On Sat, 2 Feb 2008 21:17:35 -0800 (PST), Chuck Gould
wrote:



The current US system is also highly rationed. The rich have access to
the best available care. The poor have no to very-limited access.

The rich has access to the best available food, cars, houses, clothes, ...

I actually have a plan. We stop trying to deliver public health care
through private practice. We would set up a "pretty good" system of
public health clinics and hospitals across the country. No, there
wouldn't be private rooms, and nobody would take up a *bed for
cosmetic plastic surgery or vacuuming away body fat. Some of the most
advanced heart transplant or other surgeries might not be available. A
few people might die for lack of the most exotic or heroic treatments,
but we would provide a basic level of care and repair to all comers.
Think of it as a public school, not actually intended to be the very
finest education available to anybody anywhere with any amount of
money to spend, but better than adequate for most and much better than
nothing for all.

It will devolve to rationing. The problem you have is you can't control
all of the costs. What are you going to do about salaries for the
doctors, nurses, administration staff? You will have a hard time
controlling the cost of living for one. What are fuel costs going to do
to your ability to get supplies at an acceptable cost?

If restricting access to the most ridiculously expensive medical
procedures sounds heartless, it might be. But at what point do we draw
the line? Let's assume that somebody develops a bang-on, foolproof,
absolutely 100% effective sure cure for any type of cancer. Only
problem, it relies on some ridiculously expensive rare metals and
treatment can't be administered for less than $10-12mm per patient.
Does society step up and spend $12mm in public funds to cure the
cancer of a 90-year old diabetic also suffering from kidney failure
and heart disease? Most medical ethicists would probably agree, "no".

Restricting equals rationing.

To preserve freedom of choice in the marketplace, "boutique" level
health care would also be available for those who chose to pay for it.
Insurance companies could sell policies to provide more personalized
service and fund the $500,000 heart/lung transplants and other
exceptional cases. Those willing to pay could have luxury suites,
gourmet menus, etc etc etc. The sky would be the limit.

You are proposing a two tier system. The haves and the have nots.

I have no problem allowing those with the means and desire to buy a
premium level of health care over and above what is available through
the proposed public system. That's what the patient in John's video
did, except then he decided to sue the Province to try to get the
taxpayers to reimburse him for the expense associated with his
prioritized treatment. That's not so different from deciding that
Harvard offered a better education than Local State U, going there to
get a degree, and then suing your home state for a refund representing
the difference in tution.

You want to bring the Canadian model to the USofA.

There's something wrong with the perspective that poor kids should be
denied access to decent health care (as in Texas, where a full 30% of
workers have no health insurance and the state doesn't put up the 28-
cents required to get 78-cents in Federal money for kids health).
There's something wrong with a system that causes middle class men
approaching and/or entering retirement to view the kids and the truly
indigent as "competitors" for health care.

You confuse access and insurance. Everyone has access to health care,
however, some lack the ability to pay for that access. You propose to
pay for that access with my money.

Split the system. Basic, decent, public care adequate to sustain the
general health of the poor or those who choose not to pay for anything
more exotic, and traditional private practice for folks who want the
best health care money (a lot of it) can buy.

Won't work. The basic system will fall apart as soon as you allow the
"boutiques" to exist.

The free market is the best solution, you pay as you go.

What needs to be fixed is the Worker's Comp system. Limited pool of
money to treat those entitled with the result being that those needing
care are denied.- Hide quoted text -

- Show quoted text -

On Feb 1, 12:03 pm, BAR wrote:


It will devolve to rationing. The problem you have is you can't control
all of the costs. What are you going to do about salaries for the
doctors, nurses, administration staff? You will have a hard time
controlling the cost of living for one. What are fuel costs going to do
to your ability to get supplies at an acceptable cost?

Lack of cost control would not be anything new, would it? Salaries for
doctors, nurses, administration staff would be paid from the public
funds. The system would cost a bit more than the K-12 educational
system currenty does. Doctors make more than teachers, but we wouldn't
need a doctor for every 20-30 patients. Much of the care would be
provided by nurse practitioners. Got the sniffles, sprain your ankle,
upset stomach....see the nurse andhe or she will either prescribe some
medicine or determine that your symptoms indicate need for more
serious attention.

My system would not pay the average "sniffles and annual check-up
pediatrician" 1/4 million dollars a year. The insurance company and
self insured tier (private healtth care) can pay whatever it wants to
pay.



If restricting access to the most ridiculously expensive medical
procedures sounds heartless, it might be. But at what point do we draw
the line? Let's assume that somebody develops a bang-on, foolproof,
absolutely 100% effective sure cure for any type of cancer. Only
problem, it relies on some ridiculously expensive rare metals and
treatment can't be administered for less than $10-12mm per patient.
Does society step up and spend $12mm in public funds to cure the
cancer of a 90-year old diabetic also suffering from kidney failure
and heart disease? Most medical ethicists would probably agree, "no".

Restricting equals rationing.


Restricting equals rationing? Consider my example above. Is adding a
few weeks or a few months of life for a sick and very elderly patient
a good use of (realistically) a million or more in public funds? You
over look an important detail; under my system you and/or your
insurance company could pay for as much treatment as you wanted. If 99-
year old
Joe is going to die next week and leave $1mm to his heirs without a
heroic treatment, or live another 60 days if he spends everything he's
got on a short term prop-up it should be his decision whether he
checks out when nature intended or spends his entire estate staying
alive a few more weeks. We can't, and shouldn't turn everybody into
Terry Schiavo at public expense.

The current system *already* restricts health care. Can that possibly
be news? My sister-in-law, (age 60) has had about a dozen
angioplasties and open heart surgery so far. She takes over $1000 of
dollars worth of prescriptions a month. She is still able to work.
Shocking fact- probably the only reason she isn't dead yet is that the
company she works for has been sold 2-3 times along the way. Her
insurance policies always have a "lifetime limit" of $1mm in
treatment.
She's so far beyond that it isn't funny- but each time the company has
sold a new insurance company seems to come in. They are forced to take
my sister-in-law because she is an employee of the company, and she
gets a fresh start on another $1mm.





To preserve freedom of choice in the marketplace, "boutique" level
health care would also be available for those who chose to pay for it.
Insurance companies could sell policies to provide more personalized
service and fund the $500,000 heart/lung transplants and other
exceptional cases. Those willing to pay could have luxury suites,
gourmet menus, etc etc etc. The sky would be the limit.



You are proposing a two tier system. The haves and the have nots.


I propose a system modeled after the public school system. Public
schools provide much more eduation to the have nots than they would
ever receive if they had to pay tuition. At the same time, a robust
system of private schools exists where families with the means and
those willing to sacrifice can send their kids for a specialized or
possibly superior education. General education? Public school. Want
your kid to study in a religious, paramilitary, or academically elite
environment? Pony up for private.




I have no problem allowing those with the means and desire to buy a
premium level of health care over and above what is available through
the proposed public system. That's what the patient in John's video
did, except then he decided to sue the Province to try to get the
taxpayers to reimburse him for the expense associated with his
prioritized treatment. That's not so different from deciding that
Harvard offered a better education than Local State U, going there to
get a degree, and then suing your home state for a refund representing
the difference in tution.



You want to bring the Canadian model to the USofA.


No, not at all. "I have no problem allowing those with the means and
desire to buy a premium level of health care over and above what is
available through the public system." The major criticism with the
Canadin system is that you can't use your money, no matter how much
you have, to get to the head of the line for treatment or access the
finest specialists in a particular field. My system would provide
basic public health care for everybody, and if the well off want to
buy additional insurance or pay out-of-pocket for something better
they would still have the right to do so.



You confuse access and insurance. Everyone has access to health care,
however, some lack the ability to pay for that access. You propose to
pay for that access with my money.


Hate to break this to you, but under the current system the Easter
Bunny doesn't just drop in and leave plastic eggs with thousands of
dollars inside every time an uninsured person goes to the emergency
room of your local hospital. You and I are already paying for this
care.
The doctors, the hospital staff etc don't work for free. The amounts
charged off as uncollectible from indigent patients become "overhead",
and the rates charged to insurance companies or those paying directly
for care are then adjusted to cover the increased overhead (plus
profit, of course- and the private hospitals are entitled to that). If
you pay for your own health insurance or pay directly for your care,
you are *already" paying.

Another benefit of the public system is that it is much cheaper to
prevent illness than to cure it. Getting a kid to the doctor or nurse
practitioner once a year for a general exam will allow early detection
of some conditions and preclude some half-million-dollar heroisms down
the line.



Split the system. Basic, decent, public care adequate to sustain the
general health of the poor or those who choose not to pay for anything
more exotic, and traditional private practice for folks who want the
best health care money (a lot of it) can buy.



Won't work. The basic system will fall apart as soon as you allow the
"boutiques" to exist.


Have the exclusive private schools put the public schools out of
business? If people want access to the top tier of exotic treatments
and
highly specialized expertise they can pay for it. For the rest, the
public system will be better than zero.




The free market is the best solution, you pay as you go.


The free market is alive and well under my proposal. Private health
providers will be free to charge as much as they want to as many
people as they can find to pay it. Only difference- there will no
longer be a monopoly on health care controlled by the insurance
cartels. Surely you aren't in favor of sustaining the current
monopoly? Nothing free market at all in that. The basic public health
care network breaks the existing monopoly.




What needs to be fixed is the Worker's Comp system. Limited pool of
money to treat those entitled with the result being that those needing
care are denied.- Hide quoted text -

- Show quoted text -

It's funny how in all this talk, and it's a bunch, you've totally skipped
what your first article called the 'biggest' problem, i.e. illegal
immigration.

Nor do you address the fact that the Canadians and the Dutch, from what
I've read or been told, don't go to other countries for 'boutique' medical
care. They go because they can't afford the wait in their own country. You
don't address that either.
--
John H