Socialized Medicine

[samclem]

Just read the worries expressed on this forum about the precarious state of access to health insurance in ER and it is easy to understand why many of us believe universal access is an imperative.

I think the discussion is more valuable if we avoid imprecise or misleading terms. As an example: "universal access" is precisely what we have today. Anybody can have access to any medical care. Sometimes people use the term to mean "everybody gets medical care that they don't have to pay for as an individual service."

Some proponents of nationalized/socialized/single-payer systems are actually against universal access, as they would prohibit universal ability to buy the health care an individual might desire.

 

[FIREd]

If you remove the profit motive from heathcare it will inevitably reduce the quality of healthcare. Why is that? Well... when doctors can charge what they wish... it then becomes a choice if people want to use their services or not. Doctors that are truly "a cut above the rest" may actually get that higher rate. Lesser doctors may not, and will have to lower their rates to survive. If the govt via nationalized healthcare declares that all doctors doing heart surgury for example will make the same, then why would those truly exceptional doctors wish to stay in a profession that does not reward their greater skill? The only doctors that will stay, will be the average and the mediocre caliber.

Even in countries with socialized medicine, doctors are highly compensated professionals. They still earn much more than other highly qualified professionals, like engineers. Also, even if the "good" and "bad" doctors charge the same per patient, the "good" ones have more patients and make a better living. Specialists still make more than generalists. And, the very best doctors sometimes command a premium (not reimbursed by the state). Overall, there is still a pretty wide distribution of incomes among doctors, enough to reward the best of them and motivate the others to do better.

 

[Rich_by_the_Bay]

It is very common for the term "socialized medicine" to be used by its opponents to appy to virtually any type of health care reimbursement other than fee for service. But that is a gross distortion, often feeling much like a scare tactic. That really bogs down rational debate. Here is my unsophisticated understanding:

Socialized medicine - where heatlh care resources are owned and managed by the federal government. Relevant issues of eligibility, medical necessity, etc. are all part of national policy.

Universal coverage: everyone has health insurance, though not necessarily the same level. The basic lowest level covers all necessary nonelective medical and surgical care including preventive measures. Higher cost coverage might include cosmetics, unproven (though not necessarily ineffective) modalities such as chiropractic (a whole other matter of debate), private rooms, etc.. A national debate would have to address things such as whether aggressive measures such as dialysis are covered for people over age XX, etc. It would get ugly at that level. It would look a lot like what we have now, but everyone would have some source of premium payments, so that we insured folks would not have to pay exorbitant amounts for Emergency Room care for colds, etc.

 

[Brat]

My brother gets his health care at the Portland Or VA facility and it has been excellent. They are focusing on preventing illness and have gotten a couple issues managed (weight, blood pressure). He had surgery there with good outcome.

 

[Martha]

I think the discussion is more valuable if we avoid imprecise or misleading terms. As an example: "universal access" is precisely what we have today. Anybody can have access to any medical care. Sometimes people use the term to mean "everybody gets medical care that they don't have to pay for as an individual service."

Some proponents of nationalized/socialized/single-payer systems are actually against universal access, as they would prohibit universal ability to buy the health care an individual might desire.

To say we have universal access is like saying all men are created equal. Neither are true. You might not have access to health care because you do not have the ability to pay and you are not covered by any government program.

 

[Nords]

Accept for the Navy and they are Admirals. All others or Major, Lt, Comodore or some other qualifier. Just to pick nits.

Navy keeps changing the ranks when the other services seem to be about to figure things out. The latest version is:
Admiral
Vice admiral
Rear admiral (upper half)
Rear admiral (lower half)

O-6s in charge of a squadron (more than one ship) are referred to as commodores even though they're wearing the rank of captain. They revert to captain when they leave the billet.

Luckily we never had to live with Congress' bright idea of "commodore admiral"...

 

[samclem]

To say we have universal access is like saying all men are created equal. Neither are true. You might not have access to health care because you do not have the ability to pay and you are not covered by any government program.

But "universal access" is (IMO) a deliberately vague term. Who could be opposed to "access" whether we are talking about allowing people "access" to food, "access" to the library, or "access" to the truth. Everyone has "access" to healthcare. What is being discussed is payment for that care. So, it seems more straightforward and honest to say that, and we can then turn our attention to the issue at hand: Determinig how to allocate resources, not "access."

 

[Gumby]

..

 

[Dawg52]

My brother gets his health care at the Portland Or VA facility and it has been excellent. They are focusing on preventing illness and have gotten a couple issues managed (weight, blood pressure). He had surgery there with good outcome.

My Dad had pretty good luck with the VA hospital in Jackson, MS back in the 70's-80's. He had 2 hip replacements and some eye surgery. The main problem he ran into was the hospital would lose his records from time to time. Plus when he had a doc appointment, he might have a different doctor. So when they couldn't find his records, he would have to give his history to the new doctor. But as far as the care goes, it was good.

He quit going mainly because of the records issue and he got tired of driving 90 miles for an appointment.

 

[Lister]

Everyone can go round and round on this but in essance it all comes down to everyone's desire to do what they believe is in their own best interest.

I have the solution, DO BOTH.

Those that want something like the current healthcare system get to keep it and those that want nationalized/socialized/whatever heathcare go for it. Just dont expect the folks outside of your system of choice to subsidize it, after all it is YOUR CHOICE. Give both some time and we shall see which remains viable, affordable, and provides the optimum service. That will be the one that remains.

 

[armor99]

Everyone can go round and round on this but in essance it all comes down to everyone's desire to do what they believe is in their own best interest.

I have the solution, DO BOTH.

Those that want something like the current healthcare system get to keep it and those that want nationalized/socialized/whatever heathcare go for it. Just dont expect the folks outside of your system of choice to subsidize it, after all it is YOUR CHOICE. Give both some time and we shall see which remains viable, affordable, and provides the optimum service. That will be the one that remains.

***And the crowd applauds loudly **** VERY well said Lister.... And that is exactly right.... set up whatever system you like for your self. But fund it yourself... and do not take of my money to do it.

 

[lets-retire]

Lister--That would be good, except when the government controls things it has a tendency to not let it fail. So if the socialized/govt'/whatever you want to call it starts to fail they will change the rules and require those not participating to subsidize it.

To borrow a saying from the abortion rights people, "Government get out of my womb!"

Martha--You are correct all the insurance companies can do is deny payment, but they haven't done that on any of my claims either.

 

[ziggy29]

Everyone can go round and round on this but in essance it all comes down to everyone's desire to do what they believe is in their own best interest.

I have the solution, DO BOTH.

Those that want something like the current healthcare system get to keep it and those that want nationalized/socialized/whatever heathcare go for it. Just dont expect the folks outside of your system of choice to subsidize it, after all it is YOUR CHOICE. Give both some time and we shall see which remains viable, affordable, and provides the optimum service. That will be the one that remains.

So then we create two health care bureaucracies as overhead and make it more costly for both groups? Well, I guess that creates jobs, if you're in health care administration...

 

[Rustic23]

Lister, this may work for a time. However, over time, the better doctors will gravitate to the private sector and stop taking patients from the Socialized sector. i.e. threads about doctors currently not taking new Medicare patients. Before long we have a system where those with money get good health care and those without get poor health care. Kind of like we have now?

 

[Rich_by_the_Bay]

Two-tiered medicine like it was in its waning phase when I trained: 16-bed wards, several acutely withdrawing alcoholics, no privacy, weeping families with dying loved ones just a few feet away without privacy; intern-run care, loss of all dignity. No thanks.

 

[ziggy29]

Two-tiered medicine like it was in its waning phase when I trained: 16-bed wards, several acutely withdrawing alcoholics, no privacy, weeping families with dying loved ones just a few feet away without privacy; intern-run care, loss of all dignity. No thanks.

Well, I agree in the extreme, but multi-tiered levels of care are inevitable if the government foots the bill AND "boutique" medicine paid for out of pocket isn't banned.

I think the best we can do is hold the "public tier" to at least some minimum reasonable standard. Unless you ban fee-for-service medicine for people opting out of the public health care system, it's inevitable to some degree that a few of the best doctors and facilities will opt out. One of the scarier aspects of some proposals to me is the thought of making it illegal to go outside the system and pay for your own care. IMO, this is the "land of the free" and such a ban goes against that founding principle.

 

[FIRE'd@51]

So then we create two health care bureaucracies as overhead and make it more costly for both groups? Well, I guess that creates jobs, if you're in health care administration...

Yep, and presumably the two coexisting systems would eventually stratify on adverse selection, since those who could pass underwriting would gravitate toward the private system.

When I lived in NY state, they had only guaranteed-issue, community rated individual policies for those who didn't get insurance from their employers, or were on Medicare or Medicaid. People would buy the cheaper high deductible policies if they were healthy, then switch to low-deductible HMO's if they became chronically ill. I believe this would probably happen in Lister's system, as well.

IMO, we need to have everyone in the same risk pool for any type of "universal" system to work.

 

[OAG]

I thought that was the intent (to ban any other method) of the last attempt at this a few years ago? Seems many of the same people are behind this one too.

 

[ziggy29]

IMO, we need to have everyone in the same risk pool for any type of "universal" system to work.

Unless someone has invented a magic bullet I'm not aware of, I think the only way to make coverage for people with preexisting conditions affordable is to make coverage mandatory *and* to put all the people into the same risk pool. We can debate whether or not that's a good thing, but I don't see much alternative to this IF we're going to cover everyone. Insurers have repeatedly said that they are ready to cover everyone under group rates with no exclusions if everyone, including the young and healthy, were required to be in the pool and having coverage was a mandate like having auto insurance is a mandate for anyone who drives.

 

[armor99]

Free market solutions to problems are almsot always better. Why? Because an individual business is far more agile and nimble that the lumbering slow federal govt. I hear this complaint all the time. What about people that are born into a higher risk pool, and no one wants to insure them? Usually the claim is that govt healthcare would be better.... because it would guarantee their coverage will not be dropped.

How about this for a free market solution? Let's say you have a son/daughter that has a much higher risk for a certain type of cancer. Your family history says so. You natuarally fear for your child in the future and work out this deal with an insurance company. You pay that insurance company every year since your child in born, and once your child turns 21 they will not cancel their coverage, or raise their rates for 20 years. So basically the insurance company gets your money free and clear for 21 years, but in return, you never have to worry about cancelled coverage, or rased rates again. Or at least not for a good long time. Is this solution perfect... certainly not! But it demostrates what a free market solution can do. It also shows how this sort of arangement is voluntary, vs, govt forced. Like I have said many times before I really do not like the idea of govt coercion at all. And I think most problems can be solved privately in a volutary manner...

 

[Rich_by_the_Bay]

I think the best we can do is hold the "public tier" to at least some minimum reasonable standard.

That's right. We need to provide a safe, sufficient and reasonably dignified chassis for everyone. If you want buy up to a private room, broader elective care coverage, etc, fine, but the default coverage has to be substantial and comparable across the board, IMHO.

That can be accomplished in a private practice model to a great extent. Probably have to be supplemented with some kind of community health center program for the underprivileged, etc. so that you avoid the shortage of primary care offices in neighborhoods considered less desirable or less financially viable by some.

 

[jug]

You already have socialized medicine, the minute you enter into an HMO plan. They are the gate keepers to keep costs down. They know exactly at what point to bury you when you get too "costly" As for regular insurance, they too are a form of socialized medicine. Do you think private insurers want to pay through the nose for your sickness, hell no. So what is the difference whether the government is the gate keeper or the insurer, same employees just collecting a pay check of a different color.

Probably our biggest problem is lawyers, thus causing providers to order more expensive tests instead of practicing practical medicine. How many useless expensive tests are ordered to cover one's ass? Sometimes you have to wonder if that test is medicine or fear of lawsuit. This is the real sticking point.

Also, one can complain as much as they want about socialized medicine, usually found in "liberal" European countries. But take a good look at thier lifespans, a bit higher than ours. Guess the proof is in the pudding, or we are just a bit more rambunctuous in our lifestyle than the laid back French.

jug

 

[Lister]

Lister--That would be good, except when the government controls things it has a tendency to not let it fail. So if the socialized/govt'/whatever you want to call it starts to fail they will change the rules and require those not participating to subsidize it.

To borrow a saying from the abortion rights people, "Government get out of my womb!"

Martha--You are correct all the insurance companies can do is deny payment, but they haven't done that on any of my claims either.

Agree that it would be very difficult if not impossible to keep the government system in check with no free market pressure. But "if" we could (and thats a big "if") then at least it would be our own choice.

 

[ziggy29]

Also, one can complain as much as they want about socialized medicine, usually found in "liberal" European countries. But take a good look at thier lifespans, a bit higher than ours. Guess the proof is in the pudding, or we are just a bit more rambunctuous in our lifestyle than the laid back French.

Let's be careful with using political labels such as "liberal." This is a good, relevant thread and I'd hate to see it turn into a partisan snipe-fest.

Anyway, it's important to realize that correlation does not equal causation. And just because we can say:

* Europe has "socialized medicine";
* Many European countries have higher life expectancies

doesn't mean we can conclude, "therefore socialized medicine leads to higher life expectancy." There can very well be other social and cultural factors at work here.

 

[Lister]

So then we create two health care bureaucracies as overhead and make it more costly for both groups? Well, I guess that creates jobs, if you're in health care administration...

Who said anything about creating 2 bureaucracies? Today we have free market heath care. Yes this has the insurance companies creating some overhead but like all free market things, over time the company that provides the best service for the $ will prevail. As for more goverment overhead being created for that new system, well that's the problem for those folks to worry about because they will have to fund it. no free rides here...