Thoughts and Opinions - Socialized Medicine

there are some pretty interesting points in this. Also note that it is written in 2006, prior to the current administration, so it is not an Obama or liberal bashing session.

http://www.heritage.org/Research/Budget/bg1979.cfm#_ftnref26 - http://www.heritage.org/Research/Budget/bg1979.cfm#_ftnref26

In regards to living standards:

Originally posted by excerpt from Heritage article

excerpt from Heritage article wrote:

A comparative study by Timbro, a Swedish think tank, found that EU countries would rank with the very poorest American states in terms of living standards, roughly equal to Arkansas and Montana and only slightly ahead of West Virginia and Mississippi, the two poorest states. http://www.heritage.org/Research/Budget/bg1979.cfm#_ftn15 -

(And, of course, Timbro is basically a Swedish analogue to the Heritage Foundation. They have a political/economic agenda, and are definitely not representative of the common view in Sweden. I would encourage you to walk the streets of Stockholm or Uppsala and see what the folks in the bar think.)

But that does raise a very legitimate point, driven home by the rest of the Heritage Foundation article: how to define "standard of living"? If you measure that by number of cars or average home size, well then you and the Heritage Foundation (and Timbro) are right, and Scandinavia is a horrible place to be, and certainly far worse than, say, Alabama.

But if you enclude things like average hours worked per week (with fewer being better), average vacation time taken, proportion of population living in poverty, number of homeless, teen pregnancy rate, average education level, access to internet, crime rate, drug use, access to public outdoor space, access to higher education, vertical mobility - well, then Scandinavia starts looking pretty good.

Who's to say which definition is better?

I say neither and both, and I say that the Heritage Foundation is missing the boat here, while you had it right. The reason why houses in Sweden are smaller than here isn't because they can't afford it. It is because they don't WANT bigger houses. It's a cultural difference. Maybe they would like another car in the family, maybe not. Other than collectors, you certainly won't find many Swedes in need/want of a 3- or 4-car garage. Most Swedes would consider that a waste of space and money.

So I say boo to the Heritage Foundation for measuring irrelevancies here.

But we officially went far afield here, I think.

Back on point:

Also somewhat interesting a view of Candadian socialized medicine:

http://www.city-journal.org/html/17_3_canadian_healthcare.html - http://www.city-journal.org/html/17_3_canadian_healthcare.html

Especialy noteworthy quote regarding your persistent claim that we pay more per capita :

David Gratzer wrote:

Like many critics of American health care, though, Krugman argues that the costs are just too high: “In 2002 . . . the United States spent $5,267 on health care for each man, woman, and child.” Health-care spending in Canada and Britain, he notes, is a small fraction of that. Again, the picture isn’t quite as clear as he suggests; because the U.S. is so much wealthier than other countries, it isn’t unreasonable for it to spend more on health care. Take America’s high spending on research and development. M. D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

First, on the quoted parts - Why should healthcare cost more here just because we are wealthier? That doesn't compute. A DVD player costs a lot more in Europe than it does here, as does a meal in a restaurant. Why should healthcare cost more?

As to research, this is a very valid point. I suspect that any true overhaul of the US system would uncover that we are essentially subsidizing medical research for the rest of the world. That needs to change. Either we reprice everything to recover more costs from other countries, or we separate the R&D costs from the healthcare costs so we can have level field competition. R&D is polluting the data pool.

Now, as to the article in general - very interesting. I am not that familiar with the Canadian system, but I understand that it is an odd public/private hybrid, kind of like the Swiss system, and I believe it also operates at the provincial level rather than the national level, in which case observations about Winnipeg may not be generalizable. I could be wrong.

In any event, anecdotes are always scary (although I have heard far scarier anecdotes about Canada than the lamos this guy picked). The thing about anecdotes, though, is that everybody has one. Heck, I don't have to go to the ER to look for anecdotes - I have enough anecdotes from my own life to fill a book. And I don't think I'm special on this point, I just pay attention to the issue.

And this point is made for me by the author in the very first paragraph, when he sets it up like he is talking about a US HMO, and then "shocks" us by saying that he is talking about Canada. Think about that for a minute... ... ... what does that say about American HMOs and our opinion of them?

But the more interesting part of the article comes further down, when the author is discussing the "Americanization" movement in Canada, the UK, and elsewhere: he is talking about privatization. I don't see any mention of cutting back from universal coverage. I don't see any mention of fracturing the system. I don't see any mention of cutting back on preventive medicine. Just privatization.

And you know what? I am just fine with that. I don't give a hoot if my doctor works for the state or a private practice. Here's what I want: A rock-solid guarantee (some limitations to be discussed) that when I take my kid to the doctor (a) she will get treatment, and (b) I won't get a giant bill. In the current US system, neither of those is true.

Limitations, of course - not all treatments can always be covered. There will always be a limit, regardless of the system. But that isn't my point.

My point is that I don't want my daughter declined because I forgot to bring my insurance information. I don't want to get a giant bill because I filled out a form incorrectly when I changed jobs, or because this doctor is "out of network."

What any good healthcare system needs is these things:

1. Universal coverage and access for most procedures.

2. Nominal on-the-spot fees.

3. Full portability, regardless of employment or pre-existing conditions.

4. Significant emphasis on preventive care.

I don't care what means are used to get there. Single-payer seems logical and obvious, but need not be the only way. It certainly does not have to be government operated, and does not have to be a monopoly. It is easy to envision such a system with plenty of competition to keep costs under control.

So I don't really have a problem with this article - the guy, as far as I can tell, is annoyed with government management more than anything else, and aren't we all?

Another interesting article:

http://www.haciendapub.com/article49.html - http://www.haciendapub.com/article49.html

I like this quote:

Originally posted by <FONT color=#330099><strong>Lawrence R. Huntoon, MD, PhD

Lawrence R. Huntoon, MD, PhD wrote:

The other thing the pro-socialist "crisis mongers" fail to tell people is that only one-third of the uninsured are chronically uninsured.2 For the other two-thirds, it is only a short, temporary condition, "half of all uninsured spells will last less than six-months. Three-fourths of them will be insured within 12 months. Only 18 percent of all last for more than two years."(2)

and

LRH wrote:

] Those who brandish the "crisis" of the uninsured to promote socialized medicine also often fail to tell people that uninsured doesn't necessarily mean poor. In fact, the National Center for Policy Analysis (NCPA) tells us that "a third of the uninsured households earn more than $30,000 a year and 10 percent earn more than $50,000."(2) That's at least 40 percent of the so-called "uninsured" that could well afford a $45 office visit or health insurance.(2) We need to get away from the concept that "someone else," big government or insurance, needs to take care of our every need.

Very interesting article, and gets to the heart of many of my problems with the US system. The first part about the tax and premium structure - great example of the kind of unnecessary complexity that introduces inefficiency and waste into the system. If healthcare were not related to employment in any way, it would be a big improvement.

But another interesting part is the part you quoted, about the nature of the uninsured. Also tells me the writer is a bit checked out, on a couple of points.

First, as to the "temporary uninsured." He says this like that takes care of it - like being uninsured for a couple of weeks is no biggie. IS HE FREAKING KIDDING ME? First off, I guarantee it is a big deal if you fall off a ladder, or if your kid starts to run a temperature, or if your wife thinks she feels a lump. But more importantly, systemically, it is a big deal because even the slightest break in coverage drastically increases the chance that you won't be able to get coverage every again - thanks to the wonder concept of "pre-existing conditions." In fact, not only is "temporary uninsured" a big deal, it is one of the central problems with the entire system. Who wants to cover the guy who shows up with a coverage application and stage 3 cancer? Bueller? Bueller?

This writer pointed to one of the main issues and pretends it is no big deal.

Second - the part where most of the permanent uninsured can really afford insurance if they really wanted to. Again, he presents the income numbers as if they are some grand revelation. In the meantime, the rest of us are perfectly aware that the biggest chunk of long-term uninsured are employees of small businesses, and solo operators. Dental assistants. Truck drivers. Construction workers. Also the multi-parters - the guys that work three part-time jobs. Hard-working people all, but not exactly high earners.

And then the writer goes and guarantees to me that he is checked out - according to him, a household with annual income of $30,000 "could well afford a $45 office visit or health insurance. What planet does he live on?

First off, it isn't $45 OR health insurance. You need health insurance BEFORE you get the $45 doc visit. So there is that dee-dee-dee moment. But the cavalier way he declared that they can afford health insurance, that is what really galls me.

For kicks and giggles, I just applied for some private health insurance online. Healthy couple, two kids, no preexisting conditions (I would have put down some preexisting, but I didn't feel like having a fake medical interview to make a point here). The cheapest I came up with $220 per month. Seriously crappy insurance, though - up-front deductible of $5,500 each year. What kind of insurance is that? I pay the fist $5,500 each year? Now, to get the "$45/visit" kind of insurance I had to go up to $550/month - and that wasn't exactly super-duper insurance either.

That's $550 per month, after-tax out of pocket, for a family of making $30k per year. And that's before the costs for the actual doctor's visits and medicine. And buddyboy MD, there, thinks that this is no big deal, and this family should stop looking for someone else to take care of their every need.

Please.

Regarding my healthcare costs, you still lose me on how you are comparing this to us being on the dole. Let me make it clearer.. My wife gets insurance as part of her compensation for doing a job. This job happens to be working for the school, but it is nonetheless a JOB. When I worked at previous employer, I also had paid insurance for several years. It is because it was compensation for me working for them and was part of my salary. What is the difference between my wife working at GM and getting paid medical insurance and her working for the county and getting the same benefits? I don't get the distinction.

Given that you just made a lengthy post about the glories of privatization, I find it rather ironic that you don't see the distinction.

Would it make it easier for you to comprehend if they paid her $12k more per year and than charged her for insurance?

Indeed it would, to some extent - but not really. Because overwhelmingly today most employer's pay only half of the health insurance premiums, and those premiums scale with family. Your wife's health insurance is arguably payment for her services, but not yours or your kids'.

Would her salary go up if you died or divorced her, to compensate for lower health premiums paid by the employer? Would her salary go down if you had more children, to compensate the employer for higher premiums? No? I didn't think so. (I actually don't know about your case, of course, but I know of no state or federal employment that works this way). My personal healthcare costs went up when I had kids - we considered changing plans to save money. Your wife's costs were unaffected by children. And as a result, her employer is paying 100% of the health insurance premiums for everybody in your family other than your wife. If her employer were GM, it would be the shareholders. But she works for the state, which means that the taxpayers are paying for your health insurance (and your kids'). You're welcome.

oldpbnoob wrote:

Peter Parker wrote:

And THEN, if the problem doesn't go away right away, set the family up with a dietician, a private trainer, heck even a food service if needed. THAT is what we need. We need to prevent and treat obesity, not just tell people to lay off the Big Mac. Right now some of you are thinking "ZOMG pay for a private trainer with taxes?" YES, pay for a private trainer with taxes. Because a year or two with a private trainer is a whole lot - a WHOLE lot - cheaper than dealing with that kid's diabetes for the next 50 years, followed by multiple bypass surgeries, and a giant crane to lift him out of his house.

I have seen overweight people in hospital gowns standing outside the hospital entrance smoking through their trach tubes..... You can't help stupid sometimes. Perhaps what we need to do is thin the herd. Pun intended.

Absolutely - but how? Are you prepared to cut off people from health insurance completely if they engage in certain behaviors? You may be enough of a hardass, but I don't think the rest of society is.

And that, ultimately, is why a purely free-market approach to healthcare fails.

Because, ultimately, we already HAVE single-payer universal coverage socialist healthcare. Anybody walks up to an ER, they will get treatment. Doesn't matter who or what. They will get treated, insurance or no insurance. If they can't pay, the taxpayers eat the bill.

Unless we are prepared to act like capitalists and turn away customers who can't pay, then we don't really have a capitalist system. And the free market does a very poor job of handling matters when it can't turn anybody away.

Right now, the taxpayers are the healthcare providers of last resort for everybody in the country. That's called universal socialized medicine. We are already there. The problem is that we have the world's worst socialized medicine, because the social safety net doesn't kick in until you are about to drop, which is the most costly time to start working on a problem.

And that is why almost anything would save us money, if it only got us to true universal coverage. Because then "uninsured" people would see the doctor BEFORE the rash turned into cancer, and we would save millions.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: oldpbnoob
Date Posted: 22 July 2009 at 10:10pm

Since we are discussing the American HC system, I would think it very relevant to discuss what Americans consider a standard of living. Do American want to live in 1000sq foot home, drive a Yarus or the bus, reduce to 1.5 kids, and have their parents live with them until they die? No. I get what you are saying about streamlining health care and reducing costs, but I do not think socializing the entire system is the answer. In order to have such encompassing social programs, you must have a government that is huge, and the only way to pay for it is by..... taxes. And I do not beleive the government is good at social programs. Look at welfare, unemployment, child services and yes the school systems. Heck, look at NASA and the military. Most government agencies are filled to the brim with waste and poor spending choices. And back to the point, Americans do not want to give up their 2.5 kids, 1800 square foot houses, two cars, boats, jet skis, credit cards and on an on and on..

Are there problems with the current system? Yes. Is completely socialzing the system the answer? IMO, no. Now granted, I listened to the Obama speech a short time ago and some of what he is saying makes sense. If he is truly trying to push through a system where people with existing coverage can keep it and any new programs will be paid for by savings from streamlining and such, awesome. But anything that increases my overall taxes, I am not in favor of. Period.

Last issue regarding my wifes insurance.. To be clear, she works for the local school district, not the state. The insurance is a consortium of the county school districts and is actually private insurance. Also as mentioned before, she took the lower paying job because it offered insurance. Could she have gotten a job that paid more and paid our own insurance? Sure, but why? Could she get a job making 12k more, most likely. If that is the case, and she had to pay 1/2 of her insurance, theoretically, the district should be thanking her for doing the job for 6k less than she is worth. You're welcome.

Posted By: mbro
Date Posted: 22 July 2009 at 10:18pm

Nit pick: although your wife's insurance is through a private enterprise it is paid for by tax dollars which is what makes it socialized. Sort of like federally subsidized school loans although granted through a corporation they are still a socialist (ick) program because they are being paid for through taxes.

Even better example: The government handing out military contracts to companies like Black Water to provide security detail or whatever other operation at a much higher cost than what it would cost the government themselves to just do the operation themselves. Yeah there's private enterprise involved but it's still a use of tax dollars. They're just used inefficiently because it could have been done cheaper.

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Don't blame me, I voted for Kodos.

Posted By: oldpbnoob
Date Posted: 22 July 2009 at 11:40pm

mbro wrote:

Nit pick: although your wife's insurance is through a private enterprise it is paid for by tax dollars which is what makes it socialized. Sort of like federally subsidized school loans although granted through a corporation they are still a socialist (ick) program because they are being paid for through taxes.

Pass the skull bong, I think you've had too much. So if I work for a government contractor say, like Lockheed Martin, and as part of my pay compensation, i get health insurance, than I am taking part in socialized medicine? Tax dollars pay my salary.... Or let's broaden and say anyone that wins any contract to build something for the government is technically getting paid with tax dollars.... I'll make sure to remind the construction workers building the new school down the road to thank me for paying their insurance. We can keep going if you'd like. So now let's argue, "but they pay their own insurance". Yeah, but as PP says, 1/2 is paid by the company. By my tax dollars. And they pay the other half out of their pockets. From the higher paying job that hey have outside government, that my tax dollars paid, so they can pay for their insurance that we are already paying 1/2 of. So by your argument anyone that has their salary directly or indirectly paid via tax dollars is taking part in socialized medicine? Awesome logic Bro!

Posted By: Peter Parker
Date Posted: 24 July 2009 at 8:27pm

oldpbnoob wrote:

Since we are discussing the American HC system, I would think it very relevant to discuss what Americans consider a standard of living. Do American want to live in 1000sq foot home, drive a Yarus or the bus, reduce to 1.5 kids, and have their parents live with them until they die? No.

Very fair point. Clearly we should judge American "standard of living" by American standards.

What I meant to point out was that, to a large extent, the reason why Northern European houses are smaller than American houses has less to do with wealth than with other factors, such as culture. I know plenty of Europeans who think it is offensive to live in an oversized house. For them, it is a matter of preference rather than cost.

That said, cost is certainly an issue for real estate, but here we run into an apples and oranges issue. Real estate is always unique, and many factors set the price. A crappy little 700 sq.ft. apartment on Manhattan will cost you a million bucks. That will buy you a mansion on a multi-acre spread in an exclusive neighborhood here in Milwaukee. That doesn't necessarily meanthat New Yorkers have a lower standard of living than Milwaukeeans.

But I digress. Back to healthcare.

I get what you are saying about streamlining health care and reducing costs, but I do not think socializing the entire system is the answer. In order to have such encompassing social programs, you must have a government that is huge, and the only way to pay for it is by..... taxes.

Define "huge" government? Do you measure by dollars or employees, or something else? I do not believe that a single-payer system has to be government operated, even if it is government funded. Lots of government dollars go to programs with hardly any government employees.

And what is wrong with taxes? I just want to lower costs. If I could trade my $1,500/month payment to an insurance company for a $500/month tax increase, I would be silly to decline, yes? Money is money, and a lower payment is a lower payment.

And I do not beleive the government is good at social programs. Look at welfare, unemployment, child services and yes the school systems. Heck, look at NASA and the military. Most government agencies are filled to the brim with waste and poor spending choices.

And yet, even so, the military does the job for less than Blackwater. Public schools spend less per student than most private schools (and not just the super-duper prep schools).

And for the others - NASA, welfare, unemployment, child services, and heck the military too - if the government wasn't to do it, who would? How would these services ever get provided WITHOUT the government?

That fact of the matter is that some these practically require significant government involvement. Would the interstates have been built without government involvement? The space shuttle? Child protective services? Energy transmission grid?

The reality is that there has been major and necessary government involvement in just about every significant infrastructure project ever, since the beginning of time. Great Wall of China? Government project. Columbus' Westward trip to East India for spices? Government funded. Our near-100% literacy rate? Government. Satellite TV, GPS? Government, government. The Pyramids? Government. Hoover Dam? Government.

Maybe some of these would have gotten done eventually purely by market forces, but there just are some things that government can do faster and better than the market ever could. Most of these things relate to infrastructure and "social services."

And healthcare belongs in that bucket.

And back to the point, Americans do not want to give up their 2.5 kids, 1800 square foot houses, two cars, boats, jet skis, credit cards and on an on and on..

And I don't want to give those things up either (not for healthcare insurance, anyway). But like I said, your fixation on taxes alone without consideration of the total financial result is misguided.

But more importantly - this word "socialization" is another big part of the problem. I outlined above what I think any system needs. "Socialization" isn't on the list. I think a single-payer government system is probably the best way to get there, but that is a means, not an end. But let's look at the ends and the costs:

First, and most importantly: True universal coverage.

Now, I will admit that I personally find this to be a moral imperative, regardless of cost issues. But moral issues aside, I also think this is our biggest cost sink.

Universal coverage sounds expensive, but it is almost guaranteed to be CHEAPER than what we have now. That's right, more will cost less. This is true because of what I mentioned earlier: we already have universal coverage, just incredibly inefficient universal coverage.

Dealing with the guy who rolls in to the ER in the middle of a heart attack is expensive, and right now that's on the taxpayer's dime (assuming no private coverage). So we are already paying for this guy. So my suggestion is that instead of waiting for him to have his heart attack, we pay for annual checkups. This will catch his heart issues early. We then pay for his heart medication. As a result, we don't have to pay for his heart attack, and we save buckets of money.

Same thing for pre-natal care. Good pre-natal care leads to fewer problem deliveries. Problem deliveries are far more expensive than a couple of ultrasounds - not to mention the cost of child unnecessarily born with brain damage. So let's get ALL pregnant women proper pre-natal care, and we'll save buckets of money.

This list goes on forever. Any physician will tell you that early treatment is easier and cheaper than late treatment. Right now we (the taxpayers) are paying for the late treatment but not the early treatment. How is that a good financial plan?

So let's get full universal coverage and save some money.

As for the rest of my list - well, it's basically the same analysis.

Oh, I appreciate the hard-working folk in government jobs as much as everybody else. They are generally paid less than equivalent private sector positions, but mostly keep plugging away anyway. And I don't doubt that part of the motivation for the job was the benefits. But my point stands - her salary is independent of the number of dependents she has on her policy. Therefore, additional dependants are covered entirely by the tax payers.

And, of course, while we are thanking people for working for less than what they are worth, I presume you remembered to thank the illegal aliens working for $10/day? :) Ok... unnecessary diversion.

But anyway: dl;dr = "socialization" is just a word, universal coverage is cheaper than not-so-universal coverage, and the gubmint is necessary for most big projects.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: choopie911
Date Posted: 24 July 2009 at 8:46pm

I love it when people who have never been to Canada, and really know nothing about it, badmouth the medical system. It's just so ridiculous to see what they seriously think it's like here.

Posted By: Peter Parker
Date Posted: 24 July 2009 at 9:06pm

On a separate note - just because this is how I am, I went back to look for private health insurance. This time I filled out the form online indicating that I currently had no insurance and had been uninsured for more than 60 days. I also added a random collection of pre-existing conditions. No cancer, HIV, or heart problems, just common treatable problems with prescription drugs attached: Herpes and ADD.

And then I waited.

In about ten minutes I got a phone call. Now, granted I have a sample of one, and I applied online for cheap insurance, but still - holy cow. I felt like I was buying real estate in Florida and a used car at the same time. First I had to get through the "how mucha wanna pay?" round. Seriously - he asked me how much I wanted to pay, and what I could afford to pay. I tried to get him to give me some numbers, but that was tough. I eventually broke through (after being ridiculed for wanting to pay only $100/month), and he started giving me some numbers. The cheapest he came up with was $229/month in premiums, for something he called a "cash bonus program," and it would cover everything, including my pre-existing conditions. I thought that sounded great, and asked for details.

Well, he proceeds to tell me all about this insurance. Now, I am a lawyer working in finance. I work with complex financial structures every day. Heck, I design complex financial structures. I understand insurance. I asked lots of questions. And despite that, after 20 minutes of this my understanding of the policy he wanted to sell me was minimal.

But here is basically what he was selling: I would have very low copays. Good. But that bad part was that this "insurance" basically had superlow caps on EVERYTHING. Hospital stay? Max $250/day. ER visit from an accident? $2,500 max. Prescription drugs? This part I couldn't understand fully, but it was not going to be a whole lot. So I guess by "covering my pre-existing conditions" he meant that they would contribute a few bucks towards the drugs and pay a little more if actual sickness occurred.

Not only was this the worst insurance in the world, it basically wasn't health insurance at all. Without insurance a car accident would bankrupt me. With this insurance, a car accident would bankrupt me. Awful, awful stuff. And somebody less persistent than me would never have figured that out, and would have thought they were buying good and useful insurance.

Anyway, at the end of the schtick he asks me if I want to pay with mastercard or visa. That caught me off-guard, even after the sales-pitch I had just had. But yes, he wanted me to sign up right there.

So I told him I needed to do some comparison shopping first, and asked for a number I could call back, and an emailed copy of the policy, or a summary of the terms.

This is when the real fun started. He first told me that only customers can see the policy and the terms (he said that with a straight face), so he couldn't email me anything - but more importantly, why wouldn't I just buy right now? He went into full used-car salesman mode. He suggested that I was just embarrassed that I couldn't afford it (he kept coming back to that). He suggested that my kids could get sick and die tomorrow, so I should sign up immediately or I was a horrible father. He pointed out that my pre-existing conditions were so horrendous that there was no way anybody else would possibly cover me, and I should be happy he was even still talking to me. Besides, the name of his company was "NATIONAL Health Brokers" or something like that, which clearly meant that is there was a better plan he would know about it. No point in calling around, because he knew what the best plan was (because he worked for "NATIONAL" - why else would they be called "National?").

And so on. He berated me, belittled me, mocked me, practically threatened me, for a good ten or fifteen minutes before I gave up. He then gave me a number and hung up.

Whew.

But I barely had time to catch a breath before I got a call from another agent at "NATIONAL!" following up to see if they could answer any questions. I told him he had the wrong number (I had used a fake name in my online application as well).

Over the next 24 hours I got at least two dozen calls, from different area codes, from "NATIONAL!" wanting to talk to my fake alter ego. I kept telling them wrong number, but they were undeterred. My phone now appears to finally have quieted down.

So, wow. Granted that this was budget insurance I was shopping for, but talk about the ugly underbelly of capitalism.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Gatyr
Date Posted: 24 July 2009 at 9:17pm

choopie911 wrote:

I love it when people who have never been to Canada, and really know nothing about it, badmouth the medical system. It's just so ridiculous to see what they seriously think it's like here.

And based on a video done in Quebec, no less. That's like trying to buy a gun in California and saying it's tough to get a gun everywhere in the US.

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Posted By: choopie911
Date Posted: 24 July 2009 at 9:18pm

Wow that sounds like a pleasant, fullfilling, and safe system. I'm sure the elderly and undereducated love it.

Posted By: mbro
Date Posted: 25 July 2009 at 1:05am

choopie911 wrote:

Wow that sounds like a pleasant, fullfilling, and safe system. I'm sure the elderly and undereducated love it.

Especially after the Bush medicare reforms, that was a pleasant experience when my grandfather came down with alzheimer's and his meds weren't covered. Good times indeed. I had to deal with my grandfather not knowing who I was for three years and thinking I was stealing from him every time my grandma backed me a snack to bring home. Good times indeed.

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Don't blame me, I voted for Kodos.

Posted By: Bolt3
Date Posted: 25 July 2009 at 1:55am

Rofl, I wish I knew peter parker in real life.

Great stuff.

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<Removed sig for violation of Clause 4 of the New Sig Rules>

Posted By: Linus
Date Posted: 25 July 2009 at 7:36am

Peter Parker wrote:

Dealing with the guy who rolls in to the ER in the middle of a heart
attack is expensive, and right now that's on the taxpayer's dime
(assuming no private coverage). So we are already paying for this
guy. So my suggestion is that instead of waiting for him to have his
heart attack, we pay for annual checkups. This will catch his heart
issues early. We then pay for his heart medication. As a result, we
don't have to pay for his heart attack, and we save buckets of money.

Here's part of the fallacy-

Not all heart attacks, just as not all other diseases, can "be detected early" as is the normal train of thought. It's only a certain percentage that are 'caught' early. What are we going to do, load all people with Aspirin and Digoxin?

You can be perfectly healthy and end up getting a heart attack... happens all the time.

Now on to MY question--- Are you willing to pay a lot more in everything, such as taxes, so everyone gets healthcare? (I'm using this to set up a new point-- I know your answer)

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Posted By: oldsoldier
Date Posted: 25 July 2009 at 11:52am

A lot of preventable diseases can be prevented or delayed by personal responsibility. Our high perventage of overweight people is directly coralated to heart issues. And the invividual can be more responsible in diet and other personal healthcare issues and Doctors are not required except for inexpensive annual checkups. Like mentiond the overweight individual in a hospital gown standing in the outside smoking area smoking through his trac(sp) hole should not be my problem financially.

Sit in any ER and just watch an 8 hour shift, and ask yourself if the percentage of ptroblems presented are directly associated with personal health choices. Even accident victims, the result of drunk driving, gunshot wounds due to drug problems, the 450lb heart attack victim, the HIV positive individual going into final stage AIDS, etc. Each are the result of poor personal choices. And by some peoples logic, I should be financially responsible for these problems.

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Posted By: Peter Parker
Date Posted: 25 July 2009 at 12:15pm

Linus wrote:

Here's part of the fallacy-

Not all heart attacks, just as not all other diseases, can "be detected early" as is the normal train of thought. It's only a certain percentage that are 'caught' early. What are we going to do, load all people with Aspirin and Digoxin?

You can be perfectly healthy and end up getting a heart attack... happens all the time.

No fallacy at all. Certainly health issues vary widely. I was merely using this guy's heart attack as an illustrative example of how regular monitoring will result in net overall savings. Clearly we won't catch everybody early, and sometimes early detection won't make a difference, but do you really doubt that on the average, for all conditions, early stage detection and treatment is cheaper than late stage detection and treatment?

Now on to MY question--- Are you willing to pay a lot more in everything, such as taxes, so everyone gets healthcare? (I'm using this to set up a new point-- I know your answer)

Kind of, depends, and maybe.

I do believe that there is a fundamental moral imperative for a society such as ours to provide certain services to all members. I also believe that healthcare is one of these services.

BUT - healthcare is a "scarce resource." As a matter of reality we cannot provide unlimited healthcare to everybody. It just isn't feasible, regardless of moral imperatives. And beyond the impossibility, at some point the cost becomes so great that it infringes on other moral imperatives. That's the nature of moral imperatives - they compete with each other.

Therefore, as with any scarce resource, we have to balance. We have to balance the benefit against the cost in terms of total availability, and we have to balance against the cost for allocation. Basically we have to decide how much we are willing to spend TOTAL on healthcare, and then we have to decide how to allocate the healthcare we get.

This is the same analysis used for any scarce resouce - organ transplants, for instance.

So when you ask whether I would be willing to pay "a lot" more for universal coverage, I cannot answer directly, because it will always be a matter of balancing.

And if true universal coverage would cost a lot more than we are paying today, I might decide that the cost outweighs the benefits. As it turns out, however, I firmly believe, based on available evidence, that true universal coverage could and should be CHEAPER than what we have today. And against that backdrop I find the lack of true universal coverage morally indefensible.

But let me ask you the return question: First, take as a given that we already have limited universal coverage (you will get treated at the ER, regardless of insurance or finances). Would you be willing to stop this universal coverage, and simply decline treatment to anybody without proof of insurance or a credit card, if it would save us "a lot" of money overall? Would you, as an EMT, be willing to kick the heart attack guy out of your ambulance when you discover his insurance has expired?

Bolt3 wrote:

Rofl, I wish I knew peter parker in real life.

Great stuff.

Stop by any time. I promise I probably won't charge you.

(but IRL I am a grumpy old man. you would find me a bore.)

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Peter Parker
Date Posted: 25 July 2009 at 12:17pm

oldsoldier wrote:

A lot of preventable diseases can be prevented or delayed by personal responsibility. Our high perventage of overweight people is directly coralated to heart issues. And the invividual can be more responsible in diet and other personal healthcare issues and Doctors are not required except for inexpensive annual checkups. Like mentiond the overweight individual in a hospital gown standing in the outside smoking area smoking through his trac(sp) hole should not be my problem financially.

No doubt. Obviously and completely true.

And by some peoples logic, I should be financially responsible for these problems.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Mack
Date Posted: 25 July 2009 at 12:43pm

Peter Parker wrote:

No doubt. Obviously and completely true.

And by some peoples logic, I should be financially responsible for these problems.

Not "should," OS - ARE. You already ARE responsible for those problems. We already HAVE universal coverage at the ER. I am simply suggesting that we extend that coverage to prevention medicine so that we can cut our costs.

I vote we cut our costs by letting those that are suffering from the consequences of poor personal decisions pay the penalties for those decisions by themselves. (Whether that penalty is in additional personal medical costs, reduced quality of life or a shortened lifespan can be left up to the sufferers personal choices and financial status.)

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Posted By: Peter Parker
Date Posted: 25 July 2009 at 1:33pm

Mack wrote:

I vote we cut our costs by letting those that are suffering from the consequences of poor personal decisions pay the penalties for those decisions by themselves. (Whether that penalty is in additional personal medical costs, reduced quality of life or a shortened lifespan can be left up to the sufferers personal choices and financial status.)

A basic position with which we can all sympathize - but need I point out the obvious flaws and concerns?

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Bolt3
Date Posted: 25 July 2009 at 2:01pm

"Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission."

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

I don't think every single service has to utilize a for-profit business model. The practice stated above, and the countless horror stories I've heard of and seen are surprising, but what's more surprising is that plenty of people like it the way it is. I like what Bill Maher had to say about this:

"If conservatives get to call universal health care "socialized medicine," I get to call private health care "soulless vampires making money off human pain." The problem with President Obama's health care plan isn't socialism, it's capitalism."

http://www.huffingtonpost.com/bill-maher/new-rule-not-everything-i_b_244050.html

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<Removed sig for violation of Clause 4 of the New Sig Rules>

Posted By: Peter Parker
Date Posted: 25 July 2009 at 2:34pm

Bolt3 wrote:

I don't think every single service has to utilize a for-profit business model.

This, to me, is the crux of the issue. At some point Americans got this notion that "capitalism" and "free market system" means that any government involvement or program is bad or "socialist," when this is patently false. Capitalism is not anarchy. In fact, a properly running free market (as we know it) requires significant government involvement, and much of that MUST be on a not-for-profit model.

I have said it before, and I will say it again: I am a staunch supporter of the free market. I am a tremendous believer in the power of the market, and the ability of market forces to generate wealth. But I am also aware of limitations and effects of market forces, and I think this is where many of the knee-jerk self-declared "capitalists" in this country go wrong.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: choopie911
Date Posted: 25 July 2009 at 3:13pm

Its funny I saw an article yesterday about how the US needs to get over the "everything MUST make money" thing.

Posted By: oldsoldier
Date Posted: 25 July 2009 at 3:58pm

Even in true socialist or communist nations and societies the individual still believes that "everything must make money" be it done legally or in a "black market" enviornment. If doctors can not make the money they feel they should in a "universal" health care system, do not believe for a second that a "black market" form of medical care will become where care of a higher grade than "authorized" by some government beauracracy will become the norm. Underground medical care, ie abortions before legality, or legal drug underground markets are not unique to the american marketplace.
These imdividuals preaching a form of governmental health care fail to realize that it will only cause less availability as patient to doctor ratio increases, and longer waits for space and care become the norm, and a thrieving "black market" in medical care will begin, as Doctors frustrated with government run medicine conditions and turn in licenses to work underground for better conditions, for them and patients that have the ability to pay.

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Posted By: choopie911
Date Posted: 25 July 2009 at 4:10pm

Hahahahhahhhahaha, wait you think there's shady underground medical procedures running rampant in Canada's black-medical-market? Haha, I think you need your meds adjusted.

Posted By: Peter Parker
Date Posted: 25 July 2009 at 5:12pm

Man, this topic is bringing out the long-poster in me. Apparently I feel strongly on the subject.

oldsoldier wrote:

Even in true socialist or communist nations and societies the individual still believes that "everything must make money" be it done legally or in a "black market" enviornment.

But this is patently false - even in the US today. This, of course, is the grand irony. Americans are perhaps the most charitable people on the planet. We give more to charity, both of time and money, than most anybody else. We have more charitable - i.e. NOT-FOR-PROFIT - organizations than most anywhere else.

We, as Americans, as firm believers in the ideal that everything in fact does NOT have to make money.

Heck, a whole lot of hospitals are specific examples of non-profit organizations. Are are almost all private schools. Americans have no problem finding non-monetary motivation to do stuff.

We entrust our health and education to non-profit organizations all the time - but if it is a GOVERNMENT non-profit organization, suddenly we start proclaiming the need for a profit motive.

That doesn't seem entirely consistent.

If doctors can not make the money they feel they should in a "universal" health care system, do not believe for a second that a "black market" form of medical care will become where care of a higher grade than "authorized" by some government beauracracy will become the norm.

Ok - two things.

First, there are very few universal systems in the world that outright prohibit access to optional private medical care. Certainly nothing that has been suggested in the US would do that. This is a massive strawman with no basis in reality.

Second, why this focus on what is "authorized" by the government bureaucracy? This is the old "ZOMG the gubmint will ration our healthcare bit." Do you not think that your healthcare is already rationed, by the PRIVATE, FOR-PROFIT insurance companies?

Actually, you wouldn't know about that, because at the VA you get basically unlimited care. But for the rest of us, our private health insurance comes with all kinds of limits, caps, and exclusions. Tons.

In fact, most of us with "good" healthcare insurance still have caps that would come into play if we ever suffer a truly major injury or disease. This is why HEALTH PROBLEMS are the NUMBER ONE CAUSE of bankruptcy in the US. Not divorce, not job loss, not stupidity or credit cards. No: health problems. Congratulations - you have cancer with a side of bankruptcy.

And even if the treatment itself is covered, the results are usually not. This is why I carry supplemental disability insurance - to pay for all the costs of being disabled that are NOT covered by my overpriced health insurance (BTW, that disability insurance is not included in the $1,500/month I pay - that's extra).

You wouldn't know that either, because you consider disability benefits just another part of the stuff you get from your healthcare provider - the VA.

So I don't get the focus on government rationing. Our healthcare is rationed now - by private sector beancounters. Healthcare will always be rationed, it has to be. It is a scarce resource. This idea of unlimited healthcare is foolish.

These imdividuals preaching a form of governmental health care fail to realize that it will only cause less availability as patient to doctor ratio increases

And you know what? This is one of the ways we will save buckets of money. The simple truth is that we have TOO MUCH doctor involvement in the US. A whole lot of the procedures that are done by doctors (or 2 or three doctors) are done just fine by nurses or technicians in other places - and yet they seem not to keel over immediately.

This is a result of the way insurance companies pay the medical providers. Have a physician do something? Higher charge. Lack of competition to get physicians to stop doing unnecessary stuff? Physicians do everything, and they do lots of it. In the US, we are forever testing or everything. Tests here, tests there. Why? Because it is medically sound? No, because the providers get paid per procedure. So we have lots of unnecessary procedures.

Similarly, the equipment. US hospitals have tons of equipment. MRI machines all over the darn place. X-ray machines in every room in the dentist office. Full neo-natology gear in every birthing room. That's great and all, but it is really, really expensive. Most of these machines sit unused most of the time, but the way we pay our medical providers, equipment excess is practically required.

Other places get by just fine with less equipment, and instead just get more use from the gear they have. More money saved.

So yes, health reform would, or at least should, result in less doctor time, and less equipment everywhere. This is that "waste" stuff we keep talking about cutting out.

and longer waits for space and care become the norm,

First off, this whole longer wait business is also way overblown. Sure, there are ugly anecdotes. No doubt. And maybe there will be more of those ugly anecdotes in a reformed system. But overall, this just isn't how any of these systems work. Ask our resident Canadians, our Englishmen (or Scots, as the case may be), and the Europeans. Ask them if they feel they spend a lot of time waiting.

And second, just as importantly - this is another case of waste. Clearly we want our urgent procedures to be done urgently - but so much care frankly isn't urgent, or is at least infrequent.

I read someplace that the wait-time for a hip replacement in Canada is three months (I forget the actual number - but close enough) while it is one week in the US (same). Ok, advantage US. But here is the question: how many hip replacements do you plan on having in your lifetime? Max two, I would think. So, twice in your lifetime you have to manage on a bum hip for another couple of months. Sucks, but frankly it isn't the end of the world.

And here is the trick: If I offered you NOW (say, at age 25) the choice. You can either go with the three-month wait, if and when you need a hip, OR you can choose to pay an extra $50/month for the rest of your life, and then you can have the one-week wait for your future hip instead.

And you know what? For $50/month for a lifetime I don't mind waiting three months when I need that hip. That's some old-skool accountz receevabulz skillz right there.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: oldsoldier
Date Posted: 25 July 2009 at 5:12pm

In Canada's Doctor/Facility to patient ratio I do find it interesting that there are documented cases of Canadians having to go south to the US for care since the regional facity was full. The case of the lady that was denied entry into a Canadian maternity ward since it was full and then needed to cross the border to Montana to give birth. The population to doctor/facility ratio in Canada is a lot higher than the US patient to Doctor/facility ratio. Overload any system with something free and something within that system will breakdown, and free then equates to longer waits for less function.

Simple supply vs demand, If a community has 3 doctors and 100 available beds, and a base population of 2500, and you open the door to "free" healthcare with no restictions, nothing will go wrong? It is you that must check the meds.

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Posted By: slackerr26
Date Posted: 25 July 2009 at 5:16pm

oldsoldier wrote:

the HIV positive individual going into final stage AIDS, etc. Each are the result of poor personal choices.

wow. you are so wrong...

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Posted By: Peter Parker
Date Posted: 25 July 2009 at 5:24pm

Man, my mega-post got paged...

oldsoldier wrote:

In Canada's Doctor/Facility to patient ratio I do find it interesting that there are documented cases of Canadians having to go south to the US for care since the regional facity was full.

I don't doubt that for a second. And you know what else? I know of plenty of instances where Americans have sought healthcare abroad for things that were not covered here, or were beyond their insurance cap, or where the wait-time was too long.

This is less common than the other way around simply because our extensive private system doesn't have residency requirements, which most single-payer systems do. Most Americans don't have the option to go to Canada or Europe for care. Instead they just go untreated here at home. Yep, that's much better.

The case of the lady that was denied entry into a Canadian maternity ward since it was full and then needed to cross the border to Montana to give birth.

Yeah, that's MUCH better than what happened to me a year ago. Having learned from the first time around, I wanted to stay an extra few days in the hospital after the delivery of my second child. The hospital said it wouldn't be covered by the insurance. I told them I don't care, I'll pay cash. Turns out they needed the room for somebody else and kicked us out 23 hours after my child was born, despite some apparent medical concerns that later turned out to be quite serious.

Yep. Much better.

Overload any system with something free and something within that system will breakdown, and free then equates to longer waits for less function.

Simple supply vs demand, If a community has 3 doctors and 100 available beds, and a base population of 2500, and you open the door to "free" healthcare with no restictions, nothing will go wrong? It is you that must check the meds.

That doesn't make any sense. First off, suddenly your socialist system has "no restrictions" - which is strange since just one post earlier you were complaining about all the restrictions we would have in a socialized system.

And there would in fact be restrictions. Hospitals would not function as homeless shelters.

And even as to doctor visits - they aren't candy. People (on the whole) will not go to the doctor every day just because it is "free." There is no particular benefit to doing so, and people actually have other stuff to do.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Linus
Date Posted: 25 July 2009 at 6:44pm

Now on to MY question--- Are you willing to pay a lot more in everything, such as taxes, so everyone gets healthcare? (I'm using this to set up a new point-- I know your answer)

Kind of, depends, and maybe.

I do believe that there is a fundamental moral imperative for a society such as ours to provide certain services to all members. I also believe that healthcare is one of these services.

What about food, water, and shelter?

We're in agreement

I mean this next sentence in the most respectful way: You're not in healthcare. Having said that, I will explain why I mentioned it.

You are correct, any hospital getting any funds from the federal government HAS to provide life saving interventions to ANYbody. But here's the thing many people outside of healthcare don't know--- Hospitals go WAY beyond the minimum when providing help to the disadvantaged.

Hospitals will bend over backwards to find ways to accommodate the less fortunate. I've seen it. Anyone that works in this field has seen it.

On top of that; The majority of EMS personnel, along with the rest of healthcare, tend to be conservative in views, which is why you see Liberals in Congress vying for the AMA and other groups to swing in their favor.

We're in healthcare. It's quite obvious, or it should be, that we help sick people, regardless of their ability to pay. But you also have to remember that this is capitalism, and people DO profit on other peoples sufferings. If you disagree with this, then you need to start writing your congressman for free caskets for every dead person.

So, to answer your question: No, I wouldn't kick "the heartattack man" out of my ambulance, I don't know anyone who would, and I don't know a single doctor who would refuse to help him.

One last tidbit-

Every single major healthcare innovation in the past decade, if not longer, has come from America. Capitalism drives innovation. If there is no money to be made, there is little incentive to go through the decade of FDA trials and clinicals for drugs, procedures, or other things.

If you're fine with having 2009 period medicine for the rest of your life, so be it. But where is new innovation, drugs, and procedures supposed to come from if not from the US?

Let's spend the money on something that WILL have an actual positive impact on society--- Education. Do you realize how much good $100billion a year for 10 years can help school systems? With education, people will be able to afford their own insurance.

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Posted By: Bolt3
Date Posted: 25 July 2009 at 6:46pm

And I don't think every doctor's office will suddenly turn into walk-in clinics.

Appointments will still exist.

I'm planning to go into medicine myself after college. Someone mentioned that the salary of physicians will drastically decrease and thus decrease their motivation/care, etc. As a potential physician, I can say that is not a concern of mine, nor should it be a determining factor.

Or maybe I'm just naive.

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<Removed sig for violation of Clause 4 of the New Sig Rules>

Posted By: Peter Parker
Date Posted: 25 July 2009 at 8:14pm

Linus wrote:

I do believe that there is a fundamental moral imperative for a society such as ours to provide certain services to all members. I also believe that healthcare is one of these services.

What about food, water, and shelter?

As with healthcare, depends and maybe. There are no easy answers here, and all answers are time and place dependent.

With healthcare, we have some assurance that the nature of the service is abuse-proof. Generally speaking, people will not get sick or injured on purpose. While people may act somewhat more risky knowing there are no financial consequences, the reality is that most people's health-related decisions are health-motivated rather than financially motivated.

For instance, I choose not to jump out of the window not because I can't afford the hospital bill, but because I don't want to get hurt. All the "free" healthcare in the world wouldn't change that.

This is less true of food/water/shelter. Some/many people might indeed make "immoral" choices motivated by the safetynet of unlimited food. So here and now, I do not feel that there is as strong of a moral mandate for these services as for healthcare. That doesn't mean that there is none - I do feel we have a moral mandate to provide some degree of food/water/shelter, just not as broadly and extensively as for healthcare. There is no moral obligation to support abusive behavior.

The specific applications could easily change in the future, as society and our resources change.

I mean this next sentence in the most respectful way: You're not in healthcare. Having said that, I will explain why I mentioned it.

I suspect that I am closer to healthcare than you think - which is why I asked that question... :)

You are correct, any hospital getting any funds from the federal government HAS to provide life saving interventions to ANYbody. But here's the thing many people outside of healthcare don't know--- Hospitals go WAY beyond the minimum when providing help to the disadvantaged.

And this was indeed my point. We provide a healthcare safetynet not because the law says so, but because we recognize the moral imperative. Every healthcare provider lives the moral imperative, and the rest of us know it as well if we stop to think about it.

And as a result - this is what I keep saying - we already HAVE socialized medicine. We, individually and as a society, recognize that we have a moral obligation to provide healthcare to the extent possible - and at a minimum not to withhold basic healthcare simply due to financial causes.

The bottom line is that we do not think of healthcare in capitalist terms, and we haven't done so in decades, if not centuries. For generations we have known and recognized the duty to provide healthcare, and the discussionhas really been about "how" not "whether."

And this is why I find the whole discussion of healthcare in a purely free-market context silly and a waste of time, because that is simply the wrong paradigm.

On top of that; The majority of EMS personnel, along with the rest of healthcare, tend to be conservative in views

Now this is just a local viewpoint. I can absolutely GUARANTEE that this is not true on a national level, certainly not for all groups. Internationally it becomes more of an issue of definition, perhaps, but certainly among "Western" countries you are pretty darn wrong here.

But that really is an irrelevancy anyway - don't want to hijack.

One last tidbit-

Every single major healthcare innovation in the past decade, if not longer, has come from America. Capitalism drives innovation.

That's a rather bold claim that I would dispute, but also not hijack-worthy. I will certainly concede that the US is a major contributor to medical research.

If there is no money to be made, there is little incentive to go through the decade of FDA trials and clinicals for drugs, procedures, or other things.

If you're fine with having 2009 period medicine for the rest of your life, so be it. But where is new innovation, drugs, and procedures supposed to come from if not from the US?

Well.

First - we aren't going to "no money." That isn't on the table. Right now, the pharmaceutical industry (for instance) is one of the most profitable industries on the planet. Even if their profits were cut in half, they would still be one of the most profitable industries on the planet. "Cost reduction" is not the same as "nobody makes any money." Don't worry - people will continue to get rich from healthcare in the US for the foreseeable future.

Second - this may shock you, but there are in fact researchers in other parts of the world than here. So if the innovation doesn't come from the US, where would if come from? Answer: Everywhere else. But that really is moot - see "first."

Third - here is the thing about research: You know who is NOT conducting medical research? Nurses. EMTs. My pediatrician. My internist. Heck, most physicians. Hospital administrators. Insurance company executives. Accountants. And almost everybody else in this country involved in ACTUAL HEALTHCARE. And most of the waste in the US healthcare system has nothing to do with R&D costs, but inefficient application of the resources we have. Most of the changes that should happen would not affect the motivation of the medical researchers in any way.

Fourth - but you are right. As discussed earlier, we here in the US are subsidizing cheap drugs in the rest of the world by underwriting R&D, and that needs to change. This should be part of a change as well, and it could result in lower (but still large) profits for drug companies.

Fifth - ultimately: fear not. There will be plenty of money left to motivate good R&D. And to the extent that the lowered profits shifts some money away from healthcare R&D? Well, that R&D money will find another home, where it can be put to the best use. That is what market forces are for - the efficient allocation of capital.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: adrenalinejunky
Date Posted: 25 July 2009 at 8:47pm

Peter Parker wrote:

For instance, I choose not to jump out of the window not because I can't afford the hospital bill, but because I don't want to get hurt. All the "free" healthcare in the world wouldn't change that.

while i fully agree that the number of people abusing unlimited food would be higher, there are certianly people who would (and do) abuse the healthcare industry, hypocondriacs, munchauesens patients, addicts seeking pain killers, people faking illnesses so they can stay in a hospital room for a day or so, etc.

Posted By: Linus
Date Posted: 25 July 2009 at 9:01pm

I really can't phrase it better, as has been said elsewhere;

Make sure that when you file your tax returns next year, you don't get a refund but instead give it back to the government. Otherwise, stop trying to raise my taxes to pay for your beliefs.

Government run health care is NOT the end all, be all that people think it is. Take a look at ANY, and I mean ANY, government program that took tax money in an effort to "help those that need it." Name one program that has worked, without turning into a black hole of spending.

I don't have the answers to this problem, but I do know the answer doesn't lie with the government. To quote President Reagan, "The scariest words in the English language are, 'I'm from the government and I'm here to help.'

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Posted By: agentwhale007
Date Posted: 25 July 2009 at 9:10pm

Linus wrote:

Otherwise, stop trying to raise my taxes to pay for your beliefs.

SOCIETY DOES NOT WORK THAT WAY.

Posted By: Linus
Date Posted: 25 July 2009 at 9:12pm

And yet, the majority of the country is against the healthcare reform, but the minority is very well within reach of having it.

Weird.

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Posted By: Peter Parker
Date Posted: 25 July 2009 at 9:16pm

Linus wrote:

I really can't phrase it better, as has been said elsewhere;

"Make sure that when you file your tax returns next year, you don't get a refund but instead give it back to the government. Otherwise, stop trying to raise my taxes to pay for your beliefs.

First - I am quite confident that I am a net contributor. My taxes paid far exceed benefits received.

Second - You and I are both already paying for each other's beliefs through taxes. Taxes are not a check-the-box thing.

Third - I will keep repeating this: I VERY big part of why I support proper universal healthcare is because it will SAVE US MONEY. I pay $1,500/month in health insurance premiums, for healthcare coverage that is full of holes and limits. It is ridiculous. I am trying to REDUCE my healthcare expenditures.

Government run health care is NOT the end all, be all that people think it is.

As I have also said repeatedly, I don't care if this is a government program or not. I laid out my requirements for proper healthcare a page or two ago. "Government" was not on the list. I tend to think that is the best way, but it certainly is not the only way.

Take a look at ANY, and I mean ANY, government program that took tax money in an effort to "help those that need it." Name one program that has worked, without turning into a black hole of spending.

I guess it all depends on how you define "black hole of spending," but here are some examples:

- Public education
- Military intervention
- Police
- Fire Departments
- Child welfare services
- Prosecutors
- Orphanages
- Eldercare
- Special education
- Publicly funded research
- Public libraries

Ok - tired of typing. Basically, a whole bunch.

I don't have the answers to this problem, but I do know the answer doesn't lie with the government.

How could you possibly know that? As I keep asking of OS: Is our government so horrible that it cannot manage what every European government can?

To quote President Reagan, "The scariest words in the English language are, 'I'm from the government and I'm here to help.'"

Now, I happen to be a fan of old Ronnie, but let's not get too literal with his bumper stickers. For example, that phrase would be very welcome indeed under the right circumstances when uttered by any of the following people:

- Police
- Marines
- Firefighers
- Judge
- Physician

Again - somewhere along the line, (some) Americans picked up this irrationally extremist anti-government rhetoric. Now sure how or where, since it really makes no sense at all.

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: agentwhale007
Date Posted: 25 July 2009 at 9:16pm

Linus wrote:

minority is very well within reach of having it.

Right.

Bootstraps, etc.

Posted By: Peter Parker
Date Posted: 25 July 2009 at 9:18pm

Linus wrote:

And yet, the majority of the country is against the healthcare reform, but the minority is very well within reach of having it.

Weird.

Not weird at all, for two reasons:

1. This particular reform effort, as far as I can tell, is not very good. I certainly don't support it.

2. We have a REPRESENTATIVE democracy for a reason (the reason being so we don't end up like California).

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Linus
Date Posted: 25 July 2009 at 9:34pm

I know you're smarter then to not catch on to a philosophy.

Not to get too personal-- How do you pay $1,500 a month in insurance premiums? Someone in your family, or you, have a pre-existing condition? But honestly, if you can afford $18,000 a year in health insurance, I'm not too worried about you going broke ;)

- Public education
- Military intervention
- Police
- Fire Departments
- Child welfare services
- Prosecutors
- Orphanages
- Eldercare
- Special education
- Publicly funded research
- Public libraries

We can spend a crap more on Education. Again, $100billion a year would do wonders.

Firefighters and Police get paid WAY more then many people think. I know of a city, small in size, who starts their FD out at $50,000 FIRST YEAR, and by their 3rd year, are making close to $90,000.

Firefighters and police tend to retire with 90% revenue, meaning if they made $100,000 their last year there, they get $90k a year to retire. That's HUGE. Not saying I don't support it, but people need to realize how much money those places take... and JUST for personnel. That doesn't include the $300,000 quint, or $40,000 cruiser.

But for black holes I was aiming more for Medicare, Medicaid, support for 3rd world style nursing homes. I've experienced the waste... it's pitiful.

America already spend $2trillion on healthcare. What do we have to show for it?

Is our government so horrible that it cannot manage what every European government can?

Not a single European country has a population of over 300,000,000. TOTALLY different effect when it comes to providing something to everyone when you only have to do it for 10mil, even if you take GDP into effect.

It's not the governments job to provide everyone with healthcare. I haven't seen it stated in the Constitution. Not in the Bill or Rights. Not in the Declaration of Independence. Not even in the Confederate papers.

Again, I'm not against healthcare. I'm against the money being spent on the wrong thing. You honestly can not tell me putting the proposed healthcare budget into the education budget won't be better for the country as a whole.

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Posted By: Ken Majors
Date Posted: 25 July 2009 at 9:39pm

I couldn't read all of the above because it made me want to vomit in my mouth and it made my head hurt.

I have just a few things I wanted to add.

OS deserves to have his healthcare paid for....if you don't believe that....feel free to walk a mile in his shoes.

I believe that anyone who is carrying around steel in their body due to activity involving engaging an enemy of our country in combat at least deserves to be taken care of medically for the rest of their lives.

I also believe that we do need some sort of healthcare reform in this country.
But I know for a fact....that none of use here are smart enough to do it.
I just hope that somewhere in this country those people exist and can get it done before too long.

Sorry for not reading your completely obnoxious and judgemental posts.

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RLTW

Posted By: agentwhale007
Date Posted: 25 July 2009 at 9:45pm

Linus wrote:

America already spend $2trillion on healthcare. What do we have to show for it?

Interesting argument...for a revamped health care system

I haven't seen it stated in the Constitution. Not in the Bill or Rights. Not in the Declaration of Independence. Not even in the Confederate papers.

That's a silly argument. A lot of stuff are not in those documents that we still find to be important. Societies advance.

It doesn't say, for example, that the government needs to make sure that restaurants keep their kitchens in a sanitary condition. But we find that important enough.

Posted By: Linus
Date Posted: 25 July 2009 at 9:49pm

Interesting argument...for a revamped health care system

Yes... a system that the government has no part of.

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Posted By: agentwhale007
Date Posted: 25 July 2009 at 9:50pm

Ken Majors wrote:

OS deserves to have his healthcare paid for...

That is understood. It was part of the contract for his service. I doubt anyone is saying that this isn't the case.

The point that seems to be missed here by you is that it seems a bit hypocritical for OS, who receives health care via the government, to say that people who push for health care reform from the government are inherently wrong.

Posted By: Bolt3
Date Posted: 25 July 2009 at 9:54pm

Linus wrote:

America already spend $2trillion on healthcare. What do we have to show for it?

Lolwut?

And you're against any type of reform?

Edit: Whale was faster than me.

Linus wrote:

It's not the governments job to provide everyone with healthcare. I haven't seen it stated in the Constitution. Not in the Bill or Rights. Not in the Declaration of Independence. Not even in the Confederate papers.

So what is the point of having a federal government then?

I would argue one is to protect its citizens, against all types of foreign invaders, macroscopic and microscopic. ;)

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<Removed sig for violation of Clause 4 of the New Sig Rules>

Posted By: Linus
Date Posted: 25 July 2009 at 9:58pm

Bolt3 wrote:

And you're against any type of reform?

Who said I was against reform?

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Posted By: slackerr26
Date Posted: 25 July 2009 at 10:00pm

Ken Majors wrote:

OS deserves to have his healthcare paid for....if you don't believe that....feel free to walk a mile in his shoes.

we dont need to. it was his choice to join. if we wanted to walk in his shoes, we would join too

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Posted By: Peter Parker
Date Posted: 25 July 2009 at 10:03pm

Ken Majors wrote:

Sorry for not reading your completely obnoxious and judgemental posts.

And this, folks, is how you spell "irony."

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"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: jmac3
Date Posted: 25 July 2009 at 10:14pm

Well I am against Healtcare reform, because:

http://news.yahoo.com/s/nm/20090725/lf_nm_life/us_usa_politics_plumber - Joe The Plumber is

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Que pasa?

Posted By: Bolt3
Date Posted: 25 July 2009 at 10:17pm

jmac3 wrote:

Well I am against Healtcare reform, because:

http://news.yahoo.com/s/nm/20090725/lf_nm_life/us_usa_politics_plumber - Joe The Plumber is

"Wurzelbacher said he now attends "tea parties" -- held by Conservative groups to protest against economic policies they dislike -- and does not have time to work as a plumber."

Maybe if he worked a little more, and did a little less tea-bagging he would be able to pay his taxes.

"Reporters later learned that Wurzelbacher did not have a plumbing license, was behind on his taxes, had a real first name of Sam, and was unmarried with a teenage son."

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<Removed sig for violation of Clause 4 of the New Sig Rules>

Posted By: Peter Parker
Date Posted: 25 July 2009 at 10:30pm

Linus wrote:

Not to get too personal-- How do you pay $1,500 a month in insurance premiums?

I am self-employed. Thus I pay ACTUAL healthcare premiums, instead of only half like employees do. Most people paying $500-$700 (or whatever) each month think that's what their insurance costs. They are off by 100%.

Someone in your family, or you, have a pre-existing condition?

Nope - healthy non-smokers.

But think about the question you just asked. What does it say about our healthcare system when those in need of financial help the most are merely aided on their way to financial doom instead?

"Pre-existing conditions" is one of the central reasons why we need true universal coverage.

But honestly, if you can afford $18,000 a year in health insurance, I'm not too worried about you going broke ;)

You should be - I am.

I am going to keep harping on this until it catches on. If I get cancer it will bankrupt me unless I die fast. If I suffer major trauma and I can't sue somebody for a bucket of money over it, it will bankrupt me.

Check your health insurance policy. Look closely at the limits. Annual limits, lifetime benefit, etc. Most of us are not as protected as we think. One major illness will blow right through the coverage most of us have.

The leading cause of personal bankruptcy in the United States is illness. It is a major contributing cause in something like 55% of all bankruptcies.

It worries me a whole lot.

But for black holes I was aiming more for Medicare, Medicaid, support for 3rd world style nursing homes. I've experienced the waste... it's pitiful.

It was obvious where you were headed, so I didn't go there. My point here, as before, was that government actually does a pretty good job providing a host of valuable services at a pretty good price.

That is such a complete copout. Not to mention that it makes no sense. If it makes you feel better, we could have state-level programs. Is the government of France that much smarter than the government of Texas?

But there is no reason to believe that what can be done for 50,000,000 people cannot be done for 300,000,000. If anything, it should simply lead to greater efficiencies.

It's not the governments job to provide everyone with healthcare. I haven't seen it stated in the Constitution. Not in the Bill or Rights. Not in the Declaration of Independence. Not even in the Confederate papers.

What an odd statement. As pointed out by others, there is a bunch of other stuff the government does that is also not in the Constitution - like education.

But here is an exercise for you: do a search in any legal document of your choosing for the phrase "public health and safety." You will quickly discover that this phrase appears in countless statutes, regulations, court opinions, legislative communicados, and so forth. It is extraordinarily pervasive in the legal discourse in the country, and has been from the very beginning.

If it is not a function of the government to care for the public health, somebody ought to tell them - the government has apparently been wrong for the last 200 years or so.

Again, I'm not against healthcare. I'm against the money being spent on the wrong thing. You honestly can not tell me putting the proposed healthcare budget into the education budget won't be better for the country as a whole.

Ok - it still isn't taking: GOOD HEALTHCARE REFORM WILL SAVE US MONEY. There is no increased cost. There is a SAVINGS.

And, if you like, we could put some of that savings into education.

Oh, and why does Firefox hate me? I keep getting logged out for no reason. Usually in the middle of a post.

-------------

"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Linus
Date Posted: 25 July 2009 at 10:58pm

Peter Parker wrote:

It was obvious where you were headed, so I didn't go there. My point
here, as before, was that government actually does a pretty good job
providing a host of valuable services at a pretty good price.

Not the federale government. The state and local governments. Need we start bringing up all the "pork barrel" crap? I thought we all tired of it from last November?

Ok - it still isn't taking: GOOD HEALTHCARE REFORM WILL SAVE US MONEY. There is no increased cost. There is a SAVINGS.

And yet, there is the rush to find "where to get the couple of billion needed".

Oh, and why does Firefox hate me? I keep getting logged out for no reason. Usually in the middle of a post.

Did it to me twice in this thread.

I think FireFox hates universal healthcare.

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Posted By: jmac3
Date Posted: 25 July 2009 at 11:20pm

Linus wrote:

And yet, there is the rush to find "where to get the couple of billion needed".

Don't mind my made up numbers.

Raise everyones taxes by say $100. That goes to the government for universal healthcare.

Everyone now has healthcare.

You and your employers stop giving $200 to insurance companies.

You/employers save, government makes it and can now afford the billions.

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Que pasa?

Posted By: Linus
Date Posted: 25 July 2009 at 11:30pm

Screw it.

Give everyone $1,000,000. From this point on if someone falls in to poverty, they die.

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Posted By: jmac3
Date Posted: 25 July 2009 at 11:31pm

...

-------------
Que pasa?

Posted By: Peter Parker
Date Posted: 25 July 2009 at 11:31pm

Linus wrote:

Not the federale government. The state and local governments. Need we start bringing up all the "pork barrel" crap? I thought we all tired of it from last November?

I do believe I listed a handful of federal programs already...

But I'll throw in some more just for the heck of it:

- Federal judicial system

- FBI and pals

- US attorneys

- Federal judges

- Federal prison system

- And, you know, laws and stuff

- Education

- Federal funding, direct or indirect, for 90%+ of schools in the country

- Federally owned and operated educational facilities, like the Naval Academy

- Federal student loans and grants

- Federal funding for libraries

- Federally operated libraries

- Ditto for museums

- Science

- Federal funding for private research

- Federally operated research facilities, both military and civilian

- NASA

- See "museums" above

- Conservation

- Federal parks

- Federal lands management

- Wildlife preserves

- Federal programs targeting specific troubled species and ecosystems

And there's more. There is always more.

I will not say that all of these - or even any of these - could not be done better or more efficiently than they currently are. I am sure there is significant waste. But that isn't the question.

The question is whether the private sector would or could deliver these services cheaper or better than the government does, or even at all. And I suspect that if you look closely and think about it, you will discover that the answer in most cases is no.

Ok - it still isn't taking: GOOD HEALTHCARE REFORM WILL SAVE US MONEY. There is no increased cost. There is a SAVINGS.

And yet, there is the rush to find "where to get the couple of billion needed".

Two reasons - first, because the plan isn't a real universal health plan, but just more dinking around the edges.

Second, and more importantly, because Americans are so irrationally hung up on taxes. We are apparently incapable of figuring out that paying $1 in taxes to save $3 in other expenses is a good deal.

I keep hearing Americans complain about the awfully high taxes in Europe. But overwhelmingly the complainers fail to compare apples to apples.

Let's think about it. Hypothetical example (not real numbers, but not irrational and convenient for calculations):

American family:

- Pays $100k/year in income taxes, including medicare/medicaid, SS and state taxes.

- Pays $10k/year in health insurance premiums

- Puts aside $20k/year for retirement savings

- Puts aside $15k/year for college savings (and/or repaying college debt, whichever)

European family:

- Pays $145k in income taxes (only one tax, instead of state/fed+medicare etc.)

- Pays $0/year in health insurance premiums (covered by taxes)

- Puts aside $0/year for retirement savings (covered by taxes)

- Puts aside $0/year for college savings/loan repayment (covered by taxes)

Each family is net $145k/year out of pocket, for basically the same benefits. Yet all too often, hysterical Americans look at that and simply say "ZOMG HIGH EUROTAXES!"

More specific to this discussion, I will repeat what I have said many times before: If we are going to a single-payer system (which I think we should, but which unfortunately is not where we are headed), that has to be paid for. If is it government-funded, then taxes need to go up to pay for it. Obviously. BUT AT THE SAME TIME, I could stop paying Aetna $1,500/month. I would rather pay $500/month in extra taxes than $1,500/month to Aetna. That seems like a no-brainer to me.

-------------

"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Linus
Date Posted: 26 July 2009 at 12:03am

And I'd rather not provide healthcare to those who don't contribute a cent to it themselves. Call me selfish, but I feel people should work for what they get, and not expect it just for being born here instead of 30ft over the Rio Grande.

Having said that, you, or any person I have ever asked the question to, has yet to provide a legit answer-

Why is healthcare a right that everyone should get for free, but no push for food, water, or shelter?

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Posted By: jmac3
Date Posted: 26 July 2009 at 12:14am

Linus wrote:

And I'd rather not provide healthcare to those who don't contribute a cent to it themselves. Call me selfish, but I feel people should work for what they get,

You already pay for them.

Difference is you are also paying for yourself.

The people that do contribute, but can't afford health insurance are also paying for them.

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Que pasa?

Posted By: mbro
Date Posted: 26 July 2009 at 12:25am

Peter Parker wrote:

- Puts aside $20k/year for retirement savings

Americans saving money? You must be drunk.

Linus wrote:

And I'd rather not provide healthcare to those who don't contribute a cent to it themselves. Call me selfish, but I feel people should work for what they get, and not expect it just for being born here instead of 30ft over the Rio Grande.

Having said that, you, or any person I have ever asked the question to, has yet to provide a legit answer-

Why is healthcare a right that everyone should get for free, but no push for food, water, or shelter?

Ok first of all if the do it right everyone will pay at least something. Probably through a tax on unhealthy things such as soda, non olestra chips (the uncontrollable anal seepage makes them good for you). Second, you'd rather pay more for something just to prove a point to poor people rather than pay less, get more or at the worst off, the same, just to prove that point? Are you nuts?

Where is that Jesus guy when you need him about helping out those in need?

Also at least you can agree on federally funded prenatal care and all the costs of actually having a baby within a hospital so we can at least assure that the precious life that comes with a newborn starts off in the healthiest fashion possible?

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Don't blame me, I voted for Kodos.

Posted By: Linus
Date Posted: 26 July 2009 at 12:49am

mbro wrote:

Ok first of all if the do it right everyone will pay at least something.

Theoretically, EVERYONE should be paying something now, but we all know that's not true. This plan won't change anything.

Second, you'd rather pay more for something just to prove a point to poor people rather than pay less, get more or at the worst off, the same, just to prove that point? Are you nuts?

I'll say it again since people clearly miss it. I'm not against a healthcare reform. I'm against the government providing healthcare. HUGE difference.

Where is that Jesus guy when you need him about helping out those in need?

So you're telling me every single person that will get healthcare from that plan needs it? Need =/= want.

Also at least you can agree on federally funded prenatal care and all the costs of actually having a baby within a hospital so we can at least assure that the precious life that comes with a newborn starts off in the healthiest fashion possible?

And again;

I'm not against helping people. I'm against helping people that take advantage of the system.

You've obviously been paying NO attention to the Guatemalan vs Florida hospital court case, have you? Depending on how the courts rule, that can either save, or ruin, every single hospital in the US.

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Posted By: *Stealth*
Date Posted: 26 July 2009 at 1:03am

Linus wrote:

I'm not against helping people. I'm against helping people that take advantage of the system.
.

You must be against damn near every system instituted then...

Legal, health, defense, medical, educational...

If there is a system in place, if there are rules or guidelines - some people will find a way to exploit it, hell a person created it, a person will find a way to use it differently than intended.

Because there are some people who will exploit and rip something off, is not a legitimate reason for argument on why not to institute it.

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WHO says eating pork is safe, but Mexicans have even cut back on their beloved greasy pork tacos. - MSNBC on the Swine Flu

Posted By: Peter Parker
Date Posted: 26 July 2009 at 1:06am

Linus wrote:

And I'd rather not provide healthcare to those who don't contribute a cent to it themselves.

Hi, page 5 Linus. Meet page 4 Linus:

Linus wrote:

We're in healthcare. It's quite obvious, or it should be, that we help sick people, regardless of their ability to pay.

...

So, to answer your question: No, I wouldn't kick "the heartattack man" out of my ambulance, I don't know anyone who would, and I don't know a single doctor who would refuse to help him.

Back to page 5:

Call me selfish, but I feel people should work for what they get, and not expect it just for being born here instead of 30ft over the Rio Grande.

So you would rather be stuck with a horrifically inefficient and expensive system, JUST to make sure that heart-attack man doesn't get a free ride?

That's rather illogical. Cutting off nose to spite face, and so forth.

Having said that, you, or any person I have ever asked the question to, has yet to provide a legit answer-

Why is healthcare a right that everyone should get for free, but no push for food, water, or shelter?

I thought I gave a rather thoughtful answer to that, actually.

-------------

"E Pluribus Unum" does not mean "Every man for himself".

Pop Quiz: What do all the Framers of the Constitution have in common?

Posted By: Linus
Date Posted: 26 July 2009 at 1:10am

No, you never did. You worked your way around it bringing up another, quite well thought out, idea, but never answered what I asked directly. Unless I missed a whole paragraph.

Again... emergency medicine =/= long term care. You can't compare "heart attack man" to "ghetto man who fakes pain for drugs" or "haunky that would rather spend money on alcohol then his own health".

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Posted By: *Stealth*
Date Posted: 26 July 2009 at 1:26am

Linus wrote:

Again... emergency medicine =/= long term care. .

What's the difference?

With out long term care practices you're placing yourself in a position that will likely necessitate and emergency response.

What about the people with cardiac history, high cholesterol, diabetes, corrosive nerve damage? Every single one of them will be on the phone with 911 in a short amount of time with out a long term care plan.

In-fact,

I'm willing to wager that, given a long term care plan for every person, there would be a great deal fewer "emergency needs".

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WHO says eating pork is safe, but Mexicans have even cut back on their beloved greasy pork tacos. - MSNBC on the Swine Flu

Posted By: Linus
Date Posted: 26 July 2009 at 1:30am

His argument was would I kicked "heart attack man" out of my rig because he couldn't pay. "Heart attack man" is an emergent situation that needs to be dealt with.

Chronic alcoholic with thiamine deficiency? Not an emergency.

That's the difference.

PS-- You'd be surprised what people call 911 for, or consider an emergency. One example? Gas. Again, education is the answer, not free healthcare.

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Posted By: *Stealth*
Date Posted: 26 July 2009 at 1:42am

Linus wrote:

His argument was would I kicked "heart attack man" out of my rig because he couldn't pay. "Heart attack man" is an emergent situation that needs to be dealt with.

Chronic alcoholic with thiamine deficiency? Not an emergency.

That's the difference.

PS-- You'd be surprised what people call 911 for, or consider an emergency. One example? Gas. Again, education is the answer, not free healthcare.

I intern at a regional facility - no I wouldn't be.... unfortunately :P

As for the alchy, he is and isn't - just depends on how far into the future you want to consider.

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WHO says eating pork is safe, but Mexicans have even cut back on their beloved greasy pork tacos. - MSNBC on the Swine Flu