Single payer works exceedingly well in other countries. The burden of proof should lie with those who say it won't work here.Originally Posted by radind
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Single payer works exceedingly well in other countries. The burden of proof should lie with those who say it won't work here.
Marx: Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.
Lennon: You either get tired fighting for peace, or you die.
The reduced paperwork would be a strong incentive. I hope that Vermont proceeds with a single payer system. Real life experience is better than theories.
That is true far less often than the alternative, where a new drug is actually a re-purposed or slightly altered older drug, but one that can get patent protection. Once they are under that tent, the only issue is how big the gouge will be. There just aren't that many truly innovative drugs that deserve the higher cost that is typically demanded. If you doubt that, then compare the marketing budget of any large pharmaceutical company to the budget it reserves for research. Marketing wins every time.
Marx: Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.
Lennon: You either get tired fighting for peace, or you die.
This is not a matter of burdon of proof. The issue is how to convince a majority to go to a better plan. Unless we just want perpetual stalemate, some rational conservatives will have to be convinced. Hard core Republicans are probably lost cause.
Recently I was joking with an MD friend about how many slick, good-looking pharm reps I used to see at my GP's office. My GP has a notice now that pharm-company reps have to make an appointment. My MD friend said now they just drop off samples and bring sandwiches.
After hanging out with him and other actually trained medical people it's become clear how much bs the general public has been handed and now that I actually pay some attention to state reps, their ignorance is scary.
There is this terrible idea going around that doctors are supposed to be able to fix everything. Maybe it's the dark side of the God-complex and what is probably the Boomer worship of science. I certainly was raised/programmed to believe that science could cure everything. Because so much had been done between my childhood and that of my GI parents. But this notion that the doctor should give me a pill and I should be fixed or cured is a real problem. But somehow we've gotten the notion that being ill is some sort of moral issue. And with that, if doctors can't cure it, this is their moral failing.
Good point. Single-payer lets physicians be physicians and stay away from paperwork that exists only to facilitate payments. One form would be enough for getting payment. Physicians should not need to do time-consuming paperwork just to get paid any more than they should be their own janitors.
We can't do medicine on the cheap. This isn't Cuba. Single-payer should not be understood as a means of paying physicians less.I think he sums up the benefits quite nicely. Not to mention that most of us who work for single payer are requesting an improved Medicare where payments to doctors are increased.
The greatest evil is not now done in those sordid "dens of crime" (or) even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered... in clean, carpeted, warmed and well-lighted offices, by (those) who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the office of a thoroughly nasty business concern."
― C.S. Lewis, The Screwtape Letters
I would 100% agree with that.
"The only Good America is a Just America." .... pbrower2a
Why not? I guess it depends on what you mean by 'cheap' -- but perfectly good medicine is possible for orders of magnitude cheaper than what the US system would have you believe is necessary.
"Qu'est-ce que c'est que cela, la loi ? On peut donc être dehors. Je ne comprends pas. Quant à moi, suis-je dans la loi ? suis-je hors la loi ? Je n'en sais rien. Mourir de faim, est-ce être dans la loi ?" -- Tellmarch
"Человек не может снять с себя ответственности за свои поступки." - L. Tolstoy
"[it] is no doubt obvious, the cult of the experts is both self-serving, for those who propound it, and fraudulent." - Noam Chomsky
I would appeal to the GOP's paymasters, and have them appeal to their political supplicants in turn. The CEO types know that they need single payer, but it rankles them to advocate for any social program for any reason whatsoever. Now may be the time, though. They want favors that off-loading healthcare will make redundant ... and they know it. A little less-than-gentle arm twisting is in order.
Marx: Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.
Lennon: You either get tired fighting for peace, or you die.
I'm thinking it refers to the lack of sun, sandy beaches, and sugar crops.
"Qu'est-ce que c'est que cela, la loi ? On peut donc être dehors. Je ne comprends pas. Quant à moi, suis-je dans la loi ? suis-je hors la loi ? Je n'en sais rien. Mourir de faim, est-ce être dans la loi ?" -- Tellmarch
"Человек не может снять с себя ответственности за свои поступки." - L. Tolstoy
"[it] is no doubt obvious, the cult of the experts is both self-serving, for those who propound it, and fraudulent." - Noam Chomsky
My knowledge is anecdotal, but personal. Apparently, what qualifies as formulary is not consistent across all plans. Obviously, generics make the list with little argument, but named drugs may or may not. The reasons why aren't all that clear to me. I tracked the formulary lists that were used by Express Scripts over a four year period, because my wife was using a named drug that was either unconscionably expensive or on the formulary list. Out of four years, we had to get a generic alternative briefly, while our medical plan evaluated the risks of not approving the non-formulary as a "treatment". That drug was on and off the list at different times, but no one could tell me why.
BTW, the generic substitute was virtually identical, but the named drug was time release. For this common drug feature, they got a patent on the entire drug, making a generic unavailable for many (17?) years. Since then, my wife decided to quit taking that drug, and she's doing fine without it.
Marx: Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.
Lennon: You either get tired fighting for peace, or you die.
"Cheap" means that physicians don't get paid well.
The fault with our system is in part that too many people get blank checks with little responsibility.
The greatest evil is not now done in those sordid "dens of crime" (or) even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered... in clean, carpeted, warmed and well-lighted offices, by (those) who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the office of a thoroughly nasty business concern."
― C.S. Lewis, The Screwtape Letters
Perhaps. Though in any case, who cares so much about health care, when you can just lounge around on the beach all day?
Certainly, that was the point he was trying to make...
"Qu'est-ce que c'est que cela, la loi ? On peut donc être dehors. Je ne comprends pas. Quant à moi, suis-je dans la loi ? suis-je hors la loi ? Je n'en sais rien. Mourir de faim, est-ce être dans la loi ?" -- Tellmarch
"Человек не может снять с себя ответственности за свои поступки." - L. Tolstoy
"[it] is no doubt obvious, the cult of the experts is both self-serving, for those who propound it, and fraudulent." - Noam Chomsky
Clearly it isn't India. We eat our cows here.
"Qu'est-ce que c'est que cela, la loi ? On peut donc être dehors. Je ne comprends pas. Quant à moi, suis-je dans la loi ? suis-je hors la loi ? Je n'en sais rien. Mourir de faim, est-ce être dans la loi ?" -- Tellmarch
"Человек не может снять с себя ответственности за свои поступки." - L. Tolstoy
"[it] is no doubt obvious, the cult of the experts is both self-serving, for those who propound it, and fraudulent." - Noam Chomsky
My bro-in-law was director of biostatistics for a major pharmaceutical co. for a number of years. Dude knows a lot about drugs--more than most physicians, since it's how he made his fortune. You'd be very surprised (or not) at how many drugs he doesn't take, although he has to take some due to heart problems. For example, he never takes NSAIDs. He's also quite open to responsibly researched alternative treatments and will avail himself of them much more often than he will medication.
I wanted to get lasik corrective eye surgery and he warned me not to, although he did say the makers/sellers of drugs for chronic dry eye love lasik surgery.
The sick and the poor will be with us always, as will the chronically insane and the willfully ignorant.
Naw, just buy grass-fed organic beef and your good!Yah, THAT'S probably why we need more expensive health care.
To recommend thrift to the poor is both grotesque and insulting. It is like advising a man who is starving to eat less.
-Oscar Wilde, The Soul of Man under Socialism
I have now reached the age where I have had, and seen friends and relatives have, a number of serious or semi-serious encounters with American medicine, and I think I have begun to get it.
American medicine is great crisis medicine and can save and restore lives that would have terminated rapidly decades ago, such as my older brother's, who survived an aortic dissection and has now had a second successful operation on his aorta. However, if you have something that might be serious, but probably isn't--look out. Examples from my own experience:
1. I have now discovered that the tumor in and under my skin my abdomen four and a half years ago that was and is called cancer, shouldn't be. It is a tumor that can be locally aggressive (as mine had become) and can cause serious problems if it's in a difficult spot (mine was not), but it has never metastasized and killed anyone. Yet dermatologists have succeeded in getting in classified as cancer. And as a result, whem mine was first diagnosed, a local oncologist sent me for a big cat scan that cost thousands of dollars and discovered some potential problems that were actually nothing, but convinced me and my family that I was probably toast. (As soon as I got to Dana Farber in Boston I found I was not. It was only relatively recently, though, that the DF folks confirmed to me that the tumor really isn't cancerous at all.)
2. In 2008 I impaled my abdomen on a tree branch mountain biking. It didn't bleed at all--it looked like a severe scrape--but I wasn't doing well when I got to the ER and there was a chance it had punctured the abdominal cavity. A CTScan was negative but a surgeon, whom I liked, came in late in the evening and said, 'Well, the safest thing to do would be to operate and look at it.' I was weak and ready to give in but fortunately Patti, my wife, who has worked in ERs for decades, was there, and I said, let us talk it over. "Look," she said, "he's a surgeon--that's what they do." That was enough to get my brain working again and I realized there was no evidence at all that I had done anything serious, and thus, it would be just as well to wait. Within two weeks I was fine again without surgery, saving me lots of pain, lots of recovery time, and saving my insurance lots of money.
3. When I had the skiing accident in France an American doctor--not an orthopedist--was with me. He consistently focused on the worst-case scenarios and had it been up to him I would have been helicoptered to the nearest hospital for a brain scan even though I had no neurological symptoms whatever. The French doctors simply looked me over, X-rayed me, and told me I had done nothing too serious. They were right.
4. After studying the literature carefully a couple of years ago I decided not to get annual prostate exams or antigen tests any more. They lead to thousands of cases of over-diagnosis and over-treatment and very, very rarely save a life. Some months later, the guy who invented the antigen test--a Silent--wrote an op-ed in the NY Times apologizing for having invented it, saying he no longer got it, and that it had done far more harm than good. It is my impression that similar issues exist for mammograms. Simply put, both prostate tests and mamograms discover thousands of tumors that, without the test, patients would have died many years later without ever knowing they had them because they wouldn't go anywhere.
5. I have already reported about the drug scandal the last time I had some mild ear trouble--an old drug that had been turned intoa patentable new one at $300 a dose by adding one tiny ingredient.
Some of the problem also has to do with lawsuits--any doctor will admit this now. What people don't understand is that it's not the cost of malpractice insurance that really hurts, it's the thousands of procedures that are ordered as "defensive medicine."
I enjoyed anla899's account of the eye surgery. I have been astigmatic all my life and I've been wearing glasses all the time since I was about 25 even though I can see without them. When I heard about the surgery the main reason I didn't get it was that I would still need reading glasses, and back when I was a kid and needed them only to read I spent half my life looking for them. No reason to go back to that. But it's true, the surgery can cause serious problems.
It is rather fascinating that because treatment in this country is privately financed (until you are 65 anyway), we are willing to pay anything that is asked for it, while we are now busily trying to starve all levels of government. Perhaps that's the best argument for socialized medicine. Which is now not on the horizon.
David Kaiser '47
My blog: History Unfolding
My book: The Road to Dallas: The Assassination of John F. Kennedy
As someone who is virtually blind without my "coke-bottles" on I would say some dry-eye is a small price to pay for not having to wear these things on my head.
To recommend thrift to the poor is both grotesque and insulting. It is like advising a man who is starving to eat less.
-Oscar Wilde, The Soul of Man under Socialism
Especially with all those lovely opportunistic infections floating around. I have to say, though, when I'm in short-term pain, like having wisdom teeth out, I love me my opiates. But those have been around for years.
I support any practical solution and am weary of the seemingly endless debates with no solution in sight. It makes more sense to me to first define a viable health care system and then discuss how we pay for it. I think that you are correct that some CEO's now see the need for change, but the politicians want to be reelected and we also need to try to convince electorate.
It's rather horrifying to me that just two years ago we were having serious discussions on this subject and believing this might actually go somewhere. I don't foresee anything similar for a long time.
David Kaiser '47
My blog: History Unfolding
My book: The Road to Dallas: The Assassination of John F. Kennedy
We're Americans. The fact that at least 30 countries have health outcomes equal to or better than ours, but spend dramatically less on healthcare, could be happening on Mars for all we care. We didn't invent <insert successful system of choice>, so it's bad by definition.People are still living under the delusion that you can get something for nothing, and (as previously noted) that doctors can cure everything if you just give them enough money. Until this mindset changes, nothing else will either.
I agree 100%. We won't fix it until it's too broken to serve any purpose at all. HCA is a bad Band-Aid at best - better than nothing but not by much. I guess we need to go through the Kubler-Ross cycle. Most of us are in denial. To their credit, the Tea Partiers are now at the anger stage. I hope we progress to acceptance without destroying the remaining good in our system, but, at this point, it doesn't look likely.
Marx: Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.
Lennon: You either get tired fighting for peace, or you die.
Many of the Left are also angry. And not just the far-Left that basically consists of the anarchists. We have moved so far to the right in this country, a stealth move for sure, that anyone angry at the dysfunctional systems is marginalized and considered extreme.
The health care system is falling apart. My husband has worked in the health care system for 30 years and can testify to the downward spiral. If people don't awaken to how everything is connected, and get over this idea that I have mine, and if you don't, then it's somehow your fault, all of the life supporting systems will continue on a very slippery slope.
"The only Good America is a Just America." .... pbrower2a
Unfortunately, you are correct. At one point we could not do it because the Kaiser did it. Actually, I am in favor of keeping our total health care spending where it is and creating the world’s best health care system. Then the remaining problem would be to control cost increases so that Health care costs do not continue to increase as a percentage of GDP.
