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August 27, 2005
For Brad and other 'progressives'
vis a vis Nationalized 'Health' care, this quote about the underlying philosophy of same:
"I quit when medicine was placed under State control, some years ago ... Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men who sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if his is the sort who doesn't."
quote from the character of Dr. Thomas Hendricks from Atlas Shrugged by Ayn Rand.
Posted by Darleen at August 27, 2005 11:58 AM
Comments
You'll be happy to know, Darleen, that the plans most of us on the left are talking about entirely avoid doctor-enslavement. Really the only impact on doctors will be that they'll need fewer staff people to deal with the paperwork coming from one national insurance organization than the multitudes of different private providers in the current system. The real area affected by Democratic proposals is the health insurance industry, not the medical profession.
Posted by: Neil the Ethical Werewolf at August 27, 2005 02:01 PM
Neil
Don't you find it strange that the proliferation of paperwork came about in the last, say 25-30 years as the GOVERNMENT become more intrusive?
And that includes the GOVERNMENT's virtual monopoly grant to the AMA about med-schools.
And one "national" insurance program with one set of payouts will not affect doctors with restraint of trade, how?
I'm not saying there are not problems with provision and delivery of medical services...but letting the government take over ever increasing portions of it is not the way to go.
There is already a huge market imbalance caused when the government let companies write off the medical expenses they provide employees, but don't provide such a tax writeoff to individuals.
Posted by: Darleen at August 27, 2005 03:02 PM
We're totally agreed about the government's awful concessions to the AMA. I'd really like to see more doctors in this country -- either through reducing the bizarre psychophysical endurance tests that make up so much of a medical education, or through letting more doctors immigrate from other countries. It'd also be nice to see RN's allowed to do more stuff. To keep doctor supply low and costs high, the AMA blocks all these things.
It's the corporate insurance bureacracies that are making your doctor fill out these forms, not the government. Let me show you an article about how some doctors are fighting back by only accepting payment in cash:
Cherewatenko, a broad-shouldered 45-year-old who wears black jackets and red stethoscopes at work, switched to cash out of desperation six years ago. His suburban Seattle practice was hemorrhaging money, and he and his partners realized they were spending hundreds of thousands of dollars just to process insurance paperwork.
"We said, 'Let's cut out this administrative waste,'" Cherewatenko said. Before, he charged $79 for an office visit and got $43 from an insurance company months later, minus the $20 in staff time it took to collect the payment. Now he charges $50 — and he never worries about collection costs, because patients pay in full after every visit.
Cherewatenko sees fewer patients now. His whole office would probably fit inside his old waiting room. But he says the freedom is worth it.
"Accounts receivable is zero. It's a great feeling," Cherewatenko said. "I feel like I'm a real doctor again."
Posted by: Neil the Ethical Werewolf at August 27, 2005 04:31 PM
Neil
If INDIVIDUALS not companies got the tax break on medical insurance premiums (and it really takes a catestrophic event to get any tax break for medical losses), insurance companies would be competing for individuals..and EASE of processing would be high on the list of marketable factors.
Do you have any idea of the HUGE and I mean HUGE fraud that exists in California Medical system? (similar system to medicare) Why? Because there is NO accountability at the bottom level.
When an individual goes out and purchases auto insurance, those companies have to compete in the retail market place..they offer not only COST but convenience.
For instance..I carry AAA car insurance...it may cost me a few bits more (but they rebate to their customers each renewal based on their earnings) BUT they offer one stop and hassel free processing. Getting medical insurance should be similar to car insurance. I would stand foresquare against any government try at "National Health Insurance".... Yeegawds!
More docs? Sure, open more med schools. Several have tried and been kept out. Ditto RN training programs. And do NOT give more to RN's until LVNs and others take up the slack of non-RN stuff that has been shoved on RN's.
One of my best highschool girl friends was my family doc for over 10 years until she quit California in frustration and went into private practice in New Mexico. Loves it.
Yank BACK the government interference which has produced this skewed market balance.
Posted by: Darleen at August 27, 2005 04:52 PM
Did a bit of googling on this subject.
My main problem with socialized medicine is the waiting list for patients.
http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=206
From the article:
"The Fraser Institute's 11th annual waiting list survey found that waiting time for surgical and other therapeutic treatments grew significantly in 2000-01. Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 13.11 weeks in 1999 to 16.2 weeks in 2000-01."
It's a longish article, that I'm not going to quote more of here, but it's something to think about. The article goes on to say this includes cardiac procedures. One wonders how many Canadians have died because of these long wait times.
I have no dout that every American deserves medical insurance, but socialized medicine is the wrong way to go. Too risky. Nobody in the 21st century should have to wait 4 months to have an operation. Especially a potentially life saving one.
I don't blame Canadians a bit getting medicial help in the USA. It's a shame their laughable system hasn't been done away with.
Posted by: ratan at August 27, 2005 05:11 PM
Yeah, Ratan, you can learn sooo much about health care from google. And from Ayn Rand-- who published Atlas Shrugged over 40 years ago (before, as Darleen observed, the gov't became more intrusive with the paperwork--but nevermind).
Did either one of you read the Malcolm Gladwell article in the New Yorker that I referred you to in the earlier post?
If you did, you chose not to address any of the points there about our screwed up health insurance system. If you had read the article, you would understand taht health insurance is, in fact, becoming more like car insurance....and you would also perhaps see the argument against that trend.
I hate to break the news to you Darleen, but fraud exists in insurance companies and all over corporate America too. Neil tried to point that out but you ignored his point completely.
Come to think of it, you ignore every point that doesn't agree with your worldview -- you completely skip it. And then call the commentor "smug."
Nor did either of you try to find someone to quote who knows something about health care-- like an actual M.D.....instead, Ratan googled and Darleen quoted old Alice Rosenbaum, aka Ayn Rand, the founder of a philosophy whose adherents consist primarily of college age white males with no experience in the real world. Rand was quite intelligent but had no common sense, and revered men a little too much, and who actually said she wanted to be buried in a coffin with a $ sign on it. But boy, could she write...and write and write and write.
For more on the real Rand, try this book
Whatever happend to the Hippocratic oath anyway? I suppose it was replaced by some principle of individualism. Who is John Galt?
Posted by: Brad at August 27, 2005 08:20 PM
Geez Brad
I guess the phrase "Speculative Fiction" just is outside your grasp, eh? Extrapolation ring a bell?
Rand escaped Stalin, her family perished. You don't think seeing up close and personal what some Americans still laud as just "misunderstood" communism gives her any credibility?
Oh...yes...white men with no practical experience
:::cough::alan greenspan:::cough:::
Tell me, Brad...do you get BETTER food at a centrally run chain like McDonalds or at a local run restaurant where the business succeeds or fails according to local market forces?
SURE fraud exists in insurance... this is why there are task forces set up to bust criminal fraud conspiracies...be it the "bump" teams, the crooked lawyer/crooked doctor fraud.
Funny how the NewYorker article never addresses doctors or nurses or their stake in the health care business.
And let's not forget it IS a business, a profession, like teaching or plumbing.
Do you have a RIGHT to a plumber? Should we have universal plumbing insurance?
The writer talks about EU health care without EVER saying a thing about the rationing that occures. SURE he talks about spreading the risk, of the 25 y/o paying higher premiums so he can be treated with he's 65..but the 25 y/o is ASSUMING he'll even GET care at 65 when the government decides to try and get the care delayed hoping he'll just DIE instead.
There ARE a lot of people who 'take advantage' when they don't have to pay. My eldest daughter, who works EMS in an area dominated by people who fate or choice has left financially challenged, transports a number of people to the hospital when such people HAVE NO NEED for an ambulance. They KNOW they cannot be refused a ride so use it as a kind of taxi. They'll never pay, so why worry that their tieing up of a couple of paramedics might cost someone else a life? THEY DON'T FUCKING CARE CUZ ITS "FREE."
And the rest of us will be charged (or our insurance charged) $1000 for an ambulance ride to make up for the parasites.
Go the way of British or Canadian medicine?
Heaven forfend.
Posted by: Darleen at August 27, 2005 08:49 PM
Tell me, Brad...do you get BETTER food at a centrally run chain like McDonalds or at a local run restaurant where the business succeeds or fails according to local market forces?
I'll answer your question with a question:
under a Laissez Faire capitalist system (the kind Ayn Rand and her followers promote), what makes you think that locally run restarants stand a chance against the chains?
Funny how the NewYorker article never addresses doctors or nurses or their stake in the health care business.
Well, the focus of the article is on the health insurance industry, which of course affects the doctors too. Were you disappointed that Gladwell didn't quote Dr. Thomas Hendricks?
How about this fact he cited:
"The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita."
I think that suggests that the health care business here is not very efficient, don't you agree?
And let's not forget it IS a business, a profession, like teaching or plumbing.
You're conflating the concept of business with the concept of profession.
Health care is more than a business-- that's what I meant by my Hippocratic oath reference earlier. Ask a doctor.
but the 25 y/o is ASSUMING he'll even GET care at 65 when the government decides to try and get the care delayed hoping he'll just DIE instead.
No, no, no...it isn't the government that is delaying the 65 year old's care Darleen, it is the INSURANCE COMPANY.
My eldest daughter, who works EMS in an area dominated by people who fate or choice has left financially challenged, transports a number of people to the hospital when such people HAVE NO NEED for an ambulance.
OK, this makes no sense whatsoever. Please explain why anyone would want a ride on an ambulance unless they were in serious trouble. I've never heard of such a thing. Are they faking injuries for free meds or something?
Help me out here.
Posted by: Brad at August 27, 2005 09:26 PM
Jaysus Brad, a good *progressive* like you unaware of how the poor oppressed victims of capitalist running dogs run their own lives?
By LAW if someone calls for an ambulance THEY CANNOT BE REFUSED TRANSPORT to a hospital. Anyone presenting themselves in an ER CANNOT BE REFUSED TREATMENT.
My daughter and her partner REGULARLY get calls from one side of town from people with "I feel sick" with a demand they be transported to Hospital "X" (which is usually NOT the closest hospital)... sometimes they stay in the ER, sometimes they just leave. If they have ANY medical complaint, it is usually SO minor that transportation by car would be just fine.
But the ambulance is "free" to them, so why not use it, just as the ER is "free" so why not show up and get the common cold looked at...or in the case of a some of the usual homeless... a clean bed and a couple of free meals in the ER.
And you make no sense with your intimation that somehow chains would drive out local restaurants without...without... clue me in, Brad. Just WHAT government law is keeping MickeyD's from closing down the family run Italian restuarant on the corner?
Posted by: Darleen at August 27, 2005 10:15 PM
Brad, those stats are from official Canadian province records. Yeah, they're four or five years old, but I'd bet the problem is even worse.
Is a system that forces its patients to wait 8 weeks for an ultrasound, or cardiac bypass really better than ours? Waiting two months for plastic surgery is one thing, but a cardiac bypass? Is that really the kind of system you want here?
Again, I *know* our system is broken, I've not denied that. All I'm saying is socialized medicine will not make things better, only worse. Both the UK and Canada have socialized medicine for a while now and neither of them have seemed to work out the kinks yet. Do you think we'll do any better?
I'd not mind a dual system where those who can pay insurance stay the same, and those who can't pay get a Canadian-styled system, or something similar.
Posted by: ratan at August 28, 2005 08:01 AM
Just WHAT government law is keeping MickeyD's from closing down the family run Italian restuarant on the corner?
Darleen, I recognize that you were attempting an analogy between local restaurant owners and local doctors. The implication is that they are both for-profit businesses, indistinguishable from one another. Again, I refer you to Malcom Gladwell's argument that health care is not a commodity like food or clothing or automobiles.
And I would ask you why you accept the way in which Republican politicians, whose campaigns are largely funded by the insurance industry, in effect treat the problem of the uninsured as if it is the same thing as any other kind of commodity.
I would ask you why you don't think it is a problem that 45 million are uninsured--and why you don't see the hidden costs to society.
Posted by: Brad at August 28, 2005 08:14 AM
And you, like the New Yorker article, never source your stats. Where did this 45 million uninsured come from? Of that, how many are illegal aliens? Non-citizens? How many are the self-employed? How many are only temporarily without insurance (between jobs, young adults who opt NOT to have insurance)?
The article was a setup... start with the image of someone pulling out their teeth with pliers because they "can't afford a dentist" then move on to discuss insurance vehicles while ASSUMING a stance that medical care in the US is "failing", that the EU model is "better" and that it is wrong to charge different premiums based on lifestyle (ala auto or life insurance).
The biggest assumption is that somehow the bad choices of some dictate the loss of choice for the good choices of others AND the dictation to those OF a profession on how/why/when/where/for how much they'll be allowed to practice.
YES, our current system is horribly burdened, too Byzantine, too burdensome to doctor and patient BOTH. But more of the same?
Uh. No. Thank you.
Posted by: Darleen at August 28, 2005 08:56 AM
Brad
How is the profession of medicine NOT like any other business? Why should it be treated differently? Come on, Brad, YOU are making the assertion that it is quantitatively different, now back up your assertion.
We already treat medicine too differently than many other professions and that's part of the problem. Does the government allow only ONE organization to certify plumbers? Teachers? Lawyers? Electricians? Does that organization get to determine the number of training places nationwide?
Doctors and nurses are PEOPLE and are just entitled to run their profession/practice as a BUSINESS, and a profitable one at that, as any plumber.
Oh. Medicine is a necessity? Well, I know one much more valuable that medicine... FOOD. Do you think every person involved in the production/delivery of food in this country should be treated differently because, by golly, FOOD is not just "another commodity"?
When the government skews the marketplace by either granted monopolies or by restrictive tax practices, the marketplace will adjust accordingly. Individuals are more captive of employer provided health insurance because the government gives the tax breaks to employers NOT individuals.
Now you claim that MORE government involvement by making the government the ONLY payer of medical bills will FIX that?? And because they will be the ONLY payer it will have no effect on how/where doctors will be allowed to practice?
I don't know where you live, Brad, but it sure ain't in Kansas.
Posted by: Darleen at August 28, 2005 07:11 PM