Originally posted by: eskimospy
Hey, thanks for an interesting and informative post colossus. I agree with most of what you said.
The only thing I don't agree with is your assessment of 'who is going to pay'. As I've said many times before we're all already paying for universal health care for everyone. We just pay for their care in the emergency room instead of (hopefully) their care before it gets to the critical point. It's a tax built into every product we buy and everything we do. Since we're just nickel and dimed to death by it, we don't notice.
Well I wrote a rambling response at 2AM so maybe I didn't say everything i wanted to say (err type - I should be using Dragon lol). I agree with you that were are already paying for UHC. That's why I pay 260/month for my Kaiser coverage (I'm 33) and my wife pays 290/month for Bx PPO (38). The total utilization for both of us would be about 16K over the last 20 years (6K of that is my ankle fx and plating when I was 23 and 6k for a D&C for my wife). We have both been responsible people and paid for our coverage - even if it meant no trips to movies, Disneyland, no fancy clothes. It comes to an issue of personal responsibility - which becomes a whole other post (that was my rant about the 21 year old pt). I see fairly well off middle class people at my hospital and they are uninsured. That's their choice - but if the hospital sends them a bill for $5k they either don't pay it or only pay about 1k (which in reality is probably their true medical cost). The hospital inflates their prices to get money from the "idiots" like my wife and me. We got a ~3k bill and we paid every penny of it. It would have been so easy to make a fake diagnosis and get my wife emergency medical (hell I've seen millionaire skip bills using medical).
Republicans are always complaining about personal responsibility. I tend be very fiscally conservative and am becoming increasingly socially libretarian. I am a realist (unlike pretty much the entire populace of DC which seems to be all lip service). So I think UHC is the only way to force people to buy insurance by taxing them. Somehow the right will whine about how their getting screwed unfairly by carrying the new burden. Often times the government is needed to ensure people do the right thing. What if they made taxes voluntary
Sorry - was going tangential again. Anywho - a concern is that if you immediately institure UHC w/o having the support system them system will fail. At present the primary/preventive care system is near saturation. Before you give 80 million new people unlimited access you have to make sure they have access. Even if alien came down from space and offered to pay for all the care, you would still need the primary care docs. As the baby-boomers are stretching that system to the edge - a massive influx of 80 million people will result in making the people who already "have a doc" getting pissed off at those get added to their system. This would be a short term effect (5 years) but could mean 2-3 hours waits at your docs office. The medical system needs to address this before hand - not be reactive to it. As most people will agree - most government is reactive instead of proactive. Yes preventative care is always cheaper but it requires diligent follow-up by patients (an attitude change that will be required in part of the populace).
Originally posted by: Atheus
Those statistics only count people who are in the system. Many Americans die outside the system becasue they can't afford treatment.
There is no real inside/outside the system. I'm not sure what "system" you are referring to. Perhaps you are referring to people who are poor and are afraid to go to the hospital because of the bill. I don't know of any reliable study which has addressed those numbers (I don't have a MPH so I can't pull that number out of my ass). But I do know there are also people like my mom who have good insurance who choose not to go to the hospital. I can't address those who choose not to go to the ER when necessary. I do know that regardless of payor status the access to top care (ie mean the latest evidence based agressive treatments) is more readily available to those in the US. Unless you talk to enough MPH and NIH people or read enough articles you won't see this but the US does have the best access. Most specialists in the US will attest to this. I can't even begin to count the number of emergent stenting cases or even the number of acute cholecystectomies done at my hospital to uninsured patients. In a UHC the people would have to wait for their stenting as an outpatient or wait for their cholecystectomies as an elective outpatient procedure. Now this is all firsthand experience at the two hospitals I work at in CA - but CA actually pays more out than it receives in federal funds - the rest of the US should be better off per capita.
As for the claim many Americans die outside the system - I would need to see a major study citing those findings. My firsthand experience and discussions with the docs of old seems to contradict your statement.
The American health care engine is not just broken in who pays for what but also who is getting paid for work. The founder of the Home Health agency to which i referred most of my patients to last year made 2.3 million dollars last year. The durable medical equipment companies and home health agencies are making money hand over fist. Medicine has become a business. No nurse practitioner or physician makes 2 million/yr (unless they whore out to advertisers). If you start a home health agency and bilk medicare for uneccesary services you'll make money and won't even have to ever check a pulse. Funny I'm the CEO of my S-Corp and I don't see myself making anywhere over 200k ever (unless UHC passes). As many have pointed out UHC would get rid of this waste - that is a valid and justifying arguement for it. The goverment would simply remove this waste. Initially it would run efficiently. As overutilizers are found government would just keep decreasing reimbursement until it was not profitable to operate.
I think before UHC is even considered the above consideration for primary care network, eletronic medical record, and end-of-life care should be addressed. The country also needs to do a much better job of policing hospitals. 2 hospitals just 3 miles aways can yield dramaticaly different results by not providing the proper care. Sadly most docs over 55 don't know the proper ACS and CHF protocols. I also sit on the medical policy committee at my hospital and work on making the pathways that we force physicians to use when patients get admitted. Pretty much all the young docs use the pathways - it's always the old rogues who don't follow the rules and that ends up dinging the hospital. The hospital also bears fault by not having proper protocols for nurses/PT/RT/etc. The individual hospitals should not be making these protocols out of necessity. CHF in NY is the same in MN as it is in CA. That's a simple task for NIH but Congress can't even get that done. How much docs do we have in Congress? Does anybody listen to them? Do they even care about this crap? Ron Paul?