Listened to a program today on Universal Healthcare..........

[al_bundy]

once in a while my wife looks at the best doctors in their fields, and most of them don't accept medicare or medicaid

if we go to a socialized system then the good doctors will just not participate and we will have a bad system for the peons and a good system for the rich who are advocating socialized medicine. i prefer the current system where my wife went to a surgeon who is one of the top people in his field and a full professor at one of the best medical schools in the US and got excellent care.

I have a primary physician I go to just for annual blood tests who i think very lowly about. I never take his referrals and always found my own specialists when needed who are a lot better. the few people that did follow his advice almost died in the hospitals he said they should go and they are some of the worst hospitals in NYC. And they had problems because the hospitals are bad hospitals, not due to their conditions.

 

[Martha]

With due respect to Rich, he is one doctor, who happens to be on this board, and is in favor of universal government health care.  I know many who are strongly opposed.  Let's quit deferring to Rich as the resident expert  on this political issue, simply because of his medical training ... I'm sure he will admit there are differences of opinion in his profession.

 

I like Rich's point of view on what is happening in the trenches.  We hear a lot about how we have the best care in the world andwhy endanger it by moving to a national healthcare system.  Rich questions that assumption.

Ironic that we met with an agent in today who explained that more companies are moving to HRA's / HSA's, with success.  Surprise, market forces are being brought to bear in the health care profession, and it is beginning to work.  We spend over $1M/year on group health premiums, and we will likely go this route, and do so in a way that reduces premiums for our employees, and will likely put dollars into their 401k's to boot.

I think HSAs are a great idea for the young and healthy.  The problem is that it works great if you get in while you are healthy and can accummulate money in an account.  If you already have a chronic illness or a serious illness, you end up using all your money in the HSA each year for medical care.  What I have seen over the past few years are more and more options and choices proposed that will make it easier for young and healthy people to get insurance and to save money.  These same options can make it more and more difficult for older and sicker people to get health care.  .

To the comment above that large companies tend to favor universal government health care, this is true ... for the same reason some retirees prefer it.  This solution foists the problem on to someone else's shoulders.  Small and medium-sized businesses tend to oppose such a solution, because they have often been wiser in their judicious offerings of benefits.

I propose sharing the problem with everyone, not foisting the problem on someone else, which is what we do now.  I have managed a small business of approximately 75 employees.  We would love national healthcare.  My small business clients would love it as well.  They have a hard time buying insurance for small groups and pay more than large businesses, sometimes significantly more, for the same coverage.  Some very small groups can't buy it at all.  It would also make it easier to hire more full time employees because you wouldn't have to worry so much about beneft costs.

 

[Nords]

Nords, you keep cracking me up by repeating, "I think that if any of the 180+ other countries in the world were doing it both cheaper AND better, not necessarily just one or the other, that their method would have been shamelessly copied by now." and "if 180+ other countries had a better system then it would be copied." 
It HAS been copied.. one hundred and seventy-nine times.. WE are the odd ones out!! Does the US really have nothing to learn from anyone else?
To answer your question seriously, it's because the very big, very profitable, very influential (Frist!) healthcare and insurance INDUSTRY has way more traction in the US than anywhere else. The different mentality re. health care abroad just hasn't allowed this profit machine to overwhelm their systems.

I don't know enough about foreign healthcare to be able to point to a difference, but I'm pretty familiar with human reactions to an opportunity to make money in a capitalist society.  That's why I don't buy into the insurance/pharma oligarchy theories.  Someone always finds a way to weasel around the big company's death-grips on the system, and when they start making money then everyone wants to do it.

So what differences are there?  Access?  Waiting lists?  "Defensive medicine" with extra tests ordered just to be sure?  Litigious patients?  Soylent green end-of-life care?

As for socialized medicine, I have a hard time agreeing that it's a good idea to turn over our healthcare to the government.  That's how the military got its healthcare system, and right now it's so cheap that it ain't necessarily attracting the best & brightest.

 

[razztazz]

once in a while my wife looks at the best doctors in their fields, and most of them don't accept medicare or medicaid

Class warfare. My folks had more money than your folks. Kiss my ass or you can die. Professional and Business ethics ya know. Hardly the basis for any system worth allowing to exist.

if we go to a socialized system then the good doctors will just not participate

An administrative matter.

will have a bad system for the peons and a good system for the rich who are advocating socialized medicine.

Once again., class warfare and btw ... I don't know any cabal of Rich people advocating for socialized medicine. Certainly not Republicans and they are mostly The Rich

i prefer the current system where my wife went to a surgeon who is one of the top people in his field and a full professor at one of the best medical schools in the US and got excellent care.

YAAAAAAWn... yeah until somebody gets really sick and it starts to get expensive. Or Gawd forbid you actually could go broke.. they you will start with the "There oughtta be a law!"  Black people have their programs... poor people live like kings off the Government ...  We're the richest nation in the world ... we can put a man on the moon but we can't.....why should I have to pay for this!.....  I'm usually Conservative on most issues but we really need to do something about medical care


About most MD's being ...well, I ;'ll say casual in tehe xtreme abotu their knowlge of medicine and give-a-sht factor.. yes I know that. Just shut the F up and take this drug!  But I also, belive it or not,  have a LOT of frikkin' difficulty actually PAYING for things with MONEY

I mean I need  a test or diagnostic done and they're concerned ONLY with INSURANCE INSURANCE INSURANCE.  And they willl gladly lie/wag/tweak the paperwork to get it on the insurance before they give me a price! And the times I have done this "al fresco" it was like pulling teeth to get the price THEN nobody wanted to give it to me in writting BEFORE the procedure. They'd schedule it chop chop the hustle me thru THEN I get a bill. If I waited for the bill they'd hold up the test

And as far as seeking your own specialist... tell me how you do that. Specialists do  not see "Walk in" traffic . You have to be refrred by another doctor. The principle is "YOU can't know you need a cardiologist (or whatever)  (I am not in an HMO or other network. I pay extra to keep my hands free)

There is something much more insidious going on behind the Green Door besides simply a mere insurance plan model or care access  issue.

 

[razztazz]

  think HSAs are a great idea for the young and healthy.  The problem is that it works great if you get in while you are healthy and can accummulate money in an account.

It's a red herring that does not address affordability or access. It just gets the well-off  off the hook for more taxes and has everybody else subsidize their tax bonanza.  They don't help people who simply dont have the money period, and they don't help people who dont make out taxes wise. And if you make enough money to make-out tax wise you don' need the tax break.  Welfare for the well off and healthy (so far)

Small and medium-sized businesses tend to oppose such a solution, because they have often been wiser in their judicious offerings of benefits.

I love this strange-bedfellows or cognitive dissonence or whatever it is. Most of the time the same people who poo-poo any talk of universal access/affordability such as Limbaugh and other "free marketeers" also simutaneously rail and rant  to the effect Why should employers be in the health insurance business?! Why should your employer provide you with medical insurance?!  Here, however, we are bragging about how skillful they are at it, how much they enjoy it,  and  THAT is the reason we should keep on doing it.

 

[Martha]

As for socialized medicine, I have a hard time agreeing that it's a good idea to turn over our healthcare to the government.  That's how the military got its healthcare system, and right now it's so cheap that it ain't necessarily attracting the best & brightest.

I believe that there was an article in Business Week in the last month or so about how the VA has done much to turn itself around.  Because they have customers for life, there is an emphasis on preventive care.  Their outcomes are also better than private medicine.  Sorry, I can't seem to find a link. 

But, from what I understand many of the improvements at the VA came from a good strong leader who has since been ousted by Congress (not confirmed for a new term) because he closed some clinics. 

So there is a political problem with a national system that we would need to work to get our arms around.  I still say we need to make a choice on a direction and do it.  Whether it be a nationalized sytem, a highly regulated insurance industry, or government subsidises. 

 

[al_bundy]

Class warfare. My folks had more money than your folks. Kiss my ass or you can die. Professional and Business ethics ya know. Hardly the basis for any system worth allowing to exist.

An administrative matter.

Once again., class warfare and btw ... I don't know any cabal of Rich people advocating for socialized medicine. Certainly not Republicans and they are mostly The Rich


YAAAAAAWn... yeah until somebody gets really sick and it starts to get expensive. Or Gawd forbid you actually could go broke.. they you will start with the "There oughtta be a law!" Black people have their programs... poor people live like kings off the Government ... We're the richest nation in the world ... we can put a man on the moon but we can't.....why should I have to pay for this!..... I'm usually Conservative on most issues but we really need to do something about medical care


About most MD's being ...well, I ;'ll say casual in tehe xtreme abotu their knowlge of medicine and give-a-sht factor.. yes I know that. Just shut the F up and take this drug! But I also, belive it or not, have a LOT of frikkin' difficulty actually PAYING for things with MONEY

I mean I need a test or diagnostic done and they're concerned ONLY with INSURANCE INSURANCE INSURANCE. And they willl gladly lie/wag/tweak the paperwork to get it on the insurance before they give me a price! And the times I have done this "al fresco" it was like pulling teeth to get the price THEN nobody wanted to give it to me in writting BEFORE the procedure. They'd schedule it chop chop the hustle me thru THEN I get a bill. If I waited for the bill they'd hold up the test

And as far as seeking your own specialist... tell me how you do that. Specialists do not see "Walk in" traffic . You have to be refrred by another doctor. The principle is "YOU can't know you need a cardiologist (or whatever) (I am not in an HMO or other network. I pay extra to keep my hands free)

There is something much more insidious going on behind the Green Door besides simply a mere insurance plan model or care access issue.

call it class warfare, but the reality is we will never have a socialized system where all doctors will be forced to participate. The richest senators are actually democrats and they will never pass a system that leaves them with bad medicine. the most affluent areas in the US vote democratic and people there will never agree to a socialized system that limits them. I live in NYC, and I know. We have some of the best doctors in the world here and if the government suddenly says people can't see them there will be a revolution.

depending on your health plan, you can go see specialists without a referral all you want. Only in HMO's do you need a permission slip from your doctor.

my wife used to work in one of the best hospitals in the US here where some of the richest people come for care from all over the US and most of them are openly democrat. We will never have a socialized system where all doctors must participate and will get paid very little like medicare.

at best we will have a system like the NY state health insurance where all the uninsured and self employed can enroll and the premiums are based on income with the rest of it subsidized by the state. It's an HMO, very limited and many of the top doctors don't take it. the goal is to reduce costs by reducing ER visits.

 

[Nords]

I believe that there was an article in Business Week in the last month or so about how the VA has done much to turn itself around.  Because they have customers for life, there is an emphasis on preventive care.  Their outcomes are also better than private medicine.  Sorry, I can't seem to find a link. 
But, from what I understand many of the improvements at the VA came from a good strong leader who has since been ousted by Congress (not confirmed for a new term) because he closed some clinics.

Yep, I read it-- http://www.businessweek.com/print/magazine/content/06_29/b3993061.htm?chan=gl

Maybe the military should adopt the VA's model. Right now they're two completely separate-- and not necessarily cooperative-- institutions.

 

[lets-retire]

The last time I went to the VA was 2002. I ran from there and will never return. It was the worst care I had ever received, but you couldn't beat the price.

 

[razztazz]

The last time I went to the VA was 2002. I ran from there and will never return. It was the worst care I had ever received, but you couldn't beat the price.

I second that emotion... I went there once in 1996...and had one telephone conversation with them in 1997 or 98. Lost my records..... wasn't pretty. I'm offically disabled but I opt to just walk with a limp instead

 

[Rich_by_the_Bay]

Has anyone stopped to think that maybe we are the richest/most powerful country in the would because we don't let the lazy suck off those who work their butts off.

That's a common observation and certainly may be a factor in some situations. But for all the anecdotes about self-inflicted illnesses, smokers, drinkers, obesity, etc. the reality is that everyone gets sick. Sooner or later everyone gets sick. And since health care is not like cars, you can't morally just not sell them the product cause they don't have the money.

So, if you believe the premise in your comment, it's probably best addressed in areas other than health care.

Leave the lazy/poor/high-risk, etc. out of the equation and who wil pay for it when their number comes up and they show up in the ER? Who else: the responsible, hard-working, better-off folks like us. I say cover them (means testing is fine with me) so at least you have a shot at getting them into treatment programs, paying for preventive drugs like BP meds, and keep them out of emergency rooms and the like.

I share your resentment about people who can contribute simply choosing not to, though. Just don't think they are the biggest part of the problem in re: health.

 

[haha]

I share your resentment about people who can contribute simply choosing not to, though. Just don't think they are the biggest part of the problem in re: health.

Dicey train of thought on a forum dedicated to stopping work at the earliest possible opportunity.  Should we resent ourselves?

Ha

 

[REWahoo]

Should we resent ourselves?

I resent you asking that question.

 

[Rich_by_the_Bay]

Dicey train of thought on a forum dedicated to stopping work at the earliest possible opportunity. Should we resent ourselves?

OK, point taken. Let me re-phrase:

"I share your resentment about people who can contribute to their own welfare yet who simply choose not to. On the other hand, those scum-sucking, self-indulgent, ignorant, uncircumcised barnacles who retire early should all be drawn-and-quartered with all resulting injuries excluded from their health plans."

That work?

 

[REWahoo]

"I share your resentment about people who can contribute to their own welfare yet who simply choose not to. On the other hand, those scum-sucking, self-indulgent, ignorant, uncircumcised barnacles who retire early should all be drawn-and-quartered with all resulting injuries excluded from their health plans."

Does all the above still apply if your barnacle has been circumcised?

 

[lets-retire]

Rich- I was talking macro not micro.

 

[Rich_by_the_Bay]

Does all the above still apply if your barnacle has been circumcised?

You always manage to cut through to the real meat of the problem.

 

[haha]

Does all the above still apply if your barnacle has been circumcised?

Speak for yourself man, mine's a geoduck.  

Ha

 

[Rich_by_the_Bay]

once in a while my wife looks at the best doctors in their fields, and most of them don't accept medicare or medicaid

All the best doctors I know in every field accept both Medicare and Medicaid. Virtually every physician at any major academic or research medical center does (some of the best practice in those settings).

What on earth are you referring to?

How are you determining who's the best? "Concierge" practices?

 

[haha]

All the best doctors I know in every field accept both Medicare and Medicaid. Virtually every physician at any major academic or research medical center does (some of the best practice in those settings).

What on earth are you referring to?

How are you determining who's the best? "Concierge" practices?

Agree with you Rich.

When I lived in Boston my girl friend was badly injured. She was taken care of, mostly with reduced rates or free, by world famous doctors at Massachusetts General Hospital. IMO, the best doctors are often the least money oriented

 

[al_bundy]

www.nymag.com

they do an annual survey of some of the best doctors

 

[REWahoo]

Speak for yourself man, mine's a geoduck.

I had a pithy rejoinder inquiring about a geoduck being a variety of shirmp, but...oh nevermind.

 

[sailor]

www.nymag.com
they do an annual survey of some of the best doctors

But how do they determine the best?

 

[Rich_by_the_Bay]

www.nymag.com
they do an annual survey of some of the best doctors

Al, I know these are very convincing ratings the way they are worded and edited.

I am not one of the world's best doctors. I have made the relevant "Best Doctors in Town" and even national listings virtually every year since I was 35 years old. Maybe because I am in academics. These are, alas, often polls of doctors rating their colleagues who just happen to refer a lot back and forth, etc. That plus the docs who are truly nationally recognized in their fields and live in the area. Lots of great doctors are included in the list, but even more docs who are popular. Not to demean anyone, but these are often an odd melange of true role models, ritzy practices, big practices, and good old boys/girls.

The bigger the city, the less likely they are to reflect scientific quality and interpersonal giftedness. They do measure a certain ability to sustain a legitimate, high profile practice, often with a high income slant. At least I would use caution before accepting that these listings represent "the best" or the worst. Hope that provides a bit of perspective.

They sell magazines but probably are not the definitive resource in this hard-to-measure parameter.

 

[Martha]

Exact same thing goes for Best Lawyer lists.