The Coming Collectivization of American Health Care
In the 1930s, the USSR forced independent farmers into large state-run collective farms. Despite possessing some of the richest farmland in the world, these collective farms could not feed the country. By the end of the Cold War, the USSR survived only by importing Western grain. Unfortunately, the United States is about to make the same mistake in health care by collectivizing doctors and hospitals into government-supervised accountable care organizations (ACOs).
Accountable care organizations represent the federal government’s latest attempt to “reform” American health care. Through financial carrots and sticks, doctors and hospitals would be “nudged” into large provider groups to deliver medical care according to government practice guidelines. The government would monitor ACO performance with mandatory electronic medical records, rewarding providers who met government performance targets and penalizing those who didn’t. ACO proponents claim these “integrated care systems” will raise quality, lower costs, and reduce regional variations in medical care.
Under this new system, the traditional 2-4 person small group medical practices many Americans are familiar with would rapidly become an endangered species. ObamaCare legislation requires doctors who accept Medicare patients to follow strict new documentation standards as well as to purchase (and make “meaningful use” of) government-approved electronic medical record systems. These requirements can impose enormous financial and administrative burdens on small medical offices. Coupled with declining reimbursements, many small practices will thus have an increasingly difficult time staying afloat.
Hence, many doctors are already choosing to merge into larger practices (or become hospital employees) to remain economically viable. In 2010, the Medical Group Management Association reported that 65% of established physicians hired and 49% of new physicians finishing residency chose to join hospital-based practices. Similarly, the American Medical Association reported that from 2001 to 2008, the number of physicians in solo practice fell from 37% to 25% and in small 2-4 person practices fell from 26% to 21%, with these numbers expected to decline even further.
Of course, it can be perfectly legitimate for physicians to voluntarily join large groups or become hospital employees. But it is wrong for the government to tilt the playing field to artificially favor such large groups over smaller practices.
The Obama administration regards this collectivization of medical providers as a desirable outcome, not merely some “unintended consequence.” As Obama health advisor Nancy-Ann DeParle wrote last year in the Annals of Internal Medicine, the new law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and “physicians will need to embrace rather than resist change.” Translation: “Doctors should get with the program — or else!”
Furthermore, such collectivization is merely a continuation of a much older strategy. Jonah Goldberg’s book Liberal Fascism described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal. As Goldberg noted:
[If] you want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What’s easier, strapping five thousand cats to a wagon or a couple of giant oxen?
Similarly, it will be much easier for the federal government to regulate 100 large ACOs than 10,000 small private practices.
Once doctors are herded into ACOs, they will become increasingly accustomed to simply following orders from ACO administrators (who in turn will be proxies for government health bureaucrats). The New York Times recently reported that after physicians became hospital employees, they became much more accepting of government controls over health care than their counterparts in private practice.
ACOs also threaten to corrupt the doctor-patient relationship. Suppose you see your ACO doctor for a severe headache and he says, “Don’t worry, you don’t need an MRI. Just take two Tylenol and call me in the morning.” Can you be sure he’s giving you his best medical advice — without being biased by the performance bonus he’ll receive if he orders fewer tests this year?
In 2009, when a federal task force proposed restricting screening mammograms to women over age 50 at two year intervals, they met stiff resistance from doctors who argued the proven benefits of annual mammograms beginning at age 40. The government quickly backed down. But once the current generation of doctors fades from the scene, will the next generation of more docile physicians be as willing to defend their patients’ medical interests if they conflict with practice guidelines set by their government paymasters?
Nor will ACOs necessarily save money. A recent 5-year trial followed ten carefully chosen large medical organizations that implemented “integrated care” practices similar to the proposed ACOs. Because of associated increased administrative costs, they only saved a minimal amount of money. As former Medicare administrator Gail Wilensky noted, “If it was this tough for this group that I had just assumed would be hands-down winners, what does it say for groups that don’t have a long history of coming together?”
Collectivizing American doctors will fail as badly as collectivizing Soviet farmers. Fortunately, it’s not too late for America to change its course. Instead of collectivizing physicians and hospitals, we should adopt free-market health care reforms such as advocated by Tea Party physician-activist Dr. Milton Wolf and Whole Foods CEO John Mackey. These reforms include fixing the tax code to put employer-provided health insurance and individually-owned health insurance on a level playing field, repealing costly mandates specifying which benefits insurers must offer, allowing individuals to purchase health insurance across state lines, and eliminating monopolistic medical licensing requirements that prevent doctors from practicing across state lines. Such reforms would lower costs and improve access while protecting the autonomy of both doctors and patients.
The Roman Emperor Caligula once wished that the Roman people had only one neck, so that he could slay them with a single blow. If we value our lives, we shouldn’t allow the federal government to put all doctors’ necks into a single noose either.
Also, I am a member of the Colorado chapter of Docs4PatientCare, at http://www.Docs4PatientCare.org.
It may fail as badly but let’s hope it fails more quickly. If the collectivization of doctors takes 75 years to collapse (USSR, 1917-1991, may all its supporters burn in Hell), my grandchildren will be dead before that happens.
As true as it is horrifying. We already face a shortage of general practitioners; ObamaCare will exacerbate it beyond anyone’s ability to believe.
The greatest of all ironies is that we’ve been here before; we can easily see what’s coming. Giantism in the private sector, so antithetical to American principles of independence and open competition, correlates nearly 100% with government intrusion into business. Not many people are happy — when they think about it, at least — that more than half the nation’s workers are employed by the Fortune 5000. We sense the concentration of power over us, and the enlargement of the risks to us. But it’s an inevitable consequence of Big Government, unlimited in scope…and it will have the same effects on medicine as it’s had on everything from cars to canned tuna.
This must go. He must go. The sooner, the better.
There’s a name for big business allied with big government…..fascism. Didn’t we fight a war to defeat same in the not so distant past?
There’s a reason why the Nazi Party was actually called the National Socialist Workers Party. Nazi was an abbreviation.
It was a leftist movement from the get-go. There was never anything genuinely right-wing or conservative about Nazism.
President T.D. Roosevelt tried to get a nathional health care law passed in 1909. Why? Because he saw how well Europes worked. 102 years later we still don’t have a health care program. President Richard Nixon tried to get one when he was president. I realize Pajamas Media is a rich persons news site.
Bit think baout all the people in the USA that make under $200,000. We need a national health care program.
Yep. This is a rich person’s news site. I just got off my night job as a Community Service Officer, and now Jeeves is bringing me a fifty dollar bill I’ll use to light my stogie.
Yea if making $40K per year makes me “rich” in your eyes what ever….Stop the progressive BS we need a truthfully free market system , keep the government and the AMA out of the way, cut the “malpractice” suits to a minimum and stop letting insurance companies from double dipping by insuring us the patient this “healt insurance” and the doctor with malpractice insurance, the only one who make out is the insurance company and the lawyers. We must be able to buy the level of insurance we can afford and buy it across state lines, we must break up the monopoly of “zones” that the insurance companies operate in. Also all hospitals need to accept the insurance from any place, and YOU need to be responsible for the balance due after insurance.
Face the facts life is about what you do for your self NOT about the Government “Insuring equal outcome” so you feel safe.
Wrong, wrong, wrong! We do not have enough faith in our beliefs that big government is bad. Bad systems fall apart because of their own rigidities. Russia fell apart not because Communism was a poorly conceptualized system, but because it was rigidly, but differentially enforced. Clinging to failed systems and structures causes immense pain and endless deaths. We need to fight against centralized power but we need to retain our sense of humor as we watch the self-empowered figures writhe in the systems they have created. Our opposition guarantees their ultimate recognition of their mistaken beliefs and over-reaching missteps, but most misguided systems fall under their own weight. Everyone can recognize success, but humans cannot or will not discern their failures until they are moaning at the bottom of the cliff.
President Richard Nixon tried to get one when he was president.
Yes, Rich, but Nixon’s proposed Health Service Area strictures, for example, of one CAT scan machine per every 50,000 people is the exact kind of “care” you didn’t and still don’t actually deserve, as proven by subsequent history and thus in contrast to your own counterfactual reveries!
Nor does Obama’s own completely confabulated generic “Grandma” even currently deserve only a wheelchair and “pain pills” when she can otherwise be ambulatory and thus live longer and better – especially given the American background of a continually improving medical technology which ends up benefiting everyone, and once again as proven in contrast to Obama’s regressive dreams, which apparently eschew even ATM’s!
But if you instead let Gov’t arbitrarily determine what “healthcare” is, when it is delivered, and who gets it, then all you have left, as compared to the current purpose and results of American “healthcare”, is the right of Gov’t to ration your care! That is, while delivering whatever it wants as care to “cut costs” – just as Nixon’s HSA mechanism wanted to, and as our Gov’t's current price-fixing of Medicare does, and Obamacare’s $500 billion cut to Medicare will do – and to otherwise control you via this very effective mechanism, again as administered according to political and bureaucratic fiat, and again which is exactly not the way America’s healthcare is currently directed.
Therefore, Rich, in contrast to your own and Obama’s inbred Statist reveries about America needing a gov’t-derived and directed “national health care program”, ask yourself this: starting back from the days of Hillarycare, why has no visible proponent of “Universal” healthcare in America yet been able to come up with even one valid example within our current healthcare system of someone denied care because of their inability to pay?
I’m an American citizen who moved to Ontario with my Canadian husband four years ago, so I have experience with the American system and the Canadian system.
Please, come to Canada and find out what socialized health care is really about: doctor shortages (it took two and a half years to find a doctor who was accepting new patients), scarcity of diagnostic equipment, overuse of emergency rooms, long (sometimes year-long) waits for appointments with specialists (and then more wait time for any needed surgery), and higher costs for every product and service in Canada to pay for it all. All Canadians, including doctors, are victims of this bureaucratic nightmare we call “Canadian health care.”
I have been going through a bit of a medical crisis since March. This past Friday, July 8, I finally had an x-ray I needed. On August 11, I’m having a test that was requested four months ago. How long will it be until I find out what’s wrong and get treatment? Christmas? Next Easter? Is this what you really want for America?
Besides the bad care being delivered by socialized medical systems, there is another consideration. Government-run health care is a way to control people. Why did all the monsters of the 20th century–Hitler, Stalin, Mao, Castro–and all the socialist countries in Europe implement national health care programs? Control, plain and simple. If the government pays for your medical care, then bureaucrats can dictate to you what your personal behavior should or should not be.
Americans have already lost a lot of freedom in the past two years (over 2,000 new rules and regulations since Obama took office). Wait until Obamacare is implemented. Americans will not know what hit them. It will be a tsunami of stringent regulations, higher costs, no doctors, long waits, bad care, and misery and death. And, unfortunately, these socialist medical systems intentionally ration care for the young and the old, the most vulnerable (and most unproductive in bureaucrats’ estimation) people in society.
Obamacare MUST be repealed. Anyone who thinks it is a good idea should have their head examined.
where’s the ‘like’ button? Nice post
Hey, about the head examination…. Not in Canada. Even that would take 2 years to get an appointment!
I no longer work full-time because of a serious chronic illness.
The one good thing is that I have a fine hospital taking care of me: Massachusetts General Hospital.
Except the far left wants to take that away too.
Paul Krugman has gone further than even many Democrats in Congress. Not only does he want single-payer, he wants to replace private hospitals with government-run clinics similar to VA clinics. And his far-left fans love that idea.
Evidently he doesn’t realize that VA clinics aren’t teaching hospitals and don’t do world-class research like Massachusetts General.
We don’t have a national health care system because it does not work, and we can’t afford it.
P. S. Using your logic Rich39 – this is a rich person’s site, you are on it, therefore you must be rich. Can I borrow some money?
Hehe – rich person’s news site! I guess they better kick me off . . .
I make minimum wage as a cashier.
I gross 20,000 a year, and work for the federal government, so mabye I should be at Huffington or Move-on ? But I can still think, that is why I come here.
“Collectivization” is just a word. Can mean many things.
I live in Japan, where there is single-payer insurance that covers almost the entire country. Patients can choose their doctors, and doctors (my wife is one!) choose their care freely.
Outcomes are as good as the States, at a fraction of the cost.
And, no wait times to speak of.
And yet, you could call this “collectivist.”
Why not check into why the economy has been in the tank in Japan for over 10 years?
Collectivism and it’s mind set has caused it there just like it has every other time it has been tried in every place it was tried. Japan has “spent” it’s way into a bind and will be paying for it for many years to come. The check just has not hit the table yet.
The Health Care system maybe good IN japan for now but what happens once the false economy of “stimulus” that they have tried several times catches up with reality? They as a country will be in deep trouble. Just as we will be.
Outcomes are as good as the States, at a fraction of the cost.
The Japanese are a great and honorable people, but you need to prove that item – define what you mean by “cost” and “outcomes”, etc. – bro’! I wish it were so, because maybe then we in the U.S. could more easily enact the effective cost savings measures which have eluded us, perhaps such as making our borders illegal-immigration proof, and by remedying the Demokkkrat designed and administrated Black Inner City Ghettos?
As far as the success of Japanese “collectivism” goes, I’m afraid you have forgotten that the U.S. has subsidized Japan’s economy very substantially by providing for most of Japan’s military security following WWII, something which the inveterate purveyors of the “success” of the Socialist European system have also either ignored or else actually criticized as American “Imperialism”!
Japan as a whole is hardly a “collectivist” country. Maybe a little more so than the US, but certainly not in any real sense. And the medical system isn’t collectivist in reality either. I was merely pointing out that it’s possible to have a single-payer insurance system and universal coverage without all the horror stories that people speak of when these issues are raised.
Just a question: Have you ever been really ill and had to use Japan’s health system? Most socialized medical systems work well as long as you are not really sick. Great if you have a broken leg or the flu, not so good when you have a rare form of cancer or a chronic illness. We are already seeing this in the U.S.: Avastin is about to be proscribed for the treatment of breast cancer by the FDA. Doctors will still be able to prescribe it off-label for breast cancer treatment, but the FDA action will effectively mean that Medicair/Medicaid and private insurance will not cover its’ use for breast cancer. Rationing by another name.
No, I’ve never been really sick here, thank goodness.
But I don’t think quality of care decreases with level of sickness. There are lots of things wrong with healthcare in Japan, such as extreme overprescription of drugs (people here just like taking drugs and doctors give them way too much) and hospital stays that are way longer than necessary, but these are basically instances of “over-care” rather than “under-care.”
The solutions to the current health care delivery problems as well as many other of our problems can be solved by the ingenuity of the American people acting in a free market. The problem though is that Obama and many thousands of collectivist technocrats like him believe that they have the wisdom, skill, and intelligence to manage the lives of all 300+ million of us better than we can ourselves. They also believe the market system is unfair so are using Obamacare to improve the care of some at the expense of many more. As Obama said regarding the capital gains tax, it doesn’t matter if a lower tax actually brings in more revenue, what matters is “fairness” and that to him means punishing one set of Americans. Obamacare is about power and control, it is not now never has been, nor ever will be about health care.
Sad to think that the fate of this country will come down to one vote on the Supreme Court. That is just terrible and shows how far we have fallen. If Obamacare lives or dies it will be in the Supreme Court, and the vote will be 5 to 4, either for or against it. Even the court now is so polarized that there is only one member who will cast the deciding vote. So what type of health care you get will all come down to one man, and it ain’t even the president of the United States. This is what passes for democracy these days in this country. The country never, ever, had a say in this matter. It started in Congress and the bill was railroaded through the Senate through an obscure method called “reconciliation,” something that was never intended for a bill of this scope or magnitude. Yet here we are now, crossing our fingers and hoping against hope that one man on the Supreme Court will do the right thing and strike this unholy law down.
But what will happen to this country if they uphold it? How can we channel our rage to create a good out of a horrible evil that has been forced upon us? Well, there’s always 2012. One of the few powers we have left is to elect people. And in 2012, it will be our obligation to vote in as many conservatives as possible, especially a conservative president. We are running out of time here, folks, and if we don’t do the right thing and get Obama out of office in 2012, you can kiss individual freedom goodbye and we will plunge into a new dark age of total government control over your lives. THAT is what is at stake in 2012.
This bill came to be because of a filibuster-proof Democrat Senate and a House with an overwhelming Democrat majority. I thought “reconciliation” was avoided when Republican Scott Brown was elected to replace Dead Kennedy, after promising to oppose ObamaCare, which the Senate had already sent to the House. Brown’s election ended the Dems’ filibuster-proof majority. Then the House was forced to accept the Senate’s version of the bill, as is, so that there would be no need for reconciliation of the two versions (when a filibuster could have blown up the whole thing).
I’m certain that this lack of House input is the only reason ObamaCare is not absolutely perfect, causing so many businesses and unions to require waivers from its provisions. Yep, I’m sure reconciliation could have perfected the legislation–NO Republican input required ["I won."]
The Swiss spend three percent of their health-care dollar on administration.
Americans spend ten times as much — thirty percent. Yet most of those American dollars are utterly wasted … in creating a paper trail for denying care.
America could save trillions of dollars by moving to a Swiss-style system. Swiss-type systems are no-government, all-private, and choice-driven … by every conservative standard, it would be a huge improvement over what we have now.
Consumer-driven health care: lessons from Switzerland
URL: http://www.ncbi.nlm.nih.gov/pubmed/15353534
Swiss-style health-care reform has been advocated by Republicans and Democrats alike. There’s only one problem … the name of that Republican is Mitt Romney … the name of that Democrat is Hillary Clinton. Neither of whom will ever be president … because entrenched corporate interests hate them too much.
Stop and think for a second … the trillions of dollars wasted in our present system end up in *someone’s* pocket. Whose pocket is that? Who’s making billions off of health-care waste and fraud? Let’s follow that money, folks.
Hmmm … does anyone remember Senator Bill Frist? Republican Majority Leader from 2003-2007? Gee … Frist *used* to be mentioned as a presidential candidate … until it turned out his family was making billions from health-care waste.
It sure is funny … we don’t hear much about Senator Frist anymore. Maybe it’s because Frist’s Hospital Corporation of American (HCA) has pleaded “guilty” to dozens of felony charges of billing fraud.
But heck … who cares? HCA has billions of siphoned-off health-care dollars left over … dollars to put in Frist’s pocket … and to buy more politicians and astro-turfers … and to spend on denying claims.
That’s the real reason we don’t hear much about effective health-care reform. It’s because Bill Frist and his friends prefer that things stay the just the way they are … while they become even richer.
On digging a little more, it turns out that “Bill Frist for President 2008″ campaign buttons are now sought-after collectors items … because everyone understands the reasons why Senator Frist will never run again.
Of course, paying even 1.7 billion in penalties is just a drop-in-the-bucket for HCA … `cuz HCA’s present stock market capitalization is ten times bigger than *that*.
Paying billions in penalties for outrageous fraud and waste? For Frist’s HCA, those penalties are simply a cost of doing business. HCA’s corporate motto: “Let’s keep things just the way they are.”
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
URL: http://www.justice.gov/opa/pr/2003/June/03_civ_386.htm
Hey dude you’re full of it.
1. Bill Frist does not work at HCA. He does not OWN HCA.
2. Bill Frist was never a large stockholder in HCA or Columbia/HCA, and sold what stock he had when he became senator.
3. The $600+ million 2003 settlement was the outcome of a suit filed against Columbia/HCA in 1997 after HCA had been taken over by Columbia Healthcare of Louisville. Since much of the management of Columbia was tainted by the scandal, the headquarters of the company was reestablished at the HCA headquarters in Nashville. The company was renamed HCA a few years later and the company was taken private, with Bill Frist having (as far as I know, corroboration needed) no stake. The company recently went public.
4. You’re full of it.
Other than that, don’t you agree “a physicist” sounds really, really smart? Anti-capitalism, anti-American, anti-business, anti-profit, anti-success, anti-growth, and maybe a little bit of a liar, sure, but so darned smart. [swoon]
Yer post is wrong-on-the-facts, Groovimus.
It appears that Senator Frist won’t run for president … one wonders why.
Sep. 22, 2005 SEC Investigates Alleged Insider Trading
by US Senate Majority Leader Bill Frist
URL: http://insidertrading.procon.org/view.resource.php?resourceID=002391#billfrist2005
Just stating “wrong on facts”, without stating which facts? You state instead that Bill Frist was suspected of insider trading. But you fail to state that he was cleared of this after an investigation. I know this because not only did i know Dr. Frist as a teenager, but I worked with a “Democrat” at my position a few years ago and this “democrat” insisted that Bill Frist is a crook. This is the kind of facts in which you guys traffic. You guys are confronted with a super achiever eagle scout type, and when they want to defend our society against the leftist assault you call them crooks and worse. Bill Frist got sick of politics and could see what GWB was doing to his chances and decided: hey I like my surgery career at Vanderbilt Medical Center better.
Groovimuss, you asserted that “Bill Frist was never a large stockholder in HCA or Columbia/HCA, and sold what stock he had when he became senator.”
Neither of those statements was correct.
“Groovimus, you asserted that “Bill Frist was never a large stockholder in HCA or Columbia/HCA, and sold what stock he had when he became senator.”
Neither of those statements was correct.”
Tom Frist Jr. was a large stockholder in HCA, he is a billionaire as a result. By comparison, Bill Frist’s stock holdings in the company WERE a pittance, a few million, less than $10 million if I am not mistaken, a fraction of his worth. I stand by the statement. You are the one who used the phrase “Frist’s Hospital Corporation of American HCA) has pleaded…” as if Bill Frist were a company officer or a principal STAKEHOLDER or an employee of any kind which are all false. And here is what’s laughable: you say “It sure is funny … we don’t hear much about Senator Frist anymore”. It’s funny because there is no such thing as a Senator Frist, genius. And guess what genius, you would hear much about Dr. Frist in Nashville, as he was the founder of the Vanderbilt heart transplant program and was the first surgeon in Nashville to perform a heart-lung transplant.
And guess what else genius: Bill Frist became senator WHEN the year was 2005. He sold his stock (by requesting it sold) WHEN the year was 2005. So logic says he sold his stock WHEN he became senator, not coincident with becoming senator. He sold his stock by having someone else do it is very similar to me contracting a house to be built, and paying for it permits me to say I built it without anyone being confused or any risk to me as being un-factual.
wrong decade. Frist became senator in 1995. Still he sold his stock when he was senator, after he was talked about as presidential material when majority leader. BTW the former senator was recently offered a spot on the gubernatorial ticket in Tennessee. He declined, and since he would surely win, this shows he has had enough of the nastiness of politics, and that our physicist friend is blowing smoke with the speculation of a tainted eagle scout.
Groovimus, it’s good that you now realize you were utterly mistaken about Frist’s term in the Senate: January 3, 1995 – January 3, 2007.
Yes, Senator Frist owned and sold HCA stock while he was Republican Majority Leaders, and he made tens of millions of dollars from doing it.
You call Frist’s multi-million-dollar HCA sales a “pittance” … exactly what planet do you live on?
Don’t you think that for purposes of this discussion you should call yourself “a physician” or “an economist”? A physicist can’t really be considered a special expert when it comes to ObamaCare, and I sort of thought “special expertise” was your, uh, specialty.
Collectivized farms and doctors have the same feature for the statists – the power of life and death over the peasants. Stalin and Mao used this power to great effect – starving millions of uncooperative Ukrainians and Chinese farmers to death.
About that performance bonus. It’s really a bonus/penalty system where health care providers are guilty until proven innocent. What Medicare is doing is withholding a portion of normal reimbursement on services provided and only when they have collected and reviewed performance measures will physicians and hospitals get any of that withheld money. I can’t imagine what outcome will be required to get all of that withholding back but getting less payment now, holding your breath in hopes that you’ll get that money later, is going to hurt.
As far as physicians joining larger or hospital based practices: Good luck to those in smaller communities where there are fewer doctors and hospitals to begin with.
Zachary posts:
Canada: ditto
Germany: ditto
Scandinavia: ditto
Switzerland: ditto
Belgium: ditto
Korea: ditto
The Netherlands: ditto
… etc.
All of these successful systems are public-private hybrids. By any measure, all of them work better than America’s. And there’s a simple reason: when it comes to health-care, purely socialist and purely capitalist systems equally have proved to be utter train-wrecks.
Insisting on a health-care train-wreck, purely from ideology, is stupid … no matter whether that system is socialist or capitalist. American conservatism and liberalism equally can do better than this. Kudos to Romney and Hillary—equally—for understanding this.
The Netherlands: Health System Review.
URL: http://www.ncbi.nlm.nih.gov/pubmed/21132996
You must not have looked at the British and Canadian systems lately. As with everything the government touches, their health care systems are suffering from skyrocketing costs, declining quality, and unacceptable wait times. Their systems are collapsing under the weight of their costs and inefficiencies. Do a google search on “problems with nationalized health care”, and the results will astound you. Most of these horror stories come straight from news services in the UK, and they are pro-government health care.
The US does not have a free market in health care or health insurance. The government is the major player in both areas, and that is the source of our current problems. Government interference in any market creates distortions that result in waste, fraud, inefficiency, increasing cost, and even greater problems than what the government supposedly proposed to solve. Unless we get government out of health care, our problems will only get worse just as they are in the UK and Canada.
The fact that the British and Canadian systems are no good does not mean you should put all the other somewhat similar systems in the world, which are good, in the same boat.
Most of the world healthcare systems are train wrecks in one way or another but that is what you get when you mix the public with the private.
Please give me an example of a “purely capitalist” health system in the First World. (Hint, there isn’t one – you are just making an assumption)
Here’s the perspective of someone who lives in the Netherlands and is subject to its socialized healthcare system. About five or six years ago, when this new system was introduced, it was touted as being much cheaper than the previous system, that it would lower costs, streamline everything, etc., and so forth, ad nauseum… You know, the usual talking points.
The previous system was set up thus:
Anybody making up to 24.000 Guilders (this was before the Euro) had to be insured through non-profit insurance corporations who were funded by the local government of the counties. The monthly fee was three-tiered, between a basic, full and extra package and included basically everything. Basic cost me about 25 guilders a month, if I wanted the top coverage, it would cost me 75. When I got a salary increase of gross 50 Guilders, putting me over the top of the limit, I was automatically transferred to the top level payer status. What this means was that, for the exact same package, I now had to pay between a hundred and hundred fifty guilders for coverage (including dental). I can’t say how well it was as I hardly used it since I was much younger then and the price was cheap, the rate increase was minimal. There was no competition because you were, by law, required to sign with your county’s insurance non-profit.
Fast forward to 2005/2006 when the current system was implemented. Not changed was the law that everyone had to have basic healthcare. What was changed, was that instead of the old system where you had an income cutoff that decided how much you paid for the same package, EVERYBODY would have to pay the same for the basic package. The non-profit insurers were privatized and had to compete with the insurance companies and the big one, the government decided what would be in the basic insurance policy. Read that last one carefully…
EVERY INSURANCE COMPANY HAS TO HAVE THE SAME BASIC POLICY AS DECIDED BY THE GOVERNMENT.
This would be cheaper than the previous system, they said. They could compete on the optional packages components and on price. You are allowed to switch to whatever insurer is better for you. If you don’t use the insurance in a given year, you get part of it back from the government. They (and your employer) automatically take your monthly premium out of your salary.
Here’s the outcome:
Halfway through the first year, the insurers stated that the premium was too low to be able to pay the bills. See, the government takes in the basic premium and uses it to pay the medical bills of EVERYONE. Yes, everyone, that means everybody who goes to the doctor, the hospital, the pharmacy etc. which includes those who do not have insurance. You ask, but everybody is required by law to have insurance, you said! My answer, yes, they are, but you’re forgetting the social nature of the law. There are a lot of people (unemployed, illegal aliens, asylum seekers, those that are underemployed etc.) whom either don’t have insurance or because of their status are receiving subsidized healthcare from the government.
It’s called, ‘Shared sacrifice’ or ‘Spreading the wealth around’. It’s one of the reasons the government can dictate what is supposed to be in the basic insurance package. It is why, I, a male, have in my basic package pre- and post-natal care, which I can not transfer to my wife/girlfriend since she also has the same basic package, remember? Many more things in the basic package are geared to females or things hardly anyone uses, like alternative medicine like faith healers (yes, they cover that too). I could use it if I had a daughter under eighteen who got pregnant and I and my wife/girlfriend decided I would carry her on my insurance instead of my wife’s.
Since I have neither a wife, a girlfriend or children, I pay for a lot of stuff I don’t need and for a lot of stuff I need but which is only partly sufficient. I wear glasses and contact lenses. I can only buy new glasses every three years (at a government approved supplier) and I can only pay for half a year’s worth of monthly contacts with what is in the package, so I don’t bother. BTW, only very basic lenses for glasses are covered; anything requiring a bit more work? You pay the difference.
Here’s the outcome:
The ‘money back if you don’t use the insurance in a given year’ was tossed after two years, replaced with ‘paying up to 155 Euros for medical costs yourself before insurance kicks in’. So, with the government deciding on treatments and approved medicine, you basically are sure you’ll be out of pocket when you visit your MD. Each year so far, the percentage of the rise in premium has moved between 9 and 13 percent (this year it’s risen 13). The number of treatments and medicine in the basic package have declined, being shifted to the optional packages. Remember the pre-/post-natal stuff? It’s still there, but anti-conception pills? They’re out among a host of other things.
Another thing I’m sure you all will get a kick out of and will delight those that are proponents of Obamacare (looking at you, Rich39) is the ‘Waiting List negotiation’. I’m pretty sure the health insurers here are the only ones in the world who advertise with waiting list negotiation. If you need an operation or specialist medical treatment, you can bet you’ll be on a waiting list for up to six months, maybe even longer. Hey, there is a shortage of medical professionals, has been for decades. I know this because when I lived in Surinam (former Dutch colony) in the eighties and nineties before coming back, Dutch hospitals were poaching every nurse, doctor and specialists they could get there. Most people who can afford it or can somehow get the money, are travelling to places like Belgium or Germany to get treatment instead of waiting for months because those negotiations? They too take months.
I don’t mind helping to pay something for those who can’t but that’s what my taxes are partly for. I don’t like being forced to pay for stuff I, personally don’t use. I want to be able to get the insurance that I NEED, not what the government says I have to have, of which eighty percent is not even applicable to me. I’m still waiting for my insurance to become cheaper, yet in the five years it’s been operational, it’s actually climbed almost fifty percent to what I paid before the changeover. Higher than inflation OR my income has adjusted.
So there you have it, my experience with the collective health care. I find it surprising that all of these national health plans surprise the respective governments with their massive yearly shortfalls. It’s as if the smart people who think them up have no grasp of basic math. I mean, if you give a blanket pardon to 20.000 asylum seekers (who vacation in their land of birth every year) who get a house, government assistance, pay no taxes, medical insurance covered by the government etc., you should factor those costs in, don’t you think? Oh wait, isn’t that what is being tried to do now in the US?
As a physician, I can say that this is NOT news. We have been shouting about this from the rooftops for decades. No one has been listening….until now. What has been most disturbing to us about the collectivization of medical care in this country, is that the public seems to have given its consent to this fiasco, and helped to push it along.
Physicist, the REAL reason why outcomes are as good in those other countries (debatable) and costs are lower(?), is that it is very difficult to SUE doctors and hospitals there! The cost of medical care in this country would plummet overnight if we just eliminated the parasitic liability lawsuit industry here.
And, by the way, that WILL happen. One of the UNINTENDED consequences of the collectivization of medical care is that there will be more malpractice (because there will be no accountability anymore), but NO lawsuits. Even the Democrats will be unhappy with the new system.
Any thing that makes a Democrat (progressive, communist, socialist) un happ makes me HAPPY especially if Obama is a one termer…so let’s make history once again by making the first “Black” president a one termer in 2012!
Actually they will sue, but now they’ll sue “the government”, and the government won’t contest it because they don’t have to pay, given that they will effectively bill the tax-payer.
If the proposed changes are good why does both Congress and the President not participate?
Good enough for the serfs.
That is a great point, and a good reason to elect a conservative majority that will investigate and possibly imprison, with the possibility of loss of job benefits that democrats have granted to themselves over the past few years!
I was the V.P. of a French based publishing company in Quebec for two years in the late 90′s.
Here are some practical observations (not academic or statistical) to the single payer system.
1. I had this beautiful 22 year old French Canadian girl (Well all of my 350 employees where French Canadian and 95% of them only spoke French) working for me who had a club foot. She had been on a waiting list for three years for an operation. It was low priority. When I left two years later (after turning the whole operation around, thank you, that’s called solving problems) she was still on the waiting list. This was not a unique one time occurrence, I had 350 employees so I think I know.
2. I dated a dermatologist. Based on what *she told me* she was limited to what she could make for her class of medicine and at that time it was $105,000/year Canadian. Once she made that she was welcome to work her own private practice but that didn’t seem to work out so well. It is the same throughout the system. *She told me* of surgeons who had made their quota by July and left for the Caribbean in August.
3. Generally speaking what I saw was a system that worked well until you really needed it. I was in the trenches not perched from on high looking down upon the hoi poloi.
Do you really want a Doctor looking up your you know what who works for the government and is limited to what they can make (and that WILL be how it is along with rationing, great combo, eh!). My practitioner is an internist who I’m sure makes big bucks and is very smart, maybe 38 y.o.. Do you think a guy like that under an oppressive big brother single payer system is going to go into medicine (he’ll do it because he cares, B.S., just like the young teachers who go into teaching, find out what is really going on and bail as soon as they can). No way gang, he’s heading for Wall Street and business. Of course the government could take over Wall Street and business, and take away his passport and then see what he does. That could work, albeit it has been tried before.
Cuba and Russia have free medicine. Hey go on down, go on over. Good luck. I have a Bulgarian friend who has lung cancer, he sure as hell did not go to his friends in Russia for help and he is an exec. for a Russian company, Lucoil.
My brother and sister-in-law have lived in London for 33 years. He is retired from Xerox. They come to the states for all but their most simple medical treatment. They pay a sizeable sum in the U.K. for supplimentary insurance, just in case. They tell me emphatically that the U.K system simply DOES ration and they are in the process of trying to privatize elements of it as they know the system is failing and expensive.
Taking a good system that works in a country of 6 million people and telling us we can just cookie cutter that system and stamp it on America and we are home free friend tells me that not much thought has gone into that concept.
I am not against health care reform. I believe there is good medicine throughout the world, I’ve been in most of it and used it on occasion. However, I am against solutions that are more feel good and theoretical, than actually well thought out and that ultimately work. How about some tests on Obamacare in a state to see how well it might work on the national level. Oh darn already did that.
We have the best doctors, the best equipment and the best hospitals in the world (Yes there are good, all of the above, throughout the world). To say we don’t have the best displays a totally uninformed ignorance and understanding of what is actually going on in the world. Why in the hell do people from all over the world come here if Zimbabwe or Cuba or the U.K or Canada have lower and better medical systems (the opposite is true, they come here, when they can afford the travel). Yeah I know we are way down the list, what 36th or whatever, who cares. B.S. statistics and data work based on input, kind of like the AGW crowd.
I fully understand that there are some systems that work better than others i.e., I have heard good things about the French and the Japanese, but I do not claim to be an expert. I’m all for it but a 2700 page document, written by politicians/bureaucrats, unread, waivered to cronies, based on all kinds of bad data, opposed by doctors (screw the AMA and AARP) probably not possible to implement in it’s current form and not thought out in any meaningful way is not the answer and frankly scares the living hell out of me.
Thanks
Good post. I think what you are saying about the next generation of potential doctors, capable people, is true. Conservative types in that class will opt for alternative careers, while the Socialist minded will have no qualms about a career in medicine even if it’s fully government rigged. But that is not the worst of it. Since, this means less doctors it means a shortage, and can we assume that medical school will be made a teensy bit easier to get through? Quality of care will go down when less astute socialist-minded medical students are crammed through to meet the demand. And we can see right there, that supply and demand is what it is all about – but men are not robots. Socialists have their collective eye on the demand side only, it seems.
Having medical insurance does not necessarily mean you get medical care when needed. Insurance does not provide medical care–doctors do. If I were a doctor, and the country goes socialist or even becomes too much of a hybrid, I would quit the profession. Use your insurance card to wrap around your broken leg. I am a strong believer in allowing people to go to hell their own way.
And do you really want the government to have access to your electronic medical records?
Excellent question. Imagine your medical records hacked by journalists, Wikileaks, real hackers, future employers, the FBI, random passers-by…
One study recently reported that a third or more of all IRS taxpayer records are readily accessible to hackers through IRS databases which are insufficiently shielded, yet the IRS requires digital filing for large segments of the business and independent population.
Meanwhile, Dr. Hsieh makes another powerful point: ObamaCare requires everyone to buy health insurance and medical practitioners to purchase “government-approved electronic medical record systems.”
The only logical question is: What will the government next decide to mandate we must all (individuals, businesses, practitioners) buy?
Overheard at a major insurance company:
That these market incentives exist is undeniable. To believe that corporations don’t exploit them is naive.
After all … America’s health-care insurance service just plain couldn’t be as bad as it is by accident … could it?
Republicans are going to have hearings this week to consider the possibility of eliminating the Independent Payment Advisory Board (IPAB) because it will “ration” care. I hope they come to the conclusion that if Medicare/Medicaid are continued as is, such a mechanism for limiting care is absolutely necessary to avoiding absolute bankruptcy.
Collectivization creates a tragedy of the commons–and tus requires some centralized means of limiting “overuse.”. Many of the countries listed in the comments above are willing to live with government limitations on healthcare choices, and yet still actually pay more out of pocket that most Americans. Additionally, they “free ride” off American innovation and pharmaceutical costs.
Comparisons across countries are quite difficult due to multiple differences between the systems, variable reporting requirements, as well as different interpretations of statistical categories such as infant mortality, and on and on.
Administrative costs are incomparable between private and state run operations because governments do not pay taxes, collect premiums, are able to “outsource” many tasks(without attributing the cost to the healthcare system) to other government departments, and on and on.
If people want to relinquish their freedom of choice, they are free to join a tightly budgeted HMO with capitation, utilization review, pre-authorization requirements, etc. –but no one should be able to force me to participate in a similar system. Not as either a patient, or as a physician.
As my title says I know my job that I have been doing for 39 years I also went to school to become a MD but could not stand to to see people in ill health or those that were injured in accidents so I went to Psychology and also Accounting but settled down in the Construction Industry mostly involving computers and data. I also can repair large as well as small computer systems, was certified by NASA in miniature circuit board repair as most of the the cards were one of a kind and proprietary and held a need to know clearance (secret clearance) in the U.S. Navy in the mid 1970′s!
I do know one thing for sure I was given an oath that swore to God and our country to fight against enemies both foreign and domestic and have come to the conclusion that Obama is a domestic threat as well as the Democrat Party in national politics and must be rid of either by the vote or rebellion.
I know this sounds radical, but it is necessary for the survival of this nation!
Make history by voting against all Democrats(socialist, communist, progressives, or fascist) in 2012!
Thanks for this forum and allowing me to post my true feelings about the worst government and president ever to occupy the honored office of president or senator or congressman!
this is ridiculous article. many other advanced capitalist countries have highly regulated health care systems with excellent outcomes. the problem is threefold trifecta: unhealthy population, excellent but expensive medicine, inefficiencies in providing funding for that medicine. The most efficient and cheapest system would be highly regulated, highly compensatory for health care providers, and highly incentivie good health and saving for future high-cost health problems that most of us will eventually face.
liberal realist (#18) wrote, “many other advanced capitalist countries have highly regulated health care systems with excellent outcomes.”
Please tell me where these countries are located on the planet. Canada is a socialist country. All the European countries are socialist countries. Russia is a socialist/communist country. China is a communist country. Cuba is a communist country. Mexico is a failed state. South American countries are socialist/communist countries. The Middle East countries are totalitarian states (or wannabes). India is a socialist country (as stated in the preamble of its constitution). You get the picture. Where, oh where, have all the “advanced capitalist countries that have highly regulated health care systems” gone? Where, oh where can they be?
“Canada is a socialist country. All the European countries are socialist countries. Russia is a socialist/communist country. China is a communist country.”
Canada and the European nations are capitalist social-democracies, Russia is an authoritarian kleptocracy, China is a authoritarian state-capitalist nation.
Examples of nations with both good health care delivery and healthy economies are the EU donor states (like Germany and Scandinavia), Switzerland and Austria, Japan and what used to be called the Asian tigers (Taiwan, S. Korea, Singapore). All have highly regulated health care by US standards. Each of the nations, excepting Singapore, have only one serious problem they don’t know how to deal with: low birth rates, the universal problem of affluence.
One more thing: if the socialistic health care systems of the EU donor states, the Asian tigers, and Britain and Canada are so terrible and destructive, why haven’t the voters in these democracies replaced them with a free market that treats health care like any other commodity?
The answer is simple. The people in these countries have lived for so long with the socialist mentality that they can NOT imagine that they could control much of anything in their own lives.
Here is a perfect example: The liquor industry in Canada is controlled by the Canadian government. That’s why a case of beer in Ontario costs $45.00, instead of $16.99 across the border in Michigan at a Meijer’s grocery store. (I hope the fact that beer here costs three times more sinks in. It’s true for every other product and service here as well.) Lately, there has been some talk about privatizing the liquor industry. Heavens to Betsy! You would think that would make the sky fall in. I was talking about this with a woman from Sault Ste. Marie, Ontario, and she was visibly shaken by the idea that if this happened, all the people who work in the liquor and beer stores would be out of work, those poor people. I tried to explain to her that, rather than those people losing their jobs, many more people would be put to work because of the simple fact that there would be more stores because the private sector would buy the existing stores and would also build many more stores, which would employ many more people. In some areas of Ontario, there are 20 or 30 miles between liquor stores. Any thinking person realizes that this would change under privatization. Many stores would be built to fill the gap between the existing stores. Some would succeed and some would fail. This is the free market at work. And, the price of liquor and beer would come down drastically. Geez! I don’t know why people just don’t get it.
My point is that people in socialist countries have been conditioned to think that government can solve all their problems and provide everything for them. They are robots. People my age in Canada have lived their whole lives under the socialist thumb. They are so dependent that they cannot even imagine an alternative way of thinking or having the right to manage more in their own lives.
Government does nothing better than the private sector. Government is bloated, wasteful, fraudulent in many cases, promotes power struggles and class warfare, and is incompetent in most of its endeavors. That’s why the best government is limited government.
In 2008 the Americans voted in large numbers for hope and change and boy they are getting it in spades. The Americans will now blame everyone but themselves for their own stupidity as they always do. There is a strong reason to suspect that these same Americans will reelect the god president in 2012 because their lying media will give them a scapegoat to blame anyone but the god president and his worshippers.
The people who have communist souls never learn from experience. That’s one thing that is glaring; Their “collective” arrogance and superior self-image fail to realize that “yes, that’s been tried before” and yet, even if confronted with the facts, they rationalize and basically tell us, “Well, we have the right communists doing it now.”
And, when it all fails, it has still met its goal of taking money, time, health and good living away from the people who pay taxes.
What it comes down to is this: There are two basic types of government-headed people. 1) The type who likes the free-market system, has an attitude of letting the people decide what’s best for them by how they spend their money and where they move to, etc. and 2) the type who think the public is to be ruled over, told what to do and when and how to do it, micromanaging everything in their personal and professional lives so that not a single dollar ever gets “wasted”*
*Wasted: Not given to the government.
But, sooner or later, you run out of other people’s money. Communists always count on later. It only took a generation and a half for it to happen to the USSR. Given the government of THIS nation’s lack of frugality, my bet is on less than half that time.
Here we go again…
“It is socialism. It moves the country in a direction which is not good for anyone, whether they be young or old. It charts a course from which there will be no turning back.”
—Senator Carl Curtis (R-NE), in 1965, opposing Medicare
“The doctor begins to lose freedoms; it’s like telling a lie, and one leads to another. First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him you can’t live in that town, they already have enough doctors. You have to go someplace else. And from here it is only a short step to dictating where he will go.”
—Ronald Reagan, in 1961, arguing against the creation of Medicare
Leftists never learn.
In the city where I live (near to Canada) we are able to recruit neither Canadian citizens to our clinics, nor Canadian physicians to our medical school faculty.
The reasons are simple, common-sense, and two-fold. (1) Canadian citizens are satisfied with the quality, accessibility, and price of the health-care they receive (all of which are excellent). (2) Practicing Canadian physicians want zero part of the economic, ethical, and practical horror that is the American medical billing system.
Meanwhile, in our own city’s medical school, the clinical Grand Rounds (teaching rounds) that in previous decades focused upon teaching residents to provide top-quality medical care, now focus largely upon billing codes and strategies for recruiting to our clinics a larger proportion of what are (delicately) called “sponsored patients.”
These harsh realities are not anecdotal; I experience them personally as a full professor in that medical school (my research speciality is quantum systems engineering in service regenerative healing) … I have personally attended to many such Grand Rounds … I have worked (unsuccessfully) to recruit top-quality MD faculty from Canada … only to find that they will *not* come … America’s disastrously wasteful health-care economic system being the main reason … and my sister too is a full-time family-care physician.
Moreover, the above conclusions are confirmed by every serious study of medical economics and health-care efficacy. The consensus of our medical school faculty, both MD and PhD, is that health-care reform is coming to America for one simple reason: it *has* to come. And the less ideology-driven it is, the more likely it is to work.
Time to Heal: American Medical Education
from the Turn of the Century to the Era of Managed Care
URL: http://books.google.com/books?id=6txAV-Cmj-AC
The insurance system you describe has been imposed on our nation by the government. It has very little in the way of market based incentives to promote efficiency our reduce costs. The same government would like to create a single payer system which they control. The solution to a problematic system they created is to give them even more power.
Also, being a professor at a University (public or private it is funded/subsidized by the government) and effectively a public employee I question your objectivity. I aggree with you that our medical insurance system is broken, but the solution is not more central control. Keep working for the government and let Doctors who want to practice medicine their own way have the freedom to do so.
Anonymous, your post ignores several real-world issues.
(1) Training physicians is very costly. Shall all teaching hospitals be privatized? The certain result will be that every new physician would be burdened with crushing debt … and the quality of medical teaching will suffer too. The reason is that there is a strongly negative fiscal incentive for teaching … cases go *slower* when residents “help” … and this inefficiency greatly harms shareholder profits.
(2) Taking care of veterans is very costly (teaching hospitals do much of it). Shall the VA be privatized?
The ideological answer is to privatize everything … eliminate non-profit teaching hospitals … so that physicians graduate deeply in debt … let medical teaching suffer … and send veterans to the lowest qualified bidder.
Like pure communism, these pure-market solutions work just fine in theory … yet also like pure communism, never yet have they worked in practice.
You are setting up a straw man arguement. Who said veterans should not be cared for or teaching hospitals should be privatized? States can make decisions about Universities at their level and Veterans would probably appreciate some choice in their providers. My main problem is with an insurance system in which demand is subzidized by third party payers and consumers are not allowed the freedom to purchase insurance across state lines – buying policies which fit their needs, not the needs of politicians and beaurocrats. Basically, I believe the root of the problem is that patients do not pay enough out of pocket for their healthcare. I know what about the widows, orphans, poor etc. . I have compassion but for every person who truly cannot afford to pay anything, there are several persons who are gaming the system. Heatlth insurance premiums and deductibles are the last thing they will pay for. In anycase, with Medicare/Medicaid sporting 30 to 100 trillion dollar unfunded liabilities the entire system will blow up anyway. What single payer offers is rationing and the end of medical innovation ( Canada gets drugs developed in the U.S. at marginal cost of production while the upfront cost of R&D are paiid by U.S. consumers and taxpayers). I would prefer to pay more for my own healthcare in order to have more options when I need it. Oh, and by the way, didn’t the Courts in the province of Quebec have a ruling that access to a waiting list for treatment in the Canadian system was not equivalent to treatment? This case came about because of the long wait times in Canada for various treatments.
LMay, it appears that a 100% private-sector, consumer choice-driven, Swiss-style system is just what you are looking for.
Swiss systems exist somewhere to the moderate ideological right of Hillary-care and Romney-care. More to the point, it’s a system that works … in practice, not just “in theory”.
Consumer-driven health care: lessons from Switzerland
URL: http://www.ncbi.nlm.nih.gov/pubmed/15353534
A Physicist wrote:”Meanwhile, in our own city’s medical school, the clinical Grand Rounds (teaching rounds) that in previous decades focused upon teaching residents to provide top-quality medical care, now focus largely upon billing codes and strategies for recruiting to our clinics a larger proportion of what are (delicately) called “sponsored patients.”
That is total nonsense. Either that or you work in a really crappy teaching hospital. I hope you are more precise in your actual work. I have been to more that you have. I pulled up the Duke University Department of Medicine Grand Rounds schedule at random for example:
http://clinicaldepartments.musc.edu/medicine/grs/Grand%20Rounds%20Schedule%20for%20Website%202010-2011.pdf
Anyway, as you well know professor, Grand Rounds are mostly for staff, not residents. They are not a curriculum but a series of lectures on current topics of interest which, for practicing physicians certainly includes practice management and economic issues. Residents get most of their education in departmental conferences specifically for them and in daily work and self directed learning geared toword Board and Departmental exams.
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The Prescience of Reagan (1961) on ObamaCare: “One of the Traditional Methods of Imposing Statism or Socialism on a People”
http://weaselzippers.us/2011/03/08/the-prescience-of-reagan-1961-on-obamacare-one-of-the-traditional-methods-of-imposing-statismsocialism-on-a-people/
Spindock, try calling the number below (the famous Johns Hopkins Teaching Hospital) … tell them you have high-quality insurance. Then call back an hour later, tell them you *don’t* have any insurance … and see if you get the same service.
At some institutions you will … at others you won’t. No-one knows what the real odds are … or how the America’s medical marketplace is *really* working. That’s because for-profit health-care lobbyists recently sued to block such experiments.
——
Insurance-Sponsored Patients
URL: http://www.hopkinsmedicine.org/international/patients/billing_support/sponsored_patients.html
I think you misrepresented the state of medical education in the US.
Access to medical care is a separate issue. In the ideal world everyone can get the top shelf everything right now. In the ideal world patients take all their medicine as prescribed and follow all advice about health issues. Real people, bless their hearts, are nothing like that.
So in reality in medicine we are going to take whatever resource we can get. If people really wanted socialist medical model we would have that by now.
Recruiting is a difficult job. I cannot speak to why it has been difficult for your institution. Not easy anywhere.
I am very fortunate in the fact that the last few doctor’s visits I have made were:
A: allergic shock
B: Suicide attempts
Unfortunately, I did ‘B’ a few times an almost succeeded.
I think with 0mamacare, they wouldn’t have put me on heart monitors and saline solution to save my life, they would have figured, hey, she wanted to go, GO.
I wouldn’t be alive today if it wasn’t for our current medical system.
Perhaps offing myself is the ultimate irony though, because, truth be told, I’m so tired and my life has no meaning and maybe with Bozocare, I can finally achieve my ultimate goal, which is suicide by any means possible.
I’m tired of being ‘rescued’, perhaps I need to be left to die like any poor and lowly homeless person is? I’m no better than the man on the street. Why should I be saved?
/rant off
Delia,
The medical system is still there and who cares about Obama whatever?
Your life still matters. Nobody is here by accident. Sometimes I need to say that thing about “I am a child of the universe, no less than the trees and the stars, I have a right to be here…” and go on today.
Thank you for your post.
Spindok
Spindock, that is a noble post. Delia, what Spindock says is 100% true.
Even if you are having trouble finding strength to live for yourself, maybe somewhere there is some living thing who needs *your* strength … this can be a Big Sister, or any sort of volunteer work, or a stray cat or dog who needs some love, or even just a garden that needs tending … many people have found that the love and care that you give, comes back to you (eventually) in overflowing measure.
Thank you both for your empathic posts.
You guys made me cry (in a good way).
Thank you.
The problem with the collectivization of American health care is this, it won’t work especially when there are already severe shortages in manpower, infrastructure and medical products and no amount of government can change that especially in a very bad economy.
Excellent article, Dr. Hsieh. Accurate comparison of collectivizing Ukrainian farmers and what’s being done to all of us who use health care.
The fact is, ideology is at the basis of morality. One can get an aught out of an is. The nature of man demands freedom: to think, to act on what is thought, to trade freely from other individuals for survival and for thriving. This applies to medical care, too. This does not mean the poor sick are ignored. It means no one may morally demand that others support someone else, involuntarily. Therefore, only voluntary charity is moral.
To Physicist et al, it is immoral to advocate coercion of any human, against their will, to support another human. If you are concerned that the poor sick will not be cared for, if that is really your concern, there are many ways to advocate for voluntary charity for those few people who are unable to care for themselves. But in a free market society, there would be MacDonalds to Cordon Bleu level of medicine available for every level of income. Those who are destitute or unable to work are a very small number, easily covered by private charity. And that some people are wealthy and able to whoop it up in the ICU does not affect how much wealth anyone else has to spend on medical care, as wealth is not a static commodity. It is virtually unlimited in a free society as wealth is a creation of our minds- see Bill Gates, Steve Jobs, et al for examples of wealth creation.
Medicine is no different than food, housing, clothing, computers, automobiles. It is supplied by people and those who supply any valued commodity or service must be recompensed for their work. That is not just survival, but also justice. What vendors of medicine should be paid is to be decided privately, by those with whom they trade. That too is survival and justice. For some interloper to interpose his or her judgment or some bureaucrat’s (elected or not) judgment to supersede those involved in a trade of money for medical care, is to short circuit the judgment of the patient and/or the doctor and is not just inefficient, but morally wrong. Our reason is our means of survival. To interfere with any one’s means of survival, by interposing one’s judgment over and above their own, and to do it coercively (government regulation or law) is to interfere with an individual’s only means of survival- reason- and as such is a direct violation of that individual’s right to live, right to be free.
I had an interesting talk with my son who is a premed student. He told me that there are 350,000 licensed doctors in this country. Out of that number of doctors, 250,000 intend to retire after Obamacare comes in. That leaves 100,000 licensed doctors to serve us. If the medical schools respond by churning out as many doctors as possible, the best they can do is a few thousand more than are graduating now. With Obamacare, in place the best students no longer consider medicine as their top pick for a career. Expect an increased use of nurse-practioners as a stopgap measure and the importation of foreign doctors. If you go to a local hospital today, they are already staffed with doctors from India (thank G-d we got them) and nurses from the Philippines. A doctor I knew once called the foreign nurses working in his hospital the foreign assassins, I’m assuming that he was conveying something worth recognizing. If you go to a hospital today be ready to be confronted by caregivers who don’t speak English, marginal sanitation, high infection rates, and mistakes on medications/drugs being administered to you. Remember that that is now under the good system. Wait it will get worse under Obamacare.
Remember that it was Obama who wanted to gut Medicare to help finance his new system. Remember how he bribed and coerced every Congressman or Senator he could to get it passed. Now Nancy Palossi vows to defend Medicare to the death. She is the one who led the charge for Obamacare. Remember also that 56% of the American public was against it.
Where is government by the people for the people?
you know, during the propaganda for the health care bill, I saw exactly two articles on the poor state of how this works for the Indian Health Service.
Rationing? Shoddy clinics? Long lines? Ask anyone with a “CDIB” card who tries to get seen.
Yet the AMA and AAFP actually worked to get this passed, over the objections of their members. Sigh.
The AMA also is active in limiting the number of Med Students that graduate. It was an artificial way of maintaining high salaries and incomes. The result is that we have to import doctors because of the shortage. Wait, you ain’t seen nothing yet.
Communists are the dullest people on earth. Even a dumb dog can learn a new trick, but not communists. Their excuse for past communist failures (and they are ALL failures) is always “they just didn’t go far enough” or they think they’ll do it better. They probably tried to put the square peg in the round hole for years, until eventually they had to quit and go to college. Facts are like annoying gnats to be brushed aside. Zombies.
Medical care, like every service and product, is scarce. That is, there is not enough for everyone to have as much as they want (like air). Hence it WILL be rationed. The only question is how. It can be rationed according to the free market where people can work for it and decide what it is worth to them, or it can be rationed according to govt. bureaucrats who have political agendas. Why would anyone with any sense choose to have rationing done by the later?
Earlier this week, our son came to the aid of an elderly lady taken ill on the Ketchikan-to-Bellingham ferry.
In response to the captain’s announcement, two vacationing German physicians came to her assistance. As they took her medical history, they became more-and-more appalled at her medical care and living conditions. “Americans are barbarians, to treat their elders so! This is the kind of medical care we see in a third world nation!” was their conclusion.
On hearing our son’s story, I checked life-expectancy statistics — the USA presently ranks behind every single western european nation.
German life expectancy: 79.4 years
American life expectancy: 78.2 years
http://www.worldlifeexpectancy.com/
AFTER age 50, US life-expectancy is LONGER than in Europe-also, better quality of life after 50, by most measures.
(US data are skewed by youthful immigration from poorer countries and language barriers, and therefore raw data needs adjustment.)
I have lived in the UK and the Netherlands. Socialized health care can do simply things decently (cf, Cuba), but, lacking any reward incentives, is incapable of doing difficult things anywhere near well. Nor do they absorb innovations efficiently. If “old fashioned” neglect of human needs is a major selling point to you, just move to our rival nations for their “health care.”
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