Myca Writes:

October 25th, 2007 at 6:39 am
This is certainly true. But what has it got to do with “how the free market works”?
Roughly, because the free market has no mechanism in place to provide health care to people who are unable to pay for it.

This is not true. I’ll use myself as an example because I have no dental or health insurance and yet I don’t go without care of any kind.

I go to a large public university that has a dental school and a medical school. When I had a mouth full of rotten teeth after years of not receiving dental care–due to my parents not taking me to the dentist when I was younger–I had my cavities filled and teeth cleaned for chump change compared to what I would have spent at a private dentist office for the same treatment. I also go to the university for my regular breast exams and yearly pap smears–all also performed for almost nothing. I am able to do this because my dental care is mananged by dental students under the watchful eyes of dental professors.

In order for doctors of all types to be trained they need patients to take care of during medical school. The patients that they get are often poor people like myself who go to them for high quality service for pennies of what it would cost to have the same services performed elsewhere. At the university that I go to for my health care there are numerous clinics offering a wide range of services for little to no money.

So, free and low-cost clinics at dental and medical schools are one way in which poor people receive care.

There are also numerous foundations that provide money to open clinics and fund hospitals, think of the Bill Gates Foundation or the Carnegie Foundation, or the Pritzer Foundation. Sure some of these foundations may have been formed to create goodwill in the public eye for their founders but that doesn’t erase the fact that they still do good work and give away lots of money which often funds free or low cost healthcare.

The free market also permits doctors to donate their services to people that they find needy.

In a free market there is absolutely no way to predict exactly how people will come together to fund health care, just as there is no way to exactly predict what software program will be the next Microsoft Word.

A free market permits groups of people to come together with their ideas to experiment and find out what works and what doesn’t and sometimes there is no way to find out whether or not something will work until you actually attempt it. Looking at healthcare reform from this perspective you can see that the mechanism by which the free market works is by allowing people to come up with whatever method they see best to perform a service and staying out of the way while seeing if the idea works.

I would also like to add that under a free market not everyone will have health insurance. Not only do I currently not have health insurance, I probably wouldn’t pay for it at this moment even if I could afford to. In a free market you will have plenty of young healthy people like myself who will voluntarily go without coverage because we don’t feel we need it.

After Cobra and Cal-Cobra and still being un-employed. The fee structure has changed and it has been my mother who has paid the premium monthly since 2004 so I stay insured. So I have some access.

Good thing….the stress, the illness which btw I knew was triggering a on-coming breakdown but could not get my psychiatrist( HMO bot) to frigging help me. All she could do was hold me to 15 minute interviews and prescribe drugs ( Paxil, Zyprexa etc the last straw she wanted me to take Lithium)

I was diagnoised with an advanced case of Hypothyroidism… no trip to Hawaii can cure this. I am on Levothyroid for life. I also had a BMI of 41 , Pre-Diabetes, Elevated Blood Pressure and a Weight of 285lbs

I have a General Practioner who atleast listens to me. I cannot afford my co-pays or meds for everything..So I have booted the HMO Psych Dept Bot. I am weening off the drugs. I got a California Medical Marijuana Card and I get Compassion ( Free Weed) My weight is down to 225lbs. My BMI 35. My Glucose levels have mellowed out. So has my Blood pressure.

I just refuse to be a Kaiser Gerbil. I have taken a pro-active response. I am not going to get caught up in the Big Pharma Merry-Go-Round any longer. I feel incredible. I don’t know what I can do to improve the state of healthcare in the US. I just know I cannot be a lamb and wait for Sh@t to happen.

It is unfortunate we are at the mercy of Western Medicine. It is all about preventitive care also.

I have been sick in Europe also. In my case I was in Italy. I’ll take the US for all of its foibles. You just have to break your dependence upon “Western Healthcare”.
Take charge of your life. Create alternatives.. Educate Yourself as any consumer should. Get Healthy. This crap is not changing anytime soon. If fact it can only get worse.

Without doing the research of jurisdictions in close proximity and/or without the insurance company lawyer giving that info, yes. That said, it’s rare for juries to return a judgement in favor of the plaintiff without a very solid case.

As I’ve written before, the reason for skyrocketing malpractice insurance rates has little to do with jury awards and almost everything to do with the stock market. Malpractice cases are one of the few ways we have of penalizing incompetent doctors and I would be loathe to make it more difficult than it already is to bring a case to court.

Jake, I yield to your better-researched opinion. However, isn’t it still true that a doctor who is being sued often has no real way of knowing whether or not they will be found guilty of malpractice, or found to have made a minor, but understandable, error, or if the jury will decide that they did everything right and the patient just plain couldn’t be saved?

Whatever the reason, I think the current system where doctors provide less-than-optimal care due to considerations of how it will look if something goes wrong, and where they have to charge sky-high rates in order to pay for insurance to protect them from the mistakes that they WILL make (they’re human too), needs to be fixed.

Bjartmarr,

Although I have no major disagreements w/ the rest of your comment, this really sticks out as in need of correction. While it is true that malpractice awards from jury vary wildly from jurisdiction to jurisdiction, they are fairly predictable in each jurisdiction. Talk to lawyers who work on malpractice cases (or, look up awards online - they’re available in a most jurisdictions these days) and you’ll see how much you’re likely to get for, say, a malpractice caused infant mortality vs a loss of hand function in an adult. Awards are, to my mind, amazingly predictable within any given jurisdiction. That’s the reason that plaintiffs and defendants sometimes argue over which jurisdiction a trial will be held in.

No, most of the COVERED cancer and heart patients are older. There is a very large number of us who are still waiting for Social Security Disability. (I started just over three years ago, and I finally get to go before the judge next month.) Many middle-aged heart attack survivors do not get any follow-up medical care, and they are not going to the emergency rooms either, that is until they have another heart attack when, as stated, “end stage patients are already treated”. Intermediate heart therapy is very expensive for both the medicines and the monitoring. I grouped the cancer patients in as well because what I read in their forums mirrors closely those of us with heart disease.

“much of the need for rationing will be eliminated by providing cheap preventive care”

Preventive care does not work overnight, but the slam on the system will be immediate. This is why so many Democrat healthcare plans have provisions for new hospitals and other treatment centers. The US does not yet have enough to carry the load.

I don’t mean to imply that nurses are just doctors who can’t hack it. Rather, that nurses and doctors share a subset of their skills, and that it will be beneficial to doctors to learn (at a basic level) those nursing skills that doctors today don’t know. Also, and I say this with great respect for nurses, that nursing requires significantly less training than doctoring, and as such it is an appropriate profession for those who wish to work in the medical field, but (for one reason or another) don’t want to put in the extra training time to become doctors.

All the nurses I know have an undergrad degree with some scienc-y coursework, so perhaps I was mistaken in assuming that one is required. However, even if it is not, under my friend’s plan, would-be nurses without undergrad degrees wouldn’t be prevented from going to nursing school; they just wouldn’t be allowed to continue to doctor school without the relevant undergrad degree.

Going through my friend’s plan would undoubtedly add a few years on to the process of becoming a doctor. After getting a BS at 22, a would-be doctor would take three to four years of nursing school and work as a nurse before being eligible for additional training. But then the would-be doctor would already have mastered some of the necessary skills, leading to a shorter training period for more advanced work — they wouldn’t need the entire two years to become a PA, nor the entire six years to do med school/internship. (And even if it did take that long, and they became experienced doctors at 34, they still would have spent much of that time working (and taking home a paycheck)). Are doctors today debt-free at 34?

I don’t think that your mention of specialty and sub-specialty training is relevant, as these are things that doctors must undergo anyways, and thus don’t make my friend’s system take longer than the current one.

Perhaps I am misremembering — I thought my friend had a PA step in there. Perhaps it was something else. I do remember that it was a three-tier system. In any case, neither the number of tiers nor the specific titles are important: the relevant details were that it was pay-as-you-go, that if you quit partway through you would still have a career (other than fry cook), that medical workers would graduate with practical experience (beyond what they currently get in medical/nursing school), and that doctors would have a better knowledge of the jobs of the people working under them.

As for your comments on tort reform, I understand what you’re saying, and I think that the improvements that you mention under (2) are excellent ideas. I do think that being scolded by a medical board for making a basic mistake would be a lot less punitive than having your malpractice premiums skyrocket, as happens under the current system.

As for (1), the threat of a lawsuit would be replaced with the threat of decertification by the medical board — so there would still be an incentive for hospitals to toe the line.

Rad Geek:
I live in LA, so I have a hard time imagining a group of doctors being quite so dismissive of the general public as a group of cops — I’ve never been harassed by doctors, or had my friend’s (who was peacefully protesting) skull smashed into the concrete by a doctor, or talked to a doctor who was completely unable to understand basic logical thinking. That said, I take your point that doctors might be unwilling to police themselves properly.

And yet, we just had a
major hospital closed down (for providing substandard care) by a group of doctors, and if I look in the paper I can see a list of doctors who had their medical licenses suspended or revoked for providing substandard care. I’m proposing that we try to expand the medical review board to be the first place that aggrieved patients turn to; that we acknowledge that doctors do make mistakes, and that most of them should not be career-ending, and that we acknowledge that the threat of license suspension is just as effective in deterring negligence as high malpractice premiums, and nowhere near as expensive for the patients.

In short, I disagree that our current system is the best of all the bad options, without asserting that my friend’s proposed solution will be all peaches and cream.

Myca Writes:
October 25th, 2007 at 11:43 am
I agree that there are trade-offs and potential problems, I just happen to think that the other systems out there are far, far worse. To talk about what might be a problem in a theoretical system of universal health care (whose benefits, I agree, would be ‘pretty huge’) while ignoring the glaring inhumanity of our current system is, I think, inappropriate.

And since this is what happens every single time the topic comes up, it’s frustrating.

—Myca

I have no snarky intent, so hopefully this doesn’t come out wrong.

But if this is happening every single time you talk about health care, there’s probably a reason: the things that seem obvious or not worth talking about (to you) aren’t as globally obvious or not worth talking about as you may think. Certainly on a national level, the question of limits is relevant (will Person X’s health care level go up or down? Will it be like UK or France, or somewhere in between?) Similarly, the question of costs is pretty prevalent in people’s minds.

IOW, if you don’t want this to happen to you every single time, why not stick in a little information that people want to know?

PS. In other words, “explain the details of your plan so that it can be ripped apart while I ignore the glaring problems with our current system and the glaring problems with deregulation,” is a rigged game, and one I refuse to play.

I am not ignoring those problems. In fact, you’re responding to a post in which I acknowledge that socialization of medicine is good. Instead of “explain the details so I can rip it apart,”) how about “explain the details so we can know where we agree and disagree?” A plan with no details is about as useful as a Global Plan To Do Good. It’s great for getting a consensus, but the consensus often disappears when it comes to implementation, because the devils in the details.

PPS. AND, that’s part of what I appreciated about Rad Geek’s comment, was that along with criticizing socialized universal health care, RG offered a plan of his own to be criticized. Which is fair, isn’t it?

Yup. Which is why I 1) posted questions; AND 2) answered them. You may not feel that my position is clear enough–feel free to ask me what you want to know–but if you’re going to call fairness, how ’bout posting your position?

Ermm…what do you think happens to these patients now? Emergency or acute care can not be denied by any hospital for any reason other than inability to care for the patient. So end stage patients are already treated, regardless of prior treatment or insurance situation. In fact, there might be fewer of such patients under a universal care system as people got regular preventative care, meaning that they would never get to end-stage disease and would instead die peacefully and cheaply of old age in their 80s or 90s.

Oh, great.

I’ll bet this would work out just about as well as it does in cities where people have to take their complaints of police misconduct to a “community relations board” which is itself packed with police representatives, and where the costs of civil rights settlements are taken from taxpayers rather than from the offending cops.

If your goal is to get a group of professionals to deal with people in a responsible, accountable way, then it strikes me as foolish to put the sole power to rule on grievance claims into the hands of those who have a professional interest in dismissing or minimizing complaints against themselves and their colleagues.

For deciding these kind of claims, a plain old jury trial is just about the worst system possible, except for all the others.

Then there’s the tort reform…I like the idea of tort reform, but have several problems with it.
1. Sometimes the threat of a lawsuit is all that makes a hospital behave properly to a patient. No, I don’t like this either, but I’ve told various administrators “we can’t do that (where “that” is refuse to authorize a medication or test, wait until morning for an emergency procedure, etc), we’d be violating standard of care and would have no defense if sued” a number of times when they were acting particularly egregiously. So if implemented without proper health care reform, it could actually result in worse care.
2. People make mistakes. Doctors are people. Therefore…So why not make the system such that a mistake is either harder to make or less disasterous when made. For example, enter prescriptions into a computer instead of writing them by hand. That way, the doctor’s handwriting doesn’t matter–the scrip is printed clearly and without ambiguities such as “is that 2U (2 units) or 20 (that is, 20 units)” or “qd (once a day) or qid (four times a day)”. Allergies could be entered as well and a program set up that would beep if the doctor entered in a medication the patient was allergic to or two medications likely to cause problems when given together. I also like working groups to identify common mistakes in practice and try to find ways to make them less common. All of this, of course, relies on people being willing to admit their mistakes, which would be much more likely if the system is non-punitive towards mistakes. So, contradictory feelings on tort reform, I guess.

But even if you disagree with me, and you think that we can’t pay for catastrophic care for the rare few who slip through the cracks, I assert that such a system, which covers all but the most expensive and least effective procedures, will still be better than what we have today.

If you disagree with me to the point where you think that we can’t afford to pay for check-ups and cheap early-intervention procedures for everybody…well, then we live in entirely different worlds and I don’t think we’re going to end up agreeing on much.

One thing we are fairly certain of now is if a universal healthcare system is established, it will almost immediately be flooded by cancer patients and heart patients who have been clinging to life with little or no previous treatment. Basic hospital resources like staff and bed space have a hard upper limit. Some services will have to be cut, at least in the short term.

What a bizarre and unsupported idea. Since most of the cancer and heart patients are older folks, most of them are already covered via Medicaid.

The system fails miserably because one third of our “health care” expenditures are going to administration. 500 billion dollars to people who deny claims. Plans that try to force everyone to buy private insurance won’t help, no matter how subsidized, because we’ll still be paying one out of three dollars for paperwork.

The thing is, the problems with the current system are far more complicated than just some people not having insurance.

As it is, much of your healthcare dollar does not go to providing medical care. Insurance companies tend to turn HUGE profits…and while profits aren’t bad, they are bad when they’re coming out of your pocket. In addition, about a third of the money that reaches your doctor goes into unnecessary administrativa — fighting with your insurance company over payment, filling out forms, re-filling out forms, etc. Also, insurance companies pose another problem: if you get very sick, there is a very strong incentive for them to balk at payment — after all, the best outcome for them is for you to die. Second best is for you to leave the hospital and not get treated. I don’t see a way to retain for-profit insurance companies while removing their incentive to deny payment to those who need it most, and who are least able to kick up a fuss.

Tying healthcare to employment has been covered already, I think. Suffice it to say that when you get sick, you lose your job. When you lose your job, you lose your health insurance…exactly when you need it most.

The problems aren’t all related to insurance companies, though. Some of it is doctors. The position of several large doctors’ organizations (I believe one of them is the AMA, but ICBW) is that publishing prices for procedures demeans the profession. It is next to impossible to get doctors to tell you how much a procedure will cost, before they do it. (I know, I’ve tried!) The usual response is, “Oh, I don’t know, I’ll have the front desk look into that for you. Please wait.” or “it depends on your insurance, you should call them”, or just plain “it depends”. (For our non-US friends who may not know this: you have to sign a document agreeing to pay all charges before you can see a doctor. Before you know what the charges are.) Free market enthusiasts take note: the free market doesn’t work if the patient can’t shop around.

I can’t blame our inability to shop around entirely on doctors, though. For emergent procedures, asking the patient to shop around is ridiculous on its face.

The system that trains doctors needs reform as well. As it is now, doctors usually take on hundreds of thousands of dollars of loans in order to pay for medical school. When they get out, they need to charge very high prices in order to service and repay their mountain of debt. Woe betide the would-be doctor who starts medical school and fails: he ends up with a pile of debt that he cannot pay off.

Finally, doctors in the US are scared of being sued. Malpractice insurance premiums often range into the hundreds of thousands of dollars annually — a cost which is passed on to the patient. Doctors are afraid to discuss possible treatments frankly with their patients, as this increases the chance that a patient will second-guess them after the fact and sue. Furthermore, there is every incentive for a doctor to prescribe likely-ineffective supplemental procedures, as that eliminates the possibility that they will be sued for failing to provide those procedures. (I call this the, “I think you’re okay, but I want to run some more expensive tests, just to be sure” syndrome.)

A friend recently visited Canada, where he sustained a life-threatening chest injury. He was schocked at how willing his doctor was to discuss his treatment with him. He was also astonished at the price which, iirc, was around $400 — for an operation which would have cost ten times as much in the US.

So how do we fix this mountain of problems?

First, as to the insurance issue: cut them out of the loop. We have a system, called Medicare, which provides healthcare to people over 65. It works just fine, but it needs to be extended to those under 65 as well. Yes, it will be expensive, but we can recoup much of the cost by providing people with preventive instead of emergent care. Care would continue to be provided by private practices, which would be reimbursed at government-set rates. Since there would only be one payer, this would eliminate costly battles over whose responsibility it is to pay. Anti-universal-coverage wags will point out that the system will encounter problems if Republicans come to power and pull funding: all I can say is that it’s up to us, the voters, to ensure that the system remains well funded.

Another large reform that he advocates has to do with the way we train doctors. He would like to see a system where would-be doctors start with several years of nursing school, coupled with taking shifts in the hospital, learning on the job and working to pay for school. After receiving the nursing degree, one could pursue a career of nursing, or (after a couple years of experience) one could apply for physician’s assistant training. Again, the training would be paid for by working as a PA. After a period of working as a PA, only then would a would-be doctor be eligible to apply for physician’s training. Doctors would graduate from school debt-free, and with several years of work experience already under their belts. Those who can’t hack it can quit at any time along the way, and leave without debt, and with a valuable PA or nurse’s certification.

(Nurses that I talk to particularly love this plan, as one of their chief complaints is that doctors don’t understand what it means to be a nurse.)

Finally, we need medical tort reform. Asking juries to determine whether a doctor was negligent just doesn’t seem to be working out very well, as awards are fairly unpredictable. My friend proposes that patients with grievances instead take them up with a medical grievance board made up of physicians. These doctors would decide if the doctor who performed the procedure was indeed negligent, and would award damages out of a state-supplied fund. Doctors would not pay damages for their own negligence (eliminating the need for medical insurance), but a doctor who erred too egregiously would have his license revoked.

If you’ve read this far, thanks for listening. This is really the most comprehensive and seemingly workable plans for medical reform that I’ve heard of, and I hope you’ll spread it around.

Oh, and Myca — oo oo ooh EEE EEE EEE!!! ROAR! Hee-haw!

We do need to determine the situations in which UHC will not cover something. What that line is… who knows? But everybody advocating UHC knows this, so bringing it up in the context of this thread isn’t helpful to the discussion.

What Mandolin said. :-)

Myca and I and the other regular posters here are basically invited with the expectation that we will be able to set and maintain our own rules. I could make a rule that there would be no comments on my thread but on Tuesdays, and you’d want to take that up with me — not Amp — and certainly not Amp on my thread.

We moderate each other’s threads with the standard mod rules in mind — or with the modified moderation rules — but Amp isn’t really the “boss”.

In addition, let me point out that there are other UHC threads here where you can post what you want about health care, so long as it’s reasonably polite, with no other limitation. There will be such threads again in the future, I’m sure. This isn’t one of them, and there is no obligation for it to be one of those. Personally, I find a blog with a variety of discussions and discussion restrictions more interesting than one with just one rule for all discussions.

Does that mean socialization is bad? Nope, at least not in my opinion. The net benefit is still pretty huge. But it DOES mean that supporters of socialized medicine really have two fair choices.

My problem with this, Sailorman, (and why I wanted to avoid specifically this in this thread) is that we end up in a situation where there is general agreement that the net benefits of moving to a socialized healthcare system would be ‘pretty huge’, but we end up focusing on the problems with such a system.

I agree that there are trade-offs and potential problems, I just happen to think that the other systems out there are far, far worse. To talk about what might be a problem in a theoretical system of universal health care (whose benefits, I agree, would be ‘pretty huge’) while ignoring the glaring inhumanity of our current system is, I think, inappropriate. It’s like talking about whether or not Rodney King had priors, while ignoring the cops beating the crap out of him.

And since this is what happens every single time the topic comes up, it’s frustrating.

—Myca

PS. In other words, “explain the details of your plan so that it can be ripped apart while I ignore the glaring problems with our current system and the glaring problems with deregulation,” is a rigged game, and one I refuse to play.

PPS. AND, that’s part of what I appreciated about Rad Geek’s comment, was that along with criticizing socialized universal health care, RG offered a plan of his own to be criticized. Which is fair, isn’t it?