Health Care Reform | Napa Valley Register

Home » Opinion » Michael Haley

Health Care Reform

Tuesday, March 03, 2009

Comment

By Michael Haley

Napablogger

October 28th, 2009

One final thought before signing off

September 23rd, 2009

Time for local economic stimulus

August 31st, 2009

Community in a world of chaos

August 20th, 2009

Schwarzenegger finally proposes pension reform

Today President Obama appointed Kathleen Sebelius to head up his Health and Human Services Department, a key position for his Presidency. It is a welcome effort because there is no doubt that we need serious reform, but like the efforts underway for alternative energy the costs for this program tend to be understated.

There is a vast body of literature and debate out there now, for a quick look at some of the key debating points here is a page at the New York Times that links to both Obama’s thinking and some of the arguments for and against various remedies.

My concern is that we are going to end up with a more expensive system that is worse than we have now if this is not done right. Obama is correct when he points out that health care costs have gone up four times faster than wages over the last eight years alone. It is indeed a crisis and something has to be done, as we all know.

One point made over and over by advocates for government paid insurance is that those without insurance go to emergency rooms which are more expensive. The thinking is that if they have insurance they will more often go to the doctor’s office, and they will get better care overall thus reducing the bigger expenses of letting their health go and contracting more serious and expensive problems.

I find that logic a bit specious for several reasons. For one thing, if the uninsured have insurance, they will go to the doctor a lot more often than they did before, offsetting the savings of not using the emergency room. If the emergency room is five times as expensive and they end up going five times as often, the cost ends up being the same.

I am also dubious of the claim that seeing the doctor more often will avoid major health complications. The vast majority of our medical care goes to people over fifty years old. If they get better health care they live longer, which is what is happening. Which costs more, frankly, as insensitive as that could sound. And the fact is that as one ages, you get health problems, the body wears down, even if you get good medical treatment.

The real problem with cost is that our health care system is over used. People go to the doctor too often, and many tests and treatments are done that are not necessary. Insuring everyone is going to send millions of people to doctor visits that are not going now, skyrocketing costs. This is exactly what has happened in Massachusetts, with their government paid insurance program.

All of the different plans to control costs come down to one of two ways. Either someone makes a rule that you can’t get treatment, or the price is high enough that people avoid "buying" it. The rule that you can’t get a particular treatment is made either by your insurance company or by the government.

That last paragraph explains the entire issue. The rest of the debate is centered around less significant issues, although I won’t deny there are some important ones.

No health care plan to reduce costs is going to work unless it reduces the amount of medical care being provided. Period. Look at alternative energy, one of the main areas of effort is to reduce the amount of energy that people use, to make it more efficient. The same thing has to be applied to health care.

Like energy, Americans are very wasteful when it comes to health care use. People like to go to the doctor, and when it is free, which is essentially the position that insurance puts you in, there is no restraint.

Recently I listened to a debate in the Irish Parliament led by the Health Minister, where MOP’s were objecting to her decision to not buy a new drug for the nationalized health service for a children’s disease. Her reason for not getting it was that it would cost $25 million and they just didn’t have the money. She won the debate and Irish children will not be able to get that drug. None of them.

That is the problem with nationalizing health care in any way, the government makes the decisions and one size fits all. That was the problem with HillaryCare.

The fact is that someone is going to have to decide who gets what care. The best and fairest way to do that is to charge the patients some amount of money so that they only get the treatments that they really need.

The idea that health care is a right and we should just pay to provide even the poorest and the most irresponsible a Mercedes level health care plan is not grounded in reality. It will never happen no matter how badly we may want it, because the money is just not there to do it and never will be. I hate to be such a Republican here, but some children will be left behind and there is nothing anyone can do about it.

Any health care plan that is going to work has got to involve patients paying something whenever they use the system. Otherwise it will be a government mandated dictatorship that will ultimately take away people’s dignity of being able to make their own free choices of what they want and how much work they are willing to do to get it.

214 comment(s)

a teacher wrote on Mar 3, 2009 7:46 PM:

" I don't know NB. The USA has the most expensive health care in the world. Most of Europe has gov't run health care, they spend less per capita and their overall health statistics are better than ours(they live longer, are over all healthier, lower infant mortality, etc). I think that makes an argument that gov't run health care can be better than private.

I disagree with your arguments about ER's and the uninsured. I don't think it's necessarily true that people will go to doctor more often (it certainly isn't true of me). But, even if that's true, medical professionals are pushing preventative medicine these days as a way to cut down on costs and improve health in general. It's also a better alternative to using (and tying up) ER resources when a more conventional approach would work. "

steph wrote on Mar 3, 2009 8:02 PM:

" Nobody will address the fact that if we nationalize health insurance, then we automatically need to factor in the cost of insuring any and every immigrant who arrives into our country unannounced. Can we afford to extend health insurance to Mexican nationals?

I have mixed feelings about national health insurance. My heart says that healthcare is a basic need, and people should not have to forego testing and treatment. Children especially have no say over how responsible their parents are, and they should not have to suffer for their parents negligence. Intellectually, I wonder if a national shared risk would actually benefit the country's economy, by taking the burden of coverage off small and large businesses. There are people who remain on welfare systems like disability so that they won't lose their health coverage. Right now, Medicaid penalizes people who work by increasing their share of cost or withdrawing coverage. If this was a non-issue, might we see more people voluntarily returning to the workplace, and might businesses be able to hire more workers without the burden of paying for their health insurance? Another argument for universal insurance is this: many young people forego insurance because it is too expensive. They know the likelihood of illness at their age is lower than it is for an older person, and so they game the risk. And in this way, the pool of insurance money shrinks and is spent on mostly older, sicker people who NEED insurance. The whole idea of insurance is that some people need more, some less, some none, but a smaller payment by many spreads the burden. If young people opt out, then the contributions by the remaining folks is higher. "

misfit wrote on Mar 3, 2009 8:09 PM:

" Let's not forgot...as with the UAW, how much health care workers a paid. Nurses make close to $50.00 per hour. X-ray technicians make up to 40.00 per hour with other trained personnel making up to 35.00 per hour. Add it up! Then you have the massive amounts of waste and the exorbitant cost of supplies and the even more exorbitant mark up on these items when they are passed on to the patient's bill. The whole thing is a mess and Obama is crazy to even think of tackling it but, something has to be done. So, I propose that instead of knocking everything he does because suddenly everyone will be an expert on this problem as well, that serious suggestions are made from all sides. This should not be a partisan issue.
Let's at least consider single payer. It might solve more problems than it creates...nothing is going to be perfect. "

steph wrote on Mar 3, 2009 8:30 PM:

" You know I am vehemently against government waste, corruption, and fraud. I resent the misuse of taxpayer money and government programs that foster dependence and sloth and increasing demand with decreasing contribution. I feel protective of our capitalist economy that has made our people among the most prosperous in the world.

And that is why I do NOT support government-run healthcare. I believe competition is good for Americans. Not everyone wants to be a Blue Cross member, and not everyone wants to join Kaiser or Sutter. But their competition provides constant pressure to improve quality and efficiency.
So if we are going to have universal coverage for Americans and invited guests, then I think universal insurance, where Americans can choose their providers, is the best way to go.
There must be minimal but important regulation to ensure quality but not weigh providers with unnecessary paperwork and needless regulatory costs. We already have the systems in place for providing care. Most Americans are already covered.

The problem is, we have 40% of Americans who pay no income taxes, and they'll need coverage. We may have to ask some people to pay more. We may have to cut back on coverage, implementing high deductibles.

We COULD reduce costs by instituting torte reform, but the lawyers are a powerful lobby. Doctors could create care guidelines that improve consistency and cut unnecessary costs.

I wish there was a financial expert I trusted on the subject. I'd like to see some numbers that aren't biased by one agenda or another. I'm optimistic that we could give more people the security that comes from not worrying about paying for vital health care.

We may need to cut non-essential programs. "

kevin wrote on Mar 3, 2009 9:47 PM:

" Why should health care be treated any differently than any other commodity?

Housing is more important than health care, but the government doesn't run that business (not yet anyway).

Food is more important, but we don't let hungry people walk into safeway and take what they want (like we do with sick people and hospitals).

Look at how the government has run health care so far. Medicare is bankrupt and a failure.

That is what will happen with national health care... "

napablogger wrote on Mar 3, 2009 11:19 PM:

" There are a lot of good comments here, like Misfit says it is a complicated issue with many thorny prongs.

But there is no doubt that the system is overused, I have read in a number of places that one seventh of the cost is unnecessary tests due to fear of lawsuits.

I agree with Steph that if we are going to do more the best thing is to try to offer reasonable insurance to most everyone. That is actually the moderate position, although it has been a near disaster in Mass.

If we do that and also require people to pay when they use the service that is the best. I know people use it more than they would if it weren't free because I do and I see my mother doing in on medicare.

Personally, I think the system we have in place now is good enough for those who are poor. Anyone anywhere in the US can get free medical treatment now if they need it. There are low cost and free clinics virtually everywhere. And the level of care is world class.

I don't believe we really have an insurance crisis, it has been manufactured by single payer advocates, but they have been successful so the debate has been framed in those terms.

What we have is a too high of cost crisis. But at this point we just have to do something, so expanded insurance seems the less evil. I just wish the GOP would pick another leader besides Limbaugh and become an effective counter to the Dems. "

napablogger wrote on Mar 3, 2009 11:24 PM:

" Steph, the link I provided gives a good round up of all the point of views if you click around through the links on the page(s).

The one book I could recommend that is an honest attempt to explain the different issue involved is Arnold Kling's book, "The Crisis of Abundance". He is a libertarian economist but in this book I think he fairly lays out the facts of what is going on.

There is quite a bit of agreement on what the problem is, but what to do about it is where the problems start.

For example, generally everyone agrees it is too expensive. Also, everyone generally agrees there is a lot of waste and inefficiency. Everyone but the American Bar Assoc agrees that lawsuits are a huge cost to the system. "

napablogger wrote on Mar 3, 2009 11:50 PM:

" teacher, the US system is in many ways the healthiest in the world. One has to really drill into those numbers to see what they really mean, and when it has been done the US system comes out as well as any.

I know there is a lot info out there saying we are terrible, but I think a lot of it is measured by the cost for what we get compared to others, and that also a lot of Americans, especially racial minorities, just don't use the health care system.

There is no doubt we spend a lot more, but that is because we get a lot more service. Those countries all have to limit access in one way or another. That is why I gave the example of Ireland.

Another point is that most of the advanced drug and medical research is done here, and all those countries benefit from our expenditures on that without having to pay for it like we do.

Also, Americans who do have access like it better. There are so many mixed stories like this that it is hard to know other than general statistics. In other words, everyone I know from Canada or the UK doesn't think much of their health care system. But then people can find others who think it is great.

There is no doubt that there is a lot less technology available in most other countries, and a lot less choice of care. In England, you get the doctor they give you. And their health care system costs are causing huge budget problems and further reductions in services.

Whenever the government takes over health care costs prove to be very difficult to control. "

misfit wrote on Mar 4, 2009 7:25 AM:

" There is a concerted effort among the big Pharma companies to keep the cost of drugs high. They have a powerful lobby and politicians working for them. The CEOs of the large HMOs make exorbitant salaries, that no human being should command for anything.
Money grabbers need to be cut out and the system simplified. There should be no way that that physicians should benefit from the test that is ordered or the surgery that is performed other than their fees for service. Now, the physicians own the scanners, the surgery centers and the labs.
I had a relative that had many CT scans and Pet scans ordered in one years time. Every time she had a pain, they ordered another scan. Every time they couldn't see anything new from the previous scan 2 months earlier. These are expensive tests. She had Medicare and Blue Cross. I wondered if they ordered the scans just to alleviate her concerns or to show her that they were concerned or to pad their pockets.
With a single payer, (Medicare for everyone) the system is simplified. Medicare's administrative costs are less than 4%.
Where do we get the idea that poor people get free care? If they had a devastating disease they would not get the same treatment as someone with good coverage. Their unpaid bills are sent to collections. Even with insurance, the deductibles, co-pays are too expensive as well.
Some facts from the National Coalition on Health Care:
Fifty percent of bankruptcies are due to health care expenses. 68% of these people have medical insurance.
1.5million foreclosures per year are due to unaffordable health care. "

a teacher wrote on Mar 4, 2009 7:30 AM:

" I have to say this is one of the most callous peices you've ever done. You basically say "let them eat cake".

" teacher, the US system is in many ways the healthiest in the world. One has to really drill into those numbers to see what they really mean, and when it has been done the US system comes out as well as any. "

Most of the time I read those kinds of analysis it boils down to "those darn poor people, they're always dragging down our statistics".

For example: "especially racial minorities, just don't use the health care system. "

Could the reason for that be:

a) that they don't have health insurance and can't afford health care.

b) where they live there is very little access to health care facilities.

Then there is the "we don't ration, we have choice, we don't have to wait" myth. That all depends on what you mean by "ration", "choice" and "wait". I have Kaiser, a very good health plan. My choice of doctors is a list i can chose from. If I want to see my doctor I have to wait, sometimes months or I can take whoever is available at the time.

Several of my friends have come down with cancer. I am (understandably) a little concerned, so I decided to get a colonoscopy. I only have to wait about 1 to 2 years. I hope I don't have colon cancer now, because by the time I get checked, well...

In this country you are just one serious illness away from bankruptcy. I would bet that is not true in England, France, Canada, Germany, Italy, Spain, Ireland,... "

a teacher wrote on Mar 4, 2009 10:46 AM:

" "The idea that health care is a right and we should just pay to provide even the poorest and the most irresponsible a Mercedes level health care plan is not grounded in reality. It will never happen no matter how badly we may want it, because the money is just not there to do it and never will be."

Why not? Other countries manage to do it. Why not the USA? "

napablogger wrote on Mar 4, 2009 12:29 PM:

" teacher, No, I am not saying let them eat cake. I am saying there are free health clinics, don't buy them insurance, pay for free care.

Actually, I am not recommending anything in particular because at this point we need to do something and there is too much division and I feel like we need to find something we can come together on.

So the one thing I would like to see as part of any solution is some responsibility for payment to always be on the patient.

And I don't mean payment for insurance, I mean payment for each treatment. They can make a sliding scale for poor people and if they are so poor they can't pay, then free.

But if we have a system where anyone no matter what they pay can come in and get an MRI every time they bump their knee the whole country is going to go bankrupt. That is the problem now as I see it.

Single payer will not reduce costs, it will shift them to the taxpayer, and the key problem is cost. Medicare is going bankrupt right now, it is single payer and it is not working. "

napablogger wrote on Mar 4, 2009 12:38 PM:

" Misfit, really poor people get free care.

The problem is with middle class people who have poor insurance with big deductibles, and the insurance is too expensive. People sometimes called the working poor, but many of them could afford better health plans but they just didnt' want to pay for them and got caught.

Medicare has low administrative costs but that is because they just pay for anything the doctor orders, ie your relative. If your relative had to pay some percent based on income for further tests I bet we would have saved a bundle on them.

Same with my mother, she pays her Medicare supplemental every month and goes to the Dr. every other day because she likes to. How often she goes makes no difference in what she pays. Essentially her health care is free at that point, because whether she uses it or not the cost to her is the same.

I do the same and so does just about everyone else besides teacher. That is what is killing cost. Single payer or universal whatever is not going to change that. Not using the service when you don't need it is what is going to change that.

In Europe they contain costs by eliminating service to the point that when you need help you can't get it in many instances. If you think the HMO horror stories were bad, wait til we have single payer.

A better more American solution is to put the payment on the person using the service, at least more than we do now. People will be less casual about getting all this expensive treatment, the costs will go down, and demand will go down as well. "

steph wrote on Mar 4, 2009 12:45 PM:

" Poor people are eligible for MediCaid. They do have to sign themselves up for it, and many don't do it until they show up at a hospital and an administrator signs them up so that the hospital can receive payment for services mandated by law.
Poor people have health care options.
It's the middle class who get pinched, those with benefit-less jobs that make them ineligible for subsidized coverage.
Many insurance companies are covering poor children for free. Look into it. They are not the enemy. Some are unethical in charging premiums that leave people underinsured. Consumers need protection when shopping--where's our insurance commissioner? But most insurance companies have brought healthcare access to the masses--to people who would otherwise not be able to afford that mammogram, chemotherapy, a surgery, expensive medication. To compare Medicare to an insurance company is a little dishonest. Medicare does not provide healthcare. They contract with healthcare providers and insurance companies, who have enormous regulatory burdens to manage; it is these regulations that lead to paperwork and redundancies and data collection/analysis that drive up administration costs. Some of it is necessary to protect patient rights and ensure quality. Some of it is pointless and mandated by government bureaucrats who are completely out of touch with actual healthcare delivery.
And, yes, although I believe pharmaceutical companies have brought fantastic technologies to consumers around the WORLD, financed greatly by Americans, it is true that they have enormous influence on regulators and politicians who write policies for the provision of healthcare.
The point about price insensitivity cannot be understated. If I don't have any stake in the cost of an MRI then I don't care how much it costs and I want one whether it makes sense or not. "

steph wrote on Mar 4, 2009 1:06 PM:

" Price invisibility or insensitivity (I pay the same dollars no matter how much healthcare I receive or demand) leads to increases in costs because it increases demand for expensive services no matter how expensive they are. If people had to pay out of pocket for an MRI, the cost would be lower, because the current high cost would prohibit many people from using the technology--until the price came down.

But you have to be careful. Healthcare technology profits ARE turned into research and development that improves technology. If there was no profit anywhere in healthcare, or not enough, there would be less incentive for research or for bringing technologies to market, or keeping certain drugs or tests or other treatments on the market. There would be less competition or alternatives. Quality and choices would decrease.

Before you point to "other countries" understand that they profit from developments made and financed here in the US. And all countries that have universal healthcare are facing ENORMOUS pressures over costs. Germany had riots recently, England is worried about maternal mortality, Canada desperately needs more operating theaters--there is no perfect country. Every wealthy country is in the enviable position of trying to improve healthcare and access to it.

Also, a UC Davis study refutes the idea that huge %'s of bankruptcies are caused by being underinsured. Google "Reckless Spending, Not Illness or Job Loss, Causes Most Bankruptcy". This is more in line with what most of us actually know to be true--every one I know personally who has declared bankruptcy has been an overspender. "

steph wrote on Mar 4, 2009 1:51 PM:

" teacher--
Let's look at the reality of your screening, average-risk colonoscopy.
Your wait is directly related to an increase in demand for this particular procedure. Colonoscopies take a long time to perform and have to be performed by specialist physicians who are in short supply. Medicare now pays for screening colonoscopies for all enrollees over 50 who want one. The cost is "free" or almost free--same for those with most insurance plans. You can see the disconnect here. Demand is high, supply is limited.
Know what will make your wait longer? More demand--more patients with coverage that includes "free" colonoscopies. Know what will make your wait even longer? Decreased reimbursement to physicians qualified to perform colonoscopies.
What may decrease your wait for colon cancer screening? Newer technologies that provide for quicker, safer, more accurate screening. That takes R&D which takes money and the promise of profit.
It's tough out there. Lots of tough decisions to make. "

a teacher wrote on Mar 4, 2009 1:54 PM:

" "Poor people are eligible for MediCaid."

No. Poor children are eligible for Medicaid. Pregnant women, the old and disabled are eligible. Under certain conditions other people are eligible, however, being poor does NOT make you eligible for medicaid. (source:the Center for Madicaid Services)

"Before you point to "other countries" understand that they profit from developments made and financed here in the US."

That is a rediculous argument. You are either arguing that Americans subsidize health industries, that is we pay more so that they can make a profit. Or you are arguing that free market rules don't work in the rest of the world, that is, that health industries here pay for the reasearch, but can't or don't sell their products over seas at market value, so we have to pay more.

I would say that the truth is that we pay more so that health businesses can stay VERY profitable.

The UC Davis study you mention says that the results of the Harvard Study (the one that says 57% of bankruptcies are caused by medical expenses) is flawed in that it can't say FOR SURE that bankruptcies are not caused by bad financial descisions. That is not refuting it, that is calling it's results into doubt. Not the same thing. It is probably true that medical costs cause a significant number of bankruptcies. I have three friends that have had to declare bankruptcy due to medical costs. "

steph wrote on Mar 4, 2009 2:25 PM:

" teacher--you need to dig into those WHO stats that suggest that US healthcare is lacking.

In the study, only life expectancy is used to measure quality. Different countries measure life expectancy differently. In some countries, infants born under a certain weight are not counted as live births!! Babies who die within 24 hours are withheld from the same statistics. But if you are going to give birth to a preemie (not you personally!) then you really want to be in a US hospital.

Much of our lifespan stats are affected by auto accidents (we have more cars), homicide, HIV, infant mortality associated with very young teen pregnancy, some of which can be mitigated by healthcare quality, some of which can't, in reality. When smoking and obesity decrease lifespan, how is that an indictment of the care your doctor is providing--especially if we spend BILLIONS in drugs to try to reverse some of what people do to themselves? If our country spends BILLIONS of dollars per year on dialysis for patients who blew their kidneys out with obesity-induced diabetes, and this increases costs, how is this an indictment of our healthcare system, unless you'd prefer that we tell these people, you know, sorry, but we're not continuing this treatment for you--it's too expensive. Plus, when we give treatment to elderly and disabled people to extend their lifespans, this is counted against us in the "DALE" statistic.

Interestingly, we rank #1 for 'responsiveness' relating to wait times, access, innovation.

But WHO severely penalizes the US for having uninsured citizens (and non-citizens). This is a strike against the quality of healthcare in the US, but is it decreasing your healthcare quality?

The oft-quoted agenda-driven 2001 WHO study is dishonest about American healthcare quality. "

steph wrote on Mar 4, 2009 2:28 PM:

" Uhh...teacher. What other excuse do you have for being poor once you remove being pregnant, elderly, or disabled or having certain other conditions? "

steph wrote on Mar 4, 2009 2:29 PM:

" "You are either arguing that Americans subsidize health industries, that is we pay more so that they can make a profit. Or you are arguing that free market rules don't work in the rest of the world, that is, that health industries here pay for the reasearch, but can't or don't sell their products over seas at market value, so we have to pay more."

Actually, both, teacher. I'm arguing both.

How do Canadians pay less for brand name drugs than Americans? "

steph wrote on Mar 4, 2009 2:31 PM:

" Q. Who takes healthcare profits?

A. You do. You do have a 401k? Or, your teachers retirement fund is invested in the market? "

glenroy wrote on Mar 4, 2009 2:54 PM:

" If our health care was so bad why are thousands from around the world traveling here to seek treatment?

You don’t see Americans heading to France, England or Canada seeking treatment, but you sure see a lot of them receiving heart transplants, bone marrow transplants, chemo therapy etc.

Turning our health care over to House Democrats who over the past 40 years have pretty much destroyed everything they’ve touched is the last think this country needs. "

steph wrote on Mar 4, 2009 2:59 PM:

" You didn't read the UC Davis study.
From the synopsis:
"Zhu found that bankrupt households have bigger mortgages, car loans and credit card balances than solvent ones, but make less than half as much money.

Among bankrupt homeowners, mortgages were 3.21 times higher than annual household income, versus 1.73 times for solvent households. Auto loans were double the annual income for bankrupt households, versus 0.4 times for solvent households. And bankrupt households carried credit card balances that almost equaled their annual household income, while the average credit card balance for solvent households was 6 percent of annual income.

In addition, bankrupt households had a median annual income of $25,738, versus $43,341 for solvent ones. [Delaware].
Interestingly, more than 5 percent of bankrupt households owned at least one luxury automobile (average age of the car was 7 years), compared with 8 percent of solvent households (average age was 8 years)."

The UC Davis study looked at actual consumption patterns. The study you quote was a survey that asked people why they declared bankruptcy. "

DinoSilver wrote on Mar 4, 2009 10:14 PM:

" Let's look at this from the current government run health care - Medicare. Hospital coverage is the Part A (free) because we all paid into the system during working years. You can also buy Part A if you did not pay into the system. Part B is what you have to buy, and has a sliding scale based upon income. There are also Medigap policies to cover everything else -so if you can afford it you can buy full health insurance coverage.

Now, why can't we have a system where everyone has to have Part A coverage (the insurance companies have said they will do this if everyone has to buy it), and we can have options for everything else. Health Savings Accounts would also be a great option to self insure for those that can afford it (or can buget well). This does not have to be the Medicare, government run system. This can be done privately. My point is that hospitalization coverage - should be mandatory for everyone. "

a teacher wrote on Mar 4, 2009 11:05 PM:

" GLENROY says(predictably) "it's all the librulz fault"

I don't recall saying that our health care was so bad. It's the best health
care money can buy (which I contend is the problem).

Why do Europeans come here? Well first, I'm not buying that they do, as
usual you state an opinion as if it were a fact. However, if so I would bet
it's this. In a country with universal health care, you have to wait in line
with everyone else. How do you cut the line, well, if you have money you go
where having money matters, HERE." "

napablogger wrote on Mar 4, 2009 11:12 PM:

" Steph, you know a lot about this, what are you asking for books you can read for? :) You should be telling us what to read.

I have a good idea for your blog, "Healthcare Smack Down with Steph"

On the issue teacher raised about American consumers paying part of the cost of drugs for other countries, in Canada they just flat out set prices by law. Low prices. The pharma companies caved to that which made me mad, so the result is that Americans are directly paying for Canadian drugs because we have to pay more to cover it.

Then our genius Congress wants to make a law that Americans can buy from Canada.

The drug companies are like the oil companies in that they have high profit numbers but they have high total sales and high expenses and pay a lot of taxes. Their profit margins are around 8% which is not high at all.

Having been a pharmaceutical recruiter what I noticed is that not only does it cost at least $30 million to develop a new drug, but the types of drugs that most companies pursue are the same.

In other words, if you look through who is researching what you will see that most of them are working on either AIDS drugs or cancer. If someone can find a cure for those they will make a lot of money, so there is a casino mentality amongst them to go for the big cash out.

That is the real problem I see with pharma, not too much profit. "

vocal-de-local wrote on Mar 5, 2009 12:44 AM:

" Universal healthcare could provide some benefits not yet considered. There are many young adults attending college, not because it's the best path for them to take, but because they must maintain fulltime student status in order to receive health insurance from their parent's policy. They basically take a bunch of dumbed down classes and milk it for several years until they discover that college is not the right track for them. In many respects, it's a waste of college resources.

If young people were guaranteed health insurance, we may have an entirely new generation going out there to work, not for the big corporations who provide health benefits, but as clerical workers for local business. I sometimes feel as though big industry owns us, primarily because they can offer health insurance that small businesses cannot compete with. Universal Healthcare could be a big plus for small businesses and small towns. I think many people would be more content and secure knowing that a health umbrella was protecting them. Right now, many employers only hire part time because they don't want to pay benefits. This might change.

That said, healthcare should not be entirely free. There should be a significant annual deductible for everyone., like maybe $300 deductible per person, children included. If people can afford to pay for internet and cell phones, they can afford their health deductible.

Any migrant (I don't care if they're from Sweden, Mexico or Japan) should not enter this country without a guarantee of health coverage from their U.S employer (yes, the employer should sponsor the migrant workers they employ), or, they must have a written and notarized guarantee of health coverage reimbursement from their own country.

We also need an emphasis on preventative medicine. "

vocal-de-local wrote on Mar 5, 2009 12:55 AM:

" Oh...something else. I've spent the last several years taking college Health Information Management classes. One of the reasons healthcare costs are so high is because there's a huge, interconnected and expensive web of employees who negotiate the complex interaction between caregivers and those who reimburse. I began taking these classes because I really wanted to understand the complexities of our healthcare system for the purpose of someday applying it to Universal Healthcare. The system is protective of its turf. That's all I'm saying for now. "

hsr0601 wrote on Mar 5, 2009 5:07 AM:

" The hard-earned stimulus package is founded on the pledge over the policy of transparency, no earmarks through line by line review, which is the most effective way to turn deficit into surplus, moreover, to fight the vested interests, the top priority need to be fight against the same old failed earmarks, I think.
Mr.Obama should not give in to the temptation to play by the establishment's rules. He's obligated to push hard for change; that's what voters elected him to do. "

Ruff Limblog wrote on Mar 5, 2009 5:12 AM:

" Japan has a nationally subsidized private delivery healthcare system.

They take more prescription drugs and visit doctor's offices more often than Americans do.

Everybody is covered.

They also spend FAR LESS than America does.

The Japanese system as a whole has better medical outcomes than the American system as a whole.

Their people live longer than we do.

The Japanese regulate A LOT!

There system works better than one where top insurance executives can make over $1 billion in a single year and some 50 million people have no coverage at all.

The Republican mantra of 'Tax cuts fix everything' and 'the government is always the problem' are just plain wrong again.

~Ruff "

a teacher wrote on Mar 5, 2009 6:23 AM:

" " Uhh...teacher. What other excuse do you have for being poor once you remove being pregnant, elderly, or disabled or having certain other conditions? "

Are you joking? Sometimes I think you guys never meet poor people.

let me see:

-Lack of education
-lack of opportunity
-poor local economics
-a member of the family falling seriously ill
-divorce (a very big factor)
-racism
-sexism
-bad luck

I could go on... "

a teacher wrote on Mar 5, 2009 6:27 AM:

" "How do Canadians pay less for brand name drugs than Americans? "

Several ways.

The Canadian government puts a cap on what Pharmaceutical companies can charge.

Provinces negotiate fro bulk prices.

Canada has a significantly lower standard of living.

In other words, the Canadians can't and won't pay the prices we pay, so they don't. Big Pharm charges us an arm and a leg because they can. "

a teacher wrote on Mar 5, 2009 6:34 AM:

" " teacher--you need to dig into those WHO stats that suggest that US healthcare is lacking."

You don't want to go there. If you disaggregated the statistics, say by income level or ethnicity, the USA looks worse and worse. Who you are and how much money you make directly effects your health, more so than in countries that have a national health situation.

That is my point. In the USA, being poor means you don't live as long, you're not as healthy and your family won't live as long or be as healthy.

Now I realize that you think that the poor have no one to blame but themselves, but not everybody sees it that way. "

a teacher wrote on Mar 5, 2009 6:51 AM:

" " Q. Who takes healthcare profits?
A. You do. You do have a 401k? Or, your teachers retirement fund is invested in the market? "

Let me see, my Kaiser plan costs $14K a year. My CALstrs plan MAYBE makes $1K in interest a year (I don't really know how to figure that, but it isn't much from BIG Pharm, I'm sure). I think BIG Pharm and Corporate Health care are making out in that deal.

Why is profit and business the only concern here? What about people's needs? "

Ohio lady wrote on Mar 5, 2009 7:52 AM:

" Enjoyed reading these comments, I want to add on mis-fits comment. There income figure is not correct across the states. I can only comment on Ohio's RN hour rate and it is no where near $50.00 a hour. If it was I could pay off my student loans faster. "

sdnapa wrote on Mar 5, 2009 10:05 AM:

" the problem with the whole universal healthcare program is that our government does not know how to run things well (like staying within budget and not having corruption). there are too many lobbyists, too many political agendas, too much BS.

my guess is that Japan's system runs well because the Japanese people have always been a self-disciplined people with high amount of respect for each other. it is sad to say that many Americans do not possess such attributes. there are a lot of people, with the numbers growing daily, who truly believe that it is governments job to meet their every need while they give absolutely nothing back.

if our government could show me one program that has been successfuly run by them, i might believe it's a good idea. but, facts are facts...every program run by OUR government is bankrupt and we are ALL paying for it.

government taking over healthcare is yet another huge nightmare, and my guess is that we won't get qualified doctors to help us because who's going to want to go through all that schooling, internship & residency all for a regulated pay from the government.

perhaps the question we should all be asking ourselves is why are we so afraid to die.... "

freeport56 wrote on Mar 5, 2009 10:58 AM:

" Ruff-

that was a fairly glossed over example of the Japanese health care system.

Again, government is not the answer. they are incompetent and very corruptable. Take a look at the current administrations appointees, tax dodgers....

Cuba has a great health care system too, if you can live long enough to use it. "

glenroy wrote on Mar 5, 2009 11:06 AM:

" Instead of listening to liberal excuses for all their other failed programs…..just ask your family doctor what they think about working for the Federal Government….

I’d bet my neighbors farm they overwhelming oppose government take over….and no matter which Democrat Health Care program is being considered, they are in fact going to take over health care, determine who is worthy of treatment and how much the Doctor’s will receive. "

a teacher wrote on Mar 5, 2009 11:12 AM:

" "Cuba has a great health care system too, if you can live long enough to use it. "

Actually, Freeport, the avg life expectancy in Cuba is 78.3 years and in the USA 78.2 years. "

a teacher wrote on Mar 5, 2009 11:13 AM:

" "perhaps the question we should all be asking ourselves is why are we so afraid to die.... "

I'm not afraid of dying, I am afraid of spending my last few years in miserable health. "

sdnapa wrote on Mar 5, 2009 11:39 AM:

" i don't think that anyone wants to spend any amount of time in miserable health. i can certainly understand that. i don't either.

but, this will be preventable as long as the government takes over healthcare and "distributes" it fairly????

the fact of the matter is that there is not enough money for everyone to get quality care. it's a hard fact, but it's a reality. the government can't promise us anything different. "

Joe wrote on Mar 5, 2009 1:11 PM:

" I think in order for people to get free healthcare they should have to care about their health first. Many other countries can afford to provide their citizens with healthcare because the citizens take better care of themselves. They don't eat so much junk. They exercse. Many Americans are extremely lazy. They never exercise and they eat unhealthy foods very often. Many parents feed their kids McDonalds a few times a week because it's cheap, they don't have to cook or clean. I would never feed my kids fast food. It's almost like trying to give them diabeties. Feed your kids vegetables and fruit. With healthy sides like beans and chicken. "

sdnapa wrote on Mar 5, 2009 1:35 PM:

" joe: you make an extremely good point about eating right & exercising and i couldn't agree more.

though i do have to point out there is nothing "free". that is one of the biggest misconceptions about government run programs...they are NOT FREE. there's no such thing as a free lunch...someone pays for it. "

Ruff Limblog wrote on Mar 5, 2009 1:36 PM:

" The USA is 37th in rank on healthcare in the 'industrialized' world.

Our people die sooner, are sicker and have a very high percentage of people who forgo treatment and medicine because they can not afford it and eat.

We spend around $1 trillion a year more than other countries who have better outcomes than we do.

It's interesting that Republican voices make 'non-denial' denials of my brief post about Japan's healthcare system but does not deny the FACTS I wrote.

The FACTS are the American people are being ripped off and many are dying because they don't have healthcare coverage.

When I read about the huge amounts of money being flushed down the drain in Pentagon No-Bid Contracts while other people lack healthcare it makes me wonder about the thought process of those who think things are just fine.

Those who wish to can view the White House Healthcare Summit on CSPAN and find out for themselves what is going on.

It's a fact that the CEO of United Health, owner of CA Blue Cross/Blue Shield made over well over $1 Billion, yes, Billion with a 'B' in a single year.

As always, I invite Republican voices to find untruth in what I say and bring it to this civil conversation. But they can't and so they don't.

~Ruff "

sdnapa wrote on Mar 5, 2009 2:01 PM:

" Ruff:

I did not deny or try to deny your assertion about Japanese health care system. I am sure it's running just fine because, like I said, they are a self-disciplined people and it would seem that their government knows how to run things properly. Our government does NOT. Period.

No doubt Japanese people eat right & exercise. As Joe states, many people in America don't do that. They are lazy, bad eaters. Of course you cannot legislate diet & exercise, but that sure contributes to the many health problems here, doesn't it? "

Bill wrote on Mar 5, 2009 7:56 PM:

" What a novel argument, “If the uninsured have insurance they will go to the doctor more often.”

One non emergency trip to the emergency room will more than likely turn up an actual cost exceeding 5 regular medical visits. One necessary emergency trip would be astronomically higher than 5 regular medical visits.

People over 50 account for the majority of health care expense. Bravo! A not so difficult and accurate surmise. This of course involves a preexisting condition known as aging which in and of itself is a very expensive proposition. Don’t get old and don’t get sick in America.

The problem is that health care is expensive even for the young and healthy. Blaming old folks and others for high demand is a straw man. If affordable care were available in the form of more licensed medical personnel, then perhaps doctor’s fees would actually be subjected to market forces. We don’t need high paying specialists and heart transplant surgeons. We need access to more general practioners or even medical personnel that can aid in many of the minor needs that occupy so much of a doctor’s time. There are many threatening maladies that do not require a doctor but do require a professional.

A colonoscopy at Kaiser is not actually performed by the doctor but by a nurse trained to use the machine. There may have been a doctor in the area but he did little but read the results, eventually.

Much of medicine is mechanical art, indeed medicine is considered an art not a science no matter how many TV. dramas you watch. What is mechanical about it should be relegated to mechanics and what is artful to the artists. That would immediately lower costs as mechanics will charge less than artists. "

steph wrote on Mar 5, 2009 8:28 PM:

" teacher--Cubans have a longer life expectancy because, again, they don't drive as much as we do, and they don't count infant mortality the way we do. They don't have the homicide rate we do. But to say that their healthcare system is anywhere near ours is ridiculous. There is more parity there, inasmuch as all Cubans have a threadbare healthcare system equally. In spite of what Michael Moore wants you to believe.
As for Japan, they don't have the immigration issues we have nor the slavery legacy we have. It is really unfair to compare our healthcare system to theirs on that basis. Again, Ruff, you're citing the WHO statistics without really digging into them. Teacher, you're right that there are serious problems with our culture, but that's different from saying our healthcare system is lacking. It's lacking for those who don't have access to it. Perhaps that is your very point.
I'm not here to argue that we should not try to extend coverage to more people. I do feel it is a shame on our country that people have to suffer alone with serious illness, while others use the system, arguably, excessively.

I don't feel we need to denigrate the service we do have now, nor do I believe all uninsured people deserve a pass on being personally responsible. I want to maintain the quality of care we have now and not bankrupt our country. With 40% of people paying no income tax, I just am at a loss as to how we're going to pay $14k per year per every person existing in the US for excellent healthcare. "

steph wrote on Mar 5, 2009 8:45 PM:

" Bill, a colonoscopy is performed by a doctor. Perhaps you are thinking of a sigmoidoscopy? That's different.

Wanna know why there aren't more licensed medical personnel? Because nobody wants the job unless they're paid well to do it.

The most threatening maladies require some personal responsibility on the part of the patient. The leading causes of death are related to obesity and smoking. If you don't control that, and you have a heart attack, stroke, or kidney failure, you won't call a mechanic. You'll want someone who knows what they're doing. Someone with experience. A specialist. "

anticommie wrote on Mar 5, 2009 10:14 PM:

" The left's answer to everything:

Let the government take care of it!!

Ludicrious.

One of the major reasons medical bills have gone up is the fact that doctors are forced to charfge more due to the amount of taxes, employee salaries, and lets not forget the good 'ol frivilous lawsuit insurance. Just ask doctors in any field how much they have to pay in insurance to protect themselves against the likes of people like John Edwards that make a living suing doctors.

I think the government (mainly demorats)has purposly messed up our health insurance system in order to take it over. It is the only logical explanation to me. Our government is getting more and more corrupt on all sides of the isle. "

a teacher wrote on Mar 5, 2009 10:30 PM:

" Steph. First off, I NEVER said that Cuba's health system was on par with ours. I merely pointed out to Freeport that Cubans don't die too early to use their health care. However since you mention it, Cuba has done pretty well for an impoverished country laboring under a crippling and ridiculous economic blockade by the USA.

Using the "more people die in automobiles" line is lame. It's the same logic as the CATO institute's "poor people should be happy because color TV's are cheap here" line of thought. You're trying to play statistical tricks to explain away inconvenient facts. Both France and Belgium have similar motor vehicle death rates. Both have longer average life spans.

Pick your statistic to explain away what is real. It doesn't matter. They all point out to the fact that we lead an unhealthy lifestyle here.

I also never said that health care here in the USA is bad. I've only said that health care in the USA is expensive, unnecessarily so. In this country money is what matters in health care. If you have it you're cool. If not, well... "

vocal-de-local wrote on Mar 6, 2009 1:34 AM:

" Bill, you're absolutely right.

For example, nurse practitioners can perform many of the same functions as a physician without the same level of cost. Unfortunately, in our present system, if you visit an office that uses a nurse practitioner, you pay the same regardless of whether you see a doctor or practitioner.

Our present system has its own level of bureaucracy and does not really play fair much of the time. In a well run governmental sponsored program, setting up different types of clinics for different needs would be helpful. For example, older people have different medical needs than newborns. There should be a geriatric clinic, for example, which focuses primarily on the types of medical problems older people develop. That way resources can be more focused and hopefully less expensive. For people between the ages 10 to 60, there should be tiered clinics which are categorized according to 'degree' of problem. Minor problems can be referred to clinics with several nurse practitioners and one physician who can manage the clinic and respond to the occasional case which requires more attention.

People could get a reduction in their co-pay (and there should be a co-pay with Universal Health) if they exercise, maintain normal blood pressure, blood sugar levels, and weight. We have many unhealthy people in this country and if we can't change the way the care for themselves, they need to pay more for healthcare on some level, perhaps higher deductibles? "

anticommie wrote on Mar 6, 2009 3:08 AM:

" a teacher wrote on Mar 5, 2009 10:30 PM:

"...Cuba has done pretty well for an impoverished country laboring under a crippling and ridiculous economic blockade by the USA."

It's all the US's fault about cuba!! You dont think that the communist iron fist doesnt have anything to do with it? Once again the libs attack our country!! Suprise suprise!!

When it comes to the universal healthcare, it's not my problem if people jhave insurance or not, and the government has no business running ANOTHER aspect of our lives. Why does the left want bigger government? "

misfit wrote on Mar 6, 2009 7:16 AM:

" The U.S. ranks 41st in infant mortality!
How can that be if our health system is working? Do we not really care about the life of the "Born". "

Cadence wrote on Mar 6, 2009 7:59 AM:

" "In this country money is what matters in health care. If you have it you're cool. If not, well... "
In this country and a lot of others, money is what matters in health care and everything else. Countries with national health coverage also have private clinics with short waits and all the bells and whistles for those who can afford them. Everyone else can wait in line for the national service.
The wealthy can fly anywhere on earth for what they consider the best care. They can also buy the best homes, art, autos, food, etc.
Yawn. So what else is new?
I think sdnapa hit the nail on the head. Seems to me that Americans accept the concept of mortality as a vague concept only, but do not believe it true individually.
How else to explain that while about 6% of Medicare patients die each year, almost 30% of Medicare dollars are spent on their care? Many of these patients are terminally ill. Many of their doctors can fairly accurately predict how the diseases will play out and how long the patient may expect to survive, and can use evidence-based data to confirm their predictions.
Our collective insistance on heroic, expensive and ultimately futile end of life treatments is at least partially responsible for the current high costs of care.
A greater reliance on hospice care and a very realistic discussion of death and dying is long overdue. Sadly, I suspect that in the superstitious (i.e., nearly 80% of Americans believe in miracles) climate of America, this won't happen. "

Ruff Limblog wrote on Mar 6, 2009 9:17 AM:

" A person with junk insurance can diet and excercise until the cows come home and still find themselves bankrupted by a serious disease such as lung cancer which occasionally strikes folks who never smoked in their lives.

It's a distraction to pretend that the American system of healthcare denial is going to be fixed by having people diet and excercise more.

~Ruff "

misfit wrote on Mar 6, 2009 9:33 AM:

" Conservatives would have that the poor, the middle class and the elderly just be allowed to die, with no care and neglect.
This would assist them in their ideal, utopian vision of the country being a huge, playground for the wealthy only.
We are a society and with that goes the cost of doing business. Healthcare is a right...the right to Life!
Anything less than that ideal subscribes to the scenario I described above. We simply need to find a middle ground, painful or otherwise, that is as efficient as possible. There can be a happy medium here with a little effort and the right intentions and the right people coming together to make it work. Acceptance of the status quo, simply because it is a complicated issue, is not acceptable. "

John Richards wrote on Mar 6, 2009 9:55 AM:

" "... exorbitant mark up on these items when they are passed on to the patient's bill. "

Hospitals are forced into doing this in order to make up for the deadbeats who don't pay their hospital bills at all. "

John Richards wrote on Mar 6, 2009 10:04 AM:

" "Cuba has done pretty well for an impoverished country laboring under a crippling and ridiculous economic blockade by the USA. "

A country which allowed its soil to be used to harbor Russian nuclear missiles aimed at the US deserves every bit of that blockade. If the Cuban people don't like the blockade, they know what to do to get it stopped. "

sdnapa wrote on Mar 6, 2009 10:47 AM:

" The issues I have with this whole debate is that some of you seem to believe that if the government takes over healthcare, everything will be better than it is now. I disagree.

Please name one social program run by the US government that is run properly. And please don't say social security because that system of retirement is not financially sound. Yes, it's working for the moment because we just keep going into debt, but all the baby boomers haven't retired yet. The last stat I heard was that it takes 4 working Americans to cover 1 retired person. This can't work much longer.

MISFIT: If I had a terminal illness and my choice was to leave my husband bankrupt and sell off everything we had just so I could be kept alive for a few more years, my choice would be to die. I do not believe in assisted suicide, so please don't make that assumption here. If I were poor and didn't have anything to sell or health insurance, well that would be unfortunate and sad. But at the end of the day, I would have to face the reality that I was going to die. It would certainly be a hard decision, but you know what? It would be my time to go. I'm at peace with where I'll go after I die.

We cannot trust the government to run a mandated health care system. We should be given a choice whether to buy into it based on some sort of sliding scale as I think might help some, but people that don't want it shouldn't be forced into it. "

misfit wrote on Mar 6, 2009 11:15 AM:

" thanks SDNapa...you just proved what I was trying to say in my most recent post. So...what you are saying is that, you believe that all cancer research and treatment should be suspended. We should have no blood pressure medications to reduce the incidence of stroke, that we should not have drugs like Plavix or Lipitor. We should just fold our cards and say...oh well...I will just die now. That is not in our human nature! We have the instinct to survive. It is what pro-creation is all about. I don't recall your basic ideology from other topics but, if you are pro-life...if you felt that Terry Schiavo should have been kept alive, if you feel that children who cannot be adaquately cared for should be brought into the world...then you are at odds with what you just stated. And, I would ask you...at what age would we draw the line...that our life is no longer valuable.
Also, you assume that we are only talking about terminal illnesses here. Having your hip operated and your gall bladder taken out is going to set someone back thousands of dollars, even with coverage. Can't we just try to come up with a solution that serves everyone equally. "

a teacher wrote on Mar 6, 2009 11:16 AM:

" Anticommie and John Richards, it's probably pointless to respond to your cartoon versions of the world and librulz, but I'll try.

I grew up in a Cuban neighborhood in NYC. Many of the boys and girls i played with were the sons and daughters of Cuban refugees from Castro's revolution, so I know that Castro was no saint.

However, the Cuban Missle Crisis happened 50 years ago. Castro has outlived 6 presidents that vowed to see him out of power and has outlasted the other 4. He has voluntarilly given up power and will probably die peacefully, in a nice comfortable bed with a smile of satisfaction on his face. His brother runs the show there now and I don't see much change in the near term. Our blockade has probably done more to keep him in power than anything else. It has been a waste of time. "

a teacher wrote on Mar 6, 2009 11:21 AM:

" When I was younger my friends and I used to joke that when we were old we would have to get together to form an old folks commune. We were sure that the plan for the old when we were there was going to be an ice flow.

From reading the more conservative views here, I see that is excactly the plan. "

a teacher wrote on Mar 6, 2009 11:28 AM:

" Cadence says:"Yawn. So what else is new?"

Actually, I agree with you about money. Money greases the wheels in every society, even communist ones. However, that wasn't my point.

My point was this. In those countries where there is universal health care, poor people have health care. It may not be as fast or efficient or the the best money can buy, but it is more than adequate.

Here in the USA, if you have no money you have no health care (unless you fit into a few special catagories). I find that unacceptable. "

vocal-de-local wrote on Mar 6, 2009 3:31 PM:

" In response to John Richards comment, "it takes 4 working Americans to cover 1 retired person". Well no wonder we're so hooked on maintaining over population! That explains increased tolerance of migration levels as well! "

Ruff Limblog wrote on Mar 6, 2009 3:37 PM:

" Has anyone besides me noticed that the folks on the right side of the teeter-totter are allowed much more freedom to express negative opinions of the intelligence, honesty and opinions of the folks on the left side of the teeter-totter?

Much of what I am starting to read again seems to indicate a thumb on the scales.

~Ruff "

Bill wrote on Mar 6, 2009 3:38 PM:

" Personal experience is never truly convincing but according to Wikipedia I had an endoscopic examination with a fiber optic examining my colon. This under the heading of colonoscopy in that very refutable internet source. I happened to know the nurse who administered the exam personally if not until that moment intimately and there was not a doctor to be seen. Have I been semantically incorrect? Perhaps but the procedure was a diagnostic technique and not performed by an M.D. Sorry Steph.

Have I been cheated yet again? Does it defeat the argument that Vocal de Local appears to appreciate? That much of the expense of healthcare is a built in product fostered by physicians to keep their pay up much like lawyers.

The greatest special interest groups in medicine are the AMA and American, insurance conglomerates and pharmaceutical corporations, they are the major controlling factors in determining the cost of healthcare. Numbers of medical personnel are kept artificially low causing a scarcity of doctors and other medical parishioners allowing them to charge outrageous prices many times for a service or procedure that a resident or hospital associated physician does not need to perform.
These groups represent largely their own monetary self-interest not the health of the nation.

Many qualified physicians are not allowed to immigrate here and practice medicine but will be allowed to participate as registered nurses. Medical schools are extremely expensive to operate and to attend. Arguing for the necessity of well paid medical personnel has merit but not under artificial circumstances where the medical professionals and their associates alone have the ability to set their income and limit accessibility to their brotherhood as well as what type of medicine can be practiced and by whom. "

Bill wrote on Mar 6, 2009 4:21 PM:

" Another medical faux pas by yours truly, medical practitioner instead of medical parishioner but worshiping at the alter of medical professional wisdom is a greater mistake. Never completely trust a professional’s opinion you might wind up on the wrong edge of a medical bubble. Many are merely highly overpaid mechanics but where as your autos maladjusted carburetor may leave you at the roadside trying to get the gas out of your stomach at the proper end may lead to you to a more offensive and disagreeable place.

Mercedes medical care is not feasible and yes many decisions about who lives and dies will need to be made. How much effort will be made to save the aged and their comfort at some point will need to be addressed. Access to expensive procedures that net little in the improvement of the quality of life or health will need close evaluation. What expense will justify small returns for very minor portions of the populace needs analysis. The cost return ratio of any health care plan is important.

We all need access to reasonable quality health care at reasonable cost. We are not arguing about rights here but needs. If we all had access to reasonable health care it would be a tremendous energizer for small and medium sized businesses and a blow to large insurance interests (some how I have a feeling they win no matter what.) Access to quality health care will aid in Americas competitiveness worldwide.

The debate should be framed about what is quality and what is reasonable. "

a teacher wrote on Mar 6, 2009 4:43 PM:

" I certainly have noticed that Ruff. Had anything censored lately? I have. I wonder if this will get through? "

steph wrote on Mar 6, 2009 5:18 PM:

" Hey, teacher, you don't want to take a hard look at the WHO statistics that place the US at 37th place in ranking of healthcare. You don't want to dig too deeply, make sure the comparisons are fair. Just let the roll-up number speak for itself. Even if it doesn't pass the sniff test. 37th?

How does that work when we look at another socialized institution here in the US, and discover that the US outspends many countries on education and gets worse results? Do we just let that statement stand, or do we look into those "statistics" you so malign? You'd want some honesty, to make sure all comparisons are fair, right?

Is it too much to ask that WHO compare apples to apples when compiling their report? Or, is it just easier to throw the "37th" bit around?

Isn't a good education a right? Isn't it sad that poor people don't have the same educational opportunities as wealthy folks?

You might say that a good education correlates well with a good level of personal/familial responsibility.

Well, it turns out that the same is true for health.

And, the Democrats are most certainly talking about reducing disease burden as a way of reducing costs. Yes, some people get lung cancer without smoking, but the vast majority of cancer deaths and associated costs are totally preventable. Same with the majority of diabetes and other obesity-related illness. At some point, if we nationalize healthcare or health insurance, something MUST be done about utilization, the biggest driver of costs. THAT will leave more for people who have non-preventable, treatable illness. THAT will involve personal responsibility. "

a teacher wrote on Mar 6, 2009 5:58 PM:

" But, since you asked, I do in fact look into those education statistics. It's been a big part of my job over the last few years. Ultimately, the comparisons are fair and point out some flaws in our schools.

I haven't spent as much time delving into health statistics as it's not my field. However, what I have seen points to this: the lower you are on the economic ladder, the more likely you will lose your baby. Why is that? The lower you are on the economic ladder the less access you have to health care. Not much of a surprise really.

And what is this thing you guys have with "over utilization". It's like you guys have a problem with the fact that when people have health care they actually may USE it. The Nerve of some people.

I hope this hasn't offended anybody. I would hate to upset people's delicate sensibilities. The NVR Moderator is watching... "

steph wrote on Mar 6, 2009 6:24 PM:

" There is a big difference between a colonoscopy and a sigmoidoscopy, Bill. Apart from what they are called. It's not about semantics. It's about risk level. If you remember the procedure, you didn't have a colonoscopy.
Your insurance company and your doctor are happy to have any appropriate help with high-demand procedures, especially if it lowers costs.

Perhaps you have not met any immigrant physicians, but there are many here in the US. They are paid the same as native-born. Thankfully, the standards are high for licensure and certification.
How do you feel about corporations offshoring US jobs, Bill and vdl? Well, you're going to see more of that with healthcare. Already many Americans travel to the third world for healthcare, and some radiology results are interpreted offshore, even as we import more and more physicians. You know, healthcare is experiencing a brain drain of sorts, as compensations shrink for services delivered. So, we're importing doctors from outside the US to fill the void. The rewards for years and years of expensive education, and the dedication that the profession requires--at the expense of family life--just don't add up much any more. Combine the high cost of malpractice insurance, and more and more paperwork, and the fact that smart people have choices when it comes to careers, and you get what we got: a doctor shortage.
Speaking of shortages, we have drug shortages, too--watch what happens when drug manufacturers (usually generic) decide to discontinue an unprofitable product. It happens all the time. "

steph wrote on Mar 6, 2009 6:27 PM:

" Nobody here has congratulated Wal Mart for bringing $4 generic drugs to consumers.
THAT is a trend toward affordability. It has put pressure on other pharmacies to follow suit.

On the other hand, a new study out this week suggests that no-charge antibiotics may lead to increased microbial resistance as more and more people take antibiotics they may not need. But at least they're free! "

steph wrote on Mar 6, 2009 6:32 PM:

" Bill--
What is your source for the following claim (your words):
The greatest special interest groups in medicine are the AMA and American, insurance conglomerates and pharmaceutical corporations, they are the major controlling factors in determining the cost of healthcare. Numbers of medical personnel are kept artificially low causing a scarcity of doctors and other medical parishioners allowing them to charge outrageous prices many times for a service or procedure that a resident or hospital associated physician does not need to perform.

I find myself in full agreement with what you've written after the words "Mercedes medical care is not feasible".

You should be aware that very often it's the Toyota healthcare that outperforms Mercedes healthcare. More expensive is not always better, contrary to some people's intuition. "

NVR Brian Kennedy wrote on Mar 6, 2009 7:27 PM:

" If you see a comment that violates our guidelines please send me and Dan an email.

We are:
bkennedy@napanews.com
dross@napanews.com "

glenroy wrote on Mar 6, 2009 7:40 PM:

" Amen Steph..

The libs love Britain’s ‘socialized’ medicine, though virtually all the former rugby players I’ve played with over the years equate socialized health care with as much or more agony then their injuries, horribly slow service, restricted treatment and very little patient physician interaction….sounds just like all our government agencies.

Quote for today’s Editorial on IDB

The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.

Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis.

Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?
End.

Could explain why thousands of Europeans come to ‘America’ to receive the latest, greatest cancer, heart, neurology etc treatment on this planet….or maybe they just like wasting their money. "

alucawanza wrote on Mar 6, 2009 7:50 PM:

" a teacher
I have Kaiser too. I'm amazed you have to wait two years for a colonoscopy. Are you being a squeaky wheel? Tell them cancer runs in your family or you are having disturbing symptoms. Be truthful but forceful. Keep bugging them. Be sure your doctor is proactive. Change if he/she isn't. Go up to the office on the second floor and raise some questions. Call other administrators. It really works. Also ask about being put on the cancellation list. They'll tell you they don't have one...Hah! Ask anyway. My husband was called in because off a cancellation on a cataract removal.
I really do appreciate my Kaiser coverage. They have always done well by me. I've had a lot experience with the "private" world of medicine here in Napa taking care of elderly relatives and it doesn't compare to Kaiser's efficiency. "

a teacher wrote on Mar 6, 2009 8:08 PM:

" "though virtually all the former rugby players I’ve played with over the years equate socialized health care with as much or more agony then their injuries, horribly slow service, restricted treatment and very little patient physician interaction….sounds just like all our government agencies."

Rugby players, now there's a representative demographic.

I hope the NVR Moderator ok's that. I wouldn't want to upset him... "

Ruff Limblog wrote on Mar 6, 2009 8:30 PM:

" I'd imagine that an uninsured or person with only junk insurance has just about the same access to expensive drugs that some Republican voices are complaining the British folks don't have.

I admire the touchingly innocent trust placed in 'for-profit' insurance companies by Republican voices who then turn into rabid anti-government critics when it comes to expensive treatments being available to the tens of millions uninsured and under-insured.

~Ruff "

Bill wrote on Mar 6, 2009 8:48 PM:

" An education is not a "right" much less a good one but it is a necessity even a poor one.

All these accusations of rabid socialism ignore the necessity of providing any quality education or providing any quality health care with reasonable access. that socialist education system has served the nation well if in a flawed manner yet suggest that it or health care should serve everyone and one becomes subjected to the creeping fear of the boogeyman socialist.

It is good for capitalism and democracy to have an educated and healthy populace. Neither would be available on such a broad basis unless there were an element of that socialist boogeyman lurking in the minds of some very conservative Americans. "

steph wrote on Mar 6, 2009 9:00 PM:

" alucawanza, that's not very egalitarian of you, to insist to be placed near the top of the waiting list. Why should other people have to wait longer than you for a colonoscopy? "

steph wrote on Mar 6, 2009 9:19 PM:

" All this finger-pointing with regard to infant mortality really rubs me the wrong way.

Do you know anything about infant mortality?

I challenge you to find the risk factors for infant mortality here in the US. Then read about how statistics are collected here compared to other countries.

Then tell me what, besides being truthful and compassionate, our doctors are doing wrong.

Teacher, you yourself saw that Medicaid is available to pregnant women and to children! All over the country there are privately-funded prenatal care clinics like here in Napa (Healthy Moms and Babies). You don't even have to be in the country legally to be eligible to deliver a baby in a US hospital. You can walk over the border 8 months pregnant, deliver an American baby, and if that baby dies in the first year, somehow that's the fault of our healthcare system.

What more can our healthcare system do that it isn't already doing?

Doctors cannot prevent young girls from getting pregnant (they TRY) or from using drugs (they TRY) and not all congenital illnesses can be cured. Not all babies delivered at 23 weeks can be saved. Not all SIDS can be prevented. Not all women can be kept by their doctors from rolling over on their babies in the middle of the night. Not all men can be kept by their doctors from killing their babies. Not all household accidents can be prevented by pediatricians.

You make it sound like American doctors are cruel or callous or bumbling idiots, or that administrators are locking pregnant girls out of hospitals or prenatal care clinics. "

steph wrote on Mar 6, 2009 9:56 PM:

" Overutilization: regularly visiting the doctor for minor aches and pains, visiting the doctor for minor colds, or to repeatedly seek narcotics for addiction from several doctors, insisting on expensive tests for which there is little evidence of value (sometimes over and over), insisting on antibiotics for viral infections, insisting on more expensive medications where equally effective but lesser expensive medications are available, insisting on futile end-of-life care for brain-dead family members, visiting the doctor to have one's toenails trimmed, visiting the ER instead of one's physician.

Somatization can be expensive.

How about an indigent severe alcoholic who is a regular at the ER/ED? Is that a good use of healthcare dollars? This is a Pandora's box, of course. To what extent should co-insurers subsidize the treatment of someone who abuses him or herself, with food or drugs, or sexually?

How much is too much to spend to extend a terminally ill person's life by a month or three?

How about the infamous octuplet mom? The cost of her pregnancy and antenatal care was not covered by payments she made to her private-practice fertility specialist; it's all covered by her co-insurers at her HMO. (If one of those babies die, it will be another case of infant mortality, in spite of heroic efforts to prevent it--but she insisted on 6 more high-risk babies and got 8.) "

a teacher wrote on Mar 6, 2009 10:06 PM:

" Steph, the doctors don't do anything wrong. It's not about the quality of medicine, it's about the availability of medicine. If you are poor, you don't live near medical facilities. You can't afford regular doctor visits. You can't afford prescriptions. If there is a serious problem, you can't afford to be hospitalized.

Our doctors are the best money can buy. "

steph wrote on Mar 6, 2009 10:41 PM:

" Bill, again I agree with your last entry 3/6 8:48.

I'd like to see some actual analysis that can back up the assertions.

But even as a Libertarian (officially) and mostly Libertarian-ish thinking person, I can't help but be persuaded by the idea that we should at least LOOK at how universal health insurance for Americans and documented residents could stimulate the economy. Might it decrease disability claims, or help people return to work from welfare, or allow small businesses to create more jobs? Might we see increased productivity as a result of decreased anxiety and depression that comes from being insecure about healthcare availability?

How about a consumer tax for healthcare, one that all consumers contribute to, rather than only 60% of current taxpayers? Everyone should have a stake in our economy and some responsibility for paying for their healthcare. (Ruff--was this your idea?) "

steph wrote on Mar 6, 2009 10:45 PM:

" Poor pregnant women and babies are eligible for Medicaid--the best medicine money can buy.
If you are poor in an inner city, chances are you have a county hospital nearby.

(If you are rural poor, I don't know--maybe you got me on that one.)

I'm not convinced you understand the link between being poor and infant mortality and how it has little to do with the quality of healthcare available to poor people. "

a teacher wrote on Mar 6, 2009 11:52 PM:

" "If you are poor in an inner city, chances are you have a county hospital nearby."

Actually, the chances are that you don't. The chances are that your hospital has closed down or curtailed it's emergency room services and other services. As for the rural poor, out of luck. I worked on the Lower Brule Indian reservation for a year. There was a clinic on the res, but the nearest hospital was 40 miles away in Chamberlain. Same in rural Georgia where I lived several years.

For the record, the infant mortality statistic was misfit's not me. I know that infant mortality has as much to do with lifestyle factors as health care. I also know that there is more to babies than delivery in a hospital. There is prenatal and postnatal care. vaccinations, regular doctor visits etc. "

a teacher wrote on Mar 7, 2009 12:01 AM:

" Hey Steph, this over utilization thing, got any numbers? What percentage of people over use the doctors? How many winos are using the ER/ED? I find it hard to believe it's a big number, especially given the fact that men tend not to see a doctor when they have aches and pains (or so my doctor tells me). "

vocal-de-local wrote on Mar 7, 2009 12:22 AM:

" Another problem which Universal Healthcare will have to deal with is the pharmaceutically addicted patients who claim they're in 'pain' and physicians who are obliged to prescribe drugs like Vicodin because pain is so hard to substantiate. As a taxpayer, I sure don't want to pay for the habits of drug abusers. This is a much bigger problem than anyone realizes. We cannot even begin formulating statistics on it because how can we prove which patients are faking it and which one's aren't?

The complexities are broad and it will take a great deal of smart input to make a socialized healthcare system work. If it's done correctly, we could all benefit. If not, healthcare could easily be dragged downward by people who want to abuse the system. If that happens, everyone will suffer.

This is the reason that Universal Healthcare should not be entirely free. It MUST have an annual deductible, high enough to discourage abuse yet low enough to serve those who really need it. If every person who abused or resold Vicodin on the street had to pay a $25 copay for a physician's office visit to get a refill, it might discourage or slow down the level of abuse.

Btw, taxpayers are already paying for socialized medicine. On one end we have Medicare. On the other we have Medicaid. It's the middle class who pay so dearly. Hopefully, socialized medicine will be kind to our middle class. In order for that to happen, we cannot allow abuses to continue. "

Bauhausfan wrote on Mar 7, 2009 7:13 AM:

" "One point made over and over by advocates for government paid insurance is that those without insurance go to emergency rooms which are more expensive. The thinking is that if they have insurance they will more often go to the doctor’s office, and they will get better care overall thus reducing the bigger expenses of letting their health go and contracting more serious and expensive problems.
I find that logic a bit specious for several reasons. For one thing, if the uninsured have insurance, they will go to the doctor a lot more often than they did before, offsetting the savings of not using the emergency room. If the emergency room is five times as expensive and they end up going five times as often, the cost ends up being the same."

Fascinating argument that appears to be really rational and reasonable, but in reality it is not.

People who don't have health insurance wait until whatever ailment is so bad that they have to go to the emergency room, hoping that whatever it is will go away.

The whole idea about having everyone covered is really simple, so you can go to the doctor on a regular basis, you know for a yearly physical, and that way catch problems early so they don't blow up into a major disease or ailment.

By the way, where are the statistics thrown around in this letter and on the comments here for over use of doctors in this country?

I really, really want to see them. "

alucawanza wrote on Mar 7, 2009 9:36 AM:

" steph:
Oh...you believed the doctor when he said there was a two year waiting period. I believe it's a stalling tactic. I do love Kaiser, but no matter the health provider, you must be your own advocate. I don't mind waiting in line. Just be sure there's a line. "

Bill wrote on Mar 7, 2009 10:00 AM:

" Sources are good to reference for statistical data. To understand that the American medical association is a powerful entrenched political lobby does not need asource. The AMA exercises undue influence over not merely legislation but licensing, medical standards and education. It uses its power and influence to insure certain things that are necessary for the sustained practice of good medicine but it also uses that influence to insure that a very small portion of the medical brotherhood does extremely well economically and socially.

To understand that the insurance industry is a large and politically powerful lobby does not require a source. The capricious manner in which this lobby manages to pad its pockets at the expense of the American public is evident to many employers and individuals every time they pay their premiums. The amount of income devoted to health care and the return on that investment can be demonstrated statistically but what source that would demonstrate that would be acceptable in the argument? If I were to say that insurance premiums for a family of 4 were north of $12,000 annually would it be necessary to quote the source but then defend the type of coverage and the need and risk?

Would it be necessary involve a source in claiming that median national income hovers at less than 50k (a high estimate California is actually less) and say that that insurance premiums would account for around 25% of household spending using the previous premium as an example?

Is a source really necessary to understand that drug companies are also a powerful political lobby and exercise far more influence on legislation and market price than is necessary in a free and fair market than do consumers, taxpayers or the general populace? "

Bill wrote on Mar 7, 2009 10:22 AM:

" Try the census bureau or use median income in a search or the National Health Institute, National Coalition on Health Care for sources. There are a plethora of places with facts and figures. Most demonstrate that we pay far too much for what we receive.

Few sources out line, in a cohesive manner, the real price of health care or the forces driving its price. One force behind the high cost of health care is technology, the expense of research and why this has resulted in higher costs over a long period and not lowered costs remains unexplained.

In an age driven by science and technology it has been the expected out come that these things would be a benefit to all of society and enhance efficiency and health in our daily lives yet that has not been the case. Prices have steadily risen and delivery of expected benefits has not occurred.

Rather the benefits have been misused by the medical profession and insurance companies to pad their receipts. Unnecessary procedures performed for those who can afford them while denying needed treatment to those least able and most in need. "

John Richards wrote on Mar 7, 2009 11:00 AM:

" Teacher wrote: "Our blockade has probably done more to keep him in power than anything else. It has been a waste of time."

That's not the point. Often one has to take a stance, morally or politically, not because it will produce the desired end result but because it is the right thing to do. Cubans should be deliriously happy to have kept Castro in power, right? Why are so many wanting to escape to the US via unseaworthy boats that often result in death? "

steph wrote on Mar 7, 2009 12:08 PM:

" Overutilization is a pet of the left who want to demonstrate that universal healthcare is a possibility, if only we address the issue.

Overutilization is a complicated issue; sometimes it is driven by demanding patients and sometimes by physicians for a variety of reasons, including liability management and reimbursement. Overutilization by a few patients puts stress on an already stressed system.
There are studies that indicate that vocal-de-local's plan (actually, a very common form of utilization management in practice), to have higher co-pays and deductibles, seems to inhibit poor people from accessing needed services, like immunizations or cancer screenings.
Utilization is complicated. There are careers made of studying and affecting it, in the name of optimizing resource utilization.
I agree with vocal-de-local, though, that healthcare shouldn't be "free" AND she seems to understand a real problem with narcotic utilization in the country that is hard to quantify.

Here are articles on the topic
*GE, Siemens Fight Obama Plan to Cut MRI, X-Ray Costs (Update2)
*Health Care as if Costs Didn’t Matter
*Some Surprises On Emergency Room Use
*Mass. Health Care Reform Reveals Doctor Shortage
You should know, too, that many studies show that much of the practice "preventive healthcare" does not reduce costs.

Ah, anyway. If Obama has his way, you can still get an unnecessary MRI, if you are willing to pay for it. Which is how it should be. "

steph wrote on Mar 7, 2009 12:17 PM:

" Bill--
Seems to me you're getting a deal on insurance.

What's the per-capita spending on healthcare in the US? "

steph wrote on Mar 7, 2009 12:26 PM:

" "A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.

First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20% of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24% of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.

Second, another 25% of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office."
Excerpted from "Some Surprises On Emergency Room Use" at letstalkhealthcare dot org.
We need more Primary Care physicians. More Urgent Care clinics.

Tiering drug co-pays, patient pays lower price for generics vs. brand name drugs, seems to have driven the rate of cost increase down for pharmaceuticals. "

vocal-de-local wrote on Mar 7, 2009 12:28 PM:

" Bauhausfan, one way of solving the problem you describe is to increase the co-pay for emergency room visits.

Presently, my ppo co-pay for a doctor's office visit is $25. Emergency visits are twice that amount. Guess where I'm going if I have a choice? "

a teacher wrote on Mar 7, 2009 1:12 PM:

" "That's not the point. Often one has to take a stance, morally or politically, not because it will produce the desired end result but because it is the right thing to do. Cubans should be deliriously happy to have kept Castro in power, right? Why are so many wanting to escape to the US via unseaworthy boats that often result in death? "

What total nonsense! Foreign policy should serve the needs of the people, not lecture other governments. It's also a completely hypocritical stance given given our long support of brutal dictatorships (including the one Castro replaced). "

alucawanza wrote on Mar 7, 2009 1:47 PM:

" vocal de vocal said:
Btw, taxpayers are already paying for socialized medicine. On one end we have Medicare.

Sorry, not so. My husband and I are on medicare which we signed over to Kaiser. We pay $504 monthly to Kaiser and over $800 quarterly to medicare. We also paid for medicare in every paycheck for about 20 years. We pay copays to Kaiser. Kaiser, a private company, is managing my health care. If it is privately owned.....can't be socialism. We're paying the premiums...not the taxpayers. Calstrs pays the rest....which we also paid into for a combined 57 years. "

Bill wrote on Mar 7, 2009 1:57 PM:

" There is a good story in a Time Magazine I actually bought today on the vagaries of health insurance. Perhaps it is on line? I know! I know just another liburl media rag but it does outline areas of concentration and if we can get away from the social boogeyman for a while we might understand the necessity for some form of regular quality health care provisions for all of society.

We are not talking about rights here but the needs of a nation. It behooves us to care for our own and strengthen our health generally by including as many citizens. Arguing that it is immigration or the aging baby boomers that cost so much only belittles the general need. Looking for fraud before it occurs would better be served by insuring that access is limited by something other than income.

That you can get the necessary medical help you need before you have exhausted all your personal and family resources creating the need to through your self on the sustenance of welfare is the direction the article takes. There are many more instances of personal tragedy from people who thought they were doing the right thing buying insurance only to find out that should they be come ill it would cost them their home and what ever small personal fortune they possessed.

The argument is not over whether or not there will be health care reform but the form it will take. The Red baiters will have you belive that freedom of choice will be curtailed when the reality is that it is already curtailed by a broken system.

The article suggests 5 points to consider: cover everyone, prevention beats intervention, realign doctor’s incentives, reinvent hospitals and go paperless. "

steph wrote on Mar 7, 2009 6:18 PM:

" vdl--two problems with charging people a co-pay for the ER: 1) in some areas of the country, there are no available appointments to see a primary care physician (Massachusetts has this problem) so people are forced to go to the ER and 2) indigent people will never be charged a co-pay that they will pay "

Bauhausfan wrote on Mar 7, 2009 10:30 PM:

" The cost per capita for healthcare in the U.S. is going to be 8,000:

Health care costs will top $8,000 per person this year, consuming an ever-bigger slice of a shrinking economic pie, says the report by the Department of Health and Human Services, due out Tuesday.

http://news.yahoo.com/s/ap/20090224/ap_on_go_ot/health_costs

"It is a sad commentary on the pinched and strictly censored level of political discourse in this nation that any serious consideration of Canada's successful approach to health care is simply out of bounds in America. It is nothing short of absurd that even though the nation that is closest to the US geographically, culturally, linguistically and economically has, since 1973, had a system of provincially administered single-payer government-run health systems which have kept the country's health costs at about 3/5 of what they are in the US as a percentage of GDP (9.7% vs. 17% for the US), at the same time serving all people and (not surprisingly) achieving better health statistics than the US, no one in Washington has talked about inviting Canadian health authorities down to explain how their system works and whether it might make sense here."

cut.

There has for years been a huge ongoing propaganda campaign by US health care companies and their lobbies to denigrate Canada's system, but the big truth that they cannot deny is that it is loved by Canadians. The best evidence of this: Despite years of conservative governments in Canada, and in the various provinces, no political leader has ever tried to re-privatize health care in Canada. Clearly such an effort would be political suicide, so popular is the system there. "

http://www.commondreams.org/view/2009/03/01 "

napablogger wrote on Mar 7, 2009 10:49 PM:

" bauhausfan and all: The CBO, which is the Congressional Budget Office (of Obama now) testified recently to the Senate that research shows that despite frequent assertions that preventive care will save money as opposed to people going to the emergency room, in fact it does not save money. Here is a quote from an article reviewing the testimony from Sally Pipes in the WSJ today:

"CBO director Douglas W. Elmendorf explained this last week to the Senate Committee....Preventative care, disease management and electronic medical records are also constantly cited as big cost-savers. The idea here is that if our health-care system was set up to prevent disease rather than just treat it, and could do so without duplicative paper records, it could save money. It's a great hypothesis, but research does not indicate it amounts to much. "In many cases," as Mr. Elmendorf testified regarding such initiatives, "those studies do not support claims of reductions in health spending or budgetary reductions."

Read the whole article here:

http://online.wsj.com/article/SB123629779856246193.html "

napablogger wrote on Mar 7, 2009 11:00 PM:

" bauhausfan, to your other point about documentation that our medical system is overused, I have been reading books and articles about health care costs for years and they all mention that as the number one issue.

It is one thing that both sides agree on. The one that really explains it well is Arnold Klings book which you can look up on Amazon.

It really isn't even a controversial issue, except for those not versed well in the debate. It is just a fact. One seventh of the amount spent on health care is unnecessary tests to cover for the doctors in case of a law suit--not for medical reasons.

When Kaiser first started they used to have no co pays at all. That was the whole idea. They started charging $5 a visit because they discovered that some people would come every single day if it were free, even though they had no problem.

There are a lot of people who just like to go to a doctor because it makes them feel better.

If something is free, people will flock. Look at what happened at Denny's when they offered a free breakfast.

My view is that that is the main problem raising cost in our health care system now.

If something you liked that is expensive were suddenly to become free, would you get more of it? Or would you contine to use the same amount of it?

I like to eat at Press restaurant in St. Helena, but I have only gone twice because it is so expensive. If it were free would I go more often? you bet. That is universal health care in a nutshell. "

steph wrote on Mar 8, 2009 12:27 AM:

" Oh, gee, bauhausfan, there's not like, an agenda over at "commondreams", you think?

I did a little Googling around.

In an article entitled "Canadians' satisfaction with health care declining: CMA:Access to specialists and diagnostic tests given failing grades"
I read that 62 per cent of Canadians grade the overall quality of health-care services available to them and their families as an A (21 per cent) or B (41 per cent), a decrease from 67 per cent in 2006. And Access to health care was an area that showed wide disparities in response: 29 per cent of respondents assigned an A grade for access to family doctors in their community, and 26 per cent gave an A for access to walk-in clinics.
However, the report highlights that access to family doctors and emergency rooms has been falling consistently since 2003. "The chief evolving concern is a lack of access to family doctors," CMA president Colin McMillan, told CBC News.
Access to specialists and diagnostic tests were two categories that generated poor scores. Twenty-one per cent of Canadians surveyed gave access to medical specialists an F, and 19 per cent gave the same grade for access to modern diagnostic equipment, such as MRI or CT scans.

Twenty-one per cent awarded an F for access to health-care services on evenings and weekends and 16 per cent awarded an F for access to mental health-care services.

Overall, the prognosis isn't very positive, the report finds. The proportion of Canadians surveyed who believe health-care services will either get much or somewhat better in the next two to three years has declined to 49 per cent — a sharp drop from 56 per cent in 2006. "

vocal-de-local wrote on Mar 8, 2009 1:36 AM:

" alucawanza, I'm curious about your comment.

So, you're saying that Medicare is not entirely 'free'? You mention $800 quarterly for TWO people which amounts to about $125 monthly per person which is fairly close to what my son pays for his contribution to a workplace healthcare plan. His company pays the rest.

You also pay extra for Kaiser? From what I understand about Medicare, this is an option. Am I right about this? Doesn't the Medicare system allow some flexible tailoring to your own personal preferences, offering some plans which cost more if that's where your priorities are? From what I understand about Medicare, they have tried to offer flexibility by offering different types of plans, some which cost more, some less. For those who did not pay into SSI, and for those who have not yet reached the required age limits, the prices are going to be higher. Without knowing more about your personal situation, it's very difficult for me to ascertain whether your case is typical or isolated.

I don't think it's bad for people to be making a contribution to their healthcare. Perhaps consumers will think twice about how well they care for themselves. Healthcare will not be taken for granted as long as we pay 'something' into it. And Medicare IS socialized medicine btw. Do you have any idea what your premiums would be if it wasn't for Medicare? Exactly who do you think pays for it? These things just don't drop down from the sky like fairy dust.

I'm a big believer in socialized medicine btw. I just believe it must be set up correctly or it's weight is going to collapse on all of us. "

Ruff Limblog wrote on Mar 8, 2009 7:46 AM:

" The Canadian and Japanese systems have co-pays, deductibles and premiums that must be paid by the user.

There is also a per prescription dispensing fee of $3 CDN per prescription.

However, the basic plan, which is far better than the junk insurance peddled at inflated prices in the USA is only about $50 per month, with an additional $50 per month for 'gap' coverage which is often picked up by employers.

In no case is are any of the above plans allowed to pay the prescription dispensing fee.

This means that it is a strawman to yack about 'free' healthcare since it is a common practice to have these fees as disincentives for hypochondriacs.

What privately-delivered publicly-financed healthcare systems don't 'offer' is annual $1+ Billion paydays for greedy CEOs.

~Ruff "

a teacher wrote on Mar 8, 2009 9:44 AM:

" "I like to eat at Press restaurant in St. Helena, but I have only gone twice because it is so expensive. If it were free would I go more often? you bet. That is universal health care in a nutshell. "

Again NB, the let them eat cake argument. Are you equating people's health with something as frivolous as eating out at an expensive restaurant?

I want to see your evidence for overusing the health care system. There is no person that I can think of that goes to the doctor just to feel better. "

a teacher wrote on Mar 8, 2009 10:54 AM:

" Here is a statistic that critics of Canada's health care system don't want to talk about. What percent of Canadians want Canada to adopt the US model of private health care? The answer is: not many. "

Bauhausfan wrote on Mar 8, 2009 11:39 AM:

" Steph- Yes, Common Dreams has an agenda just like the Cato Institute, Heritage Foundation, American Enterprise Institute, Hoover Institution have an agenda also. And it is a known fact that there many, many more well funded right wing think tanks than there are left wing.

"I read that 62 per cent of Canadians grade the overall quality of health-care services available to them and their families as an A (21 per cent) or B (41 per cent), a decrease from 67 per cent in 2006."

So 62 percent of Canadians give their overall quality of healthcare at an A or a B. I wonder what it is in the U.S.? I don't claim to know. I suspect quite lower. Especially those without health insurance or access to healthcare and those under insured (high deductible, regular doctor visits not covered and just plain awful coverage).

Here is the irony about that statistic
you quoted. We know EVERYONE in that country is covered. We know not one single person in that country goes bankrupt due to medical conditions. We know that is not true in our country.

We also know that they spend less than we do per capita for healthcare because the U.S. spends the most on the planet. "

steph wrote on Mar 8, 2009 12:22 PM:

" Are those our only choices, Canadian healthcare or US-style healthcare? "

a teacher wrote on Mar 8, 2009 12:59 PM:

" " Are those our only choices, Canadian healthcare or US-style healthcare? "

No, but I think that the way the Canada, Japan and Taiwan do it, single payer, gov't administered, is the way to go. "

steph wrote on Mar 8, 2009 1:31 PM:

" I've been very careful not to quote Cato or Heritage or the other think tanks you mention. They'd not be considered credible sources here.

If you're Canadian, and you're on a waiting list for a diagnostic test or procedure, you have two choices in Canada: 1) wait and hope 2) go to the US to spend money to get your healthcare. It's a problem.
And if you think privatization isn't on the minds and lips of Canadians, you've not been reading enough. One problem is, Canada has a doctor shortage because of central socialist planning (gov't control over graduation rates, meant to decrease healthcare costs--ooops!) and brain drain. And so, Canadians wait and wait, but they all wait equally, unless they have money to travel or pay out of pocket for health services.

In 2005, the Supreme Court of Canada ruled that the Quebec government could not prevent people from paying for private insurance for health-care procedures covered under medicare when the public system failed to guarantee patients access to those services in a timely way.

"Access to a waiting list is not access to health care," two of the justices wrote in the landmark decision.

But: B.C. NDP health critic Adrian Dix called the insurance plan profiteering and a violation of Canada's health-care laws.

"This [British Columbia Auto Assn.] is an example of a company that's actively soliciting for clients that have the ability to pay for the privilege of queue jumping. In my view, and in the view of the legal opinion that we obtained, it is illegal, and it violated both provincial and national health legislation," said Dix.
[source: cbc.ca "Medical wait-list insurance to be available in B.C."] "

Bill wrote on Mar 8, 2009 2:16 PM:

" The wsj article is an opinion piece not a demonstration of fact. Sally Pipes opinion is worthy of analysis, it is not a valid representation of the position taken by CBO. Her opinion is dispersed between quote as if it were a factual representation of OMB, it is not. Even the cut and paste quote illustrates her position not that of CBO.

Does anyone really believe that preventative care is not cheaper than treating a condition that has developed because of lack of care? Ask your Dentist.

Over use of exactly what services should be the question; Emergency services, seeking a doctor when an advice nurse would suffice, treatment of a medical condition that could be better addressed by a medical practitioner?

Having Wal-Mart employees depend upon county services for health care?

The Massachusetts argument of having to wait for a physician is good point showing that there are a limited number of physicians to serve a populace in need with or without state health care. A number kept artificially low by the medical profession to keep their salaries up. It’s not over use rather high demand for a scarce product.

If many of the procedures and health care choices were relegated to specific health care practitioners at a much reduced cost there would be a net savings by decreasing demand for over qualified personnel.

Ask yourself why you or your insurance is charged the same price for having your teeth cleaned whether the procedure was performed by a DDS or a dental hygienist. The insurance sets the rates but the dentist decides whether he or his assistant performs the procedure. The more times you see the dental hygienist instead of the dentist becomes a net gain in the doctor’s time. "

Bauhausfan wrote on Mar 8, 2009 2:18 PM:

" I would think that our country, so well known for innovative thinking and creativity would be able to come up with our own version of a good healthcare system. The most viable method to cover everybody and lower and in the future control costs is to have single payer. That single payers agenda is not to make a profit. "

a teacher wrote on Mar 8, 2009 3:15 PM:

" Steph, you are selective. It is true that some procedures have longer waits, the same is true here. Others are not so long. Most waits are similar to here, the biggest problems seems to be the infamous MRI machines. Times vary from province to province and Canada is a VERY big country with not a lot of people. You would face the same problems here if you lived in South Dakota or Alaska or any other rural community.

You are also leaving out the fact that the Canadian government has invested a lot of money to lower wait times with some success(ministry of health stats)

It is true that many Canadians might consider SOME private options, that is not the same as privatizing their system. In fact, if you look at opinion stats they want the government to spend more to make their system more efficient. They don't want our system.

We can turn the tables here. It may be true that some Canadians come here for treatment, but it is also true that Americans pour over the boarder to buy pharmaceuticals for lower prices. "

Bill wrote on Mar 8, 2009 3:51 PM:

" great thread , best so far.

Steph, I realize you comment was meant as a dig about a cheap price for health insurance and you are correct. I only took a quotation of the 12k as a low example and showed it was at least a quarter of total median income. to show that we are paying a high price and not really receiving much for it.

A quick look at some questionable tables from Kaiser foundation on health care per capita shows around 6k per capita if I grabbed the right number and a 21k per capita income from wikipedia. This surpasses1/3 of income spent on health care per capita.

Not very commendable and very suspicious numbers but it is indicative of health care being a major expense for all Americans.

We don't necessarily need Japanese or Canadian style health care but we do need something better than we now have. These are only models to look at.

Taiwan and Germany have other models that are worth thinking about. It is time to stop fighting what is an obvious need and start thinking about how health care and its delivery can be made to work for all Americans not just those who can afford it.

We should pay attention to the proposals in congress and from the President with close attention. We need reform now on this most important subject and I am happy to see many of the comments reflect that concern.

May I suggest a health care blog to the NVR? "

Ruff Limblog wrote on Mar 8, 2009 4:12 PM:

" Reform is coming to healthcare and a healthy debate surely could summon some Republican voices to discuss IMPROVEMENTS to what we have now instead of just whiney complaints about what they think rightly or wrongly is wrong with the way other nations do it.

I'm sad to say that we are not getting suggestions on how to make the system better or how to cover everybody from Republican voices.

Obstructionism is an irrelevant sideshow to discussing improvement.

I'd be happy to mandate that all healthcare insurance organizations must be non-profit mutual-style organizations that must re-invest all profits in improved benefits for members or refund the money to their members in reduced rates.

Add 'take all applicants irregardless of pre-existing conditions' and one premium for every member, a flat yearly deductible, and $10 copays... and you are beginning to talk about a GOOD system.

Add making all executive compensation over say 50 times the median wage of workers in the system taxable to the organization and you'd be talking about a GREAT system.

I'd probably also add there is only one level of coverage, no executives get any better coverage than the least paid lowest-benefited worker in their own company.

~Ruff "

Todd Adams wrote on Mar 8, 2009 4:38 PM:

" I wish I had time to join the discussion, but at the very least I would like to thank you for your thoughtful comments on this important topic. You can learn more from this thread than you could learn by watching cable new networks over a 10 year period. "

steph wrote on Mar 8, 2009 6:57 PM:

" Ok, teacher. Interesting comment about geography.

Because a few posts back you decried our healthcare system for its lack of care in rural counties. You do see the parallel, right? Fact of the matter is, if you live in cities, you're more likely to have closer access to healthcare (ala Europe). But, like Canada, we have lots of land with low population densities, and building a hospital in these areas makes little sense. Australia has the same problems with their aboriginal population that we have with ours--cultural differences and low densities that impede a one-size-fits-all solution.

Perhaps this explains Canada's 30th place in the WHO study, just above our 37th place.

As for privatization, you're right--Canadians are not clamoring for our healthcare system. They do want options for private insurance, but many in the country favor strict controls on how healthcare is rationed, to keep equality in the system, as in the quote I provided above. Americans who value personal liberty won't clamor for strict government control of all healthcare, either.

Canada's prices for brand-name drugs are lower than ours, not so for generics, according to a WHO study "Generic Drug Prices: A Canada US Comparison" in 2002. That study said, "In summary, while further analysis is needed to gain a more complete understanding of the factors that contribute to higher generic prices in Canada, it appears that one reason
may be that Canadian manufacturers do not experience the same pressures as American generics to compete on price." "

steph wrote on Mar 8, 2009 7:50 PM:

" Bill--
Your point is well-taken about studying other countries' healthcare models.

It's exhausting. For example, I was very intrigued by the positives and methods I just read about Singapore's healthcare system. (Singapore is often lauded for great education, as well, so I naturally was drawn to examine their system.) You know what's always fascinating, is reading the readers' comments, like those in this thread. There are charges by Singaporeans that the elderly or disabled are mistreated, that people often go bankrupt providing care for family members (Singapore relies heavily on health savings accounts), or that Singapore isn't a fair comparison because their culture is so different from ours, and their people are younger with lower rates of obesity, for example.

But we must keep trying. Because like most people in the US, I also feel as though we should protect what is good about our system (choice and excellence) and try to fix what is bad about our system (lack of access by poor and some middle class people.) "

steph wrote on Mar 8, 2009 8:40 PM:

" Bill--you need to cite a source for your claim that healthcare providers are conspiring to keep the numbers of providers artificially low.

I don't believe your claim is based in fact.

The problem is, the rewards of primary care/family practice medicine aren't enough to attract smart people to this career. I spoke about the pressures earlier. Why not go into a specialty, where the compensation is far greater? This is what leads to a shortage of providers, not some conspiracy. "

steph wrote on Mar 8, 2009 9:18 PM:

" And, with respect to preventive healthcare, again your intuition fails you, Bill.
You can read commentary at NYT entitled "Campaign Myth: Prevention as Cure-All".
Preventive medicine is good. It saves lives and improves quality of life--sometimes. But it is NOT cost-effective on the whole.

You're thinking of it this way: the cost to vaccinate someone against a disease is cheaper than treating that disease. Or, the cost of detecting a disease early will result in easier, less expensive treatment options than when the disease is found later. You're presuming a 1:1 investment/return in terms of numbers of patients. However, unlike dental cavities, not everyone is prone to many of the diseases we vaccinate against or screen for. How many girls need to be vaccinated against HPV to prevent one death from cervical cancer? How much do the side effects cost? How many women over 75 need to be screened by mammography to find one early case of breast cancer, and what is the likelihood one cancer victim will die of another illness like hip fracture or heart disease--or the treatment itself?

Of course, I don't point these facts out to dissuade people from utilizing preventive medicine, but to illustrate that the practice has a dollar cost that may be more than not offering the "preventive" care. In many cases the investment is worth the real price in terms of lives saved or quality of life increased. But healthcare spending is not limitless, and the point of showing a dollar cost savings with preventive care does not always bear out with the calculations. "

steph wrote on Mar 8, 2009 9:26 PM:

" With regard to collectivism, it's too bad we can't count on Americans to voluntarily do their part to reduce the cost of healthcare in this country and increase health outcomes by giving up smoking, obesity, alcohol and drug abuse, and promiscuity.
To the contrary, Americans want to be able to abuse their bodies and then have "the government" or their insurance companies pick up the tab on treatment.

Of course this does not address as-yet unpreventable disease, but overall healthcare costs could be dramatically reduced if everyone did their share of reducing disease burden to the best of their ability. "

Bill wrote on Mar 8, 2009 9:55 PM:

" Aw Steph you don't like my polemics, of course there are no facts on my conspiracy theory. But thinking of the medical profession and insurance corporations as altruistic concerns just does not cut it for me.

Kinda like people go to the doctor jus cause they want to see the doctor.

I think you are on to something in your post about investment/returns and I agree that we can not cover all facets of disease or misfortune and we will have to make a rational choice about what we will cover and prevent aginst and what we will not. "

Bill wrote on Mar 8, 2009 9:59 PM:

" I am going to have to argue with more specialists theory as I think that is the wrong way to go and the current large hospital model is not what we should be continuing.

Keep it coming I have to slip off to never never land. "

Bill wrote on Mar 8, 2009 10:03 PM:

" Oh and Steph, Share your sources for your opinion other wise my theories are just as valid as opinion from thin air. "

winemd wrote on Mar 8, 2009 10:35 PM:

" I only have anecdotal evidence to present. My 65 year old father has Medicare. He has diabetes, high blood pressure, high cholesterol, and a history of strokes (he is now legally blind and has memory loss). He still smokes and eats junk food all the time(he is not insulin-dependent). His doctors have him in 4 times a year at the minimum, not including specialists (for no apparent reason but to check in). He is putting water into the sinking boat as fast as the pills are bailing him out. If it wasn't for Medicare he would never voluntarily spend the money to go see a doctor. He is a perfect example of someone not doing the best he can to protect his health because of the "magic" pills, which he can get for a very cheap price due to Medicare. His attitude is that the medication has things under control so he doesn't need to do anything to help himself. "

vocal-de-local wrote on Mar 9, 2009 1:36 AM:

" Steph, I agree with your comment, "Americans want to be able to abuse their bodies and then have "the government" or their insurance companies pick up the tab on treatment.".

It's a huge problem. I realize that some of you hate government intervention, but I recently read that fast food restaurants might get taxed, like cigarettes, to help offset the costs of treating the diseases which result from eating such awful foods. The general attitude about health in this country is sickening (no pun intended!) Most people do not care about their general health until they develop cancer or until their obesity leads to heart disease.

I realize this idea would never gain acceptance, but I really do wish that there was a way for National Healthcare to address this problem. People who abuse their bodies should be paying higher premiums. For example, If weight is beyond a certain amount, or blood pressure is elevated, or their diabetes type two is uncontrolled, or they smoke or have cirrhosis from alcoholism (these are all lifestyle diseases, generally speaking), then they should have to pay an additional co-pay and deductible. Sounds insensitive but it's the only way to get it through the people's heads that their poor health habits will cost them dearly, including financially. "

Ruff Limblog wrote on Mar 9, 2009 7:34 AM:

" steph- You ask a few good questions but missed proposing a solution.

It's a good question to ask about preventative care which might cost more... we have a $1 Trillion dollars of waste fraud and abuse perpetrated on the American people by the 'for-profit' insurance industry so we have room to fund some prevention and bring everybody into the system.

And I'd like to have patients and doctors deciding which preventatives to use instead of insurance companies with their eyes on fat bonuses for denying care.

Asking only questions and not actually discussing improvements and how to pay for them is much better than before.

Soooo, now that you have gotten into the questions... what are your suggestions?

What part of which 'model' system would you support and why?

Dream a little, as a woman and a human being what could be done better when it comes to funding prevention services?

~Ruff "

alucawanza wrote on Mar 9, 2009 3:14 PM:

" vocal de vocal asked:
You also pay extra for Kaiser? From what I understand about Medicare, this is an option. Am I right about this? Doesn't the Medicare system allow some flexible tailoring to your own personal preferences, offering some plans which cost more if that's where your priorities are? From what I understand about Medicare, they have tried to offer flexibility by offering different types of plans, some which cost more, some less. For those who did not pay into SSI, and for those who have not yet reached the required age limits, the prices are going to be higher. Without knowing more about your personal situation, it's very difficult for me to ascertain whether your case is typical or isolated.

Answer: This is the plan for retired teachers. No options. We signed over our Medicare to Kaiser. We pay a Kaiser premium monthly for prescription coverage. The rest is Medicare. Calpers pays whatever the rest of the premium is to Kaiser. There is no flexibility. It's the Senior Advantage program for retired teachers. We pay Medicare premiums according to our income. Medicare checks IRS forms and charges according to your income. We make more than the minimum, so pay more.
We are satisfied with our coverage. My husband just had cataract surgery. It cost $10 for the co-pay. So, we pay $508 per month for Kaiser and a little over $800 quarterly for Medicare. Each prescription is a $5 co-pay, doctors' visits $10, lab work is $10 (no matter how many tests are needed that day). I recommend Kaiser heartily. Hope this answers your question and clarifies information you are interested in. "

Bill wrote on Mar 9, 2009 4:40 PM:

" Aluc, Volcals not the only one confused here. You just showed up with a $774.666 monthly insurance bill for two while on medicare?

Everyone's situation is different but that still appears high. I thought that medicare hospitalization was not charged and that the part B wouldn't exceed $100 per person so long as your joint income was not to exceed $!70,000.

There have been a lot of complaints about Kaiser here locally. The copay is not the problem but that $766 number sure is.

If it is correct and insurance premiums are not controlled look forward to a lot more sick and homeless people living under local bridges.

Is old age a preexisting condition we are all subject to? "

John Richards wrote on Mar 9, 2009 4:48 PM:

" "$508 per month for Kaiser and a little over $800 quarterly for Medicare."

So your total premium is $708 per month. That seems high. Have you done a cost analysis to see if dropping Medicare (part B) would save you money? As I understand it, the only benefit you get out of signing Medicare over to Kaiser is a lowering of your co-pays. I declined Medicare Part B when it was offered to me because I make only modest usage of Kaiser's services, so the higher co-pays don't bother me. I am a federal civil service retiree, and our current Kaiser premium cost is $190 for a single person, or $496 for a family (both High Option). "

John Richards wrote on Mar 9, 2009 4:54 PM:

" My math was a little off (erroneously assuming a quarter is 4 months!). Bill's number is right in that Aluc pays $775 per month. Sure seems high compared to what I pay. "

a teacher wrote on Mar 9, 2009 5:47 PM:

" Actually, as a teacher nearing retirement, I find that rather frightening. $775 is just half of what my plan costs now for the full family plan. "

misfit wrote on Mar 9, 2009 10:37 PM:

" winemd...You are wrong about the drugs being "a very cheap price"! My mother quit one of her medications because it alone was 210.00 for 30 pills. She has Blue Cross and Medicare and still, this is what her drugs cost. She is on a fixed income of 1200.00 per month. At least 300.00 goes to her medications. So much for the Medicare Drug Plan. Last year she entered into the "Donut hole"??? She had to order from Canada for a couple of months. This is a sad situation in this country and anyone who can defend it is clearly out of touch with reality. It's easy to preach about how wonderful our system is here and it might be...for a few who have complete access to it. For too many others it simply isn't available for a multitude of reasons, whether it be cost or pre-existing conditions. It is a pathetic situation and there is no excuse for a country like ours to allow it to get this bad. Get your heads out of the sand or the clouds and open your eyes to the problem. Preaching about how health care is a privelege does nothing to solve the problem. It's just more denial. "

Mr4 wrote on Mar 9, 2009 10:43 PM:

" This should be popular:

The American healthcare system is the envy of the world. Having seen places like the Mayo Clinic, Cleveland Clinic, Memorial Sloan Kettering, MD Anderson, Johns Hopkins, Duke, Stanford, UCLA, Loma Linda and UCSF, witnessing the proliferation of foreign patients (as well as foreign physicians), the US system has no peer.

But the system could be better!

The biggest problem facing our system is that we made a huge mistake several years ago. We allowed our employers to provide us with our healthcare. In doing this we removed buyer (patient) from seller (doctor), preventing the free market from operating correctly.

Employers really knew nothing about healthcare, so they delegated the provision of our healthcare to insurance companies - thus separating patients even further from the providers. The insurance companies hold tremendous leverage over the providers, resulting in unequal bargaining positions, further warping the market. And government intervention on top really made a mess of it.

The hope that further governmental meddling will solve the problem is ridiculous. It would simply remove all innovation and progress from the system.

The answer, as unpopular as it may sound, is to free up the market. Stop the practice of employers (or government) providing healthcare. They can certainly fund healthcare for employees, but until people actually choose their own care the system will never be efficient. It will always be full of waste.

Free choice by individuals can also make a competitive market for insurance companies. Today insurance companies are artificially banned from competing in certain markets.

Freeing up the market will work. But I can't imagine a single politician with the guts to do it. "

alucawanza wrote on Mar 9, 2009 11:30 PM:

" Yes, the total premium is $775 per month for two people. The Kaiser premium is taken directly out of our retirement checks. It's $254 each. Medicare bills us quarterly. The Medicare is higher because of our income. It will be lower in the following months due to the recession....I've asked that they check our current IRS forms. Are you on Medicare, John Richards? What is your premium for that? Ours is $404 quarterly the last two quarters. This is our first year with Medicare. "

vocal-de-local wrote on Mar 10, 2009 1:14 AM:

" I really appreciate your input, alucawanza. Come to think of it, my aunt and uncle over in Sonoma County are retired teachers. I recall a conversation they had about their high cost Kaiser insurance even though they are on Medicare. I've been a little confused about it but now it makes more sense.

Well, for you and your spouse, I would say that Universal Healthcare could indeed be beneficial. The cost you are paying is unacceptable. Perhaps you have some healthcare issues which make hanging onto a higher cost policy worth it. As we all get older, we do begin to have greater healthcare issues at the same time that income is decreasing. It's a problem. And it's going to be a challenge for Universal Healthcare to address because older patients utilize more resources but have fewer resources to compensate for it.

We are definitely going to need to go into it with disease and injury prevention as a priority. For example, older patients should learn to do simple balancing exercises to prevent falls. In order to maintain good health, we all need a cardiovascular workout. Good diet is really important for maintaining blood sugar and weight. How can we get people, young or old, to follow through with a prevention plan? Is it fair to penalize people for bad lifestyle choices? That's a tough one. "

vocal-de-local wrote on Mar 10, 2009 1:26 AM:

" teacher, from what alucawanza was saying, the rates are based on retirement income. If you have a lot of income producing investments or received an inheritance or whatever, then you will pay more. That's what it sounds like to me.

Personally, I would not like a Universal healthcare system which was designed to have fees based on income. There would be no incentive to save for retirement. This would be a very bad idea.

I do think that a reasonable deductible is important. But alucawanza's $775. fee would be much too high in my opinion. That's close to $400 per person per month. That's like having nearly a $5000 annual deductible except it's divided into monthly fees! Unreal! "

Bauhausfan wrote on Mar 10, 2009 5:51 AM:

" From March 9th LA Times:

As a connoisseur of health insurance lobbying practices, however, I withheld judgment until I could scan the fine print. What I found by reading AHIP’s 16-page policy brochure was that its position hadn't changed at all. Its version of "reform" comprises the same wish list that the industry has been pushing for decades.

Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors' and hospitals' fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.

cut.

Who are these "high-risk" individuals, by the way? At an AHIP convention last year, I heard a prominent industry consultant describe the customers the industry is desperate to dump on taxpayers as those with multiple chronic diseases, like diabetes sufferers with asthma or cancer patients with heart problems. He called these people "clinical train wrecks." (Nice way for someone connected with the "caring professions" to talk, isn't it?)

AHIP's commitment to an improved healthcare system is skin-deep. It endorses the quest for lower costs, more efficiency, and the fair and impartial resolution of claims disputes. Achieving these ends always has been within the industry's power, but it never seems to make any progress toward them.

For example, AHIP says it believes that "administrative processes should be streamlined across the healthcare system." But at its member firms, the administrative complexity only proliferates.

I know doctors who now have to split their working hours 50-50 between seeing patients and dickering with insurance companies over claims and preauthorizations -- a vast increase over the time they spent on administrative chores a few years ago.

http://www.latimes.com/business/la-fi-hiltzik9-2009mar09,0,4220704.column "

Mr4 wrote on Mar 10, 2009 7:11 AM:

" This should be popular:

The American healthcare system is the envy of the world. Having seen places like the Mayo Clinic, Cleveland Clinic, Memorial Sloan Kettering, MD Anderson, Johns Hopkins, Duke, Stanford, UCLA, Loma Linda and UCSF, witnessing the proliferation of international patients (as well as physicians), the US system has no peer.

But the system could be better!

The biggest problem facing our system is that we made a huge mistake several years ago. We allowed our employers to provide us with our healthcare. In doing this we removed buyer (patient) from seller (doctor), preventing the free market from operating efficiently.

Employers know nothing about healthcare, so they delegated the provision of employee healthcare to insurance companies - thus separating patients even further from doctors and hospitals. These insurance companies gained tremendous leverage over the providers, resulting in unequal bargaining positions, further warping the market. And government intervention on top really made a mess of it.

The hope that further governmental meddling will solve the problem is ridiculous. It would simply remove all innovation and progress from the system.

The answer, as unpopular as it may sound, is to free up the market. Stop the practice of employers (or government) providing healthcare. They can certainly fund healthcare for employees, but until people actually choose their own care the system will never be efficient. It will always be full of waste.

Free choice by individuals can also make a competitive market for insurance companies. Today insurance companies are artificially banned from competing in certain markets.

Freeing up the market will work. But I can't imagine a single politician with the guts to do it. "

a teacher wrote on Mar 10, 2009 9:38 AM:

" "Freeing up the market will work. But I can't imagine a single politician with the guts to do it. "

Yep. The free market ALWAYS works. It has made us what we are today.

BTW, I have some derivitives you might be interested in... "

winemd wrote on Mar 10, 2009 10:17 AM:

" Misfit…My dad has substantial memory loss and last year spent the entire year without drug coverage because he cancelled his coverage because he didn’t remember that we had signed him up. His cost for 6 prescriptions monthly (4 of which are generics) was $350 to $400. I got his coverage reinstated during the open enrollment period for this year and after the $250 deductible was paid the monthly cost is around $130. I can get it more cheaply by using mail order. His income is $784 per month. I signed him up for a Medicare health plan which includes prescription coverage at no extra premium charge (his premium for Medicare part B is $96.40 per month) by going on to the Medicare website.
I said nothing about health care being a privilege, nor how “wonderful” the system is. He needs Medicare and if it was not available he would be in worse shape than he is. He doesn’t take care of himself and expects doctors and medications to bail him out. If he took better care of himself, he would need less care, and cost less to the system. His doctors order too many tests and visits which drive up the cost of care unnecessarily. Unless there is a problem, every six months to a year should be adequate for him. At his last visit in February they wanted to schedule a follow-up for 3-4 weeks, which didn’t even give me enough time to get him in to the specialist they wanted him to see. I got him to the lab for tests. If everything is normal, then we should not need another visit with another co pay and charging Medicare the cost of another visit. If there is a problem, they could call to schedule a visit. "

Mr4 wrote on Mar 10, 2009 10:57 AM:

" The free market gave us the MRI that identified little Susie's eloquent cortex and adjacent white matter tracts , changing the neurosurgeon's approach to removing the previously "inoperable" brain tumor. The result was not only that little Susie is alive today, but that she can also walk and talk normally.

Outside of the U.S, little Susie is gone. "

Raven wrote on Mar 10, 2009 11:37 AM:

" MR4 that is pure supposition ... you have no way of knowing the outcome for lil susie ... and as for the free market......I think lil research will show that govt grants had a lil part to play in the development of the MRI....

and if it is the envy of the world why are so many Americans traveling to other countries, India for example for surgeries they cannot afford here in the US....medical tourism is a growing business "

Mr4 wrote on Mar 10, 2009 11:37 AM:

" Susie's Mom had a small breast cancer seen by mammography. The surgeon planned a lumpectomy. But Susie's Mom had a good private heath plan. She got a breast MRI that identified a second lesion next to the chest wall of the opposite breast. This new information totally changed her treatment.

Today Susie's Mom is taking Susie for a walk in the park. It is a beautiful day.

Outside of the U.S., after mourning the loss of her child, Susie's Mom loses a long and painful battle with recurrent breast cancer. "

TINAMAC wrote on Mar 10, 2009 12:30 PM:

" Just look at what happened in Massachussettes, WITHIN 1 YEAR of implementinng a statewide healthcare system it went broke so they trashed the program.

President Obama is a fraud. He doubled our deficit in 5 weeks FIVE WEEKS PEOPLE! WISE UP! the only jobs that will come from his Stimulas are government expansion jobs. I wish people would not be so shallow as to elect a president based on slanted media and "style" ... so sickening.

I'm an ANTI-SOCIAList. and proud of it. I lived in Europe for 4 years and people would come here for THE BEST MEDICINE THE WORLD HAS TO OFFER... we will lose QUALITY over Quantity. This is a fact. "

bill wrote on Mar 10, 2009 12:33 PM:

" I like to follow along here , What the heck does AHIP stand for?

Free markets never existed some body always controlled major aspects of them. the dream of Dr. patient direct negotiations with out government belies the fact that it is insurance companies that control the market.

Unregulated insurance conglomerates control pricing in the health care market. If doc wants to charge me 200 per visit for a full check up and basic lab work (ok so I am Low) and I only go once or twice a year that would be cool instead of 300 per month premium + copays would be cool.

it just don't work that way "

Ruff Limblog wrote on Mar 10, 2009 12:34 PM:

" Millions of Americans are not covered by any medical 'insurance' plan, public or private.

And as we write about it here on NVR, many millions more are finding out that unemployment is not enough to pay their COBRA payments, mortgage or rent, and still eat.

If that were the situation for Susie's Mom she'd have to go without the mammogram and the MRI and die of breast cancer, anyway.

SCHIP healthplans might save ininsured Susie right now, but there are still kids who need to be put under that umbrella.

My brother has a brain tumor and can not get medical 'insurance'. He is completely dependent on Medicare and Social Security Disability.

It's time we started talking about America's real healthcare problems like no insurance and junk insurance... and how to FIX it.

Susie and Susie's mom would do pretty well in Canada, Britain, France, Germany, Switzerland, and Japan too.

It's all well and good to spin sweet stories about folks the US system does cover.

However, it is dishonest to leave out the thousands who die because they are not covered.

~Ruff "

a teacher wrote on Mar 10, 2009 12:53 PM:

" "The free market gave us the MRI".

No, research at universities (often done with government funds) gave us the MRI, as well as inumerable other medical advances. "

Bauhausfan wrote on Mar 10, 2009 12:56 PM:

" "and if it is the envy of the world why are so many Americans traveling to other countries, India for example for surgeries they cannot afford here in the US....medical tourism is a growing business "

We have some of the top medical facilities in the world, if you can afford them. Of course there are great medical facilities all over the planet.

Medical tourism and dental as well is growing for the same reason. It is too expensive here to have things done or the insurance company beuracrat won't allow you to have it. "

a teacher wrote on Mar 10, 2009 1:02 PM:

" I have news for you MR4, medical research happens everywhere in the world, not just here in the USA. Lancet Oncology did a study of survival rates for cancer in 31 countries. They found comparable rates of survival for Breast and colon cancer in North America (that's the USA, Canada and Mexico), Australia and Northern Europe. The only significant defference was in Prostate Cancer survival rates which are significantly better in the USA.

However, the study also noted that the difference between white Americans And black Americans was also significant, by 7%. I would contend that supports what I've been saying. American medicine is the best money can buy. Too bad for you if you don't have the money... "

Mr4 wrote on Mar 10, 2009 5:01 PM:

" Teacher,

I have been involved with MR since 1982. At the time it was called NMR, not MRI. The best and the brightest scientists from all over the world have continuously streamed into the United States to get involved with this and other medical technologies.

Ask any physician or scientist from Great Britain, Germany or Canada and they will all be familiar with the "Brain Drain" suffered when they lost their best scientists to United States healthcare institutions.

And I can assure you it has been private investment that has brought the technology to the little Susies of the world. Academic Medicine plays a key role in much of the development, and sometimes there is some government funding. But far more often it is industrial support for academia that makes it happen.

Read about the pioneers - Fonar, Diasonics, Technicare, Elscint, Picker International, Resonex, Hitachi, Shimadzu, Philips, Siemens and General Electric. International true, but none run by a government.

And as for international research, of course other countries participate. But they are using technology developed here!

Bauhausfan: Good luck with that Indian acupuncture! "

Mr4 wrote on Mar 10, 2009 5:37 PM:

" You want a truly exceptional doctor?

Might I suggest Pratik Mukherjee, M.D., PhD, genius whiz-kid in the Neuroradiology Department at UCSF.

Bauhausfan, here's a clue: He wasn't born in Kansas. "

irishirene wrote on Mar 10, 2009 6:36 PM:

" I have one simple question.

If the government provides health insurance to an additional 48 million people, where will the doctors, nurses and hospitals come from? "

Mr4 wrote on Mar 10, 2009 6:40 PM:

" By the way, Massachusetts Senator Kennedy had his brain tumor diagnosed and treated at Duke University in North Carolina. I guess Harvard/ Mass General wasn't good enough.

And Justice Ginsburg, a Washington DC resident, had her pancreas treated at New York's Memorial Sloan-Kettering.

You see, choice even works for democrats! "

Bauhausfan wrote on Mar 10, 2009 7:28 PM:

" "You want a truly exceptional doctor?

Might I suggest Pratik Mukherjee, M.D., PhD, genius whiz-kid in the Neuroradiology Department at UCSF.

Bauhausfan, here's a clue: He wasn't born in Kansas. "

I am sure he is great. One question: Let's say you wanted to go see the good doctor, but your insurance company won't authorize it, and you are not wealthy.

What do you do? "

Bauhausfan wrote on Mar 10, 2009 7:30 PM:

" Just an observation: It seems to me, at least, like many of the people against insuring everyone in this country have never been without health insurance. I have, many times, and it is scary. "

Bauhausfan wrote on Mar 10, 2009 7:32 PM:

" Here's an idea for the NVR: Why not hold a community forum on the subject of healthcare reform and invite our congressman Mike Thompson to attend. I suspect there would be a large turnout and spirited debate. "

Mr4 wrote on Mar 10, 2009 7:54 PM:

" Bauhausfan: "if you can afford it"

Ever heard of St Jude Children's Research Hospital?

http://www.stjude.org

Cutting edge in every way - no treatment is ever changed due to a patient's ability to pay.

Funded by private endowment - that is until Obama eliminates the charitable contribution deduction! "

a teacher wrote on Mar 10, 2009 8:21 PM:

" "Read about the pioneers - Fonar, Diasonics, Technicare, Elscint, Picker International, Resonex, Hitachi, Shimadzu, Philips, Siemens and General Electric. International true, but none run by a government."

Wow! How selective of you. You forgot to mention Paul Latauber and Sir Peter Mansfield who pioneered the theory behind the MRI at universities. Jonas Salk invented the Polio Vaccine at the University of Pittsburgh. In fact, prior to the 80s and 90's, most of the research in medicine came out of universities and much still does.

But I know, the free market works, except when it doesn't...

As for Sen Kennedy, how fortunate is he that he can afford to go where ever he needs to. Money does that. "

Mr4 wrote on Mar 10, 2009 8:35 PM:

" Bauhausfan:

I am simpathetic to those without insurance I really am.

But it costs a tremendous amount of money to achieve that end.

If we erroneously adopt a system that makes healthcare LESS efficient rather than more efficient, the costs multiply.

I have seen government's effect on healthcare. It is unbelievably wasteful! I can give you hundreds of examples. And it is not because individuals in government are bad people. To the contrary, they genuinely mean well.

But there is no way you can use a governmental process to make the system work. There are millions of instantaneous decisions that must be made every day in order to achieve efficiency. The free market can do this. Bureaucracy cannot. "

Mr4 wrote on Mar 10, 2009 8:51 PM:

" Latauber is credited with applying CT image reconstruction techniques to the NMR phenomenon.

Mansfield developed Echo Planar imaging techniques - a small but important subset of MRI image reconstruction.

Neither one of them ever built a machine that was used for clinical diagnosis.

Damadian came up with the idea of using the NMR phenomenon to detect cancer in the human body. He founded his own company (FONAR) and scanned the first human being. By leaving academia he was disqualified from receiving the Nobel prize. But he founded the industry that saved little Susie. "

steph wrote on Mar 10, 2009 9:20 PM:

" teacher--fascinating article: "Culture, Black Men, and Prostate Cancer: What Is Reality?"

This study is easy to read and interesting and attempts to examine why black men are dying at twice the rate of non-Hispanic whites of prostate cancer, without jumping to one conclusion or the other.
The point is to try to bring culturally sensitive care to all Americans. "

vocal-de-local wrote on Mar 10, 2009 9:35 PM:

" Mr4, what about little "poor" or little "underinsured" suzie? Your assumption about little suzie is that she has resourceful parents who know where to seek the best medical care, or that she is under the care of a very resourceful physician who is willing to send little suzie to larger teaching hospitals for care.

If every uninsured parent of a little suzie took your advice, St. Jude's would go out of business. You're also assuming little suzie's parents can afford to transport her to St Jude's and that they are able to pay for their longterm lodging while suzie is being treated.

It sounds to me like you think our private sector is miraculously going to fix all of the ills of our uninsured. Be realistic.

There are layer upon layers of bureaucratic standards and hurdles serving the reimbursement (insurance) industry. We need to talk about their self interest. Sounds like "little suzie" is their invention. I look forward to seeing little suzie's face on their next PR ad. "

Mr4 wrote on Mar 10, 2009 10:36 PM:

" Vocal: Good points.

Locally we have Childrens' Hospital Oakland, Lucille Packard at Stanford, Valley Childrens in Fresno, Shriners at UC Davis and Childrens at UCSF. Indigent care all day long.

The private sector does not fix everything, but it provides all the advances and
innovation. Let's not kill it in the process of reform.

The insurance situation is a mess - too much to blog about here. "

Bauhausfan wrote on Mar 11, 2009 6:06 AM:

" "But there is no way you can use a governmental process to make the system work. There are millions of instantaneous decisions that must be made every day in order to achieve efficiency. The free market can do this. Bureaucracy cannot. "

I am not talking about the government making decisions (which are now made by corporations called insurance companies) I am talking about a single payer. So you don't have the situation described in my comment above where doctors are spending half their time dealing with so many different insurance companies trying to get things authorized.

Despite what you say, it will make things more efficient if doctors don't have to spend one minute of their time trying to work with those private corporations called insurance companies who are in business to make a profit. "

Bauhausfan wrote on Mar 11, 2009 6:09 AM:

" "I have one simple question.

If the government provides health insurance to an additional 48 million people, where will the doctors, nurses and hospitals come from? "

From the question I can guess a couple of things:

You have health insurance at this time.

You probably have not been without medical insurance.

I have a funny feeling if you were on of the uninsured or under insured you wouldn't even ask the question. "

Mr4 wrote on Mar 11, 2009 7:58 AM:

" "I am not talking about the government making decisions (which are now made by corporations called insurance companies) I am talking about a single payer. "

Please explain the difference. "

Broke wrote on Mar 11, 2009 10:15 AM:

" My insurance costs average 12 K a year for my wife and myself. Every year my Kaiser insurance has gone up 10% on average. It's depressing to say the least. My insurance for my cars, house etc goes up about the same. I don't beleive that the feds should pay for health care or should it be free. It should just be afforadable and thats up to the doctors, hospitals, and Pharms. There greed exceeds the norm. It's time to realize one thing here. This country is already broke. We print money 24/7 and spend it faster than that. What we need is a system that is good for every American. We all need to pay something for good health service but, lets not let the Gov run it. We have seen what comes of that.
Good Day "

vocal-de-local wrote on Mar 11, 2009 2:19 PM:

" Broke, the government already runs much of our healthcare system through Medicare and Medicaid. We're already paying for it, like it or not.

Medicare has some really well defined parameters from what I've noticed. I'm not old enough to be on Medicare but it's something I've studied. They've evolved over the years, attempting to streamline the process. They are fairly clear about what they are willing to cover. They do not cover everything and for this reason I believe people with resources will go elsewhere, or we will still have a free market for those who want to pay out of pocket.

Our 'for profit' insurance companies, on the other hand, are not always clear about their coverage. From what I understand, it's like a tennis match that gets played until one party or the other gives up and says "ok, you win". It's very costly every time the ball is thrown into a court. Medicare will play that game too but it doesn't last long because if the facility is doing their job correctly, any coverage issues are disclosed right away. Medicare requires a patient signature when Medicare is unwilling to cover a procedure, for example.

Medical coding is also very costly. Coders are trained to to maximize profits, to distribute things in such a way that the facility or physician gains the highest profit. Right now everything is purely about 'profit'.

We should ask ourselves if the care of our bodies should fall under the realm of 'profit'. There's a lot of greed coming from every direction. But we also must define our limits. Healthcare should not be entirely free. People cannot abuse their bodies their entire life and expect taxpayers to fix it for them. "

Broke wrote on Mar 11, 2009 5:03 PM:

" I do beleive that America is a great country. I don't beleive that our leaders are great leaders. I do think that president Obama will try to figure a way to help but, his success depends on many factors. I mean to be successful it has to be paid for with each and every American paying there share. No free rides till you reach medicare requirements. We cannot be disillusioned by political posturing. We have no money to pay for it. I realize Former Vice President D. Cheney said debt is ok. That was a well educated comment. George Bush sold us a package that some still can't figure out. They were a couple of shinning stars. We the Gov have a hard time running anything Iraq. Haliburton, are good examples of waste and poor planning. Its really very simple we can't just keep on printing money. If China calls it's loans due were are done as we know America. "

Raven wrote on Mar 11, 2009 10:53 PM:

" interesting report that came out today from the Business Roundtable as reported by AP....

Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

In a different twist, the report took those costs and factored benefits into the equation.

It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point "value" scale. That hasn't been done before, the authors said.

The results are not encouraging.

The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S. "

Mr4 wrote on Mar 12, 2009 9:54 AM:

" Raven,

We do spend too much. So let's cut out the waste rather than add to it.

In California there is an organization called OSHPD - Office of Statewide Health Planning and Development. Most wasteful organization I have ever seen!

This government 'do good' group was set up to oversee hospital construction so that we are safe in earthquakes - a noble goal.

In practice it is a joke - let me give you a real example:

Lucille Packard Childrens Hospital wanted to upgrade its CT scanner. The manufacturer built a new scanner that would fit in the exact same bolt holes as the old one and use the exact same electrical connections- just the inside guts were changed. The construction cost to make the change was zero. The manufacturer did the changeout in two days.

But in order to pass OSHPD Stanford had to hire architects, structural, mechanical, electrical and environmental engineers in order to prepare the permit. The cost came out to $300,000!

Real story. And if you talk to the CEO of any hospital in this state and mention OSHPD you will first see his/her face go white with fear, and then they will tell you their own OSHPD horror story.

And if they dare complain, OSHPD comes down hard on them in retaliation.

This is but one small example of government in healthcare. "

Raven wrote on Mar 12, 2009 12:22 PM:

" That is not an example of govt in health care.... that is an example of govt doing what it's job is .. making sure structures are safe and to the latest codes...do you really want people in buildings that were not designed to withstand a quake?..where patients cannot escape by themselves?....and I notice you don't source your information..where did you obtain it?

and that is the only comment you have about the business roundtable's report "

Mr4 wrote on Mar 12, 2009 6:56 PM:

" Raven,

Are you listening to yourself? $300,000 to analyze the placement of four bolts is an example of the government doing it's job?

Alaska has stricter earthquake building codes than California - and bigger earthquakes. When Providence Alaska Hospital in Anchorage changed out the identical CT scanners the cost was $0.

If I am in a hospital during an earthquake the first thing I would do is jump into an MR scanner. With tons of reinforced steel around me I think I would be safe. My second choice would be the CT scanner.

Like I said, that is just one example. At Queen of the Valley inpatients are actually wheeled outside of the hospital if they need an MRI or PET scan. They are rolled over to the Napa Valley Imaging Center across the lot. Wonder why that is? The hospital had to get around OSHPD - you see, outpatient imaging centers are exempt from the regulation. They are bolted to the floor exactly the same, just no added bureaucratic fees. "

Mr4 wrote on Mar 12, 2009 6:59 PM:

" Source: first hand involvement in the project. "

anticommie wrote on Mar 12, 2009 7:24 PM:

" Nationalized Healthcare = Government intervention

Plain and simple, really.

The left loves the government these days there is no doubt about it.

To those that believe that socialism and communism dont exist in this country, one only needs to glance at the White House these days, oh, and the DNC. "

vocal-de-local wrote on Mar 12, 2009 8:46 PM:

" Mr4, I hear what you're saying about government bureaucracy. But I've also noticed non government bureaucracy in healthcare. There are so many standards upon standards governing every little move clinicians or staff make. You can hardly walk across a floor anymore without having to decipher a manual. Part of this is a result of HIPAA, specifically the protection of electronic data. But some of these invented standards and regulatory agencies (non government and government) overlap to the point where it seems that those who invented them were trying to find a niche for themselves. It deduces down to personal gratification and greed. The entire industry is poorly organized. Just take a look at the vendor situation!

Also, today I received a Medicare Summary for my aunt. In a nutshell, here's the problem. She rented a lightweight wheelchair which she needed. I could probably purchase this wheelchair online for $400, at the most. Medicare's COST for monthly rental is $47 a month, no kidding. My aunts secondary insurance kicked in the additional $12 a month.

I do agree, our government is not running our healthcare system with the intentions of saving taxpayer money. What do they care. And yet all sorts of people are profiting from Medicare, the medical supply place for example. In fact, I'd venture to guess that our tax money supports a HUGE economy which we are unaware of. Are we ok if taxes are funneled through Medicare to support medical supply companies? So, I do hear you. But I still think that if there's a will, there's a way to make National Healthcare work. I just wish we could throw everything away and completely start over. "

Mr4 wrote on Mar 12, 2009 9:21 PM:

" Vocal:

You are absolutely correct in noting that the healthcare delivery system is broken. There are all kinds of absurd behaviors that seem to come out of nowhere.

As I stated in my original blog above, I believe that healthcare is disfunctional because the market is not allowed to operate. Patient and provider (buyer and seller) are separated by employer, insurance company and government intermediaries.

HIPAA (Health Insurance Portability and Accountability Act) is a perfect example of government waste. This act was passed to prevent insurance companies from denying coverage to patients with pre-existing conditions. If you think about, HIPAA should mean that the privacy of patient records no longer matters - insurance companies should be banned from denying coverage. But when the regulatory agencies went to implement the legislation, they created an enormously expensive and draconian system to insure the privacy of patient records - and in the process, did not stop insurance companies from cherry-picking patients! Almost exactly the opposite of the intent of the original legislation!

My main concern is that today's populist congress and administration think that they can fix the problem by adding a huge additional layer of legislation and subsequent administrative regulation. In my opinion that would be akin to spraying a heavy perfume over a rotting corpse. I don't see how it could solve the problem. "

Raven wrote on Mar 12, 2009 10:47 PM:

" I think of a couple things...1) the building was out of code to start with 2) it was more than 4 bolts and 3) the hospital was ripped off by the people they hired to do the work.

That said, I still want the hospitals made safe in the event of an earthquake, so I will settle for some govt 'interference.' "

vocal-de-local wrote on Mar 12, 2009 10:49 PM:

" Well, one thing is certain. If they create a hybrid plan which incorporates the existing system with a new one, you're right, we will have huge, 'additional' layers of administrative regulations. It will NOT work. We need to start from scratch, not move into it impulsively, or haphazardly creating a new system on top of an old one. The system will take years of planning before it can be implemented. And we will need to figure out how to deal with all of the employees and all of the healthcare businesses who are enabled by the existing system. "

Bauhausfan wrote on Mar 13, 2009 6:09 AM:

" You know what my favorite thing is about people, especially those of the right wing conservative persuasion, who rave about how bad government is and how bad bureaucracy is and we can't let them get involved in lowering healthcare costs, they never mention certain government agencies:

The Army
The Navy
The Air Force
The Marines
The CIA
The Pentagon
The FBI
The NSA
The Department Of Homeland Security

I have always loved it when I see a commercial airing on tv from the top 4 on my list and it says paid for by...... as if they went out and got the funding by holding bake sales or something. These are some of most wasteful government agencies in the history of the planet and yet you never hear a peep from the right wing. "

Mr4 wrote on Mar 13, 2009 8:23 AM:

" Raven: Why let the facts get in the way when you can just make up your own.

Bauhausfan: OK: I am sure there is plenty of waste in every one of the organizations you name. There is always enormous waste in any governmental action - I have never seen an efficient bureaucracy.

But outside of the waste I see at VA Medical Centers I have no first hand knowledge, so I won't bore you with made-up stuff. "

Mr4 wrote on Mar 13, 2009 9:59 AM:

" I am of the capitalist persuasion and I agree that there is huge waste in every department that you list. And every "right winger" or "conservative" I know agrees.

But how does that relate to Health Care reform? In military matters it is difficult to insert free market alternatives. In Health Care it is easy. "

steph wrote on Mar 13, 2009 1:33 PM:

" To addresss Ruff's question about dreaming of a better system, I'm afraid I can't provide a more thoughtful answer. I'm still researching. The subject fascinates me.
The problem is, every system I research has major flaws, including ours. All over the world, healthcare systems are going broke, and demands made upon those systems are increasing, utilization-wise, and resource-wise (money). Many residents of countries that share healthcare costs among all have serious complaints about rationing and poor quality. These issues cause me great concern. I realize I am lucky to have options for healthcare. I also, like most Americans, have been responsible in making this a priority for myself and my family. When I was a student/mother living at poverty level, I bought a healthcare plan for my child, to hedge against disaster, and to make sure my son got the care he needed. (I did go into temporary debt to do so.)
Many countries value equality over personal choice or excellence, and so we are culturally different in some ways. I think we have serious cultural issues here in this country with poverty and its perpetuation. We offer free education to all in this country, and many throw that opportunity away, likely as a result of being poor, and we see that poverty begets poverty.
You see, being poor is not only about having no money. It's often about making lifestyle choices that make it difficult to help oneself from leaving that status--diet, exercise, education, drug/alcohol use, smoking. And the rest of us are asked to take responsibility for those who have not done so. I'm afraid this leads to options for people to be less responsible and more dependent. "

steph wrote on Mar 13, 2009 1:51 PM:

" When people are allowed to discharge their healthcare debts, we as a society pay for that. When people use our systems without paying for them, we as a society pay for that (those of us who pay anything into society, of course.) When people stay on welfare systems, including disability because they fear losing healthcare coverage, we as a society pay for that. When sick children can't see a doctor or adults wait too long for appropriate healthcare, we pay for that, too.

We also pay for the poor choices of others, unfortunately, and their irresponsibility.

In a perfect world, everyone would contribute something to a productive society and our economy would thrive and support all the best services we need--like good education and yes, maybe even healthcare.

There are systems here in the US that do an excellent job of caring for people's health (even people who don't care for their own health--but they try and try to get people to change); these systems are very expensive, and I'm not certain that Americans are willing to pay the costs associated with providing that level of care for everyone here in the country.

I strenuously object to these soundbite arguments from people who, without researching the costs--financial or quality-wise--argue that all other systems provide a simple panacea for our healthcare woes, if only the greedy evil people would step out of the way of progress. You need to know a little something about healthcare, its consumers, its regulators, its costs, its providers, before making such superficial arguments.
Every country is facing difficult choices right now about how best to direct healthcare resources, and there are no such easy solutions. Why duplicate the same problems here? "

Bill wrote on Mar 13, 2009 2:55 PM:

" If we could all be of one mind of exactly what we mean by health care it would be an easy process to evaluate. We are not all of the same mind and we all will not accept anyone’s slant unless it fits our own special view and that is the struggle.

That we as a nation should have some form of access by all citizens to more than merely adequate health care should be the supposition from which to begin any analysis or discussion. Currently we have to many citizens receiving no health care and many citizens receiving poor health care and many who pay for health care receive inadequate health care.

The inequities in the current system are rampant and in far too many instances all too obvious, to list in this thread. Other systems also exhibit great flaws. The choice is to continue with a system that is rapidly degenerating or to seek a better way. We do not have to adopt any other countries form but create our own hopefully learning from their mistakes.

We will not create a system of Mayo hospitals across the country but perhaps we should consider a system, which fosters smaller clinics in more areas accessible to all citizens. We should not seek to cure everyone’s disease or infirmity but allow treatment for as many of the greater maladies that beset us. Its form will not be easily attained nor will it be perfect but the attempt to build it must be made. "

Mr4 wrote on Mar 13, 2009 6:49 PM:

" There is no reason that we cannot all have Mayo quality healthcare or better. We just have to remove the waste and keep the incentives to excel.

But the current nanny-state government is not capable of pulling it off. In fact, it will take our very best efforts over the next few years to keep this government from ruining what we now possess.

To think for a moment that we have to settle for less represents defeatism that is not worthy of this great country. "

vocal-de-local wrote on Mar 14, 2009 12:01 AM:

" Mr4, one person's concept of waste is another person's livelihood. I'm not sure we can all have Mayo quality medical care. There are too many people trying to milk the system for that. What we need is a sense of collective community, a willingness to equally contribute to the system.

Instead, what we have are small groups of untouchable, super wealthy at one end and a significantly larger group of people who put much of their efforts into taking advantage of government's generosity at the other end. This may be too much a part of human nature to actually control without substantial intervention. Collectivism is the only way we can all have equal access to Mayo Quality Healthcare. I'm not sure we can reach it without becoming the types of governments we detest. "

Mr4 wrote on Mar 14, 2009 7:32 AM:

" Tried before: It was called the Soviet Union. How did that work out? "

anticommie wrote on Mar 14, 2009 8:04 PM:

" Bauhausfan wrote on Mar 13, 2009 6:09 AM:

" You know what my favorite thing is about people, especially those of the right wing conservative persuasion, who rave about how bad government is and how bad bureaucracy is and we can't let them get involved in lowering healthcare costs, they never mention certain government agencies:

The Army
The Navy
The Air Force
The Marines
The CIA
The Pentagon
The FBI
The NSA
The Department Of Homeland Security"

The problem with this argument is that all of the agencies that you mention are essential in protecting the individuals and interests of the nation from inside and outside enemies. Something the average citizen cannot attempt to do on our own. Healthcare IS something that we can take care of without the government doing it for us. You should thank your lucky stars for the US Military and thank every person that serves and has served in it; including the individuals on this site, like Raven. "

vocal-de-local wrote on Mar 15, 2009 12:35 AM:

" Exactly my point Mr4. Preaching the "we can all have Mayo quality healthcare" is unrealistic without being under a different type of government altogether. "

Mr4 wrote on Mar 15, 2009 9:17 PM:

" The quality of care at Queen of the Valley Hospital today far exceeds that of the Mayo clinic only a few years ago. Medicine and technology continues to advance and will keep doing so unless stifled by government.

We take too many things for granted. It wasn't long ago that terms such as "exploratory surgery", "inoperable tumor", "cracked chest", and "crippled child" were common. The only thing a different type of government will bring us is an end to the advance of medicine. "

Raven wrote on Mar 16, 2009 10:45 AM:

" MR4...much of your vaunted medical progress is funded by that stifling government "

Mr4 wrote on Mar 16, 2009 1:55 PM:

" Raven: You are right. Imagine how exceptional is could have been today were it truly free to grow! "

Raven wrote on Mar 16, 2009 5:14 PM:

" the same way the financial industry worked when it was free of govt regulation, or should I say interference? "

Mr4 wrote on Mar 16, 2009 7:33 PM:

" Exactly. If only it had been free.

If Fannie and Freddie had not meddled in our mortgage market we would have trillions of dollars in wealth that could further improve our healthcare system today. "

steph wrote on Mar 16, 2009 8:49 PM:

" And, if only the regulators who collect taxpayer dollars at the SEC and OTS had done their jobs instead of doing nothing about Madoff and AIG.
There were government bureaucrats, but as usual, they were asleep at the wheel.
Making the big bucks for doing nothing constructive at all. "

Raven wrote on Mar 16, 2009 10:36 PM:

" LOL...the markets were freer from govt regulation than they had been in decades...should they have been completely unregulated? "

steph wrote on Mar 17, 2009 6:41 AM:

" Apparently, they were completely unregulated.
Oh, I'm sure there was all sorts of paperwork filed, and junkets made to various offices around the world, and lunches and dinners, but nobody was doing their job in these regulatory bodies. "

Ruff Limblog wrote on Mar 17, 2009 4:06 PM:

" OUR government spends hundreds of millions of dollars on medical advances.

The CDC, NIH and the other alphabet of government agencies have been around for a long time and...

still... somehow...

Our medical system has made advances.

The biggest problem is that MILLIONS of Americans can not afford to get that care.

I'm not sure why who writes the check would affect the quality of care at privately-delivered facilities.

Except for the BETTER when folks who can't afford care would have access.

~Ruff "

Mr4 wrote on Mar 17, 2009 4:40 PM:

" Ruff,

And yet all the good stuff comes from private industry.

Maybe if government hadn't been so "helpful" we wouldn't be dealing with conditions like paralysis, dementia, autism, etc. today.

Of course there is no way to know how good it could have been, but it is a certainty that if we let government run the program from now on we will miss out on future medical marvels.

As to access to healthcare you are simply wrong. I see hospitals every day and I see high-quality indigent care being provided everywhere.

But there are plenty of people driving nice cars and watching flat screen TVs who constantly whine about the cost of healthcare believing that they are entitled to the best, even if their working neighbors are forced to pay for it. "

Mr4 wrote on Mar 17, 2009 10:04 PM:

" Let me give you a glimpse of the real world out there. The following is a commercial email I received this evening regarding the stimulus bill:

"Under the American Recovery and Reinvestment Act of 2009, the National Center for Research Resources (NCRR), which is part of the NIH, plans to disburse $300 million for shared instrumentation and other capital research equipment and also $1 billion to construct, repair or renovate research facilities. In the words of the NCRR, “The availability of renovated facilities and the next generation of instruments will speed the translation of basic research to treatments and cures. These purchases and renovations also will stimulate the economy. It is expected that these awards will create or maintain jobs in America”.

There are two programs for equipment that might appeal to our research customers.

1. High-End Instrumentation Grant (HEI):

The purpose is to purchase a single major item of equipment to be used for biomedical research that costs at least $600K and up to $8 million - ie a new MR system or a major upgrade. NCRR intends to commit approximately $160 million in FY2010 to fund approximately 40 new awards. Letters of Intent are due on April 6, 2009. Applications are due on May 6, 2009. The earliest anticipated start date is December 2009."

Wow! The government is throwing a bunch of money out there trying to create a feeding frenzy.

While commercial vendors and researchers will no doubt come up with proposals to spend the money, there is no natural demand for this. This is spending money for the sake of spending money. At the end of the day it will be a complete waste of funds. "

Ruff Limblog wrote on Mar 18, 2009 9:53 AM:

" In one post, some folks advocating for 'More of the Same' in healthcare access infer that things such as MRIs will not be available if privately-delivered, government-funded healthcare is available to all Americans.

In another post, a messge is presented showing the government is planning on making MRI equipment available to more medical facilities.

Which is it? More MRIs or Less MRIs?

Privately-delivered, publicly-funded healthcare access doesn't mean 'The Sky is Falling'.

It means everybody gets healthcare without having to skip meals or declare bankruptcy over medical bills which happens at least once per minute in America.

There are a LOT more folks who will benefit from better healthcare access while I suspect that $Billion dollar paydays for healthcare denial CEOs will become a thing of the past.

~Ruff "

steph wrote on Mar 18, 2009 12:35 PM:

" Ruff, your beloved government officials want to go trillions into (more) debt, and some of this money might be used to fund a few MRI machines.
So, how often do you expect that to happen?

Just look at statistics around the world at who has the most MRI per capita, and there's your answer.

Unless you believe the government is going to be able to continue to convince the Chinese to furnish the American people with more debt with which to "buy" more MRI?

I agree with you that $8billion (or whatever, I can't find that amount anywhere) is too much for a healthcare CEO to make. I want to read more--can you find me a link? "

Mr4 wrote on Mar 18, 2009 6:09 PM:

" Ruff,

You misunderstand NIH. This expenditure does not add to clinical patient care. A scanner purchased under this program will go so some researcher - but research scanners are specifically restricted by the FDA from scanning regular patients.

Whole bunch of money blown. Nothing for little Susie. "

Ruff Limblog wrote on Mar 19, 2009 8:27 AM:

" So you are grumbling that there's too much government money being spent on medical research?

If that is the case, then we should be asking for the law to be changed to allow MRIs for hospitals and clinical use in addition to medical research.

Either way, you still undermine your own position.

The FED is now buying US-Treasuries which means we are borrowing the money from ourselves again.

In WWII, the government, with the assistance of Hollywood and local activists sold millions of 'war bonds' to sop up the extra money being spent on weaponry, since there were wage and price controls as well as rationing.

The American people's saving rate has been raised and the FED is supporting government efforts to keep the economy from coninuing to contract and collapse.

I'd consider money spent on medical equipment to be a good investment if even one of twenty MRI machines resulted in medical advances.

Much better than spending the amount required to buy an MRI machine to blow a single hole in the sand of some desert country.

~Ruff "

Mr4 wrote on Mar 19, 2009 6:13 PM:

" This is where the libs show their colors.

In this case, while I may personally benefit from this government givaway program, I am completely opposed to it because I know that it is a waste of taxpayer money - ultimately my money.

Merely throwing dollars at a research project does not make it noble. Research should be carefully planned to achieve an objective. It could be a basic sciences objective or it could ultimately be a commercial objective, but a cost/benefit analysis should carefully be made before making an investment decision. Only then could you hope to achieve an efficient allocation of resources.

In the present case, the government merely blurts out that it is going to spend X dollars and you have by April 6 to issue a letter of intent. That is absurd, and it results in a horrible waste of resources that could otherwise have been spent on better projects. Typical socialist spending of other people's money. Waste doesn't matter as long as the spenders think they are doing good deeds.

Private industry does infinitely better because they demand results for their investment - even if is is in basic research.

The lib take on projects like this is to forget principles, simply count the money, and see how much of the booty they can get for themselves.

And they call the conservatives greedy! "

steph wrote on Mar 19, 2009 11:46 PM:

" Ruff--

Whosyer billionaire insurance executive? I can't find him anywhere. You like to mention this guy, but never by name. Who is he? "

Ruff Limblog wrote on Mar 23, 2009 9:41 AM:

" Mr4-

Modern 'for-profit' corporate Pharma has no interest in cures, they search for treatments.

There is 'no money' in a $20 shot that cures, say, cancer or malaria and makes the recipient immune after that.

All the money is in treatments, "my friend".

Most of the vaccines and 'cures' nowadays come from non-profit and government funded research.

And... the idea that corporations can plan to get results from research is bunkum.

Research by definition is looking for the unknown. Nobody can 'plan' for when they will discover something at the edge of scientific knowledge because nobody knows how far the current 'edge' must be pushed to make the discovery.

Nobody can predict what will come from research and often breakthroughs come from 'mistakes' or somebody who sees something and says "That's Odd!"

That is how we got penecillin.

Corporations are all about wringing maximum profit with minimum inputs and have been ever since GM sued Henry Ford because they thought that he paid his workers too much.

Rational people do not need to make human legal fictions into more than what they are. Corporations hire PR firms for that.

~Ruff "

Ruff Limblog wrote on Mar 23, 2009 5:11 PM:

" steph- I'm sorry but inexplicably, my answer to you including a working google and a working link did not make it through moderation.

Sorry... however try googling "unitedhealth ceo McGuire billion"

You should find several returns that discuss the stockholder suit by CALPERS, and the huge settlements.

Corporations spend big money on PR trying to convince citizens that they are benevolent protectors of the sick when the actual results are far from protecting anything but the bottom line and raising management salaries and perks.

Medical researchers can only dream wistfully of having research budgets as big as CEO stock options.

~Ruff "

Mr4 wrote on Mar 23, 2009 7:58 PM:

" Oohh, Evil Pharma!

There's a good target for the demagogues!

Tell you what. Name a mid-to large Pharma company and I'll give you stories about lives saved and significantly improved.. I'll also give you stories about millions of dollars spent on drug research that ultimately ended in dead-end. Next, I'll show you how government has added tens of millions of dollars to the drug discovery process. Finally, I will tell you about massive tort lawsuits caused by a rare reaction to an otherwise life-saving drug.

And what government agency was it that produced clinically available penicillin?

I think I will plug my ears, blindfold myself and wander off to "discover" something. Can you send me some money? "

Join the conversation

*Member ID:
*Password:
Remember login? (requires cookies)
	Forgot Your Password?

Create an account

Comment Guidelines

The goal of the story comments section at NapaValleyRegister.com is to have an open, thought-provoking, civil community forum for all issues.

What gets your comment posted?

• Staying on topic

• Keeping your comment to 300 words or less

• Avoiding name-calling

• Addressing your comments to the message rather than the messenger

What gets your comment deleted?

• Personal attacks

• Derogatory remarks

• Name-calling of any sort

• Going off-topic

• Hate speech

• Racially-insensitive comments

• Implying guilt of a subject in a crime story before there is a court verdict

• Posting e-mail addresses

• Posting comments of a commercial nature

• POSTING WITH ALL CAPITAL LETTERS

• Linking multiple comments together with "to be continued..." to get around the 300 word limit.

The fine print

- Comments are either approved or denied. We do not edit comments.

- You are welcome to modify and resubmit a denied comment.

- Comments may take several hours to be posted.

- Comments posted are those of the writer, and do not necessarily reflect the opinion of NapaValleyRegister.com, its employees or its parent company.

- Do you have information on a story? Please go to our virtual newsroom to send us a news tip.

- If you feel a posted comment has violated our guidelines, please contact online@napanews.com or add a comment indicating you have an issue and our moderators will review the comment in question.

Search: