59% of US Doctors favor Universal health care - Page 3 - U.S. Politics Online: A Political Discussion Forum

pramjockey · #31 (**permalink**) 03-31-2008

Quote:

Originally Posted by Si modo

I disagree that it won't work unless all contribute. I'm not getting your reference to stakeholding, so could you expand on that? (I'm not too money savvy and maybe that's why I don't see it not working). For the folks that took the opt out yet still lost their insurance, I don't think they should be allowed to get a free ride. They made the choice (or gamble) to opt out, their insurance gets cancelled, and they are responsible for paying for that choice (budget down their lifestyle, assume debt, get bad credit, etc.) until the next year. Then they can decline opting out or show another proof of coverage to opt out.

I intend "stakeholder" to mean an individual recognizing that they have a stake in the success of the program, not just becasue of money that may be involved.

The problem with allowing "gambling" is that there is no real gamble. Health care will not be denied to the truly sick; it's not logistically possible. All that would happen is that some would get out of paying their fair share.

Si modo · #32 (**permalink**) 03-31-2008

Quote:

Originally Posted by pramjockey

I intend "stakeholder" to mean an individual recognizing that they have a stake in the success of the program, not just becasue of money that may be involved.

The problem with allowing "gambling" is that there is no real gamble. Health care will not be denied to the truly sick; it's not logistically possible. All that would happen is that some would get out of paying their fair share.

I'm still not seeing it, sorry. If you can pay for something that you prefer, then you should have that choice and those that prefer to pay themselves I expect would be wealthy - a minority. If (and it's a big if) any health care reform is done effectively, then the majority of the population is supporting it and supporting it by choice - they choose it because it makes financial sense to them for their income. Health care should not and would not be denied to the truly sick. The hippocratic oath deals with that.

(Yet I still would like to see health insurance reform tackled (in the sense of simplifying it like it used to be) before universal health care.)

pramjockey · #33 (**permalink**) 03-31-2008

So, then, you've got the system we have now.

drgoodtrips · #34 (**permalink**) 03-31-2008

Quote:

Originally Posted by Skerlnik

Very valid question.

At the risk of sounding too circumspect, let me say that I beleive that certain things are too important to society/the costs of failure are too great, to be subjected to the whims and inconstancies of the private market. (Bear in mind, I am not some commie doofus, who wants to unprivatize everything...)

Education and heathcare are two things that I consider core responsibilities of the government (public/society). If we don;t havw an educated, healthy society, not much else is going to matter. And, there are things that are simply more efficient if done collectively, as opposed to individualistically, like national defense, or roads, say.

I understand the arguments about "why should I have to pay for anyone else?" Let me submit that, done correctly (!) costs would theoretically go DOWN. If more people are paying in than taking out...well, you know the basic argument.

I just think that the people have a vested interest in not allowing others to slip through the cracks, and selfishly think it won't affect them. It sure does. And, since we could agree that preventative maintenance is pennies on the dollar as opposed to when most people bother to go get checkups, I should think that, overall, this makes more sense.

I tend to think of both education and health care as the public's investment in itself. And that's really the whole point of what government SHOULD be doing. A person's health simply should not be subject to one's ability to pay, nor some insurance company's actuarial table. In essence, the people insure their own health.

We already pay for all sorts of things collectively, anyway. Hell, I'll happily trade a few soon-to-be-mothballed jet fighter in exchange for local clinics and free checkups for everyone twice a year. We have to start thinking more as a nation instead of a collection of 350 million individuals. Surely we haven't gotten so pathetically selfish and self-centered as to begrudge other people good health? Doesn't that benefit us all?

All that said, I haven't a clue HOW to accomplish this, honestly.

I should think that we could LEARN from other nation's mistakes and create a stellar system. We have smart people here, I can;t believe we can't figure this out. I don't buy that it's automatically doomed to failure. When did Americans become so defeatist? Besides, with costs already ridiculously out of control, and a fifth of the nation uninsured, we clearly can't limp along much longer as it stands.

Screw Iraq. Think of what we could have accomplished HERE, for what we've spent over there. You know...for AMERICANS!

I am open to all sorts of ideas, and am not terrified of change. It's just disgraceful we haven't been able to figure this out. The richest nation on Earth can't even ensure its own health? What the hell is government FOR, if not that?

On the subject of Iraq (and exorbitant military spending in general), I'm with you. I certainly think that there are many, many things on which money could be better spent. I'd even support some domestic programs of which I'd be leery over the Iraq adventure.

As for an ideal way to accomplish healthcare, universal or otherwise... it's a doomed proposition. People get sick, people die, and other people get sad. All of the health care coverage in the world (or to the tune of 50% of our incomes) cannot possibly change this. Health care reform, unlike just about any other domestic policy, is inherently unwinnable (even less so than the "war on drugs" - this is unwinnable by definition).

I'm not saying this to be fatuous, but rather to point out what, exactly, we're dealing with. What will we accomplish with "much better" health care? Our life expectancies have increased steadily without socialized health care, and, aside from particular sad stories, I don't think that your average person in this country is suffering from a debilitating condition that could easily be treated with a bit more money (I know this happens, but I think it gets a disproportionate amount of coverage under "human interest"). That is, most people without adequate health coverage are not much worse off, health-wise, and most people with painful/chronic/fatal conditions would probably not be helped much per extra dollar. That is, a man suffering from, say, chronic arthritis might spend $100 on painkillers per month to feel a little better, or might have some surgery costing tens of thousands of dollars, that makes him feel marginally better than the painkillers do.

And, how exactly, do we measure his pain to determine if spending a hundred times as much money was contributing to the collective welfare or wasting the money of the collective? We can't ignore the cost of this if everyone has a stake in the collective coffers. Giving this man a bit less pain is certainly a "good" thing, but what if he would have done all right with the Advil and his surgery is that many fewer dollars that can be spent on inoculations or cancer treatments for the same amount of public money? I'm making a point - I'm asking you.

I'll save a discussion of how other people "slipping through the cracks" affects me personally for another post.

drgoodtrips · #35 (**permalink**) 03-31-2008

Quote:

Originally Posted by pramjockey

The weakness, of course, with this is that you can't be SURE that you're paying more into Social Security than you're going to get out of it. You could be diagnosed with MS tomorrow and be unable to work in 6 months. Think your company's going to support you for the rest of your life?

No, but I think that the privately funded disability insurance for which I pay will (and I could still program well into that condition). I'm not commenting on SS to make a political point (I'll save that for another thread), but rather because it's honestly how I view it. I'm aware that I'll contribute large sums of money to SS and I honestly believe that I'll never see a penny of that. Like a parking ticket, this is simply an inconvenience resulting from my circumstances - I don't like it, but I have no choice but to live with it.

Quote:

Originally Posted by pramjockey

Yeah, you do raise good points. Cigarettes? Tax them at such a rate to make up the costs that they create for the system (anticipated and current). Alcohol the same.

Fatty foods? Going outside sans jacket?

I know that's a "slippery slope" kind of thing, but once you've socialized something, people will tend to get resentful. Why should I pay for my neighbor's Sudafed when he's the dumbass that wore a T-shirt in 20 degree weather?

Quote:

Are there going to be those who abuse the system? Absolutely. But, they're already there. I can't tell you how many times I've run lights-and-sirens across town to a call that basically ended up being "I'm old and I'm lonely." System abuse already exists, and it costs us dearly. Every study I've ever seen shows that the savings to the system by creating true universal preventive care would allow the system to pay for itself. Me, I'm not really worried about that small set of abusers. They can't really do any more harm than they already are.

Oh, I agree with that (abuse being inevitable). And, FWIW, I don't advocate any removal of a system where people are treated for emergencies regardless of the insurance situation, or anything like that. But, as optimistic as you seem toward a government run program, I am skeptical. I'm not sure what, exactly, you advocate by the way (government run everything, fund to pay private insurance for those without health insurance, etc).

Si modo · #36 (**permalink**) 03-31-2008

Quote:

Originally Posted by pramjockey

So, then, you've got the system we have now.

Sort of, yeah. But if we reform health insurance, see the effect of that, then I think we would see better and safer results. I am still wary of such drastic reforms without a clear plan.

Before HMOs, PPOs, blah-blah-Os, etc. there was the simple, basic, classic health insurance and I never saw any problems with the health care crisis. I realise this is a silly "in the good old days" argument, but it may be worth a try to reform/regulate the health insurance companies first. I believe it would be the prudent approach and prefer that over a drastic approach that could have many more unforeseen economic impacts. If it is the fault of these different insurance options making med decisions, which MD you can see, when you are eligible to see a specialist, etc., then some reform would be the first step, IMO. Also, curbing illegal immigration would greatly relieve the currently taxed ER services and, with insurance reform/regualtion, perhaps folks could actually get a same-day appointment with their GP or internist when they are sick.

drgoodtrips · #37 (**permalink**) 03-31-2008

Quote:

Originally Posted by Skerlnik

Ah, the "slippery slope" argument...

Nah... I try to avoid fallacies where I can

I was genuinely asking his opinion on where it should end.

Quote:

Well, I would think that those things would be taken into account, being elective surgeries, etc. I don't know what we should do about smokers, but I do know that care AFTER the fact is way more expensive than early detection, in general.

I don't think anyone ever devised any system that is immune to "abuse". However, I see health as something we just can;t get anough of! (Oh no, he got four checkups for free! How horrible!

)

I'd be pretty happy if eveyone at least got two checkups a year and immunizations. That, alone would be incredible savings.

All I am asking people is to be open to a change, not to immediately freak out. We need pilot programs, data, analysis, time to work this out. Health care costs are, I believe, the number one cause of bankruptcy. Something's GOT to give.

Well, let me be specific about what makes me cringe. You (and other advocates of universal health care) seem to do a bit of hand-waving regarding the system that will determine how things like smoking, drug use, reckless behavior, etc are treated in such a system (saying things like "admittedly, I don't know - but we'll figure something out"). When the government "figures something out", you get the freakin' income tax system - expensive, absurdly inefficient, and generally abusable by the same rich people who are theoretically supposed to be propping it up in the fist place.

Quote:

Originally Posted by Skerlnik

That's fine, just don't demand any sort of tax break for your decision. Everyone pays in, but if you want to pay extra for going it alone, that's your business.

Well, no. What I'm saying is that I'd like to opt out of the system (and SS for that matter) altogether, if I could. I wouldn't want any kind of "break" - I'd just pay a private insurance company.

Quote:

Ultimately, your health IS my business. It affects the economy, and much else. It is in my best interest to ensure you are healthy and productive. Therefore, it is part of my duty as a citizen to make my government ensure this on my behalf.

(That's my biggest problem with our individualism. In most cases it's great, but god damn, can we be selfish at times!)

Tangentially, yes (affects the economy). But, if my health is your business and you have a vested interest in it, you then have a vested interest in removing my freedom for what you perceive to be my own good. I'm very, very leery of that, and of any system that encourages that sort of thing.

drgoodtrips · #38 (**permalink**) 03-31-2008

Quote:

Originally Posted by pramjockey

Financial situation? No. Being rich does not excuse you from your duty to your fellow human being.

Private insurance? Depends on the coverage. If it provided lifetime care and couldn't be cancelled? Maybe. Otherwise, no.

Out of curiosity, would you advocate a "flat" system (possibly with exemptions for low income), or would this "health tax" function in the same manner as an income tax?

drgoodtrips · #39 (**permalink**) 03-31-2008

For fear of cluttering the thread anymore, I'll make one last post and then see if I can't get out of the office after a nice 14 hour day...

One of my biggest sources of leeriness with universal health care run by the government is that you effectively turn health care into a zero sum game. In our current system (discounting complications and corrupt practices that I would like to see reformed), this isn't the case. To illustrate and distill my meaning, let me present an example that is, admittedly, an oversimplification.

In our current economy, people buy food in the free market. That is, you go to the store and buy food. If the food is too expensive for your tastes, you buy different food or go to a different grocery store where it's cheaper. If you're hard up, you buy less food. As the price of food goes up, demand will, to a degree, shift or decrease (food being relatively inelastic means it won't decrease a ton, but it will) - particularly unnecessary or gourmet food.

Now, let's say that we decide that everyone has a universal or god-given or whatever "right" to food. Since our government tends to manage things with the utmost efficiency, we decide that the sensible thing to do is to have the government take over all grocery stores and restaurants and provide us with "free" food. To finance this, they'll take, say, 10% of our income. But, the beautiful thing is that all food is now "free" and nobody ever goes hungry.

But, now, with food pooled like this, everyone wants to get their money's worth. Everyone paid in, and everyone is going to get his fair share, goddamnit! So, people take as much as they're entitled, whether or not they want or need it, and, in spite of the government's incredibly efficient program of filling out sixteen forms that determine how much food, exactly, everyone needs, not everyone is getting all of the food that they want in the exact types and quantities that they want. The only recourse is to collect more money from the populace to provide more food. After a lot of squabbling over who should finance this, everyone starts paying more tax for food. This leads to an even greater sense of entitlement and outrage, and even more attempts to hoard food that they paid for, goddamnit!

So, in the free market, we have a system where increased price naturally depresses demand. In our socialized food system, we have a system where increased price increases demand, which is a pretty vicious circle.

Again, I realize that is an oversimplification due to the current existence of insurance programs and the additional sentimental notions around healthcare, but the principle is still applicable, I feel.

Skerlnik · #40 (**permalink**) 03-31-2008

Quote:

Originally Posted by drgoodtrips

As for an ideal way to accomplish healthcare, universal or otherwise... it's a doomed proposition. People get sick, people die, and other people get sad. All of the health care coverage in the world (or to the tune of 50% of our incomes) cannot possibly change this. Health care reform, unlike just about any other domestic policy, is inherently unwinnable (even less so than the "war on drugs" - this is unwinnable by definition).

I think you misunderstand what would be actually accomplished.

Of course people are going to get sick. Of course people are going to die. It isn't about that. What I am saying is that the government has a responsibility to provide equal access to healthcare under the law. Basicaly, breaking the stranglehold of the insurance compnaies and big pharma, ultimately.

Why would reform be "unwinnable"?

We don't allow private companies to provide national defense for us, nor do we allow it to be unregulated. Same thing. We've provided for the common defense, now it's high time we promoted the general welfare.

Quote:

That is, most people without adequate health coverage are not much worse off, health-wise, and most people with painful/chronic/fatal conditions would probably not be helped much per extra dollar. That is, a man suffering from, say, chronic arthritis might spend $100 on painkillers per month to feel a little better, or might have some surgery costing tens of thousands of dollars, that makes him feel marginally better than the painkillers do.

Not getting your point, here. I am primarily concerned with the million of folks with no access to care, except emergency care, and the usurous heathcare insurance industry, that determines if people live or die based on some actuarial table.

My argument is that we can certainly do better. If you see no problem, I'd wager you already have decent insurance, yourself.

Quote:

And, how exactly, do we measure his pain to determine if spending a hundred times as much money was contributing to the collective welfare or wasting the money of the collective? We can't ignore the cost of this if everyone has a stake in the collective coffers. Giving this man a bit less pain is certainly a "good" thing, but what if he would have done all right with the Advil and his surgery is that many fewer dollars that can be spent on inoculations or cancer treatments for the same amount of public money? I'm making a point - I'm asking you.

I don't really know, but I'm fairly certain no system would be where some guy could just randomly walk into a clinic and grab whatever he wanted. And if you are demanding some foolproof system where there's NO wastage whatsoever, not even the vaunted private sector can do that.

It seems you are looking for reasons to fail, here.

Skerlnik · #41 (**permalink**) 03-31-2008

Quote:

Originally Posted by drgoodtrips

To illustrate and distill my meaning, let me present an example that is, admittedly, an oversimplification.

'kay.

Quote:

In our current economy, people buy food in the free market. That is, you go to the store and buy food. If the food is too expensive for your tastes, you buy different food or go to a different grocery store where it's cheaper. If you're hard up, you buy less food. As the price of food goes up, demand will, to a degree, shift or decrease (food being relatively inelastic means it won't decrease a ton, but it will) - particularly unnecessary or gourmet food.

We could use X commodity for this. I submit that health, like education, should not be commodified. My argument is that there are some things that are too important to leave to a "free market". Free markets FAIL, as we are seeing with the housing and loan industry, and we are reaping what weve sown from massive de-regulation.

Health care isn't really a supply/demand thing. It's not a product. It isn't an extravagance, like gourmet food is.

Quote:

Now, let's say that we decide that everyone has a universal or god-given or whatever "right" to food. Since our government tends to manage things with the utmost efficiency, we decide that the sensible thing to do is to have the government take over all grocery stores and restaurants and provide us with "free" food. To finance this, they'll take, say, 10% of our income. But, the beautiful thing is that all food is now "free" and nobody ever goes hungry.

Ah. But I do not advocate the government becoming a "producer" or supplier of health care. There's already a massive, perfectly good system in place already.

Quote:

But, now, with food pooled like this, everyone wants to get their money's worth. Everyone paid in, and everyone is going to get his fair share, goddamnit! So, people take as much as they're entitled, whether or not they want or need it, and, in spite of the government's incredibly efficient program of filling out sixteen forms that determine how much food, exactly, everyone needs, not everyone is getting all of the food that they want in the exact types and quantities that they want. The only recourse is to collect more money from the populace to provide more food. After a lot of squabbling over who should finance this, everyone starts paying more tax for food. This leads to an even greater sense of entitlement and outrage, and even more attempts to hoard food that they paid for, goddamnit!

Are you trying to convince me that people will somehow want to go to the doctor every day, to "maximize" their gain from the system? "Woo-hoo, I wanna have open heart surgery this week!"?

Quote:

So, in the free market, we have a system where increased price naturally depresses demand. In our socialized food system, we have a system where increased price increases demand, which is a pretty vicious circle.

Ideally, people should never go hungry in the richest, most bounteous nation on earth, either. No excuse for it.

Quote:

Again, I realize that is an oversimplification due to the current existence of insurance programs and the additional sentimental notions around healthcare, but the principle is still applicable, I feel.

Only sort of.

What we're really talking about is using the government as the insuring agent. That nobody puts off seeing a doctor, because of exorbitant copays.

Surely this is a core mission of our government?

pramjockey · #42 (**permalink**) 03-31-2008

Some very good posts, please forgive me for not replying to each individual point. I can very well understand the points that are being raised.

I think the problem is that I really struggle with medicine being a for-profit enterprise (for the most part). It seems to me that the profit motive is in direct conflict with the motivations inherent in caregiving as a medical provider. Like so many other things, the increasing influence of money has created much of the harm that we see in the system - it's not about providing the best care possible, but about exploiting the sick in order to make money.

I'm not expert enough to be able to really get down into the nitty-gritty of how a system can be designed and implemented effectively. The key word, of course, is effectively. I'm especially weak in the finance side (I'm no finance major in business school!!), so I don't know what would be the best way to fund, but it occurs to me that a tax structure rather than a flat fee makes more sense. And, of course, I recognize that to provide infinite care to the people is impossible. But, I think that it's possible, and necessary, to provide good, effective preventative care to the citizens and residents (hard to separate legal from non-legal) of the US. I also understand that there will also be those exceptional individuals on both sides; those who will abuse the system and those who will never use it. But, I feel that the potential for that abuse is minimal, especially when compared to the good that could be done.

soot · #43 (**permalink**) 03-31-2008

I agree that each individual has a stake in the health of all other citizens, and while I wouldn't exactly consider healthcare a "right" I definately think that it should be a benefit of a wealthy society such as ours.

My problem with universal healthcare lies in the administration.

Our public education is a shame.

Our Social Security system is on the verge of brankruptcy.

Our immigration/border security system is laughable.

Our veteran's healthcare system is in pretty rough shape.

Etc...etc...etc...

What would lead anyone to believe that the federal government can be trusted to administer a national healthcare system?