Universal Healthcare

[randhail]

I'd like to use this thread to talk about this major issue whether it be facts, questions, thoughts, etc. I'm by no means an expert on this, but would like to have a well informed opinion. As a future physician, any such plan would have a dramatic impact on my career.

I think most people agree that in theory, this sounds like a good idea. The current state of healthcare in this country is poor to very poor (perhap I'm being modest). You can blame almost everyone involved in the system so it's by no means an easy fix.

Do people think that major change can actually happen? I'm rather skeptical that anything truly major can get done because of the powerful lobbys that Healthcare and Big Pharma have - I don't see them doing anything that would cut into there bottom line.

What is the biggest issue in healthcare for you guys - access, cost, something else?

If universal healthcare was implemented, what system would people want? A government run program ala medicare for everyone? Would you want the option to buy supplemental coverage - sort of like a platinum membership that gets you more things than the basic coverage? Or should everyone have the same coverage no matter what? Would a completely privatized system be better?

As of right now, I don't really favor any government run program just because of the way government handles things - they don't have a good tract record on running things properly. I also think that it could create a very segregated system where people that can afford extra service will still get better care than everybody else, which sort of defeats the purpose of universal care. Although, everyone would still have some sort of access to basic care.

 

[Irvine511]

believe it or not, i think that Romney's plan in Massachusetts -- am i wrong? totally going on memory here -- wasn't a bad one.

you make health insurance similar to car insurance. it's illegal to be without it. with such pressure, employers will be hard pressed to make it available to their employees.

that seemed like an interesting idea.

 

[deep]

I think it may implode first

say in 5, 10 or 15 years.

Many have too much health insurance

and many have very little access to health care.


Car insurance?

does that pay for tire replacement, gasoline, oil changes, break jobs, paint and the like?

 

[CTU2fan]

I favor a gov't run plan a la medicare. No platinum plan either; everyone gets the same. If somebody wants to get something special they'd better have the money & will to go abroad to get it.

I agree the powerful drug & healthcare lobbies will never allow this to happen. I worry about the government's history of inefficency, but my thinnking is that with a plan that everyone is enrolled in you'd have incentive for those "in power" to do it right. Also hopefully some of the government waste would be offset by the elimination of the middle man (insurance companies).

But keep in mind, I'm (relatively) poor; if I were rich and had access to the best care in the current system I might feel differently. Probably not, but I might I suppose.

 

[Liesje]

I just hate being stuck in the middle. I had no health insurance as a student and the school required it, so if you didn't provide proof of insurance, they insured you. Except their insurance sucks monkey balls. Honestly, you're better off NOT having insurance because then you can walk right into the county hospitals. You either have to have really good insurance, or have no insurance and get the breaks.

I don't know enough about it and haven't thought it through enough to know what I think as far as specifics and how a universal system would be implemented.

 

[randhail]

I think it may implode first

say in 5, 10 or 15 years.

Many have too much health insurance

and many have very little access to health care.


Car insurance?

does that pay for tire replacement, gasoline, oil changes, break jobs, paint and the like?

You would think the system would implode, but it's been hobbling along for awhile now and seems to be Rasputin like in it's ability to survive so I'm not so sure it will implode.

Would you favor a system that gave basic coverage but not catastrophic or the other way around? or would you cover everything?

 

[AEON]

Minimizing illegal immigration would certainly help the US healthcare system. The system is currently strained taking care of non-tax paying folks from Mexico. It's simply a matter of numbers.

 

[deep]

You would think the system would implode, but it's been hobbling along for awhile now and seems to be Rasputin like in it's ability to survive so I'm not so sure it will implode.

Would you favor a system that gave basic coverage but not catastrophic or the other way around? or would you cover everything?

I guess catastrophic only.

All the rest should be treated the same as other consumer items.

and prescription coverage should kick in only at extra ordinary cases

 

[BVS]

Minimizing illegal immigration would certainly help the US healthcare system. The system is currently strained taking care of non-tax paying folks from Mexico. It's simply a matter of numbers.

Actually that's a very miniscule problem in healthcare. We have more citizens without healthcare, and who aren't paying than illegals who are raising other's insurance costs. We have just WAY too many people who don't take care, or don't even bother to take care of themselves. This is America's biggest health issue.

 

[AEON]

We have just WAY too many people who don't take care, or don't even bother to take care of themselves. This is America's biggest health issue.

BVS - I would have to do some research through the threads, but this may be the first time I actually agree with you

 

[BVS]

Probably so.

 

[Irvine511]

preventative care.

 

[Canadiens1131]

Two tiered healthcare would work best I think. We're headed for something like that in Canada in the next decade, I believe.

Socialized healthcare is great, but if people with the money want to pay for quick service at a private clinic and leave more room at public clinics for me, for instance, I have no problem with it.

Regardless of the drawbacks of socialized medicine (higher taxes, overcrowded hospitals, long wait times), there is still something comforting about being able to walk into a healthcare facility, show them my card, and get attention - regardless as to whether I'm employed or have a supplemental plan.

Healthcare is not a benefit, it's a basic human right.

 

[redkat]

believe it or not, i think that Romney's plan in Massachusetts -- am i wrong? totally going on memory here -- wasn't a bad one.

you make health insurance similar to car insurance. it's illegal to be without it. with such pressure, employers will be hard pressed to make it available to their employees.

that seemed like an interesting idea.

There is a similar bill in CA right now.

This site answers a lot of questions.

Q. Does SB 840 (Kuehl) cover undocumented immigrants?
A. Yes. It costs California less to insure undocumented immigrants than to exclude them. People without health insurance don't get preventive care and, consequently, use expensive emergency rooms and hospital care when they get sick. It is estimated that if every Californian got preventive care we could save $3.4 billion dollars a year. Most undocumented Californians are employed in essential jobs and our immigrants pay $80,000 more in taxes and fees over a lifetime than they will receive in local, state and federal benefits in their lifetimes. And it's good public health policy to insure the entire population. It helps control epidemics or outbreaks that could expose everyone to disease.

http://www.healthcareforall.org/faqs.html

I know an insurance broker for one having frantic meetings with blue cross who is against this plan.

 

[deep]

I know an insurance broker for one having frantic meetings with blue cross who is against this plan.

insurance companies goals are to eliminate or reduce risk, deny claims, and cancel coverage to customers that require payouts

their objective is too collect as much premium money as possible and pay out the least amount to make the most profit.

 

[anitram]

Socialized healthcare is great, but if people with the money want to pay for quick service at a private clinic and leave more room at public clinics for me, for instance, I have no problem with it.

Don't you think that this would simply lead to overcrowding because how many doctors in their right mind would work in an inner city ER for half the money when they can work in a posh clinic out in the suburbs, half the hours at twice the pay? You may not mind "more room" at public clinics, but I just don't see how that would be the reasonable end result.

 

[deep]

Healthcare is not a benefit, it's a basic human right.

what about food and shelter?

 

[ntalwar]

Don't you think that this would simply lead to overcrowding because how many doctors in their right mind would work in an inner city ER for half the money when they can work in a posh clinic out in the suburbs, half the hours at twice the pay? You may not mind "more room" at public clinics, but I just don't see how that would be the reasonable end result.

Even in the US, we are seeing an increasing number of "boutique doctors" that charge a few thousand dollars a year to patients in their practices. In return, they spend more time with patients than regular doctors. It'll be interesting to see how many doctors follow that trend.

 

[randhail]

Even in the US, we are seeing an increasing number of "boutique doctors" that charge a few thousand dollars a year to patients in their practices. In return, they spend more time with patients than regular doctors. It'll be interesting to see how many doctors follow that trend.

The biggest appeal of this is not having to deal with hassle of insurance companies - physicians can actually practice medicine without the insurance companies questioning there moves. It greatly improves the physician patient relationship, but raises some questions about it being fair. The current climate of healthcare has created this business opportunity and I find no fault in physicians going this route. It's also why so many med students opt to specialize rather than doing primary care.

 

[onebloodonelife]

I don't know a lot about the universal healthcare issue, but I really should because I have a chronic disease. I have great insurance right now through my mom, who's a teacher, but once I get out of school, I'll likely have to get COBRA insurance because my prescription costs are astronomical.

I think that in theory, universal healthcare is a good idea, but I don't trust the U.S. government to implement it correctly.

 

[Canadiens1131]

Don't you think that this would simply lead to overcrowding because how many doctors in their right mind would work in an inner city ER for half the money when they can work in a posh clinic out in the suburbs, half the hours at twice the pay? You may not mind "more room" at public clinics, but I just don't see how that would be the reasonable end result.

Government regulation and incentives. The problem right now, at least in Quebec, is kind of the opposite - doctors have to head off to middle-of-nowhere towns to practice for several years before they even have a chance at a position in a clinic in an urban area.

In fact, we just about already have a two-tiered system in Canada. I can think of at least five private clinics within walking distance of my downtown apartment, to be honest.

Like anything else, private clinics will be regulated.

 

[anitram]

In fact, we just about already have a two-tiered system in Canada. I can think of at least five private clinics within walking distance of my downtown apartment, to be honest.

That's true in Quebec because of Chaoulli, but it isn't like that in Ontario (and presumably the rest of the country). I wouldn't know where to find a private clinic even if I wanted one. Quebec litigates every bloody thing under the sky.

 

[BonoIsMyMuse]

I think that in theory, universal healthcare is a good idea, but I don't trust the U.S. government to implement it correctly.

That's how I feel, too. I currently have no health care, and it's always something I worry about. I can go to a free clinic on campus right now, but once I graduate next month, I'm on my own. My university isn't offering me any benefits to serve as an adjunct, though I'll be doing the same work I did when I was a unionized grad student, which is frustrating (both the lack of benefits and no longer having union representation). Part of me feels like this is wrong, but part of me doubts the government could institute a universal health care program that's really fairfor all.

As to the debate between inner-city ERs and private clinics, I think it's sort of like schools. There are teachers who teach in urban public school districts, and there are teachers who teach at private or religious schools. The quality of education between public and private schools is certainly debatable, but students aren't being turned away from schools anywhere because there aren't teachers to help them.

 

[Liesje]

As to the debate between inner-city ERs and private clinics, I think it's sort of like schools. There are teachers who teach in urban public school districts, and there are teachers who teach at private or religious schools. The quality of education between public and private schools is certainly debatable, but students aren't being turned away from schools anywhere because there aren't teachers to help them.

Except public school teachers, even at inner-city schools, often make twice as much or more than private school teachers. I'm guessing the opposite is true for doctors?

My main beef with American health care at the moment is not so much the quality of insurance (the main benefit of my job is my health coverage, it's worth taking a salary half of what I could be making), but that you have to spend hours on the phone fighting with people just to actually GET the services and coverage you're supposed to be getting. The expectations for the patient are unreal! For example, over Christmas I had a bacterial infection on my head that turned into a sinus infection and periorbital cellulitis in my eyes. I knew what it was and how to treat it b/c I've had it all before. I logged onto my health insurance account and read ALL of the fine print on how to proceed. It said that I could go to an urgent care facility for a $15 co-pay (mind you, that's ONLY what you pay up front, it ended up costing me another $60), but only after I either got permission from my primary care doctor (PCP - HMOs will NOT give you any coverage if you go to any doctor but your PCP), or tried to call her for at least 48 hours. Um, doesn't calling your doctor for 48 hours over Christmas defeat the purpose of seeking URGENT care!? I thought that was ridiculous, but I called her office anyway and luckily the recording said "this is permission to seek urgent care, we are closed for Christmas." So I went to urgent care and waited forever just to see some guy younger than me not even look at my head and say "yes you need a broad spectrum antibiotic" after 30 seconds. Duh. And that was just a simple infection. I can't imagine getting the coverage IM PAYING FOR if I ever needed a surgery or had an issue that was hard to diagnose (well, my foot ordeal was like that but I don't even want to think about it).

 

[INDY500]

Michael Moore will have all the answers in his new documentary "Sicko."

 

[yolland]

It's also why so many med students opt to specialize rather than doing primary care.

This article from today's New York Times reminded me of this thread.

In Massachusetts, Universal Coverage Strains Primary Care
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In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role. Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance. Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.
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Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months. “It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

Whether there is a national shortage of primary care providers is a matter of considerable debate. Some researchers contend the United States has too many doctors, driving overutilization of the system. But there is little dispute that the general practice of medicine is under strain at a time when there is bipartisan consensus that better prevention and chronic disease management would not only improve health but also help control costs. With its population aging, the country will need 40% more primary care doctors by 2020, according to the American College of Physicians, which represents 125,000 internists, and the 94,000-member American Academy of Family Physicians. Community health centers, bolstered by increases in federal financing during the Bush years, are having particular difficulty finding doctors.
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Studies show that the number of medical school graduates in the United States entering family medicine training programs, or residencies, has dropped by 50% since 1997. A decade-long decline gave way this year to a slight increase in numbers, perhaps because demand is driving up salaries. There have been slight increases in the number of doctors training in internal medicine, which focuses on the nonsurgical treatment of adults. But the share of those residents who then establish a general practice has plummeted, to 24% in 2006 from 54% in 1998, according to the American College of Physicians.
....................................................................................
A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.
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“It is a fundamental truth—which we are learning the hard way in Massachusetts—that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February.
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The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs. Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.

 

[anitram]

I got the feeling that randhail was implying that med students in the US don't want to deal with the hassle of insurance companies and that drives them to specialize. Which doesn't make too much sense to me given that we have a severe family physician shortage in Canada, where doctors don't have to deal with insurance companies.

I think the more honest answer is that there is much more $ and prestige in specializing and that the gap has only widened in the last couple of decades, which drives med students in that direction (let's not forget $100K loans). It's sort of why law students go into corporate law rather than legal aid, but then again for all of our faults, at least we seem a bit more honest about the desire to see a payoff than the med students I know. They want the same thing but for some reason choose to couch it in more palatable terms in public.

 

[yolland]

Are the salary gaps between primary care doctors and specialists in Canada similar to ours then?

 

[indra]

They want the same thing but for some reason choose to couch it in more palatable terms in public.

That's because everyone hates lawyers (even when they need one) where doctors are looked at more positively. If you want to earn a lot and don't care what people think of you, you become a lawyer; if you want to earn a lot but do care what people think of you, you become a doctor.

 

[financeguy]

It's sort of why law students go into corporate law rather than legal aid, but then again for all of our faults, at least we seem a bit more honest about the desire to see a payoff than the med students I know. They want the same thing but for some reason choose to couch it in more palatable terms in public.

To me, those kinds of calculations and priorities are ultimately a function of a society's overall value system, rather than of the value systems of doctors (or even lawyers!)

It's only in the US and countries heavily influenced by US neo-liberal fanatically free market values (including for example Ireland. We have the second highest paid medical consultants in the world, after the US) that high salaries are viewed as the be all and end all of a career, or that a gifted doctor (or for that matter a gifted lawyer) feels ashamed if they don't earn 300k a year.

In Germany, for example, well qualified doctors don't earn particularly huge salaries. Granted, they earn more than the average industrial wage, but not a huge multiple of it.

I actually hope that if the current recession leads to any positive results, it will lead to a rejection of neo-liberal free market fanaticism and a return to a more balanced society, especially in countries with embarassingly huge income disparities such as the US.

(Who'da thunk it , me, financeguy, the uber-capitalist of FYM, 'coming out' as a social democrat. )