BS: Universal Medicine in the USA.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 01:02 PM

But why on Earth should the money doctors get be any less? If anything they could expect to get more since there'd be more people able to make use of their professional skills.

It may be that the proposed system that's been offered in the States is twisted in such a way as to work in way that screws doctors as well as patients by cutting costs to the bone, but that's just a reason to push for a better system that doesn't have those disadvantages and that still provides the kind of comprehensive health care that works pretty well in every other advanced country.

Or perhaps the appropriate way of putting it, that works pretty well in every advanced country.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 11:37 AM

"During his 42 years in politics, Tommy Douglas proved himself as an outstanding Canadian leader. He is largely responsible for our central banking, old age pensions, unemployment insurance, and our universal Medicare. When asked why he stayed with NDP when he could have done better with a more powefful party, Douglas simply replied, " I have watched politicians for the last forty years drop their principles in order to get power only to find that those who paid and controlled the party which they joined prevented them from all the things they really believed in."³ To the end of his days Tommy Douglas was true to himself, to what he stood for, and to the people he represented."

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 11:27 AM

Universal health care, by some definition of the term, has certainly been proposed. A system of single-payer health care, with all medical providers either (1) limited to the amount of compensation authorized by Medicare or some equivalent or (2) required to work for a government entity of some sort has not, by any major political candidate or main-stream political party. If I am incorrect, please refer me to a creditable source for verification otherwise. I will readily admit that there may have been such suggestions made by entities on the idiot fringe.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:21 AM

maybe Universal Health care could help me?

prolly not.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:16 AM

You are a SICK man, John. Very sick. I could get to like you!

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:14 AM

I don't usually drop dimes in the parlance. Heck, I don't even refer to it as "the parlance". I call it "my livingroom". I had a cute little parlance guitar once, though.

Jack Parlance was scary.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:06 AM

In the parlance, 'drop a dime'.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:06 AM

...that, and there's a tiny little scratch on the LP...on the LP...on the LP...on the LP...on the LP

If only there was some cosmic nickel to place on the tone arm.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:01 AM

The reason history repeats itself is because historians repeat each other.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 02 Oct 07 - 09:49 AM

According to the philosopher Hegel, the only lesson of history is that men never learn anything from history!

Private Practice, Public Payment
Canadian Medicine and the Politics of Health Insurance 1911-1966
C. David Naylor Published 1986
McGill-Queen's Press

An interesting and objective look at the Canadian experience - many pages are available to read on the web site.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:54 AM

BTW, EmmaB, I appreciate the response. And that may well be the way things will work out. Though risks and investments are exponentially higher than they were back when your country made the switch, it's all a matter of scale.

Besides, our doctors are, by evidence of what they do, among our brightest citizens. They'll land on their feet. Many will probably lose their private practices and investments and retirements, but on a percentage basis, there are probably a number of them young enough to start over. They won't all be like my 60-year-old brother. And he won't starve either. He may just have to work longer. I know my brother. He'll work longer anyway.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:50 AM

" I've never heard of such a thing being seriously proposed."

You've never heard Universal Health care proposed? What is this thread about?

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 08:47 AM

Emma, I don't think John Hardley has yet answered McGrath's question: Is this system you are on about actually really proposed, or is it black propaganda, maybe put out by the big insurance companies? It appears to be an imaginary target, designed to provide an opportunity to rant. At any rate, having been involved in health care for many years as an administrator, and with a wife who is a health care provider, I follow the news on that topic pretty closely, and I've never heard of such a thing being seriously proposed.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 02 Oct 07 - 08:38 AM

John, I think it has already been explained to you that that is PRECISELY what happened to private practice when the National Helath Service was set up in the UK after World War 2.

There was initially considerable resistance, much as you have dwelt on

"Despite Bevan's repeated guarantees of clinical autonomy for both family doctors and specialists, and a massive majority in favour of the NHS Act in parliament, the BMA chose defence of "clinical freedom" as its rallying cry for opposition to the new service. One BMA leader described the NHS as "a step toward Nazism as practised in Hitler's Germany". Only four months before the NHS was due to start in 1948, the BMA was still refusing even to negotiate with the Minister, a stand endorsed by 9 out of 10 GPs on an 84% vote."

However.......

"Two months after the appointed day, 93% of the population was enrolled, reaching 97% by the end of the year. In spite of themselves, the doctors' feet were indeed set on a new path entirely. They learned from their own experience that release from fee- earning improved rather than impaired doctor-patient relationships. Public service enabled them to serve more people more effectively, at lower cost to the nation, with greater personal security and integrity than they ever had in private practice. By the end of the 1960s, most were supporting the NHS as vigorously as they had once opposed it, and so they have remained."

from ORIGINS OF THE NATIONAL HEALTH SERVICE

I think many other people from the UK have also commented on the excellent remuneration that General Practioners receive for this service.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:22 AM

"John's assumption seems to be that in a universal free-at-the-point-of-use system the doctors would get paid less than under the present one, and insufficient to cover their costs and give them an adequate income."

My assumption is that:

1. ....in a universal free-at-the-point-of-use system OUR doctors (in private practice) would get paid less than under OUR present one, and insufficient to cover their costs --costs, the financial risks of which were fixed and figured under our present system -- and give them an adequate income -- adequate enough to keep their present practices

2. This isn't a blind assumption -- we have the track record of insufficient payment from medicare/medicade to go on.

3. Many regular, middle class sorking grunts in America are invested in the medical care system we have -- by virtue of stocks and mutual funds in which their retirement accounts have been placed. Those too would become severely devalued.

We may decide that that's okay. We may decide to hell with doctors like my brother who invested his life into something for which he will get nothing. That happens all the time. That's why they call it "risk". But don't claim it's a win/win for everyone.

And, please....It doesn't help to have five or six of you repeating that your countries doctors own their own practices. I understand that. I read it the first time. I answered it the first time. Your doctors bought their practices (assumed the risk) under the system you have -- in other words, they knew going in what they could expect to be paid for services rendered. To make a comparison to what we are up against, you would have to imagine that your doctors assumed the risk of buying their practices AND THEN your health care system suddenly told them that their fee for services rendered was going to be severely reduced.

Subject: RE: BS: Universal Medicine in the USA.
From: mandotim
Date: 02 Oct 07 - 06:19 AM

Just to correct a couple of assumptions about the UK National Health Service; General practitioners ('family doctors') do indeed have to buy their practices in the UK, as they are set up as independent contractors to the NHS. Hospital doctors are partially salaried, but are free to develop whatever private practice they wish, and they have to fund premises, staff etc. for this practice.
In a recent comparison, UK doctors were described as the best rewarded (financially) in the developed world.
Also; US healthcare is no longer a world leader in all areas of clinical practice and research (though it remains high on the list); much important work is now done in countries where costs are lower, such as the former Soviet states, China and India. This is particularly true in pharmaceutical development.
Hope this helps to inform a good debate.
Tim

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 03:33 AM

John's assumption seems to be that in a universal free-at-the-point-of-use system the doctors would get paid less than under the present one, and insufficient to cover their costs and give them an adequate income.

I suppose it would be possible to invent a system that worked like that, perhaps as a way of making sure it didn't get introduced, but it's not how it works in the other industrialised countries which have such systems.

Subject: RE: BS: Universal Medicine in the USA.
From: Barry Finn
Date: 02 Oct 07 - 02:52 AM

In this rich & wealthy land of ours we rate internationally pretty low overall on the health care scale, infant mortality, life expectancy, acess to proper medical treatment, costs, etc are 37th though we are consided to be one the formost in technology & wealth, so something isn't right. Our system is not in need of repair it is broken & is in need of replacement. It's not hard to take a lookat some US state systems that work as well as looking to those nations that run better programs (there are at least 36 of them) & taking a look at what works for them & applying the better parts of their systems into one that would work for us. Ms Clinton's plan may not be the best but at least she's looking towards a start which is better than what most are doing & even the presenting of a national health care plan is a step that most others are refusing to do. She was slamed the last time she brought this up & even then it's time was well over due.
I'd love to see her (once she's in the Oval Office) set up a commision to look at what the rest of the world is doing & go from there.
As it is outside of the wealthy one of the most important attractions of ione's job today is it's health benifits & those range anywhere from complete coverage at hardly any cost to no coverage & they either pay out of pocket, get their own coverage or go without. Much of the population that I see are trapped by their on the job health care coverage. Retire or quit, forget it your coverage costs skyrockets & the actual coverage plumets (don't tell me about Medicare coverage I opted for as much coverage as possible & that's slim for someone who needs a lot of it & very costly to boot). Your kids are screwd once the turn 18 (with the exception of a few states that are only now just changing that coverage to age 23-26 weither they're in college or not. Unions usually provide better coverage for their people because they are in a beter position to bargin for it but their getting hit too as we see from the new Auto contract. The Drug manufactures are making a killing on the living. My mother used to raise dogs, we have one of her's, she mentioned a medication & I said that that's the same thing my son takes. We were sure it couldn't be the same because she paid about .50 per pir for her dog's perscription when my son's cost about $5 for the same pill, it turns out to be the exact same pill & then we found out r=that this isn't uncommon. Canada's become an American market place for many older & not so old who are in need of cheaper med's, there's absolutely no just reason for this, it's a shame.
The high costs of liability medical insurance is uncalled for. Malepractice is more a threat than a reality, it's the insurance companies scapegoat for unduly raping the medical community. IN the Boston aarea yrs ago we had a scandle at a day care facility, three people were charged with abuse (falsely in the opinion of many) this gave the insurance companies the excuse they needed to hit this industry with uncalled price gouges for premium to be paid for even though incidents of this kind were extremely uncommon & still are even 15 yrs later but the costs of those premiums are still sky high even with the general knowledge that these 3 were not guilty of what they'd been convicted of. This is what the malepractice insurance is about high costs for high profits! Many of our elderly even though they're covered by medicare & medicade have to make the discision between medical care &/or prescriptions or decent food shopping, that's a system gone broke.
Much of the insurance industry today believes that they are the botton line on what type of medicane & medical procedures are exceptable too. They decide weither or not some prescriptions & procedures will be covered regurdless of what the medical staff may say. Many companies just routinely deny pretty much anything as policy & then it's a case for the sickly sucker to start chasing the insurance money down for the medical parctice that's getting the same shaft as the insured, that's part of what's killing the patient & the doctor, aside from the insurance companies overwhelming both to death in paper work that neither can afford to keep up with. So both doctor & patient head towards becoming bankrupt. The government is just as bad as the insurance companies in this aspect, they are extremely slow sometimes in paying they per set undercutting costs, it's funny that everyone except the uninsured pays out so little for services rendered that costs so much higher for the same & the payment is usually collected upon reciept from the same too or else the leg breaker comes for the deed to the family ranch or whatever else.
Anyone who thinks the system works hasn't had much experience dealing with it or is well off or one of the lucky ones to either have a very good plan from work or belongs to a very healthy family!

Barry

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 01 Oct 07 - 09:28 PM

The way it works here in Canada is that doctors either join an established practice or open one of their own, they then bill the government instead of the patients for services rendered. Pretty simple really.

Subject: RE: BS: Universal Medicine in the USA.
From: Bee
Date: 01 Oct 07 - 09:26 PM

Doctors here in Canada all have their own practices, their choice of how they deliver care, their choice of where they want to practice, how much time they want to put into it - why would a doctor lose his practice because of public medical care? We have shortages of doctors in some rural areas because most doctors prefer living in cities, but those shortages are usually short term: sometimes incentives are offered young doctors to practice in rural settings.

I live sixty five km from the city. There's a small 'emergency care' hospital about 20km away, attached to a nursing home. There's a medical clinic near that mini-hospital which has six doctors and three nurses in family practice, all with their own patients. One of them is my family doctor, but if I need an appointment before he can see me (he's very popular), one of the others will see me (I've never had to wait more than three days to see someone on a minor complaint - and that was my judgement; if I needed to be seen, I would get a same day app.). There are also plenty of single practice doctors in the city, and most specialists have private practices.

Doctors get paid per service, they aren't on salary.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 09:16 PM

McGrath, to the best of my knowledge, nobody has proposed a plan that has all medical providers either working for the government or required to accept Medicare payments. Hillary Clinton's plan, which has been seriously lambasted by her critics as the prelude to socialized medicine, is if you have a [insurance] plan you like, you keep it. If you want to change plans or aren't currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums. That is from her campaign website.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 09:11 PM

McGrath, The doctors in your country did not buy their practices (which generally entails paying for them -- an ongoing thing when practices cost deeply into six figures) under a system whereby they could make the payments on their practices and still have sufficient left over for living...

...and then have the entire payment structure upon which those commitments to pay were pulled out from under them. All your doctors who own practices bought them under your current system. Do you think they could hold onto them if suddenly your "system" decided that all of a sudden your government was not going to pay as much as it had paying all along? Do you think the doctors who own their own practices could keep them if they were suddenly given only a small percentage of the fees upon which they had predicated the purchase of their practices?

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 01 Oct 07 - 08:28 PM

their cost of living won't just disappear just because they no longer have their own practices.

Why won't they have their own practices? How on earth do you think medicine runs in my country? Of course doctors have their own practices. Or put it the other way, of course patients have their own doctors.

I really do get the impression that the kind of system that you are objecting to, John, must have been dreamed up by people who are trying to sabotage universal health care in the States. Is this system you are on about actually really proposed, or is it black propaganda, maybe put out by the big insurance companies?

If it's real, it would hardly be difficult to come up with a system that wouldn't have those kind of drawbacks - just look around to countries which have been running systems like that for decades. And that's the way to oppose it, not trying to defend a totally absurd system that happens to have grown up in the absence of something better.

"they no longer have their own practices." Weird!!

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 08:13 PM

I read, kat. That doesn't mean I agree. No evil intent there, I'm just not seeing how an already existing practice -- for instance a practice that already KNOWS it cannot survive on medicare/medicade levels of payments (not in theory, but in real life practice) could expect that it will suddenly have its fixed costs of doing business taken care of when all payments are at the government-determined medicare/medicade level. It's not a hypothetical. It's real and my brother lives it.

And sure, it's just doctors. They're expendable just like any other worker whose livilhood is based on an outmoded idea. I'm sure no tears were wept for the slide-rule manufacturer when TI came along and made them obsolete.

On the other hand, it's a little different too. The slide-rule manufacturer was made obsolete and just went to another industry. But we will still need the doctors. Even the ones who used to be able to have a private practice (it'll be sort of a rich irony -- the private practices like my brother's will go up for sale and be picked up by younger doctors who will be able to buy them a penny on the dollar from the suckers like my brother, and with a new financial structure (that doesn't include a huge business loan -- having gotten the business so cheap), may well be able to make the same practice then work with medicare/medicade level payments).

This discussion has made me think about contacting my cousin to get his opinion. I hadn't really thought about him (relative to this discussion) because I just met him. We're both in our fifties, but because my father died when I was very young, and our families have always lived more than 700 miles apart, I never met the guy 'til last Summer. Anyway, he's a doctor who lectures internationally on stem cell treatment. He's a Johns Hopkins guy and has always been hospital-connected. I'd be curious to hear his take on the whole thing and how he thinks it will impact him. Would anyone be interested in his response if I called him and discussed it?

Subject: RE: BS: Universal Medicine in the USA.
From: Bobert
Date: 01 Oct 07 - 07:59 PM

Well, one thing is for sure and that is the American health care system is not working for US as a country...

We spend the highest percentage of of GNP on it of any developed country and we still don't live as long or as well as most of our developed country counterparts...

This, in itself, should have us scratching our heads 'cause something is wrong...

B~

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 01 Oct 07 - 07:41 PM

Oh, John, have you read nothing? It doesn't have to be either/or. There are always more than two solutions. Folks have posted plenty of examples of how docs made the transition, still kept their private practices, etc.

I agree with you about the medical ads; people self-diagnose according to the television ads they see and hear. I wrote an editorial about it years ago when they first started allowing prescription drug ads. I wish they would ban them, again.

Not all alternative medicine is quackery.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 07:39 PM

Perhaps so, John Hardley. However, my own experience is based upon working for over 20 years in a government-run medical program, in which all of the employees worked for the government, were immune to personal lawsuits and where the patients were generally ignorant of medical advertisements. This is also a system which normally scores well above the national average in both Joint Commission evaluations and patient satisfaction surveys. I refer to the VA, of course.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 07:28 PM

I think that there's something a little more insidious (not evil insidious -- just hidden insidious) than doctors just doing it *because they were taught that way* to the ordering of all tests.

Yes, I agree that it has to do with CYA for lawsuits. That may even be the biggest factor.

But the other factor is that everyone thinks they're a doctor these days. Sit around and chat with a doctor for a while and the discussion is bound to soon come up -- a large percentage of their patients comes into their appointments loaded for bear.

They've seen all the advertisements for prescription drugs and think they know what's best for them. Additionally, alternative medicines have made a huge comeback and REALLY well-educated people are regularly duped by quackery -- but they are sure they know more than their doctor. And they've been watching every doctor-on-TV show from Marcus Welby M.D. to House. They know what an MRI is for dad-gummit, and they expect it.

It will take some getting used to practices with only government owned equipment. For an MRI one will probably have to travel a bit (All those European countries that are socialized have about the area in miles of one of our States) until the cost of equipment like that goes way down and more machinery can be disbursed everywhere.

Lots of our hospitals are incorporated too. The stockholders (workers with their retirement accounts diversified through mutual funds etc.) will lose the value in medical stocks (just as the average worker did with the enron scandal when the savy saw the collapse but didn't share the info) as they become completely worthless. Maybe with enough lead time the savy ones can pull their medical stocks and reinvest them into something else.

Of course, those hospitals will still exist complete with whatever equipment they already have -- assuming that the government will send government doctor/managers to the hospitals that already know what's what. They'll probably just maintain as much of the staff that a hospital currently has that is willing to work for the government.

And, in reality, those who are put out of business, like my brother, will be selling their services a penny on the dollar at first because their cost of living won't just disappear just because they no longer have their own practices. So government run facilities will probably have a bit of a glut of doctors for a while. Then they can start tracking young students and grooming them as medical workers in the new system. They can manage the number of doctors to make sure that there aren't too many new ones coming into a glutted system, or give incentives to more students if they anticipate a doctor shortage.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 01 Oct 07 - 07:02 PM

Often tests are ordered by a physician in order to cover their butts in case a patient brings a malpractice suit against them.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 06:56 PM

In many cases it is not necessary for a diagnosis, but physicians order a MRI (for example) because their training pushes them to order one each of everything. Then the patient (or the insurance company) pays for it. The physician gets no compensation for ordering the test, in most cases.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 06:49 PM

You're not implying that you want practices to not have that equipment, are you? ('cause it sorta sounds that way).

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 06:32 PM

Not to say that the ridiculous cost of medical care in the US is mostly driven by the desire to increase the profit margins of the insurance companies, but medical education also plays a very interesting role.

Most medical schools are university-affiliated and are proud of being very well equipped. One result of this is that medical students are taught that CTs, MRIs, EEGs, EKGs and so forth are standard/normal diagnostic tools and wouldn't consider a medical workup on a patient to be complete without them. As a result of this, they generally won't go to work somewhere after their residency is complete if these aren't available to them, which forces their prospective employers (and a very large number of physicians, especially new graduates, are "employees" rather than having an independent practice) to either own this very expensive equipment themselves or have it available on a contract basis. And of course, to complete the circle, once you have it you are going to use it and bill accordingly.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 03:37 PM

The insurance companies themselves should be the subject of a congressional review.

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 01 Oct 07 - 03:36 PM

Yes, indeed, Emma! Now, it seems to me that I learned in my high school civics class (Do they teach civics in high school any more? I went to high school in the late 1940s, shortly after the Big Bang), that a few old geezers scribble something like

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

on some old piece of parchment. But then, who (including our fearless leaders) pay any attention to such old documents anymore?

(Now, Firth, don't be snide!)

Kent, it sounds like things are working pretty well in your area. I have tried making my next yearly appointment (cardiologist) before I leave the office, but am told, "We don't book that far in advance." And it's a bit hard to time the prescription because sometimes the doctor renews it for three months, sometimes six, and sometimes a year. He doesn't tell me.

I sort of wonder if it depends on how many more payments he has to go on his Chris Craft.

I live in an area of the city (Seattle) that's rich (!) with hospitals, clinics, and doctors' offices. I'm just a few blocks from what the "locals" refer to as "Pill Hill." But they all seem to use the same standard recording on their telephone answering machines:   "Please leave your name and telephone number after the beep. If this is a medical emergency, call 911." 911, of course, is the city-wide emergency number for calling fire, police, or Medic One. Seattle, I am told, is a great city to have a heart attack in because if you call 911 and ask for Medic One, a well-equipped van with a couple of paramedics will often appear at your door, amazingly enough, within three to five minutes. They will give emergency treatment on the spot, then transport you to a nearby hospital if necessary.

Medic One is paid for by taxes. And it's one of the services the city is proudest of.

Medic One.

But once you get to the hospital, it's on your dime. Or your insurance company's, which the hospital will determine as you are being admitted. Or, in some cases, before you will be admitted. Stock question:   "Do you have insurance? How is this to be paid for?"

There is one clinic in my vicinity where it is possible to get an appointment within a day or two, sometimes the same day. "The Country Doctor." It has a small permanent office staff that makes appointments and handles the paperwork, processing insurance claims (if there are any). I don't know how the place is supported. The doctors, I am told, are volunteers who take time from their own practices and come in a couple of days a month. The clinic provides primary care service. But if you need X-rays or something like that, they have to send you to a nearby hospital that they have some kind of arrangement with because The Country Doctor has very little equipment, and most of that, as I understand it, has been donated. They have no facilities for a heavy-duty medical emergency. The care there is pretty darned good, considering. But you almost never see the same doctor twice in a row, so there is no continuity. At least, this was the way it was about ten or fifteen years ago.

I have been told that a factor that jacks up the cost of health care in the United States is one of the engines that drives Capitalism:   good old competition. If one hospital in a locality gets an MRI or a CAT scanner (mucho bucks. As in "Mega-!"), all the other hospitals in the area feel they have to have one too. And, of course, the cost of the gadget is divvied up over all the medical bills the hospital sends out (even if you don't get a scan yourself). In other countries, one CAT or MRI scanner in a locality is considered all that is necessary, and all the local doctors and hospitals send their patients there if a scan is deemed necessary. This keeps the cost of medical equipment within a particular locality down.

I have been told that, with its many hospitals, there are more CAT and MRI scanners in the city of Seattle than there are in all of Canada. And Canada is not bereft of such devices.

It has been said that the measure of whether a society is civilized or not is in how it treats its weakest members:    its children, its elderly, its poor, its disabled, and its ailing;   and in how it treats its criminals. Does it attempt to rehabilitated, or does it merely punish?

This has been attributed to many people:   Gandhi, Churchill, Jimmy Carter. . . .

It matters less who said it than it does that we heed it.

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: PoppaGator
Date: 01 Oct 07 - 03:07 PM

In the current US system, not only does a large share of the healthcare dollar go to insurance-company profits ~ more to the point, a huge proportion of the money and man-hours is spent in finding reasons to DENY care to insured applicants.

The unfairness to uninsured citzens is a whole other ball of wax.

I think we'll get some kind of universal health system fairly soon because it is in the interest of the multinational corporations (often erroneously called "American Big Business") to unload the extra expense of providing health plans to their employees in the US.

These organizations own our governmental representatives, having paid for their elections, and will soon insist that the US government start picking up the tab for medical care, just like every other national government in the "developed world." It's the only way for American workers (and American managers, too, for that matter) to compete globally on a relatively level playing field.

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,Neil D
Date: 01 Oct 07 - 02:53 PM

I've seen cited on another thread the high cost of doing business for doctors as an argument against universal haelthcare. The highest cost of doing business in many cases is their malpractice insurance premium. In some regions this is driving some doctors out of fields like ostetrics completetly. Once again insurance is the problem. If malpractice insurance were nationalized along with health insurance would this smooth the way toward universal coverage.
   How about more in the way of grants instead of loans for qualified medical students to get rid of some of that debt burden. I've always thought that free public education should be extended through college anyway. If 12 years of public school was a good idea in the 19th century 16 years should be the equivalent in the 21st.
   If some of the financial burdens on doctors could be eased the medical community might be less hostile to the concept of universal healthcare, although the insurance industry would be more obstructionist than ever.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 11:05 AM

A public welfare system separates civilization from barbarism. We are indeed the keepers of our brothers and sisters.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 01 Oct 07 - 10:25 AM

Another situation where a fine word can take on a derogatory meaning

Welfare - well being, freedom from want, sickness etc.
          activity designed to improve social conditions of an
          individual or group.

Subject: RE: BS: Universal Medicine in the USA.
From: Bee
Date: 01 Oct 07 - 10:17 AM

I think many Americans are unaware of how people in other countries regard their health care system - it just seems barbaric to us, that people in a wealthy modern country can go without basic medical care because of insurance or finances.

I have an elderly American aunt who went ten years with a simply corrected common condition which causes incontinence in older women. She couldn't afford to have it fixed. Her medical insurance (through employment) in the US considered it a non-essential procedure. Her eventual solution was to move back to Canada, where she hadn't lived since 1948, and stay long enough for MSI to kick in so she could get some treatment. (Annoying, because she hasn't put anything into Canada, and thinks the US is a much better country, plus was a truly aggravating longterm guest for her relatives).

I've often read on US forums complaints from people made miserable by minor ailments they let go too long because of the cost - infections allowed to get very serious, pneumonia allowed to become disabling, eye infections threatening sight. These people aren't even complaining about the system, but beating themselves up for having a bad insurance company, or being unemployed, or poor.

I cannot fathom why any American would not be pushing their government to start working on a better system, and yet many seem to think public health care = communism (or welfare).

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 09:44 AM

Guitar player?

Subject: RE: BS: Universal Medicine in the USA.
From: John MacKenzie
Date: 01 Oct 07 - 04:47 AM

My doctor has just bought himself a new Aston Martin DB9!

Subject: RE: BS: Universal Medicine in the USA.
From: Kent Davis
Date: 01 Oct 07 - 01:00 AM

katlaughing,

I totally agree that insurance is a huge part of the problem. Have you ever considered what would happen to, say, grocery prices if millions of people had "grocery insurance"? If millions got "free" groceries or had only a low co-pay? If the poor had "Foodicaid" and the elderly had "Foodicare" and both got their groceries without regard to their real cost, but with their grocers heavily regulated?

Kent

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 01 Oct 07 - 12:15 AM

That is good information, Kent, but in some areas, such as western Colorado, some specialists are few and far between. For instance, there is now only one nephrologist to serve all of western Colorado. That is a vast area. He had a partner, they both worked through the largest hospital between Denver and Salt Lake City. His partner quit to save her life; she had no time for anything but rushing around. They BOTH are fantastic about giving a patient as much time as they'd like to ask all of the questions, etc. They are both wonderful doctors and truly thorough, understanding, and compassionate. I know if there were an urgent need they could get me in, but usually it takes 6-8 months to get in, esp. now there is only the one. It is an insane way to live and I totally understand the one quitting.

I know of a doctor on Cape Cod who stopped taking ay insurance at all. She notified all of her patients and helped them find other docs who could take them if they just could not pay for her services. She did so because the paperwork was too much. Now, when someone goes to her and pays $100 for an hour, or whatever she is charging, they know they will get to talk to her for an entire hour with no pressure to move along, etc. much the same as I do when I go to my acupuncturist. I know I have a solid hour of treatment and consultation with him.

I know we could never expect all docs to to the same as her, but it sure seems to work for her and those patients who like to work on a cash basis. I respect her for saying "no" to the insanity and scaling back to what she knows she can handle with integrity intact.

IMO, the biggest stumbling block to any kind of universal healthcare in the US is the insurance companies and drug companies. They are in bed together, have incredible profits, and are not going to give any of that power up willingly.

Subject: RE: BS: Universal Medicine in the USA.
From: Kent Davis
Date: 30 Sep 07 - 11:37 PM

THREAD CREEP AHEAD, but I thought it might be useful.

Don Firth and others,

In our practice, established patients are often seen within 24 hours if they are sick, and the wait is rarely over 72 hours. If they call early in the morning, they are often seen the same day. If the diagnosis is obvious and the risk of complications is low, they do not even need to be seen; we handle everything over the phone (at no charge) including calling in the prescription, if any. This is not only true at our practice but is common among primary care physicians, at least in our area (West Virginia and Appalachian Ohio).

However, sometimes patients tell me that they've waited for weeks for an appointment. This tends to happen when people call for an appointment without saying WHY they want one. Some things can wait; others can't. Patients who are not sure whether something can wait or not can and should ask. As a rule, they'll get an answer that day. If they think it can't wait that long, they probably ought to go to a quick-care facility or emergency room.

For chronic condition such as diabetes or high blood pressure, we set up the NEXT appointment before they leave the office. Try that with your specialist.

Hope this is helpful.

Kent Davis

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 30 Sep 07 - 10:53 PM

"The Commonwealth Fund is a charitable foundation established in 1918 by Anna Harkness (wife of one of the original Standard Oil investors, Stephen Harkness). Charged with the mandate to "do something for the welfare of mankind," Ms. Harkness founded the organization with an initial endowment of $10 million dollars. Her son Edward Harkness served as its first president, and through additional gifts and bequests between 1918 and 1959, the Harkness family's total contribution to the Fund's endowment amounted to more than $53 million.

The Fund is one of the major philanthropic foundations in the United States today and one of the few established by a woman. Over the years, it has given support to medical schools and to the building of hospitals and clinics in rural areas. In New York City, the Commonwealth Fund was a major contributor to the building of Columbia-Presbyterian Medical Center of the College of Physicians and Surgeons and Presbyterian Hospital at Columbia University in 1922."      ~ Wiki

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 30 Sep 07 - 10:33 PM

Anecdotal datum:   to keep a particular presciption going, I have to see a specialist once a year. Notified by my pharmacist that the prescription was running out, I called the doctor in August to make an appointment. The earliest opening he had was on October 18th. His nurse did call the pharmacy and told them to keep filling the prescription.

But--two months to get an appointment!

Similar experiences with other doctors. Sometimes what I wanted to see a doctor about simply goes away before the appointment. But what if. . . ?

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 09:30 PM

A recent article in Business Week put it bluntly: "In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.......

.....not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money.......

.......A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice.

Paul Krugman, New York Times july 2007

full report on The Waiting Game here

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 09:26 PM

That's easy enough to argue in any country that has had a military draft. If the country is good enough to die for then the country's good enough to live for.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 30 Sep 07 - 09:23 PM

Good link Emma.

Two big impediments to the US looking to it's neighbours are the "we're no.1" attitude and the "socialism" bogeyman trotted out by politicians and their financiers at the mention of universality.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 09:20 PM

Universal Health Care can be made to work. Indeed, it must. I opine the biggest stumbling block is accepting that it is the right of every human to adequate health care. To suggest otherwise is, imo, akin to saying some folks are just more naturally deserving than others. That'd be a tough one to explain.