There is no doubt that the poor need a mechanism to access healthcare, but is it any more of a “right” than it is to a place to live or food to eat. I do not see the government forcing Wal-Mart to feed the poor or a privately owned apartment complex forced to house the homeless. However, hospitals everyday are caring for these patients without question. The true challenge here is getting our society to recognize the ugly truth that healthcare will never be equitably distributed. Even with a single payer system, the good Dr. Gordon will use his resources to buy better care from the numerous free market healthcare options that will arise out of the vacancy created by this single payer system. 

Anytime we are ready to have an honest conversation I would love to hear the real results that are achieved.

I could not agree more with you. Heath care is the very epitome of what economists refer to as “public good.” If someone gets sick, their ill health costs everyone around them: Others can get sick from the infectious diseases spread by a contagious person; others are impacted economically by the decisions of the sick person and his caregivers beyond what they can mitigate, and; the risk for all of us is random and often overwhelming. The prevention based remedies that can be positively effected by the existence of a universal heath care system can obviate many problems and risks before they become unmanageable catastrophes. (For instance: people who get regular checkups are much more likely to discover and treat potential problems, such as many forms of cancer, long before they become untreatable.)

It is time that we all set aside the ‘partisan game’ and seek what will make us all individually, not to mention, collectively more free, independent and, healthier.

Nobody wins where everybody looses, and everybody looses when the sick don’t get medical care–or try to cut corners when they do get it–and, as a result, expose the rest of us negatively to both health and economic risk.

We wouldn’t tolerate a plethora of “private” fire departments renegotiating service rates at the scenes of fires. So to, we should not tolerate this very similar situation in health care.

A constitutional argument in favor of centralized government authority to enact a system to address this issue may be hiden in the line, “promote the general welfare…”

Which ever way this argument and philosophy blows, I still hold dear my independence as a citizen and physician. One may feel they have a RIGHT to healthcare, but I can assure you that you do NOT have a RIGHT to my services. A RIGHT…..this is not a term to be bandied around like some new twitter inspired lexicon.
There have been some very good arguments for all sides posted here. Reaffirmation of my views rivals the education gleaned from some of the opposing views. For now, the knowledge sharing is a “public good” on this subject and the passion of personal belief refreshing and honest.

BTW, KipEsq, health care is non-excludable… that guy with appendicitis will indeed get the operation, only it may be delayed and his recuperation may be prolonged if he waits.

And those antibiotics approach non-rivalry, surely as much as public utilities like water and electricity.

I KNOW that leaving medical decisions for patients to make based on their perception of cost-benefit is ludicrous. Even leaving it to physicians is fraught with problems, but at least these problems can be managed.

So far, private insurers have “managed” these dilemmas by foisting the elderly and poor onto the govt plans… so, why not just foist everyone on the govt plans and then at least they’ll be fully funded?

Kudos, Dr. Gordon. Well, done.

You could set aside money your whole life and still be behind the 8 ball if you get sick. Instead of hoarding it in this manner why not pay for meaningful insurance according to your ability to pay through a central mechanism. This removes the worry and tension and fulfills an essential part of the social contract. Rich or not so rich benefit when the population is as healthy as it can be. Thomas Paine: “No one joined a society to be worse off.”

To some extent everyone agrees treatment can not be withheld from anyone. People cannot be refused care in an ER or hospital whether they can pay or not(sort of like your defense argument). However this approach is both an overly expensive and insufficient way to deliver care. It would be less expensive and more life saving to give this group of people to give them health insurance.

Public Health is already an accepted necessity. In addition without individual care in the range of affordability and accessibility our survival is in danger. I have already alluded to the numbers of dead and the loss to the economy because of our present system. It just stands to reason if everyone has this need but its costs in the society are too great, then a government imposed tax and/or regulations to pay for it is the next logical step. Will there be problems or complaints? Undoubtedly, but we in the US do not even come close to the 86% satisfaction rate of Canadian Medicare, for example. Anecdotal horror stories aside, reports from other developed countries echo this result.

By fixing this major hole in our economy we will provide more capital and opportunities to private entrepreneurs. Wasn’t it health insurance premiums for employees active and retired that helped sink GM?

Simply put, a rational health care system is presently out reach financially for too many people. It is time for Medicare for all.

How does asking people to control more of their own health care dollars provide coverage for the currently uninsured? What happens when the members of the insurance pool most able to pay for their procedures realize that it’s cheaper to fly across the Atlantic for a surgery? Do you think patients would get better or worse care having to navigate a system of sub-specialists who focus only on those procedures they can perform most profitably (Hello, Lasik! Good to see ya, implantable pain pumps!)? If competitive markets were the answer, shouldn’t private individual insurance plans have taken over the market by now?

I don’t really expect much of an answer on any of those; they’re mostly rhetorical. But I do honestly wonder: What percent of annual health expenditures do you estimate to be price elastic?

And yay for the free market! I have a great suggestion for removing barriers to entry. All these professional licenses and educational requirements are far too restrictive. Besides, aren’t all those medical books in the library anyways? You could see someone like Will Hunting, M.D.! Except I guess you couldn’t call him a doctor. Maybe “Health Coach?” I bet he could handle at least half the daily case load of an average family practice MD, and he wouldn’t need to charge nearly as much. No worries about errors or anything, either: if he screws up, the free market will punish him!

-g

I have enjoyed reading your replies and your well-articulated arguments. Keep it up.

NF, I think your practice model sounds rational (and very reasonably priced) and I don’t think that conceptualizing basic health care as a “public good” or legislating a public option will prevent you from doing business the way you prefer. It simply takes the stress off people who can’t afford you by giving them the option to see one of your competitors who will accept payment from a public plan (should a public plan cover the type of medical services that you offer.) Hopefully this won’t put you out of business. If yo offer the type of personalized in-depth care that it sounds like you offer, I doubt it will.

I know EMTALA is annoying for doctors, but the stakes are much higher for patients so I’d rather “enslave” a doctor by dragging her out of bed in the middle of the night than condemn an unfunded emergency patient to painful and preventable death or disability by denying treatment because of inability to pay. I would like to see reimbursement for EMTALA care, however, and I don’t know how anyone proposes we achieve this without public financing. Still, I’m not sure if a public option addresses this problem because I don’t know what percentage of the people accessing EMTALA would even qualify for “public option” coverage. Perhaps you know, Gromit? My thought is that if we want to take the burden of EMTALA off of hospitals and providers, EMTALA may have to be reimbursed separately or public option coverage will have to be extended to every single person in the U.S., legal and illegal, whether they sign up for it or not. It’ll have to automatically kick in when an unfunded person accesses services. This is beginning to sound more like a limited form of universal coverage to me (which is what I’d like to see offered.)

Neither does health care fit the model of a regulated utility (i.e. a natural monopoly with huge upfront costs and low marginal costs). Sure, building a hospital is costly – as is building an electricity generating plant. But the reason utilities are considered natural monopolies is the electrical grid, power lines, meters, and so on that would be costly (and cumbersome) to duplicate across numerous competing utilities. Besides, there are numerous facilities that could compete with hospitals (house calls, phone consults, web or email-based visits, clinics, specialty hospitals). There is asymmetry of knowledge in medical care, but that’s true in numerous industries. The authorized Prada dealer doesn’t want its customers to know about the discounter selling identical goods below MSRP.

Health care is a marketplace, but it’s dysfunctional. So how can we turn health care into a competitive market? People need to control more of their own health care dollars. They need to save for future health care needs the way they save for retirement. Third-party payment needs to be reserved for insurable events and mostly be replaced with indemnity insurance. On the supply side, barriers to entry need to be removed and laws protecting providers from competition need to be repealed.

-g

When government intervention is logical and economically feasible, why stand in the way of a “quest to remove suffering from this world?” Removing suffering as an end of course does not justify any and every means necessary, but our government does have a responsibility to “protect the general welfare.” And are you suggesting that someone who develops cancer and can’t afford treatment just needs to be more motivated?

For jsmith (and Tom, to an extent):

The “remedy” depends on what aspect of the situation you’d like to address. The white house has identified the population of uninsured as its primary problem, in which case establishing a government run universal health coverage plan is the most direct answer. There are of course arguments for relying on free market mechanisms to some extent, but unfortunately we’ve known for decades (pdf alert) that health care – particularly the very expensive stuff that makes up the bulk of current spending – isn’t managed particularly well by market forces. Unless, of course, you go straight to “that’s too expensive for you to afford.” That is, after all, a significant factor in free market pricing.

I am not a healthcare economist, and I’m sure you’ll find varying opinions among them, but if you want to know possible remedies for various ills in healthcare systems then you need look no further than other advanced countries around the world – all of which provide some form of universal coverage. The inability of Americans to accept factual information about how other countries work is legendary, but I would think highly-educated individuals like health care professionals would be more receptive. Am I wrong?

-g