The FYM Democratic Primary

[anitram]

Yes, of course there are waiting lists for elective surgeries or treatment. When my friend had a brain tumor, she got an MRI the following morning, not 4 months later. It is a triage system.

So everyone waits for ELECTIVE procedures, but guess what? Everyone gets everything for free. You have what, 40 million people who get nothing and who knows how many more with shitty insurance who can't afford your speedy treatment anyway. What is it worth to me that I can get an MRI tomorrow afternoon if I can't afford it anyway? It's nothing more than a theoretical benefit.

I've said this before but I'm really, honestly wondering whether it is a uniquely American view to believe that you shouldn't have to wait in line for anything, because certainly everywhere else in the developed world, people wait for elective procedures without screaming that the heavens are falling. So is there some kind of cultural difference that precludes one nation from being able to cope with potential waits? One honestly has to wonder.

[INDY500]

Well, the "waiting" is de facto rationing isn't it? The truth is no country can guarantee access, quality and keep healthcare costs down. There is always going to be a trade-off. Our system provides unequaled quality, rewards innovation/excellence and provides (but does not guarantee) access through high supply...but it is costly. That is our trade-off.

[BVS]

Originally posted by INDY500
Our system provides unequaled quality, rewards innovation/excellence and provides (but does not guarantee) access through high supply...but it is costly. That is our trade-off.

And of course this is the rose colored glasses version.

[verte76]

I wouldn't mind having to wait for an elective procedure. If I can't afford it, what's the point? That's why I want universal health coverage. Unfortunately, I think Kucinich is the only Democrat proposing it.

[Moonlit_Angel]

Originally posted by anitram
I've said this before but I'm really, honestly wondering whether it is a uniquely American view to believe that you shouldn't have to wait in line for anything, because certainly everywhere else in the developed world, people wait for elective procedures without screaming that the heavens are falling.

I'm not sure how big a problem that is elsewhere in the world-I'd be interested to the answer to that, too. But you are absolutely right that many here in the U.S. have trouble with the concept of patience, and it's kinda troubling. Sure I would like everything I want right now, everyone would, but I know that's not always going to happen. There are times you're just going to have to wait, plain and simple. If it's a dire emergency that needs attention RIGHT NOW or the person will die right then and there, I fully understand the rush, but otherwise, waiting for things is a part of the medical routine sometimes.

I know my family's had to struggle over the years due in part to medical bills for my dad's health issues. Things are better now, but it shouldn't have to cost an arm and a leg just to get treated for things that many people will have to deal with eventually.

Angela

[INDY500]

Originally posted by BonoVoxSupastar


And of course this is the rose colored glasses version.

Got mine in an hour or less at the optometrist in the mall.

But, I'm not Canadian.

[BVS]

Originally posted by INDY500


at the optometrist in the mall.

That's the unequaled quality you're talking about?

[yolland]

47 million uninsured and medical bills as the most common cause of personal bankruptcy isn't a "trade-off," it's a crisis. I don't understand how anyone can in conscience rationalize it otherwise.

[INDY500]

"The truth is that some people will choose not to buy insurance even though it’s affordable, knowing that the rest of us will pay for their emergency room visits."

--John Edwards
(Hey John, the rest of us also pay for frivolous lawsuits against doctors and drug manufacturers)

Now, under John Edwards, Hillary, Barack, choosing not to buy health insurance will no longer be an option. That's how they keep costs down, by enlarging the pool of those paying into the system while rarely using it. Chiefly the young. (Something to keep in mind "Rock The Vote" voters.) But is that the best way to go, keep building on our current employer based bureaucratic mishmash of fragmented payers -- high in overhead, built around the tax code and already overburdened by government mandates?

And crisis? I don't think there are any faults in our health care system that a little more "free-market" wouldn't correct. Will there always be a role for government, yes. But I'd support any candidate that would scrap our current system and return to consumer-directed health care. Lower costs through competition -- return to "health insurance" being just that, high deductible insurance against remote and financially catastrophic illness or accident, not low deductible "prepaying" for all health expenses.
Just listen to any debate, health insurance and health care have become interchangeable. That's one of the problems.

[BVS]

Originally posted by INDY500


And crisis? I don't think there are any faults in our health care system that a little more "free-market" wouldn't correct. Will there always be a role for government, yes. But I'd support any candidate that would scrap our current system and return to consumer-directed health care. Lower costs through competition -- return to "health insurance" being just that, high deductible insurance against remote and financially catastrophic illness or accident, not low deductible "prepaying" for all health expenses.
Just listen to any debate, health insurance and health care have become interchangeable. That's one of the problems.

Wow, just wow...

What a misunderstanding of our current situation you have. Free market won't change anything. How freer would you like to make this market? And how would it change anything?

And even the profiteers of the medical industry(who will lose the most with social medicine) would tell you consumer-directed medicine is a HORRIBLE idea.

Look around you, we aren't a healthy society. Your idea would be great if we were... And it's not just the poor that are sick, the middle class and wealthy still make up for part of that percentage.

I'm assuming you don't work in the medical industry, am I correct?

[INDY500]

Wow, just wow...

Shall I pull out my cellphone as you play One?

consumer-directed medicine is a HORRIBLE idea.

So by inference, government-directed medicine is a GREAT idea? Are you against Capitalism in general, or just in the realm of health care? Really, where in our current health care system have free markets really been tried? The best example is Radial Keratometry and it supports my thesis. No insurance pays for it, so it's all out of pocket. And guess what, not only has it gotten much better over the years (lasers replacing scalpels for instance) but the costs continue to drop. Want another one? Watch how the price of the antihistamine Zyrtec plummets when it goes off prescription next year and becomes available OTC. No longer paid for by insurance. We've seen great advances across the board in medicine, but at a cheaper price? Of coarse not or we wouldn't be discussing our "crisis."

Look around you, we aren't a healthy society.

Last time I checked our life expectancy was lengthening, not shortening, but maybe I'm wrong about that.

I'm assuming you don't work in the medical industry, am I correct? [/B]

No

[phillyfan26]

Originally posted by INDY500
And crisis? I don't think there are any faults in our health care system that a little more "free-market" wouldn't correct.

Originally posted by yolland
47 million uninsured and medical bills as the most common cause of personal bankruptcy isn't a "trade-off," it's a crisis. I don't understand how anyone can in conscience rationalize it otherwise.

[BVS]

Originally posted by INDY500


Shall I pull out my cellphone as you play One?

I'm sure somewhere that's funny.

Originally posted by INDY500

Are you against Capitalism in general,

Wow, what a leap of logic. When capitalism gets in the way of people's health, that's where I draw the line. When pharma companies are driving up insurance costs because they spend millions of dollars on stuffed animals and trinkets to market their erection pill, that's where I have a problem.

Originally posted by INDY500

Really, where in our current health care system have free markets really been tried? The best example is Radial Keratometry and it supports my thesis. No insurance pays for it, so it's all out of pocket. And guess what, not only has it gotten much better over the years (lasers replacing scalpels for instance) but the costs continue to drop. Want another one? Watch how the price of the antihistamine Zyrtec plummets when it goes off prescription next year and becomes available OTC. No longer paid for by insurance. We've seen great advances across the board in medicine, but at a cheaper price? Of coarse not or we wouldn't be discussing our "crisis."

I love how you still think 47 million not insured is still not a "crisis".

So you're giving me an example of an elective surgery? Of course insurance doesn't pay for it and prices drop.

Originally posted by INDY500

Last time I checked our life expectancy was lengthening, not shortening, but maybe I'm wrong about that.

Well if that's your only indicator then by all means have at it. You can turn your eye on everything else as long as we're still living the same length of time. Ignore the sky rocketing of Diabetes, obesity, etc... who cares, it's ususally the poor folks anyways.

Originally posted by INDY500

No

So you do work in the medical field? What do you do?

[anitram]

Originally posted by INDY500


Got mine in an hour or less at the optometrist in the mall.

But, I'm not Canadian.

Hilarious.

Because you know, we here don't have optometrists at the mall.

[melon]

Originally posted by INDY500
Now, under John Edwards, Hillary, Barack, choosing not to buy health insurance will no longer be an option. That's how they keep costs down, by enlarging the pool of those paying into the system while rarely using it. Chiefly the young. (Something to keep in mind "Rock The Vote" voters.) But is that the best way to go, keep building on our current employer based bureaucratic mishmash of fragmented payers -- high in overhead, built around the tax code and already overburdened by government mandates?

If COBRA costs are any indication, I don't know too many people who have an extra $300+ a month lying around. And that's just for individual health insurance costs.

Of course, our fabled Senators would not understand this, considering that they all make six or more figures a year--and, on top of it, have legislated to themselves the free high quality health care that they want everyone else to pay for.

And crisis? I don't think there are any faults in our health care system that a little more "free-market" wouldn't correct. Will there always be a role for government, yes. But I'd support any candidate that would scrap our current system and return to consumer-directed health care. Lower costs through competition -- return to "health insurance" being just that, high deductible insurance against remote and financially catastrophic illness or accident, not low deductible "prepaying" for all health expenses.
Just listen to any debate, health insurance and health care have become interchangeable. That's one of the problems.

The only true "free market" solution would be to ban health insurance altogether, as health insurance, naturally, artificially inflate the demand curve. That, in turn, should effectively decimate our health care industry as we know it, since nobody can afford anything at all related to health care without insurance (unless you're U.S. Senators raking in five to six figure sums for speaking engagement fees, of course, then it's just pocket change).

Of course, if you're going to substantially reduce the medical industry's income one way or another, you might as well go the path of least resistance and start regulating health care costs like the rest of the industrialized world.

[INDY500]

Originally posted by melon


The only true "free market" solution would be to ban health insurance altogether, as health insurance, naturally, artificially inflate the demand curve. That, in turn, should effectively decimate our health care industry as we know it, since nobody can afford anything at all related to health care without insurance (unless you're U.S. Senators raking in five to six figure sums for speaking engagement fees, of course, then it's just pocket change).

Of course, if you're going to substantially reduce the medical industry's income one way or another, you might as well go the path of least resistance and start regulating health care costs like the rest of the industrialized world.

You have a good grasp of the economics. Three points I'd bring up.
1) Ending the employee/employer role in paying for health care should result in employers paying out that same monetary total in wages or other compensation. So you would have more to pay for health care and insurance. Of coarse your tax burden would also increase, so that would have to be addressed.
2) As more health care is paid directly from the consumer to the provider, the layers of bureaucracy would lessen (HMO's, paperwork, etc), lowering costs.
3) As more people have direct responsibly for their health care spending you would see market forces put downward pressure on prices.

As I said, there is a role for government in health care. Providing for the poor, the retired, those in prison or in the armed forces. Regulating drugs, procedures and equipment. Accrediting schools and hospitals. Licensing doctors, nurses and other providers. Stipulating basic levels of coverage, rules for treating pre-existing conditions or extremely expensive drugs, therapy or operations. And some others we could come up.

But keeping down costs artificially with price controls and rationing should not be that role.

[BVS]

Originally posted by INDY500


2) As more health care is paid directly from the consumer to the provider, the layers of bureaucracy would lessen (HMO's, paperwork, etc), lowering costs.
3) As more people have direct responsibly for their health care spending you would see market forces put downward pressure on prices.

But keeping down costs artificially with price controls and rationing should not be that role.

Tell me, how much do you really think a bypass surgery will go down? What about a major surgery at an ER, how much do you really think your logic will bring it down?

I guarantee you it won't bring it down to a price that's affordable by most. Then you have unpaid hospital costs that start jacking up the prices again. It's a cycle that WILL NOT be cured by "free market".

[randhail]

Nevermind the economic issues of universal healthcare, I want to hear how the candidates plan on dealing with 47 million new people suddenly flooding the system. It's been well established that there is a primary care physician shortage in this country. The problem is only expected to get worse as the population ages (shortage of somewhere between 85,000 and 200,000 physicians by 2020). The AAMC (governing body of medical education in the US) has decided to increase the size of new medical school classes by 3000 a year, but any benefits are likely 10 years down the road at the early earliest. Those numbers and adjustments were calculated without throwing an extra 47 million people into the equation.

If people have a difficult time finding a PCP now, just imagine what it would be like with 47 million people trying to find a PCP. The fact of the matter is that right now Primary Care as a field sucks to go into. The hours are grueling and the pay sucks (relative to the field). The average physician graduates medical school with a debt of over $130,000 and primary care is not a field that will allow you to pay that back quickly.

So these candidates will have to do something drastic to change the field of primary care to get quality people to fill the needed slots. Total loan forgiveness programs, caps on the amount of patients seen in a day, etc. Any implemented system that doesn't put the focus on primary care is one that will likely not have much of a positive impact.

These politicians love to spout off about how they're going to get coverage for everybody, but have any of them actually thought about what will happen if or when that happens? I'm skeptical at best that any of the candidates will solve this problem correctly.

[anitram]

Originally posted by randhail
Nevermind the economic issues of universal healthcare, I want to hear how the candidates plan on dealing with 47 million new people suddenly flooding the system. It's been well established that there is a primary care physician shortage in this country. The problem is only expected to get worse as the population ages (shortage of somewhere between 85,000 and 200,000 physicians by 2020). The AAMC (governing body of medical education in the US) has decided to increase the size of new medical school classes by 3000 a year, but any benefits are likely 10 years down the road at the early earliest.

How difficult is it to become licensed in the US having been educated abroad? It certainly seems to me that Canadian MDs face essentially no challenge in doing so (whereas getting an MD in a US school essentially leaves you SOL in Canada as a number of my friends have found). If this is the case with other Commowealth nations (primarily UK, Australia), or any other nation, then you could much more easily address the shortage through implemented immigration policies targeting foreign MDs. This is generally met with hostility in Canada (due to rather silly protectionist views), so I'm not sure how much easier it would be down south. But it's certainly a fix that you could have in less than 10 years and given US MD salaries, it would hardly be difficult to attract good foreign talent.

[randhail]

I'm not totally sure of this but my understanding is that getting an MD from a school such as McGill is basically the same as graduating from a US school. I think that Canadian schools even use the same application service.

Coming in from other countries is a more difficult route because regardless of how many years experience you have, you are required to complete a US residency in order to practice in a given speciality. I believe that you also have to complete all of the basic licensing exams that US students take (USLME Step I, Step II Clincal Knowledge and Clinical Skills,
and eventually Step III) Getting the residency slots tends to a little bit more difficult because US med school grads get most of them (~2/3). Coming in from a foreign med school, you really have to prove yourself. It may not be fair, but it's the way things are right now and I think it does have some benefits - it acts as a quality control measure.

I know that there has been talk about outsourcing certain things like diagnostic radiology to India since most of the images now are all digital, but the people in India must be licensed in the US so it defeats the purpose of outsourcing anyways.

The salary would certainly make it appealing for many people, but the number of hoops you have to jump through doesn't make it an attractive choice for everyone. Attracting good talent will likely never be the problem, it will be trying to ensure that only good talent makes it through and the not so great talent doesn't get a license to practice here.