And the winner of tonight's Republican debate...

madmallard wrote: here's the problem. In almost every socialised medicine provider in the world, the government tells the doctor what his service is worth. When socialised medicine is the rule, and not the option, this is a form of conscription of services. The doctor is not free to charge what they see fit for their services, instead the government decides this irrespective of the consideration of that doctor's life work, their livelyhood, their cost of education, or any of the other costs it took this person to reach their level of expertise.

You can take that out and replace "doctor" with any other government run profession: teacher, fire fighter, soldier, police officer, project manager. How is it different telling a doctor that than telling a teacher that?

As things stand, aren't many doctors employed by hospitals that dictate how much they get paid? How is it different when it's a private corporation dictating how much money you make?

Also, I'm not sure how it works in countries with socialized medicine, but is it illegal to be a private practice doctor? Somehow I doubt it. I suspect there are plastic surgeons and private psychiatrists in Canada. Somehow I suspect the result would be much like for teachers, where you can work at a private institution, but most will choose and prefer to work for public institutions because they provide better pay and benefits.

Health care is a modern day euphemism for health insurance (a method of payment).

The problem is, that no effort whatsoever is being made to control health COSTS.

$75 BandAids are unsustainable.

There is no point in having health insurance without understanding the nature of health costs, and attempting to limit the skyrocketing costs.

Without a focus on health costs, ANY program (government or private) is COMPLETELY unsustainable.

So, we pass "Health Care", the costs continue to skyrocket, we have no idea how to control the costs, and we can't pay for it. NOW WHAT?

Simple- limits benefits, or raise taxes.

Sooner or later we hit the limit on how much we can raise taxes. When that magical moment happens, only one option left- limit benefits.

Then, we can no longer argue about treatment (access to health "care") being a "right". Because, the fact is some people WILL NOT be able to afford what others can, with or without health "care".

There ARE limitations to the services available to recipients of EVERY socialized system. When you can't pay for the services, they are no longer available, and only the wealthy who can pay for them outside of the system get treated.

With or without a government health "care" plan, it is mandatory to focus on enabling the industry to hold costs and make it sustainable. Since we don't want to do that, the final result is pretty obvious.

Oh, the original question...

...the winner was Palin, for not showing up.

Salanis wrote: As things stand, aren't many doctors employed by hospitals that dictate how much they get paid? How is it different when it's a private corporation dictating how much money you make?

Very few doctors are employed by hospitals. They contract with hospitals as subcontractors, and are free to move to other hospitals or renegotiate their contracts as they see fit.

Teachers don't own businesses. Doctors do.

madmallard wrote: Its immaterial if they are earning obscene profits. I don't think it should apply to tax cuts, because philosophically, they earned that money in the first place, a cut simply allows them to keep more.

oldsaw wrote: I gotta side with madmallard on this one. I don't have a problem with any company that earns "obscene" profits. The definition of obscene is as varied as people using the word. It's as pliable as one's definition of liberal or conservative. The problem is that there are those who feel they are qualified to make that definition. What makes them qualified? And what process was used to determine what "is" and what "is not" obscene? And what should all the evil rich do with their ill-gotten gains? Maybe they should go to jail because aparently it's criminal behaviour to make a profit. Or, maybe they should pay more taxes to the government. You know, the bloated, wasteful system that borrows more money than it collects or even hopes to collect? One also has to wonder if people know the differencess between profits and profit margins (either gross or net)? Which company is more evil, the one the invests 70 billion to make 80 billion or the one that invests 100 million to make 1 billion?

Obscene sounds like it was a button word for you guys. Sorry to mash that button.

My whole point was more tuned towards groups stating we're poor as a country but can somehow still afford to subsidize some industries with tax cuts targetted to those industries. All while we cut education and other social programs vital to our future productivity and (hopefully) world relevance.

That said, if you target an industry with tax cuts, you no longer have a free market. A free market is free of any interference. Giving preferential treatment to one industry, or corporation, over another is tinkering with a market and therefore makes that market decidedly not free.

I think everyone here has an excellent point or two going. Nice.

Salanis wrote: You can take that out and replace "doctor" with any other government run profession: teacher, fire fighter, soldier, police officer, project manager. How is it different telling a doctor that than telling a teacher that?

Most of these things can't be compared directly, because either the labor pool for these things has been consolodated by a union (eliminating any competing party), or in the case of police, has no private sector counterpart. Police execute the affairs of government by force that no private entity (except maybe bail bonds-men) are granted, so there is nothing to compare it to.

As things stand, aren't many doctors employed by hospitals that dictate how much they get paid? How is it different when it's a private corporation dictating how much money you make?

A hospital is either state owned, or privately owned.

Also, I'm not sure how it works in countries with socialized medicine, but is it illegal to be a private practice doctor? Somehow I doubt it. I suspect there are plastic surgeons and private psychiatrists in Canada. Somehow I suspect the result would be much like for teachers, where you can work at a private institution, but most will choose and prefer to work for public institutions because they provide better pay and benefits.

In most of these countries, yes. If the medical specialty is offered by the state, no-one else can practice, which pretty much leaves extreme specialists (which the government won't pay for anyways), and cosmetic medicine. (also not covered by the state.)

So when the government has the monopoly on providing medical care thru use of force of law. In your example, the doctor can LEAVE that one corporate entity for another. Here, the reality is, there is nowhere else to go.

madmallard wrote: here's the problem. In almost every socialised medicine provider in the world, the government tells the doctor what his service is worth. When socialised medicine is the rule, and not the option, this is a form of conscription of services. The doctor is not free to charge what they see fit for their services, instead the government decides this irrespective of the consideration of that doctor's life work, their livelyhood, their cost of education, or any of the other costs it took this person to reach their level of expertise. People either are blind to these consequences, or understate the impact this has on other things in medicine. Becoming a doctor no longer has financial appeal, so studying medicine drops. Fewer doctors means less care to go around.

Your theory about socialized medicine relies on the idea that Dr's charge per the procedure. Most socialized medicine systems I've read about offer a Dr a salary. That salary is typically a very good one due to education levels required. Dr's are a respected profession and are treated as such in most societies. Consider also that those same societies often offer some sort of subsidized education and Dr's in socialized medicine countries can be better off than ours.

So saying being a Dr in a socialized medicine society has little to no draw? I'd argue that's untrue. But saying Dr's are only motivated by money to become Dr's and heal people? I'd argue that's untrue as well. Quite a few I know refer to it as a "Calling". The money and respect are a part of the deal, not The Deal.

madmallard wrote: We're now seeing a complication arising from Medicare that directly reflects this. Doctors are refusing to treat patients using Medicare because they either a: have a problem getting claims settled, or b: are getting paid a low-ball amount by the government for the services they performed. Whats the next step to deal with that? Likely a bill to force medical providers to accept Medicare no matter what, or pay significant tax penalties, has been kicked around already...

It's ok for private insurance companies to set a rate to reimburse Dr's for but it's not ok for Medicare to do that same thing? Believe me, there are some Dr's who will not accept some insurance companies coverage. The private insurance reimbursement rates are too low. The trouble to get paid is too great.

By that logic (medicare cost control efforts = private insurance company cost control efforts) then private medical insurance is the great socialist satan as well.

We will have to find a way to control medical care costs. It can't keep rising at it's current rate or we'll all have a local voodoo Dr on speed dial. As that's all the medicine we'll be able to afford.

SVreX wrote: [Government]Teachers don't own businesses. Doctors do.

minor edit, there.... ;p

Certain charter schools, colleges, and private primary schools (in the US usually means a religious academy) often have teachers with significant interests in the organisation.

madmallard wrote: Certain charter schools, colleges, and private primary schools (in the US usually means a religious academy) often have teachers with significant interests in the organisation.

Are you implying that public school teachers don't have an interest in "the organization" they teach at?

I'm not trying to play gotcha. Just trying to understand your viewpoint.

I think he meant a vested interest, as in a financial stake, or even ownership at times.

Xceler8x wrote: Your theory about socialized medicine relies on the idea that Dr's charge per the procedure. Most socialized medicine systems I've read about offer a Dr a salary. That salary is typically a very good one due to education levels required. Dr's are a respected profession and are treated as such in most societies. Consider also that those same societies often offer some sort of subsidized education and Dr's in socialized medicine countries can be better off than ours. So saying being a Dr in a socialized medicine society has little to no draw? I'd argue that's untrue. But saying Dr's are only motivated by money to become Dr's and heal people? I'd argue that's untrue as well. Quite a few I know refer to it as a "Calling". The money and respect are a part of the deal, not The Deal.

Doctors under socialised medicine have 2 classifications; state paid and state owned.

State paid is the primary example I was referring to so we could compare apple to apples without getting into the particulars of the example you're working from, cuz there's lots of additional factors to get into.

You're also comitting the flaw of ego bias. I never said all doctors are solely motivated by money. And by saying that some ARE doesn't mean that all are. To ignore this is not realistic and to deny that it would have any impact on how many doctors are produced is attempting to ignore the incentive personal wealth represents.

It's ok for private insurance companies to set a rate to reimburse Dr's for but it's not ok for Medicare to do that same thing? Believe me, there are some Dr's who will not accept some insurance companies coverage. The private insurance reimbursement rates are too low. The trouble to get paid is too great.

Its not okay for the goverment program Medicare, who carries the -force- of the government. Nor is it okay for a private insurance company to lobby for use of that force on their behalf either.

You're confusing the act with the system in general. Use of the force of the state eliminates any choice of alternatives. There is nothing wrong with the private insurance company to set terms of service; I wasn't compelled to use their services until this health care reform act passed.

We will have to find a way to control medical care costs. It can't keep rising at it's current rate or we'll all have a local voodoo Dr on speed dial. As that's all the medicine we'll be able to afford.

Our current administration has KNOWN that there has been an ever increasing shortage of medical providers and practitioners in the country even before passing the reform bill. Still they pushed it thru, knowing it would increase demand likely more than %30 for health care in the country.

Instead of looking at the cause of costs, as shortages are certainly one of them, they blankly said something similar to what you did. "we have to control health care costs." Without qualifying that any further, that means using the force of the state to set the costs, one way or another. This is intellectually deficient and without understatement a gross danger to the practice of medicine.

wow

this is interesting. What a thoughtful group of people we've got turning.

I haven't been this interested in furthering discussion in a while.

Agreed that it's a great discussion. I don't have much to add, but this:

Privatized health insurance (idealized, not today):

Dr. accepts health insurers which he feels pay enough for various items and are easy enough to work with that he doesn't need five secretaries to get paid

Socialized health insurance:

Dr. realizes that since socialized medicine accounts for some 90% of his available patients (what I would presume is an unavoidable eventuality), he has no choice but to accept federal insured folks. Federal government realizes that the Dr. has no choice and inevitably through political grandstanding and back deal making marginalizes the Dr.s cost down to nil. No more competition, no reason for insurers to try and better the Dr/patient relationship.

a sad thought... but this is something that was foisted on us not by the government, but by the "free market".

Over the years, Doctors have had to shell out more and more money to cover their own medical malpractice insurance (when I lived in PA.. OB/Gyn docs were going out of business right and left due to crushing premiums) and had to raise their rates to cover their own expenditures. This in turn gave rise to medical insurance and HMOs to help cover the gap between what you could afford and what the docs were charging.

Ask any Doctor, HMOs and other insurance do NOT cover everything the doc does for you. They will nit pick the bill to death if allowed.. so the doc charges the HMO even MORE to recoupe what he is actually asking for... this raises the rates even more and puts the price of medical insurance further out of reach of the normal person.

not that mandated insurace will be any better.. look at any state that mandates car insurance...

^Tort reform is integral to controlling health care costs.

very very true.

I was reading an article recently about a new thing they are doing in NY. They are taking Judges with health care knowledge and getting them involved with the lawsuits EARLY. Rather than letting these things go to Trial, the judges sit down with the lawers and a knowledgable nurse to hammer out settlements ahead of time.

Yes the settlements are often less than the people want.. but they come MUCH earlier (rather than years later) and with less costs eaten up by the court system

z31maniac wrote: ^Tort reform is integral to controlling health care costs.

How about a libertarian looking for regulations in the name of tort reform. I hate to, though, because it's really a failure of the judicial system. The framers didn't have elections in the judicial system, so I am not really sure how to handle that in utopia. If I was a judge, I would not only throw out cases like that but slap the lawyer and plaintiff with a huge penalty for wasting everyone's time and money.

^It's tough for sure.

Something else that needs to be addressed in this country is our lifestyle and diets.

People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem.

But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices?

I'm trying to think of the name of the healthcare book I read a few months ago that makes some really good points about the top 6 medical conditions (including asthma and diabetes) that could be easily prevented/treated, that currently soak up TONS of resources.

madmallard wrote: Doctors under socialised medicine have 2 classifications; state paid and state owned. State paid is the primary example I was referring to so we could compare apple to apples without getting into the particulars of the example you're working from, cuz there's lots of additional factors to get into. You're also comitting the flaw of ego bias. I never said all doctors are solely motivated by money. And by saying that some ARE doesn't mean that all are. To ignore this is not realistic and to deny that it would have any impact on how many doctors are produced is attempting to ignore the incentive personal wealth represents.

Let's cut to the chase. Here are the pay scales for UK doctors.

I'm thinking that's not too shabby. Low at first but definitely gets up there. Nothing said about state paid or state owned.

You did state that doctors lose a financial incentive under socialized medicine. The pay scales I've quoted above go a long ways towards denying that point. There is a financial incentive. But this is really a side bar. The highest cost in health care isn't doctor salaries. It's over charging by hospitals and medical suppliers. Those costs will have to be controlled. The best way to do that is utilizing economies of scale. Those come into play when you have a large group of consumers forming together to buy services. Any other way involves more state control than what you're railing against.

What's the alternative? Status quo isn't going to work in 10 years. We've had a supposed free market and this is the result. What's your solution? Saying "No" isn't going to cut it.

madmallard wrote: Its not okay for the goverment program Medicare, who carries the -force- of the government. Nor is it okay for a private insurance company to lobby for use of that force on their behalf either. You're confusing the act with the system in general. Use of the force of the state eliminates any choice of alternatives. There is nothing wrong with the private insurance company to set terms of service; I wasn't compelled to use their services until this health care reform act passed.

Again, it's not ok for Medicare to state they will pay X for a service while it is ok for private health insurance to do this? Btw - private health insurance isn't using the force of the state to control costs. They just choose to pay a lower rate, and force the healthcare providers to accept it. No force involved. Just withholding funds.

Your stance in this case is hypocritical. You're statement sounds as if you're tying logic in a pretzel to justify private insurance actions that you crucify medicare for using. Controlling costs by stating "We will not pay $40 for an aspirin."

madmallard wrote: Our current administration has KNOWN that there has been an ever increasing shortage of medical providers and practitioners in the country even before passing the reform bill. Still they pushed it thru, knowing it would increase demand likely more than %30 for health care in the country. Instead of looking at the cause of costs, as shortages are certainly one of them, they blankly said something similar to what you did. "we have to control health care costs." Without qualifying that any further, that means using the force of the state to set the costs, one way or another. This is intellectually deficient and without understatement a gross danger to the practice of medicine.

News flash. Demand for healthcare is going to rise no matter what the government does. It's not Obama's fault. Purely societal considering baby boomers are aging. My advice. Buy stock in medical supply companies.

So controlling costs is intellectually deficient and a gross danger? Maybe to hospital and insurance company profit lines. To everyone else it to equates to lower medical costs.

Rail against the night all you want but things will change. It's ok. Change is necessary and sometimes painful but it has to happen.

madmallard wrote: wow this is interesting. What a thoughtful group of people we've got turning. I haven't been this interested in furthering discussion in a while.

Yeah man. While we will disagree I completely respect everyone's opinion here. Great discussion that will end most likely today. I see it winding down.

z31maniac wrote: ^It's tough for sure. Something else that needs to be addressed in this country is our lifestyle and diets. People continue to act like being the fattest, laziest nation on earth with an aversion to exercise and something like 1/3 of people being obese isn't a problem. But my anti-gov't interference says we shouldn't regulate what people eat. But, if you choose to down McD's like water, why should I have to pay for those choices? I'm trying to think of the name of the healthcare book I read a few months ago that makes some really good points about the top 6 medical conditions (including asthma and diabetes) that could be easily prevented/treated, that currently soak up TONS of resources.

This is a good point.

I'm with you in that I really dislike the idea of gov't regulation of food and "sin" habits. I think that's the wrong way to go as gov't is too large and unyielding for this.

But we also have to take into account various factors in the discussion of health and eating habits. How food production and cost has changed over time. It used to be you could buy chicken for next to nothing. Staples like rice and corn were the same. My inlaws talk about how they used to boil whole chickens in rice for dog food it was so cheap. Can you imagine doing that now and it being economical? Now McD's is the cheapest food available and it's effects are obvious.

fast_eddie_72 wrote: In reply to DILYSI Dave: Well, you could be right. It's not what I'd have chosen. But it's too early to condem it yet. It's not implemented. Can't blame it for your open enrolment this year. It's not like it's been getting cheaper before the law.

They specifically listed the requirement that children now be insured up to 26 (well into baby making age) as a prime contributing factor to the increase. That part is law today.

And while you're right that it hasn't been getting cheaper, in the 15 years or so that I've been seeing increases, the last 2 years are the biggest by far.

Xceler8x wrote: Great discussion that will end most likely today. I see it winding down.

Seems like it. I think we've all outlined our opinions. If we were the congress we'd have a vote now and likely come up with a damn good law or two to improve things. Instead, let's play 6 hours straight coverage of how many times weiner showed his weiner and if Sarah Palin asked her husband what he was making for dinner in her time as governor.

Back on topic: Reply to XC...

I understand your opinion is that the state could handle the costs better. mine is that the private industry could do it better with supporting legislation (deregulation here, regulation there). Like I said, I respect your opinion, and at this point we'd vote.

Xceler8x wrote: Again, it's not ok for Medicare to state they will pay X for a service while it is ok for private health insurance to do this? Btw - private health insurance isn't using the force of the state to control costs. They just choose to pay a lower rate, and force the healthcare providers to accept it. No force involved. Just withholding funds.

It's OK for Medicare to say "We will pay X" as long as it is also OK for the Doctor to say, "I won't accept Medicare patients" the same way he can refuse to accept various insurers. As soon as the government says "You HAVE to accept Medicare." then no, that is not OK.