Common Ground Exp.1: Universal Healthcare

[Willravel]

This is the first experimental branchoff of the Common Ground Project.

Rules of the following thread:
1. Absolutely no flaming whatsoever. This thread is about honest and open debate of the issue of universal healthcare. There is no need to be angry or feel threatened by anything written in this thread.
2. Constructive and on task posts. Again, this is about UH, and not larger issues surrounding it like party battles or paranoia. Please stick to the issue in every post.
3. Keep an open mind. Repitition will be considered as a lack of growth in the debate/conversation. New information and opinions should be included in every post and should take into account all posts preceding it.
4. Mutual respect and willingness to be sympathetic. A great deal of what moves politics forward (and a lot of what hurts politics by it's often absence) is mutuality and sympathy for the "other side". When you cease to understand your adversary or the other side of an argument, your own argument loses a great deal of perspective and the conversation spins out of control. In order to keep this a balanced and constructive debate, please carefully consider what everyone says, even if you have completly disagreed with them in the past. Wipe the slate clean and come into this surrounded by friends.
5. Enjoy yourself. Politics can be a very intense and sensitive area for people. Remember that you're just sitting at home or in the office posting on a message board on the internet. You don't really know who's going to read or respond to what you say, and their can be something free and interesting about that.

Background: Universal healthcare, or socialized medicine, is a publicly administered system of national health care. The term is used to describe programs that range from government operation of medical facilities to national health-insurance plans. In 1948, Great Britain passed the National Health Service Act that provided free physician and hospital services for all citizens. The system was later amended, now charging a small fee for the filling of prescriptions and the purchasing of eyeglasses and dentures; it is funded jointly by a health-insurance tax and by the national treasury. Doctors are salaried by the government and receive an additional allotment per patient and for the performance of special services.

Sweden maintains a compulsory health-insurance plan that provides for income compensation, hospital treatment, most of the physician's fee, and part of the cost of medicines. Maternity benefits are provided for expectant women. A large percentage of Israel's medical care is provided by the Histadrut, the national labor union. A number of private welfare organizations also provide care, and the armed forces maintain a number of military hospitals whose services are widely used since many citizens of Israel are military veterans. Canada has a federally sponsored system of medical insurance with voluntary participation on the part of each province; the system is funded by taxes and contributions from the government.

The United States is the only major Western country without some form of socialized medical care. However, it does sponsor Medicare, a federally administered program for those over 65, and Medicaid, a federally funded program of medical care for the poor that is administered by the individual states. Veterans have access to Veterans Health Administration facilities; care is free or partially subsidized, depending on whether injuries and disabilities are service connected.

The debate: How is Universal healthcare working worldwide? Should it be improved/removed anywhere? Would the US benifit from universal healthcare? If yes, how would America benifit from universal healthcare?

[KMA-628]

For "Common Ground" background: CLICK HERE

[guy44]

This is my proposal for a "compromise" on the health care issue. It would avoid establishing a universal health care system while simultaneously ensuring all Americans receive health coverage. And its cheaper than the current system. Except for the first link, all others are from the same Washinton Monthly article.

1. Medicare faces a far greater crisis than Social Security, meaning that now is the time to address America’s health care crisis:

Congress' Government Accountability Office projects Medicare will exhaust its hospital-care trust fund by 2019, more than 20 years before Social Security becomes endangered, the Los Angeles Times reported…"The Medicare problem is about seven times greater than the Social Security problem, and it has gotten much worse," said Comptroller General David Walker, head of the GAO. "It is much bigger, it is much more immediate, and it is going to be much more difficult to effectively address."

http://washingtontimes.com/upi-break...1454-7887r.htm

2. The current free market system for health care is inadequate:

The same problem exists across all health-care markets…Suppose a private managed-care plan invests in a computer program to identify diabetics and keep track of whether they are getting appropriate follow-up care. The costs are all upfront, but the benefits may take 20 years to materialize. And by then the patient will likely have moved on to some new health-care plan. As the chief financial officer of one health plan told Casalino: “Why should I spend our money to save money for our competitors?”
Or suppose an HMO decides to invest in improving the quality of its diabetic care anyway. Then not only will it risk seeing the return on that investment go to a competitor, but it will also face another danger as well. What happens if word gets out that this HMO is the best place to go if you have diabetes? Then more and more costly diabetic patients will enroll there, requiring more premium increases, while its competitors enjoy a comparatively large supply of low-cost, healthier patients. That's why, Casalino says, you never see a billboard with an HMO advertising how good it is at treating one disease or another. Instead, HMO advertisements generally show only healthy families.
If you're a fee-for-service health-care provider, investing in technology that leads to more treatment of pseudo-disease is a financial no-brainer…But investing in any technology that ultimately serves to reduce hospital admissions, like an electronic medical record system that enables more effective disease management and reduces medical errors, is likely to take money straight from the bottom line. “The business case for safety…remains inadequate…[for] the task,” concludes Robert Wachter, M.D., in a recent study for Health Affairs in which he surveyed quality control efforts across the U.S. health-care system.

http://www.washingtonmonthly.com/fea...1.longman.html

3. One problem is that it is very difficult for people to gravitate towards the best health-care providers in an open-market system:

If health care was like a more pure market, in which customers know the value of what they are buying, a business case for quality might exist more often. But purchasers of health care usually don't know, and often don't care about its quality, and so private health-care providers can't increase their incomes by offering it…And so we get results like what happened in Cleveland during the 1990s. There, a well-publicized initiative sponsored by local businesses, hospitals and physicians identified several hospitals as having significantly higher than expected mortality rates, longer than expected hospital stays, and worse patient satisfaction. Yet, not one of these hospitals ever lost a contract because of their poor performance.

In addition:

…most people don't buy their own health care; their employers do. Consortiums of large employers may have the staff and the market power necessary to evaluate the quality of health-care plans and to bargain for greater commitments to patient safety and evidence-based medicine. And a few actually do so. But most employers are not equipped for this. Moreover, in these days of rapid turnover and vanishing post-retirement health-care benefits, few employers have any significant financial interest in their workers' long-term health.

http://www.washingtonmonthly.com/fea...1.longman.html

4. Under the free-market system, even when health-care providers have tried to offer the best possible care they have failed:

A telling example comes from semi-rural Whatcom County, Wash. There, idealistic health-care providers banded together and worked to bring down rates of heart disease and diabetes in the country. Following best practices from around the country, they organized multi-disciplinary care teams to provide patients with counseling, education, and navigation through the health-care system. The providers developed disease protocols derived from evidence-based medicine. They used information technology to allow specialists to share medical records and to support disease management.
But a problem has emerged. Who will pay for the initiative? It is already greatly improving public health and promises to bring much more business to local pharmacies, as more people are prescribed medications to manage their chronic conditions and will also save Medicare lots of money. But projections show that, between 2001 and 2008, the initiative will cost the local hospital $7.7 million in lost revenue, and reduce the income of the county's medical specialists by $1.6 million. An idealistic commitment to best practices in medicine doesn't pay the bills. Today, the initiative survives only by attracting philanthropic support, and, more recently, a $500,000 grant from Congress.

5. Amazingly, the best health care system in the United States is now the Veteran’s Affairs hospitals:

Yet here's a curious fact that few conservatives or liberals know. Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be “significantly better.”
…the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

6. There are several reasons why the VHA system outperforms America’s best private institutions – and at lower cost:

First, unlike virtually all other health-care systems in the United States, VHA has a near lifetime relationship with its patients. Its customers don't jump from one health plan to the next every few years. They start a relationship with the VHA as early as their teens, and it endures. That means that the VHA actually has an incentive to invest in prevention and more effective disease management. When it does so, it isn't just saving money for somebody else. It's maximizing its own resources.
And, because it is a well-defined system, the VHA can act like one. It can systematically attack patient safety issues. It can systematically manage information using standard platforms and interfaces. It can systematically develop and implement evidence-based standards of care. It can systematically discover where its care needs improvement and take corrective measures. In short, it can do what the rest of the health-care sector can't seem to, which is to pursue quality systematically without threatening its own financial viability.
The system runs circles around Medicare in both cost and quality. Unlike Medicare, it's allowed by law to negotiate for deep drug discounts, and does. Unlike Medicare, it provides long-term nursing home care. And it demonstrably delivers some of the best, if not the best, quality health care in the United States with amazing efficiency. Between 1999 and 2003, the number of patients enrolled in the VHA system increased by 70 percent, yet funding (not adjusted for inflation) increased by only 41 percent. So the VHA has not only become the health care industry's best quality performer, it has done so while spending less and less on each patient. Decreasing cost and improving quality go hand and hand in industries like autos and computers—but in health care, such a relationship virtually unheard of.

7. My proposal is to allow ordinary Americans, not merely veterans, to buy into the VHA system. Details on how that may be accomplished vary. The author of the VHA article suggests:

What if we expanded the veterans health-care system and allowed anyone who is either already a vet or who agrees to perform two years of community service a chance to buy in? Indeed, what if we said to young and middle-aged people, if you serve your community and your country, you can make your parents or other loved ones eligible for care in an expanded VHA system?

We could start with demonstration projects using VHA facilities that are currently under-utilized or slated to close. Last May, the VHA announced it was closing hospitals in Pittsburgh; Gulfport, Miss.; and Brecksville, Ohio. Even after the closures, the VHA will still have more than 4 million square feet of vacant or obsolete real estate. Beyond this, there are empty facilities available from bankrupt HMOs and public hospitals, such as the defunct D.C. General. Let the VHA take over these facilities, and apply its state-of-the-art information systems, safety systems, and protocols of evidence-based medicine.

8. The benefits of this proposal, as defined by the same author:

Once fully implemented, the plan would allow Americans to avoid skipping from one health-care plan to the next over their lifetimes, with all the discontinuities in care and record keeping and disincentives to preventative care that this entails. No matter where you moved in the country, or how often you changed jobs, or where you might happen to come down with an illness, there would be a VHA facility nearby where your complete medical records would be available and the same evidence-based protocols of medicine would be practiced.
You might decide that such a plan is not for you. But, as with mass transit, an expanded VHA would offer you a benefit even if you didn't choose to use it. Just as more people riding commuter trains means fewer cars in your way, more people using the VHA would mean less crowding in your own, private doctor's waiting room, as well as more pressure on your private health-care network to match the VHA's performance on cost and quality.

9. I think that the author of this article seriously underestimates the importance of pressuring private health-care networks into providing better service. Why not let Americans choose between the VHA system and their private health-care provider; we can each choose which one we would prefer. Essentially, we could force private-health care providers into greater competition. Market forces would dictate if and how the VHA system and the private health-care providers survive.

10. In this way, we could increase health-care options for Americans, stimulating competition amongst health-care providers and offering an optional socialized version of health-care to everyone. I believe that the money spent now by the government to cover those without health insurance would be less than the amount it would cost to give all uninsured people access to the VHA system. Even if it would cost more, well, we could ensure universal health care without implementing a universal health care system. Everyone is covered, private health care still exists, competition is increased, and health services improve. Isn’t that a good compromise on the health care issue?

[flstf]

The VHA approach might be worth looking into however the system probably should be open to all and not just vets. Currently dozens of hospitals are being sued for overcharging the uninsured. Below is a link to one such suit, there are many more ro be found with a quick google search.

It is ironic that those who find themselves without insurance because of layoffs etc.. are required to subsidize the insured. I guess soon it will also be harder to keep their house with the new bankruptcy law.

Lawsuit Filed Against NC Hospitals
Insurance companies negotiate with hospitals and set specific rates for medical services. Often these rates are based on the Medicare reimbursement schedule. So there is little room here for passing on these costs. The insurers will only pay for the medical services received. They will not pay for these overhead costs.

So the only people hospitals can pass their costs onto are uninsured patients.

This has lead to an awkward situation where uninsured patients – the people who can least afford expensive medical treatments – are billed at rates 2 to 5 times higher than insured patients.

[KMA-628]

I haven't had time to pose an argument yet, but here is the core of my feelings on this.

As a free-market capitalist, the very notion of Universal Healthcare goes against my beliefs. (Note: I use the "free-market capitalist" term loosely).

However, the system created by the "free-market" has become so corrupt that it goes against my beliefs as well. I have this really wacky belief that the "healthcare" I receive be mandated by my doctor, not by a bean-counter.

So, that leaves me with two choices: Fix the current system or take a look at a replacement.

How do you fix a corrupt system? I don't think you can. I think once a system has become corrupt, it is usually beyond fixing as the power players that led to the corruption have a vested interest in keeping said system corrupt.

So, I approach it from a different angle.

I come in from the money angle.

According to research, the American gov't spends more on healthcare, per person, than any other country in the world. So, what we have is, other countries are able to provide a Universal Healthcare system to all of their people for less money than we spend--and we don't even provide healthcare for everybody.

Something is wrong with that formula.

In this case, I would be willing to consider a Universal Healthcare system if:

a) It provides healthcare for all legal citizens of the U.S.
b) It ends up costing less, per person, than our current "system".
c) The quality of care does not go down.

Am I abandoning my principles here? No, I don't think so. I realize that my primary principle isn't working and isn't going to work. I realize that I may still be able to get what I really want, less government spending. Plus, I get the warm-fuzzy knowing that something I supported was actually thought of as a betterment to society.

My primary concerns with switching to a Universal Healthcare system is:

a) The switch itself. How does a country like the U.S. make a 180 degree change in a healthcare system? What do we do with all of the privately owned hospitals? What do we do with insurance companies? I realize there are problems in our insurance companies and hospitals, but by shutting them down are we going to take a major economic hit? We are talking about an industry that pumps billions and billions of dollars into our economy. Is socializing the system going to hurt us in the transition?

b) How do we keep research and development at current levels? How do we keep the incentive on the private sector to create new medicines and technologies? Or, do we leave that up to the gov't now? (not something I would be 100% comfortable with).

c) No new taxes. If we are already spending this incredible amount of money per person on healthcare, we should have no problem designing a system that provides healthcare for all, for less money, using exisiting funds. Now I realize that there would be start-up and transition costs, I don't include that in my "equation". I am referring to an operating system that is less per-person than our current expenditures.

So, as you can see, the devil really is in the details here.

The first, most important question to me is how to actually make a succesful transition--any ideas?

[Manx]

Originally Posted by KMA-628

c) The quality of care does not go down.

Define this. The potential quality of care or the quality of care for the average American?

The free-market approach to health care is going to provide a higher potential quality of care - but you're far less likely to receive it. The universal approach to health care is going to lower the quality of the best possible care, but you are far more likely to receive it.

In other words, do you hold the opinion that the U.S. health care system provides the best care in the world, and if so, are you willing to sacrifice that?

[KMA-628]

A couple more things to add related to the "concept" of this thread:

a) This is not a pro/con Universal Healthcare thread. If that is the type of comment you would like to make, please don't as there is another thread for that. This is a thread to see if "reform" to our healthcare system can be achieved with a system that would be favorable to most people (I realize nothing is ever going to appeal to 100% of us).

b) If you have an idea that might appeal to both sides, that doesn't revolve around Universal Healthcare, please give us your idea. Universal Healthcare isn't the only idea, it just happens to be the one, for now, that has generated the most support from "both sides of the aisle".

c) Hardline stances aren't going to help much. Our current system isn't perfect and a universal system isn't perfect, the "truth" will most likely fall somewhere in between. We are looking to see if we can come up with a design that makes both sides comfortable with it.

d) Police ourselves. If you see the thread getting out of hand, jump in. If you see someone trying to take the thread way off topic, then jump in.

[KMA-628]

Originally Posted by Manx

Define this. The potential quality of care or the quality of care for the average American?

The free-market approach to health care is going to provide a higher potential quality of care - but you're far less likely to receive it. The universal approach to health care is going to lower the quality of the best possible care, but you are far more likely to receive it.

In other words, do you hold the opinion that the U.S. health care system provides the best care in the world, and if so, are you willing to sacrifice that?

Since most of the same people that are providing our healthcare now will be providing our healthcare under a universal system, I can hope that the quality of care stays the same.

I think the question is going to fall under motivation.

Money is a powerful motivator. Will the same monetary incentives be in place under a univeral healthcare system? I don't know. As I mentioned, I wasn't really prepared to state an "argument", but I did want to add my two cents.

Also, I have absolutely no experience with a universal system. Right now, working in the healthcare industry is very attractive as kids grow up and make career decision for themselves--will those same incentives be in place under a universal system?

What is the pay difference between a doctor in the U.S. and a doctor in a country that has a universal system?

Is there a country that is really well-known for its quality of care under a universal system? I seem to remember roach pointing out that France had excellent quality of care--does anyone have more info on that?

If we were to model our proposed system after someone else's, who would we choose as a model?

For those that live in a country that has a universal healthcare system, what would you change about it. What do you see as it's flaws? It's greatest benefits?

As you can see, at this point, I have more questions than anything else.

[roachboy]

simply put
access to basic health care seems to me a fundamental human right.
the lack of it is a violation of same...

this as i understand debate on the question here to be hamstrung by curious assumptions about taxation and a general political climate that leaves folk little choice but to see in the social consequences of capitalism evidence of moral failure on the part of those who do not benefit from holding capital.

i can see why this issue is problematic for conservative ideology--to allow a coherent debate on this issues directly into thinking about the social consequences of capitalism.

that and, judging from the sustained hatchet job done on the clinton healthcare panel by right media during its last period of being in opposition (for example) it is prety clear that defense of insurance company interests is a non-trivial aspect of republican party activities. so i have serious doubts about whether universal health care would be assembled during the sorry tenure of bushworld.

i would recommend looking into the french model for organizing such a system.
it is a more complex model than the single-payer system--perhaps because it is more viable than a singlepayer system--and because (these days) it is france--this option tends to be excluded from debate. but this system is rated as the best in the world, if you allow for trivialities like access to be factored in (which requires a downgrading of the american technological fetishism on the one hand, and a taking account of the fact that the present system means that the lives of the children of the wealthy are worth more than the lives of the children of the poor)

i have posted a bunch of information on this in earlier threads on health care and dont have time at the moment to do it again. (mea culpa)

[Willravel]

Guy44- Good lord, that's a lot of stuff....but it works off an assmption that I'm not sure I can accept: The private medical providers have fumbled tthe ball in a huge way, so the government can be trusted to set up a decent healthcare system. As for right now, there is some money in the VA "buisness", but if the market were to shift suddenly to covering hundreds of millions of Americans, outside interest from investors would begin to put pressure on people for privatization. Just like S.S., some pussy-ass politicians will see an opportunity to make a buck, and just sell it right back, despite the fact that the government stands to actually make money off universal healthcare. Am I just being paranoid? Is there some way to make a law that prevents foul play?

[flstf]

Originally Posted by Manx

The free-market approach to health care is going to provide a higher potential quality of care - but you're far less likely to receive it. The universal approach to health care is going to lower the quality of the best possible care, but you are far more likely to receive it.

In other words, do you hold the opinion that the U.S. health care system provides the best care in the world, and if so, are you willing to sacrifice that?

I think that sacrificing some of the best care for those at the top of the ladder is not too high a price to pay in order to make it so that low and middle class can get some health care. This goes against my Libertarian leanings and I would like to hear if anyone has any ideas on how to fix the present system so there is some free market competition instead of the present setting of prices by insurance companies.

I would imagine that the wealthy will always be able to buy better health care anyway. I don't think I'll be standing in line at the clinic next to Bill Gates anytime soon.

[Willravel]

Originally Posted by roachboy

i can see why this issue is problematic for conservative ideology--to allow a coherent debate on this issues directly into thinking about the social consequences of capitalism.

Perhaps it would be better not to point out faults of other parties, it might actually be better to avoid terms like "conservative", "neocon", "liberal", etc. As this thread is trying to establish, there are people who exist between terms, and labels can be dangerous and erroneous when refering to them. This is about de-polarizing and working together towards a common goal: the betterment of humanity.

[Bill O'Rights]

Originally Posted by guy44

7. My proposal is to allow ordinary Americans, not merely veterans, to buy into the VHA system. Details on how that may be accomplished vary. The author of the VHA article suggests:

Hmmm. Not sure how I feel about this.
1. As a veteran, I don't really care for the term "merely veterans".
2. I "earned" the right to use the VHA, by serving in the United States Air Force, for eight years.
3. To what extent are we talking "community service", here? Two, full time, continuous years? Or does slopping mashed potatoes on someone's plate, in a homeless shelter, one night per week, constitute community service. If so, that devalues the service that I gave in the United States Armed Forces.

On the other hand, I do feel that every American deserves that type of quality healthcare. Quite a conundrum for me.

[KMA-628]

Originally Posted by flstf

I would imagine that the wealthy will always be able to buy better health care anyway. I don't think I'll be standing in line at the clinic next to Bill Gates anytime soon.

I think by having an optional private insurance system, you could avoid this.

Maybe the Universal Healthcare system should be opt-in/opt-out. Maybe a small, and I mean small, tax break for opting out.

Kinda like paying for schools. Even if you don't have kids, some of your tax money goes to pay for public schools. The idea is that, even if you don't have kids, you benefit by living in a more educated society.

[flstf]

Originally Posted by KMA-628

Maybe the Universal Healthcare system should be opt-in/opt-out. Maybe a small, and I mean small, tax break for opting out.

I suppose something like this could work, similar to the opt in/opt out personal SS accounts being proposed. However care would have to be given so that the private insurance companies couldn't negotiate lower costs for their members at everyone else's expense like is being done today (see post #4).

[KMA-628]

Originally Posted by guy44

This is my proposal for a "compromise" on the health care issue. It would avoid establishing a universal health care system while simultaneously ensuring all Americans receive health coverage. And its cheaper than the current system.

I think that, on order for this to work, the system will need to be all or none.

Don't discount the conservative opinion by thinking the only way to appeal to us is with a 50/50 system.

Money is going to be a very important factor and most conservatives want the government to spend less, not more.

Many conservative contentions with Universal Healthcare revolve around the idea that it is going to cost more.

If you can get over that hurdle, dealing with the other problems will be a lot easier.

[roachboy]

Money is going to be a very important factor and most conservatives want the government to spend less, not more.

Many conservative contentions with Universal Healthcare revolve around the idea that it is going to cost more.

except when it comes to the military of course.
it is curious, this split in priorities.
you could imagine a situation in which maintaining the basic physical and mental well-being of the population would matter as much as developing new and improved ways to kill people. we are not in such a situation.

also, it seems to me that this position on health care is of a piece with the strange notion that taxation is an end in itself visited upon the holders of capital by an evil state, which is understood as being a generator of irrationality in itself---as a function of the market ideology that underpins most conservative thinking these days. so you get this absurd line about taxes existing to punish the wealthy. so long as this position passes for reasonable, you will never see a shift away from the kind of capitalist barbarism you have now (think about the implications of unequal access to basic health care along income level [dare we say class?] lines and you can work this out for yourselves--it is easy)

strange how that works, isnt it?

[flstf]

I wonder how damaging having universal health care would be to the economy? All those malpractice lawyers with no work and insurance industry layoffs. The more I think about it, it will take a lot to overcome these lobbies.

[Willravel]

Originally Posted by flstf

I wonder how damaging having universal health care would be to the economy? All those malpractice lawyers with no work and insurance industry layoffs. The more I think about it, it will take a lot to overcome these lobbies.

This is an excelent point. There are a lot of people who make a living on the problems in the current healthcare system. They take advantage of problems inherant to a system that is supposed to help people. A lot of solutions to current job problems in the US can be remedied by better schooling and job training, so it might be good to take those lawyers and give them different skills that will be benificial to the US econemy (I mean specifically helping those who would be hurt by the switch to socialized medicine with scholarships). If the lawyers are so trained and they are able to find work in other areas, the lobbies will fall apart. A lot of the focus of our government funding should be diverted after the establishment of a stable government in Iraq back to funding the intilectual resources of the US and their certian positive effect on our econemy. An investment in knowledge, not war, would be an excelent way to become more respectable in the world opinion.

[KMA-628]

So.....assuming a bill passes to create a Universal Healthcare system.

How does one go from private to public?

Has any other country accomplished this in "modern" times?

[Tarl Cabot]

I disagree with some of your positions.

Originally Posted by KMA-628

Since most of the same people that are providing our healthcare now will be providing our healthcare under a universal system, I can hope that the quality of care stays the same.

Doubtful. I know several physicians in my area that refuse to participate. The physicians will retire, go into teaching, or employ another method to get out of the scenario in which bean-counters rule.

Money is a powerful motivator. Will the same monetary incentives be in place under a univeral healthcare system? I don't know.

Absolutely not. I also know some who no longer do risky procedures, because the insurance companies have limited the compensation for them. If you were paid the same for clipping someone's toenails as for doing brain surgery, and you disliked appearing in court for extended periods, which would you do, and which would you refuse to do?

Also, I have absolutely no experience with a universal system. Right now, working in the healthcare industry is very attractive as kids grow up and make career decision for themselves--will those same incentives be in place under a universal system?

Nope. Physicians these days are telling their kids to be dentists. The nursing industry isn't attractive either, but PAs seem to be happy (for now).

What is the pay difference between a doctor in the U.S. and a doctor in a country that has a universal system?

Depends on what kind of doctor, and what country.

Pediatricians are notoriously underpaid, and with what they go through, and litigation issues, it's hard to understand why anyone goes into it.

My solution (as someone who was promised VA benefits when I left the service, but has since been told I won't be getting them) is that the only way a universal system will work is with a tiered system. With the lower tier required, in return for being a drag on the portion of society which has to pay their bills, to forfeit their current right to sue anyone and everyone.

[flstf]

Originally Posted by Tarl Cabot

I know several physicians in my area that refuse to participate. The physicians will retire, go into teaching, or employ another method to get out of the scenario in which bean-counters rule.

Aren't the costs mostly being set by the insurance company bean-counters today? I thought that most doctors and hospitals agreed to the insurance companies terms in return for being included on their referral list. In many cases doesn't this make the only people who are charged full price the uninsured? (see post #4)