Anyone in our country with even half a brain knows that our healthcare system is a mess. Even the healthcare professionals know it. In fact, the only entities that like our system, other than possibly the filthy rich, are the health insurance companies, and that's because they are currently in charge and running the system. So why haven't we done something about it?Fear. That's why. Too many of our people have swallowed the health insurance industry's propaganda about "socialized medicine". Most people don't even understand what socialism is, let alone socialized medicine, but they have been trained to fear it. Never mind that we are the ONLY industrialized nation in the world that doesn't cover all of it's citizens with some form of a government run healthcare insurance system.
But here in America, we stumble along with a system in which insurance executives make our healthcare decisions, some 40 million people have no coverage at all, and most of our middle class is just one serious disease away from bankruptcy. The fact is that per patient, we spend more money on healthcare than any other nation, and receive less for it. All because we have been taught to fear the dreaded "S" word.
Now I agree that some of the socialized systems in the world would not be a good fit for this country. Take the English system for example. There the entire system is owned by the government, including hospitals and clinics, and doctors are government employees. That would not work in this country.
We do need a single-payer government-run system of healthcare insurance, but Canada or France would be a better model. The doctors, hospitals and clinics should remain independent businesses who rise and fall based on the quality of care they provide. There is no reason why we can't create a government single-payer system that would:
* Cover all our citizens with adequate health insurance.
* Put doctors back in charge of making treatment decisions.
* Allow each person to choose his own doctor and hospital.
* Provide this coverage at less cost to the business community.
*Spend less overall on healthcare expenses and get better care, because the huge profits and overhead of the insurance companies will be eliminated.
* Provide economic stability to the middle and working classes, even if their families are hit by a serious disease.
The only reason we can't have a system that accomplishes all of the above, is because it could be labeled as "socialized medicine" -- something we have been taught to fear. Personally, I'm sick of this ridiculous cowardice. So what if it is socialized medicine? What's so bad about that if it accomplishes all of the above?
And don't try to feed me that old lie about how the Canadians hate their system and would prefer ours. That's just more lies and propaganda. I've been to Canada and met many Canadians, and I've never met one that would trade their system for ours. They're too smart for that.
So please, if you're one of those people who are terrified of socialized medicine, tell me why. I'd really like to know. Do you fear it because someone told you to, or do you have a valid reason? I suspect it's the former.
Go to this site to find out what a decent single-payer system could look like. Then come back and tell me you prefer our broken system.
(Above cartoon is by Jeff Parker at caglecartoons.com.)
i just hope they do something and do it soon..
ReplyDeleteMy problem with your description of a one payor system is the fact that the only way they can lower costs when covering all those new people is to lower the amount reimbursed for individual visits/procedures/hospital stays etc... This is essentially price fixing. It already occurs today with medicare/medicaid. Medicare sets prices that are many time 50% lower than what private insurance companies are reimbursing to doctors/hospitals. This in turn causes the private insurance companies to lower their reimbursements. It's a vicious cycle. This causes doctors to try and increase volume to make up for decreased revenues. It has also caused some great doctors to quit participating in the medicare/medicaid systems because they simply can't pay the bills with the pennies they get reimbursed.
ReplyDeleteThe second way a one payor system limits costs is to ration care. If something has a fixed high price (like an MRI), then the most cost efficient way to run a mri is close down all the MRIs in a city except like 2. Then make a waiting list to make up for the limited test time available. If your illness is not serious ( serious to the system, not you) then you wait.
This is not what a free market United States is all about. Health care is a privilege, not a right. I would favor mandatory purchase of health insurance ( like many states do for car insurance) over single payor system.
I have made a wide range of salaries in my 15 years since college (between 20,000 and 200,000), yet I have always made health insurance for me and my family a priority (over a luxurious house, fancy car, or taking lots of vacations). I think most americans just need to get their priorities straight.
"Health care is a privilege, not a right." Do you REALLY believe the rich should have the "privilege" of getting good health care, while the poor shouldn't get decent health care? Anything else the poor don't deserve -- food, water, clothing, shelter, etc.?
ReplyDeleteIf you really believe that, then you are an evil person.
For some reason I can't find free health care for all in the constitution. And no, it doesn't fall under life, liberty, and the pursuit of happiness.
ReplyDeleteAnd the "poor" do have an option in this country right now under medicaid. And having worked as a physician at a county hospital for 10 years, I think we provide excellent health care regardless of ability to pay. I'm just saying that if you have a job, then setting aside a portion of your check to provide health insurance for your family should be a first priority. I can't tell you how many people that have 40-50K/year jobs come in with zero health insurance and then climb into their mercedes/escalade to go home.
I have no problem with people who can't work (disabled,elderly,etc...) and those who are temporarily out of work (laid off,etc..) getting some form of government help to pay for their health insurance. I just have a fundamental problem with the government running the entire system.
Go check out your local VA (I working one as a resident for 2 years). Just go to the main clinic or the hospital admitting area and sit. Just watch the bureaucracy. Watch people wait 4-6 hours. Watch people see PAs and nurse practitioners when they thought they were going to see a doctor. Just watch people being told the wait for an appointment with the specialist they need to see is 6+ months. It is a freaking mess. And no matter how much I didn't like it as the doctor, I couldn't do a thing to change it. And the staff doctors were so underpaid, they could care less. Most of them were there to finish out the last few years before retirement or because they had visa issues.
Now picture every hospital in the country being like that. Picture about 1/3 of the hospitals being closed due to duplication of service (that will be great for the economy). I'm afraid that when you get free health care, you get what you pay for.
No one is talking about a VA type system, where the hospital is owned by the government and the employees and doctors are government employees. To compare a single-payer government run health care insurance system to that is to be a bit disingenuous. You built a straw man to knock down.
ReplyDeleteAs I said in the post, doctors and hospitals should be private businesses, and everyone should have the right to choose their own doctor and hospital.
I have Blue Cross insurance, and I can't do that. I must choose a doctor from their list and go to the one hospital they have contracted with (even though I don't believe it's the best hospital in my city).
In addition to the right to choose my own doctor and hospital, I don't want some flunky working for the insurance company deciding what care I can get. I want my doctor deciding that. But currently, doctors can only give the treatment the insurance company approves.
I also think we should cut out the enormous profits of the insurance companies, and use that money to pay for health care. We pay more for health care in this country than any other country, and we receive less for it.
Why is it all the other industrialized nations can have a health care system run by the government that covers everyone, but it is too hard for us? The reason is that we've swallowed the propaganda from the insurance companies and Big Pharma. If everyone else can do it (and do it cheaper), then so can we.
And don't even try to tell me lies about the health care in those other countries. Not a single one of their citizens would trade their system for ours.
As for the wonderful health care given the poor by our county hospitals, you obviously aren't poor or you would never have said that. Try waiting 12-24 hours in one of those hospitals just to see a nurse, and then tell me how great that care is.
First, monopolizing the payor system will effectively create a dictator style health system. Example: If big brother government decides that doctors should only get $10 to see a patient for a "routine" visit, or what is currently a 99213 CPT code in todays medical billing system (FYI that is what Canada in all their greatness has decided that a visit of this level is worth reimbursing), then guess what, all the doctors have to take a big gulp and swallow it. Its the old golden rule, he who has the gold (the govt.) makes the rules. Now in our current system, which I do not think is perfect, if blue cross (or any other insurance company) decides to cut the rate for a given visit/procedure, then the doctor has the choice to say "ok, if thats what you want to pay, then don't include me. I will participate in other plans". Now this can be effective if enough patients clamor together and either a)complain to the company to change their reimbursement or b) drop the company and choose another insurance comp (ain't competition great). But the problem is, too many people with insurance are more worried about getting their co-pay as low as possible than they are about what the company actually reimburses to the hospital/physician.
ReplyDeleteSecond, if you cut the profit from insurance and pharma, you take away their motive to provide a good service and make good drugs. It's a sad fact, but very true. I know they aren't perfect now, but I can't see them being better when run like the post office or internal revenue system.
Third, the majority of people in canada, UK, and france do like their system. Because for healthy people (which is the majority), being able to get free yearly checkups and visits for colds is great. However, for those unfortunate enough to be struck by severe illness, particularly if they are >65, are just flat out screwed. When I was a fellow in NYC, I can't tell you how many brits we used to see who had coronary disease needing bypass, but because they were >65, they were relegated to waiting 12-24 months. Many were coming with their retirement in tote, to pay for the service they needed. I am not making this up. Fortunately, the university I worked for discounted the hospital stay significantly for their cash payment.
Third, like I said, I work in a county hospital in houston. 95% of our patients have no insurance (because they are mostly in the country illegally) . There are lines sometimes, but no one waits 12-24 hours. I know there may be public hospitals that still do that (I know it was like that in NY when I trained), but we (hospitals and doctors) are working endlessly to improve the system. We offer 24 hour clinics to take pressure off the ER, we have specialists assigned to the ER to be available more readily. So, sorry, I'm not poor. I have been in my life, if all you use to define poor is annual income, but I do care for them. I just don't think socializing the payor system will create any incentive for hospitals or doctors to provide top notch service for anyone (rich or poor).
You may not think people have to wait many hours to receive care, but it happens regularly. I have had to wait 14 hours in a Texas hospital myself, and that's pretty normal.
ReplyDeleteAs a physician, you probably have the money to get whatever care you need. As a government worker, I can only afford whatever care my insurance is willing to pay for. In other words, I have an insurance executive making my health care decisions.
It's no wonder that you like the current system, and I think it's sick, perverted and badly broken.
I managed to buy the care my family needed even when I was a student for 8 years and made zero income. I also never went on government assistance (other than loans for tuition). We made medical insurance a priority like food, water, and shelter. We never had a "cadillac" health plan, and I still don't, but I made sure it was one I was happy with. Currently, I pay for a very inexpensive plan that is catastrophic only, and have a health savings account. One of the most underutilized health insurance options.
ReplyDeleteAs a government worker you should complain to your boss that you would like better health insurance options. Oh wait a minute, that's right, it's the government (the same people you want in charge of our whole health system), they probably won't listen to the workers. They probably even...gasp...use the lowest bidder for their insurance provider. Yeah, I'm pretty sure I don't want them in charge of the one and only medical insurance provider in the country.
I don't like the current system. It needs adjusting. The American people also need adjusting. We are the me first generation that wants the biggest houses, nicest cars, and nicest lifestyles (all usually on credit), the minute we turn 18 and start working. Yet when we don't prioritize and make health care a priority in our monthly spending, then we all want it free, because its our right. What else is there that we have to have to live, that not everyone gets equally? Food? Maybe we should nationalize all the grocery stores and restaurants and the government should buy us all food. I mean, it's our right...we need it to live, right?
Shelter? We all know there are a lot of homeless people out there. The government should just buy us all a house. Obviously I'm being sarcastic, but I think when you nationalize an industry, you better look at why you are doing it, and then decide if it's going to open a pandora's box when it starts getting applied to other things.
Lastly, I am a physician. I do make a nice salary that I thank God every day I am able to make (although by medicine standards I am at the bottom of the totem pole, as I work for the county). However, I am not going to apologize for this or feel bad because I make more than others. I have given up a significant portion of my life in school, I continue to work 80-100 hours a week, I miss more time with my kids than I wish to ever think of, and on a daily basis I deal with the fact that people may live or die based on decisions that I make. I don't say these things to complain, I love what I do. i love caring for people. And I know that being a doctor is not the only profession that requires one to make any of those sacrifices. But I do feel that these things justify the salary I make. And finally, I feel as though I am a good custodian of the money I make. I pay my taxes (38%), I donate to charity, and I put away money for my family's health care, my retirement, and my kids education. I don't drive a porsche, I don't live in a 500K house, I don't eat at fancy restaurants every weekend. So this is not an elitish rich person's point of view I am expressing.
I think that creating one big health insurance company that is controlled by the government (single-payor) would cause a regression to the mean with regard to the health care provided. Some would get better than they have now, some would get the same, and some would get worse. It's basically saying we would rather have average health care for all than to have anyone getting excellent care (even though they are paying for it). It's just not American.
I still find it odd that every industrialized nation can provide good health care coverage to all their citizens, except the United States.
ReplyDeleteIt's amazing that no-one talked here about the effectiveness of the system in its ultimate measure.
ReplyDeleteLook at the life expectancy in the countries with the socialized medicine.
Japan: 82.87 years
Canada: 80.36 years
France: 80.9 years
UK: 79.76 years
compared to
USA: 77.89 years
Yes, probably doctors make a lot less in these countries. But this is because they are not in such a need in those countries, isn't this good? Would you rather have more sick people, or less doctors?
It doesn't matter where (which state) you got the ticket, once the ticket is issued it will be on your DMV print out (record) for some period of time. Even if you moved to another and change your license, that ticket will still appear.
ReplyDelete