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Thread: It's time for national healthcare - Page 133







Post#3301 at 08-01-2012 06:08 PM by Ragnarök_62 [at Oklahoma joined Nov 2006 #posts 5,511]
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Quote Originally Posted by sonrisa View Post
-- Medicare also has very low overhead costs. This is what I don't understand- what is so damn difficult about combining Medicaid & Medicare, lowering the age requirement to 0, & covering all income brackets?

or does that sound too much like right?
1. Straight on wrt Medicare.
2. The PlatformTM has the "set the Medicare age to 0" in it. Funding? Well, we could drop the payroll tax and add a VAT to cover the cost or let the playwrite MMTTM
do it. Yes, single payer would get rid of the ridiculous overhead nonsense we have now.
3. Income brackets isn't really an issue. Yes it should also be "universal". The President, Congress, and EVERYONE else should be in on the deal. No special Cadillac plans for any high up potentate, private or public.
MBTI step II type : Expressive INTP

There's an annual contest at Bond University, Australia, calling for the most appropriate definition of a contemporary term:
The winning student wrote:

"Political correctness is a doctrine, fostered by a delusional, illogical minority, and promoted by mainstream media, which holds forth the proposition that it is entirely possible to pick up a piece of shit by the clean end."







Post#3302 at 08-01-2012 08:16 PM by Ragnarök_62 [at Oklahoma joined Nov 2006 #posts 5,511]
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Quote Originally Posted by The Rani View Post
Absolutely. More government involvement definitely cuts down on waste.
Yes, absolutely. Cf.

https://www.unitedhealthcareonline.c...Guide_2012.pdf

Oh, and there are a whole lot of other forms there as well.
MBTI step II type : Expressive INTP

There's an annual contest at Bond University, Australia, calling for the most appropriate definition of a contemporary term:
The winning student wrote:

"Political correctness is a doctrine, fostered by a delusional, illogical minority, and promoted by mainstream media, which holds forth the proposition that it is entirely possible to pick up a piece of shit by the clean end."







Post#3303 at 08-01-2012 08:36 PM by annla899 [at joined Sep 2008 #posts 2,860]
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Quote Originally Posted by Ragnarök_62 View Post
Perhaps that's part of the reason the US pays more of its GDP (according to WHO) than any other country in the world. (Yes, I know there are other factors, hence the reason I wrote part).

Right now I have a PPO which is part of Cigna but which is administered through a 3rd party. Does this make sense? Also, the amount of money of my college spends on health benefits has more than doubled since 2006 (from $16 million to $36 million). Some of this may to due to the aging of the faculty and staff, but we've had a hiring freeze since 2009.







Post#3304 at 08-01-2012 10:33 PM by Ragnarök_62 [at Oklahoma joined Nov 2006 #posts 5,511]
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Quote Originally Posted by The Rani View Post
The more that "other" people are involved in paying for/providing medical services, whether those others are in the public or private sector, the more that people should expect to pay for those services.
If you want to cut down the costs, you have to cut down on someone's payments, whether it's the middlemen or the medical providers themselves. And since the middlemen make the rules (whether it's the U.S. gov or CEOs) you can guess how that one will turn out.
The "other people" would be fat cat CEO's and shareholders of the health care insurance industry. meow, meow, purr purr Nice kitties!

DSM-IV code = V62.2 Occupational problem
Last edited by Ragnarök_62; 08-01-2012 at 10:42 PM.
MBTI step II type : Expressive INTP

There's an annual contest at Bond University, Australia, calling for the most appropriate definition of a contemporary term:
The winning student wrote:

"Political correctness is a doctrine, fostered by a delusional, illogical minority, and promoted by mainstream media, which holds forth the proposition that it is entirely possible to pick up a piece of shit by the clean end."







Post#3305 at 08-01-2012 10:34 PM by Ragnarök_62 [at Oklahoma joined Nov 2006 #posts 5,511]
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Quote Originally Posted by Ragnarök_62 View Post
The "other people" would be fat cat CEO's and shareholders of the health care insurance industry. meow, meow, purr purr Nice kitties!
Universal Medicare would cut down on this caviar kittie kibble.
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There's an annual contest at Bond University, Australia, calling for the most appropriate definition of a contemporary term:
The winning student wrote:

"Political correctness is a doctrine, fostered by a delusional, illogical minority, and promoted by mainstream media, which holds forth the proposition that it is entirely possible to pick up a piece of shit by the clean end."







Post#3306 at 08-02-2012 12:04 AM by Ragnarök_62 [at Oklahoma joined Nov 2006 #posts 5,511]
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Quote Originally Posted by The Rani View Post
You wouldn't describe politicians as fat cats?
No.
This: 296.64 - Bipolar I disorder, most recent episode mixed Severe with psychotic features. Like I said, I'd put them on Medicare and some Seroquel. I'd use Seroquel as the atypical antipsycotic of choice since they'd be doing a lot of sleeping. Seroquel is notorious for inducing longish cat naps.
MBTI step II type : Expressive INTP

There's an annual contest at Bond University, Australia, calling for the most appropriate definition of a contemporary term:
The winning student wrote:

"Political correctness is a doctrine, fostered by a delusional, illogical minority, and promoted by mainstream media, which holds forth the proposition that it is entirely possible to pick up a piece of shit by the clean end."







Post#3307 at 08-02-2012 05:20 AM by Galen [at joined Aug 2010 #posts 1,017]
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Quote Originally Posted by The Rani View Post
Absolutely. More government involvement definitely cuts down on waste.
Not really, here is a doctor that says otherwise for some very sound economic reasons. Now that I think of it there is another doctor would also disagree. You can't say that the United States has had anything resembling a free market in medicine except in two specialties, lasik and cosmetic surgery has had decreasing prices, especially when you consider the prices in constant dollars.

Years ago Milton Friedman criticized the insurance industry on the basis of the third party payer problem and single payer suffers from the same problem. Then there will be the inevitable bureaucratic stupidity that will make service suck and costs increase which are a direct consequence of all central planning in economic affairs.

Now the shouting down will begin from people who won't read any of the references because the want to believe that government can wave a magic wand and fix everything.
If one rejects laissez faire on account of mans fallibility and moral weakness, one must for the same reason also reject every kind of government action.
- Ludwig von Mises

Beware of altruism. It is based on self-deception, the root of all evil.
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Post#3308 at 08-02-2012 09:11 AM by Brian Rush [at California joined Jul 2001 #posts 12,392]
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Folks, if we want to know whether a single-payer system would reduce health-care cost, we don't have to engage in theoretical speculation, we can simply take a look at every advanced nation in the world except for this one, all of whom have had single-payer systems for a long time and see whether it does reduce costs. Empiricism: a good thing; learn to love it.

I do understand all of the rationales and arguments for those of you who think it won't (government bureaucratic inefficiency and all that). Nevertheless, it moves.

As for who in the system as it stands now would take the hit, physicians are an unlikely candidate because that's not where most of the money goes; even the highest-paid medical specialists have only a six, or at most very low seven-figure income. The likely losers are the pharmaceutical companies and (of course) the health-insurance industry.
"And what rough beast, its hour come round at last, slouches toward Bethlehem to be born?"

My blog: https://brianrushwriter.wordpress.com/

The Order Master (volume one of Refuge), a science fantasy. Amazon link: http://www.amazon.com/dp/B00GZZWEAS
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Post#3309 at 08-02-2012 10:13 AM by Brian Rush [at California joined Jul 2001 #posts 12,392]
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Quote Originally Posted by The Rani View Post
I wonder if Europeans are happier with their systems because they have more realistic expectations, too.
That might be part of it. Of course, having full coverage for everyone and paying one-tenth what we do for medications might, too.
"And what rough beast, its hour come round at last, slouches toward Bethlehem to be born?"

My blog: https://brianrushwriter.wordpress.com/

The Order Master (volume one of Refuge), a science fantasy. Amazon link: http://www.amazon.com/dp/B00GZZWEAS
Smashwords link: https://www.smashwords.com/books/view/382903







Post#3310 at 08-02-2012 11:39 AM by JohnMc82 [at Back in Jax joined Jan 2011 #posts 1,962]
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Quote Originally Posted by Brian Rush View Post
Folks, if we want to know whether a single-payer system would reduce health-care cost, we don't have to engage in theoretical speculation, we can simply take a look at every advanced nation in the world except for this one, all of whom have had single-payer systems for a long time and see whether it does reduce costs. Empiricism: a good thing; learn to love it.
Empiricism is great, but your statement "every advanced nation in the world except for this one, all of whom have had single-payer systems for a long time" is utterly false.

Single payer refers very specifically to a certain type of universal healthcare, and after the last few years of reform in the UK, Canada, and Australia, it could be argued that Taiwan is the only true "single payer" system left.

Now back to the empiricism. Single payer is the cheapest form of universal healthcare, but it isn't the form that delivers the highest patient satisfaction ratings or the best medical outcomes. There is a reason, after all, that "universal healthcare" is a much more popular position in America than "single-payer" is.
Those words, "temperate and moderate", are words either of political cowardice, or of cunning, or seduction. A thing, moderately good, is not so good as it ought to be. Moderation in temper, is always a virtue; but moderation in principle, is a species of vice.

'82 - Once & always independent







Post#3311 at 08-02-2012 11:55 AM by playwrite [at NYC joined Jul 2005 #posts 10,443]
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Did you get your rebate check yet?

As we continue to undertake the pragmatically fruitless debate over the charms of national single payer, you may not be aware until the check arrives that, thanks to Obamacare, you may have a cash-money rebate from your insurer in the mail.

These rebates will be annual with the first checks going out this month to 12.8 million Americans eventually total $1.1 billion.

These rebates are a result of insurers exceeding the Obamacare limits on their expenses beyond actual health care benefits for their customers. Those non-benefit expenses that are limited include CEO salaries as well as the insurers profits. The 15% (employer plans) and 20% (individual plans) overhead is higher than that of Medicare or Medicaid, giving the private insurers every chance (obviously, with the rebates they must be having some difficulties); if in the end, they can't, then they'll have to drop out of the business. Obamacare is literally having the private insurer system put its money where its mouth is. Guess what the country would have to turn if they can't? Seems like we might be able to hold off on debating single payer, hey?

More here -

http://abcnews.go.com/blogs/politics...k-in-the-mail/

Health Insurance Rebates: Is Your Check In The Mail?

A new provision of the Affordable Care Act — called the Medical Loss Ratio, or the “80/20″ provision — could mean some Americans will see a rebate from their health insurance companies tomorrow.

The provision is aimed at holding health insurance companies accountable for how they spend the money collected through premiums. It compares the dollars they spend on health care costs vs. other overhead costs — like marketing, salaries and administrative expenses.

Under the law, small-group and individual-plan insurance companies that annually spend less than 80 percent of premium dollars on medical care owe their customers a rebate. For insurers to large businesses, the percentage split is 85-15.

This is the first year the provision is in effect, and insurance companies that owe rebates must pay them by tomorrow, Aug. 1.

Here’s a look at the health care rebates, by the numbers:

- Health insurance companies have to pay out a total of $1.1 billion in rebates by tomorrow.

- About 12.8 million Americans will receive a rebate, according to the Department of Health and Human Services.

- The average privately insured family will see a $151 rebate from this provision, but payouts will vary by state.

- About 31 percent of Americans who have individual insurance are eligible for a rebate. They’ll get their checks directly in the mail, averaging about $127, according to a study by the Kaiser Family Foundation.

- For people who buy insurance through their employers, those rebates won’t come directly in the mail. They’ll first go to the employer, which decides how to distribute it. Employers who offer insurance can either send out individual checks to their employees, or put those rebates toward lowering future premium costs.

The employer could also use the rebates as a lump-sum reimbursement to the accounts that pay premiums, or spend it in other ways that “benefits its employees,” according to the Department of Health and Human Services. This can include lowering copays or adjusting cost-sharing to cut group insurance costs.

Employees should contact their employer for details about how their rebates will be distributed.
Whether they owe a rebate or not, insurance companies in every state have to notify their customers by tomorrow if they’ve met or failed this part of the law.

For information on how your health insurance company stacks up on the 80/20 provision, click HERE: http://companyprofiles.healthcare.gov/
Obviously, it's easy to see why the GOP is so desperate to win this election and end Obamacare. If they don't, not only will it become cherished by most Americans, but it will also clearly show how ugly the GOP and how utterly stupid the sheeple that listened to them.

I now return you back to the pointless.
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Post#3312 at 08-02-2012 12:17 PM by Brian Rush [at California joined Jul 2001 #posts 12,392]
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Quote Originally Posted by JohnMc82 View Post
Single payer refers very specifically to a certain type of universal healthcare, and after the last few years of reform in the UK, Canada, and Australia, it could be argued that Taiwan is the only true "single payer" system left.
"It could be argued" is not equivalent to "it's true."

It's not true. I'm not wrong. Single payer is the norm, and we're the odd man out. The only way to argue otherwise is to nit-pick over the definition of the term so as to deprive it of all meaning.
"And what rough beast, its hour come round at last, slouches toward Bethlehem to be born?"

My blog: https://brianrushwriter.wordpress.com/

The Order Master (volume one of Refuge), a science fantasy. Amazon link: http://www.amazon.com/dp/B00GZZWEAS
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Post#3313 at 08-02-2012 12:40 PM by Odin [at Moorhead, MN, USA joined Sep 2006 #posts 14,442]
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Quote Originally Posted by Brian Rush View Post
Folks, if we want to know whether a single-payer system would reduce health-care cost, we don't have to engage in theoretical speculation, we can simply take a look at every advanced nation in the world except for this one, all of whom have had single-payer systems for a long time and see whether it does reduce costs. Empiricism: a good thing; learn to love it.

I do understand all of the rationales and arguments for those of you who think it won't (government bureaucratic inefficiency and all that). Nevertheless, it moves.

As for who in the system as it stands now would take the hit, physicians are an unlikely candidate because that's not where most of the money goes; even the highest-paid medical specialists have only a six, or at most very low seven-figure income. The likely losers are the pharmaceutical companies and (of course) the health-insurance industry.
Oh, the Libertarians just know that Single Payer systems in other countries are doomed, just like they just know that hyperinflation is always just around the corner.

I take the pronouncements of Austrian Schoolers about as seriously as I take practitioners of I Ching, Tarot, or other forms of divination; that is, not at all.
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







Post#3314 at 08-02-2012 12:44 PM by JohnMc82 [at Back in Jax joined Jan 2011 #posts 1,962]
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Quote Originally Posted by Brian Rush View Post
"It could be argued" is not equivalent to "it's true."

It's not true. I'm not wrong. Single payer is the norm, and we're the odd man out. The only way to argue otherwise is to nit-pick over the definition of the term so as to deprive it of all meaning.
I always thought words lost meaning when they were thrown around in an inappropriate context.

So let's say you want to insist on calling Canada, Australia, UK single payer. Fine. What does that make France and Switzerland?

Single-payer means one payer. If the government is the only insurer, it is a single-payer system. Hell... if Blue Cross was the only insurer, it would still be a single-payer system. It would be a non-universal, for-profit system, but it would still be single payer.

Most countries have the government as a primary insurer, but it is actually rather rare for it to be the only one.
Last edited by JohnMc82; 08-02-2012 at 01:31 PM.
Those words, "temperate and moderate", are words either of political cowardice, or of cunning, or seduction. A thing, moderately good, is not so good as it ought to be. Moderation in temper, is always a virtue; but moderation in principle, is a species of vice.

'82 - Once & always independent







Post#3315 at 08-02-2012 01:39 PM by Brian Rush [at California joined Jul 2001 #posts 12,392]
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Quote Originally Posted by JohnMc82 View Post
So let's say you want to insist on calling Canada, Australia, UK single payer. Fine. What does that make France and Switzerland?
Perhaps it's best to begin by defining the term "single payer" so as to avoid any further confusion, whether inadvertent or deliberate. A single payer health-care system is one in which the government either directly makes or mandates in detail through regulation all payments for basic health-care services. That makes both France and Switzerland single-payer systems as well. Although Swiss insurance providers are technically privately owned, they are not allowed to make a profit on mandated insurance, and the government sets what must be covered, what premiums can be charged, and what can be paid for services. France takes things one step further and makes premium paid a function of income, using a social insurance model.

The distinction of Great Britain, by the way, is not single-payer but actual socialized medicine, with the government not only making/controlling payments and costs but also running clinics and hospitals and employing most health-care personnel. Single payer and socialized medicine are not the same thing. Most advanced countries today do not practice socialized medicine.

We could have a functionally similar system to other countries in one of two ways. Either we could expand Medicare to cover everyone, or we could expand upon the requirements of Obamacare to more closely resemble the system in Switzerland. Either of those approaches would amount to a single-payer system for purposes of controlling health-care costs. My belief is that the Medicare-for-all approach would be easier to implement and probably work better.
"And what rough beast, its hour come round at last, slouches toward Bethlehem to be born?"

My blog: https://brianrushwriter.wordpress.com/

The Order Master (volume one of Refuge), a science fantasy. Amazon link: http://www.amazon.com/dp/B00GZZWEAS
Smashwords link: https://www.smashwords.com/books/view/382903







Post#3316 at 08-02-2012 03:11 PM by Deb C [at joined Aug 2004 #posts 6,099]
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Among the highly-industrialized, the United States stands out for having so many of its political leaders argue that healthcare is some kind privilege -- a commodity that seeks profit -- and not a right granted to all.
"The only Good America is a Just America." .... pbrower2a







Post#3317 at 08-02-2012 06:16 PM by Brian Beecher [at Downers Grove, IL joined Sep 2001 #posts 2,937]
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Quote Originally Posted by Deb C View Post


Among the highly-industrialized, the United States stands out for having so many of its political leaders argue that healthcare is some kind privilege -- a commodity that seeks profit -- and not a right granted to all.
Isn't this at least partly the fault of our forefathers who didn't think of this when the Constitution was written. It was proposed at the time of New Deal legislation, but somehow was dropped. This was a shame if for no other reason that it would have been easier to administer at a time when the population was smaller and more concentrated than it is today.







Post#3318 at 08-02-2012 06:25 PM by JohnMc82 [at Back in Jax joined Jan 2011 #posts 1,962]
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Quote Originally Posted by Brian Rush View Post
Perhaps it's best to begin by defining the term "single payer" so as to avoid any further confusion, whether inadvertent or deliberate. A single payer health-care system is one in which the government either directly makes or mandates in detail through regulation all payments for basic health-care services. That makes both France and Switzerland single-payer systems as well. Although Swiss insurance providers are technically privately owned, they are not allowed to make a profit on mandated insurance, and the government sets what must be covered, what premiums can be charged, and what can be paid for services. France takes things one step further and makes premium paid a function of income, using a social insurance model.
Well if that's the definition you want to use, carry on. Just don't act too surprised when people assume you meant what the dictionary says.

National Library of Medicine:

Single-payer system: An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.
This part of your definition "or mandates in detail through regulation all payments for basic health-care services" is beyond the scope of what single-payer actually means, and more accurately applies to most multi-payer universal systems - or any market-based system with strict regulations. Hell, using your defintion, one could argue that Obamacare is single-payer because it regulates payments and accessibility of basic services.

The distinction of Great Britain, by the way, is not single-payer but actual socialized medicine, with the government not only making/controlling payments and costs but also running clinics and hospitals and employing most health-care personnel. Single payer and socialized medicine are not the same thing. Most advanced countries today do not practice socialized medicine.
But the NHS doesn't even own all of the hospitals anymore, nor have they upheld the bans on competing payers. So the NHS isn't really socialist or single-payer as of the last few years.


We could have a functionally similar system to other countries in one of two ways. Either we could expand Medicare to cover everyone, or we could expand upon the requirements of Obamacare to more closely resemble the system in Switzerland. Either of those approaches would amount to a single-payer system for purposes of controlling health-care costs. My belief is that the Medicare-for-all approach would be easier to implement and probably work better.
Medicare for all would be single-payer for sure. The Swiss system really isn't, so to slap the same label on both of them makes it really, really hard to debate the details and relative pros/cons.

From my research, multi-payer systems are a little bit more expensive than single-payer systems, but the patients and doctors tend to be a good bit happier with the little bit of extra choice they get - and the outcomes tend to be a little better.

American medicine doesn't even fit on that comparison chart: it's way too expensive and ineffective to compare with any kind of universal system. So even though I agree it is time for universal healthcare, I think it is also important to note what makes those systems unique, and how those options all fit in to America's political culture.

And... as I've said a hundred times before... there's a reason why "universal healthcare" has much stronger polling numbers than "single-payer."
Those words, "temperate and moderate", are words either of political cowardice, or of cunning, or seduction. A thing, moderately good, is not so good as it ought to be. Moderation in temper, is always a virtue; but moderation in principle, is a species of vice.

'82 - Once & always independent







Post#3319 at 08-02-2012 08:40 PM by Odin [at Moorhead, MN, USA joined Sep 2006 #posts 14,442]
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I have to agree with John, here, the French and Swiss systems cannot really be called "Single-Payer", because that term implies that the government directly pays HC providers. I would call the French and Swiss systems to be "Public Utility", in which insurance companies are highly regulated public utilities.
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







Post#3320 at 08-04-2012 11:55 AM by JDG 66 [at joined Aug 2010 #posts 2,106]
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Quote Originally Posted by playwrite View Post
There's a misunderstanding here because of your inability to communicate clearly...

It is unclear what you are trying to say here. Let me help you --

First, Obamacare adds tens of millions of people paying health insurance in large part because they are being subsidized...
-Playwrite's claim was that Uncle Sam should be allowed to force people to buy health insurance because not buying it forces up the cost for those who do buy it.

This shows:

Quote Originally Posted by JDG 66 View Post
http://keithhennessey.com/2012/06/28/uninsured-tax/

...This gets CBO’s 21 million uninsured in 2016 down dramatically to 3.9 million who will be both uninsured and pay the tax. Total U.S. population in 2016 will be about 327 million...
...that less than 4 million PAYERS will be added to the rolls (4 million who didn't want to be part of the system).

And then he claims that I'm difficult to understand.







Post#3321 at 08-06-2012 05:54 PM by Deb C [at joined Aug 2004 #posts 6,099]
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US Medicine: We Can Do Better Than This

by Dave Dvorak, MD

How much will this cost?” he asks. It’s the question at the heart of any business transaction: Is this new car, this plane ticket, this iPad worth the asking price?

But the man sitting before me is not a customer in an automobile showroom or an electronics store. He is my patient in the emergency department, and he is weighing whether to undergo the chest CT scan I have just recommended.

“I’m uninsured,” he says. “I lost my health coverage when I got laid off from my job three years ago. This is all coming out of my pocket.”

An ex-smoker in his late 40s, he has been coughing up increasing amounts of bloody sputum over the past month. What began as occasional, tiny red flecks has progressed to thick crimson streaks he can no longer ignore.

“I can only give you an estimate,” I say, “but I’m guessing a chest CT scan plus the radiologist’s fee will run in the neighborhood of $2,000.”

Like most emergency physicians, I have catalogued in my brain an endless litany of precise numbers—physiologic parameters, normal lab values, weight-based drug doses. But when it comes to knowing the costs of the myriad tests, medications and treatments that I routinely order for patients, I can offer little more than a rough estimate.

“I was afraid you’d say something like that,” he says. “I figured CT scans don’t come cheap.” He sighs quietly. “I’m raising my 8-year-old daughter on a pretty lean budget.” He looks thin in his hospital gown and a shade pale, a few days of graying stubble on his chin.

“But I’ve been worried about this for too long,” he says. “I know I need to have it.”

An hour later, I am seated at my computer scrolling through digital CT images while the radiologist on the phone describes the findings.

“In the hilum of the left lung there is a 4.5 centimeter lesion very likely to represent malignancy,” she says. My gaze falls on the irregularly shaped white mass, its tiny tentacles invading the delicate latticework of the surrounding lung tissue.

“Unfortunately, it gets worse,” the radiologist says. “There are also multiple scattered smaller lesions throughout both lungs, highly suspicious for metastases.”

There was a time during medical school and residency when I regarded abnormal clinical and radiographic findings with intrigue. I remember the excitement of hearing my first heart murmur. Of palpating a thyroid nodule. Of visualizing an ovarian mass on pelvic ultrasound.

But after years of clinical practice and countless patient encounters, I now find it difficult to view abnormal findings separately from the human lives they affect. I see an elderly woman’s hip X-ray, knowing that the fracture line coursing through the femoral neck likely spells the end of her days of independent living. A peculiar bright patch lighting up in the brain’s left hemisphere on an MRI scan signifies that a man will no longer be able to grasp a pen or a coffee mug in his right hand, will never again be able to speak a meaningful word to his family.

I hang up the phone, my eyes lingering on the CT images, the sinister white lung mass and its small-but-ominous satellites. And I am aware of their significance—that a middle-aged man will not live to see his daughter’s wedding.

I return to the patient’s room and sit down on the bedside stool. Before I speak, I feel his gaze upon me, anxiously searching my face for any subtle indication of the words to come.

“I’m sorry to have to give you this news,” I say, “but your CT scan shows findings concerning for lung cancer. It’s possibly spread to both lungs.”

He stares ahead, unblinking, his facial pallor seemingly more apparent. After a few moments, he speaks.
“On some level, I was expecting something really bad like this,” he says. “But, of course, you always hope that everything will turn out fine.”

My mouth, having grown dry, lacks the appropriate words to console him in this moment of utter sorrow. So I put a hand on his arm.
“I’ll talk to our on-call oncologist,” I tell him. “We’ll figure out a plan for you.”

He waits patiently until I return to his room once more, armed with an action plan.

“The oncologist is going to admit you to the hospital and start the workup,” I explain. “He’ll order a PET scan to see if there’s been spread to other parts of the body. Then they’ll do a biopsy of that main lesion in your lung to determine the best treatment options—whether it be radiation, chemotherapy or some combination of the two.”

A long period of silence follows, time for my patient to process the information I have conveyed. I anticipate forthcoming questions.
“I suspected that you’d want to do all those things,” he says, finally. “But I’ve already been thinking this through, and I’ve decided that I’m going to have to pass on your recommendations.”

It is not a reply I was expecting. “Why is that?” I ask. “As I said before, I’ve got no health insurance,” he says. “But there’s one thing I do have—my house. And it’s fully paid for. I guess I’m not willing to mortgage it—and ultimately lose it—to pay off endless medical bills. My house is the only thing…” His voice trails off.

After a pause, he continues. “My house is the only thing I’ll have to leave my daughter when I’m gone.”
Tears have gathered in the corners of his eyes. I offer him a box of tissues, and he takes one.

We sit together in a room in a modern emergency department in a rich country, a land where highly trained specialists confidently wield the newest technologies and expensive pharmaceuticals. But these treasures are not accessible to all, for ours is also a land where private health insurance is bought and sold as a commodity. Ours is a system known to shake down sick people for money they don’t have. Ours is the only wealthy democracy that fails to guarantee health coverage to all of its citizens.
Just as it is failing now.

He looks down at his watch. “Thanks for all you’ve done. I really appreciate it. But I’ve gotta leave now,” he says. “I have to go pick her up from school.”

As I watch him reach behind his neck to untie his hospital gown, I can’t help but feel that we owe him so much more. I can’t help but feel that we—health care providers, hospital administrators, insurance company executives, politicians, all those who strenuously fight the changes that our system desperately needs—we all have failed him.

I can’t help but feel that we are better than this.


This article first appeared in the July 2012 issue of Minnesota Medicine.

© 2012 Minnesota Medical Association

Last edited by Deb C; 08-06-2012 at 05:57 PM.
"The only Good America is a Just America." .... pbrower2a







Post#3322 at 08-07-2012 02:54 AM by JohnMc82 [at Back in Jax joined Jan 2011 #posts 1,962]
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08-07-2012, 02:54 AM #3322
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Quote Originally Posted by playwrite View Post
As we continue to undertake the pragmatically fruitless debate over the charms of national single payer, you may not be aware until the check arrives that, thanks to Obamacare, you may have a cash-money rebate from your insurer in the mail.

These rebates will be annual with the first checks going out this month to 12.8 million Americans eventually total $1.1 billion.
Nope, no refund. I did get a letter from my insurer stating that I wouldn't be eligible for one! Really just an early warning that premiums will be heading up (again.)

Who could have guessed that forcing Americans to buy a product from profit-driven providers would cause the price of that product to go up?!
Last edited by JohnMc82; 08-07-2012 at 02:56 AM.
Those words, "temperate and moderate", are words either of political cowardice, or of cunning, or seduction. A thing, moderately good, is not so good as it ought to be. Moderation in temper, is always a virtue; but moderation in principle, is a species of vice.

'82 - Once & always independent







Post#3323 at 08-07-2012 09:13 AM by Justin '77 [at Meh. joined Sep 2001 #posts 12,182]
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08-07-2012, 09:13 AM #3323
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Quote Originally Posted by JohnMc82 View Post
Nope, no refund. I did get a letter from my insurer stating that I wouldn't be eligible for one! Really just an early warning that premiums will be heading up (again.)
Ditto to that here. Oh well...

Who could have guessed that forcing Americans to buy a product from profit-driven providers would cause the price of that product to go up?!
But...but...
Health insurance is the same thing as health care! I mean, that's why everyone was happy to get forced to pay for the first, and nobody even cared to talk about the second?

Right?
"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







Post#3324 at 08-07-2012 09:41 AM by JohnMc82 [at Back in Jax joined Jan 2011 #posts 1,962]
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08-07-2012, 09:41 AM #3324
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Quote Originally Posted by Justin '77 View Post
But...but...
Health insurance is the same thing as health care! I mean, that's why everyone was happy to get forced to pay for the first, and nobody even cared to talk about the second?
Yeah and let me tell you about those great deals! It is about $150 a month for the pleasure of being a healthy 30 year old, and if I did get sick or in to some kind of accident I'd quickly be on the hook for another $700 a month.

Any sick person can easily come up with $850 a month, right? Problem solved, then! I wonder why idiot America isn't happy with this great deal the lobbyists cooked up.
Those words, "temperate and moderate", are words either of political cowardice, or of cunning, or seduction. A thing, moderately good, is not so good as it ought to be. Moderation in temper, is always a virtue; but moderation in principle, is a species of vice.

'82 - Once & always independent







Post#3325 at 08-07-2012 10:17 AM by Deb C [at joined Aug 2004 #posts 6,099]
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08-07-2012, 10:17 AM #3325
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Here's a little history of who has worked for and against a national healthcare.

Bill Moyers Essay


BILL MOYERS: I read a news story this week that sent me on a nostalgic trip down memory lane. This past Monday, July 30th was the 47th anniversary of Medicare, and to celebrate it, the “Raging Grannies,” as they’re known, gathered outside the county office building in Rochester, New York to protest rumored cuts to their Medicare coverage

RAGING GRANNIES: This old grey granny now needs a test or two --

BILL MOYERS: They praised Medicare in song as “the best deal we have in the country,” and even called for expanding it Medicare into universal health care for everyone.

It seems the Republican Speaker of the House, John Boehner, was coming up from Washington to raise funds for Republican congressional candidate Maggie Brooks. The “Raging Grannies” wanted to make certain Ms. Brooks didn’t sign on to the GOP budget which includes cuts to Medicare.

For myself, the “Raging Grannies” channeled a familiar voice, the Texas twang of my boss back in 1965, Lyndon Baines Johnson. I was a White House assistant at the time and had been working with the President and others on the team trying to get Medicare through Congress. Even with overwhelming Democratic majorities in the House and Senate, it was one tough fight. Others had tried before us.

In his 1948 State of the Union message, President Harry Truman said:

HARRY TRUMAN: This great Nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.

BILL MOYERS: But every time Harry Truman proposed legislation to do just that, Congress refused to budge. In the 1960s, John F. Kennedy took up the cause:

JOHN F. KENNEDY: Our working men and women, instead of being forced to ask for help from public charity, once they are old and ill, should start contributing now to their own retirement health program through the Social Security System…

BILL MOYERS: But his proposal failed in the Senate by just two votes.
On the other side, actor Ronald Reagan, still in private life, had signed on as the American Medical Association’s hired spokesman in their campaign against Medicare. Doctors’ wives organized thousands of small meetings in homes around the country, where guests listened to a phonograph record of Reagan deploring the evils of “socialized medicine”:

RONALD REAGAN: Behind it will come other Federal programs that will invade every area of freedom as we have known it in this country […] until one day, as Norman Thomas said […] you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.

More: http://billmoyers.com/segment/bill-moyers-essay-everyone-should-be-entitled-to-medicare/


Last edited by Deb C; 08-07-2012 at 10:19 AM.
"The only Good America is a Just America." .... pbrower2a
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