So very true. I've already been downsized once and expect that it will happen again soon since my job is directly tied to the auto industry. You're a body in a chair and the people in charge will cut you loose without batting an eyelash if they think they can save a buck. Last time around for me, after the CEO of the company took a $6 million pay increase, he axed my whole department 3 months later splitting duties between another data center and India.

Want2Stay

Partisan politics will not solve the problem. Each party needs to own the responsibility of what they have allowed to occur for decades. They should all be ashamed. As should the people that demand a free lunch on the backs of the next generations to come.

Are you suggesting that the government should disallow and/or discourage free enterprise for a specific profession and not other professions?

If a teacher teaches in public school, should they not tutor students privately?

You are scaring me.

Why attack me on a personal level?

Fear not young whippersnapper...Mr. W is here, cape and all.

Single payer systems exist around the world without much fanfare. Many nations are, in fact, quite proud of their national healthcare.

In Canada, Physicians can still choose to "opt-out"...but unlike England, to do so they must "opt-out" completely.

Here is a snipet from the following link:


Canada - the "illegality" of Private health

Teachers and Physicians aren't comparable.

Firefighters and Police are....what if you called 911 because a mad man was lighting your house on fire and nobody came, because they were all out supplementing their incomes doing private security work for someone? That's more comparable.

Mr. Wondering

Number of Americans Outside the Income Tax System Continues to Grow

In 2004, The number of Tax Returns with Zero Tax Liability was: 32.4%

"In addition to these non-payers, roughly 15 million individuals and families earned some income last year but not enough to be required to file a tax return. When these non-filers are added to the non-payers, they add up to 57.5 million income-earning people who will be paying no income taxes.

Even 57.5 million is not the actual number of people because one tax return often represents several people. When all of the dependents of these income-producing people are counted, roughly 120 million Americans – 40 percent of the U.S. population – are outside of the federal income tax system."

Still think you'll ONLY be paying roughly $1000 more in taxes to cover the "Single Payer System" that you think we should go to??? Better think again.

What % of the 120 million, 40% of the population (of course that's a figure from 2004 and the number increases each year) that have zero liablity taxes do you think currently have health insurance and pay their own premiums? People that will continue NOT to have to pay taxes, nor will they have to pay insurance premiums with your idea of health care, therefore increasing the burden for those of us that DO PAY TAXES.

Then add in the "illegal's" in this country that will suck the system dry, cause the wait times to be even longer and ALSO not pay taxes.


Have you ACTUALLY ever been in a DR's office or ER in the USA where people had to wait for any length of time to be seen? Its not pretty. Most people expect to be seen 'yesterday' when they are sick and they don't want to wait for 30 minutes to see a Dr much less a few weeks.

It's easy to say now, while you're still enjoying your Private Health Care, and can be seen anytime you want with little or no waiting, that you won't mind waiting, but the next time you're in pain, or someone you love is in pain and needs to be seen, drive into a major city and go to the ER. Then you will be able to appreciate "Waiting to be seen". Or the next time you (or better yet, one of your children since most of us will move heaven and earth when our kids are ill) need blood work or a test or Xray done.....just tell your/their Dr. that you'd like to wait a couple weeks so that you can experience the "FULL" effect of a "Single Payor" system.

Yeah.....Single Payor Health Care sounds like great idea......

My husband hires off duty Los Angeles police AND firefighters most days of filming. They are paid by the production company. Hiring off duty LAPD and LAFD is mandatory under certain circumstances.

OFF DUTY free enterprise.

You cannot 'Assume' that just because someone loses their job that it means that they don't have health insurance coverage. What if 90+% of those peeople have working spouses that they can be covered under?

My H is getting ready to lose his job but he'll have Health Insurance....though my employer.

Comments like yours is like the "Chicken Little" attitude don't you think?

I'm sorry Tabby, but I DID NOT say that about Emergencies. Go back an reread what I DID say, as in ... But, you might say, that is NOT an emergency condition. And you would be right. But BEYOND "emergency care" there IS a huge difference in ACCESSIBILITY of the healthcare system.

British Columbia Wait Times


--------------------------------------Cardiac
Fiscal___All_________________Surgery________Hip________Knee
Year___Surgeries__Cataracts_(Open Heart)Replacement_Replacement
2007/08...4.4..........8.3..........9.0 ............11.0..........16.9
2006/07...4.0..........7.2..........11.3............13.3..........19.9
2005/06...4.0..........7.1..........9.0.............16.8..........25.0
2004/05...4.9..........9.4..........8.9.............22.1..........28.9
2003/04...5.0..........10.9.........16.0............20.1..........28.7
2002/03...4.1..........8.7..........15.1............17.0..........22.8
2001/02...4.1..........9.0..........15.1............18.7..........25.4


All of these figures are WEEKS of WAIT time before receiving surgery.

That average of ALL surgeries is over a MONTH, but HEART surgery and ORTHOPAEDIC surgery is SIGNIFICANTLY LONGER.


Waiting, and waiting, and waiting....for the system to "get to you" as you sit as a number on the "Wait List," which by the way, is mandatory.



Very unbecoming of you, Mr. Wondering. You KNOW I have never said such a thing.

How about addressing the issues instead of resorting to personal attacks?

Actually Mr. W, I think teachers are quite comparable to physicians. Education is as important to society as health and most people (here at least) believe it is an essential right.

You seem to know my laws better than I do but I have anecdotal experience. There is one doctor here that has his family practice so many days a week, and then works in a private sports medicine clinic on the other days. The private clinic offers specialized services that generally aren't covered under public health care. These are not life saving or medically essential treatments, but rather treatments atheletes seek to allow them to play their sport through or after their injuries. It's something above and beyond regular health care.

I don't know of any private clinic around here that offers the exact same services that public health provides.

Can you see it now???

And to respond to this:
Yest there is a huge difference. I can get checked out, diagnosed and treated without financially ruining myself or my family. Uninsured Americans cannot.

I work for a large HMO. The BIG one - founded before I was born in 1945.
It is a system that works well. It is not a perfect system. It is a system that was GREATLY IMPROVED by competition.

When I was first employed by the HMO (I've been employed by this HMO 28 years), it was pretty much a "take it or leave it" choice to the consumer, and the "leave it" left few options. Then, slowly, our competition began to pick off some of our members (rightly so) because our "brand" became over-priced.

The thing that bothers me THE MOST about single payer government run health care is the (probable? likely?) lack of incentive to improve service due to a complete lack of competition.

Take away the competition ~~~> watch incentive and innovation decline.
"Get in line and wait your turn, you have nowhere else to go."

The underlying basis for pre-paid medical plans is to keep the members healthy and well, which saves resources which cuts costs. The emphasis drilled into my head for the past 28 years is ~~~> PREVENTION. The members have an interest to keep THEIR premiums down - so (in theory anyway) they buy into the prevention (Thrive) goal. Everyone knows that the most cost effective and universally beneficial dollar spent on health care is the dollar spent on vaccines. This can be extrapolated to other preventative services (mammograms, colonoscopy, prostate screening exams, etc).

Pre-paid health plans do better financially when they keep their members healthy and out of the hospital. The traditional fee-for-service health plans do better financially when they treat the sick, order the most expensive tests, perform surgery, etc.

The following is true:
Our members used to have NO CO PAY when they were seen the ED (Emergency Department). So, what was the result of NO CO PAY? The ED was misused by members to treat everyday and non-emergent symptoms and illnesses. This misuse caused delays in seeing the really urgently sick - and - drove costs way up. The conditions were changed and there is now a $100 CO PAY to be seen in ED (which is chicken feed in the "real world" of private hospital ED costs). The members moaned/groaned about the "outrageous cost" - but do you know what the result was? The company was able to lower the premiums to the general membership.

The second thing that bothers me about single payer government run health care is the lack of patient incentive to avoid inappropriate use of the healthcare system. Make something "free" and the floodgates of misuse are thrown wide open.


ALL THE TIME people ask for inappropriate tests/treatments which are not indicated - without any concern that this is exactly what drives premiums up.
"Hey Doc, I want a total body CT/MRI scan."
"Really? What symptoms are you concerned about?"
"Nothing really, I just thought it would be a good idea, just in case."
"Research has not shown that total body CT/MRI scans are necessary, and there is a lot of radiation exposure."
"You guys are so cheap!"

People tend to become less cost conscious if their perception is: "This is free, so give me more".

If there is a large healthcare system functioning without adjunct HEALTH EDUCATION available to the patients - it is going to be a much more costly system. The bad health habits that people are resistant to change suck up healthcare resources and cause costs to soar. You and I pay more because Jack and Jill are obese, smoke, drink, and don't take their medication. Jack and Jill are using up resources that you and I might need later when we're older.

Another thing that bothers me about single payer government run health care is the unlikelyhood that health education will be covered.


When Hilary Clinton was First Lady and was on her mission to do a broad sweeping national healthcare reform, she used my HMO as a possible model. But, there are down sides to this model as well. No doubt. Some services are less than stellar. Mental health services is an example. And other issues get pulled under the umbrella of healthcare - like nutrition - social services - medical equipment/supplies - prescriptions. Our company has a very large and vast and generous pharmacy formulary - and to keep costs down - they get competitive bids from pharmacy companies and use low cost generic alternatives when appropriate - and members think they are being cheated when they get a generic - NOT realizing their premiums go WAY UP with pharmacy costs.

And, people try to cheat. Yes, they do! People ask for an excessive amount of sick days when their employer needs a back-to-work note. "Because it's free" .... if their employer is the major payer of their health insurance it is comparable to cheating on your time card.

So, single payer government run health care is not some shining castle on the hill where everyone gets what they want (or needs) when they want it (need it) .... it is going to limit people's choices - it has to.

The next time some patient comes to me with an advertisement they cut from a magazine and demanding I write a RX the "new and improved" drug that is no better than the generic - I will smile and remember this post I just wrote. And I will do my best to educate my patient as to why this is not a choice their HMO will pay for, but I am more than willing to write the RX and they can fill it at their own expense. They usually decline when they have to pay for it !

Of course I can see it now. You confused my comment about waiting in an American ER (or a Canadian ER for that matter) which is relatively short (even when measured in hours for non-life threatening emergencies when the ER is being slammed with serious emergency cases) with the wait times for ELECTIVE SURGERY. The wait times in the American system is WAAAAAY shorter than it is in the Canadian "take a number and wait your turn" system. THAT is what I was referring to.


That's right, if you are NOT talking about emergency care (where no one can be turned away regardless of payment source or ability to pay), then if you want a physical, pay the approximate $200.00 for a complete physical yourself and they will see you without "financially ruining yourself."

If there is a medical problem that needs treatment, as I have said, I have "no sympathy" for someone who could qualify for health insurance and could afford the premium but "just doesn't want to pay the premium."

As I have also said, I think that there needs to be some changes to help those who have "uninsurable" medical conditions or who simply want insurance, can qualify, but don't have the income resources to pay the required premium.

But I will also tell you that I carry a number of insurance plans that DO NOT cost a lot and give some coverage for the "financially strapped" individuals, both for healthy people and for people who have health conditions that would cause a problem getting regular, full-blown, major medical insurance.



Regardless, as I have said to Mr. W. several times, I DO think that are some changes that would be beneficial to have implemented on a "national basis," but they would have to be a "payor source" sort of thing and NOT one that can dictate punitive reimbursement rates to the PROVIDERS of healthcare as Medicare and Medicaid already do.

You want one "example" of the sort of change I would like to see, but don't think the guru's who want to nationalize healthcare and take over complete control would "go for?"

1. Require all insurance companies to insure anyone (no underwriting for 'insurability') that wants to pay for a plan.

2. LIMIT the 'exposure' to the insurance to a maximum of $100,000 (not a million, two million, five million, etc.)

3. That limit of $100,000 would cover the VAST majority of all medical costs (the average Hospital stay costs $20,000 to $30,000, and things like heart bypass surgery costs around $80,000). That LIMITS the potential exposure to the insurance company and actually redirects the emphasis of the plans to PREVENTATIVE care.

4. Have a National Pool of insurance money that "kicks in" when a patient's costs EXCEED the $100,000 amount. That "pool" could be funded with taxes, and even "reinsured" via something like Lloyds of London if the costs to that "pool" exceed some number, say $500,000 or $1,000,000.

That keeps "control" of healthcare in the hands of the patient and the Doctor, and out of the hands of a bureaucrat.

That keeps "financial ruin" away from people who DO develop some serious conditions.

And that system "ends" when they go on Medicare, which already exists and already IS a "National Healthcare System" that is broken in many ways but still "workable" if we don't destroy the terrible "profit" potential of insured (outside of a capitated system like Medicare) patients wherein the costs WILL be paid that allow Medicare and Medicaid to even exist. Again, the issue is the PROVIDERS and THEIR payment for "services rendered."

Now, if you'd like to offer up another alternative that preserves the accessibility and high level of care (I don't like B+ or B- care....it breeds complacency and ineffectual care), I'm all "ears."

Perhpas that is what you were refering to, but this is the sentence that you wrote:

This is a direct comparison of an ER wait to an elective surgery wait, something that is seen frequently and is grossly misleading.
Now if you want to compare American vs Canadian system wait times for elective surgery, I'll shut up now. I'm absolutely certain American wait times are shorter but I really don't know specifically what they are.


And there probably isn't a single, simple solution to this either. Looking at all the various systems in the world today, nobody is perfect and there's always room for improvement. Your ideas are interesting. I personally would still prefer my Canadian system but this might be a better solution for Americans.

I'd like to add to a couple of your points Pep and I'm not sure where some of the original quotes came from so forgive me in advance for miscrediting anyone. I'm also not going to quote your entire post because it makes these threads too long. In addition to Pep's points regarding prevention, I'd like to point out that we aren't talking about economic development or enterprise here but medicine and health. We ALL have incentive to improve services and develop new treatments and cures. The driving force isn't about how much profit to be made but how can we cure or prevent diseases that have traditionally been a death sentence.

Here there are rules in place that minimize this. For example, you must get a referal from your family physician to see a specialist and you need a dr's order to get diagnostic procedures done. You can't just walk in off the street to get an MRI.

Where it gets abused at ERs and walk-in clinics - the 2 places where you can just walk into. The walk-in clinics are there to take the burden off ERs (which are more expensive to run and designed for true emergencies). Many ERs will turn you away if you show up with the sniffles and send you to the nearest clinic. But most cases of sniffles don't really need professional medical attention so this can still be a drain on the system.

Also, keep in mind that medical treatment is something you only seek when you need it (hypochondriac's excepted here). You don't go in for angioplasty because they are running a special. You go in when you need it.

I don't really know if the Canadian system addresses this as a specific policy per se, but there is health education in public schools (also taxpayer funded) and they do run a bunch of commercials on various topics (quitting smoking, eating healthy, exercising etc.).

This is no longer free here. I think it's $5 or $10 or something like that. Although the walk-in near me provides free sick notes for students (there is a university in the neighbourhood)but only for the day that they are seen (as in, you can't go in the next day saying I'm sick and was sick yesterday so I missed my exam).

No it's not a shining castle. It's got it's benefits and disadvantages. We Canadians feel the benefits far outway the limitations and as such we are striving to improve it. You guys are looking to improve your system as well. What you come up with in the end is likely going to be completely different than ours anyway, but hopefully will be a vast improvement on what you currently have.

My quote below:



Your response below:



I did not mention "new treatments and cures" which is another subject entirely that you brought into your response to my quote. Research and development is not the topic of my post. Delivery of service is my topic.

Just so we're clear and my point does not get confused with what you wanted to say.

By the way - I did not comment on the Canadian system.

Tabby, you can continue to "think" I said something I didn't and you can continue to parse what I wrote to "make your point" if you'd like, but I'll quote the ENTIRE thing again one more time to give the complete context.

"MANY Doctors donate their services, here in the USA and around the world, especially in the area of "Medical Missionaries." Hospitals are NOT allowed to "turn away" anyone, regardless of "ability to pay," who presents with an Emergency. THAT is one of the reasons why Emergency Rooms have become "walk in clinics" for anyone, regardless of a "true emergency" or not. Hospitals WILL prioritize (triage) the cases based on a "severity" or "immediately life threatening" basis, hence the "wait times" for people to be seen because the law also states that NO ONE can be seen or treated unless THAT case is under the direct supervision of a licensed Doctor. {this was speaking about Emergency Rooms in the USA and WHY the wait times in the ER's in the USA are increasing as more and more people are using them as "walk in clinics" even though there ARE Urgent Care Centers in MOST areas.}

IF someone were treated, say by an ER Nurse with YEARS of experience, and something happened where the patient or patient's family didn't think the "outcome" was all that they wanted, GUESS who gets pulled into COURT on a "malpractice" suit?
{this was alluding to "practicing medicine without a license and the attorney's just "hovering" and "seeking" malpractice suits}
But EVEN a wait in the ER of a few hours is NOTHING compared to the average WAIT time of 10 weeks in the Canadian system to be seen and treated. But, you might say, "that is NOT an emergency condition." And you would be right. But BEYOND "emergency care" there IS a huge difference in ACCESSIBILITY of the healthcare system."


I was responding to Mr. Wondering regarding "wait times" for services that are NOT emergencies. I was also responding to his idea that Attorneys donate their time for free and so should Doctors. The whole point of the statement was that wait times in the ER, regardless of whether or not it is in the USA or Canada, COMPARED to the wait times for elective surgery, ARE "relatively very short even IF the ER wait is measured in hours."

Equally "on point," is that wait times for ELECTIVE SURGERY in the USA are VASTLY shorter than in Canada. Look at the BC statistics for Open Heart (Cardiac) surgery and for Orthopaedic surgery (Total Hips and total Knees), and you will see "ridiculously long" wait times of 3 to 4 MONTHS in British Columbia.




I would HOPE you prefer your Canadian system, as it is the ONLY choice you have as a Canadian.

But that is also my point, it takes away CHOICE and you have to settle for what the government "gives you."

IF you don't want to wait 4 months to get that terribly painful arthritic knee replaced, or 3 to 4 months to get the potentially LIFE SAVING Heart Bypass operation to correct a "90% blocked artery BEFORE it triggers a Heart Attack, you don't have any choice BUT to wait. And NO, "going to the USA" to get it NOW (which is what the Canadian Prime Minister "opted for"), while an option NOW, will no longer be an option when a government run healthcare system "Takes Over" all of healthcare.

And if they go so far as to require a "pass," as Canada does for seeking care in a Province other than your own Province, so much for going to the "Medical Center of your choice" even IF they have better "expertise and outcomes" than what might be available in your own State.

There would still be competition under single payor.

I, the consumer, would decide whether to go to Dr. A or Dr. B or even Hospital A or Hospital B.

Eliminating the middle man, the health insurance industry, doesn't effect competition between medical providers for patients.

Perhaps the incentives can be found by paying the doctors and hospitals that treat the most patients the most money. Maybe rewarding them on outcomes to...so they will strive and compete to produce the best outcomes, such that the patients choose them over others.

Perhaps the complacency will come in because you foresee just too many patients for the doctors and hospitals to handle. Too many customers is a problem every business should have. But with the expected US ingenuity I expect competition to arrive in the form of efficiencies. Regional centers of excellance will spring up where patient might have to travel by car up to 200 or 300 miles to receive fast, state of the art, production line type procedures such as cataract surgery, hip replacements, etc.

Also...FH claims a emergency room nurse can't give treatment to a ER patient by law because the attorney's would be circling otherwise. Well...the law was put there BY the doctors as an artificial impediment to competition. The lawyers only get involved when a mistake is made (or allegedly made) and the law was not followed. It's THEIR (physicians) law. (sidenote: attorneys used to have this protection but not anymore...banks and insurance companies have been practicing law for years now). The US single payer system could change that law and allow RN's and paraprofessionals like PA's and other "certified paraprofessionals" to handle a LOT of routine care with or without the dircet and immediate supervision of a practicing physician. As long as they follow the standard of care...the attorney's can't do anything about it. This change gets at the exorbinant cost of services.

Mr. Wondering

Mr. Wondering, your naivete concerning the healthcare system is stunning.


1. That ASSUMES that there IS more than one hospital within a "reasonable" distance to even be able exercise such a choice, which, by the way, patients already have as a choice IF, and only IF, THEIR Doctor is "on staff" at that hospital. Being "on staff" at hospital does NOT mean that "wait times" will go down, it would more likely result in longer wait time just "as if" they were practicing at a "public" hospital AND at a "private hospital."

It further assumes that there ARE Doctors "just waiting to accept more patients." Not so. Many Doctors are "full up" and are not accepting new patients. How would you INCREASE the supply of Doctors? Look again at Canada? They can't keep up with their own needs and only approach a net "break even" by IMPORTING Doctors away from other countries.

The issue, once again, is NOT the building, it is the PEOPLE who provide the service, AND the availability of the BUILDINGS that house the appropriate services to be used by the people who actually PROVIDE the care.

If all you want is the availability of a "hot and a cot," we can set up MASH tents and cots, and more of those Canadian microwaved cardboard tasting "Meals Ready To Eat." At least they would be hot meals.

2. There would be NO competition for "improvement" because there would be no "increased profit motive." All that would remain is "how can we keep the staff employed TO BE ABLE TO provide ANY services and if we "can steal more patients away from "hospital B" then they will be more likely to "go away" and we will be the "only game in town.

3. There is ALREADY a growing shortage of Physicians and an impending CRISIS in Nurses.

Your "solution" is to "dumb down" the expertise of the caregiver?
You want to "blame" Doctors for this "problem?"
I believe that ALL healthcare professionals are governed by State Laws and Licensed by the State to practice within the limits of that license. Even I, as an Insurance Agent, am licensed by the State. I am sure that even YOU don't practice Law without a license. Why not have Paralegals perform the same work that YOU as an Attorney do? Surely they could be "more available" to the public AND cost a lot less money?

Yep, you the consumer COULD choose under your envisioned system. Only the choice between "worse and worser" doesn't seem too appealing as "just another bureaucratic system" takes over the delivery of healthcare. "Put in the time," "punch the clock," get paid regardless of what happens. You have stated previously that a B+ or a B- healthcare system is Okie Doakey with you. That's NOT "excellence." That's "taking what's available" at best. But it's NOT the case today and won't be the case unless the government gets its hands on the system.

Do you think the VA system provides "A," "B," "C", "D," or "F" levels of service and excellence? How long has that system been around and under the exclusive control the wonderful Federal management?


Sure there always SOME people, even in government run systems who actually DO CARE, but not the majority. Good luck in the "lottery of luck" in hoping "this time" you will be lucky enough to actually get one that does care about YOUR health problem.

And did I mention...WAITING LISTS to get YOUR problem fixed "in a timely manner?"

Did I mention 3 to 4 MONTHS of waiting to get a needed Heart Bypass operation or a Hip or Knee Replacement operation at one of the 'stellar' Canadian hospitals (as long as it is within the Province you live in and not elsewhere, even if "elsewhere" might have a record of "better outcomes?"





Mr. W., we don't have to hope for a "maybe" they will "spring up," they already exist. That IS the current state of affairs with Regional Medical Centers and LEVEL 1 Trauma Centers.

The question is the "survivability" of even those centers under a Nationalized Healthcare system. Will they "close their doors" tomorrow? No, but the erosion of the system will be steady and increasing as more and more the ones who can't "keep the doors open" because costs exceed income from the government.

THAT, too, is already happening and IS a product of the smaller hospitals dealing with the "less serious" problems and the payor sources NOT paying "enough." That's particularly true when the predominant "payor source" for the patients is Medicare or Medicaid.



Well done. Spoken like a true attorney. And that hasn't stopped ONE malpractice suit from being filed. By the way, what IS the "standard of care" that is the JUDGE and JURY that would prevent lawsuits? The last time I checked, anyone can sue anyone for almost any reason. They may not win the suit, but they WILL cost money for everyone involved. Money that goes to the lawyers, win or lose.


Mr. W., we are "on the same page" when it comes to finding ways to improve accessibility to healthcare and to finding ways to address the high cost of both insurance AND the "costs of running a healthcare business" of any kind, espeically when truly catastrophic healthcare problems hit a person and their family.

We differ IMMENSELY on the "how to" side of the issue, especially when focusing solely on MONEY and who pays for "plan" either through premiums or taxes.