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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 12:45 AM   #21
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Re: Wow, what do people do who don't have health insurance?!

Quote:
In fact, we are already starting to see a shortage in primary care physicians
Interesting -- according to a chart on the front page of the WSJ last week, this is exactly correct. It looks like the number of medical school graduates filling family-residency positions has decreased from a peak of about 2300 in 1997 to about 1150 in 2006. Wow, that is a 50% cut. It takes awhile to see the effect in the overall market since the older doctors have to retire over time.

Also, the average salary quoted (2003) in the US for General Practicioners was $121,000, quite low for the caliber of people that become physicians, the amount of time and money it takes to become one, and the competing professions out there. (not to mention the chance of getting sued)

On the other hand, my brother-in-law (aged in late 40's) is making a killing as a surgeon in the Midwest as part of a small 5 surgeon practice. He makes a little over half a million a year in a modern city with moderate weather where the average house costs roughly $125,000. That is what I call a "4x salary," about 4 times the median house price. (then again, he had to pay over 75K for the malpractice "tail" insurance when he left his last job to protect him against malpractice suits from those past surgeries)

On the third hand, it seems like Physician's Assistants can do a lot of things that GP's used to do? Can't they prescribe medicine in certain states now, etc.? Maybe that is good enough for front line care?

Also, the AMA actively opposes allowing doctors to immigrate to America in order to reduce the supply. A good friend of mine (now US citizen) is married to a brazilian doctor and they live in the US. She was a practicing doctor in Brazil, is fluent in English, passed her US boards on first try last year, and also went to Brazil's best medical school. The immigration process has been very difficult. She must now serve several years of low paid residency. And it will take her at least five years from beginning of this process to become a practicing doctor in the US. And she may even have to serve several years in a low population, rural outpost first depending on how the visa situation turns out.

Kramer
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 08:53 AM   #22
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by mykidslovedogs
Now you know why health insurance is so expensive....because healthcare is expensive! Healthcare providers are not overcharging....they are compensating for below cost services they provide to Medicare and/or Medicaid patients (gov't only pays avg of 30 cents on the dollar for Medicaid and Medicare services). With the rise in the babyboom population, it's only going to get worse. We should be thankful that our providers have the private sector to fall back on to retrieve lost income....otherwise, we'd start losing good doctors over time. In fact, we are already starting to see a shortage in primary care physicians, because young interns are discovering it's not worth it to go into that field since their income potential is greatly limited by price-controls for the masses of Medicare and Medicaid recipients that they would be required to provide services to.
Your point is valid.

However, there is a fairness issue here to the private sector payees. Why should they subsidize government based healthcare. Isn't that what taxes are for. If they government-based healthcare is not paying for the services it gets then there should be an adjustment to their payment structure.

We should have a real debate in this country about what level of treatment people getting government-based healthcare are entitled to and then pay the true cost through taxation. That is the only fair way.

This backdoor healthcare welfare just isn't right.



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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 08:56 AM   #23
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Re: Wow, what do people do who don't have health insurance?!

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Originally Posted by kramer
Interesting -- according to a chart on the front page of the WSJ last week, this is exactly correct. It looks like the number of medical school graduates filling family-residency positions has decreased from a peak of about 2300 in 1997 to about 1150 in 2006. Wow, that is a 50% cut. It takes awhile to see the effect in the overall market since the older doctors have to retire over time.

Also, the average salary quoted (2003) in the US for General Practicioners was $121,000, quite low for the caliber of people that become physicians, the amount of time and money it takes to become one, and the competing professions out there. (not to mention the chance of getting sued)

On the other hand, my brother-in-law (aged in late 40's) is making a killing as a surgeon in the Midwest as part of a small 5 surgeon practice. He makes a little over half a million a year in a modern city with moderate weather where the average house costs roughly $125,000. That is what I call a "4x salary," about 4 times the median house price. (then again, he had to pay over 75K for the malpractice "tail" insurance when he left his last job to protect him against malpractice suits from those past surgeries)

On the third hand, it seems like Physician's Assistants can do a lot of things that GP's used to do? Can't they prescribe medicine in certain states now, etc.? Maybe that is good enough for front line care?

Also, the AMA actively opposes allowing doctors to immigrate to America in order to reduce the supply. A good friend of mine (now US citizen) is married to a brazilian doctor and they live in the US. She was a practicing doctor in Brazil, is fluent in English, passed her US boards on first try last year, and also went to Brazil's best medical school. The immigration process has been very difficult. She must now serve several years of low paid residency. And it will take her at least five years from beginning of this process to become a practicing doctor in the US. And she may even have to serve several years in a low population, rural outpost first depending on how the visa situation turns out.

Kramer
When you need major medical care - we are going to send you to the doctor and hospital that makes the least amount of money !

I hope that it works out for you !
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 08:59 AM   #24
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by MasterBlaster
We should have a real debate in this country about what level of treatment people getting government-based healthcare are entitled to and then pay the true cost through taxation. That is the only fair way.
The problem is, you can't tax people enough for government healthcare. If we were continually taxed to pay for the government programs, eventually, we would be taxed far in excess of what the cost of private insurance costs.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 09:00 AM   #25
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Re: Wow, what do people do who don't have health insurance?!

Was talking to my RE agent last night. Sad story of a couple trying to "go bare". In the middle of selling their home, huge medical problem came up. At the end of it all, they lost all their money, and their house. Then some more lien holders showed up at the last minute and the real estate agents involved in the home sale had to kick in some money out of their commissions to resolve all the financial demands.

Penniless, no home, smashed credit. Very sad.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 09:06 AM   #26
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by mykidslovedogs
The problem is, you can't tax people enough for government healthcare. If we were continually taxed to pay for the government programs, eventually, we would be taxed far in excess of what the cost of private insurance costs.
And it's not just government healthcare programs. It's everything that the government does. The programs grow year after year, and the poor taxpayers are then subject to pay it. So who works for who ?

When the economy is good they increase spending on all of the programs.

When the economy is bad they just increase the taxes to pay for those now increased programs.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 09:15 AM   #27
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Re: Wow, what do people do who don't have health insurance?!

Pray for continued good health.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 09:18 AM   #28
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by Cute Fuzzy Bunny
Was talking to my RE agent last night. Sad story of a couple trying to "go bare". In the middle of selling their home, huge medical problem came up. At the end of it all, they lost all their money, and their house. Then some more lien holders showed up at the last minute and the real estate agents involved in the home sale had to kick in some money out of their commissions to resolve all the financial demands.

Penniless, no home, smashed credit. Very sad.
That is sad. Too bad they don't live here in Texas. It's virtually impossible for a creditor or legal judgment to take your homesteaded primary residence (or retirement accounts) here. Asset protection laws for the primary residence are as strong in Texas as any state in the union.
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 10:23 AM   #29
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Re: Wow, what do people do who don't have health insurance?!

Just ask OJ!

----------
No, seriously.. this is a terrible issue. it's only from outside the US that I see how hard it is to navigate, especiallly between states/regions. I have no problem paying for what I get. But the system now seems completely arbitrary .. depending on what insurance co. you have (or more likely what insurance co. your employer allows you access to).. plus completely different experiences also from one state to the next. Fairness and human decency not part of the equation, much less the free market!!!

If DH and I ever come back to the US, we'll enter the dreaded "uncovered for more than X days" zone(despite having been covered). We'll pay a pretty price. Which would be ok if it were comprehensible. It's not. TAXES are more comprehensible and more fairly levied, and that's not saying much.

I just saw a fifty-something ER poster talking about a $185/mo. premium.
How is that possible, even with a high deductible?

We accept the inequities because we accept the spin-the-wheel-and-the-winner-takes-all LUCK paradigm. Hey! CFB's RE agent made a dime off the next guy's misery.. why not us!? We favor the chances of the (potential) winners in the system; the losers fend for themselves until they hit rock bottom, whereupon we (taxpayers) pick up the tab, funnel it back into the game, and spin the wheel once again. Errrgh.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 11:53 AM   #30
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by MasterBlaster
And it's not just government healthcare programs. It's everything that the government does.
Yeah, private health insurance companies are gonna straighten it out anytime now. :

I have this crazy idea about where we can get $150 billion a year for health care....
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 11:59 AM   #31
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Re: Wow, what do people do who don't have health insurance?!

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Originally Posted by eridanus
I have this crazy idea about where we can get $150 billion a year for health care....
And will that $150 billion "revenue source" avoid consistently growing faster than inflation and population growth? Our experience with Medicare should indicate otherwise.

As long as health care continues to eat an ever-increasing percentage of the GDP, creating a new revenue source to meet needs NOW will not create a good long-term solution. Like Social Security and Medicare, you can only raise taxes to keep them "solvent" so many times before they become an unacceptably large drag on the economy.

So let's consider ways to keep health care costs from spiraling out of control in the future. Do any of them avoid restricting the availability ("rationed care") or reducing the quality and technology available?

There is the crux of the problem.
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 12:17 PM   #32
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by ziggy29
And will that $150 billion "revenue source" avoid consistently growing faster than inflation and population growth? Our experience with Medicare should indicate otherwise.

As long as health care continues to eat an ever-increasing percentage of the GDP, creating a new revenue source to meet needs NOW will not create a good long-term solution. Like Social Security and Medicare, you can only raise taxes to keep them "solvent" so many times before they become an unacceptably large drag on the economy.

So let's consider ways to keep health care costs from spiraling out of control in the future. Do any of them avoid restricting the availability ("rationed care") or reducing the quality and technology available?

There is the crux of the problem.
The "revenue source" would've been diverted from one of our "spend like a drunken Democrat" President's budget line items.

Anyway, you're right. We need to figure out how to reduce spiraling costs, and the solutions will have to kill a few sacred cows. Making bills more transparent and making hospitals more e-capable will only take us so far.

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They do this: they croak!
Old 02-28-2007, 12:37 PM   #33
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They do this: they croak!

http://www.washingtonpost.com/wp-dyn...022702116.html

Quote:
Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.
The issue isn't this one kid. The issue is a system wherein short-term gains are preferable to (theoretical) long-term losses. Even when the losses include human lives.


$80 sounds better than $250k. Unless you're the entity on the hook for the $80.. and couldn't give 2 s*** about who is going to pick up the $250k .. or not.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 01:44 PM   #34
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Re: Wow, what do people do who don't have health insurance?!

medical bills--I feel lucky I've had to take my wife to two hospitals in two entirely different states and both bills were in short hand. I've had to go to two different hospitals, one in the same state my wife went to the other in a different state, and again the bills were short hand English. The total is four different hospitals in three different states. When I do eventually receive a bill with nothing but codes on it, you can bet I will either be on the phone with the billing department or in their office until I receive and adequate explanation for what I was billed.

Medical rationing-- We have it now and any solution we will have it. The main difference is currently health care is rationed by the patients ability to pay for non-emergency procedures. The solution is rationing will be for everyone. My preference is not to take a benefit for those who have worked hard or are still working hard to afford insurance. For those of you who have retired early (before Medicare eligible) and now complain that the cost of health insurance is unacceptably high, my position is, it sounds like you are not really able to afford to retire. Go back to work (heresy, I know), even a part timer should be able to afford most insurance policies when all of the other bills are paid form another source.

The only way for the government to "fix" health care is to take it over. Anything short of that will eventually lead to taking it over. I recognize the current system is screwed up, but not as bad as letting the government run it. What program has the government run that is accomplishing all of it's goals well, while staying within budget? I can't think of any. Why would they be able to do it with national health care? If your financial planner kept losing you money would you trust them with more money? They aren't doing what you are paying them to do.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 02:21 PM   #35
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Re: Wow, what do people do who don't have health insurance?!

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Originally Posted by lets-retire
Medical rationing-- We have it now and any solution we will have it. The main difference is currently health care is rationed by the patients ability to pay for non-emergency procedures. The solution is rationing will be for everyone.
<snip>

The only way for the government to "fix" health care is to take it over. Anything short of that will eventually lead to taking it over. I recognize the current system is screwed up, but not as bad as letting the government run it. What program has the government run that is accomplishing all of it's goals well, while staying within budget? I can't think of any.
So your solution is for the insurance companies to voluntarily ration more fairly? And the companies will do this why?
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 02:57 PM   #36
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Re: Wow, what do people do who don't have health insurance?!

My point is our system will not cover everyone. The government controlling health care is not a good solution, and I think is worse than the beast we already know. I'd rather stay with the beast I currently know than the one I've known in the past to be more flawed than the private sector.
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Re: Wow, what do people do who don't have health insurance?!
Old 02-28-2007, 07:28 PM   #37
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Re: Wow, what do people do who don't have health insurance?!

Here's a good example of rationing in a universalized system:

Canada is able to buy prescription drugs at a discount from the USA ONLY because the pharamaceutical companies figure they can afford to sell LIMITED amounts of prescription drugs to Canada (and other poorer countries) by separating markets and cost-shifting higher prices to Americans who are willing to pay more for their prescriptions in the form of health insurance premiums. This is wonderful for Canadians, right? (but not for us, because we pay the higher prices to compensate...)

Canadian pharmacies figured out that they can profit from their discounted prices by selling their drugs back to Americans in the free market at a premium, through illegal reimportation. This is good for Americans. But who ends up with the short end of the stick?....

Canadians are now experiencing SHORTAGES of certain prescription drugs such as Lipitor, and Canadian pharmacies are now LIMITING patients to 30 day supplies in order to compensate. RATIONING. Ultimately, it is the ONLY solution for universalized systems. They can't make up for the shortages with production from their own pharmaceutical firms, because the technology just isn't there. Their socialized system has stifled development of prescription drugs in their own country. Thus, they have to depend on the USA for their supplies of prescription drugs.

Is this how we want America to end up? Think about it. Because, if we universalize and force price controls on our pharmaceutical companies, it will work for a while, but in the LONGRUN....Americans will begin see shortages of prescription drugs, just like the Canadians are now beginning to face.
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Re: They do this: they croak!
Old 02-28-2007, 11:04 PM   #38
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Re: They do this: they croak!

Quote:
Originally Posted by ladelfina
http://www.washingtonpost.com/wp-dyn...022702116.html

The issue isn't this one kid. The issue is a system wherein short-term gains are preferable to (theoretical) long-term losses. Even when the losses include human lives.


$80 sounds better than $250k. Unless you're the entity on the hook for the $80.. and couldn't give 2 s*** about who is going to pick up the $250k .. or not.
Shouldn't it be everyones personal responsibility to take care of their own teeth? A simple tooth brush, floss, and toothpaste for $4.00 would probably have prevented this problem. Maybe we need socialized dentistry as well as socialized medicine to provide care for people who are too lazy or ignorant to provide for themselves.
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Re: Wow, what do people do who don't have health insurance?!
Old 03-01-2007, 12:11 PM   #39
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Re: Wow, what do people do who don't have health insurance?!

I've been "on break" from the healthcare discussions, but I would hesitate to assume that a 12 year old's tooth abscess was caused by failure to brush and floss. And no matter what, a 12 year old shouldn't be dying because of a tooth abscess.



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Re: Wow, what do people do who don't have health insurance?!
Old 03-01-2007, 12:15 PM   #40
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Re: Wow, what do people do who don't have health insurance?!

Quote:
Originally Posted by mykidslovedogs
Here's a good example of rationing in a universalized system:

Canada is able to buy prescription drugs at a discount from the USA ONLY because the pharamaceutical companies figure they can afford to sell LIMITED amounts of prescription drugs to Canada (and other poorer countries) by separating markets and cost-shifting higher prices to Americans who are willing to pay more for their prescriptions in the form of health insurance premiums. This is wonderful for Canadians, right? (but not for us, because we pay the higher prices to compensate...)

Canadian pharmacies figured out that they can profit from their discounted prices by selling their drugs back to Americans in the free market at a premium, through illegal reimportation. This is good for Americans. But who ends up with the short end of the stick?....

Canadians are now experiencing SHORTAGES of certain prescription drugs such as Lipitor, and Canadian pharmacies are now LIMITING patients to 30 day supplies in order to compensate. RATIONING. Ultimately, it is the ONLY solution for universalized systems. They can't make up for the shortages with production from their own pharmaceutical firms, because the technology just isn't there. Their socialized system has stifled development of prescription drugs in their own country. Thus, they have to depend on the USA for their supplies of prescription drugs.

Is this how we want America to end up? Think about it. Because, if we universalize and force price controls on our pharmaceutical companies, it will work for a while, but in the LONGRUN....Americans will begin see shortages of prescription drugs, just like the Canadians are now beginning to face.
Our insurance company used to limit us to 30 day supplies. Now it has been up to a 90 day order at once. I am surprised at how frequently we cannot get our entire order filled at once because of shortages.
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