I don’t think I’ve ever read a better post than this one by La Lubu of Feministe on why we need S-CHIP, why we need national healthcare, and why our current system is abso-fucking lutely sadistic and nonsensical.
I cried twice reading it.
Feel free to comment, but unlike a lot of posts, I’m going to be really strict on moderation on this one. If you’re saying things that can reasonably be interpreted as “It’s okay if a bunch of people die horribly because that’s how the free market works,” then your comment will be replaced with animal noises.
Really.
Don’t be a dick.
[I see there’s been an error in our moderation; it looks like the data didn’t save after you were banned.
However, you were banned. Please do not continue posting here. –Mandolin]
[Ahh, yes . . . and as I said: Moo, moo, moo. Oink. Meow. —Myca]
Bryan is on the right track. Other high-tech industries show a downward curve on price over time; why is medicine the exception? Arguably it’s because governments are paying people to do stupid things instead of smart things.
It’s never “ok” for people to die, whether it’s because of capitalist greed or socialist inefficiency.
Whuf whuf whuf. Bark! Bark! Grrrrr, taxes. Woof Democrats! Aroooooooooo free market!
Healing the sick is totalitarian? What?
Probably the best healthcare in the world can be found in France. Americans like to blah blah blah about the profit motive, but it was French doctors who did the first ever face transplant. Not for money, but for acclaim and pride in their profession.
Healthcare there is free for qualifying French people (ie, anybody with a job or on welfare) and extremely cheap for uninsured foreigners, which described me when I lived there and, alas, had more interactions with the healthcare industry than I would have liked.
In France, healthcare is a right. They take their rights very seriously. Nobody talks about money until everything is done. Their system is sooo much better than the American system.
And the anglophones here can blah blah blah all they want about how the French system doesn’t work or is about to fail or something but in the mean time, sick French people get the best healthcare in the world and sick Americans get jack.
Other high-tech industries show a downward curve on price over time; why is medicine the exception?
Medicine and other high-tech industries show a downward curve on price over time for older tech. No one wants to put up with older tech in medicine because it means anything from putting up with obnoxious side effects (ie Benadryl versus Claritin) to dying unnecessarily (i.e. alpha-interferon versus imatinib for CML). Claiming that medical care “should” be getting cheaper over time is like saying that iPhones “should” have been cheaper than other cell phones when they came out. In either case, if you want the latest, greatest thing, it costs more.
And before we get onto the “but the free market is what makes the US the place that all the innovations happen” bit, let me point out two things. One, the US is not the place where all the new innovations happen. It does produce more than its share of new medications, but that is because of the NIH: private spending on medical research is about the same in the US versus Europe, but the US spends more public money, through the NIH, than other countries. In short, it is the “socialist” part of our system that provides the edge.
To add my own tale of woe: when my mom had cancer, her health insurance refused to cover standard treatment. She had just turned 65 days earlier, so my dad went to the hospital that was treating her and asked them to bill medicare. They said it would take weeks for the paperwork to clear. She didn’t have weeks. Desperate, my father offered to pay cash to the Stanford University Hospital. They would not take cash. They would only take insurance.
My dad, who was fortunate to have resources and wits called a lawyer who sent a threatening letter to the insurance company who finally relented and my mom finally started treatment – so late the radioncologist was visibly distressed. Fortunately for the bottom line of our nation’s economy, the delay ended up saving them a lot of money, since she only got half the normal course of treatment before she died.
Given the statistics for her type and phase of cancer, there’s a good chance that she would have died anyway, even if the insurance claim had gone perfectly. But my family would have been spared the hair pulling and the humiliation. You’re not good enough to get treated at our fancy private university hospital. you money is no good here. we don’t care what happens to your sick mother.
It was the uncaring disinterest that hurt me most of all. My mom was dying and they didn’t give a damn. So three years later when I was sick and in France, I don’t know if the folks treating me cared or not about me personally. there was the language thing. I had a disease that doesn’t exist in France (got it in Germany). I may have been annoying. But when I had a few moments and I told them about my mom’s insurance, they were all outraged because of their ideal of human rights.
So maybe the French system is ‘totalitarian’ or expensive for taxpayers or whatever. It’s a better place to be sick, and I’d bet your next months’ insurance premium that’s cheaper than the fucking war in Iraq. America HAS the resources, but our leaders would rather use it to kill than to cure.
Arguably
Putting ‘arguably’ before a completely frivolous argument is like putting ‘with all due respect’ before an insult.
I had a disease that doesn’t exist in France (got it in Germany).
FSME? (Don’t answer that if you don’t want to. Morbid curiosity on my part.)
I’ve dealt with the German medical system a number of times. Loved it every time. I’ve never had to wait more than a week for an appointment, no copayments, even when I’ve had to pay cash (as in when I was there too short a time to get on one of the national insurance plans), it was cheap and simple. Plus they provided translated documents for me to submit to my insurance for reimbursement. Sigh. Why am I living in the US?
Justadog, you do understand that your laughable ‘solution’ would have done fuck-all to help La Lubu in the linked story, right? Since, as you would know if you read it, she had health insurance.
She also had a job.
She had a job AND health insurance, and it didn’t matter because as it becoming increasingly apparent, the healthcare system doesn’t care whether or not you (or your children) die as long as they can save a few bucks.
And all you offer is a standard conservitive tax-rant.
Well, whatever.
Unless you are able to contribute something useful to this conversation, and unless you do it very very soon, your comment is going to become animal noises.
—Myca
Bryan, who’s written five comments since the deletion of your first — banned. you. are. posting. stop. thanks.
“If socialized medicine goes full throttle in Oregon it will bring every illegal, every indigent, and every free-loader into the state.”
I know more than a few people waiting for Social Security to approve their disability who also have their eye on Oregon, as well as every other state that may get close.
Our system is screwed up because Democrats have continuously blocked tort reform
every doctor i know, and i know quite a few, both conservative and liberal, think the “tort reform” red herring is complete and utter bullshit, propagated by a minority of greedy and unscrupulous doctors in collusion with the insurance companies. principled doctors, such as those that work in community hospitals and in the public health sector, are more interested in competency of health care than some fictional epidemic of malpractice suits. if you paid any attention to the news, you’d find there has been a real epidemic of, for instance, dead people with surgical equipment accidentally sewed inside their bodies by surgery residents who’ve been working for 36 hours straight without sleep. that’s a teaching hospital administration issue, not an insurance issue.
High drug costs can be contributed [sic] to the cost of research.
also bullshit. high drug costs can be attributed to the cost of advertising.
Like auto insurance, people would have to prove they had medical coverage when tax time came along. If they can’t prove they had coverage then the government would withhold a portion of any refund and purchase health insurance (through a private carrier) with that families money.
what health insurance package are you talking about is cheap enough that it could be covered by a tax refund? i know a lot of people that would love one that was that cheap. i don’t think it exists.
but aside from any attempts on my part to respond with logic, this is both a bullshit idea [which i have inexplicably heard before from quite a few conservative idiots] and is completely insane because owning a fucking car is a little different from getting health care, in that driving a car is a privilege, not a right. are you telling me that you really want to live in a society where getting health care when you are sick is a privilege and not a right?
i sure as hell don’t.
Of course, people too poor to get a tax refund wouldn’t have anything withheld. ZOMG TEH SOCIALZD MEDICINE!!1!!!!
Myca: … our current system is abso-fucking lutely sadistic and nonsensical.
This is certainly true. But what has it got to do with “how the free market works”?
There is no free market for healthcare in the United States. The systems whose merits are being compared and debated are two different styles for government regimentation of the practice of medicine, one of them state-socialist and the other state-corporatist. In the former, the State directly controls payment and administration in every aspect of healthcare. In the latter, select cartels, heavily privileged, heavily regulated, and heavily insulated from competition, controls much or all of the work of payment and administration.
Maybe something more like the former system is better for many people than something more like the latter system. But there are specific historical reasons why, for example, and why most people depend on their bosses for health insurance. But these reasons have a lot to do with specific government actions (wage controls during World War II, for example, and ongoing tax incentives for employer-provided health insurance plans) and not much to do with market dynamics. Whether State-regimented healthcare is better on a corporatist model or better on a socialist model, none of it says much about the virtues or vices of a free market in healthcare, since that is not yet one of the options that has been brought up for consideration.
r@d@r: … high drug costs can be attributed to the cost of advertising.
High drug costs can be attributed to many things. But among the most important factors are certainly the government-created, government-enforced patent monopolies on new drugs. When the government forcibly suppresses market competition from generics, this unsurprisingly tends to create monopoly pricing.
What I do not understand is why the government gets a free pass on spending hundreds of billions of dollars to kill people in another country, but the thought of spending even a fraction of that money to guarantee healthy lives for Americans is viewed as such an onerous burden.
Maybe it has something to do with how cheaply we also buy education.
Okay, that is a bit of a cheap shot, but seriously – I don’t see how our health can be viewed as a luxury. What is wrong with the idea of guaranteed health care? What is so sacrosanct about the insurance industry that it must be coddled? Are people opposed to national health care aware of how insurance works for most people? Do they realize that “paying taxes for other people’s health care” could easily become “other people paying taxes for their health care” with a single accident or diagnosis?
It’s not just a one-way street.
Yes, Lisa, that annoys me too – the self-described small government independent who opposes any sort of government health care and *also* opposes war. But of course, the relative amounts of attention, activism, and blog posts they dedicate to the respective issues betray their true priorities, in a manner that leads one to think that these people don’t understand the quantitative difference between the money spent on the two, and the qualitative difference between helping people and killing them. Rather, rinse, repeat for education, PBS, earmarks for public aquariums, etc. etc.
Give me the rabid Republican any day. There’s a goofy sort of dignity to someone whose hypocrisy is completely unabashed.
“If you REALLY believe in strangers paying for the health care of others then I expect you to take your full kicker check (assuming you paid taxes) and gather up as many children and their parents and take them to some clinic and pay for each to get a check up. All others that feel the same way – do the same.”
Justadog, without taking a deep breath and plunging into the nutty depths of the rest of your post, let me just ask you this: why stop there? Why should you pay for the police protection for others? Roads? Printed money? Oh, some of it will come back to you, for sure – just as you’d use some some of the universal health care you paid for. But by far the majority of it is being spent for the benefit of strangers. (While we’re at it, what form of government spending *isn’t* spent on strangers, pray tell?)
I say, any time the city needs to hire more police, those who need them the most should have to pay the most. Runaway children, prostitutes, old ladies with big purse bags – take some personal responsibility! Start pooling your money, appeal to private charities if you have to, but don’t hide behind the violence of the State!
Why should I have to pay for the investigation of YOUR kidnapped child? MINE is perfectly fine, obviously because I’ve been a better parent than you.
I could go on, but I have to ingest two copies of Nozick before I can regurgitate another one of these lines and my body can’t handle any more cellulose.
Yes, I know you have an ad hoc philosophical justification as to why some forms of giving money to strangers enforced by Men With Guns is acceptable, and why some are not. Every political faction has their own. No one is under any obligation to accept yours.
I was very moved when I read that piece also. I don’t feel informed enough to comment on the issue of S-CHIP but I feel that the case made on Feministe is very compelling indeed.
Time’s up, Justadog.
Sylphhead – Re: your last 5 paragraphs.
You’re awesome.
—Myca
“Whuf whuf whuf. Bark! Bark! Grrrrr, taxes. Woof Democrats! Aroooooooooo free market!”
Myca, I owe you a box of chocolates in exchange for the awesomeness of that edit.
I encourage anyone who thinks developing new drugs is cheap, easy, or simple to go and try it. Really. Because I know a lot of people who do it for a living, and it is difficult, slow, extremely high risk, and VERY expensive.
There are some alternative driving forces possible (like purchase promises) which provide incentives to develop with a greater benefit to the public. But though you can change the incentives, there’s no way to change the fact that developing drugs is difficult.
In any case, what about rationing? I believe most socialized countries ration health care to some degree, either explicitly or through bureaucracy. Rationing is perfectly acceptable, mind you; it allows for a huge cost savings to cut off some of the isolated low-success high-cost patients, which means there’s more money to treat everyone else. I find it an interesting topic because it’s rarely discussed openly.
Roughly, because the free market has no mechanism in place to provide health care to people who are unable to pay for it.
I’ve heard over and over again that our current system is not a free market, and that’s cool, but then it’s incumbent on the person claiming that a free market would provide healthcare to those without money to show precisely how that would happen, because I don’t see it.
And if you’re proposing a free market system, but you’re not claiming that it can provide healthcare to those without money, then what you’re saying is, “it’s okay if a bunch of people die horribly because that’s how the free market works.”
—Myca
The ugly “What you’re saying is…” beast rears its head again: speaking for myself, I’ll say that “what I’m saying” can usually best be understood by what I SAY, and not what others claim I said. But that’s just me; perhaps you feel differently.
Irrespective of that, I have a question: what level of health care do you think that everyone should be entitled to? What level and type of health care should we guarantee to every citizen who needs it? (and do you also believe that this should be guaranteed to noncitizens?)
Imagine, for an example, that you could assign each of the health care options below into “covered” or “not covered” categories; how would you do so?
-Short term emergency care
-Palliative care, whether short term or long term
-Preventative care
-Long term care
-“Best practices” and/or “best technology” care
-Unlimited care; i.e. that level of care available to those in the U.S. with either truly outstanding health insurance, or truly enormous amounts of money.
-High-cost care
-Medically unproven care
-Untested / early test phase care
-medical procedures that the patient thinks they need
-medical procedures that the patient’s doctor thinks the patient needs
-medical procedures that the plan administrator (government, insurance, etc) thinks the patient needs
I am curious.
Let me rephrase.
If you oppose universal health care and you do not explain clearly by what mechanism you will give medical care to poor people, you will be banned.
You will be banned because I am interpreting your position to mean “it’s okay if a bunch of people die horribly because that’s how the free market works.” You probably don’t say this in as many words, because people rarely state the odious things that they believe in that way.
Good news, though! You have the opportunity to disabuse me of this interpretation by explaining what your alternate plan to provide medical care across the board for the vast majority of poor people is.
In other words, if you want to post here, you have to own, explain, and actually defend your beliefs, not just make hand-wavey references to ‘stealing other people’s money’ or that kind of thing.
—Myca
If you oppose universal health care and you do not explain clearly by what mechanism you will give medical care to poor people, you will be banned.
How about this: we’ll collect tax money from the taxpayers, put it into a fund, and use that fund to pay for the free-market care that poor folks need but can’t afford. We can call it Medicare, or possibly Medicaid…
It isn’t rocket science.
Cool, and you have no problem expanding Medicare and Medicaid radically so that they’d prevent situations like La Lubu’s?
I ask because La Lubu’s situation is what the point is. She had a job. She had insurance. It was still a sadistic fucking nightmare. A solution that does not address that is not a solution.
—Myca
Myca,
How ’bout this? Instead of only asking your opponents to post a position–so that you can attack it, based on its presumed issues, you ALSO post a position? Otherwise, you seem to be setting up the claim that “their position is bad” = “your position is good.” That may make for simpler argumentation on your part, but it’s not a correct argument.
And that is why I asked you those questions. Why do you think they’re irrelevant?
And Amp: what’s up with this type of moderation? I know Alas has generally been one of the more open boards. As I read this, there is now a requirement that has nothing to do with the normal moderation issues here. I.e. a non-attacking, non-insulting, argument that doesn’t meet Myca’s standards will be converted into animal noises? That type of mockery and mod action is very unlike the normal stuff, and is (should be) beneath Alas as a whole.
Sailorman, I didn’t set this up as a feminists only post, since this isn’t exclusively a feminist issue, but you should consider it the same sort of thing.
In order to post here, you need to meet a minimum set of criteria. I set these criteria because on this topic, that’s the kind of conversation I want to have . . . I do not want to have to explain why everyone deserves healthcare, and I do not want to have a tax debate. I want to discuss methods to avoid the issues La Lubu encountered and to make sure nobody else encounters those issues.
You are refusing to make an effort to meet those criteria. Please start meeting them or stop posting. Now.
—Myca
Myca, you’re asking for two different things. As you noted, La Lubu wasn’t poor. What, then, is the connection to whether a hypothetical market arrangement would help the poor?
If you want to talk about La Lubu’s situation and how she would have been better off in a free market, I’d be glad to do that. What problem do you see La Lubu as having had, that a free market health care system couldn’t take care of at least as well as a socialized system?
And I have to agree with Sailorman about the moderation. If you don’t want a certain class of opinion expressed, then say so and enjoy your echo chamber in peace; nothing wrong with a good echo chamber discussion once in a while. If you want to have an argument or discussion with people who disagree with you, then do that. You’re essentially inviting people who disagree to try and toe a certain line so that you can then indulge in mockery of the ones who aren’t quite articulate enough to hit your standard. It’s childish.
No.
This post is not for attacking universal health care. That’s not it’s purpose.
This post is for offering solutions. Preferably, solutions that bear La Lubu’s experiences in mind.
If you have no solutions to offer, you probably have nothing to post.
—Myca
Um, yeah. So if you post a position, you’ll be sharing with us YOUR solution.
No, the only people who have been animalized were out and out trolls . . . and what’s more the moderation goals for this post have been explained in detail and clearly, both in the post itself and in the comments.
We’re now done talking about them.
Nobody is making you comment here. If you don’t have anything constructive to offer, then don’t offer.
—Myca
You know, Myca, I read the posts in question before you “animalized” them. They weren’t trolls. They were people who disagree with you. It’s frankly chickenshit to moderate the way you are moderating.
It’s clear that you don’t want an actual discussion. I’m not quite clear on what you do want, and as you say, nothing is requiring me to comment here. So I’ll simply say that water runs downhill, tanstaafl, and good luck to you in your social dreaming. Good day, sir.
Okay, my position is that we need universal, tax supported health care that covers every man, woman, and child in America.
Also, foreigners who are visiting our country should be covered.
I believe with what we already pay on health care as a nation, we can do this easily, paying roughly what we do now, but providing health care that doesn’t depend on employment status and doesn’t bankrupt the patient or the patient’s family.
How this would have helped La Lubu should be obvious.
Feel free to criticize, but any criticism you offer will be compared to the solution you offer.
—Myca
Sailor,
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”.
Ditto.
Not true! It’s entirely possible that you are not capable of having the sort of discussion I would like to have, but that’s a different sort of thing.
I would like to have a conversation on this topic with people who share my basic goals . . . that is, health care for everyone in the country who needs it, and who do not consider ‘the free market’ a reasonable argument against that.
Since I think you’ve been pretty damn counterproductive in this thread, I’d like to ask you not to post in any of my threads from here on out.
—Myca
Myca: If you oppose universal health care and you do not explain clearly by what mechanism you will give medical care to poor people, you will be banned.
Well, I will give medical care to poor people (other than myself) by continuing to do what I already do. I scrape by on about US $13,000 a year and I give about 1/3 of that to groups that provide direct economic and medical aid to other poor people (Direct Relief, abortion funds, Planned Parenthood, battered women’s shelters, rape crisis counselors, etc.). I’m able to give that much partly because I don’t have any children to care for and partly because I have wealthier family members that I know I could ask for help in an emergency. But even without those advantages, I’d be able to give this kind of money more comfortably if it weren’t for the government’s constant draining of my resources through taxes to pay for red tape, corporate welfare and armed thugs. In any case I do think that I, at least, am doing something more to own my beliefs than just waving my hands around. As for explanation and defense:
Myca: I’ve heard over and over again that our current system is not a free market, and that’s cool, but then it’s incumbent on the person claiming that a free market would provide healthcare to those without money to show precisely how that would happen, because I don’t see it.
OK, but that’s not what’s been argued so far. What keeps happening is a comparison between something horrible that happens, or almost happened, under the U.S. state-corporatist system, and what would happen under some other state-socialist system of healthcare. But comparing the characteristics of one tightly-controlled government-regimented system of healthcare to those of another tightly-controlled government-regimented system of healthcare illuminates very little about how a free market would work, because neither of the options under comparison has very much to do with free markets. If you want to argue that state-socialism is better than state-corporatism, fine, but you should leave the free market out of it. If you want to argue that a free market in healthcare would still have features that make it worse than state-socialist healthcare, that’s fine too, but it requires some further argument that hasn’t yet been given in any detail.
As for the beginnings of an argument that you give in this comment:
Myca: Roughly, because the free market has no mechanism in place to provide health care to people who are unable to pay for it.
I’m not convinced. Because, well, of course it does. The “mechanism” is the same mechanism that exists in state-corporatist or state-socialist healthcare systems: people who are unable to pay for healthcare themselves can get it by getting other people to pay for part of it or all of it. The question is what means of getting other people to pay for it are available–and whether these means are voluntary or coercive.
Any State-run system of medical care that you happen to like could, in principle, be provided by voluntary mutual aid on a free market. The State has no special ability to make medical care “free,” or to summon up money from nowhere to pay for it; for the State to cover the medical costs it has to get money, labor, or supplies from somebody else, and whatever the State takes could be given voluntarily. Suppose that you like the way that money is collected and distributed in the French medical system; then on a free market, nobody is going to stop you from creating a nonprofit French Mutual Society for Medicine that uses the same bureaucratic mechanisms to collect, allocate, and pay out money. The only limitation is that, whatever system you cook up, you cannot force people to pay in, and you can’t force people to use your system for their own healthcare costs.
You might claim that unless everybody is forced to pay in, there wouldn’t be enough money to go around. But consider the billions of dollars that are voluntarily pissed away every two years trying to elect a slightly more “progressive” gang of weak-kneed establishment politicians, and what might happen if those resources were redirected towards direct action rather than electioneering and lobbying. Let alone the amount of money that might go to healing people rather than killing them if individual people, rather than belligerent governments, had control over the dollars currently seized in taxes.
You might instead claim that even if there is enough money to go around, this kind of model puts poor people at the mercy of donors for their healthcare. But I could just as easily respond that using the State to cover healthcare costs puts poor people’s at the mercy of the political process, which certainly offers no guarantees that the least powerful and least connected people in a society are going to get what they need, or even get decent human respect. In either case, people who aren’t very powerful need to organize and struggle to protect their interests from people who are more powerful than they are. The question, again, is what means of struggle are (1) morally preferable, and (2) strategically effective.
I don’t think it’s crazy to see voluntary, bottom-up mutual aid as both morally and strategically preferable to top-down political regimentation. Voluntary mutual aid may not actually produce a healthcare system that looks much like the nationalized healthcare systems common in western social democracies, but I think that the differences would largely be for the better: less bureaucracy, more alternatives, and more control in the hands of the patients themselves. Unlike the corporatist system in place today, medical costs would be drastically lower, thanks to the removal of the government-created monopolies and cartels that currently control every aspect of the insurance, medical, and pharmaceutical industries. And unlike the corporatist system in place today, medical costs might be covered not only by charities or churches or bosses (gag), but also through grassroots associations such as mutual aid societies and labor unions. (There is some actual history here; lodge practice medical arrangements in the U.S., U.K., and Australia used to provide healthcare to working-class folks at a rate of about one day’s wages for one year of healthcare, before the growing trend was halted and obliterated by the politically-connected medical establishment, with the backing of the State.)
Hope this helps.
Sailorman: I’m not myca, but I’ll give you my opinions on which of these should be funded and to what extent:
-Short term emergency care
Obviously. The alternative is to have people dying on the doorsteps of hospitals. Probably including people who do have insurance but got hit by a bus while going out to the corner store and who forgot to bring their insurance cards with them. I strongly suspect that even the caricature “evil republican” who cares nothing for poor people doesn’t want to risk dying because he or she forgot his/her insurance card one time.
-Palliative care, whether short term or long term
Duh. Sorry, nothing more to say here, except that allowing people to die in pain is bad.
-Preventative care
Definitely. For one thing, this is a money saver. Preventive care is not free and it would cost something to, for example, run a colonoscopy through the large intestine of every person 50 or older, but not as much as treating a bunch of colon cancer cases would. Preventive care for cheaper and better medical care. Which preventative tests are cost effective, useful, and lead to better or healthier lives can be debated, but the basic principle can not.
-Long term care
Yes. Reason #1, leaving people to die or get acutely ill after a major illness is inhumane. Reason #2, it is also expensive. If long-term care isn’t covered then people who are well enough to leave the hospital but not well enough to manage on their own stay in acute care hospitals, at greater expense, because no doctor is going to dump them on the street. Both because of the humanitarian issue and because they know that if they do the patient will just end up in the ER again, much sicker, in a few days. Again, doing it right is cheaper than stop-gap measures.
-”Best practices” and/or “best technology” care
Of course. Who wouldn’t want to get–or give–the best possible care. The question “does new technology X really add anything to the standard of care” can reasonably be asked in a number of situations and, if it doesn’t then new technology X doesn’t have to be covered as standard of care until it is refined to the point that it is helpful, but really, why give sub-standard care?
-Unlimited care; i.e. that level of care available to those in the U.S. with either truly outstanding health insurance, or truly enormous amounts of money.
Depends. Does the “unlimited care” in question add anything to survival or quality of life? If yes then yes, if no (for example, paying for private rooms in the absence of medical indication) then that’s what supplemental insurance and/or private payment is for.
-High-cost care
As above: only if it is proven to be worthwhile.
-Medically unproven care
No, except in the context of a clinical trial. Paying for clinical trials, on the other hand, is an excellent idea. The fact that the US has had the NIH to do just that has kept it a leader in the field for many years.
-Untested / early test phase care
As above.
-medical procedures that the patient thinks they need
-medical procedures that the patient’s doctor thinks the patient needs
-medical procedures that the plan administrator (government, insurance, etc) thinks the patient needs
Sorry, I’m not sure what point you’re trying to make with this group. The people who need to decide the care plan are the doctor and the patient, not the insurer, whether government or private, if that is the question.
In any case, what about rationing? I believe most socialized countries ration health care to some degree, either explicitly or through bureaucracy.
For whatever this is worth, if you measure rationing by uptake of new drugs, you’ll find that it is not nearly as drastic as you might think and quite variable by country and even by drug. For example, imatinib uptake was extremely rapid in both the US and the EU. Rituximab, on the other hand, was taken up more slowly in the EU than in the US, with a good deal of variability between EU countries. Uptake in the use of both drugs was quite low in South Africa, the only other really good example of an industrialized country without a universal health care system of some sort or another. So univeral health care is neither a clear marker for “rationing” nor a perfect defense against it. Medications with an obvious benefit get used quickly in most systems, those with less immediately obvious benefit, more slowly.
Rad Geek:
Good comment, and I’ll respond a bit later, when work is less eat-my-brain-y.
I just wanted to say that yours is a perfect example of how you can post from a free-market perspective while sharing my basic goals. I disagree with a lot of what you wrote, but I really appreciate that you come from the angle you do.
—Myca
To be honest, I think La Lubu got better care within the system as is than she would have received in a totally socialized, single-payer system. What you want, Myca, is a system without exceptions, and I don’t think that is possible.
Rationing is necessary in a socialized system because of the pigeonhole effect. If you only have five hospital beds and they are full, the sixth patient must wait. The way around this is triage, and I don’t think La Lubu would have made the cut.
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.
This is why these bills have so much problem getting out of committee, even those who support totally socialized healthcare cannot agree on how to implement the short-term goals. The infrastructure of the current US system is insufficient for handling a socialized system.
Also, you are not considering a very large bloc of players, the individual states who are demanding large roles both in determining the nature of the system and in running the system once established.
Finally, such a system as you want would have to be made bulletproof, because the next Republican president to come along will be hacking it to shreds with line-item vetoes, that is if he or she doesn’t just scrap the whole thing altogether.
The hypocrisy of the “free market, pay your own way” crowd never ceases to amaze/amuse me. The same folks who go on and on about how horrible it would be to have one undeserving person benefit from a universal national health plan are the same ones who will scam like crazy to get their aged parents declared indigent so their nursing home care will be paid by MedicAid. I’ve seen it over and over — so-called conservatives ranting about the evils of socialism running straight for social services to beg for help when disaster strikes them.
I’ve also known way too many people like La Lubu who did have insurance and still wound up bankrupt due to medical bills. The health care system in the U.S. is broken, it is currently being operated as a for profit, private system and is not working, so maybe it’s time to admit there are some areas where the free market and profit motives simply are not appropriate.
Incidentally, La Lubu was lucky in a way — the baby was covered by insurance at the time of birth. I don’t know if insurance companies can still get away with it, but back in the 1970s the employer-provided plan issued by Aetna that my family had was written in a way that explicitly excluded an infant from coverage until it was at least 10 days old.
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It’s probably worth noting that unless things have changed a great deal, most directly-state-funded healthcare systems would have let La Lubu’s baby die. Saving micro-premies is one of the high-cost/low-success areas of medical care that tend to be unavailable in State-run systems. (25 weeks is borderline for NHS now, and pre-surfactant was almost certainly below borderline–surfactant made a HUGE difference at that age.)
Dianne: I actually support a socialized system of health care. But I don’t believe that such a system is attainable without rationing of health care.
In a fashion similar to the way Myca thinks the free market folks are failing to account for how the poor are going to get covered, I think many of the socialized medicine folks are failing to account for how people like La Lubu (whose treatment, if I recall from her outstanding post, cost somewhere in the range of $750,000) are ALL going to get covered.
And while I would like a more socialist health care system, I would also prefer not to have a relatively socialist ECONOMY (like, say, France.) Absent such, I think any socialist system of health care is going to have some pretty strict limits on care.
Or, more specifically:
1) We cannot afford to give everyone the same standard of care which we currently have available to rich people.
2) As a result, there will ALWAYS be something that isn’t covered, which you wish was covered.
3) As a result, that will have a selectively bad effect on poor people, because (unlike rich people) they can’t supplement their inability to get coverage.
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.
First, you can claim that you will provide what I refer to as “unlimited coverage”, which is pretty much equivalent to what rich people get. I don’t think there’s any way that we can achieve this without a pretty radical societal change, and perhaps not even then. But if you think so, you’ve got to explain how.
Second, you can simply set up a socialized system with rationing. This is where I come in. The interesting thing about it is that you can have ANY AMOUNT of socialized medicine based on rationing and budget. You can provide only free immunizations, or you can provide free child physician visits, or you can provide all citizens every medical treatment they desire.
But in that second, socialized, system, people die. And they die because they are poor. Of course, far fewer of them do so, if the system is a good one. But there will always be SOME that aren’t covered, who suffer from it.
So what I find frustrating are the “magic money” claims that socialized medicine will simultaneously provide for everyone AND provide for a level of case similar to La Lubu’s. In the U.S.A., I don’t think it can.
Does that mean I, um, ‘want people to die a painful death?’ No. Maybe Myca would think so, though.
In my opinion, we have to make tough choices. And I think many people–including Myca–are trying to duck them.
So to answer my own questions (I agree with you on any not posted here):
Because it’s cheaper. We can provide everyone access to a nurse practitioner more cheaply than we can provide access to a physician.
Say a lot of people think they have melanoma. For a given price, can look at everyone with a “suspicious mole” one of two ways. First, we can send SOME of them dermatologists. That way, the chance of a correct diagnosis is much higher. But dermatologists are more expensive, so not everyon gets to go. Alternatively, we can send them all to physicians. The chances of a correct diagnosis are still OK, but not as high. And so on. (and, of course, there’s the issue of how long everyone has to wait.)
The problem of course is that unlimited care offers an increasing cost/return ratio. You can run one test and catch 80% of the cancer. You can test again (double the cost) and catch 90%. You can run a third test (now triple the cost) and catch 93%. Which scenario do you choose?
No debate about clinical trials; I agree with your whole answer. But (and I didn’t intend for this to be a trick question) would you include “alternative medicine” in this? I would.
Actually, that’s sort of the point.
There have to be guidelines IMO, or else you get too much variation depending on which doctor you end up with. And there have to be limits, or else you get no cost control (see the 1, 2, or 3 test question as above.)
That means that there will always be some oversight that the doctor and patient can’t control.
It’s probably worth noting that unless things have changed a great deal, most directly-state-funded healthcare systems would have let La Lubu’s baby die.
Well, um…no.
Sweden has been providing care for babies born at 24-28 weeks since at least the 1970s. They are now definitely providing high tech care for 23 weekers.
Likewise, the Netherlands definitely covers 25 weekers, with decent results.
I could go on, but I think that the spam filter will be very unhappy if I keep posting links. Suffice it to say that La Lubu’s baby would not be left to die in most or possibly any country with universal health care.
Sam, what’s your evidence that in (to pick a country which has been cited on this thread for its excellent health care system) France they refuse to treat premature babies at all?
Amp,
I didn’t look at France–I looked at the NHS. Per the BLISS site, care is sometimes available below 25 weeks, standard at 25 weeks. My guess was (and is) that pre-surfactant, that cut-off was higher since surfactant use had such large effects on survival to the lower ages. I don’t know how to find out what NHS policy was in the mid-1990s.
Looking at France (medisite.fr), it is hard to tell what policy is. Exceptionnellement, et souvent au prix de séquelles, on a réussi à sauver des enfants prématurés de 5 mois et demi, soit de 26 semaines makes me think maybe standard of care in France starts at 26 weeks. I don’t know French medical terminology enough to figure out how find definite answers.
Dianne,
Maybe Sweden is an outlier, maybe the NHS and Netherlands are. I’m guessing that 25 weeks is the cutoff in the Netherlands (based on your link), as it is for automatic care in the UK.
Because it’s cheaper. We can provide everyone access to a nurse practitioner more cheaply than we can provide access to a physician.
I think that this is a misunderstanding of what a nurse practitioner does or can do. A nurse practitioner or physician’s assistant is generally someone with very high skills in a very limited area. Their ability in that particular area is or should be as high as a physicians, but their ability in other areas of medicine may be much lower or nil. So, for example, in the melanoma scenario, sending people to an NP or PA for melanoma screening might make sense: the practioner in question should have an ability equivalent to a physicians’ in correctly diagnosing whether the mole is truly suspicious and needs a biopsy, can be watched, or if they patient should be reassured and sent home with only standard screening. But they shouldn’t be asked to also adjust the patient’s blood pressure medication or estimate her fetus’ gestational age. In short, send them to an NP or PA for specific tests, to a physician for more complicated workups.
The problem of course is that unlimited care offers an increasing cost/return ratio. You can run one test and catch 80% of the cancer. You can test again (double the cost) and catch 90%. You can run a third test (now triple the cost) and catch 93%. Which scenario do you choose?
In the particular example I gave–colonoscopic screening–the answer is fire the colonoscopist: if he or she is only catching 80% on the first round there’s a huge problem. On the more general point, I’d say that that is a problem that should be addressed through public health measures and cost/benefit analysis of the situation. Also clinical research into better screening methods because an 80% true positive rate is crap. (Unless you’re talking about a very slow growing lesion–ie precancerous lesions of the cervix, in which case you simply do repeat screenings on a yearly basis and count on the repetition to save you.)
But I can’t see any way that it is ok to say “ok, poor people only need to be screened once, rich people need to be screened 3x.” Either one screening is enough or two or three are. No matter what the economic status of the patient.
But (and I didn’t intend for this to be a trick question) would you include “alternative medicine” in this? I would.
I would draw the same line for “alternative medicine” as for standard medicine: if it works it’s covered, if it doesn’t, it isn’t. Of course, that leaves a huge grey zone for things like accupuncture which show mixed results on studies. In general, I’d err on the side of covering more rather than less, but the exact level can clearly be debated.
That means that there will always be some oversight that the doctor and patient can’t control.
True, there is such a thing as “standard of care” which all practitioners are expected to provide, regardless of how or even if they are paid. But, IMHO, the entities in charge of establishing standard of care should be as separate as physically and politically possible from those providing insurance.
The sad truth of the matter is that care varies wildly in both universal health care systems and private insurance systems, despite hospital accredidation, licensing boards, internal policing of practioners by medical organizations, and every regulation in the world. In fact, as far as I can tell, volume is the thing that matters most: If you have disease X, go to the practitioner who cares for the most people with X at the hospital that sees the most X every year. No matter whether the hospital in question is public, private, VA, religious, etc. If they see a lot of it, they’re probably good at it. For whatever that helps.
Also to point out…The US has high rates of premature birth, even after correction for less accurate methods of establishing gestational age so it is entirely possible that la lubu wouldn’t have given birth at such an early point if she had lived in a country with universal health care.
Sailorman said:
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?
Sailorman,
What Mandolin said. :-)
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.
In addition to universal health coverage, I believe that it needs to include mental health & dental coverage as well. The three are parts of the whole. If one suffers, the other two often do as well. Dental Insurance in the US is even worse than HI.
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.
A friend of mine, who is an MD, explained his healthcare plan at one point. I liked it not only because it provides everybody with healthcare, but because it was thought up by a guy who is “in the business”, and knows more about the subject than I do.
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!
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.
Sorry for the cross-post Bjartmarr. I love the training idea. I’d like to make a requirement that every MBA first has to do time as a secretary.
Oh, and to the folks who think that we will need rationing under a universal coverage system: much of the need for rationing will be eliminated by providing cheap preventive care rather than expensive emergent care. We live in the richest country in the world; I think we can afford to pay for check-ups for everybody, cheap early-intervention procedures for those who need them, and expensive catastrophic care for the rare few that slip through the cracks.
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.
Sorry, I don’t care for the training idea, at least not as it stands. Several problems with it:
1. Nurses are not simply physicians who couldn’t hack it. They need to have particular skills that are different from those that doctors need. I’d rather see nursing taken more seriously as a profession and this sounds like a way to get it taken less seriously.
2. Doctors need to get a proper undergraduate degree in a basic scientific field so that they will proceed with a basic understanding of biology, chemistry, and physics and not fall for stupid ideas like, for example, creationism. By the time they get an undergraduate degree in some basic scientific field, a nursing degree, a PA degree, an MD, then specialty training, sub-specialty training, etc, they’ll be retirement age before they can go into practice.
3. PAs are not physicians who are less skilled. A good PA is highly skilled and the equivalent of a physician in his or her area. Their skill set is simply more limited than that of an MD. Hence, asking MDs to first be PAs is basically asking them to learn to specialize before learning the basics.
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.
Bjartmarr: 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.
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.
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.
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.
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?
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.
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?
Here’s a crazy idea. Instead of arguing over health care, why don’t people just change the farm bill and enforce stricter policies with the EPA? That way we’re not poisoning ourselves… think of it as a preventative measure.
Dianne:
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.
“Since most of the cancer and heart patients are older folks, most of them are already covered via Medicaid.”
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.
Asking juries to determine whether a doctor was negligent just doesn’t seem to be working out very well, as awards are fairly unpredictable.
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.
Ferg, re preventive care not handling the huge number of people already sick: point taken.
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.
However, isn’t it still true that a doctor who is being sued often has no real way of knowing…
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.
I am a woman in California. I belong to the almighty HMO Kaiser. I was born in this HMO. I was fired in 2004 because of a nervous breakdown episode of threatening phone calls. I was unable to contact my doctor directly (HMO hell) when I tried to get my Doctor to intervene. I hung up on the hosptital (a big no-no for a psych paitent )and the cops were sent to my house and I was 5150 ed.
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.
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.
Maybe if the US Government would stop providing free health services ( among many other services ) to people from other countries that come to the US, our health care system wouldn’t be quite in the state it is in. I don’t mean to sound cold hearted I know everyone deserves health care, But it seems a lot our health care resources are being spent on foreigners and illegal aliens that I believe should go home!