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» Hatrack River Forum » Active Forums » Books, Films, Food and Culture » Democrats at least pretend to have a spine, it's a Christmas miracle! (Page 6)

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Author Topic: Democrats at least pretend to have a spine, it's a Christmas miracle!
Swampjedi
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That's basically what I was getting at, above.

I say yes.

Resources are scarce. If we want the government to be involved in health care, then it has to make choices of how to allocate resources. Some of these allocations will directly result in death. Call them death panels if you want, but the finite nature of resources makes them necessary.

Edit: Stupid TOPP.

People want a painless solution where hard choices don't have to be made (e.g., the federal budget).

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Destineer
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Be careful here. They won't be death panels, exactly. They'll be "how long are we going to pay to keep you alive?" panels.

After the govt stops paying, it should always be your option to pay out of pocket, or with private health insurance if they'll cover you.

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kmbboots
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Right. But are there limits now as to what insurance will cover? Even the spiffiest Blue Cross policy I could find had a lifetime limit. Surely people can and do pay for care beyond that out of pocket. Any reason they couldn't do so under a different plan?

Edit: Or what Destineer wrote.

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Ryoko
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As I understand it, one of the biggest problems with this issue is that in many cases patients do not have advanced directives that adequately indicate their wishes.

Perhaps a first step (in a universal healthcare system) might be to require everyone to make some sort of choice (sort of like we do with organ donation) about whether to sustain life below a certain threshold or not.

This is a scary choice to make, obviously.

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The Rabbit
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quote:
Resources are scarce. If we want the government to be involved in health care, then it has to make choices of how to allocate resources. Some of these allocations will directly result in death. Call them death panels if you want, but the finite nature of resources makes them necessary.
Can you please provide some data to back up this assertion.

It is contradicted by all the data with which I am familiar. Under the current system, 45,000 Americans die annually because of lack of health insurance. link to press release Link to Harvard Study Link to another study with similar findings

The "free market" death panel is killing 45,000 deaths a year. Before I get worked up about how many people will be denied life saving medical care under "socialized medicine", I want to see some evidence that it will be worse than the current system.

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Raymond Arnold
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I thought Swampjedi was making the same point you were, Rabbit.
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The Rabbit
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quote:
Originally posted by kmbboots:
Right. But are there limits now as to what insurance will cover? Even the spiffiest Blue Cross policy I could find had a lifetime limit. Surely people can and do pay for care beyond that out of pocket. Any reason they couldn't do so under a different plan?

Edit: Or what Destineer wrote.

What people seem to be missing is that we (everyone who pays taxes, has medical insurance and/or pays any medical bill out of pocket) are subsidizing these people right now. People who exceed the lifetime limit are generally people who are critically ill and in intensive care for extended periods of time. If you are in intensive care, the hospital doesn't throw you out when you exceed your lifetime limit. They don't check to see if you can pay out of pocket and dump you out on the street if you can't. And if your lifetime medical costs are already in the millions, chances that you and your estate will be able to pay any significant fraction of the additional costs are next to nothing. So how do hospitals recoup the those costs, they pass them on to everyone else.

Under the current system, we are already paying for these people.

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kmbboots
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Right. I am just trying to find out why people think that people will be kicked out under a new system any more than they already are.
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The Rabbit
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I think one of the biggest misconceptions in this debate is that under the current system, people who are uninsured don't cost the rest of us anything.

Not having health insurance and not getting any medical care are not the same thing. People who have strokes and heart attacks, are injured in accidents or have any medical emergency nearly always get medical treatment whether they have insurance or not. If you look at the current US medical spending, it includes all of that.

What people who don't have insurance are generally skipping is routing health care. They aren't having their blood pressure checked, aren't being screened for heart disease, diabetes and cancer, aren't getting medication for chronic conditions. aren't getting proper follow ups when they've been seriously ill and so on. In other words, under the current system uninsured people are not getting the most cost effective types of medical care and thus incur much more expensive care when they become critically ill. When those people can't pay the huge bills (which they generally can't), they declare bankruptcy and the rest of us pick up the tab.

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kmbboots
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Yep. They get very stuck and we get stuck with them. Even people with insurance but higher copays or deductibles end up having to skimp. I have good insurance, am reasonably healthy and I still have almost a grand in medical bills.
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The Rabbit
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quote:
Originally posted by Raymond Arnold:
I thought Swampjedi was making the same point you were, Rabbit.

Perhaps he was, I thought he was arguing that having the government allocating limited health care resources would lead to more deaths than the current system. All the evidence points in the opposite direction.
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Ryoko
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Rabbit,

What do you think about the idea of requiring people to make some sort of advanced directive (under a universal healthcare plan)?

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Geraine
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As horrible as some people think healthcare in this country is, I think it is pretty good. My rates may have gone up, but I don't feel like it is going to waste. I don't have to wait for anything. I can call up a doctor today and get in the same day.

I believe healthcare should be available to everyone, but should not be provided to everyone.

As much as people complain about our current system, there are issues with single payer systems as well. This page has a ton of articles from the British press regarding their own system:

http://aolanswers.com/questions/american_media_fail_tell_8627579461110

I don't think there is a good solution to the health care issue yet. Our current system may be broken (though not as badly as some claim) but putting your life in the hands of the government and just trusting that they know what is best for you is ridiculous.

Pretty soon they will be telling you when you can retire, what drugs you can take, what food you can eat, and what cars you can drive......Oh wait... [Razz]

For me this is about freedom. Do I want to hand more power over the government? For those of you that want a single payer system, I would like to know why you personally believe that the government is the best entity suited to running health care. What has the government done in the past that makes you want to entrust your entire well being to their whim?

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kmbboots
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Geraine, single payer health care won't tell people what kind of health care they can have; it will tell people what kind of health care it will pay for. Just like insurance companies do now.

Like right now, you can retire whenever you want to. If you don't want to wait for Social Security to kick in, nobody is making you.

What have insurance companies done that make you want to entrust your entire well-being to their whim? More to the point, to their bottom line?

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The Rabbit
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quote:
As horrible as some people think healthcare in this country is, I think it is pretty good. My rates may have gone up, but I don't feel like it is going to waste. I don't have to wait for anything. I can call up a doctor today and get in the same day.
What kinds of medical care have you and your family needed recently? There generally isn't much of a wait anywhere to see GP, but waits for specialists are a different story. Have you had to help oversee medical care for anyone who was critically ill?

quote:
I believe healthcare should be available to everyone, but should not be provided to everyone.
How would you propose we decide who should be provided with healthcare and who should not? Ability to pay is not always easy to determine before a patient is treated. Would you have emergency rooms check for ability to pay before they treat a trauma patient? If a member of your family were suffering from a stroke or bleeding to death, would you want the hospital to delay treatment until they could verify your insurance? Would you have hospitals kick people out when they reach their maximum lifetime limit?

Furthermore, the extent of medical bills often isn't known (by anyone) when treatment is started. People often fully intend to pay their medical bills, but as they begin to mount find that they can not. Medical bills are one of the leading reasons people declare bankruptcy? How would you suggest we deal with that?

Let me give you a real life example. Some friends of mine who are married are both employed in jobs that offer no medical insurance. Because of her medical history, they cannot obtain medical insurance for less than a king's ransom. They could likely afford the average premium payment, but that option isn't available to them because of her history so they have no insurance. Last year she broke her ankle. She had a metal plate and some screws which became infected leading to three separate hospitalizations, three surgeries and some time spent in intensive care with septicemia. As a result of one broken ankle, they now have medical bills that are several times their annual income and have no choice but to declare bankruptcy (which of course means that you and I will end up paying their medical bills). How would you suggest we should handle this kind of situation?

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The Rabbit
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quote:
Originally posted by Ryoko:
Rabbit,

What do you think about the idea of requiring people to make some sort of advanced directive (under a universal healthcare plan)?

I think its a good idea for people to have a living will, with or without universal healthcare. I don't particularly like the idea of mandating it and don't really see what advantage there would be to doing it.

I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.

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MattP
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quote:
I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.
I think those policies are already present in addition to the maximums.
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The Rabbit
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quote:
Originally posted by MattP:
quote:
I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.
I think those policies are already present in addition to the maximums.
If they are, I have yet to see them clearly articulated in any policy, public or private.
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kmbboots
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Generally, you have to have approval for treatments. All insurance companies need to do is to deny approval for treatments that, in their opinion, aren't worth the expense.
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The Rabbit
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quote:
Originally posted by kmbboots:
Generally, you have to have approval for treatments. All insurance companies need to do is to deny approval for treatments that, in their opinion, aren't worth the expense.

Which is what I meant by "seemingly arbitrary decisions about what will and will not be covered".
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kmbboots
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I am not contradicting you, just expanding on what MattP wrote.
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Darth_Mauve
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There was an interesting comment made about why Health Care and being forced to to buy insurance was different than being forced to buy any other service or product.

"If I don't buy a Big Screen TV, and my team makes it to the Superbowl, I can't run out to the store and demand that they give me a big screen TV to watch the game. However, if I don't own insurance, and I discover I have cancer, I can go to the hospital and demand they cure me for free."

Many conservatives are arguing that having the government not allowed to force us to buy insurance means the end to liberal dreams of fixing the health care system.

But if the present system is not working--medical expenses are taking up larger and larger percentages of our income--with more and more people finding them larger than they can afford--and it will continue--and insurance reform isn't going to be allowed to work, what can we do? The answer is treat it like a fire department.

They used to sell fire insurance--so that if your house catches on fire the fire department will come out and put the fire out. Then they discovered that if your neighbor didn't buy fire insurance, and their house caught on fire, then that fire became a danger to your house. So most governments decided to forget the outsourced, pay-as-you-go fire departments--and just had everyone pay in the form of Property Taxes.

So if we can't get health insurance reform approved, the only option left is to take over the whole thing, kick out insurance companies and privately employed medicals, and do it all through the government.

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The Rabbit
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quote:
Originally posted by kmbboots:
I am not contradicting you, just expanding on what MattP wrote.

And I was just expanding on what I'd written and why I thought the existing system is undesirable.

I would much rather have decisions about rationing medical care made by a group of people who were responsible to the public than by the invisible hand of the market or an insurance company whose primary responsibility is to make a profit for their share holders.

Markets are great for maximizing profit and economic activity. If you consider profit and economic growth to be the primary objective of a health care system, then the US system is in fact the best in the world as it generates the most profit and the highest GDP.

If on the other hand, you think the objective of a health care system should be to improve the peoples health and well being, . . . .

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katharina
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quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.

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Orincoro
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quote:
Originally posted by Geraine:
[QB] As horrible as some people think healthcare in this country is, I think it is pretty good.QB]

That's just so FANTASTIC!.

Good thing you HAVE insurance!

If only I had thought of THAT!

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The Rabbit
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quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.

That is the dogma of the free market fundamentalists**. While it is true that freeing up markets can under certain circumstances stimulate innovation and efficiency there is no evidence that it always does this or that it is the only thing that does this. In fact, there is strong evidence that market competition actually degrades the quality of medical care.

Since we are dealing with an issue that influences the lives and well being of real people, its really important not to gamble on unproven theories. We need to look at what the data says and all the data points toward the same thing -- universal coverage under a single payer system.

**Free market fundamentalist is a term I learned from the nobel prize winning economist Joseph Steglitz. It implies an unshakable faith in free markets even in the presence of strong evidence to the contrary. I believe it is appropriate in this context as all of the data is strongly against the benefits of free market for health care. If you disagree, please provide links to the data and studies that would support this contention rather than simply repeating it as a self evident truth.

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Orincoro
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quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Are you aware of the concept of a "public good?"

Let me give you the example Planet Money used a few weeks back. Lighthouses. Lighthouses, I think you will agree, are good for productivity and economic activity. Without lighthouses, shipping would be more difficult and dangerous, and therefore costly.

However, there were some economic barriers to building lighthouses before the advent of a federal government. The free market, for instance, would love to *have* light houses in certain places where it is expensive to build and maintain them, such as on rocky shoals and cliffs. However, the free market did not, before the government stepped in, build such lighthouses. The reason was that there was no mechanism for limiting the use of a lighthouse, and so there was no incentive for trading partners who benefited unequally from their existence to cooperate in building them. One might abstain from contributing, and reap more benefit from doing so, while other companies might desperately need lighthouses to do their shipping. So, no lighthouses where it wasn't absolutely necessary and sure to be profitable for those who could afford to build them- because the industry as a whole could not cooperate in this.

The public good model fits with health care just as well or better than it does with certain other already government controlled industries, such as the mail. The mail, as a counter-example *is* limitable. You don't put on a stamp, you don't get your letter sent. The USPS exists because the government has an interest in a guaranteed means of communication and delivery separate from market forces, in order to maintain communication and trade. Likewise, health care is a public good. It is a good that cannot (read *will never*) be provided to all who need it by a private industry, leastwise a poorly regulated one. Yet this commodity is not limitable. Hospitals cannot turn away patients, and doctors are sworn to do no harm- so we end up with shitty care for a lot of people who could have gotten even ok care earlier, but couldn't. Why? Because the industry will make the same sorts of decisions that the lighthouse builders used to make. "What is good for my company, right now?" That is the kind of question we expect private industry to ask. And sometimes what is good for the market is not good for society. And that is a situation I find unacceptable. You need to look about as far as overall health care spending to see what I'm talking about here. The health care industry takes in more money per capita than in any other system in the world. So that's a successful industry right? By most economic metrics, we're not only doing ok, we're doing *GREAT.* Except millions of people still don't have adequate access to care. Strange that. I wonder how that happens.

And as to a much earlier and very cynical question Geraine asked of me, as to what industries I think should *not* be socialized: the answer is most of them. But there are features of good government they don't talk about on fox news. Government, at its very base, is intended to fulfill exactly this sort of function- to operate where private industry is incapable of stabilizing the dispersal of goods in a way that is beneficial to mutual security, peace, and well-being. It's not a wonder to me that the republicans don't seem to believe in government anymore. Perhaps they don't believe in these things either.

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The Rabbit
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Health care markets simply do not function the way people intuitively believe markets should function. Competition between hospitals can result in higher costs and poorer outcomes. For example, studies have found that there is an inverse correlation between the number of neo-natal ICUs there are in a community (pre capita) and survival rates for premature babies and a direct correlation with cost.

Free market fundamentalists will argue that more competition will lead to lower costs and better quality, but that is exactly the opposite of what happens. Here's why. There is a limited demand for NICUs. That demand isn't going to increase no matter how many NICUs there are or how cheap they might be. But hospitals aren't just competing for NICU patients, they are competing for delivering babies. Since child birth is something you know is going to happen months in advance, parents can shop around for a hospital. They are more likely to choose a hospital that has a NICU just in case. The result is that every hospital wants a NICU. But NICUs are expensive to own and operate. They require a lot of expensive specialized equipment and specialized nursing care. Since only a small fraction of babies require a NICU, a community is better served by concentrating equipment and expertise in a small number of facilities. Competition actually drives it in the opposite direction, more lower quality NICUs at a higher price.

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CT
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quote:
Originally posted by The Rabbit:
Health care markets simply do not function the way people intuitively believe markets should function.

Again and again, this is what assessments show.

Good example, The Rabbit.

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Glenn Arnold
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I'd just like to comment on the "you have to wait for health care in Canada" meme, from my personal experience. (Wow, this is really long)

I hurt my back in 1996. I went to the doctor (Dr. Compain). He told me I had a back strain, gave me pills and told me to take a couple of days off. When I went back to work, the safety manager and I filled out an accident report form, and it asked if I had any x-rays or MRIs taken. I hadn't, and the manager told me to ask the doctor why, on my follow up visit. I did, and he answered angrily that the safety manager could order his own MRI when he got a medical degree. I switched doctors.

The new doctor said that without an MRI, he really didn't know what was going on in my back, but he didn't order one. It seemed like he was taking a "wait and see" approach, but time went on, and he kept refusing to order the MRI. I went to a chiropractor, who told me to get a lawyer. The doctors were getting paid, and I was still working, so I didn't see the point in getting a lawyer.

I have a seasonal cough (probably related to allergies) which caused my back to get worse during cough season. Each year it got worse. I went to the doctor, and each time he mentioned an MRI, but didn't order one. I asked him why, and he said that he couldn't get one without authorization from worker's comp, but didn't go into details.

I switched chiropractors, and the new one also told me to get a lawyer, and also sent me to a neurologist. The neurologist listened to my story, and said that based on my initial symptoms, that it was clear that I had pretty serious disc involvement, but that I needed to get a lawyer so I could get approval for an MRI from worker's comp. I finally got a lawyer, and he told me to have the neurologist request authorization. He also told me that worker's comp has 30 days before they are required to respond, and that I should call them after 31 days, because they wouldn't authorize the MRI. 31 days later I called. They told me that they hadn't got a request from the doctor.

I told the doctor this, he rolled his eyes and said he'd send in another request. 31 days later, I called again. They hadn't got a request from the doctor. I argued that he had sent it in twice, but they insisted that he hadn't. After some argument they said they hadn't had any requests from Dr. Compain since I had initially seen him over 2 years earlier. I told them that I had seen several doctors since then, and that the request came from my neurologist, Dr. Benjamin. They said they had absolutely no record that I had seen Dr. Benjamin.

I went to see Dr. Benjamin, told him the story, and he said to his receptionist: "Show him the checks." His office scans every check and keeps a copy with the patient's file. They had been paid by the company that had "absolutely no record" that I'd seen him.

I called the insurance adjuster again, told her this, and told her that I needed the MRI because I was in pain and needed help. She told me that I wasn't in any pain. Just like that. "You're not in any pain."

At this point my lawyer explained that unless we could get a document from the insurance company that denied approval of the MRI, we couldn't take it to the comp board. He sent a letter to the insurance company, but still nothing happened.

A friend at work told me to stop coming to work. My co-workers could see from the way I was walking, wincing, generally going through ridiculous gyrations to escape the pain that I needed help, but I didn't see how taking a couple of days off would actually let my back get better, so I kept going.

Eventually I caught a cold that caused me to sneeze and cough more severely than normal, and one night I found that I couldn't walk. I kind of fell on the bed and my wife called the ambulance. They hauled me the emergency room, bawling like a baby (it was really embarrassing!). There they said that if the MRI was open, they would take one, but it wasn't. So they gave me a shot of morphine.

I stopped going to work. I was still coughing, and I tried to make an appointment to see my Primary Care doctor, but I had to see a physicians assistant. I told her the cough HAD to stop, because it was tearing my back apart. She gave me codiene, and told me to see my doctor, and ask him to submit the request for an MRI to my regular medical insurance, and tell them it was a worker's comp case, but that they wouldn't approve the MRI, and let them work it out between the two companies.

I week later I saw the doctor, told him what the P.A. had said, and he crossed out the encounter form, told me that the receptionist would give me back my co-pay, and that he was going to pretend this visit hadn't happened, because I was asking him to commit fraud.

At this point I felt absolutely hopeless. After a week or so, I decided to call the insurance company myself, and they told me that yes, that was exactly what the doctor should do, and said the doctor had no business claiming that I was asking him to commit fraud.

I went back to the doctor, and told him what they'd said. He answered tersely that he would do this, but made it clear that he didn't think it was kosher. The next day I got a letter from his office telling me that I had "threatened him and his staff" and that I "should find another doctor." I'm not sure how a cripple who could barely walk could threaten them. Anyway he ordered the MRI.

I got the MRI, and took copies to the neurologist, and the chiropractor. I had bulges on both sides of my l-4,l-5 disc, about the thickness of my thumb on both sides. The neurologist sent me to a neurosurgeon, who scheduled surgery for July 25, 2001.

In the meantime, my lawyer finally got a denial from the insurance company, and scheduled the first of many court appointments.

I got the surgery, and was declared "permanently partially disabled" and told that I would be covered for medical treatments for the rest of my life. That was in 2002. Since then, I've had about 6 court appointments, because every time I need treatment greater than a doctor visit, I have to get approval from worker's comp. They have 30 days to respond. 31 days later they claim they didn't get a request. My lawyer serves them a request. They deny it, and a court date is set for sometime within the next six months. Then the court approves the treatment, but usually by that time the acute pain is gone. I get the treatment anyway because I know that if I don't, it will look bad that I got approval but didn't get the treatment.

This is the way worker's comp insurance works in the U.S.

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Samprimary
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lol @ 'you're not in any pain'

*jedi mind trick hand wave*

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Samprimary
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Also to note:

quote:
Originally posted by katharina:
Health care that covers everyone will certainly cost more than health care that doesn't cover everyone.

Remember always how many times we have to go back to reiterating how this is demonstrably false. Our coverage system ends up costing more precisely because of a lack of coverage for millions, among other things.
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Juxtapose
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Glenn, thanks for sharing all that.

I can't imagine how frustrating that would be, but it's fascinating in an awful way.

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AvidReader
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quote:
Originally posted by CT:
Key Findings

■ Thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13 percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany—all countries with competitive insurance markets that allow consumers a choice of health plan—reported these concerns.

■ The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K. adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.

■ U.S. , German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S. adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access.

Hmm. Sounds like I need to do some research on what the Swiss are doing.

Thanks for the link, CT!

ETA: I can't spell thanks, but I mean it. [Smile]

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Swampjedi
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quote:
Originally posted by The Rabbit:
quote:
Originally posted by Raymond Arnold:
I thought Swampjedi was making the same point you were, Rabbit.

Perhaps he was, I thought he was arguing that having the government allocating limited health care resources would lead to more deaths than the current system. All the evidence points in the opposite direction.
Perhaps the use of the phrase "death panels" flipped on a filter. [Cool]

Rabbit, I do, in fact, agree with you on this. The free market decides who lives and dies, too.

Destineer, correct. There will always be the option to go it alone, as there is now. However, the result of (government|corporate) decisions on when supported care ends is likely quick demise. If I've been fighting cancer for decades, chances are I'm broke from being nickel-and-dimed ( X some large factor) by OOP expenses.

How do we deal with the "bathtub" curve of expenses (High at either end, relatively low in the middle), especially with an aging (and politically powerful) population?

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katharina
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quote:
Originally posted by The Rabbit:
quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.

That is the dogma of the free market fundamentalists**. While it is true that freeing up markets can under certain circumstances stimulate innovation and efficiency there is no evidence that it always does this or that it is the only thing that does this. In fact, there is strong evidence that market competition actually degrades the quality of medical care.

Since we are dealing with an issue that influences the lives and well being of real people, its really important not to gamble on unproven theories. We need to look at what the data says and all the data points toward the same thing -- universal coverage under a single payer system.

**Free market fundamentalist is a term I learned from the nobel prize winning economist Joseph Steglitz. It implies an unshakable faith in free markets even in the presence of strong evidence to the contrary. I believe it is appropriate in this context as all of the data is strongly against the benefits of free market for health care. If you disagree, please provide links to the data and studies that would support this contention rather than simply repeating it as a self evident truth.

Namecalling. [Roll Eyes]

This discussion is too deliberately stupid to be worth the bother.

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The Rabbit
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I have not called anyone involved in this thread any names. I used a name for a certain belief system which has been defined and used by very notable individuals. As I said before, I believe the term applies because all the data with which I am familiar demonstrates that the free market leads to higher prices and poorer quality health care. If you are familiar with studies that support your point of view, please provide the links rather than simply continuing to assert that the free market will solve all problems.
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Darth_Mauve
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There are three reasons that Health Care does not fit standard capitalist models.

1) When purchasing a widget there is a rational hierarchy of requirements. Cost, Quality, and Speed of Delivery vary on specific cases, but in each case the buyer can decide is X cost worth Y quality delivered in Z amount of time or is X-10 worth Y-10% delivered in Z+3 Days?

However, in health care the distance between the value of Y--Quality--is almost infinitely more important than X--Dollars. How much would you need to save before going to a 2nd rate physician for heart surgery, or using a 2nd rate procedure with only 50% chance to save your life instead of 90%?

2) Z is often the most deciding factor. Z = time. If you are having a heart attack, or you are feeling ill, you want to be healthy now, not after shopping around doctors and determining that a 10% savings is offered by Doc Oct on the other end of town.

Rational decisions which are required for a rational market to exist, are rarely made when the health of you or your loved one is at stake.

3) Even if you could act rationally about your own health, the basic market formula does not work.

Mr. W sells Widgets. If I want to buy them I shop around, so Mr. W has an incentive to keep his prices low to induce me to buy his widgets.

Dr. D sells his services. He sells them to the insurance companies, though I am the recipient of his services. He has an incentive to keep his prices to the insurance company low or else my insurance company won't accept him as a doctor.

However, the insurance company is selling the option on his services to my employer. My employer is looking for an insurance company that offers the most doctors at the cheapest price. The insurance company is looking to keep doctors on their lists more than lowering prices so they can sell more programs.

My employer is looking for the least expensive--to them--insurance program that will result in the fewest complaints. The service the doctor gives the patient is irrelevant. The service the insurance company gives to the patients is what is important. If only 1 in 100 patients is ill to the point of having issues with the insurance company, the number of complaints is small. If 25 in 100 complain that their doctor is not on the approved list, the number of complaints is large, and the employer will go to another insurance company. Hence the insurance company has only a limited motivation to keep standard costs down.

It gets much more complicated than that, but basically the simple supply/demand mechanics of the market are splintered and motivations are lost when there are 4 active players--Patient, Doctor, Insurance, Employer. Add Hospital, Billing Agency, and more to the list and it becomes gridlock.

So the question becomes, who would you rather have on a death panel--an expert who's job is controlled by a corporation looking only for profit, or an expert who's job is controlled by an elected official looking only for reelection.

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DarkKnight
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quote:
Remember always how many times we have to go back to reiterating how this is demonstrably false. Our coverage system ends up costing more precisely because of a lack of coverage for millions, among other things.
As a wealthy country, we choose to spend more on healthcare which is vastly different than costing more. Lack of coverage is a factor, not THE factor
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kmbboots
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But why do we choose to spend more when we could get better for less? And help those the some of us feel we have a moral obligation to help?
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DarkKnight
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The choice of spending more includes more testing, more procedures, and consuming more health care not necessarily paying more.
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CT
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quote:
Originally posted by DarkKnight:
The choice of spending more includes more testing, more procedures, and consuming more health care not necessarily paying more.

I can't quite parse that.
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Orincoro
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Don't sweat it Rabbit. You win, so Katharina changes the rules or quits. She does this often. I know you know it- I am just saying to be clear to anybody who might be reading this and thinking... what awful people abuse this poor person so??
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DarkKnight
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CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.
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MrSquicky
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Rabbit,
I've appreciated the restraint and patience you (and others) have shown in this thread.

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kmbboots
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I am more and more convinced that all the data in the world won't be enough to convince those that, in their hearts, really don't feel that other people are worth helping.
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Blayne Bradley
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quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

No you get them done to avoid getting sued.

Remove the ability to get sued and the costs of testing goes away.

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CT
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quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

Oh, that I get. I have intimate knowledge of that concept.

I have trouble parsing your sentence, particularly how the latter portion connects to the former. But no matter -- whether or not I understand you is of little matter, and likely not worth your time. [Smile]

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MrSquicky
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quote:
Originally posted by Blayne Bradley:
quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

No you get them done to avoid getting sued.

Remove the ability to get sued and the costs of testing goes away.

There's a lot of reason why we run more tests. One the big ones is that, in our current insurance model, they're a good revenue stream for the doctors who order them.
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Destineer
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quote:
Originally posted by Geraine:
For those of you that want a single payer system, I would like to know why you personally believe that the government is the best entity suited to running health care. What has the government done in the past that makes you want to entrust your entire well being to their whim?

Didn't you ask this exact same question a couple pages back, and receive a perfectly satisfactory asnwer in terms of a list of govt programs that work very well?
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