  Long lines, irritable employees and poor service.  Send your complaints to the Healthmaster General.

Comment by Caldoc on 11/22/08 at 4:53 pm

>  Is the time right for universal health care?

If we would get our terms right, this discussion would go better.
It’s not “health care” we’re talking about here, it’s “health insurance.“  We have the best health care in the world, and basic health care is accessible to everyone living in America, American or not.
Too many of us have bought into the lie that if you don’t have health insurance then you can’t have health care!

Philip Thwing, MD
Family Practice
Greeneville, TN

Comment by Philip Thwing on 11/22/08 at 7:23 pm

I live in Canada. I have virtually free health care (except for prescription medication). It is WONDERFUL! There is all kinds of propaganda in the US about Canadian health care. That it is terrible etc. etc. That is all not true! I can see a doctor in 30 minutes and see a specialist in a week if I need to. The doctors do not call any insurance company or other person to get permission to provide treatment - the doctor makes the decision about the kind of treatment that is required. It is a fantastic system - and the insurance companies stand to lose fortunes should the same system be adopted in the USA.

Comment by Angela White on 11/22/08 at 10:21 pm

Eric, I don’t blame you for being afraid, in fact I understand completely. When a bunch of companies get together and say: “Yes, we’ll let you pass these laws, as long as you force all the people to pay us”, that’s extortion. When Congress agrees to it, that’s corruption! I have come to understand that we are being threatened by members of congress, like Sen. Tom Coburn, who tell us that if we pursue government run health care, they will make it the worst system we can imagine. We have been warned time after time that if we take even the tiniest step in a direction they have deemed to be “socialism”,  they will push it to the most ridiculous extreme, that we’ll soon be standing in line for shoes. I’m sick of having to compete for representation, and getting canned answers because Congress is out to lunch with lobbyists. They have corrupted our system, and if we don’t stand up for ourselves, nobody will. I’m not going to take it anymore, and neither should you.

Comment by James Hovland on 11/22/08 at 11:54 pm

I am looking forward to government-mandated health insurance.  Those of us with private insurance are tired of paying premiums that partially support health care for those who have no insurance.  And those who pay for individual insurance are tired of the tax subsidy given to those who get insurance from employers (McCain was right about this part).  As for the crack about the post office, we in the US have a great postal service, certainly better than Britain’s and Candada’s.  Some people just hate government; they need to get over it.

Comment by Richard Ward on 11/23/08 at 12:15 am

IN WW2 we had 11 million men under arms and managed our finances!In Iraq we spend $3B a month without paying for it.Why is it we can finance wars but not health care?
Can it be wars are profitable -even when they are just or unjust?

Comment by frank lipsky on 11/23/08 at 12:32 am

Consider this.  The best health (and dental!) care I ever received was when I was in the Navy.  Wasn’t that “government run health care”?  The active duty doctors earned a good wage and benefits, and most had their educations paid for.  The generally worked better hours then their civilian counterparts and had top of the line equipment—one difference of course, is that they were essentially immune for any malpractice claims.

Comment by MJ on 11/23/08 at 12:41 am

The perhaps Dr. Philip Thwing, MD, you could explain why the US ranks 32nd in the world by infant mortality rate?

With 20% more deaths/1000 live-births than “Cuba” I find it difficult to understand your characterization of the US as having “the best health care in the world”.

Perhaps you could clarify your statement.

Comment by Alan Carre on 11/23/08 at 12:47 am

I am a nurse who whould probably lose money if universal health care would pass. Doctors are always upset when the very topic is brought up. I understand that they spent years in school and then pay their dues as residents not to mention the thousands for their education. They need to be compensated for that. I just want everyone who is afraid to remember why we went into this field for. TO TAKE CARE OF THE SICK. If you can just go back to the days of childhood. When, if you were sick even a child would tell you then just go to the doctor. Prevent illness with regular primary care physician visits. Cut down the wasted resources of the ER for colds. We need to fix a BROKEN system. The government needs to fix it. We can and will. There are too many people with various beliefs on this matter. Think of others as well as yourself. We will need a system for everyone to fix the problem. If you are rich then buy an extensive plan above and beyond it if you must, but society needs to take care of the weak, poor and ILL.

Comment by James Michael on 11/23/08 at 12:58 am

Those who advocate for government-run health care apparently have never received medical services at government-run clinics or hospitals like the OLD and FILTHY Charity Hospital in New Orleans. Government-employed doctors and nurses have no incentives to work hard i.e. seeing more patients because they are on fixed salaries. i.e. they get the same pay whether they see 20 or 100 patients a day. Government-owned hospitals and clinics have no incentives to improve their facilities and services due to constant government budget constraint and deficit. On the other hand, private hospitals/clinics and private physician practices are constantly trying to improve their facilities, their services, and their efficiency because they are in competition for more customers (patients). The more patients they see the more money they make. The NAVY and armed forces are an ELITE group of people who must receive good health care and the best equipment possible. (We do not want to send a sick and ill-equipped soldier to the battle; and the government cannot afford to provide the same kind of services to the mass due to excessively high costs). If you don’t believe me, the next time you are sick, just go to one of you local government-run public clinic or hospital and see how long the wait line is and what kind of services you receive.

Comment by vdinh on 11/23/08 at 1:15 am

Philip Thwing, MD doesn’t know what he’s talking about. Report after report shows people aren’t getting access or are avoiding care because unable to pay or enter via emergency rooms or sacrifice up to home loss and bankruptcy in exchange.
I’m in France, where there’s a single payer system, so doctors have NO PAPERWORK. (They swipe your health card and type in the treatment code(s) and the info goes electronically to Social Security.) Everybody’s covered. There’s no “out of area” and coverage applied throughout the European Union. Choice of doctors is completely free. The WHO rates the care the best in the world (USA 37th) and the cost as a % of GDP is about 40% less than in the US.

Comment by gadfly on 11/23/08 at 1:26 am

I find it quite remarkable that most Americans seem utterly convinced that socialised medicine is of poor quality, involves long queues and is generally evil.  The most astonishing thing is that most of them have never experienced it! 

Having tried both systems in several counties (US, UK, Australia, France, Germany & HK) I find that the “socialised” system can perform pretty well.  It really depends on how much money is invested and how well it’s organised.

For example, the American insurance based system is pretty much organised to maximise the insurance companies profit.  (Quite undestandably.)  So it offers a pretty fantastic deal if you never get ill but in reality is structured to deny care if it’s needed.  (I wonder what percent of GDP is spent on Health in the US)

The UK system offers universal essentially free care - with the consequence that GPs are under severe pressure and minor non threatening procedure can be considerably delayed. 

The France and HK have somewhat alleviated this problem by making GP visits private.  In addition they encourage private hospitals (as reluctantly does the more doctrinaire UK) - but the existance of a lot of Government hospitals provides competition and tends to keep a bridle on costs. 

As for the important question of doctors and Nurses - these are fairly competitive.  Clearly if they weren’t all of these professionals would simply work elsewhere.

What a remarkable set of propaganda the AMA and their politial flunkies have propagated!  Geobbels would be green with envy!

Comment by Geoff on 11/23/08 at 2:43 am

[Quote (vdinh):]
“If you don’t believe me, the next time you are sick, just go to one of you local government-run public clinic or hospital and see how long the wait line is and what kind of services you receive.“
[/Quote]

Did it ever occur to you that perhaps they aren’t getting enough **FUNDING**?

Contrasting US government-run hospitals to private-run hospitals (in the same country) only measures the commitment of the “US government” towards quality health care to that of the individual (US) consumer.

Apparently your verdict is that the US government’s commitment to quality health care is *lacking* to say the least.

Here’s a tip: when arguing for or against a particular philosphy or system, you should adopt a position which is *not* contrary to the point you are trying to make.

Comment by Alan Carre on 11/23/08 at 3:26 am

Alan Carre’s comment about us infant mortality is more reflective of personal choices than a health care system. If people make poor choices about reproduction (fail to seek appropriate care, consume drugs or alcohol during pregnancy, reproduce repeatedly while unable to support themselves) no system yet devised can save their infant.

Comment by Steve Jones on 11/23/08 at 3:32 am

[Quote (vdinh):]
The NAVY and armed forces are an ELITE group of people who must receive good health care and the best equipment possible.
[Quote]

Astonishing statement… almost beyond belief. I’m a little surprised at finding myself addressing it.

———

So, by implication here, only “elite” groups “must receive good health care and the best equipment possible”. By contrast, the riff-raff (ie. the general population) do not require good health care and the best equipment possible. Instead they should be left to make-do with whatever they can afford. After all, they aren’t out waging war against 3rd world countries now are they?

They (the riff-raff) do have some minor contributions to make that you should probably be aware of. Like for instance the small matter of doing all the work necessary to ensure the continued existence of the country. Examples include food production, science and innovation, manufacturing, transportation of goods, banking, general infrastrucure, communications and networking, energy production, economics and trade, legislation and policing, etc etc etc… Not to mention nursing, doctoring and so on.

Is this not what those “elite” warriors are engaged in protecting? Would it not make sense then, that the country should be regarded as at least as important as those that protect it? those who are willing to lay down their lives if necessary in order to achieve that end?

Comment by Alan Carre on 11/23/08 at 3:58 am

[Quote (Steve Jones):]
Alan Carre’s comment about us infant mortality is more reflective of personal choices than a health care system.
[/Quote]

That’s a sweeping statement backed by no evidence whatsoever. And, even if true, it implies that US citizens are particularly bad at making “personal choices” regarding health care.

So why would that be? Could it be that they are uneducated compared with other industrialized countries like say “Cuba”? Or (more likely) perhaps it’s because it costs a lot of money to go to the doctor for advice.

Either way you present an argument *for* government-run health care while trying to argue the opposite. If, as you say, people in the US are no good at making decisions regarding health care (what a judge would call “expert medical decisions”), then perhaps they should not be in a position to have to make such decisions in the first place.

Comment by Alan Carre on 11/23/08 at 4:19 am

Alan, to the contrary,the sweeping statement is to relate infant mortality to the healthcare system without any evidence of cause and effect. More free, accessible healthcare is available in this country for mothers and infants than any other segment of the population. Ask any public health nurse, MD or other provider who routinely works in this field. Patients show up intermittently for care, don’t follow through with their providers, and in the end many just throw their hands up and ask the state, or whomever, to save them. The rate of maternal drug use and alcohol consumption in this country among certain segments of the population far outstrips that of most third world countries, where recreational drugs and alcohol are beyond the means of the average young mother. And to specifically take your example of Cuba, family sizes are smaller, and there is almost no maternaldrug use.

We can have any healthcare system we want. We just have to be ready to pay for it. VAT, higher income taxes, perhaps some personal responsibility and you can have what you dream of, a social system that wraps its arms around whomever decides to reproduce in whatever carefree manner.

Comment by steve jones on 11/23/08 at 10:13 am

I work for a large hospital and most of my relatives live in Germany, so I have seen both systems at work. First, I would not trade our healthcare for the healthcare in Germany hands down. I have seen both a tragic birth injury with my niece and elderly relatives with disease processes that would have been addressed much more thoroughly here insurance or no insurance. Our ER’s are required to see everyone and the system is clogged with visits for minor skin rashes, earaches, etc. Although we have free clinics within miles of the ER, Medi-cal puts no responsibility on the insured member to go to a clinic first for minor illnesses and it is breaking down the system. I do not trust the government to create an efficient healthcare program equal to the one offered today. We ( employed) will still be paying for insurance for the unemployed as our system does currently. My job requires analysising case data and it has been a real eye opener.

Comment by deb catherine on 11/23/08 at 10:33 am

I am in health care [a Physical Therapist], and have worked primarily with the elderly in a variety of settings for 15 years, so I am quite aware of the workings of Medicare, private health insurance, and Social Security. With very few exceptions, I much prefer to treat a patient with Medicare. In most cases, I am allowed a reasonable amount of time and visits to get the patient better, with much less paperwork, phone calls and reimbursment hassles than with private insurances. One exception is the Medicare plans that are administered by private insurances. The time and energy required for clinicians to repeatedly convince insurance case managers to continue paying for basic services is astounding - some companies require a call every week. I just read that 1/3 of American primary care doctors plan to cut back their hours or quit entirely within the next 3 years, because they must spend so much time on paperwork and reimbursement issues, forcing them to either cut back on time with their patients, or burn out. I think we all want to cut back on wasteful practices that increase our costs, and maximize the quality and convenience of our medical care. Private insurances, with some exceptions, have demonstrated that they drive up costs and drive down quality over the last 15 years. Medicare, while flawed, has done much better on all fronts during the same period. And Social Security, which was touted by the Bush administration as being broken and in crisis, keeps chugging along providing basic income for all seniors every month. How would they be doing if the Bush administration had succeeded in putting all of our Social Security deductions into the stock market?

Comment by Margaret on 11/23/08 at 10:36 am

Alan:
You missed my point. I never state that the general U.S. population does not deserve the same level of medical care that our armed forces are receiving. I also never say that our government is not capable of providing high-quality medical care. The problem is the high costs associated with high quality. Just think about it; you can not expect the same level of customer services from a used car dealership vs. a Hyundai dealership vs. a GM dealership vs. a Mercedes-Benz dealership for the same costs. Our government has to provide high-quality medical services to our armed forces because we do not want to send a sick soldier to the battle (and we do not want a pilot with poor physical condition and heart disease to fly a multi-million dollar jet either . Our government CAN provide high-quality (unfortunately, high cost) medical care but to a small group of people only (U.S. Armed Forces: 1+ million ?) vs U.S. population (300+ million). If we are willing to pay taxes at 2 to 3 times the rate we are currently paying, then our government will probably be able to provide universal “free” health care for everyone like the system the Europeans are receiving. I don’t know what the tax rates for the Europeans are but I suspect theirs are much higher than ours. I do know for a fact that a gallon of gas here costs 3 to 4 dollars; in Europe it’s 10 to 12 dollars.

Comment by vdinh on 11/23/08 at 10:51 am

Margaret:
Are you aware that MEDICARE spending is spiraling out of control because of lack of oversight and cost control measures like those used by private insurances?
Private insurances have to institute these cost control measures (more paperwork) because they have to make sure the patients really need the services;  MEDICARE, on the other hand, less paper work leads to unnecessary services and fraudulent billing (Frauds that cost MEDICARE billions of dollars every year). I have never seen a private health insurance or corporation that could continue operation even if it reported a business loss or deficit every year like our government.

Comment by vdinh on 11/23/08 at 11:16 am

[Quote (steve jones):]
Alan, to the contrary,the sweeping statement is to relate infant mortality to the healthcare system without any evidence of cause and effect.
[/Quote]

Dunno if URL’s are allowed… we’ll see.

/ wiki / List_of_countries_by_infant_mortality_rate_(2005)

[Quote]
The infant mortality rate (IMR) is the number of deaths of infants under one year old in a given year per 1,000 live births in the same year. This rate is often used as an indicator of the level of health in a country. The current world infant mortality rate is 49.4 according to the United Nations and 42.64 according to the CIA World Fact Book.
[/Quote]

Now why do you suppose they’d say that? I mean, they didn’t have to say that it “is often used as an indicator of the level of health in a country”, but they did. So why? Perhaps there *is* evidence that the two are related?

It seems that the assumption must be that healthy people’s babies have a higher chance of survival than unhealthy people’s babies. Is that such a sweeping leap of illogic?

Healthy: good chance to reproduce.
Unhealthy: less chance to reproduce.

I think Darwin said it in a different way, something about fitness being related to reproduction. Yes, there is lots of evidence that Darwin was correct and so there is lots of reason to couple reproductive success with health.

Now let me ask you, what factors do you think would contribute most to the “level of health of a country”? (I guess the last thing would be it’s healthcare system no?) It’s “personal choice” apparently, and “recreational drug use” (which the US is exactly on par with vs. other western countries). Take it’s northern neighbor Canada who’s infant mortality rate is 31% lower. They use lots of recreational drugs. I know because I used to live there. What about Netherlands? recreational drug capital of the world? Their rate is better than Canada’s!

I guess I must be delusional with my sweeping statements and admit that it’s all due to “crack” and the innate immorality/stupidity of the common human female in the United States. Thanks for the correction.

Comment by Alan Carre on 11/23/08 at 11:30 am

To the person in Canada who thinks their health care is great, but it doesnt pay prescriptions!!! DO you know what some prescriptions cost? I have cancer and one anti nausa pill cost $7200.00 a month! You have no idea how awful that would be if you were to get a illness like cancer! There are many people (I know) from Canada that drive here to the US to get their cancer prescriptions (and many treatments—that Cancada does not do but the US does)! AND, they have to pay for them! Cananda BTW does not even offer some of the newer prescriptions becasue of the cost! Whats more important? The dollar or a life?

Comment by sue on 11/23/08 at 12:02 pm

vdinh:
Yes, it is expensive (on the surface). Lots of things are expensive, especially objects or services of high value. But that doesn’t make them unaffordable or impossible or inherently wrong. Especially for a country as wealthy as the United States.

Do you know where I got the best medical treatment and attention in all my experiences with hospitals, clinics and doctors? Well I’ll tell you: It was Phnom Penh Cambodia.

Cambodia is a heartachingly poor and deeply wounded country that has virtually no universal health care AT ALL. It has fantastic private clinics though, often staffed by American doctors. Nobody can afford it though; at $10-$40 a pop, that’s your whole month’s salary down the tubes in one visit! For an outsider from a fairly-rich country however, it’s a medical paradise.

How is it possible for these doctors (as I said, *American doctors*) to be able to work for so little in Cambodia but not in the US? You might guess because it’s cheap to live in Cambodia, but actually it’s only cheap if you live *like a Cambodian*. Westerners pay comperable prices for equivalent commodities there as they would in the US.

Well I don’t know the answer, but I can venture a guess which is this: “No insurance”. There’s no such thing as medical insurance in Cambodia just as there’s no real universal health care. Basically it’s between you and the doctor and there’s absolutely NO 3rd party even remotely in the picture. That is, nobody is “taking a cut” from the transaction.

Of course the health situation in Cambodia is disasterous so I wouldn’t put it up as a prime model for the world to follow. But the idea of being able to go to a doctor and pay for EXACTLY what you receive (no more and no less) can produce a very hospitable [no pun intended] medical environment.

Comment by Alan Carre on 11/23/08 at 12:26 pm

Geoff:
“For example, the American insurance based system is pretty much organised to maximise the insurance companies profit.  (Quite undestandably.) So it offers a pretty fantastic deal if you never get ill but in reality is structured to deny care if it’s needed.“
I do not believe that the majority of private insurances would deny paying for the medical care or services if the patients TRULY needed them. Only a small number of cases in which medical care was really needed but insurances wrongly denied paying for it. That’s why you read or heard about those multi-million dollar lawsuits for patient injury or death against those insurance companies. Most insurance companies would deny paying for the services only if the patients do not truly need them, if the services do not really offer benefits for the patients, or the services cost much more than what the patients are paying (Policy coverage)

Comment by vdinh on 11/23/08 at 12:31 pm

Hidden and not so hidden costs of Corporate Health Care.

Lobbyists: It’s is their job to be a constant influence in the ear of your representative in Congress. Their goal is to influence politics that favor(profit) the insurance industry. This is an expense that contributes to high insurance costs.

PR: This is also referred to by many as “propaganda”. Like the lobbyist, the goal here is to influence politics for the benefit of the insurance industry. This too contributes to the high costs of insurance. The current campaign is pushing for a “mandate” on the premise that it is the “uninsured” who are mostly to fault for high price of insurance.

Political contributions: Again, the goal is to influence our political system for the benefit of the insurance industry. Beyond simply contributing the the high costs of insurance we pay, political contributions and lobbyists compete against the peoples interests in Congress.

Lawyers: Any time a claim is paid, it cuts into the insurance company’s profit. Lawyers, expensive as they are, help keep profits up by denying any claim they can. One example from Sicko cited an “undisclosed Yeast infection” as the reason for denying payment for care and canceling coverage. If you didn’t watch Sicko because you were told it was “anti-American” propaganda… refer back to PR expenses. Lawyers contribute to poor service and individual financial burdens from unpaid medical bills.

Screener: This is the individual that will decide whether or not you will be profitable to insure. Disclosing all of you medical history may prevent you from acquiring coverage, failing to do so may result in unpaid medical bills. Refer back to Lawyer expenses.

Advertisement: This is the main battle ground of competition between the many insurance companies. As expensive as advertising may be, it is imperative for any corporation to be profitable. Spending lots of money in this area also ensures favor with broadcasters for an additional boost in PR assistance. This is just another cost that is passed on to the consumer contributing to the high price of insurance.

CEO: These individuals make more than any government employee or elected official. His or her goal is to keep profits as high as possible, buy jets and take long vacations.

Some of these expenses may be an exaggeration, or not, the short list is by no means complete. And NO I didn’t point out all the faults in every other nation like those opposed to National Health Care would have liked me to.

I support HR 676. I am opposed to being threatened with loss of choices, long lines and rationing, by any politician in a position to prove what a terrible job they are capable of if we ditch their corporate buddies.  Understand that these people are not providing us with an honest warning, they are not fear-mongering, they are threatening us.

Comment by James Hovland on 11/23/08 at 1:29 pm

Making government-run health care look bad is a business strategy.

It’s simple to understand, at least for anyone looking to understand it, if you’re not, just point at how costly MediCare and MediCaid are, and go on paying for the insurance companies propaganda campaign to keep it that way.

The problem with our “failing” government-run program is related to the slander waged at them. Of course people with money do not enroll in these programs, they have already been told how terrible they are.

Those who can, and want to get insurance, do. Those who can’t, either because they can not afford it, or have too many medical problems to qualify, turn to the government.

Now imagine yourself managing this in a business perspective… You get the high-risk people, the ones that need care now, or more accurately, yesterday rather than tomorrow. The other main set of clients you get may or may not need help immediately, that really isn’t the issue though, the real issue is that this group has no money to contribute to the big picture. Good Luck managing this. You have the insurance companies, who have taken all the healthy and rich clients, bashing you for not being profitable. You can push for political change as an option, but 3/4 of Congress is bought and paid for, and an army of lobbyist has been raised to convince the others. The people don’t trust you because you are… ooooooo the “government”, or even worse… “socialism”.

Socialism is not scary, what is scary is that we have politicians threatening to push Socialism to miserable extremes if we take even a single step in that direction. The fear intended doesn’t cover the entire intent of the threat, they want us to also be hostile, look down on, and ridicule anyone who suggests it. The only people Socialized Medicine is any threat to is… You guessed it! The Insurance companies.

Ever considered ditching our Socialist police force, and replacing them with private security that only enforces the law for those who pay? Why should I pay for your protection and security asks the “Capitalist”.

Comment by James Hovland on 11/23/08 at 2:17 pm

[Quote (James Hovland)]
Ever considered ditching our Socialist police force, and replacing them with private security that only enforces the law for those who pay? Why should I pay for your protection and security asks the “Capitalist”.
[/Quote]

I’ve seen this system first hand. That’s how it is in Cambodia: You have a problem? sure the police are more than willing to help. That is, if you pay them. And I mean in cash (no receipts of course). Otherwise they have no interest because there’s nothing to be gained by doing their supposed “job”.

This is how it works:

Suppose someone knives your sister, she dies and that displeases you. You know who the killer is so you decide to go and attempt to solicit some “justice” from “the police”...

Step 1: You go to the police station to report this event. Well you *try* to report this event but instead you are told to sit and wait (this is intentional; you can see behind the glass that they’re not doing anything other than sleeping or tossing darts or whatever).

Step 2: Someone in uniform approaches you and offers to help you out *now* instead of sitting and waiting forever. You agree and then that person and *AS MANY OTHERS AS HE CAN BRING ALONG* come to investigate the crime.

Step 3: After (the police) bargaining with the murderer to pay up for what (s)he’s done you’re given an offer. If the murderer is rich, they may offer up a sum to settle the matter. If not, the police will offer you a chance to pay for their punishment (this can be costly…). You can accept the deal or not, and that’s the end of the legal part of it.

Step 4: After spending all your savings to pay for the criminal’s jail fees, you can thank the police officers (if you want) but of course you must pay them as well for their troubles. They’ll usually settle for $20 or so if the whole thing took less than 30 minutes. BTW. that’s *per officer* and regardless of their role in the “legal” part - sleeping or eating a sandwich counts as involvement.

Now you tell me if that isn’t the finest example of pure capitalism imaginable? A business model that any company’s CEO would look apon with profound envy: No costs, 100% risk-free profit. Plus the government even tosses in a couple dollars or so every day just in case nothing happens!

Comment by Alan Carre on 11/23/08 at 3:59 pm

Alan, you’re welcome for the correction. Look closely at the rates of poverty among certain segments of the population. You’ll find that inner city poverty, cross-border migration and other US-specific issues don’t pertain to Canada. By the way, the vaunted Canadian health care system cannot cope with its own population, and routinely sends its overflow patients south to the US to deliver care that it has chosen not to plan for. Once again, we can have the health care system we want. We just have to be ready to pay for it.

blogs.usatoday.com/ondeadline/2007/08/rare-identical-.html

voxday.blogspot.com/2008/05/comparative-neonatal-care.html

Comment by steve jones on 11/24/08 at 12:10 am

vdinh: You state that there is a lack of oversight and fiscal responsibility in Medicare compared to private insurances. This was true in the early 90’s - I can tell you that it is not true now. There has been extensive revamping of the Medicare system over the last 10 years, and there is now stringent oversight and limitations on utilization, reimbursement, and clinical quality of care. This is why many private rehab companies that had sprung up in the early 90’s to exploit Medicare for profit went out of business in the late 90’s.

A clinician does not have carte blanche under Medicare to do anything forever and get paid for it - Medicare just does not micromanage every step you take. You have to justify what you do. There are clear limitations on the utilization and reimbursement of services, but they are mostly reasonable. Let’s say it takes an average of 4 weeks of Physical Therapy for someone to achieve goals for a certain diagnoses, why should I have to call or write up a new request for visits every week, or every 2 weeks? It’s a waste of everybody’s time, and time is money. Medicare, and some private insurances, allows enough time initially to successfully treat most patients. Then, if you have a more difficult case, you have to request more time and justify it. This is a more efficient use of staff time and resources, for clinicians, billing offices, and 3rd party payors.

vdinh, You talk about Medicare costs spiraling - sure it is, there are a lot more old people, and there have been paperwork increases with Medicare along with the reforms of the last decade. But private insurance costs are spiraling out of control too! The cost of health insurance is a major bottleneck limiting the creation of new jobs and businesses, which makes it difficult for existing companies to stay in business, retain employees, and maintain the health and productivity of their employees. You may think that private insurance companies are more efficient than government programs such as Medicare or the VA. This is not my experience, either as a patient, an employee, or a clinician. There are good government programs and bad government programs. There are good private companies and bad ones. There are very few well-run companies of any kind in the country these days. Healthcare is a business, and American business is in a sorry state.

You must also consider the shortage of healthcare practitioners of all stripes, and the stress on them. They are trying to continue to provide quality care to your grandmother, your sister, even you, despite coontinually increasing workloads, regulatory restrictions, and paperwork. We need to cut out unnecessary tasks as much as possible, to make it easier clinicians to treat all the people that need care, not drive them to burnout so that they cut back or quit. This will only increase the shortage and the stress on those remaining. It is a vicious cycle. Lack of qualified staff is limiting every kind of healthcare facility, all across the country. When resources are scarce, be they human or material, you have to make the best use of them that you can. When you stretch people too thin for too long, they will eventually snap. When even doctors are saying “I quit” in large numbers, this tells you something is really wrong.

You would not believe the amount of staff, time, equipment and space that are needed in even a small medical clinic, just to keep track of all the different requirements, forms, and billing for all the different payors we have now. Multiply this by all the clinics, hospitals and other providers who are billing 3rd party payors in this country - it’s incredible that we as a country could choose to devote so much time and resources to this. Efficient systems are simplified as much as possible. Our current system is incredibly fragmented, complicated, confusing, and inefficient. Choosing universal government managed healthcare and/or reimbursement is not just the compassionate and fair thing to do - it is the most efficient and effective way to run the business of healthcare.

Providing good healthcare is a complex task. If we have some kind of universal health system, we can all put our energy into making it operationally efficient, clinically effective, and fiscally responsible. Any organization needs good leadership, good systems, dedicated staff, and adequate funding and resources to get the job done. Let’s look at Medicare, the VA, Kaiser Permanente, Blue Cross, etc. Let’s look at how programs such as these are managed in different states and regions of the country, let’s look at the systems in Canada and Europe. Let’s find out what’s important to the people utilizing healthcare. Let’s look at evolving computer and internet technology, which is now at a state where it could vastly improve our healthcare systems, if we utilize it properly. We have plenty of models to pick and choose from. Let’s forget about ideology and focus on what works.

Comment by Margaret on 11/24/08 at 6:32 pm

The last time we were jerked around by Medicare (last June, when they almost cut our re-imbursement by 11% but at the last second inceased it by 0.5%), I decided to take no new Medicare patients, though I continue to see the ones I have in my practice. Not many of the primary care docs around here will take on new Medicare patients.  We’ve always known that these patients take up a lot of time & energy, and that the reimbursement barely covers overhead, but when you add in the uncertainty of governmental whims to the draconian rules they use to enforce them, then it just becomes no longer worth it.

Comment by Phil Thwing, MD on 11/24/08 at 8:02 pm

Margaret:
I understand the troubles you have been going through to get your services approved for reimbursement. You need to understand the reason health care providers like us have to obtain prior authorization for extended and costly services because there are many providers who provided unnecessary services (Services that patients don’t really need or services that don’t really benefit patients) and a few even billed for services that were not performed. This is just one of the many ways the payors (even MEDICARE now) must use to curtail the rising costs of health care. I was not talking about private insurances or Medicare being efficient or inefficient. I was talking about private hospitals/clinics & physcian practices under a multi-payer system being more efficient in providing medical services to the patients than government-run hospitals/clinics under a single-payer (government-provided) system. Under a single-payer system, you may have less paperwork (less forms to fill out) but that does not mean the single payer will not try to “micromanage” the services you provide. When the single payer (like MEDICARE) is low on funding, they will make it much harder for the patients to receive the services (care rationing) and they will also lower the reimbursement rate. A single-payer health care system provided and run by the government is not a good idea considering how broke and how efficient our government is. In addition, government can and will make things complex even under a single-payer health care system. Just take a look at our government tax code system.

Comment by vdinh on 11/25/08 at 12:50 am

steve jones:
I get the impression that you, and many others here, seem to feel that I have a personal opinion about US-government run health care. Actually I don’t live in the US so it’s completely irrelevant to me whether or not your country decides to commit pubic suicide, becomes even more Fascist than it aready is, or adopts any form of health-care whatsoever; doesn’t cost me anything…

I’m merely pointing out the logical inconsistencies in your arguments. But since, by your own admission, it’s highly probable that your mother was an imbicile and a crack-whore, it’s certainly understandable that you’d likely be unable to think very clearly.

To wit: I assume your welcoming my gratitude “for being corrected” implies that you firmly stand by your position that the average human female in the US is an ignorant and immoral drug-fiend and hence more-than-deserving (in fact guilty) of what’s coming to her doomed and similarly retarded offspring, yourself included.

Well if you’re a US citizen I can see why you might be a little bit ashamed of your fellow citizens for their stupidity (especially the females) so I will offer you some helpful advice:

If you are so ashamed of your country, why don’t you attempt to move to a new, and more progressive one? one which isn’t subject to “US-specific issues” regarding poverty, drugs and stupidity.

I mean that’s what I’d do if I lived in a country of “R-tards” such as your own.

Comment by Alan Carre on 11/28/08 at 4:19 pm

Just another example of our government’s inefficiency due to bureaucracy.
http://news.yahoo.com/s/ap/20081209/ap_on_go_ca_st_pe/marines_mrap_investigation

Comment by vdinh on 12/08/08 at 10:40 pm

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