Comments on: Controlling health care costs will require patient sacrifice, that how that will affect the status quo

By: Nuclear Fire

Nuclear Fire — Sun, 23 Aug 2009 14:39:16 +0000

Health Care Reform: American’s quit sitting on their fat asses, eating themselves to death, smoking, drinking to liver failure and stroking out on drugs. Or maybe just have the Govt not pay for treatment of conditions that are completely preventable. Medicare wants to not pay for “never events.” A similar approach to patients could (if the incentive actually motivated their lazy asses) results in both decreased costs AND improved health.

Win win win.

By: EKB

EKB — Sun, 23 Aug 2009 13:44:15 +0000

I would like to see a break down of the stats shoing that 70% of Americans are satisfied with their coverage. What percentage of these had to use their insurance for significant health care problems? What percentage of people who had to use their insurance for significant problems are satisfied with their coverage (or were at the time of the problem)? What specific insurance coverage (i.e. Kaiser, United Health Care, Medicare A and B) most satisfied people who had to use it for serious medical problems?

By: Dave McNeil, M.D.

Dave McNeil, M.D. — Wed, 12 Aug 2009 05:24:37 +0000

I feel a tad awkward saying that solutions ARE at hand and, further, they are NOT that difficult to comprehend or implement.
I invite interested persons to see two entries at http:doc2dochealthcarereform.com : They are “Successful Ideas” and “47M – 37M = 10M”. Together they inform that the problem is not as severe or as intractable as many want us to believe.
Healthcare resources are finite, demand for them can be practically infinite. Therefore there MUST be some sort of rationing. It will be either by market mechanisms or third-party authorities, probably government.
Here is an example to illustrate the difference:
You have a fatal condition. There is a certain cure. You will need quarterly doses for two years. Each costs $38,000. Which do you prefer:
1) You appreciate that you cannot afford it and either: a) get your affairs in order or b) initiate heroic efforts, including contacting all relatives and friends, holding raffles and bake sales, auctioning off “one year of (LEGAL) servitude”, borrowing from a bank – and raise the money for treatment.
— – — – OR — – —
2) You are told that, even if you happen to have or are able to raise the money, you CANNOT be treated because the cure has been determined illegal due to its high cost.
?????
OMG!!! — – It’s a no brainer to me.
PS – Do NOT write that these options will not work for the poor. That is elitist nonsense. Pilot programs have succeeded in the Medicaid population. (The money is granted to them, and more than made up through health care cost savings.)

By: Dr. Mitchell

Dr. Mitchell — Mon, 03 Aug 2009 20:20:05 +0000

Regarding “find the data” detailing outcomes differences between the UK and the US: this kind of data cannot be accomplished because the two types of health care systems are significantly different.

For example: you can go to the guidelines clearinghouse and find the statin guidelines for the UK. If you read them, you’ll discover that the UK universal coverage only covers a statin in the most dramatic of circumstances, compared to our NCEP guidelines. When the ENTIRE APPROACH to treatment of an illness differs, then direct comparisons of outcomes cannot be made.

We can look now at the CHD stats, and notice that the US has a slightly lower rate of CHD compared to the UK, yet the differences don’t appear to be large. (Figures available on Americanheart & UK heart websites.) You simply can’t use that as information to suggest there are no differences in outcomes. Our rates of obesity, diabetes, hypertension, etc. are higher than that in the UK, yet we are more proactive about treatment of hyperlipidemias. Considering these issues, there actually might be a huge disparity between UK and US outcomes–but you cannot appreciate these with direct comparisons. That’s an erroneous way to discuss this issue.

Same with Canada.

By: Tom

Tom — Sun, 02 Aug 2009 18:21:20 +0000

Trenchdoc, I’ll give you a quote: “To each according to his needs, from each according to his abilities.” Sound familiar? This was tried for 70-odd years. Didn’t work too well.

Man has a right to the product of his labor, to appropriate that for the benefit of a few seems to me to be wrong. Government spending should benefit all: see spending on defense, highways, even (wince) the USPS. Redistribution of wealth is not the proper role of government.

By: Kyle Varner

Kyle Varner — Sun, 02 Aug 2009 01:31:29 +0000

Henry Blankett makes a very valid point. The way I see it, the idea of getting health care for everyone is a pipe dream because the supply of physicians is artificially limited. I’m a US citizen attending medical school in the Caribbean. In order to graduate, I have to pass Step 1, Step 2 and Step 2 CK. I have to go through residency training just like everyone else. Then I’ll have to pass step 3. After all of that, I’ll be eligible for a license in about 40 states. Why not 50? Because states have been lobbied by existing physicians to keep out competition.

Somehow, in medicine, the big boys get the government to keep out their competition. ~30 states have “certificate of need” laws requiring you to prove that you aren’t “duplicating services” if you want to open a hospital. Law prohibit people from buying insurance across state lines. Hospitals have to get the permission of the ACGME to increase the number of residents they hire. Everywhere, the big boys get protected and the patients get buggered. Now they want the government to get more involved? I can guarantee you that it won’t be patients OR doctors who benefit from this new scam.

By: Henry Blankett

Henry Blankett — Sat, 01 Aug 2009 21:03:13 +0000

IVF-MD said: “…there is an even better solution for people like you — the magic of the free market…f you compare your level of satisfaction with things that you have choice and control over (restaurants, stores, hairstylists) vs those which you have little control over (politicians, public school teachers, post office employees) you might have a better idea of whether medicine is better off being free market vs a government controlled monopoly.”

Without getting into a debate over the fictional “magic” of the free market, it needs to be empasized, over-and-over again, that there is no such thing as a “free market” American health care system in the first place. First,
as one of the responders points out, the private health insurance racket is an oligopoly — a few major providers collude with one another for their personal profit (and everybody else’s loss).

Secondly, even if we remove private insurance from the setting, the deliberately tiny number of available medical school admissions and the even tinier number of subsequent residency training positions artificially contracts the size of any physician market available to patients. Why not allow for more licensure of outside-USA-trained specialists, for example? Answer: the AMA.

By: Tom

Tom — Sat, 01 Aug 2009 16:01:51 +0000

“basic government health plan competing with private plans”

The key word there is competing. Can one realistically believe that the government would allow its health plan to go bankrupt? If it cannot be allowed to go bankrupt, it is not a fair competition, and private plans will go out of business. In government, the more something fails, the more money is thrown at it (public schools, etc.), while in the marketplace, failure is rewarded with termination.

By: A Skeptic

A Skeptic — Sat, 01 Aug 2009 15:50:14 +0000

I don’t see the problem with a dual system of a basic government health plan competing with private plans giving people a choice of whether or not they want to pay more for private plans offering more or different services. We have dual public/private educational systems. People have a choice, but at least everyone has access to the public system with the option if paying more for private school if they can or want to. There are public/private choices for recreation. You can either go to a public park or beach for free or a minimal fee or you can pay a lot of money to go to a fancy private theme park. We have two tiered systems in many aspects of everyday life. If you’re arrested and have few resources, you get a public defender. He/she may not be the best lawyer in town, but at least you get something. Right now if you’re sick and can’t afford medical care, you may be completely out of luck. Yes, there will be rationing in a government plan. I think the public is now mature enough to get past the Harry and Louise BS and understand that having something is better than nothing.

By: Anonymous

Anonymous — Sat, 01 Aug 2009 00:37:57 +0000

If you compare your level of satisfaction with things that you have choice and control over (restaurants, stores, hairstylists) vs those which you have little control over (politicians, public school teachers, post office employees) you might have a better idea of whether medicine is better off being free market vs a government controlled monopoly.

Unfortunately, medical insurance is often a monopoly or oligopoly to most people. Most people with employment based medical insurance have just one to three choices of medical insurance plans through their employers, each with its own limitations on which doctors can be seen to get full payment. And they have plenty of bureaucracy, denying valid claims for no reason, etc..

The medical insurance system today in the US has degraded to the point that all of the feared problems of government universal insurance schemes are true today, but without any of the advantages of universal insurance schemes.