Health Care reform from a Doctors perspective

[aspawloski4th]

How do you even know I listen to Rush Limbaugh? It’s not that I don’t like you b/c we don’t hold the same world view, I just really dislike the fact the government should give everyone handouts and the fact you claim all businesses are evil but have no comprehension how they are run.

You are the one snivelling for government handouts.

Put it this way. I know theoretically how they are supposed to be run,inwhich case there was at one time one of those in my family, that was started by my greatgrandfather. Too bad no one with all the deails are surviving because one could write a manual on how to run a business ethically and morally, and also eficiently. So don’t tell me about running businesses. Basically you are saying in the case of health isurance that people must die or loose their homes to keep the business afloat. If thats what it takes to keep health isurance companies operating then health insurance companies need to be replaced.

 

[wabrams]

Where I live, there has recently been resistance to the introduction of nurse practitioners and midwives, despite evidence that both result in better care and more economical care. Some doctors actually refuse to work with them, or try to set up a system where they have so little leeway that the benefits are largely lost.

I have perosnal experience with both of those: a Nurse midwife delivered our child and was great; in my opinion and my wife’s much better than dealing with an OB/GYN. I have no love for Nurse Practitioners; in my not so humble opinion they are wanna-be doctors. They can go to NP school at their own pace, training varies widely from program-to-program and it can even be done online. I have been “treated” by one and I have worked with them and have come to the conlusion I wouldn’t let them touch me w/ a ten foot pole. As to studies regarding better care from a NP, all of those studies I have read have come from nursing organizations; hardly unbiased.

Through their powerful lobbying, NP’s have pushed some states to let them open their own offices w/ no doctor oversite.

I love physicians assistants; training in standardized, they were created by doctor’s so their training and approach to medicine is the same and they have more knowledge of medicine.

 

[wabrams]

I don’t think this is the case with nursing programs everywhere, though I could be mistaken.

It is the case with all nursing programs; if it wasn’t, then there would be a high failure rate of the nursing boards due to variations in curriculum.

In any case, I agree that a regular RN and a doctor do different jobs, though a nurse practitioner, who is indeed a nurse, is a different story.

Please see my above post.

Though not having any expertise does not seem to stop doctors from offering opinions. Many women go to their doctors for advice about breastfeeding, and the doctors give it, despite having only about an hour of non-practical teaching in modern programs. Older doctors have none at all unless they pursue it themselves. The same often goes for complaints that really ought to go to a physiotherapist or nutritionist.

I’m in radiology and we run into that problem re: doctor’s recieving a couple of hours in radiation safety and then ponitificating like they understand it at the same level the radiologists do or paranoid about exposure.

 

[wabrams]

Put it this way. I know theoretically how they are supposed to be run,inwhich case there was at one time one of those in my family, that was started by my greatgrandfather. Too bad no one with all the deails are surviving because one could write a manual on how to run a business ethically and morally, and also eficiently. So don’t tell me about running businesses. Basically you are saying in the case of health isurance that people must die or loose their homes to keep the business afloat. If thats what it takes to keep health isurance companies operating then health insurance companies need to be replaced.

What you are saying is that all insurance companies should go bankrupt if they can’t run it like a mom’n’pop company, leaving EVERYONE w/o insurance. I will tell you about running a BIG business as others have done on this board b/c you have no idea how anything bigger than a mom’n’pop company are run.

 

[Bluegoat]

I have perosnal experience with both of those: a Nurse midwife delivered our child and was great; in my opinion and my wife’s much better than dealing with an OB/GYN.

They did a study recently at our local women’s health hospital, and actually found outcomes worst with OB/GYNS in normal pregnancy. It was only designed for that hospital, but is a typical finding for that kind of study. (They didn’t look at midwives). I know many Americans though who are not allowed by their insurance provider to give birth with a GP! Model of care is a big deal in maternity care though - the medical model has been shown to be far less effective in low-risk pregnancy and birth than the midwifery model.

I have no love for Nurse Practitioners; in my not so humble opinion they are wanna-be doctors. They can go to NP school at their own pace, training varies widely from program-to-program and it can even be done online. I have been “treated” by one and I have worked with them and have come to the conlusion I wouldn’t let them touch me w/ a ten foot pole. As to studies regarding better care from a NP, all of those studies I have read have come from nursing organizations; hardly unbiased.

Through their powerful lobbying, NP’s have pushed some states to let them open their own offices w/ no doctor oversite.

I love physicians assistants; training in standardized, they were created by doctor’s so their training and approach to medicine is the same and they have more knowledge of medicine.

Here in Canada, there seem to be few physicians assistants, though I think they are allowed in some provinces. I have never seen one here. NPs that I know all did their programs through the university.

It is the case with all nursing programs; if it wasn’t, then there would be a high failure rate of the nursing boards due to variations in curriculum.

The exams are different here in Canada, however, and I assume other places also have their own certification process. Canadian nurses seem to be highly sought after in the US, so standards may be higher.

I’m in radiology and we run into that problem re: doctor’s recieving a couple of hours in radiation safety and then ponitificating like they understand it at the same level the radiologists do or paranoid about exposure.

I am not sure what is with this on either side. Why not refer patients to the appropriate expert? Why do patients accept that doctors know about all these subjects in detail?

 

[St_Francis]

Your not actually implying money in the private sector can be used more than once are you?

I’m not exactly sure how what I wrote implied that…

 

[St_Francis]

People were much more willing to offer support when those receiving were realy needy. With the government giving away billions to those who don’t need it, it is easy for people to assume charity is no longer needed. With the damage the government has done to the Christian charity network, they are just building more and more depenency on themselves.

Yes, this is precisely why I am against government hand-outs.

 

[wabrams]

I know many Americans though who are not allowed by their insurance provider to give birth with a GP! Model of care is a big deal in maternity care though - the medical model has been shown to be far less effective in low-risk pregnancy and birth than the midwifery model.

But you also have to remember that when child birth moved from a GP to an OB/GYN, there were more advances in that field with better results for mom and baby. I think that OB/GYN’s are now more focused on procedures (c-setc, etc.) than actual delivery and care.

Here in Canada, there seem to be few physicians assistants, though I think they are allowed in some provinces. I have never seen one here. NPs that I know all did their programs through the university.

PA’s are purely an American invention. They are recruiting American PA’s to go to Europe to help establish schools.

Here in the US, NP programs are master and doctorate level degrees.

Canadian nurses seem to be highly sought after in the US, so standards may be higher.

I think it has more to do with our nursing shortage than anything.

I am not sure what is with this on either side. Why not refer patients to the appropriate expert? Why do patients accept that doctors know about all these subjects in detail?

Patients generally are refered to the appropriate expert, but the patients rarely see or talk to the radiologists.

 

[royal_archer]

I’m not exactly sure how what I wrote implied that…

Sorry more was in my head than got into the note.
Prior poster said current money supply was less than total debt and your reply said that it could be paid for. Obviously you and I understand that the money supply does turn over frequently making more money available over time than is available at any point in time. Hence my sarchastic response.

 

[Bluegoat]

Sorry more was in my head than got into the note.
Prior poster said current money supply was less than total debt and your reply said that it could be paid for. Obviously you and I understand that the money supply does turn over frequently making more money available over time than is available at any point in time. Hence my sarchastic response.

My question with regard to this is why is it that people think that a system of universal health care would be more expensive? All the evidence I have seen says it would be cheaper.

 

[kfinstad]

If a doctor is receiving 154 thousand dollars each yr., it’s an expense separate from any overhead the business has incurred, as is insurance. So, if a doctor has his / her own business, and would like to reduce expenses, his salary being a major expense could be cut–to make insurance, and any overhead expenses, more affordable. My point is the following: expenses for insurance, and for overhead, do not come out a doctor’s personal income–it’s a separate expense.

So far as who is wanted to cutting a head open for such-and-such a purpose: do you really want students going into the medical field without any experience? As a veteran, I have been treated, or diagnosed, at a number of different facilities, and students from universities are integral parts of treatment, and diagnosis.

In terms of government control, although, at present I do oppose not government control of healthcare, but socializing health care. I argue: capital involved with operating healthcare–money, labor, equipment, time, etc., where the Department of Defense is concerned is neither a form of communism, nor socialism: it is capitalism. Capitalism as set forward, to my understanding, by Adam Smith, stated, that capitalism must allow for education, justice in terms of preventing fraud, and healthcare for those unable to care for themselves–a military: I believe, must fall under the category of justice, and at times, there are those unable to care for themselves within the military, casaulties and the like.

There are many government controls to insure against malpractice–where healthcare is concerned. It is inappropriate in some respects, for a government, such as a U.S. democracy, supported from taxes, generated by a capitalistic economy, to begin demanding for people, universal health coverage for all; when all, clearly, are not in the position of being unable to care for themselves, but there are many within Catholicism, the Pope, I believe: is included among them, who support more than a capitalistic economy, and this may be read in the Catechism of the Catholic Church. As a religious practice among Catholics, health care reform put forward by liberals is able to be legitimately able to be supported, and where healthcare reform is a political document; the provision for abortions, to be covered, is able to be supported. What may not be able to be supported, both by those with religious causes to support, and by political causes to support–is the point, that all are unable to care for themselves, that those who are unable to care for themselves, should suffer in order, to provide coverage to those who are able to care for themselves.

 

[royal_archer]

My question with regard to this is why is it that people think that a system of universal health care would be more expensive? All the evidence I have seen says it would be cheaper.

The evidence can be misleading. where apple to orange comparisons are made. Much of the evidence is also just a record of experts estimates with those estimates based on a variety of assumptions. So I would rather address the tendancies in the conversion to socialized medicine. Here are some things that have a tendancy to drive up costs:

1. If the person has less financial burden for using a service he will use the service more and will drive up costs.
2. There are many who we do not currently have to pay for. With socialized medicine we will have more users we have to pay for.
3. If people can get something for free but only if they don’t have an income they will be less likely to have an income driving up the costs for the rest of us.
4. Things that are not currently covered will have to be covered by insurance companies.
5. Instead of paying based on need we will have to pay based on perceived income For most who work this will cause our costs to go up.
6. Hammer at Lowes $20, Goverment purchased hammer $200.

 

[Bluegoat]

The evidence can be misleading. where apple to orange comparisons are made. Much of the evidence is also just a record of experts estimates with those estimates based on a variety of assumptions. So I would rather address the tendancies in the conversion to socialized medicine. Here are some things that have a tendancy to drive up costs:

1. If the person has less financial burden for using a service he will use the service more and will drive up costs.
2. There are many who we do not currently have to pay for. With socialized medicine we will have more users we have to pay for.
3. If people can get something for free but only if they don’t have an income they will be less likely to have an income driving up the costs for the rest of us.
4. Things that are not currently covered will have to be covered by insurance companies.
5. Instead of paying based on need we will have to pay based on perceived income For most who work this will cause our costs to go up.
6. Hammer at Lowes $20, Goverment purchased hammer $200.

These are just statements about perceived human behavior. Some are probably true, but may well be compensated for by other effects - for example, better preventative care. I think some may not be entirely accurate, and I’m not even suure what you mean by number 4 - how you think it makes a difference.

But really we have no idea based on the things you have said - they prove nothing from a factual perspective. I am sure you are not intending it to, but it seems like an evasive answer.

As it stands now, the US spends more money on health care than many other countries with similar quality of health care on a socialized model. So why do you think that in the US a universal model would cost more than what you have now?

 

[Bluegoat]

But you also have to remember that when child birth moved from a GP to an OB/GYN, there were more advances in that field with better results for mom and baby. I think that OB/GYN’s are now more focused on procedures (c-setc, etc.) than actual delivery and care.

I’d be interested to see evidence of that. I would suggest that in all models outcomes improved in the 20th century for reasons that had nothing to do with OB/GYNS. In the initial move of childbirth into hospitals, outcomes actually became much worse.

And here, as in the UK I believe and other places, childbirth has never been routinely handled by OB/GYNs.

I think it has more to do with our nursing shortage than anything.

I think the nursing shortage has a lot to do with the desparation for nurses, but there has been a longstanding preference for Canadian trained nurses, and certianly the impression here used to be that the nursing standards were higher. (However, that was before nurse training moved into the universities, so it may be different now.)

Patients generally are refered to the appropriate expert, but the patients rarely see or talk to the radiologists.

This has not been my observation in all cases. Certainly most doctors seem to refer to specialist doctors appropriately. In the case of the example I gave with breastfeeding information, rarely do GPs or pediatricians make appropriate referrals and they cause a lot of harm with the advice they do give, and I find many fail to do so with nutritionists as well.

 

[royal_archer]

These are just statements about perceived human behavior. Some are probably true, but may well be compensated for by other effects - for example, better preventative care. I think some may not be entirely accurate, and I’m not even suure what you mean by number 4 - how you think it makes a difference.

But really we have no idea based on the things you have said - they prove nothing from a factual perspective. I am sure you are not intending it to, but it seems like an evasive answer.

As it stands now, the US spends more money on health care than many other countries with similar quality of health care on a socialized model. So why do you think that in the US a universal model would cost more than what you have now?

Those responses were why I think the costs would go up if not restrained by rationing of medical care. They are not Facts in the sence they were not quantified, they are just forces that exist. The bottom line of what things will cost will be more influenced by how much money is alloted and quality of care will go up or down accordingly.

#4 addresses the governements plans for minimum coverage for qualified health insurance programs. This will create a list of medical services that have to be covered by insurers. It is believed that this list will add new costs that the insurance companies would have not paid for other wise.

Preventative medicine may reduce costs by avoiding more serious conditions. This presumes people take the time to go in for complete check ups instead of just when they are sick. There is no guarantee people will take this option. There is also a theory that catching things early will reduce the number of sudden deaths which would actually drive costs up.

I am a little leary of the assertions that we pay more for health care. There are to many factors for an apple to apple comparison such as:

1. Do they measure quality the same way in each country or do they add points to the quality of health care in other countries soley because it is more “available”. What are the life expectancies as compared to the median world wide expectancy for their ethnic class?
2. Is it simply a matter of total health care costs divided by number of citizens? if so, what about the medical toruists that come to America who add to our total costs but not the number of citizens?
3. What is the impact of our significant medical tourism industry as it relates to the comparisons in cases such as the Canadians who come down here for significant treatments but stay home for minor issues. This would tend to artificially drive up our average costs but drive theirs down.
4. What is the impact of luxury medicine or extreme procedures that are available here but not in other countries. Or Americans can pay for them but those in other countries can not. There are many conditions which are rare but have extremely costly treatments. Some of these do not have a very high increase in life expectancy for each dollar expended. Are other countries rationing medical care to keep such costs down?

 

[Viki63]

. Here are some things that have a tendancy to drive up costs:

1. There are many who we do not currently have to pay for. With socialized medicine we will have more users we have to pay for. .

I have to disagree with this. We currently pay for nearly everyone, one way or another. People without adequate insurance are more reluctant to visit their doctors, so they get sicker and when they finally go to the emergency room, it costs much more to treat them. Or it is too late, and they die.
Or, what’s more likely, they are forced into bankruptcy.
I am in disease management, and talk to people every day who avoid seeing their doctor and getting needed tests – not that they aren’t insured, but because even with insurance they can’t afford the co-pays and 20% of the costs of care.
I believe the administration of healthcare should be a non-profit enterprise, as it is in other countries. We could still have insurance companies for those who want to buy extra care.

 

[royal_archer]

I have to disagree with this. We currently pay for nearly everyone, one way or another. People without adequate insurance are more reluctant to visit their doctors, so they get sicker and when they finally go to the emergency room, it costs much more to treat them. Or it is too late, and they die.
Or, what’s more likely, they are forced into bankruptcy.
I am in disease management, and talk to people every day who avoid seeing their doctor and getting needed tests – not that they aren’t insured, but because even with insurance they can’t afford the co-pays and 20% of the costs of care.
I believe the administration of healthcare should be a non-profit enterprise, as it is in other countries. We could still have insurance companies for those who want to buy extra care.

According to the current administration 47 million people do not have access to coverage. So either Obama is lying or those 47 million people will be added to our costs. Right?

Actually those with out insurance have to pay a lot more out of their pocket and are discouraged from getting treatment unless it is absolutely needed. adding these people to the insured pool will drive up total costs. Wtih the biased funding approach these people will not be paying their fair share and Others will be forced to pay for more than their fair shair to an increasing degree.

 

[Bluegoat]

Those responses were why I think the costs would go up if not restrained by rationing of medical care. They are not Facts in the sence they were not quantified, they are just forces that exist. The bottom line of what things will cost will be more influenced by how much money is alloted and quality of care will go up or down accordingly.

#4 addresses the governements plans for minimum coverage for qualified health insurance programs. This will create a list of medical services that have to be covered by insurers. It is believed that this list will add new costs that the insurance companies would have not paid for other wise.

Preventative medicine may reduce costs by avoiding more serious conditions. This presumes people take the time to go in for complete check ups instead of just when they are sick. There is no guarantee people will take this option. There is also a theory that catching things early will reduce the number of sudden deaths which would actually drive costs up.

I am a little leary of the assertions that we pay more for health care. There are to many factors for an apple to apple comparison such as:

1. Do they measure quality the same way in each country or do they add points to the quality of health care in other countries soley because it is more “available”. What are the life expectancies as compared to the median world wide expectancy for their ethnic class?
2. Is it simply a matter of total health care costs divided by number of citizens? if so, what about the medical toruists that come to America who add to our total costs but not the number of citizens?
3. What is the impact of our significant medical tourism industry as it relates to the comparisons in cases such as the Canadians who come down here for significant treatments but stay home for minor issues. This would tend to artificially drive up our average costs but drive theirs down.
4. What is the impact of luxury medicine or extreme procedures that are available here but not in other countries. Or Americans can pay for them but those in other countries can not. There are many conditions which are rare but have extremely costly treatments. Some of these do not have a very high increase in life expectancy for each dollar expended. Are other countries rationing medical care to keep such costs down?

My understanding is that medical tourism is actually a money-maker for many doctors and hospitals in the US, but also, it is really a very small number and not really a factor either way.

Well, as far as medical outcomes, life expectancy, and so on, the American system is not the greatest and not the worst. But, as you point out, it can be difficult to ascertain the meaning of such statistics, since things like life style can also make a contribution. But of well off, western countries, all of which have socialized medicine, people are of a similar or mostly better level of health than Americans. And the US is among the highest of all for health care costs. Given that this is true across so many countries, I find it significant.

So in the WHO study I quoted earlier, it ranked the US health care system as 37th. But it ranked the overall health of Americans much lower, at 72nd.

Your question about measuring whether they get “points” for all having access is - not in measurements of actual health of citizens, though in a measurement of a medical system as a whole, perhaps (but there are few such attempts. So if we say that people in country X have Y% infant mortality, it isn’t a factor.

I am still not understanding why you think insurers will start charging an arm and a leg for extended plans? In my province, I pay nothing for my basic government supplied care. (In a few provinces, there is a yearly premium for those above a certain income level, of about $500.) My family is covered through my husband’s employer for extended health care for about $6 a month - it is a very good plan and we have the most extensive version offered. Good plans from Blue Cross start at about $60 a month I think. So I guess I just have no experience with the scenario you are suggesting.

Of course, those who want a nose job or some other exotic care can always pay out of pocket for such things.

 

[royal_archer]

My understanding is that medical tourism is actually a money-maker for many doctors and hospitals in the US, but also, it is really a very small number and not really a factor either way.

Small number but at significant cost per incident. people aren’t comming here for sprained toes, they are coming for the ultra high end of the spectrum such as reconstructive surgery and transplants.

Well, as far as medical outcomes, life expectancy, and so on, the American system is not the greatest and not the worst. But, as you point out, it can be difficult to ascertain the meaning of such statistics, since things like life style can also make a contribution. But of well off, western countries, all of which have socialized medicine, people are of a similar or mostly better level of health than Americans. And the US is among the highest of all for health care costs. Given that this is true across so many countries, I find it significant.

Trying to be culturaly sensative here but the US does have a significat popluation representing all the other occupied continents. Many people in the US come from areas of the world where life expectancy and health are extremely low. I believe that impacts u much more than european countries and possibly more than Canada.

So in the WHO study I quoted earlier, it ranked the US health care system as 37th. But it ranked the overall health of Americans much lower, at 72nd.

Do they have any comparison between ethinic groups here in America and their counterpart countries of ancestory?

How much of a bearing do the many immigrants in America have on the numbers? Evidently other countries have much stricter controls on who comes into their countries.

Your question about measuring whether they get “points” for all having access is - not in measurements of actual health of citizens, though in a measurement of a medical system as a whole, perhaps (but there are few such attempts. So if we say that people in country X have Y% infant mortality, it isn’t a factor.

That is why I like objective numbers.

I am still not understanding why you think insurers will start charging an arm and a leg for extended plans? In my province, I pay nothing for my basic government supplied care. (In a few provinces, there is a yearly premium for those above a certain income level, of about $500.) My family is covered through my husband’s employer for extended health care for about $6 a month - it is a very good plan and we have the most extensive version offered. Good plans from Blue Cross start at about $60 a month I think. So I guess I just have no experience with the scenario you are suggesting.

Of course, those who want a nose job or some other exotic care can always pay out of pocket for such things.

I wasn’t talking about extended plans, I was talking about private plans.

 

[wabrams]

My question with regard to this is why is it that people think that a system of universal health care would be more expensive? All the evidence I have seen says it would be cheaper.

Our own GOA office has said the costs will be unsustainable. They are about as unbiased as it gets.