Thank God we don't live in Europe and have that horrible socialized medicine!

[primavera]

Just think, if I lived in Europe, I would have been deprived of the happy opportunity to wait four full months to get an appointment to see my physician. I might actually have had a productive day today instead of sitting around in a waiting room with 70 other impatient patients, waiting for a good two hours to get to see a physician for 5 whole minutes. Why, those commie bastards in Europe would have made me see a physician immediately, without having to have an appointment at all! You think they'd let me blow half my afternoon waiting around in a waiting room like I can here? I think not! Even more outrageous, they might have given me the chance to exchange more than ten words with a physician. On top of all of that, they wouldn't even have been considerate enough to charge me $500/month for insurance, can you believe the nerve? Oh, the evil of it all! Well, all I can say is it's a damned good thing we live here in the US, where capitalism has given us the finest health care system in the world!


:banghead:

[endarkenment]

1. I have at least one friend who seriously subscribes to this bullshit.

He actually thinks that our health care nightmare is superior to what they have in Europe and Canada. When pushed for details he can't actually come up with anything rational, but he is sure that it is very very bad 'over there'.

[Hydra]

2. Amazing that people would rather have shit

Than to pay "extra taxes"

[MountainLaurel]

5. Amazing isn't it?

It's just disgusting.

And often the same people never realize just how sick the system is: They don't question the system when they see a jar at the local convenience store collecting money for chemo treatments for a 5-year-old or a cop whose insurance plan doesn't cover physical therapy after he was in a car wreck.

[cutlassmama]

3. You got 5 actual minutes?

I'm lucky to get 1-2 minutes.

[MountainLaurel]

4. Yikes!

10 whole words, huh?

[Fire_Medic_Dave]

6. Wow that sucks!

I went to the dentist didn't even get the chance to sit down, did pick out a magazine though. Had my teeth cleaned found out I had an abscessed tooth, had a root canal and was still out of the office in less than 90 minutes it cost me $180 dollars. Then I took my mom to the cardiologist, they made the appointment friday afternoon, we waited 5 minutes, then mom got a full assessment, a twelve lead ekg, we spent about 20 minutes with the doctor. Got mom scheduled for a bunch more tests all within the next three weeks. She didn't pay a dime. Just to put things in contrast to your experience. I don't really know what the answer is something needs to be done though. We have epidemic levels of obesity and diabetes in this country, I have relatives in Tennessee and TennCare there has been a disaster for the state. Given the way FEMA and many other federal organizations have been run I'm not sure I want the government in charge of my healthcare. I am sorry about your situation, when my wife was in grad school, the insurance situation for us was very expensive and not very good.

David

[primavera]

7. Thanks

Actually, we've got pretty good insurance, as far as insurance goes, although every year the premiums go up, the coverages go down, the co-pays increase, as do the restrictions on who I can and cannot see. I'm happy for you that you've had some positive experiences with our medical system, but it sounds so out of keeping with what I hear from others, as well as what my own experience over the years has been, it makes me wonder where you live. I know some states have more generous state laws with respect to health care than do others, and, probably most importantly, some areas simply have better ratios of physicians to patients. Admittedly, here in New Orleans, the ratio of physicians to patients is particularly bad, but, to be honest, I've had similar problems in other parts of the country with more advantageous ratios.

I appreciate your post though, as I'm always curious to better understand people who have an instinctive distrust of government handling things like their health care. My father is similarly suspicious of government administration of such things and I always wonder why. I mean, government may or may not be particularly efficient, but consider the alternative: the private sector thrives when it maximizes profits. You don't maximize profits by lowering rates and increasing services; you maximize profits by doing just the opposite, i.e., increasing rates and lowering services. There's nothing politically subjective about that statement, it depends upon no ideology, it's a mathematical fact that the more you pay out and the less you take in, the less money you have at the end of the day for yourself. But it follows logically from that fact that private companies have an inherent, inescapable motive to do the opposite of what is in your best interests as a consumer. So how can anyone be surprised that health insurance companies will consistently try to make do with less, try to get out of having to pay claims, try to impose constraints upon what kinds of treatments and medications patients can receive? They're in the business of making money, that's what they do, what else would anyone expect them to do? To my way of thinking, then, government administration has a huge advantage over the private sector as, unlike the private sector, their salaries are fixed, they receive no stock options, they consequently have no profit motive to try to cheat me out of costly but essential health care services.

Again, I concede that government may not be the most efficient administrator, but, even on that score, I think public health care has a huge advantage over private health care, because they don't waste as much time squabbling over what is and is not covered and by whom. In the US, fully half of the cost of our health care system has nothing to do with providing patient health care, but rather is purely administrative cost, in other words, all of the forms that have to be filled out to receive coverage, all of the backing and forthing between the health care providers and the insurance companies over who's going to pay how much for what, claims adjusters striving to find ways out of having to pay claims (they get paid bonuses for denying claims, you know), correspondence between the insurance companies and patients regarding disputed claims, attorneys filing and defending against suits for wrongfully denied claims, the list goes on and on and on. Jeez, and people think government is a mass of red tape? Man, government is small potatoes next to the willfully-created red tape jungle generated by the health insurance industry to thwart and obfuscate patients from getting their hands on even a penny more than is absolutely necessary. In contrast, in Europe, all of that time and money and effort is saved because everything's covered by the government, end of story. They consequently have a whole lot more money left over to spend on patient care, having not blown all of their money on bickering over who's going to pay for it.

I think the public character of health care in Europe smoothes out a number of other wrinkles as well. For instance, medical education is publicly paid for, so medical school graduates don't have to worry about how they're going to pay off the quarter mil in student loans they had to take out in order to obtain their educations. Lower financial burdens plus less stress having to contend with all of the red tape and hassle we have here and the undue influence of private insurance companies constantly trying to backseat drive makes being a physician a more attractive profession. Consequently, more people are willing to become physicians; consequently, there are more physicians available per capita to treat patients; consequently, you don't have to wait as long for appointments, don't have to wait in waiting rooms to see your physician, and your physician is free to spend more time talking with you and thinking about your case rather than freaking out about them 50 other patients they still have yet to see today. Similarly, because medical education is free, physicians don't have the heavy debts to pay back, and consequently there is no justification for the sky-high salaries doctors make in this country. Sure, the government paid a couple hundred grand educating their physician, but, as a consequence, they don't have to pay them $500K a year for the next 40 years. That's a big savings.

All of this makes logical sense to me and it coincides with what I experienced living in Europe and seeking medical care there. Every time I went to see a physician, I just wandered in off the street, presented myself to a receptionist, explained my condition, and - every time - within five minutes, I was sitting in front of a physician discussing and receiving treatment for the problem. And it never cost me a penny, even though I was a foreigner. So this is where my experience and reasoning takes me. Yet plainly your experience and reasoning leads you to an opposite conclusion. That's cool, I don't for an instant imagine myself to always be right, but it makes me curious to know what your experience and thinking is to have led you to a different conclusion. Care to share?

ed. sp.

[Fire_Medic_Dave]

8. Thanks for your response.

I'm glad you didn't take it wrong. I'm not necessarily against a single payer health care system. It definitely gives foreign businesses an advantage over the US in shear economic terms. I have seen what happened in Tennessee with TennCare, it was a disaster for the State, largely in part of governmental and private sector mismanagement. I have 2 main concerns. Cost and quality of care. Europeans are far healthier on average than people in the US. The cost in the US will be enormous. Doctors now perform tests even when they are 95% sure that they know what the problem is, out of concern of questions of malpractice. So Tort reform may be necessary. Another area is R & D of new drugs and new instruments. The free market has given us tons of great equipment and drugs that have saved lots of lives. What will happen to those industries if we become a single payer health care country. Most other countries place strict price controls on medications, that has caused health care in the US to be more costly but it's one of the only ways to reduce costs.

I have worked in the lowest income areas of a medium sized city for over 8 years as a fire medic. People call 911 for anything and everything, stomach ache, foot pain, nausea, vomiting, nose bleeds, etc. I got called to a mans house for respiratory distress. He had congestive heart failure I could literally hear him gurgling from 25 feet away. As I was assessing him I asked if he had been taking his lasix. He said no he couldn't afford it. His wife and his brother were both sitting outside with him, both smoking when we got there and both smoked 2 packs a day. But somehow they couldn't afford the $5 dollars a month for his meds or be inconvenienced enough to drive to the Health Department where he could get it for free. So instead he called 911 costing the taxpayers a $1200 taxi (ambulance) ride to the hospital. Now at that time he was very ill and he needed the ambulance and the ER. He probably could have avoided the whole thing by taking his medicine.

So to sum it up my concern is costs skyrocketing and then quality of care being cut to reduce costs. When health care is completely free people will abuse it. It will be a difficult transition, although it doesn't sound like either candidate is going to do much. Admittedly I'm a little bit jaded after watching a lot of people abuse themselves and then abuse the system. There may be a balance I think a national catastrophic plan we be a great place to start and would likely get huge bi-partisan support and would drastically lower insurance costs. I went to school at UTK and had an emergency appendectomy without any insurance. My total bill was like $10,000. I got some of it reduced, the surgeon wrote off his fee. I ended up with like a $6,000 dollar bill from about 4 different services. Tennessee had a law that says as long as you pay $25 a month on a medical bill it cannot be turned over to collections and interest cannot be added. That was 20 years ago but I think they still have a similar law with the same $25 dollar limit. I did eventually pay all the bills after 5 years.

Thanks for the pleasant and respectful discussion, we'll continue after some sleep.


David

[primavera]

9. You raise some interesting points

I feel like we kind of get into a number of chicken and the egg type situations here. As you say, Europeans are healthier than Americans, so the cost of their health care is less. But would as many Americans be unhealthy if health care were more accessible? Maybe part of the reason that Europeans are healthier than Americans is because they've grown up in a health care system which invites and encourages regular availment of preventative health care measures and their citizens enjoy greater health awareness as a result of more frequent contact with the health care professions. I don't know, maybe it has nothing to do with that, I'm just thinking aloud, you understand.

Similarly, the costly abuses of the system you reference may, in some measure at least, reflect poor access to health care. I'm not even low income and have generally had insurance, yet I've resorted to emergency room visits because I couldn't afford to wait weeks or months for an appointment to see my regular physician. Perhaps part of the reason people end up abusing emergency services is because they don't feel that they have access to less costly preventative health care measures. If that were indeed the case, perhaps a system in which everyone could see a doctor whenever they felt the need for it without having to worry about how much it was going to cost them to do so might alleviate some of the expensive abuses.

I will readily admit though that abuse is always going to represent a cost in the system. But I think the flip side of that coin is how much abuse are we willing to endure in the private system, which is by no means free of it? How many times do we hear about patients who were unable to obtain potentially life-saving treatment because their insurance companies refused to pay for it? How many mental health patients and drug addicts roam the streets and pose a threat to society because no one is willing to foot the bill for treating their conditions? Make no mistake, we pay a price for all of those people who slip through the cracks. How great is that price relative to the price of people in a universal health care system abusing the system? You worry about sky-rocketing costs and appropriately so, but are you sure that the sky-rocketing costs which concern you aren't already upon us? How much did you pay last month for health insurance for yourself and your family? A friend of mine with no medical conditions last year paid $16,000 to insure herself, her husband, and her two children for the year. That was more than her mortgage payment. Next to those kinds of costs, I can't help but wonder how great the costs of a small percentage of people abusing the system could be in comparison.

I'm harder pressed to have a response to your point about the advances in pharmacology and biomedical technology which the private sector has given us. I'm honestly not sure what would happen to those industries if government became the primary consumer of health care products and demanded fairer pricing from such companies. I do know that the pharmaceutical industry is one of the wealthiest industries on the planet, with some of the highest profit margins, and is clearly in no danger of going belly up anytime soon. I'm inclined to suspect therefore that they could probably survive some reduction in their profit margins without being crippled. Some of their executives might have to make due with only ten Bugattis in their garage instead of twenty, but really, how many $2 million Bugattis can a person drive at one time anyway?

That said, I think it's fair to say that transitioning over to a universal health care system would face culturally-specific challenges in this country, where our sense of individualism and the right to make obscene amounts of money at the expense of others is so much a part of our national identity. You admittedly can't make a health care system cost effective if you're willing to pay the designer of some drug or piece of equipment the kinds of astronomical sums such people are accustomed to receiving in this country. Challenging the right of individuals to receive those kinds of heart-stopping sums is natural and expected in Europe; here, it's antithetical to our beloved "American dream." And I honestly don't know how to get away from that, but I don't see any alternative if we're to have any hope of reducing the sky-rocketing costs of health care here. In Europe, physicians earn between $100-200K/year and CEOs of companies earn maybe $400-500K. In this country, a cardiologist can earn seven figures easily and corporate executives earn tens of millions a year. It's going to be awfully hard to balance a health care budget that includes paying some CEO $150 million a year.

Anyway, time I was heading off to bed as well. Thanks for the chat and have a good one! :hi:

[Fire_Medic_Dave]

10. Hard to say.

Access is a problem. I'm pretty happy seeing a PA or a Nurse Practitioner most of the time, some people aren't. I can always get in and see my Nurse Practitioner within 4 hours, I know if it's something serious she'll go get a doctor to consult with. In regards to personal costs premiums for my wife and I are 3k a year we probably have another 2k in co-pays etc. This year has been bad thanks to 3 root canals for me, I just picked up some overtime though. I realize that is not an option for some people. I have worked 2 or 3 jobs since my wife was in grad school. I see the same problems you do though. Without wholesale changes to the way the entire industry does business there will be no progress. Which brings about some other issues like is it then fair to pay our doctors $200k and pay our entertainers $10 million a film? I guess you could tax them 9.5 million a film and pay for a lot of healthcare but I don't think congress will go for it.

David

[primavera]

11. You're right, it's the tip of the iceberg

You can't really get into issues of disparate compensation in the medical industry without it immediately spilling over into all of the other forms of income inequality so rampant in our society. Our level of income inequality in this country is at the highest level it's been since the Great Depression. With 80% of the wealth in the country being owned by the richest 10% of the population, we're starting to approach almost feudal levels of wealth disparity. With only 20% of the country's wealth left to distribute amongst the remaining 90% of us, you're inevitably going to be trying to spread too little butter too thinly over too much bread. Personally, I think that goes a long way towards explaining why Europe has such a huge advantage over us: they have a much greater percentage of their national wealth at their disposal with which to implement programs for the benefit of the country. Here, that wealth goes to buy lear jets and mansions for a tiny minority of the population. But, of course, even though that's simply a mathematical fact, you can't say that out loud in this country without immediately being accused of being a commie and compared to Stalin. Sigh.

[primavera]

12. And the ordeal goes on...

Last week, in compliance with my physician's instructions, I attempted to call her to obtain the results of lab tests. Naturally, she can't take my call, so I leave a message. Fine. My physician never calls me back, but today, four days later, I get a message from her assistant, responding to the message I'd left for my doctor, and requesting that I call her (the assistant) back. She leaves a number to call, which, it turns out, is the front desk number. So I call the front desk and ask to speak to the assistant and am told that I can't speak to the assistant, but I can leave a message for the assistant's assistant. I explain that I don't want to talk to the assistant, much less the assistant's assistant, I want to talk to my physician. The receptionist sounds genuinely shocked that I would even suggest speaking to the physician personally and tells me that "it's impossible for her to connect me to the physician directly," so that's right out of the question. Nor can she connect me to the assistant, the best she can offer is to leave a message for the assistant's assistant. So, care to take bets on how long it will be before I'm ecstatically grateful just to speak to the physician's assistant's assistant's housekeeper's potted geranium?

Oh yeah, thank the heavens I live in America with the finest health care system money can buy. Because God knows I'm going to need it after I go buy a gun and shoot myself.

[MountainLaurel]

13. Man, you are going to be on their shitlist

First, the snarkiness after the 90-minute wait for your appointment and now this. I think the only person you're going to be allowed to talk to here are the Environmental Services folks who wash the dirty exam gowns. I wish I had access to the patient records, 'cause I'd love to see what's written in the notes section about you.

[DavidDvorkin]

14. And then there's all that awful vacation time they have to get rid of

Instead of spending so much of their lives at their jobs, as we lucky Americans get to do.

And oppressive unemployment and pregnancy benefits.

What a nightmare!