Universal Healthcare...an idea whose time has come??

Punzy, you make valid points, just curious if you've seen these numbers and what you're take is on it?

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis (14).
Hospitals provide about $34 billion worth of uncompensated care a year (14).
Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage (14).
The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300 (14).
The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices (11).

So, if the US were to move to a single pay healthcare system and indigents and
un-insured people were able to get preventive care, is it not possible that the funds saved could be given back to the physicians and hospitals in compensation?

You assume the uninsured will actually show up for routine appointments. For many, this is difficult because they are too busy working, have transportation barriers, need to tend to family matters, etc. Others are too lazy or frankly lack the neuronal connections to understand why it is better to go to a PCP's office as a matter of routine instead of an ER as needed.

Why do you think that under the single payer/universal system the quality of care would decrease?

Do you think standardizing the rates would make it more difficult to attract skilled professionals to certain areas or specialties?

It seems that if everyone can go anywhere they want for care, those providing the best care/service would benefit, so unlike communism there is still an incentive.

Why do you think that under the single payer/universal system the quality of care would decrease?

Do you think standardizing the rates would make it more difficult to attract skilled professionals to certain areas or specialties?

It seems that if everyone can go anywhere they want for care, those providing the best care/service would benefit, so unlike communism there is still an incentive.

I think it would be a debacle. I have worked in the VA enough to get a sneek-peek of how things might be. I think standardizing rates will kill the drive people have to go into certain specialties that are more demanding physically and mentally. The natural outcome of people flocking to one provider in favor of another is poor access to a quality doc (because she will be slammed daily) and patients giving up or grudgingly going to the 'worse' provider, assuming the 'worse' provider stays in the game long enough. If you doubt any of this, please carefully read the New York Times story I provided above regarding the wonders of British dentistry.

You assume the uninsured will actually show up for routine appointments. For many, this is difficult because they are too busy working, have transportation barriers, need to tend to family matters, etc. Others are too lazy or frankly lack the
neuronal connections to understand why it is better to go to a PCP's office as a matter of routine instead of an ER as needed.

Say what? :wacko:

Well here's another thought:
Maybe the drug companies can get rid of all the commercials and have one universal commercial that says:
Will cause flatulence, rapid channel surfing, neo-conism, eye twitching, drooling,........................etc.

Save all that marketing money so the drugs are cheaper. :lol:

Punzy, you make valid points, just curious if you've seen these numbers and what you're take is on it?

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis (14).
Hospitals provide about $34 billion worth of uncompensated care a year (14).
Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage (14).
The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300 (14).
The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices (11).

So, if the US were to move to a single pay healthcare system and indigents and
un-insured people were able to get preventive care, is it not possible that the funds saved could be given back to the physicians and hospitals in compensation?

Punzy -- or anyone -- know any stats on the numbers of ESSENTIALLY HEALTHY baby boomers that are turned down for health insurance due to that pre-existing condition called "LIFE"?? I personally know several people that can afford to pay for insurance but have been turned down on some inane premise. IMO...If the health insurance underwriters weren't so *&&&$$@@@" there could be many fewer uninsured folks --- therefore more ESSENTIALLY HEALTHY people paying premiums (& probably not making many claims) --- more money in the the till to cover the resulting fewer # of uninsureds (along the lines of Mango's rebate idea). Seems like a better business strategy....

The members of my family that work in the healthcare profession are constantly talking about skyrocketing use of ER's by the uninsured due to the fact that ER's are the only healthcare option for many uninsureds since ER's HAVE to provide treatment. The "charity" hospital where my family lives is CLOSING the inner-city hospital & rebuilding a whole brand new facility WITHOUT an ER in the "wealthier" area of town. It will end up forcing all the acute care onto the other "for profit" hospital in town. Don't see how the quality of care can help but go down in this scenario.

Reformation is needed...but I just can't get my arms around an already inefficient govt. administering a health care system.😱. That thought makes me sick enough for a visit to the ER :blink:.

Keep an eye on West Virginia's new Medicaid system. Here is a snippet from a recent New England Journal of Medicine article:

The redesign of the West Virginia Medicaid program has recently become a leading but controversial example of efforts to reward personal responsibility. West Virginia has a population of 1.8 million; as compared with the United States, it has a higher percentage of residents with Medicaid coverage and near-poor or poor incomes (see graphs). In May 2006, the federal government approved the state's plan to provide reduced basic benefits to most healthy children and adults who are eligible for Medicaid because of low income while allowing them to qualify for enhanced benefits by signing and adhering to a "Medicaid Member Agreement" (see box).3 The enhanced benefits include all mandatory services as well as additional age-appropriate services that focus on wellness. Examples include diabetes care beyond basic inpatient and outpatient services, cardiac rehabilitation, tobacco-cessation programs, education in nutrition, and chemical-dependency and mental health services. Under the basic plan, prescriptions are limited to four per month; under the enhanced plan, there is no monthly limit. According to Nancy Atkins, the commissioner of the Bureau for Medical Services in the West Virginia Department of Health and Human Resources, the goals of the redesign are to streamline administration; tailor benefits to specific groups; coordinate care, especially for members with chronic conditions; and "provide members with the opportunity and incentive to maintain and improve their health."

To remain in the enhanced plan, members must keep their medical appointments, receive screenings, take their medications, and follow health improvement plans; West Virginia will monitor "successful compliance with these four responsibilities."3 Members whose benefits are to be reduced because they have not met these criteria will receive advance notice and have the right to appeal. Those who meet their health goals will receive "credits" that will be placed in a "Healthy Rewards Account" to be used for purchasing services that are not covered by the Medicaid plan. Although details about how these accounts will work and what services will be eligible for purchase are forthcoming, the services might include fitness-club memberships for adults or vouchers for healthful foods for children. In July 2006, transition to the new plan began in three West Virginia counties; the program will eventually include about 160,000 people ? or about half the state's Medicaid beneficiaries. Beneficiaries who are 65 years of age or older or who have disabilities will retain their current level of coverage, as will some others, such as children in foster care.

I personally know several people that can afford to pay for insurance but have been turned down on some inane premise.

I know several people (including people in their 20's) who can't get private insurance because they've taken an anti-depressant in the past. If these people don't get a job with group health insurance, they're screwed.

For example, I know a healthy woman who was covered under her husband's insurance (she didn't work). He divorced her, and because she had taken an antidepressant during the divorce, she can't get health insurance. She's gotta find a job with group health insurance, or else she'll be a bag lady if she gets a serious illness.

I know several people (including people in their 20's) who can't get private insurance because they've taken an anti-depressant in the past. If these people don't get a job with group health insurance, they're screwed.

For example, I know a healthy woman who was covered under her husband's insurance (she didn't work). He divorced her, and because she had taken an antidepressant during the divorce, she can't get health insurance. She's gotta find a job with group health insurance, or else she'll be a bag lady if she gets a serious illness.

One of my friends got rejected for the same reason...rejected for a temporary situation. If that's a problem for the insurer, it's beyond me why they couldn't still insure w/ a particular exclusion?:idontno:.

Now Skunky, a plan like that W. Virgina one has possibilities nationwide for people seeking standard healthcare.
I don't understand why clinics can not be set up with Physicians Assistants with a doctor on staff for them to consult in the event they have questions?

I've met many a P.A. who had quite a bit of experience and for follow up, they are invaluable.

I don't have the attention span for reading through all of this, but I will state that if we got rid of the FDA, drug prices would be lower, drug companies would have many more options, treatments and cures, and fatalities from poor drugs wouldn't hold a candle to fatalities resulted from the drugs that make it to market years later and the drugs that never make it to market. Anyway, just wanted to throw that in. Carry on.

And this, my friends, is why we'll never get anything done. Our lefty friends jump in with their perspectives on providing healthcare to the uninsured, our righty friends advocate throwing out all consumer protection services provided by the government. People with a strong political perspective come to the issue with their minds made up. They muddy the waters for everyone else.

From my perspective, I have seen the best surgeons go into plastics instead of neurosurgery because they want to make money. I have seen the lobbying efforts of HCA, Tenet, Pfizer, Astra Zeneca, et.al., as well as some medical specialties such as orthopedic surgery and cardiology pay off a hundredfold. I have seen the chilling effect of the Medicare fee schedule on physician encounters.

For those of you who don't like the fact that your doctor doesn't spend more than fifteen minutes for you, does it help you to understand why now that you realize they are paid $33.18 per encounter and all their staff and overhead must be paid out of that? Does it bother you that the best doctor in a market is paid at the same rate as the worst? Well, that is what the Medicare fee schedules conversion to a relative value scale allowing insurers to use it to pay providers has done. The only way for a doctor to make a better living for himself is to see more patients. That is not the way a free market works. As I've stated before, we already have nationalized healthcare -- it is just administered by insurance companies and hospitals and drugs remain unregulated. It's not working. Quality of care has gone down for most Americans in the last ten years, the cost of that care has gone up. It's the very lack of a market driven system that has caused these problems. There is no correlation between what is charged for things and what they cost, the quality of service has not impact on what can be charged for that service.

As for those of you who have family and friends that can't get coverage, I respectfully disagree. They can get coverage, it just costs too much. It costs so much because they underwrite into groups that spend as much as those premiums plus 3-5% as a group. Those charges are completely out of touch with reality because the party that pays the bills is not the party that consumes the services.

No one in this country goes without healthcare. The last surgical group I managed did 10% of their $80,000, best in the world, breast reconstructions for free. If they are truly poor, they qualify for Medicaid. If they are not poor enough for Medicaid, they have been priced out of the market for healthcare by the problems with our over-regulated system and it's lack of consumer-driven decision-making. If they can afford a haircut, they can afford to pay $35 dollars for an office visit and $4 for a prescription.

Incidentally, this is an excerpt from a previous post to which I've referred above...

We have three healthcare systems in America. If you divided the population into three tiers based on socio-economic levels (and to some extent the states they live in - in Kansas, Missouri, and California only the top 2-3% have first tier care).

If you fall into the first tier -- you have ample personal reserves, good insurance coverage with out of network benefits or a healthcare spending account and a hospital/surgical indemnity policy, and possibly are a member of a boutique medicine clinic -- you have the best healthcare in the world and it is two to three times better than what you'd get anywhere else in the world.

The second tier (from about the 20th to 80th percentiles) have access to healthcare through insurance coverage that has limited out of network benefits and a provision that it's reimbursements are tied to the government's fixed prices for Medicare and you are responsible for any difference in costs if you go out of network for care. People in this group basically already have social medicine, it is just administered by private companies like Blue Cross, United Healthcare, Humana, etc. These people get adequate care, but the insurance companies make it so difficult and expensive for doctors to deviate one bit from the basic standard of care that it is the rare patient that gets the best care available. The patients in this group get care comparable to what is available in Canada and Great Britain, etc.

The third tier is uninsured or undersinsured with so little in the way of personal reserves that they may actually be worse off than people who qualify for Medicaid. These people often can't afford to see private doctors and end up in public indigent clinics or emergency rooms. After seeing these doctors, they often can't afford the medicines prescribed for them. The people in this bottom group have some of the worst healthcare in the developed world.

The reason this is all so disgusting is that we spend so much for healthcare that everyone of us should have top tier care. The third party payors and hospital-pharmaceutical complex combined with a government that doesn't understand the industry they are regulating cause so much waste and misallocation of resources as to make it laughable. That's why I don't support any of the single payor models for universal healthcare.

As for those of you who have family and friends that can't get coverage, I respectfully disagree. They can get coverage, it just costs too much.

No one in this country goes without healthcare. If they are truly poor, they qualify for Medicaid. If they are not poor enough for Medicaid, they have been priced out of the market for healthcare by the problems with our over-regulated system and it's lack of consumer-driven decision-making. If they can afford a haircut, they can afford to pay $35 dollars for an office visit and $4 for a prescription.

I know people who COULD NOT get coverage because of preexisting conditions. They wanted it and knew they would need it and could not afford their medical bills without it. Cost was not the issue, finding someone to insure them was.

People in this country DO go w/o healthcare. I don't think you appreciate how "truly poor" you need to be to qualify for Medicaid. My grandmother is a widow on a fixed income and my mother had to do some financial maneuvering to get her to qualify. Gma isn't out catching rays on the Riviera, she shares a 2 bedroom home w/ 2 children and a grandchild. She prepaid her funeral costs so she was "poor" enough for adequate medical care! If you are old and have any savings or assets you do not meet the qualifications. $35 for an office visit and $4 for a prescription doesn't sound like too much to pay...........except that's not what it costs. People pay hundreds of dollars for prescriptions, even w/ insurance coverage, and old people having to chose between food and medicine is not some political hyperbole.

I am a healthy person whose only medical expenses/incidents are regular dental & medical checkups, birth control pills, and the occassional sports injury. I pay almost $200 a month for that basic care and also have to pay for my prescription out of pocket because it's not covered under my health care (ironically neither is pregnancy, though I can't think of a more basic female health issue.) The last time I went to the doctor for a follow up on an injury, I was seen by a PA for almost 10 whole minutes and the charge was $170. No x-rays, prescriptions etc. I consider myself a middle/upper middle class person w/ above average medical care.

My sympathies obviously does not lie w/ your doctor friends who do $80,000 boob jobs (those must be pretty impressive) or the pharmaceutical companies who I believe are ruining the health care system. I think malpractice insurance is a major problem and sympathize with doctors about that, but overregulation is not. Even w/ the FDA controls you feel are too strict, drugs are constantly being recalled and restricted for their side effects.

Well lets not go getting our panties in a wad here. I am sure Punzy knows what the Medicare schedule is and who qualifies. Even though Skunk is a doc and Punzy is in industry, I have always found them to be objective and Skunky always looking for the least expensive route to treat someone which I find admiral.

I can certainly understand the 15 minutes with a doc. Between what my plan pays and my co-payment I often wonder how some of the stay in business. My doctor did it for a long time and eventually has gone to not even accepting insurance anymore.

But Punzy, where can someone go to a doctor for $35 who doesn't have insurance? In New York you can not even see a vet for that price. :lol:

I know people who COULD NOT get coverage because of preexisting conditions. They wanted it and knew they would need it and could not afford their medical bills without it. Cost was not the issue, finding someone to insure them was.

People in this country DO go w/o healthcare. I don't think you appreciate how "truly poor" you need to be to qualify for Medicaid. My grandmother is a widow on a fixed income and my mother had to do some financial maneuvering to get her to qualify. Gma isn't out catching rays on the Riviera, she shares a 2 bedroom home w/ 2 children and a grandchild. She prepaid her funeral costs so she was "poor" enough for adequate medical care! If you are old and have any savings or assets you do not meet the qualifications. $35 for an office visit and $4 for a prescription doesn't sound like too much to pay...........except that's not what it costs. People pay hundreds of dollars for prescriptions, even w/ insurance coverage, and old people having to chose between food and medicine is not some political hyperbole.

I am a healthy person whose only medical expenses/incidents are regular dental & medical checkups, birth control pills, and the occassional sports injury. I pay almost $200 a month for that basic care and also have to pay for my prescription out of pocket because it's not covered under my health care (ironically neither is pregnancy, though I can't think of a more basic female health issue.) The last time I went to the doctor for a follow up on an injury, I was seen by a PA for almost 10 whole minutes and the charge was $170. No x-rays, prescriptions etc. I consider myself a middle/upper middle class person w/ above average medical care.

My sympathies obviously does not lie w/ your doctor friends who do $80,000 boob jobs (those must be pretty impressive) or the pharmaceutical companies who I believe are ruining the health care system. I think malpractice insurance is a major problem and sympathize with doctors about that, but overregulation is not. Even w/ the FDA controls you feel are too strict, drugs are constantly being recalled and restricted for their side effects.

Hey, hey, wait just a minute. I think you are assuming I am a conservative and are confusing what I have said things other people have posted. I never said the FDA controls are too strict. In fact, I believe the contrary. The FDA's budget is today underwritten by the very drug companies they regulate, and the current administration is appointing drug lobbyists to head the FDA. It is a horrible cluster*&^% and fuels the spiraling costs of drugs. It is a classic example of why I think a single payor, susceptible to lobbying and beholden to corporate interest, will neither improve the quality of healthcare nor decrease its costs.

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) and this act in conjunction with the Consolidated Omnibus Budget Reconciliation Act (COBRA) provide a safety net for anyone who has had healthcare coverage through an employer or an individual policy to continue that policy without being subject to medical underwriting or pre-existing condition exclusions provided they do not let a policy lapse for more than 90 days (or 30 days for ERISA and Individual policies). People who cannot get insurance at some point made an unfortunate decision that the COBRA or an individual policy was too expensive, and that is unfortunate. I don't mean to sound like a hard-a$$ -- it was unfortunate that I did not have a wind policy on my house in New Orleans and lost ten years' savings and investments. Sometimes people make bad financial decisions and they have to take responsibility.

As for not understanding how truly poor someone has to be to qualify for Medicaid, I have to laugh. I've had to assist so many people to sign up for Medicaid so that physicians and hospitals I've worked with could receive some sort of compensation. I have also had to help a lot of people apply for a special short-term Medicaid that many people can qualify for when they have an expensive ($18,000+) short term illness. Medicare is age-based, or kicks in with long-term disability. I don't want to pry, but did your grandmother not look into Medicare? Or was it that she required care in a long-term care facility? If someone is truly choosing between food and medicine, I am assuming that is because they have a condition for which there is no generic rx treatment available and are taking an expensive brand name medication. That proves my earlier point -- if everyone paid for their own drugs directly, would drug companies charge $200 for a thirty day supply? Or do the drug companies set the price at $200 because most people have insurance and will pay because a copay is a copay and there is no real competition? Regardless, if you know someone who is choosing between food and medicine please have them pm me and I will help them sign up for a prescription assistance program with the pharmaceutical company.

Your $200 premiums further illustrate my point about our system's problems. Let's say you are 28, and from the sounds of it healthy and rarely utilize healthcare. You are underwritten as a group with one hundred other women aged 25-29. Let's say one of those women gets breast cancer, and because of her young age has genetic testing ($3000) which shows she is positive for BRCA (a gene that causes breast cancer) and opts for a double mastectomy ($568 for the surgeon for pre-and post-op visits, surgery, writing a couple of letters to the insurance company for prior authorization for removal of non-diseased breast/ $14,598 for the hospital, two night stay on med/surg floor), chemotherapy ($1600 to the oncologist for customizing a treatment program based on the type of cancer and administering 12 rounds at an hour per round, $15,000 to $50,000 for the chemo drugs) and opt for breast reconstruction -- if she doesn't mind painful capsular contraction or the unnatural look of the cheaper implant option ($920 to the surgeon who must pay $250 - $400 for each implant, $10,400 to the hospital for outpatient surgery), and then $380 per month for estrogen receptor inhibiting drugs to protect her ovaries so that she can forego an oophrectomy and maybe preserve her fertility for a few more years. In this scenario, the insurance company is going to spend at least $85,646 (I've left out the costs of labs and diagnostic imaging because I don't know those off the top of my head), and underwriting predicts 1.54% incidence of catastrophic illness in this group. 40% of people in this group are on at least one maintenance drug like Allegra, Lunesta, Celexa at about $65,000, four will need outpatient surgery $48,000, and most will have a yearly exam with labs $6500. That is where your groups' $240,000 in premiums go. If you look at my example of the breast cancer patient, you will notice that only$2588 of the $85,646 is paid to the physicians who prescribe and manage the care. That is a real world example. I honestly believe that there is a way to get hospital and drug costs under control other than subjecting us all to a Medicare-like program which will diminish quality and slow innovation. Further, I don't trust the government who has orchestrated the kind of misallocation of resources outlined above to fix the problem.

The dollar amounts above are the amounts that would actually be paid, not the charges. The charges and the actual costs have nothing to do with each other, which is what makes it virtually impossible to navigate the world of healthcare without insurance. While your nurse practitioner's bill may have said the charge was $170, I promise you that was not what she accepted as payment or she's making about 3 to 4 times what a board certified physician would command in this market. If you have any financial obligation above and beyond a copay you will receive an explanation of benefits which will show what she was ultimately paid, what she wrote off, and the amount of your co-insurance. As an example, I got a bill today from a provider. The charges were $1945.00, the insurance company paid $345.00, I paid $155.00, and the provider wrote-off $1445.00. In my experience, that is pretty typical. You state that $35 and $4 isn't what an office visit and a prescription cost. Well, that my not be the advertised price, but that is what they cost. Wal-Mart has a $4 formulary and there is an acceptable treatment for the overwhelming majority of conditions on it. And you can look up 99212 (intermediate level office visit, established patient) at http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp?agree=yes&next=Accept for yourself. People without insurance just have to ask providers for the same discounts they give to the insurers, I've never met one who was not willing to do so. There are also free clinics and indigent care facilities available. There are many, many resources available to those who fall between that cracks.

As for the $80,000 boob jobs. The two men I worked for dedicated their practice to two procedures they developed called DIEP and GAP breast reconstructions for women who have had breast cancer. These procedures use a woman's own tissue without destroying her abdominal muscles or her latismus muscles to reconstruct natural looking breasts. Their patients breasts look and feel natural, do not develop painful and disfiguring scar tissue, and the women have far fewer psychological difficulties following their reconstructions. They are two of five surgeons performing these procedures in the world, and they are by far the best at it. They charge $80,000 but that is not what they are paid. They either lose money or operate for free on about 20% of their patients, they break even or make a very modest amount of money on 60-70% of cases, and make very good living off the other 20%. When I was hired, I was given the task of making sure they made as much money doing this world-class surgery as they would if they were popping implants in trophy wives all day. That was all that was asked of me. I did a bit better than that for them. They are world class surgeons, and deserve to make a good living. Frank Gehry is a world class architect, and deserves to make a good living as well.

Well lets not go getting our panties in a wad here. I am sure Punzy knows what the Medicare schedule is and who qualifies. Even though Skunk is a doc and Punzy is in industry, I have always found them to be objective and Skunky always looking for the least expensive route to treat someone which I find admiral.

I can certainly understand the 15 minutes with a doc. Between what my plan pays and my co-payment I often wonder how some of the stay in business. My doctor did it for a long time and eventually has gone to not even accepting insurance anymore.

But Punzy, where can someone go to a doctor for $35 who doesn't have insurance? In New York you can not even see a vet for that price. :lol:

In New York City, I think the relative value scale (RBRVS) is closer to $42. 😀 Thanks for the kind words, Mango.

In New York City, I think the relative value scale (RBRVS) is closer to $42. 😀 Thanks for the kind words, Mango.

Your welcome sweetie. You know your stuff. :wave:
Skunky and I have agreed to disagree on some things like herb potions and bug juice, but it's quite evident that y'all are in the biz to help people and not purely in it for economic reasons and for that....:bow:

Punzy...I REALLY appreciate all the information & perspectives that you've posted here. It's giving me ALOT to mull over & consider. Thanks so very much.

And this, my friends, is why we'll never get anything done. Our lefty friends jump in with their perspectives on providing healthcare to the uninsured, our righty friends advocate throwing out all consumer protection services provided by the government. People with a strong political perspective come to the issue with their minds made up. They muddy the waters for everyone else.

From my perspective, I have seen the best surgeons go into plastics instead of neurosurgery because they want to make money. I have seen the lobbying efforts of HCA, Tenet, Pfizer, Astra Zeneca, et.al., as well as some medical specialties such as orthopedic surgery and cardiology pay off a hundredfold. I have seen the chilling effect of the Medicare fee schedule on physician encounters.

For those of you who don't like the fact that your doctor doesn't spend more than fifteen minutes for you, does it help you to understand why now that you realize they are paid $33.18 per encounter and all their staff and overhead must be paid out of that? Does it bother you that the best doctor in a market is paid at the same rate as the worst? Well, that is what the Medicare fee schedules conversion to a relative value scale allowing insurers to use it to pay providers has done. The only way for a doctor to make a better living for himself is to see more patients. That is not the way a free market works. As I've stated before, we already have nationalized healthcare -- it is just administered by insurance companies and hospitals and drugs remain unregulated. It's not working. Quality of care has gone down for most Americans in the last ten years, the cost of that care has gone up. It's the very lack of a market driven system that has caused these problems. There is no correlation between what is charged for things and what they cost, the quality of service has not impact on what can be charged for that service.

As for those of you who have family and friends that can't get coverage, I respectfully disagree. They can get coverage, it just costs too much. It costs so much because they underwrite into groups that spend as much as those premiums plus 3-5% as a group. Those charges are completely out of touch with reality because the party that pays the bills is not the party that consumes the services.

No one in this country goes without healthcare. The last surgical group I managed did 10% of their $80,000, best in the world, breast reconstructions for free. If they are truly poor, they qualify for Medicaid. If they are not poor enough for Medicaid, they have been priced out of the market for healthcare by the problems with our over-regulated system and it's lack of consumer-driven decision-making. If they can afford a haircut, they can afford to pay $35 dollars for an office visit and $4 for a prescription.

Everyone please continue to point fingers, but the Feds are going to shut down the health insurance circus soon. We are going to get either the greater or lesser of two evils, because the public's perspective of insurance companies,hospitals,providers is rather toxic. The inflation in premiums/prices in this industry is not sustainable. I pay about 7k year for coverage, and I have had to wade through a big city emergency room full of non-emergency cases to get treatment for my wife. I have had to throw the hospital minion out of my wife's room seeking prepayment for the deductible of services yet to be rendered. I have had to wait 48 hours for the first glimpse of a physician, because my wife was "stabilized", and therefore of lower priority. All this took place in a city drowning in doctors and where the nicest, newest buildings are the hospitals. It took place in a hospital where both my children were born. It took place next to the doctor's parking lot which looked like a Mercedes/Porsche dealership. There are many culprits here, but I'm saying the party's just about over.

Everyone please continue to point fingers, but the Feds are going to shut down the health insurance circus soon. We are going to get either the greater or lesser of two evils, because the public's perspective of insurance companies,hospitals,providers is rather toxic. The inflation in premiums/prices in this industry is not sustainable. I pay about 7k year for coverage, and I have had to wade through a big city emergency room full of non-emergency cases to get treatment for my wife. I have had to throw the hospital minion out of my wife's room seeking prepayment for the deductible of services yet to be rendered. I have had to wait 48 hours for the first glimpse of a physician, because my wife was "stabilized", and therefore of lower priority. All this took place in a city drowning in doctors and where the nicest, newest buildings are the hospitals. It took place in a hospital where both my children were born. It took place next to the doctor's parking lot which looked like a Mercedes/Porsche dealership. There are many culprits here, but I'm saying the party's just about over.

I wonder which professions you believe warrant salaries that enable one to afford a house in SoWal, Bob?

I'll agree with you that too many doctors don't respect their patients as customers. The biggest shortcoming in medical education today is that physicians never have any sort of business training, and that basic customer service is never emphasized or rewarded. I honestly believe the main reason I was successful in turning practices around was just putting an emphasis on customer service and teaching the whole staff (especially the doctors) to see patients as customers and respect their time. I believe that provider indifference would change for the better if more Americans change to HCSA plans with high deductible indemnity policies and doctors could set their own charges. If we go to a single payor system, I think the indifference will be way worse.

And Bob, let me go out on a limb and ask -- are all the hospitals in your area owned by a single corporate entity? Is that large hospital corporation well connected with state government and well represented by lobbyists in Washington? If they are able to get a hospital license without an ER, I am betting they made big huge contributions to many campaigns the last time around. I'm guessing a Florida Hospital affilliate, maybe?

I definitely don't mean to imply that I think healthcare as it exists is great. There are many problems, but I have watched the way the government's attempts to control costs thus far have hurt so much more than they have helped. If we have issues with customer service now, we will only be cutting off our noses to spite our faces if we move to a single payor system.

I know a lot of people have talked about good doctors in the area, but has anyone had good customer service with their doctors and especially their doctors' staff?

http://www.floridahospital.com/ Do not go there if ill. Seven locations for their convenience.

http://www.floridahospital.com/ Do not go there if ill. Seven locations for their convenience.

Ding, ding, ding! What do I win? :floor:

For their convenience....I love it! :clap:

I want everyone to make a great living. But with good compensation there should be reciprocity of providing competent service.

Again, attention span and stuff, but here is Friedman making the argument more eloquently than I could begin to.

http://www.freetochoose.net/1980_vol7_transcript.html

The price consumers pay when it comes to medicine could be their lives. In the 19th Century pharmacies contained an impressive array of pills and potions. Most were ineffective and some were deadly. There was an outcry about drugs that maimed or killed. The Food and Drug Administration in response to consumer pressure succeeded in banning a whole range of medicines. The tonics and lotions with their excessive claims disappeared from the market. In 1962 the Kefauver Amendment gave the FDA power to regulate all drugs for effectiveness as well as for safety. Today, every drug marketed in the United States must pass the FDA. It's clear that this has protected us from some drugs with horrific side effects like thalidomide. And we all know of people who have benefited from modern drugs. What we don't hear much about however, are the beneficial drugs that the FDA has prohibited.

Well, if you examine the therapeutic benefits of significant drugs that haven't arrived in the U.S. but are available somewhere in the rest of the world, such as in Britain, you can come across numerous examples where the patient has suffered. For example, there are one or two drugs called beta blockers which now can prevent death after heart attack, we call it secondary prevention of coronary death after myocardial infarction, which if available here, could be saving about 10,000 lives a year in the United States. In the ten years after the 1962 amendments no drug was approved for hypertension. That's for the control the blood pressure in the United States, where as several were approve in Britain. In the entire cardiovascular area, only one drug was approved in the five year period from 67 to 72. And this can be correlated with known organizational problems at FDA.

These carts are taking to an FDA official the documents required to get just one drug approved.

Worker: Well, hi there, must be the new one they called me about.

Friedman: It took six years work by the drug company to get this drug passed.

Worker: This one right here, all 119 volumes.

Friedman: The implications for the patients are that therapeutic decisions that used to be the preserve of the doctor and the patient are increasingly becoming made at a national level by committees of experts. And these committees and the agencies for whom they are acting, FDA, are highly skewed to avoid risks. So there is a tendency for us to have drugs that are safer but not to have those that are effective. Now, I've heard some remarkable statement from these advisory committees in considering drugs. One has seen the statement, there are not enough patients with the disease of this severity to warrant marketing this drug for general use. Now that's fine if what you are trying to do is to minimize drug toxicity for the whole population. But if you happen to be one of these "not enough patients" and you have a disease that's of high severity or a disease that's very rare than that's just tough luck on you.

For ten years Mrs. Esther Usdane suffered from severe asthma. The medication she received had serious side effects. Her condition was getting worse. But the drug her doctor preferred is prohibited by the FDA. So, twice a year Mrs. Usdane had to set out on a journey.

Mrs. Usdane: I had been very sick. I had been in and out of the hospital several times and they couldn't seem to find a way to control the asthma and I had to change my lifestyle once I was out even for a short time, mainly because the cortisone derivatives were softening the bones and causing a puffiness of the face and other changes in my body. The doctors were pretty anxious to get me off the cortisone derivative.

Friedman: The drug her doctor wanted her to have had been available for use for five years in Canada. Once across the boarder of Niagara Falls, Mrs. Usdane could make use of the prescription that she obtained from a Canadian doctor. All she had to do was go to any pharmacy. There she could buy the drug that was totally prohibited in her own country. The drug worked immediately.

Mrs. Usdane: This one made such a difference in my life both because of the shortness of breath being resolved and also because now we don't have to worry so much about the softening of the bones. Fortunately, once I got that medicine, very quickly, everything sort of reverted back to a much more the normal lifestyle and I'm very grateful that I was able to find relief.

Friedman: It was easy for Mrs. Usdane to get around the FDA regulations because she happens to live near the Canadian boarder. Not everyone is so lucky. It's no accident that despite the best of intentions, the Food and Drug Administration operates so as to discourage the development and prevent the marketing of new and potentially useful drugs. Put yourself in the position of a bureaucrat who works over there. Suppose you approve a drug that turns out to be dangerous, a thalidomide. Your name is going to be on the front page of every newspaper. You will be in deep disgrace. On the other hand, what if you make the mistake of failing to approve a drug that could have saved thousands of lives. Who will know? The people whose lives might have been saved will not be around. Their relatives are unlikely to know that there was something that could have saved their lives. A few doctors, a few research workers, they will be disgruntled, they will know. You or I, if we were in the position of that bureaucrat, we'd behave exactly the same way. Our own interests would demand that we take any chance, whatsoever, almost, of refusing to approve a good drug in order to be sure that we never approve a bad one.

Drug companies can no longer afford to develop new drugs in the United States for patients with rare diseases. Increasing, they must rely on drugs with high volume sales. Four drug firms have already gone out of business and the number of new drugs introduced is going down.

Where will it all lead? We simply haven't learned from experience. Remember Prohibition? In a burst of moral righteousness at the end of the first world war, when many young men were oversees, the non-drinkers imposed on all of us prohibition of alcohol. They did it for our own good. And there is no doubt that alcohol is a dangerous substance. Unquestionably, more lives are lost each year through alcohol and also the smoking of cigarettes than through all the dangerous substances the FDA controls. But where did it lead?

This place is today a legitimate business. It's the oldest bar in Chicago. But during Prohibition days it was a speakeasy. Al Capone, Buggs Moran, and many of the other gangsters of the day sat around this very bar planning the exploits that made them so notorious; murder, extortion, highjacking, bootlegging. Who were the customers who came here? They were people who regarded themselves as respectable individuals, who would never had approved of the activities that Al Capone and Moran were engaged in. They wanted a drink but in order to have a drink they had to break the law. Prohibition didn't stop drinking, but it did convert a lot of otherwise law obedient citizens into law breakers. Fortunately, we're a very long way from that today with the Prohibition on cyclamate and DDT. But make no mistake about it, there is already something of a gray market in drugs that are prohibited by the FDA. Many a conscientious physicians fees himself in a dilemma caught between what he regards as the welfare of his patient and strict obedience to the law. If we continue down this path, there is no doubt where it will end. After all, if it is appropriate for the government to protect us from using dangerous guns and bicycles for logic calls for prohibiting still more dangerous activities such as hand gliding, motorcycling, skiing. If the government is to protect us from ingesting dangerous substances, the logic calls for prohibiting alcohol and tobacco. Even the people who administered the regulatory agencies are appalled at this prospect and withdrawal from it. As for the rest of us, we want no part of it. Let the government give us information but let us decide for ourselves what chances we want to take with our own lives.

As you can see all sorts of silly things happen when government starts to regulate our lives. Setting up agencies to tell us what we can buy, what we can't buy, what we can do.

Remember, we started out this program with a Corvair and on the bill that was castigated by Ralph Nader as unsafe at any speed. The reaction to his crusade led to the establishment of a whole series of agencies designed to protect us from ourselves. Well, some ten years later, one of the agencies that was set up in response to that, now finally got around to testing the Corvair that started the whole thing off. What do you suppose they found? They spent a year and a half comparing the performance of the Corvair with the performance of other comparable vehicles and they concluded and I quote "The 1960_63 Corvair compared favorably with the other contemporary vehicles used in the test." Nowadays, there are Corvair fan clubs throughout the country. Corvair's have become collector items. Consumers have given their verdict on Ralph Nader and the government regulations. As Abraham Lincoln said, you can't fool all of the people all of the time. It's time all of us stopped being fooled by those well-meaning bureaucrats who claim to protect us because they say we can't protect ourselves. The men and women who have fostered this movement have been sincere. They believe that we as consumers are not able to protect ourselves. That we need the help of a wise and effervescent government. But as so often happens the results have been very different from the intentions. Not only have our pockets been picked of billions of dollars, but also we are left less well protected than we were before.

6th Gen, I don't understand how you can rail against the FDA's cumbersome process when we can all pick up any newspaper and read about the Cox 2 inhibitors that have caused cardiac death in thousands of people. Now we have Evandia making news. The push to make AIDS drugs avaiable quickly in the early nineties provided a fast track for groundbreaking drugs. The process may still be cumbersome, but drugs that kill people are still getting through. Further, I don't understand how relaxing the FDA's requirements for getting a drug to market would make them universally available, since r&d budgets are generally about 30% of the marketing budget at any given pharmaceutical company.

As for universal healthcare, House Call with Sanjay Gupta on CNN today has a great look at each major presidential candidate's healthcare plan. It's a great crash course for voters who want to learn about the issue and various candidates positions.

I'll disclose that I've been an Obama donor. However, I have to say that Guiliani's plan is the only one I could really support. And I think he'd make a terrible president.

What time is this show on please? 😀
Punzy, just curious of your professional opinion on Hillary's health care ideas? :blink: :cool: