National Health Care Questions

[caryalsobrook]

so many valid questions as the result of my post and that is good. I'll take the numerous questions asked by sinner first and go from there.
1. Support by health care providers of a single payor system. Neither you nor I have actual statistics on this issue, only our perceptions of the numbers. I would suggest that those healthcare providers who work for the government or teach at an institution of higher learning, or work for a salary would have a higher percentage of support for a single payor system. you also may see a higher percentage of those who practice in so large a group practice that they have turned all of the business aspects of private practice over to a practice manager but these would still be less that those on salary or in government work. those in smaller groups or in solo private practice would give far less suport for such a system. My perception is that only those who work for the government would support such a system by a majority. I have no proof and freely admit it but I will contend that you have no proof that a majority support it either.
2. Concerning German support of their system, I am a dentist and have personally treated a West German who visited this country for a summer and wished to get her dental work done here(which was quite substantial) and willing to pay for it so long as it could be completed during the summer. I asked her why she did not get it done in West Germany since they had socialized medicine. Her response was "You don't understand. The level of care is controlled by the government and I am not satisfied with that level. I can not pay for it here since the government will not allow the doctors to perform the services I want and allow me to pay for it. I am willing to pay for it and I am allowed to do that in this country." If you look back at my orriginal post, those who have little need for care like the system and those who either require or want a higher level of care dictated by the government do not like the system.
3. Cherry Picking- I did not cherry pick, I only responded concerning countries that I had knowledge of. If you have knowledge of other countries that are different than those I refferenced then so speak. I specifically would emphasize Canada because it has been bought up many times as the ideal model for a single payor system and enjoys a close proxicimity to us. My statements are accurate concerning the countries and challenge you to prove them wrong.
4. Working for the insurance company- I HAVE NOT EVER WORKED FOR AN INSURANCE COMPANY IN ANY WAY SHAPE OR FORM. There is no law or requirement that makes me do so. If any provider works for an insurance company, is their choice and theirs only. Market conditions may make them FEEL like they have to BUT THEY DO NOT HAVE TO.
5. Sale of drugs- I think you asnwered your own question so I will quote you "law governing the sale of drugs" If you don't like the law governing the sale of drugs then why do you advocate a single payor system forbibbing the sale of healthcare??
6. Medical profession part of the problem- If you read my post you will see that I specifically criticised the healthcare profession for charging for their services as if it were a used car lot. I stated that if the profession would say "hell no, my fees are the lowest I will accept and are market driven and charged the same no matter who received the care, then we all that pay would be better off"

When I graduated from dental school, I spent about 1 1/2 years working as an independent contractor(I don't know how else to put it unless call it self employed) until I could buy the land and build my office. After that I was in solo practice from then on. That is my background and the vantage point I see the problem. What is yours.

One question for you. It is simple and can be answered with a simple YES or NO. Are you willing to deny a patient's freedom to choose the level of care he or she desires and is willing to pay for it, and are you willing to deny a person who happens to be a health care provider the freedom to work for who he chooses? I'd like an answer.

[caryalsobrook]

This is from wikipedia on England's National Health Service.
Experiences, perceptions and reporting of the NHS
Although the NHS has a high level of popular public support within the country, the national press is often highly critical of it and this may have affected perceptions of the service within the country as a whole and outside. An independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received. Of hospital inpatients, 92% said they were satisfied with their treatment; 87% of GP users were satisfied with their GP; 87% of hospital outpatients were satisfied with the service they received; and 70% of Accident and Emergency department users reported being satisfied.[14] But when asked whether they agreed with the question "My local NHS is providing me with a good service” only 67% of those surveyed agreed with it, and only 51% agreed with the statement “The NHS is providing a good service.[14] The reason for this disparity between personal experience and overall perceptions is not clear. Similarly the survey also showed that net satisfaction with NHS services (the number reporting satisfied less those reporting dissatisfied) was generally higher amongst NHS services users than for all respondents (users as well as non-users). Where more people had no recent experience of that service, the difference in net positive perception reported by users compared to non users was more likely to diverge. For example, the least used service surveyed was walk in centres (only 15% of all persons surveyed had actually used an NHS Walk in clinic in the last year) but 85% of walk in clinic users were satisfied with the service they received. Users' net positive satisfaction was 80%. However, for all respondents (including non recent users) the overall net positive satisfaction was just 25%. The service with the highest rate of use was the GP service (77% having seen their GP in the last year) and the difference in net satisfaction between users and all users was the smallest (76% and 74% net satisfied respectively) [14] It is also apparent from the survey that most people realize that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable).[14] Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).[14]
Most people think that the NHS is well run, with 73% of people reporting that they are satisfied with the running of the service and only a little over 10% reporting themselves as dissatisfied.[15]
It has often been said and agreed that any proposal to overturn the NHS and replace it with a private system like that of the US would not be accepted by the public. The public, although sometimes critical of the NHS would never let it be taken away.

If you read my post, I said that those who had little need for treatment, supported the system and those who had a greater need for the system (that being a single payor system) were opposed to it. The last I heard, England was broke and having protest because of the need to cut student funding and were next to riots due to the spiriling cost of food due to inflation(A clasic result of massive government deficit, sound familiar?) Furthermore, England once had a single payor system and has since created a 2 tiered system whereby one can chose to pay for their own care and choose the level they are willing to pay for. There is no doubt that once a country goes to such a system the difficulty of returning to a system more like ours is almost insurmountable. It may be only the total finantiol calapse of a country's finantial system is the only thing that returns a country to sanity.

I'll ask you the same question that I asked sinner. Would you deny a patient the freedom to choose the level of care they choose if they are willing to pay for it and would you deny the healthcare provider the freedom to sell his services to those who are willing to pay for it? Yes or no. You cannot have a single payor system otherwise.

[caryalsobrook]

I don't mean to bring up Bush, but something did come to light under his tenure. At least for me, maybe others saw it long ago, but...

It became apparent that BOTH mainstream political parties in America abandoned the concept of freedom and liberty. Under dems, it came disguised as "let us take care of you in exchange for more gov't regulations". (as you referred to) Under republicans, it came under "Let us keep you safe from all the terrorists that are out there in exchange for for privacy and civil rights concessions and tax breaks for the rich".

Under both regimes, the working class and middle class picked up the tab.

Here are some observations:

The deficit has skyrocketed under both republican and democratic administrations.
Our civil rights and privacies have eroded under both republican and democratic administrations.
The gap between CEOs and workers has grown under republican and democratic administrations.
The number of uninsured and impoverished people has increased under both parties.
The holdings of the richest people in the country and world has increased under both repubicans and democrats.

I don't see either party as a solution to our poor trajectory that we're on. I will credit Obama/Bush for averting a total banking collapse and depression, but then again, that had the multi-nationals' interests to bear also.

Nice to agree with a conservative once in a while. Not sure its ever been called a "compliment" before...

Have a good one.

Just to point out that I did not criticize an individual, nor party nor a specific administration. I only discussed policies.

[sinner]

so why are there many MDs, DOs, etc & other health care providers supporting a single payor system?
Also why has the German health insurance plan been well accepted by the citizens?
You are cherry picking! Change takes time. Now for all your experience how about your vision for a failing system?
Who are you working for now? I might suggest the insurance industry. ( by the way I am also a health care provider) How come many oncologist stopped or change their practices when the law governing the sale of chemo drugs was changed? (About 50% of them made changes or dropped out of their $600,000 dollar a yr. income because the change decreased their incomes to about $300,000).
The medical profession has been and will continue to be a major part of the problem!

Care to answer my question?

[caryalsobrook]

Care to answer my question?

I answered your question. But I will be blunt. I believe that there are FAR more healthcare providers, that being MD, OD, DDS, DMD, and optometrists that opposes single payor system that support it. My opinion is based on the fact that there are far more private practitioners than there government practitioners. I CANNOT prove it since there has been no such creditable poll done. For the same reason, YOU cannot prove that a majority supports such a system. Do you think that there is any way that I can be any more accurate?

Now YOU answer my question.

[dnf777]

Care to answer my question?

It was kind of a trick question. And along with Cary's answer, I agree, it is impossible to answer, as there are no good polls out there right now.

Over half of all healthcare dollars that exchange hands right now come from the gov't. About 5 years ago, gov't provided dollars surpassed private. Tricare is the largest HMO in the world, or at last glance it was anyway.

Cary: the only comment I would add about what percentage of providers support vs oppose single-payor........Is what percentage of providers UNDERSTAND single-payor systems?? What type of single payor? Gov't? Gov't via the conduit of private insurance?

Its impossible to give a straight answer, as its impossible to ask a straight question. Its a complicated beast.

[caryalsobrook]

It was kind of a trick question. And along with Cary's answer, I agree, it is impossible to answer, as there are no good polls out there right now.

Over half of all healthcare dollars that exchange hands right now come from the gov't. About 5 years ago, gov't provided dollars surpassed private. Tricare is the largest HMO in the world, or at last glance it was anyway.

Cary: the only comment I would add about what percentage of providers support vs oppose single-payor........Is what percentage of providers UNDERSTAND single-payor systems?? What type of single payor? Gov't? Gov't via the conduit of private insurance?

Its impossible to give a straight answer, as its impossible to ask a straight question. Its a complicated beast.

I offered to discuss healthcare with you in the past and you declined. Now look where you are And look how much we agree Now look at the title "SINGLE PAYOR" and look at the rest ot the countries around the world who have systems that fall into the category. I challenge you to show me one that differs from what I have said with the exception of England which is trying to get away from it.
Couldn't resist coudd you?

[dnf777]

I offered to discuss healthcare with you in the past and you declined. Now look where you are And look how much we agree Now look at the title "SINGLE PAYOR" and look at the rest ot the countries around the world who have systems that fall into the category. I challenge you to show me one that differs from what I have said with the exception of England which is trying to get away from it.
Couldn't resist coudd you?

I'll take your ribbing in the nature it was meant.

What I declined to discuss was a specific case of ethics, for entirely different reasons and as because of part of my responsibilities, I should not do so.

Any-hoo...

I'm surprised that more businesses haven't come out in support of single-payer. All those other countries that have SPHC, the employers are not burdened with providing health care, as they are here. I've hear that up to 25% of the price of a new American-built car goes to paying health benefits for the men and women on the line. (I'm sure someone with knowledge can correct me if I'm off)

while taxpayers would be asked to pick up the tab, it would unencumber business from health premiums, which could be reinvested in growth and employment.

Not saying good or bad, just odd that hasn't been discussed much.

[sinner]

I answered your question. But I will be blunt. I believe that there are FAR more healthcare providers, that being MD, OD, DDS, DMD, and optometrists that opposes single payor system that support it. My opinion is based on the fact that there are far more private practitioners than there government practitioners. I CANNOT prove it since there has been no such creditable poll done. For the same reason, YOU cannot prove that a majority supports such a system. Do you think that there is any way that I can be any more accurate?

Now YOU answer my question.

http://pnhp.org/ and http://www.npr.org/series/91971170/g...h-care-for-all
if you haven't looked at these it might be worth your time.
The problem is our curent culture will not support much change.
I studied this for 13 years. None are as bad as you state and none are as good as our government states.
Interesting the Germany system found that puting physicians on a budget made a difference in cost but little impact on outcomes.
Also are you familiar with such instrument as SF36. or SF12 or 8?
I have been an advocate that "we" get paid on our outcomes for 30+ years.
So far not much luck by the NCQA to move us in that direction.

[sinner]

I answered your question. But I will be blunt. I believe that there are FAR more healthcare providers, that being MD, OD, DDS, DMD, and optometrists that opposes single payor system that support it. My opinion is based on the fact that there are far more private practitioners than there government practitioners. I CANNOT prove it since there has been no such creditable poll done. For the same reason, YOU cannot prove that a majority supports such a system. Do you think that there is any way that I can be any more accurate?

Now YOU answer my question.

Opinion mine: this is the same gang that got us into this mess!
Would I deny care to some one who chose to pay for it them selves?
No but then would you deny the same quality of care to someone who could not pay for it?
How about a heart valve replacement that the bill was $125,000 for: self-pay or insurance or ?????.