I have a friend who is a radiologist - who lost his job to the digital world, but if he wants to have a hope of employment in medicine, he has to cough up that $50k annual liability insurance.

It's really sad when the expectation on medicine creates an environment for liability lawsuits where the doctor can lose his license by simply being accused 3 times - no judgments, just accusations.

I wouldn't BE a doctor. One of the best family docs in Utah - head of six counties rural medicine hated the system that distanced patients from the cost of care to the point where medical care was priced out of reach.

If we had to pay for care each time we went, would we use it so callously? Co-pays don't give us the true perspective of the true cost. Would we avoid taking care of ourselves by eating right, exercising, avoiding vices like cigarettes, etc.? Would we run to our doctor for the latest greatest drug we just saw advertised with all the subliminal "life is grand if you take this drug" messages. Or would we be a bit more skeptical and take more responsibility for our own wellbeing?

Medical care is just way too over-used. Then we blame the docs for when things go wrong. There are proportionally few real liability cases compared to how many get filed.

Lawyers can do a great deal of good. But mixed with a sympathetic sob story, some of them do a great deal of harm. Just ask my friend who coughs up 50k every year, regardless of whether he has a job or not...

Mr. W. - YOU may not have gone Law School to become a rich lawyer, but I'm willing to bet that you didn't practice "Pro Bono" for everyone either. What exactly IS the purpose and intent of "billable hours" for Lawyers?

I'm equally willing to bet that a large percentage of people who DO go into Law do so KNOWING that they can make a lot of money, and it is the Money angle that is the "key."

Now, turning to your idea that "there will never be a shortage of people that desire to undertake the noblest of professions," allow me to both agree AND disagree with you.

There ALREADY is a shortage of people. If you don't believe me, check out the looming Nursing crisis.

Second, the issue is NOT, imho, "people who desire," it is an issue of COMPETENT, well-trained, people. What you may be overlooking in this sentiment is that you are advocating the same sort of questionable notion that we see in schools today of eliminating "grades" so that we don't "damage" some child's "psyche."

To take it to the "extreme," why let Political Science majors enter Med School without any "requirements" other than the "desire" to enter the "noblest of professions?"

Anyway, you seem to be seriously considering this issue of Healthcare, which IS a legitimate and serious issue. So let me post a few articles for you to read and think about, rather than "just" those of supporters of some sort of "goverment run" healthcare system.

Maybe after reading some we could discuss some of the particular issues if you'd like.

Likewise, I would invite anyone who wants to participate in such a discussion to also FIRST read the articles (presented by Mr. W and that I will present) as a basis of "background information" on which to formulate a discussion.

http://www.heritage.org/Research/HealthCare/bg2197.cfm

Government reinsurance would not only stifle existing efforts by insurers, employers, and individuals to seek out value, but also likely replace those efforts with more regulation.

Expanding Existing Government Programs
I will expand Medicaid and the federal State Children's Health Insurance Program (SCHIP) eligibility and ensure that they continue to serve their critical safety net function. Finally, I will encourage states to continue to innovate and experiment with different methods of coverage expansion, as long as they meet the minimum federal standards established for the national plan.[36]

Expanding Medicaid and SCHIP. These proposed expansions are nothing new. Given the dynamics of the status quo, including the steady decline of employer-based health insurance, public program expansions have been routine features of current policy.

Medicaid, the federal–state health program for the poor and indigent, is already a $350 billion program, and previous Medicaid expansions have unquestionably helped to "crowd out" private health insurance coverage for certain populations.[37] Nonetheless, during 2007–2008 alone, 36 states expanded Medicaid eligibility.[38] Contrary to the original intent of SCHIP to provide health coverage for poor children in working families ineligible for Medicaid, states have also steadily expanded SCHIP eligibility, reaching well into the middle class, with periodic bailouts from Congress.[39]

Compared to private coverage, these programs are conspicuously lacking in quality care, particularly in giving patients access to physicians for appropriate care at the appropriate time. Researchers at the Center for Health System Change found that 21 percent of physicians were not accepting any new Medicaid patients between 2004 and 2005.[40] Research also shows that Medicaid and SCHIP patients were more likely than the uninsured and private health plan enrollees to go to emergency rooms for non-emergency needs.[41]

Compounding the Entitlement Crisis. Meanwhile, America faces an entitlement crisis. Spending on Medicare, Medicaid, and Social Security is projected to rise rapidly, pushing up primary federal spending (excluding interest payments on the national debt) from 18.2 percent of gross domestic product in 2007 to 28.3 percent of GDP in 2050.

According to the Congressional Budget Office (CBO), financing entitlement spending will require massive tax increases, including doubling individual and marginal tax rates in every bracket and doubling corporate tax rates.[42]

Expanding Medicaid and SCHIP would only deepen the entitlement crisis. Both programs are fiscally challenged and promise more than they deliver, undermining access and quality for those on these programs today. For example, it was projected that Medicaid and SCHIP, combined federal and state spending, would cost $717 billion by 2017.[43]

For states, the Medicaid and SCHIP crisis is apparent. Medicaid is already the largest item in state budgets, accounting for 22 percent of total state fiscal expenditures in 2006.[44] Senator Obama's unspecified expansions of these public programs would accelerate this process and significantly affect the remaining health care economy.

A Step Toward a Federal Takeover? Perhaps of greater concern, these expansions could serve as first steps in a more ambitious federal takeover of American health care. Although these expansions appear incremental and thus less radical, they could be highly consequential. Simply expanding eligibility for children up to 400 percent of the federal poverty level ($84,800 for a family of four) would qualify more than 70 percent of American children for a government health care program.[45]

Inhibiting State Flexibility. The Obama proposal would severely restrict state variation and experimentation by requiring state innovations to meet the specific minimum standards of the proposed new government health plan.

This highly prescriptive approach would be a major step backward. One of the most promising developments during the past three years has been the willingness of state governors and legislators to experiment with different methods to expand their citizens' health care coverage. Not surprisingly, state legislatures have produced a flurry of state health reform legislation. However, confining state reform efforts to a narrow, single federal standard would effectively end any serious experimentation and discourage any outside-the-box innovation.

In this sense, the Obama health care plan would follow a path opposite from that of the successful welfare reform of the 1990s, which gave state officials broad goals and a high degree of flexibility in designing approaches to encourage work and reduce welfare dependence. There is serious bipartisan interest in replicating this success in health care policy.[46] State flexibility is not only desirable, but also necessary because the provision of health care varies widely across the states, reflecting differences in demographics, political culture, and insurance markets. Of course, this flexibility would be undesirable only if the real goal of the process is to centralize health care decision-making in Washington, D.C.

This is a brief exerpt from a very good discussion of Pros and Cons of the healthcare issue. I strongly suggest taking the time to read the entire article.



http://www.cwru.edu/med/epidbio/mphp439/National_Health_Care.htm


National Health Care in the United States: Exploring the Options and Possibilities
by Peter Lawson


INTRODUCTION

This chapter is an exploration of some of the suggestions and debates that have surrounded the issue of national health care in the United States over the past few decades. In particular, this chapter will be an attempt to clarify some of the most common positions (both pro and con) surrounding the potential for a national health care system in the United States. Every effort will be made to present data from an objective point of view in order to allow readers to evaluate the strength of the arguments made. In the interest of concision and brevity this chapter will divide this complex issue into two distinct domains of discussion: moral, ethical and philosophical positions, and economic challenges. While this chapter will attempt to synthesize and summarize a variety of positions and opinions in regard to the issue of a national health care system, it should not be considered an exhaustive exploration of all the potential arguments regarding this issue. With this in mind, a number of interesting and potentially illuminating references will be provided at the end of this chapter, which could guide a reader in further research.

According to US Census data for 2001, the number of Americans without any form of health insurance was 41.2 million or 14.2% of the population. This number rose by 1.4 million from the previous year. Alarmingly, nearly 11.2% of children (8.5 million) under the age of 18 were without health coverage in the United States. While these data in their aggregate form seem to point to something of a crisis in health insurance coverage for millions of Americans, a closer look at some seemingly paradoxical demographics of the uninsured adds another layer to the picture. For example, consider the following excerpt from a US Census Bureau report on health insurance in 2001.
Among the entire population 18 to 64 years old, workers (both full- and part-time) were more likely to have health insurance (83.0 percent) than nonworkers (75.3 percent), but among the poor, workers were less likely to be covered (51.3 percent) than nonworkers (63.2 percent).1

As poor workers become ineligible for governmental insurance programs (such as medicaid) due to income limitations, they are still likely to be working in jobs that do not provide insurance benefits. This same document reports that, among the poor, the overall rate of those without health insurance was 30.7 percent, more than double the rate for the population as a whole.2 The uninsured face numerous threats to their health and are at increased risk for mortality and morbidity (for a more detailed examination of the issues surrounding the uninsured, see Eagan and Olds this volume).

Few would argue that these rates of persons without health insurance are acceptable. However, a sometimes acrimonious debate has surrounded this issue and its potential solutions. One such heavily debated suggestion to deal with the nations uninsured and underinsured has been some form of a national health care system. But before beginning a discussion of some of the various proposals that have been made and the arguments that surround them, it may be useful to examine a number of key ethical, moral and philosophical positions which underlie these arguments.


ETHICAL, MORAL AND PHILOSOPHICAL GROUNDS OF THE DISCUSSION

Though the discussion surrounding a national health care system in the United States can quickly turn into one that is dominated by political and economic considerations of feasibility and implementation, the issue itself is grounded in a set of ethical, moral and philosophical considerations. Various experts and pundits have weighed in on the debate surrounding calls for a national health care system precisely because this issue forces one to consider some of the most intrinsically difficult questions within the political and economic philosophy of the United States: the role of the state in private life, the appropriate position of the government vis a vis the market, and rights of individuals within a capitalist marketplace. Though the scope of these complex issues is certainly beyond the capacity of this chapter, some of the broad strokes of these issues may be useful for the development of the discussion at hand.

A recent meeting of the International Labour Organization (ILO) in Geneva, Switzerland produced a resolution in which health care was deemed a basic human right.3 This resolution represents a recent incarnation of decades of international recognition of the key role of health within a conception of basic human rights. Article 25 of the United Nations Universal Declaration on Human Rights, drafted in 1948, states:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.4

One of the strongest statements of health as a basic human right was generated at the International Conference on Primary Health Care in Alma Ata, USSR in 1978. Article I of the Declaration states in part “The Conference strongly reaffirms that health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right…”5 Here the definition of health stretches into what some might consider utopian territory; however, the essential statement that health itself is basic human right echoes that of the UN’s Universal Declaration on Human Rights. Numerous national and international organizations have declared health and access to health care to be basic human rights. For example in 1998, “Dr Gro Harlem Brundtland, Director-General of the World Health Organization, called on the international community to enshrine health as a basic human right.”6 While the conception of health and access to health care as a basic human right may beg the question of the responsibility of the state to provide protections for such rights, suffice to say, that within these broad international agreements, it is assumed that the state functions, in part, to ensure and maintain the rights of its citizens.

Yet notions of health and health care as basic human rights are by no means monolithic or unchallenged within the discourse of health care provision. An alternative vision of health care as a commodity is also articulated and merits our attention. Various policy advocacy groups and think tanks have offered a view of health care as a service most efficiently and effectively provided through a free market. For example, Sally Pipes of the Pacific Research Institute (PRI) advocates for free market solutions to solving the dilemmas of health care in the United States. From a neoclassical, liberal economic position, governmental regulation or intervention in the market is something to be avoided. From the libertarian perspective advocated by organizations like PRI, governmental interventions “create dependency on the state, and allow the government to have excessive influence and control over people’s lives.”7 In a commentary published in The Washington Times, Michael Hurd succinctly argues

Health care is not a right -- no matter how often you hear otherwise. Health care is the consequence of heroic efforts on the part of individual doctors, who have every right to charge what the market permits. If we take away the right of medical professionals to set their own fees, we will undermine their independence and chase the best ones into early retirement.8


Here the rights to which Hurd refers are based on specific liberal conceptions of the free market and the rights of individuals to participate in that market. In Hurd’s argument, rights are intrinsically tied to the rationale of the economic exchange taking place, and not a notion of basic human rights (as described above).

Hurd’s economic argument leads us to a series of economic questions that are better addressed through the lens of a specific proposal for a national health: How much would such a specific national health initiative cost? In what sectors of the economy would potential burdens be born? What other economic impacts (both positive and negative) might arise from the implementation of a national health care system? In order to address these issues, we will now turn our attention to one suggested form of national health care (the so-called single payer system) while bearing in mind that a number of other national health plans have been suggested with widely different mechanisms and potential economic effects.


DEBATING THE ECONOMICS: THE CASE OF THE SINGLE-PAYER SYSTEM

Cost is inarguably one of the central features in any discussion of the existing health care delivery system in the United States or any potential replacement or reform of the existing system. The United States spent $1.4 trillion on health care in 2001, or 14.1 percent of its Gross Domestic Product (GDP). According to one recently published study, this figure is expected to grow to $3.1 trillion by 2012, an amount which would constitute 17.7 percent of the GDP.9 Critics of the current health care delivery system note that many other industrialized nations spend considerably less on health as a percentage of GDP while maintaining health care services for all citizens; none spends more as a percentage of its GDP. In 2000 for example, Canada spent only 9.1 percent of its GDP on a national health care delivery system which provides health care for all Canadians.10 Let’s consider some of the discussion surrounding the economics of a national health care system for the United States, focusing on the proposal for a single-payer system.

While numerous ideas have been suggested to reform the US health care delivery system, one of the most cogently argued cases for a single-payer health care system in the United States was published in 1989 by David Himmelstein and Steffe Woolhandler in the New England Journal of Medicine.11 As presented by the authors, a single-payer system would provide health care coverage for all Americans by setting federally mandated fees for services and paying these through a single source (i.e. the federal government). Because many of the current health care dilemmas faced by patients and providers alike are focused around economic issues, it is not surprising that Himmelstein and Woolhandler make economic considerations central to their argument. Himmelstein and Woolhandler argue that “the public administration of insurance funds [through a single-payer system] would save tens of billions of dollars each year. The more than 1500 private health insurers in the United States now consume about 8 percent of revenues for overhead.”12 Under the single payer system proposed by Himmelstein and Woolhandler, federal regulation would control costs by eliminating redundant administrative bureaucracy and profit from the system. The authors argue that despite the need to levy taxes in order to support the system, the long-term benefits would balance initial costs, since the current high cost of health care is already borne by citizens, employers, and the government (through programs like Medicaid and Medicare).

Critics of a single-payer system argue that “the evidence demonstrates without doubt that socialized medicine is inefficient and more expensive than the free-market alternative.”13 Citing the tax burden of the National Health Service in the UK, Conrad Meier argues

England’s single-payer health care plan has turned into a tax burden far worse than what we’ve experienced to date in this country. The burgeoning costs—in the form of high income taxes, insurance taxes, premiums, lower wages, reduced productivity and job opportunities, plus extra fees and hidden taxation—have become a stranglehold on middle- and low-income consumers.14


While it should be noted that the UK system is not, in fact, a single-payer system (in the UK the government controls and regulates all aspects of health care, under a single-payer system the government would provide remuneration and set fees), the sort of argument Meier mobilizes forms the bulk of economic arguments against the implementation of a single payer system in the United States.

There is nothing approaching consensus concerning the economics of a single-payer systems. Proponents argue that additional cost incurred in the provision of health care for all citizens would recouped through increased efficiency and the elimination of for-profit insurance coverage. Opponents of a single-payer system argue that such a system would increase inefficiency and costs by placing the burden of a massive centralized bureaucracy in the hands of the federal government. Interestingly, economic arguments opposing a single-payer system often blend economics with ethics and morality. As Meier suggests

The propaganda produced in support of single-payer health care ignores the truth and is designed to motivate people through the use of scare tactics; distorted and often fabricated information; and undocumented facts and figures on how much such a plan would cost in premiums, income taxes, lost state revenue, job dislocation, individual freedom, and human suffering.15


Certainly this criticism could be levied against Meier’s own analysis which notably contains no citations or references to empirical data. These data are strikingly absent, as is independent, non-partisan research and analysis on the subject, and more efforts toward this end will likely be necessary before a reasonable conclusion can be reached about the future of a national health care system in the United States.


Endnotes
1. http://www.census.gov/hhes/hlthins/hlthin00/hlt00asc.html
2. ibid
3. International Labour Organization. Resolution Concerning Health Care as a Basic Human Right. Joint Meeting on Social Dialogue in the Health Services: Institutions, Capacity and Effectiveness. October 2002. Geneva. http://www.ilo.org/public/english/dialogue/sector/techmeet/jmhs02/jmhs-res.pdf
4. United Nations Universal Declaration on Human Rights. 1948. http://www.un.org/Overview/rights.html
5. World Health Organization. Declaration of the Alma Ata Conference. http://www.who.int/hpr/archive/docs/almaata.html
6. www.who.int/inf-pr-1998/en/pr98-93.html
7. http://www.pacificresearch.org/issues/social.html
8. Hurd, M. Rhetoric Notwithstanding, Health Care Is Not A Right. The Washington Times. April 6, 1993. http://www.drhurd.com/medialink/health-care-not-a-right.html
9. http://www.seniors.gov/articles/0203/health-costs.htm
10. http://www.2ontario.com/welcome/ooql_402.asp
11. Himmelstein, D., and Steffe Woolhandler. A National Health Program for the United States: A Physicians’ Proposal. The New England Journal of Medicine. January 12, 1989.
12. ibid
13. http://www.heartland.org/archives/health/may02/myturn.htm
14. ibid
15. ibid

Additional Reference Sources
Heritage Foundation. www.heritage.org
The Heartland Institute www.heartland.org
The Pacific Research Institute www.pacificresearch.org
Physicians for a National Health Plan. www.pnhp.org
The Universal Health Care Action Network www.uhcan.org

I spent the last 2 days at a RNP/PA convention.

Here is one basic desires of the current American health care consumers:

"I want the best of everything and I want someone else to pay for it."

Choices must be made about which services are to be "covered". Who do you want making those choices?

Another SOBERING fact .... in 2011 the first babyboomers hit age 65 .... and that will mark just the beginning of the increased demands on the healthcare system.

The tyranny of "standard of care" is pushing costs upward.
The pushing of so-called "new and improved" brand name prescriptions by direct advertising to the public is pushing costs upward.

Because enforcing the law is a constitutionally mandated service the excutive branch of the government is REQUIRED to provide. The executive branch has the role of enforcing the laws passed by the legislative branch.

Therefore, you have a police force.

Healthcare is not a stated right. Laws are passed to ensure rights are protected, and the police enforce those laws.

Besides, most policing is done at a local level. So if a community wants to provide healthcare, just like it provides police and fire and other emergency services, I'm all for a community doing that.

I'm simply against any NATIONAL effort to do so.

If you think government should provide healthcare, then become mayor and have your town provide healthcare.

Or become govenor and/or part of your state legislature and work to bring this about in your state.

But to say this is a right that should be provided by the federal government is a misapplication of the role of federal government.

The government doesn't provide rights, it simply protects them. So if you think healtcare is a right, then the only thing the government can do is to make sure that your rights to obtain health care are not taken away based on your religion, political affiliations, gender, race, or anything of that sort.

But not having enough money is not a matter of discrimination. If you don't have enough money, your rights are not being infringed.

But the reality is that no hospital will turn away someone in dire need of care, even if they cannot pay. So those of us with insurance end up subsidizing them anyway.

AGG

AGG - it is not the 'reality,' it is the Law. The hospitals CANNOT refuse emergency care to anyone, regardless of ability to pay.

And WHO is "subsidizing them anyway" is NOT the issue. It is AN issue, but the reality is that there is no such thing as a "Free Lunch." SOMEONE IS paying for that "free care." For most of, it is the TAXPAYER who is paying for it through the welfare program of MEDCAID. But there are a lot people who don't even bother to have Medicaid even if they qualify for it. In addition, the reembursement from Medicaid is insufficient to cover the cost of care that is provided. So a certain amount is "passed on" throught the "Usual and Customary" charges for those services to people who have insurance, which DOES pay for it. The operative thing here is that it is paid by the INSURANCE COMPANY, not by you the policyholder. Very few policy out there DO NOT have a "cap" on YOUR Out-of-Pocket exposure to what you have to pay in the way of deductibles and/or co-payments.

If it were NOT that way, then think of as if YOU were REQUIRED to provide a meal to anyone who knocked on the door of you house, and you could not charge that person for the meal.

One or two, or even several, of these "Free Meals on Demand" and YOUR household budget might actually start to feel 'strained.'

Too many of these 'mandatory' meals to others, and no ability to get additional revenue (income) to keep paying for the food you have to buy (not to mention all the other things needed such as someone to prepare the meals, make sure that no harmful things (like salmonella) are present, someone to clean up after the meals, etc.), and YOUR own ability to pay for your own needs might just become "impossible to sustain." Now, if those meal recipients happened to have a "card" that others would pay YOU for at least SOME of your costs, that would "help," but it would only delay the "inevitable" as the additional "pay" would still be below your costs. IF that "card" would pay your costs you could keep feeding all those who showed up at your door, BUT only because someone else was paying for it. Unfair. Perhaps. But either you own the home and CAN provide a meal, or you don't own the home and you go knocking on someone else's door yourself.

That's REALITY, AGG.

If ALL you want to focus on is the issue of WHO pays for healthcare, then you are "missing the boat" on all the factors that play into "Superior Healthcare" that we enjoy in this country. It is not called a "Healthcare SYSTEM" by mistake. There are many factors that enter into the AVAILABILITY OF and DELIVERY OF healthcare services.

And that is what most people don't understand about this issue of a "single payor system," with the Government as the "single payor." The GOVERNMENT DOES NOT PAY FOR ANYTHING. What they "pay for" is "cost shifted" to the available TAXPAYERS.

As for running a healthcare system, they can. Just look at the VA system. Anyone can run a healthcare system, that isn't the "issue." The issue is the DELIVERY OF and the QUALITY of that healthcare.

WHY do you think that so many Doctors limit or refuse to treat (in their private practices) Medicaid patients? Why do you think that so many Doctors are considering doing the same with Medicare patients? It is the same reason as the "people knocking on your door for a meal" example stated earlier.

FH, I agree with your perspective on healthcare....but this is a bit off. The "checks" may in fact be written by the insurance industry...but these funds come from the insured.

I spent 9 years (post police) at Aetna USHC and know that insurance premiums are in fact higher due to the uninsured (same with pharmaceuticals...a few years at Pfizer too).

When you get a chance, take a look at lifelaboratory.org to see what we are doing to help fix the healthcare "problem." Government run healthcare is not the answer. If the federal government can't even effectively run VA centers...how in the world are they going to manage a universal healthcare system? They won't.

Also, despite the protests of some here...lawyers have a big part in the mess that is now our healthcare system. Is it any wonder that in every poll I have ever seen regarding careers that lawyers are always among the least respected...and doctors among the most respected. Anyone that doubts the hand that lawyers have in this need only watch commercials during the day where these rabid sharks are trying to get you to sue for this or for that.

The healthcare pie is big enough right now. It needs to be better managed and sliced. Handouts to those that CAN work yet choose to not work should stop. Sorry, but a healthy person that chooses to remain unemployed...without healthcare should not be my problem. The ranks of the lazy are sure to swell with the coming administration change...."hey look, not only a check each month...but now they are given us healthcare too...God bless the USA"

I have an interesting perspective in that I have worked with the low life's of society that have attempted to steal, beg, cheat for everything they get. I also worked in the healthcare field for a number of years. My volunteer position now for a fledgling 501c3 has certainly been eye opening. Both candidates really did not seriously address the issue of healthcare during the campaign....big surprise huh? Hopefully Obama will surprise me and do something more than hand out more dollars to his constituents.

MEDC - Yes, insurance companies are not charities. They DO pay claims as a result of premiums, and that is also why "adverse selection" is huge problem. There is a difference between "risk" and "known" when it comes to healthcare problems that might require treatment, and the attendant payment for that treatment.

However, when someone gives an insurance company a premium (small by the total amount of coverage attained), they are in effect "buying" a bank of several millions of dollars (given a 'standard' major medical type of plan). Regardless of the 'type' of plan though, it is all about "leveraging" the amount of money that someone has to pay for services they want or need.

In order for the COSTS billed by the Providers to be paid, there IS an amount that is "built into" all premiums as part of the COST structure, because the reality is that the Providers provide care to everyone, regardless of ability to pay.

In fact, if anyone ever looks at the paperwork they sign when they use healthcare services (i.e., go into the hospital) they will find verbage in the papers that they are signing that they agree that they are personally responsible for the bill REGARDLESS of any insurance they may or may not have.

That's because it IS a service provided to the individual, not to the insurance company.



I will do that. Always interested in ideas to make healthcare more affordable to everyone. I have long had one "basic" change that I would like to see, but to date I've not heard of anyone even attempting to see it would be possible.



Anyone who has been involved in the healthcare delivery system KNOWS this is true. It's primarily the lawyers who want to "deny" this fact. But just take a look at John Edwards to see how "altruistic" lawyers can be in profiting off the misery of others. Check out the "award" to the lawyers as part of the "settlement" or "judgment." Edwards didn't build that multimillion dollar home without FIRST getting rich litigating.



There are two basic issues here, MEDC.

The first is what you are talking about...personal responsibility. Unlike that "Peggy" (referred to by a lot of folks now as "Peggy the Moocher")who thinks Obama is now going to pay for her gas and mortgage, most people think that the individual, not the "State," is responsible for their own "wants and desires" to be "granted" to them.

The second are those who, through no fault of their own, HAVE serious medical problems that DO need treatment, or they die. Because the cost of healthcare IS very high for those with serious conditions, something needs to be done about "accounting" for those sorts of problems so that people are not "bankrupted" as a result and left destitute AND, then, on the welfare roles. (That's part of the changes I alluded to earlier that I would like to see in the "system.")




I'd like to think he would, but he's a Socialist at heart and I don't have any realistic hope there. The Democrats have been pushing for Socialized Medicine for a long time and I don't see any real potential for positive change there.

By the way, you've probably heard Obama's "mantra" of wanting to extend the same sort of healthcare plans available to members of Congress, right? What he doesn't tell people is that the healthcare is provided by Insurance Companies, not the government. And there's a huge variety of plans available under names that might not be too familiar to most people, like HMO's, PPO's, etc.

MEDC - I read through the entire site and it seems as though it is basically the same thing that has been in the healthcare industry for years.....OUTCOMES based healthcare.

Basically there are two primary components of Outcomes based systems:

1. Preventative care to minimize "small problems" from potentially developing into "big problems;

2. Attempting to address "procedures" when there is little known "positive outcomes" to treating a given condition.

Obviously, PATIENT cooperation is VITAL or it's "just another nice idea." Getting the PEOPLE to "buy into" preventative care, in all areas of life (like diet and exercise to name just a few major contributing factors) is KEY to the success or failure of the concept.

As an example of the current state of medical "after the fact" treatment, if I were diagnosed with Pancreatic Cancer, given the current level of treatment protocols, treatments available, and statistics for survival for "treated" or "not treated," I would personally opt for "no treatment, get my affairs in order, and prepare to meet my Lord."

On the other hand, if it were Colon Cancer, I would treat it as aggressively as possible.

That's the sort of thing that "Outcomes" based systems look at, with the attendent savings on therapies with "questionable" positive outcomes that DO COST a lot of money to attempt to treat.

But there ARE also other "values" that have to be considered, not the least of which is the question of the "value of a human life." Considering my stance on abortion, you might guess where I tend to "come down" on that issue as well.

As a further example, my sister (51) had a ruptured brain aneurysm in July, the type for those who understand some biology, that normally kills someone before they even make it to the hospital (without getting too technical, it was "base of the skull" Circle of Willis, type). She survived the ER, the Medivac flight, the 7 hour surgery, the month in the ICU, the 7 repeated trips back to surgery, the Ventricle shunt, and is now "on the mend" with only some weakness and some short term memory loss.

But the BILLS are HUGE. So "value of life" issues are REAL, as are the "Outcomes" possibilities.

Outcome based...yes, LL is a proponent of that. But, the approach is not the same. Even HMO's were outcome based...heck, before Aetna bought USHC we were all about that.

LL is a research arm dedicated to not only improving outcomes...but also expanding the reach of healthcare as it pertains to primary. As you are most likely aware, family care has become the forgotten child in the US healthcare system. Foreign trained students now fill the majority of FP residency programs. There are more than a few reasons for this...but they do all come down to finances.

I have one brother that is a FP and one that is an oncologist. The FP has a group of 9 doctors and combined they do not make as much as the oncologist. They work harder...longer hours and yet their compensation has remained flat since 1994....all the while, costs have skyrocketed.

When I get the chance I will post some information to give you a better idea of what we do. We work in collaboration with the University of Chicago, Wharton, Jefferson just to name a few.

BTW...all donations are 100% tax deductible!

and btw, I am with you on the value of life stuff.

My brothers practice is 14,000 strong and they have NEVER written a referral for an abortion(elective procedure...not to save mother's life). It is against their beliefs and they will not do so.

Don't you think that if we had to write a check out for the insurance premium instead of that nice convenient payroll deduction we'd pay more attention?

Kind of like the lulled to sleep sensation we get over taxes - we don't feel what we never see, so we don't protest.

The Boston Tea Party was over a 10% tax folks! What are we up to now? 60%?

7.5% social security
7.5% social security employer co-pay (if you're self employed you FEEL this one - if not, you just don't see it as an income, but have no doubt, the employer wouldn't have to pay it if he didn't hire you)
2.5% Medicare tax
? don't know if there's an employer match on this one
28% Federal income tax (some pay more, some pay less - but I guarantee you, if you tax the rich, that will pass through to the goods and services you buy - so you will pay it!)
20% State income tax (again, some more, some less)
7% sales tax (poor Texas pays over 8% on almost ALL services, Connecticut, South Dakota, New Jersey, New York and New Mexico pay taxes on ALL services, Oregon pays no sales tax)
and if you own property, that could be another 1-10% income tax depending on how modest a home you live in compared to your income...

Just how much more can you afford to live without to fund health care for non-payers who do nothing to improve life for themselves and others around them?

Kayla, did you mean this? Or did you mean he coughs up $$ for a 50k policy every year?

50K is most likely accurate and LOW for some specialties.

I have a friend who works as a radiologist - got laid off from his full time work with 3 hospitals, but still pays a 50,000$ per year liability insurance premium. Malpractice coverage is for the millions - mandatory coverage for a radiologist costs a minimum of $50,000 per year. That's more than the median income in the country.

My friend is now stuck commuting 5 hours from home to a hospital that doesn't farm out radiology work. He spent the last two years working at various hospitals through a placement service, spending 3 weeks away from home at a time, then a weekend home.

Reality is that student loans for quality medical schools are in the quarter-million dollar tuition range. If an MD is "lucky" he lands a 10 year captive practice where the hospital pays off the student loan in return for 10 years, hours to be determined by the hospital - usually in the 60-to-70 hour range.

Part of my job involves interviewing people from all professions so I learn what each one makes on average, and the liabilities of living with that profession - to family, personal development, income bottom line, etc.

The medical profession is NOT the unconditional high pay we've been made to believe it is.

And remember - 3 accusations is all it takes for you to become uninsurable - EVEN IF ALL THREE ACCUSATIONS ARE FALSE!

OMG, that's outrageous. I am learning so much about our healthcare "system" from reading these posts (both sides). I never much cared before now but it's becoming a concern as I get older.

It totally sucks! I interviewed a family practitioner in my community - he hadn't been paid for all the hours he'd put in during a particularly bad flu season. His payroll had frequently been miscalculated.

If our current medical system treats professionals like hourly hired hands, how can we possibly expect that the quality of our health care is going to be better under an even more degrading system?

Have you walked into a government owned clinic lately? Social security office? Other agency?

I have, KA, but that's not something the "single payor source" folks want to talk about usually.

The Feds are good at setting up programs and red tape requirements, but not so good at implementation and management.

Ever try to have someone removed from a government job for lack of compentence...or any other reason for that matter?

Goooooooood luck!



And your experience with the $50,000 is definitely on the LOW side. It gets progressively worse the more directly involved in potential problems with direct patient care. That's why so many OB Doctors have swithed to just Gyne and given up the delivering babies stuff. "Problems" with "your pregnancy" become THEIR liability. But the SP source folks want everyone to believe that lawsuits and liability willl just "go away" if the government holds the "purse strings."