Health Care Bill It's about Fire and Money
- Thread starter wallygator69
- Start date
youbet
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Yes, it does seem that associations and unions have a similar effect on resource allocation efficiency as govt's. It does seem like the cost of funding medical schools and their students would be small compared to having a doctor/nurse/technician shortage. An abundant supply of highly competent and qualified medical professionals would allow market equilibrium pricing to occur as opposed to the inflated salaries that result when supply is artifically constrained by associations or govt's.
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
The AMA has worked for at least 50 years to keep down the supply of doctors. Medical education is very good in some ways, wasteful in others. The success of PAs and Nurse practitioners shows that much of the preclinical medical course is essentially lost on primary care oriented students. Even very scientifically motivated students who are likely a minority anyway usually can't really understand the science unless they arrived at school already knowing much of it, and they take time off for PhD study etc. It goes too rapidly, and most of the students have their minds on being sure they can handle the clinic.
The AMA is less powerful today, but there are other groups with similar agendas. However, it should be rememberd that in a managed, non-competitive market like the market for medical services, more practitioners may actually wind up costing more money rather than less, as more Docs are out there ordering tests etc. to be sure they can meet their financial obligations and Mercedes payments.
Ha
youbet
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
An interesting view on that Ha!
I disagree, but I see where you're coming from. I'd tend to think that a lower patient per doc ratio would eventually result in the docs having time to analyze the patients situation more thoroughly and fine tune the tests being ordered instead of calling for "test battery #256." But I'm no medical field expert, so your view could certainly be correct!
An increase in dentists hasn't resulted in declining prices. On the contrary, like HaHa suggested, it seems they are actually costing more - as if to make up for declining patient rolls.
Note - I think this exists with both physicians and dentists, but is not across the profession. Much more individual and with some specializations.
Note - I think this exists with both physicians and dentists, but is not across the profession. Much more individual and with some specializations.
Well, that's my point. I think a lot of the negative response is from people who are unhappy with Obama's performance on the economy, the bailouts, stimulouss package, mounting deficit, whatever. All very scary things, and no one knows for sure, if it was the right or wrong decision. Yes, I know about the buddy system and the ties between Wall Street and Congress. There are a lot of crooked politicians in office not acting in our best interest. But there are also good ones who are.
However bail outs (the economy issues) is not the same as Health Care Reform. No party, whether Democrtic or Republican has no good ideas.
Sometimes they get it right and sometimes they don't.
So when I talk about being irrational, I am talking about people who deliberately distort the facts. If you read the pages on the matter of "End of life Counceling", there is nothing proposed that remotely suggests euthanasia. It is about filling out forms and taking care of end of life decisions, which everyone should be doing anyway. So when people say this is euthanasia, and use this as an argument against the bill, I say their statements are irrational. (assuming they can read)
I am not stating that people who don't agree with my way of thinking are irrational. I am saying that some of the statements I have heard "opposer's" use in their argument is irrational and unfounded.
Actually, I am very interested in hearing why people are opposed to it. I just would like to hear some real facts, or peoples fears whatever they may be. I am fundamentally in favor of reform, but I am open to hearing peoples concerns. I always like to keep an open mind to both sides. I might learn something that way.
crazy connie
Thinks s/he gets paid by the post
- Joined
- Feb 1, 2006
- Messages
- 1,183
M Paquette
Moderator Emeritus
Even better, this counseling is already part of the Medicare services. Starting this year (2009) during the 'Welcome to Medicare" physical exam within the first 12 months on Part B, besides the usual screenings, the doctor should talk with the patient about end-of-life planning, including advance directives.
The provision in the House bill from Rep. Earl Blumenauer, D-Ore. adds funding to repeat the end of life planning every five years. The largest cost will be for the short chat in the doctor's office, and the printing cost of additional brochures discussing advance directives.
In my current HMO a nurse does this discussion with every patient in pre-op, and every patient over 50 seeing a doctor. It must last all of a whole minute. Nobody's offered to send me off to watch the nature film in the little room above the Soylent Green factory yet.
ERD50
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I agree with you. This HC issue is especially emotional and potentially extremely far-reaching, so the fervor level is high. And there are groups (on both sides of most issues) that set out to deliberately (or ignorantly/innocently) distort the facts. That's an ugly side of a democracy. But try to control it and you will face cries of "free speech!".
They are not the same, but they have similarities. And since we can see how the C4C bill went, it can be used for some insight. Not exactly apples-to-apples, but it should not be ignored.
1) Big bills.
2) (Attempted) Rushed through.
3) No thorough analysis, or even fully read.
4) No measure of success, so how do we evaluate it?
So when C4C threatens to run out of money 20x faster than expected, I think it is reasonable for people to think that Congress didn't do their homework. That scares me on all the bills in front of them.
OK, I'm an independent, no tie to either party. I am having trouble remembering the last time Congress passed a good bill. Maybe this should be a separate thread, but I can't think of one.
The "Do Not Call List" came close - that was wildly supported by the public. But Congress played politics with it and exempted themselves. What better way to tell us that they are "above the law", than by making lawmakers exempt from a law?
-ERD50
ziggy29
Moderator Emeritus
This is all fine and good if the sick and dying person already has an advanced directive of their own. When my dad had terminal cancer he had an advanced directive that indicated DNR and no heroic measures to prolong life -- just medications to make him more comfortable. That's fine and good when it's patient-driven.
The problem is, in the absence of such directives, someone other than the patient has to make these decisions, and if the government is involved in the decision there will be a vested financial interest in choosing to let the patient die -- not just in terms of saving health care costs but other things as well -- Social Security, public pensions, et cetera. I'm not saying it's a bad thing to forego "heroic" measures with relatively low chances of a positive outcome, but to me it's a little scary to think the government has a vested interest in letting you die.
ziggy29
Moderator Emeritus
"[Congress] can make no law which will not have its full operation on themselves and their friends, as well as on the great mass of the society. This has always been deemed one of the strongest bonds by which human policy can connect the rulers and the people together. It creates between them that communion of interests and sympathy of sentiments, of which few governments have furnished examples; but without which every government degenerates into tyranny." -- James Madison, Federalist #57
We’re mostly in agreement - I wasn’t being critical. One has to work hard to find rational, reasonable and well-articulated argument on both sides. Certainly the media seems to have no incentive to promote this, politicians even less so.
There is a clear lack of leadership – both political and professional (health care industry) in the drive for health care reform. Until the need for reform is clearly articulated out for those that currently have care and coverage, progress toward consensus is unlikely. This troubles me greatly – health care coverage is our (my) greatest financial risk, far exceeding the aggregate of government financial mismanagement.
ERD50
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Are you saying that the political exemption to the Do Not Call law is (may be) unconstitutional? Fascinating if that's the case. And I think Madison has an excellent point (not surprisingly).
I'm fine with my reps calling me about an issue, an upcoming town hall meeting and the like. But I should have the right to "opt out" of their campaign commercials that invade my privacy.
-ERD50
ziggy29
Moderator Emeritus
No, I'm not saying that at all; the Federalist Papers are not the Constitution. And there is no Constitutional requirement that Congress bind itself to the laws they pass. As much as I agree with Madison in principle here, this passage does not have any legal standing.
But it does provide an insight into the thoughts and goals of the founders, and it shows how much the original egalitarian ideal of citizen government has given way to an elitist, careerist ruling class which practices "do as I say, not as I do."
Yes, I am concerned with costs too. However, how long have we waited for the goverment to take on this issue and do something. When Clinton was in office and we were in much better financial shape. They were still successful in defeating it.
I agree there must be a means of supporting the program, and this is still being debated. The fact is. It is doable. Many countries have good working programs that involve government intervention. Even those that are not run by the government, but regulated by the government such as the Netherlands.
They use private insurance companies, but everyone is required to carry insurance, same as having to carry insurance if you drive a car. However, no one is singled out because of pre-existing conditions or price gouged, or denied because of it. No insurance company is allowed to drop a person because they are too ill. They also set limits on what can be charged. They are spending 9% of GDP compared to our current 16%. There life expectancy is two years greater than ours.
If this is a more preferable solution, why has this never been proposed when the Rebublicans were in power? Why did they not propose any solution? Do you really feel we can't figure out a way to pay for it like other countries have? To me, it's a question of priorities when it comes to government spending. Every govenment has it's limits in what it can spend. Our government has been notorious in ignoring this I know.
However, what has priority in spending? Health care for all citizens or going to the moon and occupying 50 countries. Don't jump on me for those two examples. There is a long list to pick from.
I agree there must be a means of supporting the program, and this is still being debated. The fact is. It is doable. Many countries have good working programs that involve government intervention. Even those that are not run by the government, but regulated by the government such as the Netherlands.
They use private insurance companies, but everyone is required to carry insurance, same as having to carry insurance if you drive a car. However, no one is singled out because of pre-existing conditions or price gouged, or denied because of it. No insurance company is allowed to drop a person because they are too ill. They also set limits on what can be charged. They are spending 9% of GDP compared to our current 16%. There life expectancy is two years greater than ours.
If this is a more preferable solution, why has this never been proposed when the Rebublicans were in power? Why did they not propose any solution? Do you really feel we can't figure out a way to pay for it like other countries have? To me, it's a question of priorities when it comes to government spending. Every govenment has it's limits in what it can spend. Our government has been notorious in ignoring this I know.
However, what has priority in spending? Health care for all citizens or going to the moon and occupying 50 countries. Don't jump on me for those two examples. There is a long list to pick from.
M Paquette
Moderator Emeritus
So, it sounds like the current Medicare funding of one discussion with a doctor during the Part B physical about getting an advance directive is a good thing, and the proposed law to fund discussions 'as often as' every 5 years is probably a good idea as well, in case the patient changes his mind.
This is already the case, of course. Roughly half of all healthcare spending in the United States comes through government channels already, through Department of Defense, TRICARE, Veterans Health Administration, Indian Health Service, State Children's Health Insurance Program, Medicare, and Medicaid. About 27.8% of the population is covered under these programs. The high spending per capita of the programs reflects the relatively high cost of care for the covered patients in some of these groups.
Well, a good place to start our search for proper government spending priorities might be the US Constitution, where the responsibilities of the US Government are outlined. I think many Americans might be shocked at how limited that role is supposed to be. It is a lengthy document, and covers some important areas in rather minute detail (e.g. even going into such issues as the day of the year that Congress will convene, defining the precise physical area to be occupied by the US Capitol, etc). The founders took time to address the big issues of defense, courts, etc. Regarding going to the moon--the constitution even says the government should be advancing science. But, somehow not a damn thing was said about the federal government taking money from some people in order to give it to other people. There's nothing in there about the government establishing a health care system for all Americans. All these other "good ideas" have been somehow seen as having been implied by the very innocent and innocuous "promote the general welfare" clause. Talk about driving a battleship through the eye of a needle . . .
??
The 16th Amendment allows the Federal Government to levy an income tax. If that's not taking money from someone and giving it to someone else, I don't know what is.
Congress has been empowered by the Constitution to enact laws. It is the duty of the Supreme Court to decide if those laws contradict the Constitution (Article 1, etc.)
ERD50
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
This is in-line with what samclem has posted previously. Makes sense to me, I'd take it (devil in the details though).
As an independent I like to try to keep partisan politics out of it. The fact is, the party now in power is going to have to come up with a solution - it's doubtful anything from the other side will gain traction - that's politics. Same as when the other party has a majority.
So, what is the current admin waiting for? If they proposed that, I think they could get some support. If they have not already used up any momentum they had.
-ERD50
ziggy29
Moderator Emeritus
OK -- so if you're not one of those people who claim the 16th Amendment was never really ratified, if we accept the Constitutional legitimacy of a federal income tax, what about other forms of taxation proposed for health care such as payroll taxes and value added taxes?
Payroll taxes aren't strictly income taxes because they don't hit all income, but only *earned* income, and as such they are somewhat regressive.
The question was about government spending priorities. The Constitution goes into some depth in describing the functions of the various branches of the federal government. I think it's safe to assume the taxes collected under the 16th Amendment and all other levies by the Government support these functions enumerated within the Constitution. I was pointing out that, though the Framers went to considerable lengths to specify these functions, a federally-mandated transfer of assets from some citizens to others and/or provision of medical care was not among the things they mentioned. They could have penned it in, but they did not.
For those who believe "free" health care is some kind of right, the proper course of action is to seek a constitutional amendment.
But, I digress. . . .we can return now to the real world.
youbet
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
As I recall, that wasn't the case. In fact, Clinton (both Mr and Ms) failed to sell it.
There is a difference between government paying for health care provided by private providers and government owning the hospitals and clinic. Too tired from a camping trip to talk about it more. Maybe later.
M Paquette
Moderator Emeritus
Well, now we won't need to worry about this. A Senate committee has pulled this clause from the health bill they are looking at.
Persons enrolling in Medicare Part B will be permitted the current one (1) chance to discuss an advance directive during the Part B physical under current (2009) rules, and the Medicare hospice care informational brochure printing will no longer be funded.
M Paquette
Moderator Emeritus
I'd just like to note that I am very concerned about the whole idea of government run death panels. That is a function that should remain with private insurance. The government simply cannot run death panels as efficiently as traditional profit-motive incentivized private free market death panels.
Shouldn't all Americans have access to death panels? Why does the proposed plan limit death panel access to those 65 and older? That's simple age discrimination. I strongly feel that killing should be merit-based; Priority should be given to the needy, such as whiners, people with hairy moles, outies.
*SIGH* Pardon me. I had to spend some time today in an office, waiting for paperwork to ever so slowly be processed. For entertainment, the office had a couple of drones carrying on about 'death panels', euthanasia, and how they didn't think the government should be involved in health care. One of those days that makes me question the idea that 18, warm and breathing is sufficient to qualify someone to vote...
Shouldn't all Americans have access to death panels? Why does the proposed plan limit death panel access to those 65 and older? That's simple age discrimination. I strongly feel that killing should be merit-based; Priority should be given to the needy, such as whiners, people with hairy moles, outies.
*SIGH* Pardon me. I had to spend some time today in an office, waiting for paperwork to ever so slowly be processed. For entertainment, the office had a couple of drones carrying on about 'death panels', euthanasia, and how they didn't think the government should be involved in health care. One of those days that makes me question the idea that 18, warm and breathing is sufficient to qualify someone to vote...
