4/7 In Massachusetts, Universal Coverage Strains Care
http://www.nytimes.com/2008/04/05/us/05doctors.html
\_ If you add more people to the system and not more dollars this
will happen. Universal care will end up costing taxpayers more
money for a reduced (or the same) level of service - and don't
give me this BS about how preventative care will save money. If you
think that's true then make the Universal system include only
preventative care.
\_ Well, any solution that amounts to layering a bureaucracy on
top of the existing system is dubious.
\_ ...well, hell, if you don't believe preventative care will
save money, how about you go ahead and stop receiving any of it
and let us know how you're doing in about 10 years?
\_ I think you missed his point. -!pp
\_ Not if his point was that preventative care will save
\_ Not if his point was that preventative care won't save
money or cut costs in a Universal healthcare system.
\_ Do you mean 'will not save?'
\_ Er, yes. Will fix soon and erase both of these
comments.
\_ Preventative care won't save money if it then leads to
expensive procedures anyway. However, I'm all in favor
of free medical exams. Free clinics funded by the government
do this already. That's the extent of it, though.
\_ http://www.overcomingbias.com/2008/04/prevention-cost.html
-- ilyas
\_ Excellent: _some_ preventative medicine will save costs;
indiscriminate spending on unproven preventatives will
raise costs. That's important to know so's we can focus.
\_ Does early cancer screening save costs, improve
quality of life, or neither? I would argue that
overall it might improve quality of life, but it
doesn't lower costs. In fact, it adds to costs
because you have the cost of the screening plus the
costs of the treatment which is much the same either
way. On top of that, as the article points out,
you've extended a life so that you can have more
expensive screenings and ultimately (in many cases)
a recurrence anyway. Prevention works for conditions
which we have cures for like polio. It doesn't work
so well for cancer, heart disease, and such which
is probably where most of the medical $$$ go anyway.
\_ Have you included the value of saving the lives
of fully-productive adult members of society in
your calculation? [Hint: No.] -tom
\_ We are comparing prevention to no prevention +
treatment. Are you claiming that the former
actually saves more lives (aside from the
known beneficial cases, e.g., vaccinations)?
-- ilyas
\_ The data shows that the cases where preventative
care actually does save productive lives are
very rare, except for those few known things like
vaccines or a single colonoscopy at a certain
age.
\_ This depends entirely on what you consider
preventative: is abstinence education prevent-
ative? how about safe sex classes including
information on condoms? It makes sense, though,
that certain testable measures are much more
reliable than, say, handing out pamphlets.
\_ No, because over 1/3 of the current costs of the medical system
go to the "free market" beauracracy. All those countries that
go to the "free market" bureaucracy. All those countries that
have introduced universal health care have cut costs. I leave
it as an exercise for the reader to discover how this could
possibly have happened.
\_ US government != European governments. As history proves
over and over again, US government = inefficient beauracracy
that cannot be trusted, and hence we have no choice but
to rely on the free market.
\_ You mean inefficient like the US Army or Marine Corp?
\_ Our military branches are efficient at torture.
\_ They save costs because you die while waiting to get the
surgery you need because of rationing. The free market
can allocate resources much more effectively than some
bureaucrat can. If you really want to cut costs you should
eliminate insurance entirely. Right now people don't pay
attention to whether their doctor charges $1400 versus
$1200 for a procedure. If it's within the customary
averages insurance companies are going to pay it.
However, if that extra $200 comes out of their pocket you
can be sure people will pay more attention to costs. Our
current nightmare of employer-sponsored HMO plans is
basically already Universal Healthcare for the working
class. Sure, you can purchase individual coverage but how
many people eligible for an employer-sponsored plan do
that? (And if they do, not many employers refund their
portion of the premium!) For the elderly we already have
Medicare. Universal health care is a step in the wrong
direction. Eliminate virtual-mandatory participation in
these plans and watch both doctors and patients become
much happier as they split that 1/3 overhead that HMOs
currently enjoy. I pay $600/month for health insurance if
you count my portion and my employer's portion and I am
under 40 and healthy. That's your UHC tax right there.
Refund it back to me and let me decide how to obtain
medical care. Don't legislate away the only choice I have
(not to participate).
\_ Savings have to come from eliminating bureaucratic fat,
better experimental study design (so we actually know what
works), and more personalized medicine (relying on averages
works), and more RUSSIAN medicine (relying on averages
is expensive and kills people). People who just want
Universal Healthcare <tm> basically aren't thinking about
the problem, they are just shouting a political meme.
-- ilyas
\_ You mean how the free market so efficiently allocated
resources during the dot-com bubble and the housing
run-up and collapse? Simply repeating your ideological
position does make it any more persuasive. Yes, the free
market rations health care according to ability to pay and
state run systems allocate them according to need. Guess
which one gets more bang for your buck? People die in both
systems waiting for health care.
\_ What exactly was wrong with the <DEAD>dot.com<DEAD> bubble or
the housing run-up? It's how markets work. I'm sure
you far prefer the former Soviet Union which didn't
have those "problems". Bureaucrats cannot decide
"need" as well as dollars can. I argue that more
bang for the buck is the one that eliminates the
middle-man.
\_ The medicare and VA bureaucracy is much more
lightweight than the HMO/medical insurance one is.
I prefer what works, not what my ideology tells me
"must" work.
\_ I think you are the one with an ideological
problem here.
\_ Another issue is that people without insurance or ability
to pay still get care in emergency rooms. I don't know
what the $ numbers are for those cases. But most med
insurance is pretty obviously not very efficient. If med.
insurance should be mandatory it should have really
high deductibles. The biggest problem with insurance
is that it neuters market forces towards the medical
industry. With most insurance plans, all doctors and
all drugs cost similar amounts, barring some brand
name vs. generic category things. The consumer as you
say has little reason to look for medical "deals".
And insurance is expensive, and those who aren't insured
freeload.
\_ Exactly. There is no reason to shop around. When
shopping for a new doctor how many people inquire
as to his rates? How many times do you pay your
bill at the doctor *after* services are rendered?
High deductibles and large co-pays make sense, but
I do not think that's what the UHC people have in
mind. Anyone who has spent time at a free clinic
(or knows someone who works at one) realizes what a
disaster that is for all involved. We should be
looking for a more streamlined solution, not a
bigger and more difficult to administer solution
with mandatory participation that will screw
middle-class taxpayers even more than they already
are while doing nothing to improve medical care.
\_ I agree with everything except for your conclusion.
UHC works very well in the places it has been tried:
the US Army, VA hospitals, Canada, England, etc. In
this country, we will probably have to have a two
tier system, more like England, rather than a
mandatory participation system, like Canada, though.
\_ Do you know anyone in the military? My gf's
mom was an Air Force and then Army nurse
(active duty) for 30 years and when she
retired from nursing she continued to work
closely with Tricare, NIH, VA, and State Dept
(believe it or not they are involved for things l
like sharing patient data between branches of
military) as a consultant. She was also a
hospital administrator for a military hospital
and her daughter (my gf's sister) is Air
Force reserves, former Army, and works
full-time for the VA right now. In addition,
my gf's dad and stepdad were both military
officers and my gf's sister's ex-husband is
active duty Army who spent time in Iraq. I
can say from my experiences at military
hospitals (visiting) and from the stories
I've heard that I do not want military
medicine or the VA as a model for anything.
\_ I grew up on military bases all my life. My
father was a hospital administrator for the
Navy (35 years service). While I would not
suggest that OCHAMPUS is by any means perfect,
it provided adequate health and dental coverage
for us throughout my childhood. I would
consider it a fine model for basic services.
--erikred
\_ The key words you used were 'adequate'
and 'basic services'. I would say
'substandard'. I wouldn't go to a military
hospital unless I had to. Lots of military
people like it because it's free to them,
but if I had a serious illness I would
rather it be treated elsewhere. Also, ask
your dad about the waste that goes on. For
instance, military hospitals require the RNs
to be trained in almost every discipline.
Private hospitals only require nurses train
in the field they work. I think that part
of the reason that military healthcare
seems cheap is that many costs are
hidden. For instance, doctors' salaries
are very low (which scares me in itself)
but there are other benefits they receive
which many think makes it worth their while.
You will not be able to hire doctors
privately at those salaries because the
total package needs to be evaluated
(e.g. retirement benefits, travel benefits,
and so on). I am not sure if studies that
examine the costs of military medicine
account for these externalities. The
military hospitals receive many benefits
private hospitals do not just by virtue
of being part of the military machine
and yet the quality of care still sucks.
\_ I was a medic for three years, so yes
I am familiar with the military medical
system. I think it is fine. The VA
system is even better. We can easily
hire doctors at the pay level that the
military pays them: that is what MDs
make everywhere in the world, except
here. The AMA artificially keeps the
supply low, to inflate salaries. I am
surprised that such a purported free
market cheerleader would not be aware
of this fact.
\_ Many people would dispute your
assertion re: AMA. The AMA does
not have this power. Less than
20% of physicians are members and
the AMA has no direct regulatory
authority. Also, many countries keep
MD salaries artificially low. Spain,
for instance, recruits MDs from
Eastern Europe and Third World
nations at low salaries and
holds them hostage with visas.
It's not worthwile for Spaniards
to even bother with medical
school at those wages. The
salaries of US doctors are high
and it's one reason we have a
high standard of care. Plus, US
doctor salaries have actually eroded
over the past 40 years.
\_ The AMA controls licensing for
medical schools, which is how
they keep the number of doctors
low. Show me proof that MD salaries
have eroded over the last 40 years,
because I don't believe it. Maybe
for primary care docs, but almost
assuredly not for specialists.
Salaries are high due to monopoly
pricing power, not quality.
\_ The AMA does no such thing.
The government controls
this. Sure, the AMA is a lobby
but they can't mandate anything.
http://tinyurl.com/e33gk
http://tinyurl.com/4yn35s
\_ Your articles provide support
for my claim that an
artificial shortage of MDs
has been created. And a four
year snapshot of MD salaries
from 10 years ago doesn't
prove much. Lately MD salaries
are going up:
http://www.csua.org/u/l96
\_ An artificial shortage of
MDs has been created by
whom?
\_ AMA of course.
Why is it so hard to
get a medical edu.?
Actually learning the
stuff isn't that hard,
but getting into the
school is. -!pp
\_ The articles dispute
that the AMA has any
such power.
such power. It is
the gov't that you
trust to admin UHC
which is the problem.
-/
http://www.acgme.org/acWebsite/newsRoom/newsRm_acGlance.asp
"The ACGME's member organizations are the American Board of Medical
Specialties, American Hospital Association, American Medical
Association, Association of American Medical Colleges, and the
Council of Medical Specialty Societies. Member organizations each
appoint four members to the Board of Directors, which also includes
two resident members, three public directors, the chair of the Council
of Review Committee Chairs and a non-voting federal representative."
The AMA is one of the people on the board of the organization that
certifies medical schools, but is not the only member.
\- Might be of interest: WSJ article on non-profit hospital profits:
http://tinyurl.com/55v9th
\_ Nice to know, but in the end it is the government (through Medicare)
\_ Nice to know, but in the end is it the government (through Medicare)
that funds residents. In theory, we don't need any more accredited
programs to churn out more doctors. We just need more students in
the existing programs.
\_ In other words, the AMA (amongst others) controls licensing for
medical schools, which is what I said. The AMA also agressively
lobbies the government to underfund medical education, but that
is a bit more complicated as there are other players. But for
generations, the AMA has done everything in its power to keep
the number of doctors artificially low. Nice to see that some
people are waking up to the fact that this might not be a good
idea afterall.
\_ This is what you said:
"The AMA controls licensing for medical schools"
(This statement is not really true as the AMA does not
have sole, or even majority, control. They have input.)
"which is how they keep the number of doctors low."
(This statement is not really true either since, as I
pointed out, the number of residents is largely
determined by the government.)
The AMA is a lobby out to protect the interests of
doctors. Wow, what a shocker. Next you will tell me that
UAW is trying to protect American autoworker jobs. However,
the AMA always gets blame for artificially limiting the
number of doctors and the reality is that they don't have
that capability. They have the desire, but let's not
overstate their authority. The biggest party at fault is the
government - the same government that people want to run
Universal Health Care.
\_ You said "the government controls this" which is entirely
false. "The government" is you and me, put the blame
where it belongs.
\_ You can increase funding for medical residents? You
should get on that. |
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