# Healthcare: THE FACTS!



## omegax (Oct 25, 2006)

We FAR pay more for our care than any other nation on Earth, even when you include their taxes (we pay 33% more than second-place Switzerland). However, the mortality statistics and life expectancies in every other industrialized country are every bit as good as ours, and in some cases better. The quality of our care, as a whole, is not significantly better. Medicare has a fraction of the overhead of private insurance. It's a completely unsupportable fallacy that government does a poor job when it comes to health insurance. EVERY country that has universal care pays less than we do. The old "you think it's expensive now, wait 'til it's free" chestnut is not supported by the experience of any other country on the planet. 20,000 people die every year of treatable illnesses because of lack of insurance coverage.

The only other arguments I ever hear are "b-b-b-but Socialism!", and "This one Canadian guy died waiting for X". First: the Socialism thing. That particular ideological stand is costing this country 20,000 lives every year, as well as at LEAST 4% of our GDP (if we even paid as much as Switzerland, it would offset the GDP contraction from the recession!). As far as the anecdote about somebody who died waiting: anecdotes are one thing, but the mortality stats don't lie. The quality of our care is statistically no better. Also, let me remind you that our current system allows 20,000 people to die, every year.

Honestly, watch the Frontline specials "Sick Around America" and "Sick Around the World". You can watch them on-line. They've also accumulated a lot of very good articles in the accompanying links sections.


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## Plainsman (Jul 30, 2003)

How would you stop those 20,000 people from dying? Can you stop everyone from dying? How do you separate a death from poor health care from a death that could not be saved no matter the health care given? Who defines which is which? What is the death rate in each nation? I would like to see life expectancy for most of the European nations, and then the United States. We work harder than any of the European nations so I would guess we have more stress related health problems. How do we statistically correct for that? Is that a health problem or a social problem?

I don't know Omegax, what you posted sounds like political bs until some real numbers are available.


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## omegax (Oct 25, 2006)

The numbers are in the Frontline specials.


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## Bobm (Aug 26, 2003)

apples and oranges

you cannot compare a homogenous population like switzerland to a country like ours thats full of uneducated ghetto blacks ( single mothers) and illegal aliens take them out of the equation and our healthcare numbers look much better.

and frontline is extremely biased pro government healthcare and every other left wing idea


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## omegax (Oct 25, 2006)

Wikipedia good enough? http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy We're number 45, behind basically all of Western Europe, and Canada.

So, because those 20,000 people would have died some day, we can just discount it? The "Sick Around America" special profiles one young lady that died of very treatable lupus, racking up a huge bill that could have been avoided with treatment in the process, because of a lack of coverage.


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## omegax (Oct 25, 2006)

Sure, Bob, anything that doesn't agree with you, must be biased. Sometimes TRUTH has a bias.


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## blhunter3 (May 5, 2007)

Comparing USA to another country is exaclty like comparing apples to oranges, due to the fact of the huge difference in demographic's in each country.


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## omegax (Oct 25, 2006)

BULL... all people get sick of the same diseases.

You think our demographics cause us to pay DOUBLE what Germany does? That country has an aging population that is 20% immigrant, and they cover dental and long-term care!


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## Chuck Smith (Feb 22, 2005)

omegx....

Here is the thing about a "United Health Care Plan".

Example: Lets say you have prostrate cancer. In the US there would only be 3 specialists that care for prostrate cancer. Now if you did not live close to them you would have to travel. Now that would go with diagnosis, care, operations, post care, kemo, etc. THen you would have to also wait for appointments.

The way our health care system is now almost every hospital has someone who knows or can diagnosis problems, care for problems. If not it is a short drive to the place.

Another reason why things cost more is because the US is leading in the research for all of the aliments of the world. They are leading in drug research, testing research, etc. So the cost of grants, etc are passed onto the consumer. These other country's are using our research and development with out doing the work. They reap the benefits of our work.

Did you know it takes about 1 Billion to get a drug approved for consumers to use.

*If our health care system is so bad why do people from other country's come to the Mayo Clinic to seek health care every day?*


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## omegax (Oct 25, 2006)

What's the prediction that there would only be 3 prostate cancer specialists in the US based on? Would the rest just vanish?

The Swiss have large drug companies as well. Roche pharmaceutical ring a bell? It's not like they're not bringing new drugs to market.

Is your assertion that if the US wasn't paying exorbitant rates for health care, that the world would revert to the dark-ages?

The list of people I can remember who've come to the Mayo: The king of Jordan, the Shah of Iran, and the princes of Saudi Arabia. I'm noticing a pattern: rich people from poor countries with crappy systems. You're not going to catch the premier of Japan doing it.


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## omegax (Oct 25, 2006)

Another thing about the demographic differences. It's not as if our demographics are going to change. Explain to me why borrowing models that have saved other countries boat loads of money wouldn't still save us money, even if our demographics are different.

Let's say hypothetically, that costs are significantly different by race. That may account for a cost difference between us and Germany, if we were to borrow their ideas, but it wouldn't explain why their system wouldn't still save us money compared to what we spend now. If they save money with it, so would we, even if it's not as much (which I'm very skeptical of, anyhow).


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## Chuck Smith (Feb 22, 2005)

> The list of people I can remember who've come to the Mayo: The king of Jordan, the Shah of Iran, and the princes of Saudi Arabia. I'm noticing a pattern: rich people from poor countries with crappy systems. You're not going to catch the premier of Japan doing it.


Those are the people you hear about in the papers and what not. Walk around the subways, halls, the shops in that area, restaurants. You hear many forgein languages. These are people going through the clinic. Talk with the desk clerks, the nurses, the people who work at mayo clinic, etc. I live 20 miles from Mayo Clinic in Rochester. Have friends, family, etc work there. I have friends that work in the motels, hotels in the area. They tell me about the people the encounter on a daily basis and these people tell them testing at mayo or treatment at mayo, etc.



> The Swiss have large drug companies as well. Roche pharmaceutical ring a bell? It's not like they're not bringing new drugs to market.


That is one company. Look how many are in the US. Also you know what the Roche company has to go through to get drugs into the US....
$1 billion or research, testing, etc. Every Drug that gets introduced to the US has to do the same thing. Where does that cost get passed onto.

I don't think it cost Roche 1 billion to put a drug on market in Switzerland. I am not sure because I don't know. But the US has the strictest laws to protect consumers when it comes to pharmaceuticals.



> What's the prediction that there would only be 3 prostate cancer specialists in the US based on? Would the rest just vanish?


No they won't vanish but under a Universal health care system they will make those specialists change professions. That is the way it is in Canada and other countries. There will be X number prostrate cancers specialists, X number heart specialists, X number of bone cancer specialists, X number of Brain Tumor specialists.....you see the pattern. They will take the cases per US of each medical situation and then have a percentage of those specialists. Then they will move them around demographicly.

So if LA has the highest rate of bone cancer patients then that is where the majority of them will be. Guess who will get screwed.....the midwest! The south will have plenty of specialists because of snow birds and retiree's.

Now I agree that health care is way out of control. But socialized is not the answer.


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## swift (Jun 4, 2004)

Omegax what part of healthcare do you work in? Just the fact that you said Medicare is well run totally crushes any validity you might of had.

Why didn't the King of Jordan and the rest of those rich people go to Switzerland or Germany? Because the best healthcare in the world is in the United States.

Another newsflash Lupus is a terminal illness. Like many other illnesses you can live with it for years but it will get you in the end.


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## Plainsman (Jul 30, 2003)

I also doubt it would be that cheap. You may pay less out of pocket at the doctor, but your going to pay a heck of a lot more in taxes. The people who want universal health care know that some person who makes a lot of money is going to pay a lot of taxes to take care of them. Simply another freeloader scheme.


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## omegax (Oct 25, 2006)

That's probably true about moving the specialists around. However, a town like Fargo would probably have a good number of them, because it services a fairly large population. Also, compared to the cost of procedures, an airplane ticket would be CHEAP.

Roche brings drugs to market in the US. They make Tamiflu. As part of comprehensive reforms, we may need to bring that cost down, anyhow.

As far as the Mayo. I'd wager just about anything they it's largely composed of rich people from countries with crummy systems, and rich people from countries where they'd have to wait.

BTW, I am willing to concede that we would have to wait more. That's why I don't want to go with England's completely socialized system. Although never getting a bill would be nice, they do wait a lot compared to many other countries. I don't mean to make it sound like there wouldn't be sacrifices. We also need to cap malpractice damages to bring down costs.


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## Chuck Smith (Feb 22, 2005)

Here is another little story that I was apart of.

I was on a fly in fishing trip in canada. One of the people in our group got a sick and needed some meds. The outfitter we were going through wife worked at the clinic in this small town. They guy bought the meds he needed for about 1/4 of what it costs in the US. We thought that was great and talking with the wife we thought she would brag up the health care system. She said it was horrible. The only plus to the system was cheaper medication. But like what I have mentioned above about the specialists came right from her mouth.

Another thing about meds....do people know that if a company comes up with a certain med that cures or treats something and they patent it no other company can bring a new drug that does the same thing to market for 10 years. Or if a generic for is developed it can't come to market for 10 years. Many companies find or make the generic form for the same drug and then patent that one and don't put it out on the market for 10 years. And keep selling the higher priced one.

The medication or drug development laws need to be revamped so it does not take as much $$ to get a drug to market and if a generic form is available get it on the market ASAP.


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## omegax (Oct 25, 2006)

swift said:


> Omegax what part of healthcare do you work in? Just the fact that you said Medicare is well run totally crushes any validity you might of had.
> 
> Why didn't the King of Jordan and the rest of those rich people go to Switzerland or Germany? Because the best healthcare in the world is in the United States.
> 
> Another newsflash Lupus is a terminal illness. Like many other illnesses you can live with it for years but it will get you in the end.


I never said Medicare was good. I said that it had less overhead. Think about it, it doesn't turn a profit, and the claims process is always the same.

Remember the stories a couple of years ago about fewer people coming to the Mayo because the US wasn't popular around the world? Long story short, they are now going to countries like France. We're not the only game in town. However, anecdotes are pretty meaningless. The overall quality of care in other western nations is as good as ours.

True, lupus is terminal. However, given the right drugs, this woman could have lived for years (90% of people with lupus live for more than 10 years, and 78% live for more than 20!). Treatment could have prevented having to go to Duke to have millions of dollars worth of surgeries to remove the parts of her vital organs that her immune system attacked.


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## omegax (Oct 25, 2006)

Plainsman said:


> I also doubt it would be that cheap. You may pay less out of pocket at the doctor, but your going to pay a heck of a lot more in taxes. The people who want universal health care know that some person who makes a lot of money is going to pay a lot of taxes to take care of them. Simply another freeloader scheme.


As a percentage of GDP, every country pays less than we do for our care. That means that, on average, they pay less than we do, even when you take their taxes into account.


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## omegax (Oct 25, 2006)

Chuck Smith said:


> Another thing about meds....do people know that if a company comes up with a certain med that cures or treats something and they patent it no other company can bring a new drug that does the same thing to market for 10 years. Or if a generic for is developed it can't come to market for 10 years. Many companies find or make the generic form for the same drug and then patent that one and don't put it out on the market for 10 years. And keep selling the higher priced one.
> 
> The medication or drug development laws need to be revamped so it does not take as much $$ to get a drug to market and if a generic form is available get it on the market ASAP.


They also play games like making variations on the same drug to keep the patent clock ticking. We need to close a couple of those loopholes.


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## Bobm (Aug 26, 2003)

> Sure, Bob, anything that doesn't agree with you, must be biased. Sometimes TRUTH has a bias.


Everything and everyone honest with a brain has bias, theres nothing wrong with that

I like frontline and watch it all the time, it has some great and informative stuff on it it also has biased left reporting on some issues

Anyone telling me that a documentary produced out of public telivision from Boston,massachusets can't be biased left is being unreasonable.

All PBS is biased left, infact virtually all media except fox news is , fox is clearly biased right

to have bias is fine to not recognize it exists when considering a source of info is stupid


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## Chuck Smith (Feb 22, 2005)

> We also need to cap malpractice damages to bring down costs.


That is another reason why health care is so high in the US. Watch TV and you will see lawyers bring class action suits again many drugs that are on the market because some doctor mis-diagnoised and gave the wrong drug. Then they try to bring anyone else into the suit.



> As far as the Mayo. I'd wager just about anything they it's largely composed of rich people from countries with crummy systems, and rich people from countries where they'd have to wait.


I don't know. But I do hear German spoken quite a bit. So if that health care system is so perfect why are they at the Mayo Clinic?



> That's probably true about moving the specialists around. However, a town like Fargo would probably have a good number of them, because it services a fairly large population.


There are cities in California that have a larger population that the whole state of ND. MN would be screwed as well. The Mayo Clinic in Rochester would be dismantled and shipped around the country.

The thing is our health care system is one of the best in the world other than the cost of it.

I hate to sound morbid but the truth of the matter is people are out living their lives. People are just getting too old and the cost is getting passed down the line. Look at the amount of pills diabetics take. Then you add pills to control cholestoral, acid reflux, etc. When most of that could be taken care of if the people would eat right and exercise.


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## swift (Jun 4, 2004)

Omegax this is your quote...



> Medicare has a fraction of the overhead of private insurance. It's a completely unsupportable fallacy that government does a poor job when it comes to health insurance.


All you have to do is look at the medicare system, the Indian health system and the Veterans Affairs system to realize US government healthcare is terrible.

Socializing healthcare is not the answer to having affordable healthcare. Look at the GST in Canada, Germany and all the other countries you support. Taxes are sky high.

Affordable healthcare should start with tort reform, LESS government interaction, and finding a way to make medicines affordable. Also INDIVIDUALS have a responsibility to APPROPRIATLY access heathcare. If you don't know what that means, spend a weekend in an EMERGENCY ROOM and see all the sore throats, sprained ankles and ear aches that come in.

The idea that a less than ideal healthcare outcome entitles someone to be a millionaire is the biggest problem with healthcare and drug costs. Watch the advertisements on TV some day and you can see what I'm talking about. Someone has to pay John Sakolak and the miriad of other ambulance chasing attorney's out there. That person is you and me. OH wait I pay for health insurance do you? If not then you don't have to worry about the lawyers you just have to hope a Doctor misses something sometime so you can reap the benefits.


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## omegax (Oct 25, 2006)

Chuck, you won't get any disagreement from me about making tort reform part of the healthcare debate!

There is no _perfect_ system. Those Germans can't be poor. They're paying for it out of pocket!

Specialists already gravitate to anywhere where they stay 100% busy. If they could stay 100% busy in Fargo, servicing ND, and NW MN, they'd still be here. We might have an easier time keeping specialists in semi-rural areas, if the prices were pre-set like they are in Japan. If you bill procedure X at $Y, whether you're in Timbuktu or NYC, why move?

People living longer is a large part of why costs are going up for every country. However, I just keep coming back to the countries saving money by instituting universal plans. Nothing's going to freeze the cost, but we can save a lot of money.


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## omegax (Oct 25, 2006)

Swift, their taxes are sky-high for a lot of other reasons. As a percentage of GDP, we pay 16%, and Germany pays around 8%. Their health care makes up a significantly smaller part of the money spent in that country than ours does.

There's no reason why we can't punish people for making bad choices, even with a universal system. We could use co-pays, or deductibles. Basically, the same thing most insurance plans do now. I'm well-insured, and I know darn well I can't afford to go to the ER, unless I'm bleeding.

I already said it while replying to Chuck, but I agree that tort reform would have to be a big part of a healtchare reform discussion.


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## swift (Jun 4, 2004)

> As a percentage of GDP, every country pays less than we do for our care. That means that, on average, they pay less than we do, even when you take their taxes into account.


This week I've seen atleast 30 patients in clinic with colds. Viruses that will get better given time. People don't want to hear that though and want medicine to fix them. At $75 a visit that is $2250 of healthcare costs that is completely unnecessary. But you blame me for charging $75 dollars for the visit not the 30 people abusing healthcare.

If I sound bitter its because I am. We in healthcare put way more into our professions than most and get to hear how we don't deserve what we get. The good ole days of being a doctor are gone. Most work for a salary as an employee. The govt has passed laws preventing any perks from the hospitals to the medical staff. If you have not heard of the STARK laws look it up.

The high ratio of GDP going to healthcare is a result of abuse by the consumers, attorney's and the insurance companies. Fix those and the ship will be righted. Nationalize us and the ship will sink.


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## Chuck Smith (Feb 22, 2005)

> Specialists already gravitate to anywhere where they stay 100% busy. If they could stay 100% busy in Fargo, servicing ND, and NW MN, they'd still be here. We might have an easier time keeping specialists in semi-rural areas, if the prices were pre-set like they are in Japan. If you bill procedure X at $Y, whether you're in Timbuktu or NYC, why move?


You are not getting it. Lets use this as another example. Right now there are 100 specialists in the US for XZY disease. Under a universal health care system they would take those 100 specialists and only make 10 of them specialize in XZY disease. The other 90 will change specialties. So if you have XZY disease you will have to travel unless you live near one of these specialist. Now with just population being the greatest on either coast I am sure 8 of them would be on the coasts. Then you have two for the rest of the country.

Now with your Fargo example. I am sure they would stay more busy in Chicago than fargo.....or Kansas City.......or St. Louis.....or Cincinati. You see my point.


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## swift (Jun 4, 2004)

You guys type faster than I can think.

As far as specialists here's how it works in the US socialized medicine called the VA system.

A patient that has primary VA benefits comes to my ER with a bleeding ulcer. I MUST transport him 250 miles to a VA center for treatment or the VA will not cover his stay. There is a surgeon on staff in the small town (Lets use Williston as an example) that can fix the problem but the patient doesn't want to be saddled with the bill and the VA has already said they will only cover intial stablization in the ER. The VA will not cover ambulance transfer to the VA center unless they use their own ambulance. So we wait for 5 hours for a VA ambulance to come, pick up the patient from our hospital and transport him 5 hours back. Then the patient is evaluated at the VA center and need for surgical intervention is deemed necessary so they are transferred to the local medical center for surgery. If the patient survives to be transferred.

The thing I find ironic is before govt got into healthcare. Dr's ran healthcare. Some politician said Dr's are getting too many "kick backs" in this system so we need to step in to control that. Now after 25 years of govt taking over to keep costs down our GDP is 16%. AND people say the way to lower the costs is to involve government more! WOW.


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## Bobm (Aug 26, 2003)

*This report came out today *and is ample evidence of how the govt runs programs, if you read this and still want them to take over healthcare you are being irrational.

Nothing the government does is efficent, has as good a service or lower cost than the private sector

the idea that the government has that because they screwed these programs up terribly by stealing the money that this is somehow is the justification or reason we should hand over healthcare to the feds is typical government logic.

We should revolt and run these people out of the country IMO



> ABC news
> 
> Funds Running Out Faster Than Expected for Social Security and Medicare Programs
> Social Security Trust Fund to Run Out by 2037,
> ...


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## omegax (Oct 25, 2006)

Chuck Smith said:


> Now with your Fargo example. I am sure they would stay more busy in Chicago than fargo.....or Kansas City.......or St. Louis.....or Cincinati. You see my point.


I'm saying that there will be a specialist anywhere they can be 100% utilized. If they're as busy as they can be in Fargo, there's no point in going elsewhere.


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## omegax (Oct 25, 2006)

swift said:


> But you blame me for charging $75 dollars for the visit not the 30 people abusing healthcare.


Absolutely NOT! They're making a crappy choice. Hopefully the $75 is enough to deter most people from doing the same.

I don't disagree with you on what needs to be done to right the ship. I want to cut down on your malpractice costs by capping damages (and a 3-strikes policy sounds good to me, too). There are so many variations on universal care that we don't have to do anything as drastic as nationalizing doctors or hospitals, like England. I hate so come back to the same countries all the time, but those are the examples I know the best. In Switzerland, everything on up to the insurance companies is still private. In other countries, the hospitals are private, but the insurance is a national plan (Taiwan's an example. Their cost is CHEAP). There are so many variations. Universal coverage doesn't require nationalizing anything.


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## omegax (Oct 25, 2006)

Bobm said:


> Nothing the government does is efficent, has as good a service or lower cost than the private sector


If that were true, the costs in Western Europe would be much higher... especially Great Britain, where it's ALL run by the government. Why wouldn't their cost be higher than the Swiss, where it's all private?


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## omegax (Oct 25, 2006)

swift said:


> You guys type faster than I can think.
> 
> As far as specialists here's how it works in the US socialized medicine called the VA system.
> 
> ...


If there was one national insurance plan, there would be no need to have a different VA system. The VA is a prime example of what costs (financial and otherwise) come with doing it piecemeal like we are.

My beef's certainly not with doctors. I do understand how you could feel like you're under attack. That's certainly not my intent. I have my sights set on the insurance industry, more than anyone.


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## Plainsman (Jul 30, 2003)

> We in healthcare put way more into our professions than most and get to hear how we don't deserve what we get. The good ole days of being a doctor are gone.


Swift, everyone things the grass is greener on the other side of the fence. My neighbor who is a doctor pays through the nose for malpractice insurance. He has a heck of a lot nicer house than I do, but he works terrible hours for the money he gets. I would not trade places with him.

Omegax who are you going to cheat to make this system cheaper? If you have the doctors, the nurses, the facilities, and you add another whole layer of government employees to administer the system something has to give. Will you cut the doctors pay in half, the clinic, the nurse, surgery in a garden shed, what? Fewer doctors, fewer nurses, fewer facilities, what? Since you brought up the old, I have heard them say that those federal employees would have to decline care for those that were not worth it. Lets see now, if your not working and contributing to Social Security, Medicare, Medicaid, your not worth it. 
We could just skip this whole thing and kill the old. Oh, I'm sorry, I mean euthanize. Euthanize, I like the way they pronounce that it sounds like your going to be younger when they are done.  Sort of like pro choice instead of abortion. Sounds a lot better than suck the babies brains out. :eyeroll: Please refer to my post on control the language and you control the people.  Lets all invest in health care. :eyeroll:


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## Bobm (Aug 26, 2003)

omegax said:


> Bobm said:
> 
> 
> > Nothing the government does is efficent, has as good a service or lower cost than the private sector
> ...


Why?
because they ration the medical services we take for granted, if you over a certain age you will be put at the end of the list.

I do a lot of business with a gentleman in the Netherlands hes a good friend of mine I've known for years he recently was injured( not seriously) and needed a simple xray the wait was 3 months. He could not cancel to make a sales call with me in Russia because if he did they wait would again be three months. These lead times are do to rationing of services.

here the wait would maybe one or two days tops, hours if it was a emergency


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## Bobm (Aug 26, 2003)

Heres a good read about the ethics of rationing health care you have to make up your own mind where you stand. Rationing is the inevitable result of govt run healthcare and exists in every country that has nationalized health care.

Aged-Based Health Care Rationing 
By Claire Andre and Manuel Velasquez

Challenges for an Aging Society

I hate the men who would prolong their lives
By foods and drinks and charms of magic art 
Perverting nature's course to keep off death 
They ought, when they no longer serve the land 
To quit this life, and clear the way for youth.
-Euripides 500 B.C.

Has the time come when we decide that prolonging the lives of the elderly who "no longer serve the land" is truly a burden on the youth of society? Is the day of rationing our nation's health care services on the basis of age close at hand? As the ranks of the elderly swell, and demands on the nation's scarce health care resources increase, the once whispered suggestions that health care should be rationed by age are now growing audible.

Currently, about 12% of the population is 65 years or older. By the year 2030, that figure is expected to reach 21%. The fastest growing age group is the population aged 80 and over -- the very segment of the population that tends to require expensive and intensive medical care. The projected demands from a growing elderly population on a health care system that is already taxed to the breaking point, together with continual advances and availability of expensive life-extending technology, have led to troubling questions about society's ability to meet future health care demands, and to the increased tolerance of proposals for rationing.

Perhaps the most prominent advocate of aged-based rationing is Daniel Callahan, author of Setting Limits. In this book, Callahan proposed that the government refuse to pay for life-extending medical care for individuals beyond the age of 70 or 80, and only pay for routine care aimed at relieving their pain.

*Justifying the Limits*
Those, like Callahan, who support proposals to ration life-extending medical resources on the basis of age maintain that such a rationing system would bring about the greatest good for the greatest number of people. While the health of the young can be ensured by relatively cheap preventive measures such as exercise programs and health education, the medical conditions of the elderly are often complicated, requiring the use of expensive technologies and treatments -- and often, these treatments are ineffective in providing any tangible benefit for either patient or society. In short, the costs that arc incurred to prolong the life of one elderly person might be more productively directed toward the treatment of a far greater number of younger persons whose health can be ensured by less costly measures.

Furthermore, the advocates of rationing argue, society benefits from the increase in economic productivity that results when medical resources are diverted from an elderly, retired population to those younger members of society who are more likely to be working.

Advocates of health care rationing also argue that issues of justice are at stake in this social debate. It's estimated that the government now spends more than $9000 per elderly person and less than $900 per child each year. The skewed distribution of health care resources, they say, is not only detrimental to the overall health of the society; it is also unjust, because the elderly receive a disproportionately large piece of the health care pie, while a far greater number of younger people are deprived of an equal share of the nation's health care resources. Moreover, "need" should not be a fundamental criterion for determining how much health care the elderly (or others) are allotted. In the context of constant technological innovations to prolong life at all costs, the "needs" of the elderly know no bounds and drain the pool of resources that ought to be made available to all age groups.

Many advocates of rationing also support Daniel Callahan's contention that the drain on health care resources to extend the lives of the elderly has the effect of violating the rights of the young to live out a "normal" life span Elderly persons, they say, ought to bc entitled to treatment to relieve pain and suffering, but by the age of 70 or 80, they have lived out a natural life span and achieved most of life's goals and possibilities, and therefore they ought not to receive treatments to extend their lives at the expense of those who have not lived out a normal life span.

Finally, those in favor of age-based rationing claim that withholding treatment from the elderly would not be unjust, as critics claim, because, as they point out, everyone grows older. If we treat the young one way and the old another way, over time, each person is treated the same. Thus, a health care policy that treats the young and old differently will, over time, treat people equally.

*Against Age-Based Rationing*
The arguments presented by the advocates of health care rationing provoke strong disagreement. The claim that rationing would bring about the greatest balance of benefits for society is disputed by those who argue that any rationing policy depriving the aged of live-saving medical care would result in enormous costs and few benefits. For the young, such a policy would lead to heightened levels of anxiety and fear as they approached old age, while the elderly, not wishing to die and feeling abandoned by society, would despair.

Furthermore, if financial savings were achieved by rationing care by age, there's no guarantee, given our present political system, that any savings on the old would actually be directed to the young, or that they would result in real improvements in the overall health of our citizenry. The actual benefits would depend on what kinds of resources were transferred to what sorts of treatments.

Opponents of rationing argue that there are other policies, far less harmful to society, that could be adopted to deal with the increased demands on the health care system as the population ages. For example, society could transfer funds from military spending to health-care, and could enact reforms to improve efficiency and reduce costs in the health care system.

Others who oppose rationing health care on the basis of age argue that a mere consideration of benefits and costs fails to give due weight to other more important moral considerations, such as justice and rights. Justice, they argue, requires that people be treated similarly unless there are morally relevant reasons for treating them differently. In determining who should or should not receive health care, it is relevant to consider a person's need for health care, the likelihood of recovery, or the likelihood of improving a person's quality of life. Age, however, reveals little about a person's medical need or prognosis, and should no more influence the distribution of health care than race or sex. It is the medical liabilities we often associate with old age, not age itself, that count as relevant reasons for treating people differently. If our aim is to use costly resources more effectively, then we ought to deny treatment to all patients whose prognosis indicates a short life span, chronic illness, or little likely improvement in the quality of life, rather than denying treatment simply on the basis of age.

Moreover, it is argued proponents of age-based rationing try to pit the young against the old as if providing benefits to one group means unfairly taking them away from members of the other group. But, this is mistaken. We don't claim that it is unjust to spend more educational dollars on children than on adults. Similarly, it is not unjust to spend more medical dollars on the aged than on the young, so long as every individual has the same access to medical care over a lifetime.

Those who oppose rationing health care by age argue that such a policy would violate our moral sense of respect for persons. Embarking on age based health care rationing in order to cut health care costs or to increase productivity treats the elderly as a mere means to economic ends, failing to respect the fundamental dignity of persons.

Furthermore, to claim that it is better to preserve the lives of the young than those of the aged is to assume that the lives of the aged have less value than those of the young. In fact, many opponents of age-based health care rationing argue that in modern society, all people have a fundamental right to the medical care they need to maintain good health and a reasonable quality of life, regardless of any characteristic, be it race, religion, sex, socioeconomic class -- or age. Assuming that an elderly individual no longer has this right, or that an elderly person's right is diminished, is just wrong. To claim that the elderly's right to health care must be restricted because they have achieved a "natural life span" -- that they have no life goals or possibilities -- is simply erroneous. In fact, their major life achievements may still be ahead of them. The right to health care does not diminish with age. An aged person has as much of a claim on medical resources as the young person, and consequently age-based rationing is an unequivocal violation of this basic right.

As medical technology continues to advance, the ranks of the old and the very old continue to grow, the costs of health care continue to increase, and the competition for scarce health care resources grows ever more intense, our society will be forced to confront the issue of health care rationing, or at least the problem of equitable distribution of limited health care resources. The strategies that we adopt in trying to balance the needs of a changing population to the supply of resources may establish important precedents with implications reaching far beyond the health care field.


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## omegax (Oct 25, 2006)

Plainsman said:


> Omegax who are you going to cheat to make this system cheaper? If you have the doctors, the nurses, the facilities, and you add another whole layer of government employees to administer the system something has to give. Will you cut the doctors pay in half, the clinic, the nurse, surgery in a garden shed, what? Fewer doctors, fewer nurses, fewer facilities, what? Since you brought up the old, I have heard them say that those federal employees would have to decline care for those that were not worth it. Lets see now, if your not working and contributing to Social Security, Medicare, Medicaid, your not worth it.


ALMOST EVERYONE:

Patients may have to wait a little longer and have our damage awards capped.

Lawyers won't be big fans of not finding the big paydays.

Insurance companies would have to be non-profit, if not completely usurped by a new government insurer (in which case we wouldn't be adding a layer, we would be replacing the insurers with a government layer that at least has to answer to congress, rather than not its shareholders).

Drug companies would have to give us the same prices as other countries or we would just reimport them. We'd also want to find a way to get generics to market faster, and bring down the costs for new drugs, as Chuck suggested. BTW, Medicare was forbidden in the Part D legislation from negotiating directly with drug companies. That's ridiculous!

I'd like to see something like Japan does where hospitals and the government negotiate the prices so they're uniform from hospital to hospital. However, that may be tough to do here. The problem there is that you can't shop around, and if you're not paying for it out of pocket, you have no reason to anyhow.

I'd actually like *Swift's* opinion: could we use more neighborhood "quickie care" type places, or would that be harmful in that people wouldn't really have a primary care physician? The Brits have neighborhood places that they're assigned to that become their primary care physician, but that might be a tough sell here. I'd be OK with it, personally. I'd like to see people getting screened out for viruses, and sprains, before they get to the ER.

There would be a lot of cost savings by people not waiting until their condition was critical, as well. We'd also have to modernize the records system. The Taiwanese all carry a smart card that allows any doctor in the country to bring up their records and file their claim electronically.

I don't have all the answers. I guess my main point is that governments all around the world provide good care for less money. We don't need to be afraid of it. It doesn't even have to be "socialism" to be universal.


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## Bobm (Aug 26, 2003)

read this

http://www.independent.org/publications ... sp?id=1201


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## omegax (Oct 25, 2006)

Bobm said:


> Why?
> because they ration the medical services we take for granted, if you over a certain age you will be put at the end of the list.
> 
> I do a lot of business with a gentleman in the Netherlands hes a good friend of mine I've known for years he recently was injured( not seriously) and needed a simple xray the wait was 3 months. He could not cancel to make a sales call with me in Russia because if he did they wait would again be three months. These lead times are do to rationing of services.
> ...


The Dutch system is mandatory insurance, with private hospitals (a lot like Massachusetts, actually). There's more to it that a wait for an xray was that long. It definitely wasn't a result of government rationing. That's like blaming my insurance because the hospital couldn't see me for months.


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## omegax (Oct 25, 2006)

That article's assertions about Japan conflict with everything I've heard. Including the last paragraph of this: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/socialized.html the whole thing's pretty interesting.

You're right. Imposed controls doesn't work, but Japan negotiates the prices with the hospitals, for uniformity as much as anything.

Rationing is NOT the logical conclusion (as if your insurance company wasn't already doing it in the name of profits). The AARP (can you think of an organization who would be more against rationing?), says it's BS.


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## Plainsman (Jul 30, 2003)

I belong to AARP. I have no voice, and they are as liberal as you get. If they get what they want of course they would go with some sort of socialism. They are retired, have their money stashed, and would love some more living off the taxpayer. I am one of those AARP, but differ in values. Thanks for the free health care, but no thanks. I want the best I and my insurance can pay for, and I have to much pride to live off you. Thanks anyway, and I mean that sincerely.


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## Bobm (Aug 26, 2003)

in the netherlands the insurance is private however the government is responsible for the accessibility and quality of the healthcare. The guy I'm taking about is a weathy businessman not some ignoramus.

Hollands system is commonly regarded as the best in europe.

But I'm getting nowhere but frustrated I do not believe the government does anything for our benefit.

IMO everthing they do is for personal power and control, so I'll ask you a simple question

WHy do you think its reasonable to make me go into a health care system I dont want to go into?

I would find it perfectly reasonable to have two systems one for the people that want the govt to tax them AND ONLY THEM and provide its services.

And a seperate private system for the people and medical hospitals physicians that want to opt out and pay their own way.

Comment on that


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## Plainsman (Jul 30, 2003)

Bob, that reminds me, the Obama administration says we can keep any insurance that we have now and like. However, we still pay taxes through the nose on the government health care. We don't get a break. That simply means we get nothing for something.


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## Nodak_Norsk (Aug 5, 2007)

I only read about half of the posts, but trust me-universal healthcare is a nightmare. I come close, being under TRICARE right now, and it is awful. I have had some bad care in the past, and the waiting is a nightmare. My daughter was in the ER for 7 hours last night before getting a temporary splint for a broken arm and she has to get a referral approved before she can see an orthopedic surgeon for a cast. They had one doctor on staff! And I have been waiting two months to find out if I have colon cancer, and still have weeks to wait....it is so hard to live life with that kind of worry. I contemplated flying back to MeritCare, and should have-they would have diagnosed me by now. So I wait.


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## omegax (Oct 25, 2006)

Bobm said:


> in the netherlands the insurance is private however the government is responsible for the accessibility and quality of the healthcare. The guy I'm taking about is a weathy businessman not some ignoramus.
> 
> Hollands system is commonly regarded as the best in europe.
> 
> ...


I wouldn't say it's reasonable to force you into anything. I'd like to keep my own plan too, and I suppose it's feasible to do both, but once there is an alternative, you'd have to tax employers who don't offer coverage, or they'd all just drop their plans.

As far as your idea, it would depend on how you did it. If the government plan had "guaranteed issue", you'd also have to force people to carry some insurance. Otherwise, you'd have, as an example, people who should have gotten that mole looked at years ago buying insurance to cover their probably skin cancer. "Sick Around America" covered what happened when NY tried guaranteed issue, without forcing people to have insurance. It drove the costs way up, and threw off the whole pooling of risk. If you were forcing young, healthy college grad job seekers into the plan, the risk pool would probably be fine.

However, how would you cover the unemployed? You can't very-well tax their income to cover it. It would have to be subsidized by the rest of the participants, which could work, if there were enough people in the plan. One of my biggest concerns would be coming down with some long-term illness, like diabetes, and then losing my job. In that case, you basically can't get insurance, once you exhaust COBRA (if you can afford it to begin with, without a job). If taxing only the participants would sell getting some sort of coverage for everybody, I'd be in. We'd still reap most of the same benefits.

There are some questions in my mind about if it could work, and that all depends on who winds up in the plan.


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## Bobm (Aug 26, 2003)

I find the employer insurance coverage comments interesting

tell me why except for health insurance every other form of insurance is negotiatied between the customer and the insurer.

Do you get your auto insurance from your employer how about flood, home you name it.

I know how it started thats not my question tell us how and why its better.

Also tell my why health insurance is even considered insurance, does you auto insurance pay for oil changes... tires?? does your home insurance pay for new storm windows?

comment on these questions please

one more thing do you know the cost of health "insurance" is wildly inflated because of a lack of competitiveness. IE you cannot go to other states to buy it so people in New Jersy for example pay way more than people in Georgia or ND.


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## Bobm (Aug 26, 2003)

heres some free market Ideas I like what do you think of them?

Eliminate government health insurance mandates. If my wife and I want to buy a health insurance policy that does not include coverage for mental health issues, the normal costs of pregnancy and child birth, drug and alcohol abuse and treatment or sexually transmitted diseases, then we should be permitted to purchase just such a policy. Check with your health insurance carrier in your state and see if you can buy such a policy there. More likely than not you will learn that various pressure groups have coerced the politicians in your state to make coverage for these items mandatory. This does nothing but drive up the cost of medical care.

Give individuals the same tax treatment large employers get when it comes to purchasing health insurance. That is, allow the individual to take a complete tax deduction for every penny that individual or household spends on health insurance coverage. Just why have politicians made it cheaper for your employer to buy that coverage for you than it would be to buy it for yourself? Awww come on; this one is easy. They've made it easier because they want you to rely on your employer! The goal here is to destroy your sense of self sufficiency. First you learn to rely on your employer. Then you buy this horsesqueeze that health care is a right. They your transfer your reliance over to government ... and politicians lift a toast to one another.

Clean up regulatory restrictions. Why shouldn't an optometrist be allowed to give some simple eye drops for diagnostic purposes? Why should you have to rely on a doctor with seven years of education and training to diagnose a simple sore throat? Why can't a nurse stitch up a small cut. Why can't a dental assistant pull a baby tooth? We have a system of regulation here that was designed not to protect the patients, but rather to protect the practitioners. Ophthalmologists don't want optometrists to use eye drops for simple diagnostic procedures. Physicians want you to sit in their office for 45 minutes - and then another 20 minutes sitting on that crinkly paper on that table in their examining room - so that they can ram a tongue depressor down your throat before you get your antibiotic prescription. Reign in the regulatory agencies .. give the free market and our ability to make decisions for ourselves run the show.

Move away from employer-provided policies. Let's move to a system where all health insurance policies are privately owned. What happens then? We go out and we comparison shop for those policies ... and competition enters the picture. We also learn that we, not our employer and not the government, are responsible for our health care.

Speaking of competition, no government should be able to prevent a health insurance company to refuse coverage to anyone because of that person's lifestyle choices. Stupid cigarette smokers should have to pay higher premiums to companies who specialize in insuring the ignorant. Ditto for lard *****. Reckless drivers pay higher premiums ... so should people who are intentionally reckless with their health. That lowers the premiums for those of us who are nearly perfect.

Expand health care savings accounts. Politicians hate these medical savings accounts because they teach self reliance. Remember folks, the more self reliance we have in our society, the less we need government. The less we need government, the less we need politicians. They don't like this equation.


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## Bobm (Aug 26, 2003)

http://abcnews.go.com/Politics/Business ... 814&page=1

:roll:


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## omegax (Oct 25, 2006)

Here's the problem with doing away with minimum standards: You need to pool the risk from people who don't have those needs with those that do, otherwise any coverage that does cover those things is impossibly expensive. It sounds great to a healthy person, but at that point, sick people might as well not even have insurance, and we're back at square one.

I wouldn't have a problem moving away from employer plans, with a few stipulations: all plans must have minimum standards mandated by the federal government, for reasons stated above. All plans must be guaranteed issue. People must be required to carry insurance (a pre-requisite for guaranteed issue). Insurance companies are non-profit. If those standards are met, I'm on board.

I am 100% with you on the regulations. I want the person whose time costs the least doing the most they safely can. A significant number of things I've ever been into the hospital for wouldn't really require a doctor. Now, that's not to say that I don't value a doctor's expertise, but I would much rather they spend their time where it's needed. It just seems more efficient. It could probably cut way back on waiting.

I wouldn't have an objection to people who make crappy choices paying higher premiums. However, I don't trust a for-profit insurer being the arbiter of who's "fat", etc.

I think you're forgetting that your employer already shops around, and has a heck of a lot more buying power than an individual does. That's why it's done that way, not because of some grand conspiracy. Employers also have a larger pool of risk, so their plans can be cheaper. If one person gets sick at a business with 20 employees, the insurance company will jack their rates a lot more than an employer with 20,000.

I'm with you on HSAs, too. I think there should be a lot more tax-deferred savings options for Americans, in general. I would like to encourage saving to the degree we can. However, that's another topic.


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## Plainsman (Jul 30, 2003)

Nodak_Norsk, don't fool around waiting. If I were you I would get my rear end back to North Dakota fast (no pun intended). Worry like that is a drain on a persons health. I hope your not to strongly anti religious for me to say I'll be praying for you.


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## southdakbearfan (Oct 11, 2004)

As a person with a family member on medicare, I can tell you it is a fricking disaster, the people administering it and advising people to drop their own insurance to go on it are complete morons. It is costing my father almost double what it would of if he would have kept his insurance, which they told him to drop because it would be much cheaper, and now he can't get back on.

If you look at the foreign systems, they lag significantly in technology and safety. A friend's father had some heart issues in canada on a hunting trip last year and their exact quote was "It was like walking into the 1970's". If you also look at the taxes paid in those foreign countries for the systems it is astronomical and only going up.

Switzerland has already admitted their taxes would have to go up substantially if the US goes to a gov't health care system as we are subsidizing the drug industry that can't pay the bills off the rest of the world that has regulated the prices below what they actual cost.

Many of the european countries have a significant portion of their population seeking healthcare in other countries because of it. Now they may be well off, but what exactly does that tell you about it's quality and timeliness.

While the health care system needs some changes in regulation and the drug industry, I think we have all seen what great management comes down from the federal level in every industry they invade.

Maybe we should kick all the damn illegals out living off the rest of us for a start.

Any stats released out of the countries like china aren't worth the toilet paper they are written on, as they lie about everything to make us look bad. Just look at the olympics, they stopped almost all car/truck traffic in Beijing to help with the smog they didn't want the world to see.

Every level of gov't added to anything = wasted millions of dollars.


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## omegax (Oct 25, 2006)

Foreign systems do not lag "significantly". Any differences are so small to be statistically _insignificant_. Their outcomes are just as good, and their life expectancies are better. This isn't Mozambique we're talking about. I don't care if the hospital looks like the bridge of the Starship Enterprize, if the outcome isn't any better it doesn't justify the cost difference. What happened to fiscal responsibility and a little thing called "results"? As far as government = waste, look up what happened in Taiwan, when their government got involved. It's just not a supportable argument that government invariably does a bad job. I wanted to let this thread die, because taking on everyone is tiring, but as long as somebody posts a blatant, unsupported supposition, I can't. It doesn't even _have_ to be a government system. Everybody assumes that universal care requires more government intervention than it does. There are many places that cover everybody for less money, and all the hospitals AND insurance is still private. At that point, we could probably do away with Medicare and Medicaid, and remove MORE government.


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## Bobm (Aug 26, 2003)

WHERE DO YOU GET YOUR INFO THAT SIMPLY ISN'T TRUE?

PEOPLE IN BRITAIN DIE IN MUCH HIGHER PERCENTAGES THEN HERE BECAUSE OF THE WAIT FOR RATIONED CARE.

CANADA ALSO RESEARCH IT


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## Bobm (Aug 26, 2003)

here read this

http://www.heartland.org/policybot/resu ... tmare.html

http://allnurses.com/social-health-care ... 25170.html


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## omegax (Oct 25, 2006)

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

They're doing something right. They run through more stats in "Sick Around the World", too. Also, 2 can play that game: 20,000 people die every year because of lack of insurance.


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## Plainsman (Jul 30, 2003)

> but as long as somebody posts a blatant, unsupported supposition


That would include you to omegax. So far everything has been opinion, or the opinion of someone who knows someone in a country with social health care. I have not seen any statistics to back anything up. I also have relatives in other countries under socialized health care, but I think I will sit this one out. 
So does anyone have any statistics? It would be good to see something from a scientific peer reviewed publication. Not a political site publication, or gray literature.


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## Bobm (Aug 26, 2003)

No one in the USA dies from lack of insurance not even illegal immigrants our federal laws prohit refusal of treatment to anyone that requests it PERIOD.


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## omegax (Oct 25, 2006)

Here's a link with most of the "Sick Around the World" data in short. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/. However, it doesn't talk about the quality stats, or is people like their systems. In the special, they did use life expectancy as one of the stats, which I did already post the Wikipedia link to, even then, they discounted the Japanese, because of their diet, etc.


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## Bobm (Aug 26, 2003)

life expectancy has little to do with healthcare and much to do with lifestyle and heredity


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## omegax (Oct 25, 2006)

Bobm said:


> No one in the USA dies from lack of insurance not even illegal immigrants our federal laws prohit refusal of treatment to anyone that requests it PERIOD.


Really? What about the woman in "Sick Around America" who could have lived for many, many years with her lupus, but because she couldn't get treatment wound up dying, and in the process racked up millions of dollars worth of surgeries, the costs of which had to be passed on to paying customers. When people can't afford preventative care, the outcomes are far worse, and more expensive. Not to mention, that if your case was true, we might as well be honest that we're all paying for it anyhow, and find a way to get the people insurance so they can get the preventative care and bring the costs down for the rest of us.


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## omegax (Oct 25, 2006)

Bobm said:


> life expectancy has little to do with healthcare and much to do with lifestyle and heredity


Ok, if you're going to dismiss it anyhow... What about countries that recently implemented reforms? It defies logic to think that they'd put up with lowered statistics, and rationing, when they clearly remember the good ol' days. Heck, the life expectancy in Mexico is within 2 years of ours. At that point Mexicans can't skew the mean down too much.


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## Bobm (Aug 26, 2003)

Well the NY times is certainly not a right leaning paper

http://www.nytimes.com/2000/01/16/world ... nted=print

--------------------------------------------------------------------------------

NY times
January 16, 2000
Full Hospitals Make Canadians Wait and Look South
By JAMES BROOKE
Dressed in her orchid pink bathrobe and blue velour slippers, Edouardine Boucher perched on her bed at Notre Dame Hospital here on Friday and recounted the story of her night: electric doors constantly opening and closing by her feet, cold drafts blowing across her head each time an ambulance arrived in the subzero weather, and a drug addict who started shouting at 2:30 a.m., ''Untie me, untie me.''

But as nurses hurried by on Friday morning, no one thought it remarkable that Ms. Boucher, a 58-year-old grandmother awaiting open heart surgery, had spent a rough night on a gurney in an emergency room hallway. After all, other hallways of this 3-year-old hospital were lined with 66 other patients lying quietly on temporary beds.

To explain overflowing hospitals here and across the nation, Canadian health officials are blaming the annual winter flu epidemic.

But, at the mention of flu, Daniel Brochu, the veteran head nurse here, gave a smirk and ran his pen down the patient list today: ''Heart problem, infection problem, hypertension, dialysis, brain tumor, two cerebral hemorrhages.'' On Thursday, he said, crowding was so bad that he was able to admit one patient only after the ambulance crew agreed to leave its stretcher.

When Canada's state-run health system was in its first bloom, in the 1970's, Americans regularly trooped up here on inspection tours, attracted by Canada's promise of universal ''free'' health care. Today, however, few Canadians would recommend their system as a model for export.

Improving health care should be the federal government's top priority, said 93 percent of 3,000 Canadians interviewed last month by Ekos Research Associates. In another poll last month, conducted by Pollara, 74 percent of respondents supported the idea of user fees, which have been outlawed since 1984.

''There is not a day when the newspapers do not talk of the health crisis,'' said Pierre Gauthier, president of the Federation of Specialist Doctors of Quebec. ''It has become the No. 1 problem for Quebecois and for Canadians.''

In Toronto, Canada's largest city, overcrowding prompted emergency rooms in 23 of the city's 25 hospitals to turn away ambulances one day last week. Two weeks ago, in what one newspaper later called an ''ominous foreshadowing,'' police officers shot to death a distraught father who had taken a doctor hostage in a Toronto emergency room in an attempt to speed treatment for his sick baby.

Further west, in Winnipeg, ''hallway medicine'' has become so routine that hallway stretcher locations have permanent numbers. Patients recuperate more slowly in the drafty, noisy hallways, doctors report.

On the Pacific Coast, ambulances filled with ill patients have repeatedly stacked up this winter in the parking lot of Vancouver General Hospital. Maureen Whyte, a hospital vice president, estimates that 20 percent of heart attack patients who should have treatment within 15 minutes now wait an hour or more.

The shortage is a case of supply not keeping up with demand. During the 1990's, after government deficits ballooned, partly because of rising health costs, the government in Ottawa cut revenue-sharing payments to provinces -- by half, by some accounts. Today, the federal budget is balanced, but 7 hospitals in Montreal have been closed, and 44 hospitals in Ontario have been closed or merged.

Ottawa also largely closed the door to the immigration of foreign doctors and cut the number of spaces in Canadian medical schools by 20 percent. Today, Canada has one medical school slot for every 20,000 people, compared with one for 13,000 in the United States and Britain.

With a buyout program, Quebec induced 3,600 nurses and 1,200 doctors to take early retirement. And across the nation, 6,000 nurses and at least 1,000 doctors have moved to the United States in recent years.

At the same time, demands on Canada's health system grow every year. Within 30 years, the population over 65 is expected to double, to 25 percent.

Unable to meet the demand, hospitals now have operation waiting lists stretching for months or longer -- five years in the case of Ms. Boucher.

As a result, Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care.

Last summer, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians' Hospital in Plattsburgh, N.Y. There, scores have undergone radiation treatment, some being treated by bilingual doctors who left Montreal.

Business has been so good that the Plattsburgh hospital, which was on the verge of closing its cancer unit, has invested half a million dollars in new equipment. And on the Quebec side, the program has allowed health authorities to boast that they have cut the list of cancer patients who have to wait two months or more, to 368 today from 516 last summer.

In Toronto, waiting lists have become so long at the Princess Margaret Hospital, the nation's largest and most prestigious cancer hospital, that hospital lawyers drew up a waiver last week for patients to sign, showing that they fully understood the danger of delaying radiation treatment.

With the chemotherapy waiting list in British Columbia at 670 people, hospitals in Washington have started marketing their services to Canadians in Vancouver, a 45-minute drive.

A two-tier system is also being used for other kinds of operations.

''I would like to buy mother a plastic hip for Christmas, so she doesn't have to limp through the year 2000 in excruciating pain,'' Margaret Wente, a newspaper columnist for The Globe and Mail in Toronto, wrote last month. ''I could just drive her to Cleveland, which is fast becoming the de facto hip-replacement capital of Southern Ontario.''

Allan Rock, Canada's health minister, disapproves of such attitudes. In an essay in the same newspaper, he wrote sarcastically: ''Forget about equal access. Let people buy their way to the front of the line.''

In defense of Canada's state health system, he wrote, ''Its social equity reflects our Canadian values.'' Mr. Rock, who hopes to become prime minister one day, said that health delivery could be improved through better, computerized planning. He attacked a proposal in Alberta to allow private hospitals, warning readers, ''The precedent may be set for American for-profit health-care providers looking to set up shop in Canada.''

But the idea that there may be room in Canada's future for private medicine is gaining ground.

''We have no significant crises in care for our teeth or our animals, largely because dentists and veterinarians operate in the private sector,'' Michael Bliss, a medical historian, wrote on Wednesday in The National Post, a conservative newspaper. ''So we have the absurdity in Canada that you can get faster care for your gum disease than your cancer, and probably more attentive care for your dog than your grandmother.''

In Ontario, Canada's wealthiest province, the waiting list for magnetic resonance imaging tests is so long that one man recently reserved a session for himself at a private animal hospital that had a machine. He registered under the name Fido.

To Ms. Boucher, who jealously guarded her 15 square feet of corridor space today, such cocktail circuit anecdotes were not amusing. Glumly eating her cold breakfast toast, she said, ''It scares us to get sick.''

Photo: At a hospital in Montreal, Edouardine Boucher ate breakfast Friday on a stretcher in a hall, under a note on the wall that marked her patient spot. Sixty-six other patients without rooms also waited in the corridors. (Pascale Simard for The New York Times) Map of Canada shows location of Montreal: Hospitals in Montreal and other Candian cities are overflowing.

Copyright 2009 The New York Times Company


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## Plainsman (Jul 30, 2003)

> Really? What about the woman in "Sick Around America" who could have lived for many, many years with her lupus, but because she couldn't get treatment wound up dying, and in the process racked up millions of dollars worth of surgeries, the costs of which had to be passed on to paying customers.


Single incidents of many kinds happen every day under any system. I would like to see someone come up with some statistics. Statistics need enough data points to be valid. Single incidents are just that single incidents. Does anyone from either side have something like that? PBS doesn't present statistics that have any confidence levels much less acceptable 90 percentile (higher is required to publish in science). Evidently sample sizes are to small to build high confidence level publishable statistics. Anyone have anything from a publication like the American Medical Association, New England Journal of Medicine, American Journal Of Medicine, Annals of Internal Medicine,
Archives of Internal Medicine, British Medical Journal, anything.

I think what we are arguing so far is political. I believe more in private industry that government run. I believe in my choice, and my doctors choice rather than some GS11 in an office a thousand miles away. America was born of people trying to get away from government interference in their freedom. I guess that revolutionary attitude still exists in me. Give me independence every time.


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## omegax (Oct 25, 2006)

You don't think we could improve on Canada's system? All universal plans aren't the same.

Where would the "rationing" come from in a plan like Switzerland's where the plans are all private, and so are the hospitals? Even the guy who lead the charge against their current system (former president, if I remember correctly) says he likes how it turned out. That says a lot to me.


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## omegax (Oct 25, 2006)

Plainsman said:


> I think what we are arguing so far is political. I believe more in private industry that government run. I believe in my choice, and my doctors choice rather than some GS11 in an office a thousand miles away. America was born of people trying to get away from government interference in their freedom. I guess that revolutionary attitude still exists in me. Give me independence every time.


I hate to sound like a broken record here on day 2, but I haven't gotten a lot of response about the Swiss system, so I'll ask directly. What do you think of their system? Everything's still private, and you get to make the choice. From what I can tell, the cost savings compared to our system comes from improved preventative care, and the haircut that the insurance companies have to take.

The biggest problem I see is that independence runs contrary to what insurance is: pooling of risk. You're throwing your lot in with millions of other people. If there's one plan that scrimps on coverage for certain things to save on cost, the competing plan that does cover those things would eventually become full of only the people who have those problems, and then the risk for the company is far greater, and the cost would be far greater. That's why minimum standards are absolutely necessary, and why McCain's buy-from-another-state plan was foolish... it wouldn't have been bad if there would have been federally mandated minimums.


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## swift (Jun 4, 2004)

Omegax, you said...


> You're right. Imposed controls doesn't work, but Japan negotiates the prices with the hospitals, for uniformity as much as anything.


In the US prices are negotiated with the insurers too. Medicare sets rules to be followed and prices to be paid to hospitals and clinics that choose to accept Medicare. In turn private insurance companies negotiate costs based on Medicares numbers. As it stands now every $100 billed to medicare from a hospital in the midwest medicare pays ~$42. In the contract that hospitals sign to partake in medicare those hospitals cannot bill the patient for the unpaid balance.

Since there are more voters on the coasts, the percentage of reimbursement is higher than in the midwest. So the DRG for pneumonia in New York pays the hospital more than the same person with the same pneumonia in Fargo.

The thing people must understand is nobody is entitled to healthcare unless you pay for it. We have far too many people that fail to pay their debts in this country. Those people that do, have to pay for their own debts and everyone elses. Omegax take a trip to New York city, Boston, LA, Savanna Georgia, Nashville and hang around the Compton's and Harlems and trailer parks in those cities. You will understand why Healthcare is so expensive. You will see where the economy is stimulated on the street corner and back alley's and the $1000/wk heroine addict that spends several nights a month in the ER due to his lifestyle but has never paid a hospital bill. I say this country has too many leeches and not enough responsible people. Let natural selection take care of a those that leech for a change.


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## Chuck Smith (Feb 22, 2005)

Two things scare me about the Universal health idea.....

One: That doctors would be spread out through out the nation like I have mentioned over and over. The mayo clinic in rochester would be dismantled and shipped around to different parts of the nation. I chose to live with in 30 miles of one of the best health care systems in the world for a reason. It is close for me and my family.

Two: The cost would get pushed onto taxes. You would see more and more taxes. Now with the bail outs that will be pushing the national debt and pushing that on the future. Then if you and a socialized health care....that would be pushing the $$$ onto tax payers, small business owners, business owners, consumers, etc.

I would be more in for reform.....like mentioned before about the laws that are in place for medication to hit the market. $1 billion to get one drug to market. That is crazy. Then all the malpractice law suits. Everything like that needs to get reformed. Then the system IMHO will right itself.


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## blhunter3 (May 5, 2007)

swift said:


> Omegax take a trip to New York city, Boston, LA, Savanna Georgia, Nashville and hang around the Compton's and Harlems and trailer parks in those cities. You will understand why Healthcare is so expensive. You will see where the economy is stimulated on the street corner and back alley's and the $1000/wk heroine addict that spends several nights a month in the ER due to his lifestyle but has never paid a hospital bill. I say this country has too many leeches and not enough responsible people. Let natural selection take care of a those that leech for a change.


AMEN.


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## omegax (Oct 25, 2006)

You and I already pay for the heroin addict (I don't like that any more than anyone else), but leave the guy who needs ongoing treatment for a condition that could become worse out in the cold. Let's at least be fair about who gets treatment paid for by the rest of us. I want to cover the guy who wouldn't need the ER, if his condition were in check.

Swift, since you're back, what do you, as a doctor, think of Bob's idea of having nurses carry a bigger load, and my musing about if more "quickie care" places would be a good idea? My thought is that I'd like the guy whose time costs the least doing as much as possible.


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## Chuck Smith (Feb 22, 2005)

omegax..



> Since you're back, what do you, as a doctor, think of Bob's idea of having nurses carry a bigger load, and my musing about if more "quickie care" places would be a good idea? My thought is that I'd like the guy whose time costs the least doing as much as possible.


Then the nurses would have to carry malpractice insurance. because now if a nurse slips up it goes back on the doctor because they gave the order. But if you have the nurse do more then they have to carry the insurance. Also they would need more education.

So what you are doing is making the cost of becoming a nurse more expensive. Which would lead to more people not being nurses...which would lead to less people in the health care industry....which would lead to longer waits and less care available....etc.


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## Plainsman (Jul 30, 2003)

> You will see where the economy is stimulated on the street corner and back alley's and the $1000/wk heroine addict that spends several nights a month in the ER due to his lifestyle but has never paid a hospital bill. I say this country has too many leeches and not enough responsible people. Let natural selection take care of a those that leech for a change.


We can only hope natural selection takes place before the low life piece of crap kills someone.


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## Chuck Smith (Feb 22, 2005)

Omegax....

Here is another example of what would happen with a universal health care system....(swift already hinted at it)....

The Mayo clinic used to offer a health care plan that if you had anything wrong with you, you could go in and pay nothing out of your pocket for their employees. *THEY USED TOO...* That included family members. The cost was about $10 a month for that one employee for the family plan.

I knew of people that would go in just with a cold or a flu. The reason was because they got meds for free. Yes they could have went to Walmart and bought cough medication, asprin, etc. But hey....why go there when I can get stuff straight from the hospital.

Now with a universal health care more people would do things like this. They would go in because....Hey I don't have a high deductible, I don't have a deductible, it won't cost me a thing, etc. So who will end up paying for all of this care that really is not needed? TAX PAYERS


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## omegax (Oct 25, 2006)

Chuck, I completely agree with your reform ideas.

I just want to go farther. In a time when thousands of people every month are losing their jobs, I worry about what happens if I were diabetic, and then lose my job. If you can afford COBRA in the first place (95% of people don't take it), they only have to offer it for a while. At that point, finding private insurance is next to impossible. Guaranteed issue sounds good, but the corresponding problem is, as NY found out, people wait until they have emergencies to get insurance, which drives up costs for everybody, including group plans. So, you have to go a step further, and require insurance. Massachusetts did this, but some families are being really burdened by their required premiums. However, if we institute reforms, like the ones you suggest, we should be able to keep the costs for the plans low.

That's what it would take for all of us to not ever have to worry about being able to BUY private insurance, without regard to "pre-existing conditions".

As far as people going in for sniffles, if the insurance plans stay private, they can handle that their own ways. Most do it with co-pays and deductibles. Even, in the extreme case of a national insurer, which you guys have already completely panned (don't worry, I won't go back to banging that drum), they could do the same things. I'd definitely want to couple higher deductibles with HSA's though, and expand them like Bob suggested.

Honestly, I don't think we're that far apart. Heck, I started this tangent because I worry about my ability to even buy insurance in the future, not because I want it provided to me for free. The problem is that making sure we could all buy it links it all together.


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## swift (Jun 4, 2004)

Omegax, First for the record I'm not a Doctor, I am a Physician Assistant, My wife is a Doctor in the same clinic I work in.

Your Idea of quickie centers is already up and running. There are many "urgent care" centers around the country. Many are manned by Midlevels with MD/DO remote supervision. These places fill a niche for the busy working class people that aren't usually the drain on healthcare.

It sounds like you want to re-invent the HMO systems that were basically run out of business by the Doctors and patients because of delays in treatment. From what I've seen in your descriptions of the Swiss they have an HMO system inplace.


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## omegax (Oct 25, 2006)

You're still an insider, and I value your opinion. Do you think the "rapid care" type places are harmful to people having a relationship with a primary care physician? I mean, I haven't really had a primary doctor, since I was a kid, but when I get older it might be pretty nice. Would we benefit from having more of those places, or are their costs just as high as traditional hospitals?

We've all conceded that the people who are drains skip out on the bills anyhow, and their costs are passed onto the rest of us. Addressing that problem is critical to our current system, and any long-term goals we might have. You're not going to get any disagreements here about the idiots.

When I really nail it down, my ideal for the US system is to guarantee that we could all _buy_ insurance, not necessarily have it provided to us. Even that brings up those interlocking problems I mentioned before, though.

I, actually, had to read up on HMOs a bit. The English model sounds more like the HMO model than anyone (gatekeepers and whatnot). I suppose that as part of the Swiss model, some people would chose HMO-type plans, though (EDIT: Now that I read a little more, many of the insurance plans in Switzerland do offer discounts for people for use HMOs... HMOs aren't really the model, but they are a method). Except that I don't think they dictate prices back to the hospitals. That's a great way to have ungodly wait times. Truth-be-told if I wound up on the open market, I would probably accept having to go to a gatekeeper.


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## Chuck Smith (Feb 22, 2005)

> Chuck, I completely agree with your reform ideas.


Ok you agree......now my question to you is why put in a system if reform does not happen first?

The first step is reform. Then see if the system rights itself. Then if it does not right itself then change the system.

------- Off subject-----------

That is one of the big problems with the Obama admin. Lets look at the housing/mortgage problems. If they put in controls for the mortgage companies and strict guidelines of how to borrow money to people. (ie: if your income before taxes is this you fall in this bracket....no down payment you fall in this bracket, etc.) Then they would not need all this bail out money.

If you look now they are just giving money to these companies with out any strings or guidelines attached. So you know what is happening.....money vanishing.

Also on the housing market issue. The market goes in cycles....it always rights itself. It did in the late 70's and early 80's and it will again. With out goverment involvement. But nope the goverment steps in and is only prolonging the downward part of the cycle. Also you throw in the lack of controls (like I mentioned above)....we will be right back where we were a year ago.

-------- Back on topic -------

They need to have reform before you can put in place a new system.


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## omegax (Oct 25, 2006)

Chuck,

Again, we agree. Mass. is having big trouble because the costs that people now _have_ to pay are too much for many families. The only thing is that I'd make sure that you do it all at the same time, because once the heat's off it may never get done... Albeit, if you fixed the guaranteed issue/required insurance problem first, eventually the costs would creep back up to the point where it would become critical again. However, that's certainly far less than ideal.

The scary thing, to me, is that the insurance industry just came to the table with a proposal to do guaranteed issue is there is a requirement for everyone to carry insurance, which _is_ what I'd eventually like to see, but I really do hope that the problems in Massachusetts occur to everybody, before it's too late. There are just so many unintended consequences that I don't want any politician shooting from the hip.


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## hunter9494 (Jan 21, 2007)

Obama's plan is to throw your money, your children's money, your grand kids money and THEIR kids money at any and all problems. his plan is ruinous and will turn out to be a disaster...when all is said and done he will go down as the worse President in history


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## swift (Jun 4, 2004)

I'm a bit biased since my primary job is manning the urgent care and ER. Rural America is differant in our urgent care runs out of the same clinic as the primary care and is attached to the hospital.

Urgent care centers (UC) are good in that they provide a place for sick people (acute illness/injury) to be seen without clogging up the clinics that (in our area) are typically booked with the elderly. Since we have mostly good people living good lives in the Dakotas people live longer. They also take care of themselves better which means they schedule routine doctor visits. This is a feather in the cap of the people we live with. And the medical communities.

The problem comes in the folks that use the UC's for primary care i.e. blood pressure follow ups, diabetes care and so on. These people do so out of convience. So they have decided, in their mind, that their ongoing health is less important than whatever they have planned during the day. There is a need for a "relationship" between doctors and patients to maximize their care. Trust is also a huge implication in getting good health care. The Patient must trust the Dr is doing his/her best for the patient as an individual and the Dr must trust that the patient will follow through with the plan of care set forth. When primary care is done at an UC (aka "doc in a box") there is less investment by both entities regarding the longterm cares.

Some will argue that continuity of care is so important and UC's subvert that. I think that is a fiscal arguement moreso than a real concern. Me treating someone with a sprained ankle and referring them back to their PCP is not a problem since it is an acute problem. BUT me in a UC changing the meds of someone with high blood pressure may cause a very big problem.

To summarize I do feel UC's have a niche if the public is willing to use them for what they are designed for.

There is another popular UC setting that is gaining popularity nicknamed the $50 clinics. They cut overhead by not accepting any insurance. They do not have any ancillary services like xray or lab and whatever your problem is the cost of the visit will be $50. Poeple like these because there is no muss and no fuss.


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## Bobm (Aug 26, 2003)

DEATH OF U.S. HEALTHCARE

By DICK MORRIS

Published on TheHill.com on May 12, 2009

When all of America's top health insurers and providers met at the White House this week and pledged to save $2 trillion over the next decade in health costs, they were pledging to sabotage our medical care. The blunt truth, which everybody agreed to keep quiet, is that the only way to reduce these costs is to ration healthcare, thereby destroying our system.

Here's why:

• Essential to any cost reduction is a cut in doctors' fees. Congress is trying to cut Medicare fees by 21 percent. But cuts in fees and doctors' incomes will just discourage people from entering the profession and those already in it from practicing. The limited number of doctors and nurses in the United States is the key constraint on the availability of healthcare. Our national inventory of 800,000 doctors is growing at only about 1 percent a year (18,000 med school graduates annually minus retirements), while the nurse population is stagnant at 1.4 million. To stretch these limited resources so that they can treat 50 million more people is possible only through the most severe kind of rationing.

• As in Canada, the best way to cut medical costs is to refrain from using the best drugs to treat cancer and other illnesses, thereby economizing at the expense of patients' lives. Forty-four percent of the drugs approved by the Canadian health authorities for use in their country are not allowed by the healthcare system due to their high cost. As a result, death rates from cancer are 16 percent higher in Canada than in the United States. We will pay for the attempt to save $2 trillion with our lives. (And remember, one cannot opt out of the Canadian system and pay for the medications out of pocket.)

• The only real way to save money on the scale projected is to ration healthcare services. Optimists say that this can be achieved by increased use of preventive care. But the Canadian experience indicates that when government -- or its satellite private insurance providers -- ration healthcare, they cut preventive care first. *In Canada, colonoscopies are so rationed that the colon cancer rate is 25 percent higher than in the U.S. (even though Canada has a much smaller proportion of poor people, whose frequently bad diets make them more prone to the disease).*
Obama's pretension that nobody will find changes in his or her current health insurance plans except for a magical reduction in their cost by $2,500 a year is a fool's proposition. Private health insurers will be no more private than TARP-funded banks or government-subsidized car companies are in Obama's America. They will be controlled by government healthcare planners who will approve treatments, limit drug use, hold down medical incomes and bring their cost-cutting programs to bear. Inevitably, their ax will fall on the oldest and the sickest among us, those least "deserving" of our newly limited and, under Obama's program, diminishing healthcare resources.

The other radical changes Obama is bringing about in our nation can always be reversed. New taxes can be repealed or lowered. That which was nationalized can be privatized. Government which has grown can be cut. But once the healthcare system is extended to cover everyone, with no commensurate increase in the resources available, the change will be forever. The vicious cycle of cuts in medical resources and in the number of doctors and nurses will doom healthcare in this country. This wanton destruction will not be reversible by any bill or program. A crucial part of our quality of life -- the best healthcare in the world -- will be gone forever.

Politically, voters will feel the impact of these "reforms" very quickly. When they face rejection or limitation at the hands of the bureaucrats, they will quickly understand that the their options have become limited. Just as in the 1990s, when HMOs first became universal, the patient outrage will create a political force all its own and those who foisted this brave new world on the American people will be in their crosshairs.

Go to DickMorris.com to read all of Dick's columns!


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## Bowstring (Nov 27, 2006)

Require everyone to prove they have had insurance for the previous year for each dependent claimed and themselves when they file for their income tax return. If they can't provide the policy number, no tax refund would be issued. There are 43 million with out insurance and 40% get a complete refund of withholding tax. It should cover a good portion of the costs.

I know this sounds radical, but Minnesota did this years ago with auto insurance. If you have no insurance you don't get a license! Very quickly we had 99%(I'm guessing) of the cars insured. Minnesota has slacked off on this for some reason but it sure worked.

I have Blue Cross and a high deductible(keeps me from going to the Dr. for a cold, etc.) and still its over $600/mo. I chose to pay this monthly instead of spending $125/wk on misc. entertainment. Minnesota could reduce my income tax, because they could eliminate a large portion of the costs for MinCare. Then I might be able to spend a little on entertainment etc. I'm not going to hold my breath.

Of course you would still need funding for those that actually can't pay for insurance. :beer:


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## Bobm (Aug 26, 2003)

true competition would drive your insurance costs way down, its one more example of government fooling with the market making it less efficient


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## omegax (Oct 25, 2006)

Ok, how's this? We do what we can to bring costs down. We require insurance, and make guaranteed-issue mandatory (as the insurance industry offered). At that point, anyone who wants to could buy insurance, and hopefully, it would be much cheaper. That one's good enough for me. I'd just keep my employer plan, but if I were a diabetic who was laid off, I'd still be able to buy private insurance. There are two things that I could see a lot of you finding objectionable: We'd have to mandate minimum requirements for the insurance policies, otherwise people with problems would just opt-out of the system (their costs would be so high that any fine you slap on them would be less), and we'd be back to square one. I know Bob's not a big fan of that one. We'd probably have to subsidize some low-income people. However, subsidizing the low-income would probably allow us to drastically cut or maybe even do away with Medicare! I know you guys are on board for that! There would be a lot of details to hammer out, though.

I wouldn't trust Dick Morris as far as I could throw the man. I don't really like using Wikipedia for things like this, but this article appears to be really well-sourced (when's the last time you saw a Wikipedia article with 121 sources?). http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared The chart about the mortality rates for all cancers shows that Canada beats the US.


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## omegax (Oct 25, 2006)

Bobm said:


> true competition would drive your insurance costs way down, its one more example of government fooling with the market making it less efficient


I appreciate market-based approaches to a lot of things, but your faith in the market is misplaced when it comes to health insurance. Market forces force insurers to try to stick each other with the costliest patients. The ultimate conclusion of unregulated market-based health insurance is a complete a la carte system, which doesn't really insure you from anything unforeseen.


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## Bobm (Aug 26, 2003)

Thats not true and I am not talking about things" unforseen"

I asked you why I have to have insurance to cover pregnancy, drug addiction ect for example my wife and I are not going to have any more children or use drugs

the government drives cost up a lot by limiting where you can buy insurance , you cannot buy from a out of state plan unless it has a base in that state for instance. limit competition Supply) price goes up period.

what was your answer?

thats the type of meddling that drives up the cost of insurance


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## Bowstring (Nov 27, 2006)

It's to bad politicians are so narrow minded. They have to realize that a combination of adjustments like you all bring up on the board is necessary.


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## omegax (Oct 25, 2006)

Bobm said:


> Thats not true and I am not talking about things" unforseen"
> 
> I asked you why I have to have insurance to cover pregnancy, drug addiction ect for example my wife and I are not going to have any more children or use drugs
> 
> ...


My point is that once you allow plans to pick and choose what they do and don't cover, the competing plans that do cover that will, over time ONLY have people with those problems in them. At that point, it's like not having insurance for those things at all, because their premium reflects the real cost of having those problems. What about a diabetic who is diagnosed at 30? They didn't have that problem, why would they lump themselves in with a pool of people who do? I don't have Crohn's disease, why would I pay like I do? That's not a problem until I come down with Crohn's disease.

The market can and would drive companies to try to stick each other with the costliest patients. So, in order to cover an ailment, you'd have to pick plans that did cover them. With a guarantee that just about everybody on that plan has that problem, the premium absolutely would reflect the cost of that disease. At that point, why have insurance for it at all?

Even if you rule out things that are impossible, like pregnancy coverage for post-menopausal women, you're effectively lumping the costs onto only the people who will need it. Which doesn't sound bad, until you realize that the premiums for everybody who's left will absolutely reflect the true cost. Why carry the coverage?

Insurance is pooling of risk. By having an a la carte system, you might as well save yourself the overhead involved with the insurance, and go to nothing but HSAs.


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## Chuck Smith (Feb 22, 2005)

One thing is State goverments are the problem. When I first started my self employed career (about 10 years ago) there was 6 health insurance companies in MN. Now there is 2. The state puts mandates on these companies on things that need to be covered and what not. So these companies leave.

So you want the goverment controling health insurance? They are part of the reason why it is so high. Like others have stated.....pregnancy is covered in my plan. I am single and a man. But I am covered if I get pregnant. I also have to pay for drug dependency.....I am not an addict or anything....why do I have to pay for that......one answer.....MN STATE GOVERMENT!


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## swift (Jun 4, 2004)

The term Health care reform should be changed to health insurance reform. With insurance companies forcing contracts of participation with health providers they are looking out for the interest of the company instead of the insured. Companies like BCBS are non profit corporations that profit billions yearly. They are able to hide profits in the form of bonuses and earmarked projects.

Many people have said to mandate health maintanence. Here is another personal example of the insurance company dictating care to the customer. An obese patient with diabetes, high blood pressure and asthma looks at bariatric surgery (wt loss surgery). Studies support that this intervention reduces the amount of medicines people need, increases their length of and quality of life and is the only intervention proven to cure type II diabetes in many patients. Cost of the procedure is about $26,000. Medication costs monthly for this patient run about $300. In just 8 years the savings in meds will cover the cost of the surgery not to mention hospital visits that will not happen, quarterly diabetic checks with lab work that wont be necessary. The insurance company views bariatric surgery as cosmetic surgery and will not cover any of the cost. If the patient pays out of pocket the insurance company benefits by the reduction of those costs.


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## Bowstring (Nov 27, 2006)

Bobm said:


> Thats not true and I am not talking about things" unforseen"
> 
> I asked you why I have to have insurance to cover pregnancy, drug addiction ect for example my wife and I are not going to have any more children or use drugs
> 
> ...


That's a good point about costing the level of insurance we each want. But what do you do with the low income young family in the northwoods of some state I won't mention, that wants to lower their monthly insurance costs and exclude the type of coverage you mention. And then can't pay for the hospital/Dr. fees when the next addition to the family happens? It seems like we would be back to the same mess.

:huh:


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## Bowstring (Nov 27, 2006)

swift said:


> The term Health care reform should be changed to health insurance reform.


I agree,if the cost of medical care is included.


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## Bobm (Aug 26, 2003)

Omegax your post is a perfect example of the hypocrisy of both the dems and the republicans they both champion freedom of choice in the areas of life they deem fit and want to use the force of government to dictate areas they "personally" think is " the way it should be".

If you feel that a government beauracrat is more qualified to make these personal decisions in your life there really not much I can say. I have the confidence to make these decisions myself and live with the consequences of my decisions. With the Dems is healthcare and gay marriage, what kind of cars we drive ect with the republicans its no gay marriage, what you can do with your own body ect.

I'm sick of it and frustrated that you or anyone else somehow thinks they own my life or even a piece of it. ANd yes that is what you are advocating because I give up a piece of my life for every dime I earn and its not your to spend.

Now I want to make it clear I am no anarchist and realize we need laws for a civil society but guys like you make life miserable for guys like me.

I cannot state strongly enough how tired I am of the premise that the fools in government can make better decisions about my PERSONAL life than I can.

Thats why I feel most comfortable as a libertarian, your way of thought has dumbed down this society into a bunch of dependent ( to the delight of politicians both dems and rep) wimps.

People should be held accountable for their own decisions, only children and the elderly should get preferential treatment other than that if you are obese and its not proveably related to some physical issue out of your control and you get diabetes too f'n bad, die if you don't have insurance.

If we started holding people accountable for this stuff they wouldn't be lardasses in the first place. If you spend your like choking down donuts too bad suffer the consequences. Sames goes with smokers they should have to pay a premium that reflected the risk they have willingly taken, gays and aids same thing.

What has happend to this country? that we no longer hold anyone responsible for their own actions that very fact has contributed greatly to the declin in our society.

sorry for the tone of this post but I am really fed up with some jackass in Washington meddling with my personal affairs, and their ignorant minions selling their vote to them in return for seizing my lifes hard work and handing to the lazy and irresponsible.


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## seabass (Sep 26, 2002)

Bob,
What are your thoughts on this?

http://www.msnbc.msn.com/id/30763438/


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## omegax (Oct 25, 2006)

Bob, it's not that want to take choice away from anybody, myself included. I just don't want a race to the bottom, and, without regulation, that's what the market would force insurers to do. I agree that people should be penalized for stupid choices (auto insurers do it). Those would be details to be hammered out, but we definitely can't leave the regulation up to "the market". The market would quickly figure out that not covering anything is the most profitable route. There wouldn't be competition! It's not like people whose plan dropped coverage for disease X, which they don't have, would leave their insurer for a more expensive one!

Even if you just let people buy from across state lines, without any mandates for the quality, health insurers would all be clustered in one or two states with the most favorable laws for them. At that point, you have no say at all in the quality of your insurance. I can't just call up a state rep in another state and start complaining... I suppose I could, but it's a pointless thing to do.

For the record, I actually wouldn't mind the buy from across state lines plan, if there were federal mandates on the quality (I could at least call up my US rep and give him an earful). There are cost savings from labor, facilities, etc. to be gained by being in another state and having one large campus.

Insurance just runs contrary to Conservatism. It socializes risk. I understand a philosophical disagreement with that. I really do, but doing away with insurance isn't really practical.


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## omegax (Oct 25, 2006)

Seabass, I almost think you should start a whole thread on that. It could be thought-provoking.


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## Chuck Smith (Feb 22, 2005)

I am not getting to Opening it across state lines?

Does that mean I could buy insurance from a different state? The problem with that is that you will get screwed over and so will the insurance company. Look at it this way. You buy your health insurance from State X and you live in State Y. In state X it is cheaper because it does not include a somethings. But you live in State Y and State Y has certain mandates. Now you get the illness that is not covered in your plan. You can't get denied medical care. So they treat you for that illness. WHO IS GOING TO PAY FOR IT? Yes the tax payers or the people who bought insurance in state Y. Now that insurance company that is in State Y will ask for Federal help or they will lobby to get laws passed so this does not happen.

So this is how you will get screwed:
1. A law will pass so they can deny you health care.
2. State taxes go up (even higher than they are)
3. Fed taxes will go up because they will need the funding that the insurance company asked for.
4. All companies that don't cover that illness will get a surcharge from the fed to help out that funding request from the one insurers and that will get passed down to policy holders.
*the list can go on and on.

That is why so many health insurance companies have pulled out of MN. Because the state of MN requires them to cover so much and MN can't deny health care to people.

Because look at it like this.....you know who is paying for all the homeowner claims from Katrina......EVERYONE!!

- If your home owners insurance company did business in LA they are passing the costs on to you.

- The price of re-insurance (insurance for insurance companies) went up. Who do they (Every insurance company out there) is passing that cost onto....consumers

- Taxes.....yep helping out the federal goverment to aid in the payments made by them to insurance companies and people.

So unless I am missing something with the opening up the "state lines" thing. It will cause a whole other set of problems.


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## Bobm (Aug 26, 2003)

omegax said:


> Bob, it's not that want to take choice away from anybody, myself included. I just don't want a race to the bottom, and, without regulation, that's what the market would force insurers to do. I agree that people should be penalized for stupid choices (auto insurers do it). Those would be details to be hammered out, but we definitely can't leave the regulation up to "the market". *The market would quickly figure out that not covering anything is the most profitable route*. There wouldn't be competition! It's not like people whose plan dropped coverage for disease X, which they don't have, would leave their insurer for a more expensive one!
> 
> Even if you just let people buy from across state lines, without any mandates for the quality, health insurers would all be clustered in one or two states with the most favorable laws for them. At that point, you have no say at all in the quality of your insurance. I can't just call up a state rep in another state and start complaining... I suppose I could, but it's a pointless thing to do.
> 
> ...


1)The bold stuff is not true if it was insurance wouldn't exist the government wasn't in it from the start. How would they make money period. there is always somone that will insure anything its just based on risk ever hear of loyds of london?

2)I never said or implied this



> I really do, but doing away with insurance isn't really practical.


3) you implication all insurance compainies would cluster in states favorable to them is incorrect the market is always ready to fill a void in competition, If people were allowed to freely move to the insurance company of their choice, someone would start another company (heck I would start one) because a company that treated people fairly would get all the business at areasonable profit.

this whole point of yours implies that all insurace agencys are crooks which is patently untrue I've had many insurace claims over the last 35 years without a single problem auto heath home ect.

The whole ( and this is a left wing idea) idea that all corporations are corrupt is untrue our corporate structure is what made this country great.

4)The idea that insurance runs contrary to conservatism is evidence you dont understand conservatism



> Insurance just runs contrary to Conservatism. It socializes risk. I understand a philosophical disagreement with that. I really do, but doing away with insurance isn't really practical


Insurance doesn't socialize risk, government mandates in how insurance companies structure policies insurance socializes it, there is a big distinction here you are missing

5)


> At that point, you have no say at all in the quality of your insurance. I can't just call up a state rep in another state and start complaining... I suppose I could, but it's a pointless thing to do.


Insurance contracts are pretty cut and dried if an insurance companiy refuses to pay a LEGITIMATE claim you sue them and they are subject to fraud laws no matter what state the reside in

Omegax you have a dark view of American business because of a few bad apples that give the rest of them a bad image. The vast majority of us work for corporations and we bend over backwards to treat our customers fairly, *but and this is an important but *in my industry cusotmers are free to move to our competition for any reason without govt intervention.


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## Bobm (Aug 26, 2003)

Chuck limiting competition (supply) always drives prices up you cannot refute that and limiting by state where you can buy does just that


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## Bobm (Aug 26, 2003)

seabass said:


> Bob,
> What are your thoughts on this?
> 
> http://www.msnbc.msn.com/id/30763438/


Seebass he is a child and if you look up a few of my posts you will see that I feel children and the elderly should get special consideration.

I think the judge is right to order he get the chemo and his parents are religious zealots and religious zealots christian, muslim, jew you name it they are all nutcases.

Minors correctly get special protection from dangers and from themselves for example they are not allowed to use alchohol drive vehicles until they get to a point that our society makes the judgement they are ready to make good decisions.

Like I said I'm not a anarchist that doesn't want any laws.

That said if I decided I didn't want chemo and the judge forced it on me I would have a huge problem with it, but I' in my late 50s not a child


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## Chuck Smith (Feb 22, 2005)

> Chuck limiting competition (supply) always drives prices up you cannot refute that and limiting by state where you can buy does just that


I understand that. But one thing people don't realize is how insurance works.

Take your auto insurance. In your state the liability limits could be less than what is required in another state. But if you travel into that other state with the higher *STATE* mandated limits your insurance company automaticly is on the hook for those new limits once your vehicle crosses the state line.

So what I am saying if the USA opens up the "state borders" for health insurance it won't matter because it will only matter what your home state mandates for coverages. Again that is why MN has driven out so many health insurance companies is because the state mandates so many coverages to be in its basic policy.


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## Bobm (Aug 26, 2003)

Chuck nothings is perfect that I know of but competition always forces companies to meet the standards required to do business, but you are correct MN GOVT is meddling with the health care insurance market and driving up costs. If they got out of it that would correct itself.

this I will remind you, I think is the whole point of this thread, atleast from my point of veiw

the government no matter how well intended always screws this stuff up and has no business being in it


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## Chuck Smith (Feb 22, 2005)

Bobm,

You and I are on the same page. Goverment does not need to get involved like people think is so great. They compare canada and other countrys.

The Health Insurance industry needs to move back towards private and not so much state mandated stuff.

That is why I keep wondering why opening up the boarders for options in buying Heath Insurance (right now) would not make one bit of difference. Because what ever company you go shop with will take in consideration what state you live in and then charge you accordingly. Just like every other form of insurance.


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## Bobm (Aug 26, 2003)

Chuck thats true but there would be many many not two companies vying for your business that would drive the price down and the selection up

obviously we need to get the government out of it its like this my insurance carrier requires me to have maternity no way do I need that its like a car insurance policy requireing you to have full coverage on a 78 rusted out chevy pickup just a bunch of nonsense.


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## Chuck Smith (Feb 22, 2005)

Bob....

To let you know the state lines are open. But companies don't want to be in the state right now. So like I mentioned before if the state lines "opening" up and I go and get a quote from another company in a different state they will just charge me the same as I am paying now or will charge more because they don't want to be doing business in the state. So that is why "opening" up state lines would not matter one bit. Because they are already open.

I understand if more companies in one state would drive down cost.....kind of like supply and demand. But if the state regulations make it so no company wants to do business in the state it does not matter. Because any company can do business in any state they wish. So opening up statelines does not matter one bit. It is if the company can make ends meet in that state if they want to do business or not.

------------------ Side note how insurance companies work--------------

Everyone thinks insurance companies are all about making profit. That is not the case to get an A rating (which all companies are trying to do) that company has this business model. Every $$$ brought in via premium they want to spend that same amount out. Now the money going out includes Claims paid, administration fees, daily business operation costs, building rental or mortgage costs, investment costs, the secretary at the front desk, etc. Then if that year they do turn a profit (bring in more than they pay out) they invest it to make reserves stronger. So when the years they don't turn a profit. They also have to spend money in other things like research grants to university or medical facilities.

---------------------------------------------------------------------------------

So like I said right now any insurance company can do business in any state just as long as they meet that states requirements. But some don't want to take the risks because some of the states require too much coverages and then they lose the dollar in/ dollar out model.


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## Bobm (Aug 26, 2003)

they are kind of like lawyers easy to hate until you need one


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