The health care business is a business. Who shall perform operations and heal the sick? If you want trained, competent, professionals, don't they deserve compensation? Should we distribute medicine based on need? Whose need? Who determines? You may be able to force a doctor to work for free (or at a reduced rate), but I would hate to see the consequences. The health care business is a direct product of a system which looks to compensate the needy at the cost of the productive. Since doctor's must now negotiate payments with large health groups so they aren't seen as greedy, you get what you pay for (or don't pay for).

I have never once suggested that doctors be paid less, I have numerous times suggested that insurance companies are the problem. You haven't addressed that and instead you are attempting to twist my words and state that doctors should work for free. Take a look at the Insurance Industry Stocks on Yahoo Finance. There are only a handful of companies there that have less than 10% Return on Equity (ROE). That should tell you that these companies are making just a little bit of a profit. If you click on any of the companies and drill deeper into their history I'm sure you'll see that they are money making stocks.

Specifically if you want to look at the Aetna Profile you'll see the salaries and stock options for their officers in 2003. The CEO made a total of 17M Dollars. Hmmm, things must be bad in the insurance industry, no room to cut premiums at all. Take a look at the stock performance over the year: stock performance. They are clearly not a dog stock, money is being made hand over fist here.


Bucket, maybe my brain is just working a little slow today, but I am really trying to understand what you point with this story is. So far I haven't grasped it, and I'm not blaming you for that, but do you think you could try and articulate it in a different way? Clearly I have one understanding of it (and have responded based on that) and it is different than your understanding.

Actually you touched on a subject which worried me for a long time - the "commercialization" of Health Care. One of the things that bother me a great deal (any most of my family as well) is that when you call a doctor or a hospital to make an appointment, the first question they ask is not "What's the reason for your call?" but "What's your health insurance?" Now both of my grandmothers were in health care - one was an ophthalmologist and another was working in a lab - and both were not paid well at all (the system in USSR was set up that docotrs were paid just as much as any average citizen - as a matter of fact the jobs in health care were not prestigious at all). However, both were excellent physicians, both were highly regarded by their peers and patients - because both of them worked in the field not because of money or financial gain, but because they loved their job and they considered it their true calling in life, to heal people. Isn't it the very premise of the hippocratic oath which supposedly every graduating medical student around the Globe traditionally takes? I believe that compensation of doctors has nothing to do with quality of health care you receive in return - I have seen the same percentage of bad, disinterested physicians here in US as in Russia even though they get paid ten times more than their colleagues around the world. Why? Because you can not make a bad doctor better by paying him more.

[quote=Cube Jockey,Aug 2 2004, 04:59 PM] [/QUOTE]
I have never once suggested that doctors be paid less, I have numerous times suggested that insurance companies are the problem. You haven't addressed that and instead you are attempting to twist my words and state that doctors should work for free. Take a look at the Insurance Industry Stocks on Yahoo Finance. There are only a handful of companies there that have less than 10% Return on Equity (ROE). That should tell you that these companies are making just a little bit of a profit. If you click on any of the companies and drill deeper into their history I'm sure you'll see that they are money making stocks.

Specifically if you want to look at the Aetna Profile you'll see the salaries and stock options for their officers in 2003. The CEO made a total of 17M Dollars. Hmmm, things must be bad in the insurance industry, no room to cut premiums at all. Take a look at the stock performance over the year: stock performance. They are clearly not a dog stock, money is being made hand over fist here. [/quote]
You say you don't wish for doctor's to work for free and that you blame the greed of insurance companies. Let's examine this concept.

1. With a UHC system, doctor's compensation for services would have to be controlled. A central system would not allow itself to be at the whim of whatever costs doctors want to charge. No system operates in such a manner. If doctor's costs were not a concern, than most people would be able to afford them without government intervention. This is the central need that insurance companies fill. This is why insruance companies have negotiated with doctors on fees and payments. The difference is that doctors negotiate with insurance companies by mutual agreement.

2. If a doctor is forced, by government regulation, to accept payment for services it is tantamount to the use of force. We have in effect put doctors under a form of slave labor. Doctors will not be able to refuse patients who use government insurance. The system would not work otherwise. You, in fact, will take all control away from the doctor in terms of the use of his skills.

3. Since doctor's will work for less than their market value, we can consider that for many patients, they will actually be giving their product away. Forcing a doctor to work for %80 compensation means he is performing a free service for 2 out of ten patients. Remember, if it is something he negotiates with a private insurance carrier, the doctor has done this of his own free will. He is free to refuse the insurance companies terms. He will not likely to be free of the government's terms.

4. Statism is not static. We begin by moderate price controls and voluntary doctor participation in a government insurance plan possibly. People will continue to redefine need, since need is subjective. They will not only want doctors, they will want the same doctors as those who pay privately. Doctors who wish to earn fully from their production will only accept private clients. So, only the best doctors will work privately. To equalize matters, and gain more votes, the government will make it increasingly difficult to opt out of the government plan. It is also a matter of economics to saturate the pool with supply to bring down costs. Doctors who opt out of the pool lead to increased costs.

5. Statism versus individualism cannot be dealt with through compromise. Compromise will always lead to extemes and in this matter will always lead us to increased statism. For this reason, UHC is a terrible concept.

This is a myth, and there is no evidence to support it. If you'll look at any of the currently proposed plans for UHC such as Kucinich's plan you'll see that no where does it require the payment for doctors to be controlled.

Secondly, if you look at the real implementations of UHC such as in Canda, you'll see that this is in fact not the case. Basically you are ignoring the evidence (much of it posted in this thread) and advoctaing your view of UHC instead.

http://www.reclaimdemocracy.org/weekly_200...healthcare.html

You are simply wrong (Check out link above). In Canada, the state sets the fee rates which doctors can collect. Doctors in Canada make less than doctor's in America. While there are advantages and disadvantages in both systems, make no mistake, doctor's in Canada are not free. No state will write a blank check to cover whatever a doctor wishes to charge. By definition, some sort of scale would have to be set.

Therein lies some of our skepticism, UJ. Have you noticed what has been happening to the tuition and fees at these colleges and universities? Up, up, up--and all with no discernible increase in services offered. We are concerned there might be a similar phenomenon with UHC.



...thus providing further evidence for our skepticism that the cost of such a system (and therefore its tax burden on us) can be controlled. For if this is the case, then just exactly who is controlling costs?

There is a solution to this. The current system does contain a lot of waste. Uninsured still need care, and can get it when its life threatening. Insured people pay for this. Also, waiting until that time to get care is certainly not cost effective. So, there are some savings to be had. There just needs to be a system that captures those savings and redirects it towards insuring the uninsured. Personally, I think what Hillary's commission discovered is that this won't be nearly enough to cover all the costs. Unfortunately, that means higher taxes for those of us who do have insurance. So, we'd be paying more money for less services. And we're not too excited about that. Are there certain benefits we might be accruing (knowing that it could easily be us in the uninsured category). Yes. Would we be willing to pay something for that benefit? Yes. Are we concerned that that cost might be far more than we'd be willing to pay, so that we'd end up with less coverage for more money than the current system? Yes.

The math on this is really not in favor of UHC. One of the driving factors behind UHC is that there are a LOT of uninsured people out there. Well, it takes a LOT of money to provide health care to that many people. That money has to come from somewhere. Eliminating insurance companies creates its own set of issues. First, tell me exactly why you think the government would be able to do this more efficiently than private companies (goes against the very grain of capitalism). Second, even if they could, you've now provided UHC--but created a very large group of unemployed people. I doubt that's really the best path to take. So, you're left with capturing the excess burden put on the system by those without insurance, and using that savings to pay for the insurance. I think that has possibilities, but I haven't seen any plans that go that route, indicating it's either unworkable, or that political implications are making things go another route.

Tuition has been going up, in states that have been reducing their taxes or eliminating outstanding debt through spending cuts. This is not a reflection of rising costs, it is a shifting of burdens, and the 'blame' lays with the voters, not the system.



Ok, what is the solution. The only thing in your post that resembled a solution is...



That's vague, and you concede it can't work, so where is the solution?



By "we" who do you mean exactly? It's not doctors, or people who study UHC...



What math? You have provided none. What you have provided is a lot of conjecture and vague disparagements regarding the government's ability to manage; and that is the sum total of your argument as far as I can tell. You reach for isolated examples of where UHC has failed because of a poor implimentation and attribute those failings to the system, or you make broad statements like the one above.

You ask me why the government could do it more efficiently than private companies? Because governments all over the world DO handle it more efficiently. There is a large body of proof that Health Care can be efficiently managed by government. Perhaps there is an equally large body that argues the opposite. What I do know is that your 'evidence' consists of obscure examples and "gubermint is bad" generalizations. I have no need to continue proving that government can do it.

So now that we've adressed the question of government efficiency, I suppose I should address the other side of the coin; private companies. In my experience private companies can be INCREDIBLY wasteful. In Ontario alone private companies have mismanaged privatized sectors including environmental testing, medical diagnostic services, health-care, roads, and information systems management.

If you can prove that corporations are by their nature more efficient than government in every example you'd have something. Otherwise you are left with the position that private companies are USUALLY more efficient. Given that, the burden is on you to demonstrate how they are more efficient in this area, since a whole slew of us have provided loads of evidence that they are not.

... and "it goes against the principles of capitalism" isn't evidence.

The government would be able to do it more efficiently because it would take profit out of the equation. It also consolidates the bureaucratic overhead into one entity and in general simplifes the process (see this post). As I have stated numerous times and have backed up with financial data (see this post), insurance companies are in business to make money. They do not care about your health, whether your dying uncle can afford heart surgery, whether an experimental (but expensive) treatment could save your mother's life, or that 43 million Americans do not have insurance and therefore cannot have health care. They care about increasing their bottom line, having accountants make medical decisions, putting money in stockholders pockets and paying their CEO's millions of dollars a year. All of those things are very capitalistic, but unfortunately they run counter to the interests of those seeking medical care. Capitalism in the medical industry is not sound because the principles run counter to the goal of medicine.

Secondly, the only approach I have seen advocating elimination of private insurance companies is Kucinich's plan (linked several times in this thread). His plan advocates doing that over a 10 year period. I think that is more than sufficient time for those people who will be displaced to either get jobs with the government agency or get trained and move to a new industry. Large labor shifts like this have happened numerous times in our history -- at one point we employed about 400K phone operators, computers have since replaced them.

One thing I think we might be losing sight of here is that offering care to everyone (i.e. UHC) is only part of the solution. There are numerous other reforms that need to take place in the medical industry in order to fix things. If you believe UHC is supposed to be some panacea that will fix everything, it isn't and that is a mistaken assumption.

[quote]Tuition has been going up, in states that have been reducing their taxes or eliminating outstanding debt through spending cuts. This is not a reflection of rising costs, it is a shifting of burdens, and the 'blame' lays with the voters, not the system.
[/quote]

Granted--but that still doesn't remove the fact that the same thing could happen with UHC (also, universities continue to cite rising costs as one of their main needs for additional funding--note that costs at private schools are also rising, eliminating any impact from state budgets).

[quote]The government would be able to do it more efficiently because it would take profit out of the equation. It also consolidates the bureaucratic overhead into one entity and in general simplifes the process (see this post). [/quote]

I am open to that possibility...but would need convincing. Something akin to a hard cap on spending would help convince me--although Congress has shown itself quite capable of working around spending caps.

[quote]All of those things are very capitalistic, but unfortunately they run counter to the interests of those seeking medical care. Capitalism in the medical industry is not sound because the principles run counter to the goal of medicine.
[/quote]

Again, granted. However, I need convincing that that our health would be in this new government agency's interest as well (especially given my concern about costs, which would likely translate into bureaucratic processes and service restrictions). Bureaucracy tends to create its own set of inefficiencies--with the added drawback that there wouldn't be anywhere else to turn to if you didn't like the service being provided. I have had to go to government agencies before (INS)--there is, in general, no faster way to be de-personalized than to run up against the bureaucratic monster. No one there cared in the slightest about our problem, or what they could do to fix it--they were only interested in their process. We were just a number to them, and not even a number they cared to deal with. Exactly what would make adminsitration of UHC any different, particularly in the face of cost pressure? I, like many Americans, have a strong concern here that the cure might be worse than the illness.

[quote]Secondly, the only approach I have seen advocating elimination of private insurance companies is Kucinich's plan (linked several times in this thread).[/quote]

True. As you state, even this could be made workable. I myself am certainly no fan of insurance companies. Just pointing out that there are two sides to most coins--and that if eliminating insurance companies was going to be where the cost savings came from, that it would entail its own set of costs and issues.

[quote]By "we" who do you mean exactly? It's not doctors, or people who study UHC...[/quote]

UJ, by 'we' I am implying those of us skeptical about the ability of UHC to provide us with the benefits we want at a cost we can afford. As I have stated, I am not opposed to UHC philosophically, this makes me--and the group of others like me--the people who, I think, would need to be convinced to get UHC passed.

[quote][quote]
There just needs to be a system that captures those savings and redirects it towards insuring the uninsured. [/quote]

That's vague, and you concede it can't work, so where is the solution?[/quote]

UJ, I'm not attempting to present a solution, but rather to convey the concerns that many of us have about the costs of the new system.

[quote]
[quote]The math on this is really not in favor of UHC. [/quote]

What math? You have provided none[/quote]

But I did, math of the simplest sort, since simple is often the most profound.

[quote]One of the driving factors behind UHC is that there are a LOT of uninsured people out there. Well, it takes a LOT of money to provide health care to that many people.[/quote]

Simple. It will cost a LOT of money to provide these benefits. Therefore, there is a LOT of skepticism about where that money will come from. What I propose is something specifically I would need to see addressed in any plan I would support--that being how it would capture those inefficiences and use that money to fund the plan. Specifically, not with broad statistics. Because there is one fundamental fact here that we all (whether we're opposed or in favor of UHC) -- it will cost a LOT of money to insure all the uninsured. Whether all, or most, of that can be made up in improved efficiencies is mere conjecture at this point--but they don't detract from that simple fact, and that is where our skepticism comes in. Or, perhaps to put a more personal point on it--would you be willing to sing a paper indicating you will pick up all of my health care cost increases in the event it does end up costing more money? If not, then I stipulate that, deep down, you share our skepticism.

[quote] I have no need to continue proving that government can do it.
[/quote]

Ahh, but you do. For if you fail to convince those of us who are merely skeptical, much less those of us who are fundamentally opposed, then you have no chance of ever getting such a system implemented.

[quote]Given that, the burden is on you to demonstrate how they are more efficient in this area[/quote]

Not true. The burden of proof is on those who want change, leaving the rest of us free to erect massive strawmen at our choosing Not fair, maybe, but true nonetheless.

[quote]You ask me why the government could do it more efficiently than private companies? Because governments all over the world DO handle it more efficiently[/quote]

I will grant that people in some countries, most notably Canada, do seem to like their UHC, and it does seem to have been provided at a reasonable cost. I have also heard horror stories from many other countries where it has been implemented. All of which is neither here nor there--for these countries are not us. There is a very large difference between the US and all those countries that have implemented UHC--they are all much farther down the socialist scale than we are, and therefore more receptive to such government programs and the related costs. So, while I might look at programs and statistics from other countries as indicators, I am not willing to state that any system anywhere can be carried over here without specific steps detailing exactly how that would happen.

[quote]One thing I think we might be losing sight of here is that offering care to everyone (i.e. UHC) is only part of the solution. There are numerous other reforms that need to take place in the medical industry in order to fix things.[/quote]

True--and therein might lie some of the other savings I would need to see (malpractice reform perhaps chief among them). In fact, I might argue that UHC is putting the cart before the horse--the multitude of other changes might need to come first, both as a logical step in the process, and also as a way of verifying that the supposed cost savings from many of them would, in fact, be realized.

[quote]If you believe UHC is supposed to be some panacea that will fix everything, it isn't and that is a mistaken assumption.[/quote]

Absolutely, and I will say that I am quite reassured to hear you say it, CJ. For, as I recall, one of the big stumbling blocks that Hillary's commission ran into was the supporters of UHC being unwilling to compromise from their ideal system, thereby making the cost unworkable. I think any implementation of UHC, at least in this country, will have to make some hard choices about what the level of service would be. Your statement leads me to think that, at least among some of us, a workable solution could be found.

Those are some good points Hobbes, and I'm not sure I can really address them without a very specific plan being on the table for discussion. Seeing as Kucinich was the only politician with the vision to propose something like this (and he won't be president), I doubt we'll see a plan like that any time soon. Other politicians have plans, but nothing as grand and far-reaching as this.

The only thing I can suggest as far as knowing whether or not the bureaucracy can work is to look at Canada. I know that several sources have been cited saying there are problems with the Canadian system, but I have know way of knowing whether or not they are credible. I have noticed that all of our Canadian members (so far) are in support of UHC. To me that is more credible than any news publication that may or may not have an agenda.

Hobbes, people on this forum speak for themselves, and for the issues they discuss. Nothing more and nothing less.

As for your post, it is thoughtful and patient, but I think you are either taking the wrong approach, or trying to cleverly corner those on the "for UHC" side of the debate.

You have carefully positioned yourself so that you don't have to prove anything. As eloquent as you are being, you are carefully avoiding providing ANY evidence whatsoever. How can I successfully dissuade you when I am not privy to the reasons BEHIND your reasoning. Either admit your opinion is based on speculation alone, or provide us with the facts that you are working with so they can be adressed. How else can you expect us to have a proper debate?



Perhaps you don't understand how taxes and services work. People vote for a government that reduces taxes; their government services decrease, and they are forced to pay out of pocket. You end up paying for it either way.



That makes no sense whatsoever. There is no hard-cap on what you pay to an insurance company. That's like establishing a 'hard-cap' on the amount of ballots printed for an election. Health care costs are prone to fluctuations, and increases (especially considering the aging North American population.) However, the same growth occurs in the private sector, so I fail to see the difference? Once again you seem hung up on the idea that government would by default be more wasteful and costly... and once again you have backed it up with nothing more than vague accusations and generalizations.



Well, one solution is to have health-care managed on a state-by-state basis yet funded federally. By attaching health-care management to the state level, state legislators are directly responsible to their voters for the policy and management. Here in Canada the decline of health-care in Ontario was one of the key reasons why the Conservative government was turfed.



Profundity is in the eye of the beholder Hobbes. Where is this simple math? I mean, you have made suggestions like "A would cost more than B," but that is no more math than "I think you're hot" is a sonnet.



You're right, it is conjecture. That is why we are providing research, evidence, and facts in an attempt to build a credible case. So far these have all been glossed over and dismissed out of hand, since I see no refutation. Explore your OWN skepticism with the underlying facts behind it and we can get somewhere.



I will not sign any such thing obviously. I cannot guarantee what will happen any more than I can guarantee that we'll be alive tomorrow. Look, the sun could very well emit a tremendous burst of radiation that annihilates the atmosphere, and we'd have no way of knowing it could happen. All we can do is assume that it won't based on our own understanding of solar mechanics; based on observation and research. That is what CJ, English Horn, myself et al are trying to do. If you're not interested in that I wonder what purpose you have for participating.

Am I skeptical that UHC could work? No. Can I guarantee that it will work? No more than I can guarantee I'll be alive tomorrow. I plan on it, but stuff happens.

Of course, there is another reason why your scenario is impossible (which I don't doubt is intentional.) You are expecting 'us' to extract some sort of individualistic determination of outcome based on a large-scale information.



You'd have a point if it weren't for the fact that this is not a legally binding debate, nor planning session on health care. All it is a discussion if it could (or will) work. You have your opinion, and we have ours. We BOTH have a burden. I specified yours because we have provided all sorts of proof, and still, even after my last post challenging you on this subject, HAVE PROVIDED NONE. Surely if your skepticism is so reasonable then there is hard evidence to support it.



Assuming this is directed at me... Well, if you want I can post what I see as an ideal system for health-care in the United States; but I don't know if it could meet your 'exacting' standards as you seem to be of the mind that unless we can provide a detailed model that accounts for every factor then we are just engaged in idle speculation.

While we're at it, since you are not philosophically opposed to UHC, and you claim to see some benefit, why don't you describe a model you do see as working.

I can't agree with a model of UHC that involves doing away with insurance companies.
I voted yes for UHC however, as far as I can understand, the present system is far too convoluted for us to simply excise one or two parts of it. As the system works (or doesn't really) insurance companies are near the heart of our economy. The "risk pool" model that has been repeatedly mentioned is a simplification. In reality insurance companies "share risk" with banks, reinsurers, and even the government. They have a complex system of investment and partnership across nearly all industries. To get rid of them would be a huge blow to all Americans as mutual funds and banks would find themselves without their greatest partners.

However, I also agree that the federal government, not being out for profit, has a good chance of running a more efficient health care system.

Here is my middle ground:

I think that the UHC system should provide for a minimal amount of health care focused on prevention of major illness. This should include check-ups and basic treatments, emergency treatment and generic medications.


Futher services should be supplied by private insurance companies. This would be specialized health care, extra check-ups, additional tests, preferred hospitals/doctors.... Also it should be possible for private companies to "buy" health care services from the government and resell them in bundles for individuals or corporations.


The pros of such a system (beside keeping our economy) are many I think:
1) There would still be an incentive to actually be a doctor in the US. (I recall a transfer student from Germany I coached. She told a group of kids that both her parents were doctors back home. Another girl gasped, "then you must be rich!" The transfer student looked astonished and confused. She didn't realize doctors were rich in the US)

2) Small American companies would be able to sustain themselves because it would be easier to hold good employees. Particularly in services and tradeskills it is common for people to leave their job to take a job (even for a paycut) in order to get healthcare. I don't like the Kucinich plan for taxing companies for health care. Because many small companies can't even affford a health care plan now they would be destroyed if they were suddenly forced to pay for one with an additional tax. If ALL companies already provided health care then that program would make sense.

3) It seems obvious (based on the numbers bandied about in this thread) that insuring ALL people will lead eventually to lower costs for everyone due to less critical care AND shared risk benefits.

4) Putting health care under one big umbrella will allow better and easier management of issues relating to doctors' competencies, malpractice, S.O.P.'s, and all procedural matters. If nothing else this will close many of the loopholes that lawyers are presently gorging themselves upon.

As far as cons go, welll I'm too tired for that right now I think...

I think the funniest thing here is not one person has shown any concern for those who are actually supplying a skill. (No, I think one person mentioned doctors in Germany don't make much money). I provided a link to an explanation of Canada's system which controls doctor's compensation (not surprisingly this was completely ignored). Someone else has noted that German doctors are compensated less than U.S. doctors. UHC is a criminal endeavor. It would force doctors to work as slaves. Doctors would either have to work for less than they're worth or choose a new profession. If England and Canada are any indication, we will simply see fewer comepetent doctors. What next? Compulsory service. Why not? People in here are already denouncing the right of doctors to make a profit. Someone even had the audacity to claim insruance companies are at fault becuase they look to make a profit too. How dare they! Since when is making a profit considered evil? This is America. We coined the term, "makng money" while those in Europe produced for a king or emperor. Saving 100 lives isn't worth the cost it would take to enslave one doctor. I would love everyone to have health care and be able to see the best doctors available. I am not willing to enslave doctors to do it. People have found it en vogue to cry the infamous, "money is the root of al evil," to denounce thier idea of injustice. What is the root of money? It is production. So, what these people are really railing against is production itself. UHC is a cleverly disguised ploy by those who wish to level the playing field, not by producing more, but by forcing people to produce less. What other result do you expect when you try to distribute production based on need?

ibelsd, you are free to bang the "taxation is theft" drum on this site as much as you want; but do not think that it places you above the debate that we are having. Nobody is acknowledging your post because nobody agrees with your basic principles. I have several doctors in the family, and while their careers may not be as lucrative as some of their U.S. counter-parts, they are far from slaves.

Now, as far as your 'economic' theory goes, care to back it up? Can you state that health care 'production' is lower in countries with UHC than those without? And by state, I mean PROVE; not lament on the evils of socialism.

I'd like to see some proof to back that assertion up ibelsd if you insist on continuing to present it as your argument, and not just rhetoric claiming doctors would be "slaves" under UHC.

If you check out salary.com you can look up the low, median and high salaries for various professions. As an example, the median salary for a typical Anesthesiologist in the United States is $252,343. The low is $202,419 and the high is $289,427.

Respectfully, I would suggest that it wouldn't be a huge burden if that salary got aligned a bit with reality (note: I'm not saying pay them $30,000 a year or make them "slaves", so please don't interpret it that way). Doctors specializing in this area are basically responsible for administering drugs to a patient during surgery to keep them under and out of pain. If there was some kind of reality in the medical professional market like the markets for other jobs have there is no way these people would be making an average of 250K a year.

Do doctors deserve to be paid well? Yes. Should they be paid 250K a year for a specialty? I don't think so.

The debate is all over the place. All sorts of minutia.

For example: Profit. Profit is nothing more than people getting a salary for their time and expertise or a return on an investment. I do not understand why profit through the public sector is bad but profit via government is good. The word 'profit' is flung out as some sort of bad word.

For example: Polling people to see if they like their current health service. This is only valuable if those polled have some sort of comparison to offer. If only exposed to one system, how can they tell if it is good or not ?

The big picture is comparing socialism to the free market. If you are a socialist, you will like UHC. If you are a free market person, you will not.

For those of you who like socialism for somethings but not for other segments of the market I wish there was someone explaining why health care should not be in the free market. Public education is an area of the market which needs to be socialist as it is the means to equal opportunity. What is the rationale for health care?

The rationale has been explained ad nauseum I think. UHC would allow the approximately 40 million people who are uninsured to receive proper health-care; and would stabilize costs for those who are under-insured or burdened by the costs of said insurance.

The rational for socialized medecine is simple, it is even in the Declaration of Independence..
..something about all people being created equal...

Combine that with the idea of basic rights to "life, liberty and the pursuit of happiness" and you can quickly build an argument that, in a society that has the technology and ability to keep all people moderately healthy, that all people should have access to at least some part of that...

IT is IMPOSSIBLE for you to devise an argument contesting that some people deserve more than others to have their health without negating the equality clause that predicates the foundation of our country.
Do some deserve health care because they have more money? or they have a better education? or a better job?? So the guy that gets hired instead of me for the good job with benefits, in some mysterious way, deserves to have the health care that comes with the job while I, because I didn't have the right answer for one of the interview questions, deserve to have no health care??

We need our health in order to pursue those unalienable rights to which we all have a license. If such health is easily obtainable by our country (we have the knowledge, the well-trained people, and the facilities) then it would follow that heatlh (as a limiting factor in our ability to obtain our rights) should also be one of our rights.

I think there is an opening in this argument to allow for certain people to lose the right to health as they can lose their other rights. Those that abuse their rights by putting their health in great risk should be considered when we think about UHC.. Smokers, IV drug users, and all other sorts of people are certainly putting one of their basic rights at risk and it is unjust for their abuses to become the burden of their fellows. In other words, those people would have to pay for more of their services in order for true equality to be achieved.
After all, if someone trie to end their own life we charge them criminally and if they impinge on others rights we do the same. Likewise we have laws requiring people get the education that is their right and we charge parents who fail to send their children to school.

As a basic "right" I think that healthcare should be taken very seriously.


As far as doctors' pay goes I stand by my simple outline I already gave. In a system where only basic care is provided by UHC there is stil la strong market for insurance providers and doctors to market themselves or to stand out having good services for consumers of health care.
Companies can provide health care packages that build upon the standard care provided by the government. Doctors can stand out as the most desireable in their field and thus take on only customers with additional coverage.

I am all for competition in the health care market. I struggle to find that much competition in the system we have now. Look at the average wages of an anesthesiologist two posts back....
The main difference between those who make the most and those who make the least has little or nothing to do with their skill level. It is a combination of where they practice, which insurance they carry, and how much of the year they work.

The present system in which we live is bloated, fat and ugly...health services are dolled out like momentos at a baseball park. If nothing else I would like to see a reckoning in the way we deal with and pay our doctors. Bad doctors should go and goood doctors should have a venue for being more competitive. Look at these websites to learn just how bad it has gotten with "bad doctors".
here and this database of bad doctors

Our government is already (albeit sluggishly) trying to regulate the practices of the health care industry. It's time for faster change.

I'm a market person, and I support UHC, at least for preventative and basic health care. The 'Market' depends on free association, free exchange of goods & services, and no barriers to competition. UHC lowers the barriers of market entry by new firms, increasing competition, and all the good things that come with that.

Ideally, I'd like to see the UHC tax, and all other payroll taxes, eliminated in favor of a national sales tax with universal refund. This would lower the marginal cost of employment, reducing unemployment and further decreasing the cost of market entry.

Furthermore, we (taxpayers / federal government) ALREADY pay for the majority of health costs in this country, through direct payments, federal employees, and tax-advantaged health-care insurance purchases.

As for anesthesiologists, their salary is not 'profit' but rather 'wages', there is a difference. These people spend many more years in schooling, and making lesser wages as interns, than most. They also must pay high malpractice costs. The anesthesiologist is THE person responsible for you waking up from surgery. There's a high level of responsibility, rare and difficult skills, and risk of financial liability, hence the high wages.

http://www.nyu.edu/projects/rodwin/french.html
French physicians in private practice ($69,300) was 42 percent of the annual income of their U.S. counterparts ($164,300).

http://www.sin-medicalmistakes.org/OurComments12.htm
doctors in Britain are paid up to 50% more than their French counterparts ( and this is before the new deal which has been refused)

Utilization. As in the United States, in the course of a year 78 percent of the French consult a physician at least once, but the number of physician visits per capita is significantly higher in France (8.3) than in the United States (5.5).

As you can see, in France and in England, physicians get paid less, but are expected to work more. I could provide similar stats for Canada and Germany, but I think I have provided more than just conjecture to back up my arguement.

I am not saying that a UHC system wouldn't have benefits. The French system has its strengths. I simply don't think any benefit is worth costing someone else their freedom.

Now, of course, I should return your challenge back to you. After all, you are obviously in favor of changing the current system, so I would think it is your duty to PROVE that a state system wouldn't infringe on the rights of physicians by asking them to work harder and accept less compensation.

So you consider making $70,000 a year to be slave labor? Man, what do you think of the average guy working at WalMart to feed his family?

The fact is, $70K a year puts a person in at the very least the top 25% of earners in the country but more likely in the top 10-15%. This is hardly slave labor.

As to your assertion that because they are required to "work more" and therefore deserve more money? So what, teachers in this country have a job that is arguably more difficult and stressful and look how much we pay them.

I doubt that the drop in doctor's salaries would be as drastic as you claim, but there were surely be a drop (and I think that is warranted). It also wouldn't be slave labor. It might even convince people to go to medical school because they want to help people, not so they can get a membership to the local country club and play golf 3 times a week.

[quote=Cube Jockey,Aug 3 2004, 08:21 PM] refused) [/QUOTE]
So you consider making $70,000 a year to be slave labor? Man, what do you think of the average guy working at WalMart to feed his family?

The fact is, $70K a year puts a person in at the very least the top 25% of earners in the country but more likely in the top 10-15%. This is hardly slave labor.

As to your assertion that because they are required to "work more" and therefore deserve more money? So what, teachers in this country have a job that is arguably more difficult and stressful and look how much we pay them.

I doubt that the drop in doctor's salaries would be as drastic as you claim, but there were surely be a drop (and I think that is warranted). It also wouldn't be slave labor. It might even convince people to go to medical school because they want to help people, not so they can get a membership to the local country club and play golf 3 times a week. [/quote]
Slavery
Inflected forms: pl. slav·er·ies
1. The state of one bound in servitude as the property of a slaveholder or household.
2a. The practice of owning slaves. b. A mode of production in which slaves constitute the principal work force.
3. The condition of being subject or addicted to a specified influence.
4. A condition of hard work and subjection: wage slavery.

No where does it mention a maximum wage one must earn before one can be considered a slave. By your very definition, you expect doctors to be bound in servitude to the needs of the people. You call their desire to make money, greedy and have no qualms about reducing what they earn. It is one thing if people refused to pay. It is another thing if the government, sanctioned through the use of force, demands they accept less for their production. You are in favor of this type of system while I am morally opposed to it.

ibelsd, you are ignoring the most critical element of slavery, FORCE. Nobody is forced to be a doctor, nor practice. By your rationale anyone who takes a pay-cut is a slave. I take it you don't need to have it explained how ridiculous THAT is.



What bearing on reality do your morals have? The government isn't sanctioned by force, it is sanctioned by the electorate. More to the point, not all models for UHC demand that the government set prices. If the various implimentations of UHC approach the subject of compensation entirely differently, how can you rationally proclaim to be morally opposed to the principles of UHC? What you are really saying is that you are opposed to ANY government involvement in the free market (or you are just irrational.)

If a doctor charged an extra fee besides receiving the UHC payment, I bet the doctor would indeed risk the use of force such as the police coming to take him away. Any time there is a law restricting the market place you are calling upon the force of law to back it up. Maybe it is not slavery but it certainly depriving some people of liberty.

Joe, what do think will occur in France and England as shortages of doctors continue? They can offer more money, but there is a limit to what they can or will offer. You don't think kids will be slotted as doctors through government programs? How did the Soviet Union assign people jobs? Why was this needed? Your system works if one condition is true, namely that people live for the good of others. History does not support that arguement. The founding of this country does not support that view.

You claim the government does not rule by force. What is the military? What are police. The government is the only body sanctioned to use force by the people. It is meant to be used to defend the liberties of people. When it becomes against the law for a doctor to earn a living by utlizing his means of production on the free and open market, then we are not using the government's mandated force to protect him, but to enslave him to the needs of others.

You are now suggesting, that instead of freely employed individuals, that doctors are simply civil servants. The government cannot demand that I take a pay cut since I don't work for the government. My employer could give me a pay cut, but then I am free to find another employer who wishes to utlize my skills and pay me more. In a UHC system, a doctor does not have that option. Their rates will be capped no matter who they work for.

Finally, while not all models of UHC explicitly state cost controls (I will take your word since I haven't seen them all), they will occur. No system in the world operates a national health care system without some sort of cost control structure that implements caps on doctor compensation.

I'll have to side with Ultimate Joe and Cube Jockey on this point (see, I actually can take sides ).



This is ignoring one huge issue--malpractice insurance. This is usually 50% or more of a doctor's salary here. Therefore, the real net salary of the US doctors here is closer to $82,000--very similar to the cited salaries of the French.

Incidentally, this is also a huge area where UHC could have benefits (one of the related issues requiring reform, which Cube Jockey has referenced). If doctors are currently committing half their salary to malpractice insurance, this represents a huge area of potential savings through reform (incidentally, with or without UHC).




Uh-oh, they're on to me (see if anyone gets the "Liar, Liar" trailer reference).

UJ, this is intentional, but not meant to avoid the debate. Essentially, I find myself representing the status quo--aware of the current problems, but skeptical of proposed solutions. I am therefore trying to perform, in this thread, the function of 'sounding board'. Address my questions, and you can have my support (and, I think, that of a significant group of like-minded people). I will say that both you and Cube Jockey are doing a good job on that so far--this is one of my favorite threads, since it seems like we are having an excellent discourse with falling off into pointless sound-bites.

http://www.familylawyerservice.com/news4.htm
In 1986 physicians paid an average of 10.8 percent of their gross revenue for malpractice insurance. This number steadily declined over a ten year period, so that by 1998, doctors were only paying 6.4 percent of their gross revenue for the same insurance.

http://civil.udg.es/EUROCENTRE/Projects/Me...malpractice.htm
http://www.mtla.net/news4.html
- Even France and Germany --where there is no real jury or tort system and where civil medical malpractice litigation is not allowed-- are undergoing a so-called medical malpractice 'crisis.' The same is true in Australian and New Zealand.

There is a ton of information out there on different models used around the world. France and Germany, who don't have a torte system for medical malpractice (is that even an option in this country)? have their own problems. I am not sure where you got your information, but it does not appear to be even close to correct. Maybe, using more realistic numbers, you will reconsider your position.

ibelsd, your argument is neither here nor there. It does nothing to confront the issues we are presenting. All you are suggesting is that there is some statistical ambiguity regarding malpractice rates. How does that blunt the potential effectiveness or UHC? So lets discuss some of the real reasons that you adressed in your previous post...



They will probably continue doing what they already do; offer tuition rebates and incentives. That's what Canada is doing. I can't speak for European states but here the process for licensing foreign-trained doctors is also being updated. Nobody is being forced. Will kids be slotted? Of course not. If that's what you really think then I would love to see your reasoning. If the Soviet Union is the best parallel you can find then you suffer from an almost criminal ignorance of foreign governments.



No, I didn't. I claimed they weren't SANCTIONED by force. They are sanctioned by the people. Any tin-foil protestations amount nothing more than personal repugnance for the currently formed government and have no bearing on reality.



I can't help but notice that you aren't using the "QUOTE" feature of this site. COuld it be that you're not actually quoting or paraphrasing what we are saying. I don't say anything close to what you suggest here, and I am offended by the way you cavalierly put words in my mouth.

I suggested no such thing. More importantly, these words which are supposedly attributed to me make no sense whatsoever. Civil servants are as freely employed as anyone else. They apply for a job, they get it (or they don't), and the work for their employer in exchange for financial compensation. You attach far too much importance to the 'servant' element of the label "civil servant." The moniker is used to apply someone who works for the government, nothing more and nothing less.

Regardless, doctors are not civil servants and I do not suggest that they are. A doctor in the U.S. bills an insurance company, a doctor in Canada does the same thing. The only difference is that the insurance company is run by the government. In neither example is the doctor an employee of the state.



This is absurd. Doctors operate in two primary areas, in a hospital, or in a private practice. In a UHC system like the one here (you know, Soviet Canuckistan) doctors hospital salaries are not regulated; the hospital sets their own budget, and as such the salaries. In a UHC system a doctor is free to practice medicine however he sees fit; but the amount he can bill the government for a specific service is restricted.



If you stopped putting your foot in your own mouth perhaps you'd stop putting words in mine. I never said UHC models don't have cost controls. I said they all approach the question of compensation differently. Unless you can display a willingness to read and comprehend exactly what it is I am writing, I see no reason to continue wasting time responding to you.

I am sorry but the line about Soviet Union is total nonsense. Where did you get that people were "assigned" jobs? You can go after school and pick any profession you would like. My parents were free to chose their field of work, as well as me. By the way, both of my grandmothers were in the medical field and I know quite a bit how the system worked over there. You might be surprised to learn that despite shortages of supplies USSR produced some brilliant doctors who pioneered some surgeries and procedures now used around the globe (particularly in the area of eye surgery... something I know because my grandma was an ophthalmologist.)

The specifics of doctor's profession is that it should NOT be attractive because of it's high pay - people should go there because it's their calling. Look around - United States doesn't have a shortage of musicians and artists, even though those professions are not well paid at all. That's what make a good professional great - his job is his life.

Well said EH,

I think ibelsd sees UHC in only one light. The problem with that is that we are in the U.S.A. !
If there nothing else that we are good at it is at making things work our own way.
It is not at all unrealistic to accept the possibility that we can have a system of health care in which basic services are government sponsored and the rest (as I explained in my unreadably long posts) can be open to the market..

Example: You go to the doctor and find out you have skin cancer. The government will pay for your treatments at the hospital closest to you and they don't skimp on services. however, there is a reknown doctor at another hostpital that specializes in oncology. In order to get additional services form this exceptionally skilled doctor you would need to pay yourself OR have additional insurance...

As we debate here this is pretty much the system that exists for health care....
The only difference is that the coverage given by the government in my example would instead be an HMO. HMO's don't give full health service and they are rather honest about that. Right now, if you get sick and the "best" cures aren't covered by your HMO you can still get them..you just have to pay out of pocket. (and you had better know to ask your doctor to not limit treatment to those allowed by the insurance..or they will do just that and not tell you otherwise)


This is just one possibility and I think there is room for competition in this system. Not every doctor would make loads of money..but shouldn't it be earned by talent anyway?

I just read this entire thread and I've seen a lot of doom and gloom scenarios about the possibility of slavery and the rise of a socialist state.

These intellectual party games have a vague amount of entertainment value but what do they do to resolve the actual problem at hand? I'll answer my own question. NOTHING.

And continuing to do NOTHING is not an solution to our broken health care system.

Case in point:

WASHINGTON (Reuters) - Nearly half of the 8.5 million U.S. children who lack health insurance have not seen a doctors or nurse for a medical check-up in the past year, according to a study published on Tuesday.

One third of uninsured children have no regular source of medical care such as a pediatrician, meaning they are probably going to be taken to an emergency room for routine needs, the study found.

"What these data tell us is what low-income working parents across this nation already know -- that not having health insurance is bad for our nation's children," said Dr. John Lumpkin of the Robert Wood Johnson Foundation, which released the study.

"Without insurance too many children are missing the regular check-ups and preventive care that will prepare them to do their best in school. In this, the richest nation in the world, no child should be without health care coverage."

The study by the Urban Institute used statistics from the Centers for Disease Control and Prevention to show that 48 percent of uninsured children had not had a well-child visit in the past year.

In comparison, 70 percent of children with private or public health insurance had a checkup in the past year, the report said. The American Academy of Pediatrics recommends that children get eight routine examinations by the time they are 2, in part to get key vaccinations.

http://story.news.yahoo.com/news?tmpl=stor...nce_children_dc

We've permitted the rise of a new class war in America between the insured and the uninsured. There are literally sick children sitting next to well children in our schools.

According to the web site, The Cost of War.com (http://costofwar.com) the U.S. has spent over $125,964,420,114 billion dollars so far in the Iraq war. That's money that could have insured 53,992,530 children for a year.

I find these arguments about the cost of providing UHC being prohibitively high laughable. There's always enough money to kill people. What we seem to run short of is the money, moral fiber and compassion to keep them healthy and alive.

This Social Darwinism makes me sick.

I disagree with the image nighttimer is trying to portray of children in America. First off it is essentially illegal to send your child to school without their immunizations...yes I know there are exceptions but poverty is not one of them. So no child who seeks this is going without this health protection..if you can not afford to immunize your child the state or county will help you.

Also in my state in order to register your child for school not only do they need their immunizations but also a yearly medical exam. If again you can not afford your own doctor visit you can take your child to the county health dept. I know this varies state to state tho.

Not to mention in school children have hearing and eye tests and basic phys exams of their athletic ability. If your child is showing sign of mental illness or learning disabilities the school again will organize check-ups and evaluations for your child with financial assistance if you need it.

This argument seems void of the basic fact that there is a state medical system or public health service in place for America's most needy..I know I have had to access it myself.



So if you are injured and the ambulance comes for you and wants to take you to your local hospital which is notorious for poor service, safety and staffing issues..you can tell them never mind the critical condition I am in..take me 20 miles north to the more affluent neighborhood's hospital? You think they will do that? Or how about you are a poor mother who works fulltime and you got an hour off from work to take your kid to the doctor..are you going to waste 25-35 min driving to the better doctor in the more affluent neighborhood or are you going to have to resolve to take them down to your nearby office? Even if you are unhappy with the doctor, staff or level of care provided.

As opposed to what happens right now, that would be an improvement. Because either the poor person in a bad neighborhood doesn't get that kind of care, or they have to go to the less well-to-do hospital and the people that are paying for insurance pick up the bill in the form of higher premiums.

I'm sorry to tell you Bucket, you aren't bringing up anything new here, the problems you describe are as bad or worse with today's system and UHC would go a long way towards solving those problems. There are some problems that simply aren't going to be solved no matter what we do like the mother scenario you illustrated in your post. If you live in a bad neighborhood you are always going to have to deal with that, and it won't improve until you start making more money and move out.

UHC does not imply that all hospitals or doctors would be equal, it does imply that everyone would get some level of care (the level of that care is I guess up for debate even amongst supporters). There is nothing but good that can come from that.

To draw a hypothetical example from Nighttimer's post - if an uninsured child gets a respiratory infection the parents might not be able to take him to the doctor because it would be too exepnsive. The rest of us would pay the $10 co-pay and buy $5 worth of anti-biotics and be done with it. So this child continues to be sick and eventually it turns into something serious and he has to go to the ER. So now instead of spending $15 to fix the problem, you are looking at a $2500+ ER visit. Since the family is uninsured guess who picks up the tab there? Those of us that pay for insurance, the hospital sure doesn't eat the cost.

So if you ask me whether I'd rather pay for a <100$ doctor visit and some drugs or if I'd rather pay for a $2500+ ER visit I'll take the doctor's visit every time.

That right there is the heart of the whole UHC debate, several people have said until they are blue in the face that preventative care is the best. It also happens to be the cheapest. The uninsured can't have preventative care because those doctors are generally very strict about payment (either you have insurance or you pay cash up front - no exceptions), where in the ER they treat you first and worry about payment later -- if you can't pay there isn't much that can be done.


Immunizations aren't the problem - kids don't die of measles or chicken pox very frequently. It is a case of Bronchitis that could have been cured with a $10 doctor visit and $5 of antibiotics that is the problem when it becomes serious and possibly life threatening. Schools do not regulate anything outside of immunizations and the school nurse certainly doesn't provide that kind of care.

First, I don't use the quote feature as randomly as many becuase I attempt to look at the entire body of the other person's arguement. I could pull random quotes out and completely butcher what someone else means, thanks Joe. But beyond that, what I find laughable is that at every turn I have been asked to prove my pessimism of a single payer system. I have gone out and dilligently done that and even provided some links so others could look more closely at the sources. In return, I have received nothing but the vitriol of those who do not respect the work of others. Joe, a doctor negotiating with an insurance company is not equivalent to a doctor working at the directive of a government agency. I am sorry you don't get that. Argue the facts. Every national system in the world is dealing with a shortage of doctors, places state controls on doctor's rates, places more of a burden upon those doctors, pays their doctors less, and offers medical care substandard from that found in the U.S. (France is a possible an exception in terms of quality, but the results are mixed at best). On the plus side their hospitals run to close to 100% capacity meaning that arguably they are more efficient. On the down side, it means the wait to get into a hospital is much greater than that of the U.S. The golden carrot is that everyone gets treatment... eventually.

Some people have argued, in the U.S., we can use some sort of hybird system. While, on the surface, this seems like a fine idea (or better than complete nationalization), it is a red herring. No system partially socialized remains so for long. It will only be a matter of time before it becomes fully engulfed by the federal government. This is supported mathematically, sociologically, and biologically. I make the theoretical mathematical arguement below. Sociologically, it has been proven that beaurucracies become akin to living organisms who exist only to grow. This is matched by the biological equivalent of the fight for existence of any living being. I simply do not see room to compromise.

Here is the bottom line. This plan asks doctors to work harder while taking less pay. The idea that this will make better doctors because they will go into the profession for the right reason is laughable. It certainly has not had that effect anywhere else in the world. Of course, the right reason is subjective. To me the right reason IS to make money. Unless you understand the root of money, that probably seems completely evil to you. Your premise is that we can demand more of people who produce in order to contribute to the needy. Take that to its logical end. Do the needs of the needy ever diminish? Are the abiities of the producers inexaustable? This is simple math. Your plan doesn't work! In theory and in practice it is a failed idea. PROVE to me otherwise.

That may be the way you feel ibelsd, but I can guarantee you that isn't how everyone operates. It doesn't come down to money as the root of all motivation.

I have several friends that are doctors and every single one of them will tell you that if you are going into the profession for the money then you are going to be very disappointed and you might not make it. You become a doctor because you want to heal people, not because you want to make $150K a year.

If people were only motivated by money then why would we have teachers, firemen, cops, EMTs? These people don't make exorbitant sums of money and yet their jobs are very difficult, can have long hours and can be very stressful. The only possible explanation for this is that not everyone has money as their primary motivation for their every action, some of us do things because we want to make a contribution or do something worthwhile with our lives.

I think it is odd that you don't equate making money to contributing or doing something useful. I believe making money is precisely the symbol of someone who wishes to produce and is a sign of respect from those who acknoledge that person's production. UHC wishes to take the production, but ignore the acknowledgement of respect. What kinds of people do you suppose that will attract?

Show me a job in which paying less money for production improved the quality of work.
The means of production must be equivalent. Obvioulsy, paying less for increased production due to cheaper means of production (ie. a new alloy) is not relevant. Show me a field where work production was improved in quality solely by lowering the compensation for production. Give me a real world example. I have been asked to PROVE things like doctor salaries and costs of malpractice. The responses have always been an effort to ignore the evidence that was requested. So, now is your chance. You have repeatedly claimed lowering doctor salaries would improve the profession. Show me. Enlighten me. I eagerly await what will surely be an illuminating experience.

Hypothetical indeed. My point is nightimer's and now your own posts shown some statistical data or a singular piece of information to portray the entire reality. Do either of you have kids? This is my first question to ask..because your kid is not going to be able to be in school if they are sick..the school will send them home until you prove they are under care, being treated and taking meds. If you had kids you would know this.
Also I ask this because you must be unaware of what there is out there available for children through the state or county. In my state we have a special health ins. offered to qualifying families..I am sure your state has the something similar. Here is the website so you can have a look...
FAMIS
Without question my school's nurse would direct a parent to this service.

I think we often look at children's poor health..and say why is the state neglecting them..when often the question should be why is the parent. I know a lot of kids go untreated for illnesses because they have bad parents..my mum has been a teacher for years now and spent some time in really poor school districts and you just can not imagine the level of neglect some of these kids suffer from their own parents..they aren't even being bathed or given clean clothes let alone doctor visits..yet they do have access to clean water.
I think a lot of parents don't bother to take action when their kids are sick until it is something critical even tho they do have access to state or federal health services.

My comments about the poor working mother having to use poor health services was directed to UJ. Yet I do agree with you..that is the point I made back pages ago..I doubt UHC would change much.

Well first off, I never stated reducing doctor salaries would "improve" the profession. Again you are inventing things and attributing them to me.

Secondly, I already listed 4 professions that do not make a lot of money, arguably have a job just as tough and important and many times face pay cuts due to city and state budget constraints. You chose to completely ignore that and continue with your assertions that people only do things for money and money is the measure of a person's success. I think that the teachers, social workers, religious figures, policemen, firemen, and countless other professions would vehemently disagree with you.

Bucket you are getting caught up in little details of the posts Nighttimer and I made trying to prove them wrong and you are missing the point. It is always better to provide preventative care for people than to wait until it is an emergency. I don't see you refuting my point about going to your local doctor's office vs. going to the ER. That is the point, not whether I was incorrect about sick kids being able to attend school or not.

UHC would provide at the very least preventative care for everyone. In the long run this is going to save the system money because you cut down on ER visits. The math is pretty simple there.

Just to offer you an example how very little chooisng the medical profession has to do with money, visit the site of Doctors without Borders (Medecins Sans Frontieres) - these people work virtually for free in all the dirty holes of the world. Do they do it for their resumes? Do they do it for money, fame, and respect? From their "About Us" page:



Now, THESE people chose their profession for all the right reasons.

My premise is not to demand anything. My experience has been that the best doctors are those who couldn't care less about money, go an extra mile while caring for a patient, stay till midnight in the hospital to work and instead of vacations spend months in Africa helping people as part of MSF. Best musicians are those who practice for 7 hours straight JUST BECAUSE THEY LIKE IT and not because they need to practice in order to pass an audition to the orchestra. Best artists abandoned their successful careers in (insert career here) and spent their lives in poverty doing what they love to do.
These people produce the best professionals.

Did you even read the link to FAMIS bucket provided? Preventative care is already available, at least in Virginia, to those who qualify....and the qualifications are pretty reasonable. Five years ago I would have qualified for this myself, and I didn't consider myself to be indigent or even hurting financially. If this is available in Virginia, it is likely available in other states as well.

Your four "examples" don't show increased quality at lower compensation. You have shown some jobs appear to be undervalued, particularly when run be the government. No surprise there. You have not shown that the lower compensation results in BETTER production.

So, you are acknowledging lowering doctor's salaries would result in descreases in quality or just trying to ignore the issue?

I have no idea how this is relevant. What bearing does it have on the issue of UHC? All I said is that people have the same ability to choose their doctor in the system here in Canada as Americans do. Forces beyond people's control would naturally impede this choice, both north and south of the border. In the ambulance case though; unless it was the sort of emergency when time was a factor, odds are the ambulance would go to the best hospital without direction from the patient in question. Again, I fail to see the relevance though as your two scenarios can apply to private or public systems without deviation.



All you have PROVED is that doctors have a lower annual salary in France, Britain, and Germany. Your 'evidence' regarding malpractice is one link to a site for tort-lawyers in a small tri-city area in Pennsylvannia that uses six year old information. That is all you have proved. The rest of your posts have contained pseudo-intellectual assertions regarding freedom and financial compensation, which everyone here has disagreed with, albeit a bit vehemently.



That is your BELIEF; it is about as factual as my belief that I am going to die in a particular university cafeteria; it's just a feeling I get when I walk in the door.



Again, I would love for you to actually provide a quote indicating this. Go ahead. If you can find ANYWHERE where I have said this, I will change my signature to "ibelsd is a god who's glory I am not worthy to bask in." If I've said it repeatedly, then surely finding an actual QUOTE should be easy. Of course, if you're just attributing words to me that I didn't actually say, and ideas I didn't actually espouse (as I said you have) then you will be unable to do this, and exposed for your fraudulent posting.

What I have said, and will continue to say, is that the quality of care isn't necessarily reduced in a UHC system. That is NOT the equivalent to what you are suggesting. You imply a cause-relationship that I feel does not exist.

Lets be entirely honest here; people don't pick their careers solely on the sort of money they make. Sure it is an attractive feature; but hardly the only one. I don't know a single person who went into medical school solely for the money. Are there doctor shortages in Canada? Yes; but it is a new phenomena and we've had UHC for quite some time. The factors involved do sometimes involve pay, but it has more to do with rising training costs (as a result of a push to REDUCE government spending), hostility from certain governments towards the health-care sector (like my home province of Ontario), and an aging population which is causing an increase in demands on the system.

...still no concrete examples.

I know for a fact that the 'poor' use ambulances and ER visits to compensate for lack of health insurance, even when free health clinics exist. That is the case here in Washington, DC, where approximately 70% of 911 ambulance calls are for non-emergent cases...though the system misusers quickly learn what to tell the call taker to get a quick trip to the hospital.

As a point of fact, healthcare insurers now only pay the prevalent rate for services, not whatever the doctor charges. There isn't really a free-exchange of services. I see no reason that a doctor couldn't charge above the standard rate for services, it's just that the insurance company will only pay the standard rate. I also don't see why this would change under UHC.

If there's a doctor shortage, we as Americans, know how to fix that: make it cheaper to become a doctor, and raise the wages of doctors. We can also continue to make doctors more productive by shifting some of their workload to less expensive PAs, Nurse Practicioners, RNS, LPNS, Techs, etc.

I don't think Ibelsd's fears are groundless, but more so, I don't think his fears outweigh the probable benefits. We would have to maintain vigilance against slipping efficiency and effectiveness.

Yes, Mrs.P I read the FAMIS link. However, not everyone lives in Virginia and I know that programs like this do not exist in every single state, even if they do happen to exist in several.

That fact aside, by presenting that link both you and Bucket are arguing in favor of Universal Health Care because that is what that program is -- it uses government funds to provide health care to children. So if you support programs like that, why wouldn't you support universal health care?

You are just looking at Canada, Joe. The fact is that there are doctor shortages in Egland, Germany, and France. All these are coincedences not caused by the common system? Why is there no such shortage in America? Are our training costs lower than the costs in Canada? Do we have less of an aging population? I don't really know. You made these conclusions. By the way the quality of healthcare argument was directed towards Cube, not yourself. In terms of the concept of money which I stated as my belief, in truth, that is its objective value. I work an hour and receive some compensation in the form of money. Money I earn is representative of my labor. It is a compensation for my production. Money I receive which does not come from my production, comes at the expense of someone else's production. This is not a belief, this is the value of money that we, in a capitalist society, have agreed upon. I suppose this separates America from every other country in the world. Our history doesn't consist on working on behalf of a monarch or emperor. We have never considered our labor as something which belongs to someone else. Therefore, we have never regarded money as something that is anything but a reflection of our own work. Of course, this view is corrupted daily with concepts like UHC. More and more, there is a clamour to be more like France. To be more like England. It isn't in our nature. Someone noted Americans like to do things their own way. I think this gets confused with arrogance or conceit. In fact, it is usually because unlike the rest of the world, we have never existed as a society that didn't recognize the rights of the individual. UHC violates those rights. You can claim they do so on behalf of the needy, children, the common good, etc. Ultimately, it denies the rights of doctors to trade their skills on a free market to the best of their ability. You, and others, may feel this is a worthy cost. I disagree. What is disingenuous is attempting to deny that anyone's rights are being violated. The attempts to claim that doctors will not lose their rights to make money because the loss is not absolute is dishonest. If a thief stole half your money, is he not still a thief? You simply cannot argue both sides of the coin. I have provided evidence which supports that doctor salaries will have to be controlled by the state. I have provided evidence which shows doctors in state systems are paid lower than their peers. Frankly, whether lower or not isn't the issue. Even if the state paid above market value, the same violation of rights would exist. Just come out and admit it. The rights of the individual, in your mind, can be sacrificed for the good of the state. As untenable as a position as that may be, at least it is an honest position.

ibelsd, now you have me curious. Do you believe that a socialized military (which we currently have) is also a type of theft? US soldiers are not necessarily paid market value for their efforts. And they are asked to sacrifice themselves for the good of the country.

The reason I bring this up is I'm wondering how far your radical capitalistic beliefs go. Do you believe that all forms of socialism, such as a government-financed military, to be inherently statist? If not, then what criteria do you use to differentiate a social military from social medicine? If so, then...bravo...you've entered the realm of anarcho-capitalism (which would be outside this debate).