Will ObamaCare Make Early Retirement More Difficult?

[Sailor Sam]

I actually came up with a rather simple, rules based compromise between a full blown single payer system and a totally unregulated market that would cover everyone to a basic level without permitting politics to distort what is covered and what is not.  I can't recall anyone ever being able to poke a hole in it yet.  Anyone game for that one?

These are the rules...

Just to make sure I understand, lets examine Acute Lymphoblastic Leukemia, the most common childhood cancer. In 1960 the treatment for Acute Lymphoblastic Leukemia was to pray a lot, and 5 year survival rates were around 10%. By the 1970's the survival rate was 50%. Currently, the 5-year survival rate is 98-99%, with 90% leukemia free for 10 years, which is considered cured.

Under your proposal, these kids could be treated with 1966 technology free of cost, but a treatment that virtually guarantees their remission would be an out of pocket cost?

Second case, my knee surgery didn't exist 50 years ago. It returned me to full function, and allowed me to keep my job. No surgery, no knee stability, no more job inside my profession. I would be strictly out of pocket for the diagnostics, the surgery, and the physical therapy, right?

[MoonShadow]

I actually came up with a rather simple, rules based compromise between a full blown single payer system and a totally unregulated market that would cover everyone to a basic level without permitting politics to distort what is covered and what is not.  I can't recall anyone ever being able to poke a hole in it yet.  Anyone game for that one?

These are the rules...

Just to make sure I understand, lets examine Acute Lymphoblastic Leukemia, the most common childhood cancer. In 1960 the treatment for Acute Lymphoblastic Leukemia was to pray a lot, and 5 year survival rates were around 10%. By the 1970's the survival rate was 50%. Currently, the 5-year survival rate is 98-99%, with 90% leukemia free for 10 years, which is considered cured.

Under your proposal, these kids could be treated with 1966 technology free of cost, but a treatment that virtually guarantees their remission would be an out of pocket cost?

Not necessarily, just not covered by the universal/single  payer system.  There would still be all the funding choices that currently exist; family insurance coverage, community donations & support, charities, etc.  There would also be a higher likelihood that said child could be sponsored, as the current law doesn't permit in-kind or corporate donations without limit.  Tiny Tim would be more likely to get support from Mr. Scrooge, because Mr. Scrooge can deduct all of his, very public, generosity; towards his employees or anyone else.

Second case, my knee surgery didn't exist 50 years ago. It returned me to full function, and allowed me to keep my job. No surgery, no knee stability, no more job inside my profession. I would be strictly out of pocket for the diagnostics, the surgery, and the physical therapy, right?

See above.  Same situations apply.  I would presume that your knee surgery was paid for by medical insurance, and you didn't pay for it out of pocket.  Again, insurance would still exist, and probably look much like it currently does, if that is what you want.  The 50 year rule is somewhat arbitrary, but there needs to be a significant delay there.  First, all patents need to have long been expired, so that the generic markets can stabilize & mature the pricing.  Second, it establishes a basic standard that is difficult to manipulate via the political process, because the history of medicine is easy to demonstrate.  In this way, all those indestructible, single twenty-somethings have a baseline of coverage, along with anyone else who happens to be in the territorial borders of the United States, regardless of their legal status.  If medical care is a human right, this is what that human right looks like.  Again, it's really about access to medical care; not the quality of that care.  Easily half of the population of the world outside of North America or Europe doesn't have access to this level of quality of health care.  Also, there is a decent chance that such a program would be relatively cheap, as at the moment this kind of taxpayer funded care already occurs due to the emergency service laws most states impose upon public hospitals, and much of those ER visits by the uninsured and/or territorially unlawful need not rise to the level of emergency care.

[Telecaster]

1)  If a medical procedure, service or medication existed in any documented fashion 50 years prior to January 1st of the current year, they are covered by the national, taxpayer supported, single payer system.  Period.  No committee debates about what should be covered, and to what degree, etc.  If the wealthiest person in the United States could buy the medical procedure 50 years ago, it's covered, but modern substitutions are not.  For example, the system would pay for the cost of a leg cast in the fashion that existed 50 years ago, but if that method is no longer in use, the system does not pay for the modern waterproof, exothermic, quick-setting version that is in common use today.  Not even at a partial degree.  If your doctor doesn't have the old method, or refuses to use it because it's antiquated, there is no payment at all from the national system

So no digital x-rays, no MRIs, no treatments for HIV/AIDs, no rubella or mumps vaccines-- actually quite a number of vaccines wouldn't be covered-- no arthroscopic surgery, no lithium battery powered pacemakers, no life-saving heart attack drugs like  tPA, no minimally invasive robotic surgery, virtually no fertility treatments, no statins...

Sounds like a dystopian hell hole of a medical system, based on blind dogma instead of science. 

Here's an idea:  If the public is going to pay for public health care (which we already do) then the focus on actually providing cost effective health care, instead of focusing on creating a completely arbitrary standard (must be 50 years old!).

I just can't wrap my brain around the fact that cost and effectiveness should have no role in public health care.  I would put those measures at the very top.   

[Spork]

Caveat: I haven't read most of the back-n-forth arguing.  I always skip those bits.  I generally come to this site to find things I have in common with folks.  When arguments break out, I start ignoring/skipping threads.

That said: I did see you were a physician.  I grew up in a physician's family and I can generally see things through my Dad's eyes.  I understand your frustration in this.  I am also a pretty extreme Capitalist/Libertarian type.  I am not pro-ACA.  But... I do take the subsidies.  I take them because the market changed in such a way that it was sort of impossible not to.  It is my unprovable theory that this was the intent... to make the market tip in such a way that uniform healthcare seems the only viable option. 

I am FIRE'd and living in a state with no income taxes... so I would pretty much be one of the freeloaders people are complaining about.  If my calculations are correct, I think I'll be paying no income tax this year.  I can't say I like the system, but it's the one we have.  Being Libertarian puts me in the serious minority for effecting change.  Outside of voting Libertarian and sending them money, I'm sort of out of options.

I too am more libertarian leaning.  I as you being human would take the subsidy.  You would be a fool not to take the free cash.  Especially since without it your costs actually 120%.  You may be correct that the long standing plan is to make our system so intolerable that the only option is a one payer system.  I just fear that this system will be as poor as medicare/medicaid which will drag down the quality of our physicians.  This fear is just one more reason why I save as much as I do so that I don't have to rely on the government for my paycheck.  And you know what, if at that point I am offered a subsidy for my health insurance.  I sure as hell will jump right on it.  Even though I despise the whole system.

The economic term that you are looking for here is "transaction friction".  There is a relatively high overhead on transactions & settlements in our current, insurance dominated, health care access system.  (Health care is not a human right, but access to health care probably is.  A free person always has the right to engage in business, including the business of providing or consuming health care services)  Obamacare didn't improve this 'friction', and seems to have made it worse overall.  Single payer would actually improve this portion of our system, which is overregulated and seriously outdated.  There is no rational reason that, in the age of the Internet, I shouldn't be able to know exactly how much a given service will cost me and from whom. 

Right on, thanks for the terminology.  I believe your assessment is exactly what is going on.  I can call 3 surgeon buddies of mine and ask them how much to remove my gallbladder and not a single one will know without running numbers through their collection service.  BTW, this service isn't cheap and adds to the cost of my procedure.

If the single payer is our government, then I fear it will come with increased bureaucratic red tape and the same pathetically low reimbursement drastically altering the lives of many physicians in this country.  Some would have to close their practices since Medicaid covers about 80% of the cost of the service. Also, look at how horrible the government handles medical care via the VA. I have worked in a VA hospital and their documentation and bureaucracy is much worse than the private sector.  We all had a saying "everything takes longer at the VA."  I hated working there so much.

A few ways we need to cut costs is:
1) Stop incentivizing patient satisfaction.  This leads to unnecessary testing. Which costs more and leads to false positive results and increased risk of unnecessary procedures which also increase cost.
2) Stop incentivizing pain control financially.  This has created a slew of opiate addiction in the US also  costing a fortune.
3) No more lawsuits unless there was malicious intent while allowing peers to scrutinize practice methods and enforcing continuing medical education or revocation of licensure if no improvement in quality of care.  Eliminating the fear of lawsuits will allow us to practice evidence based medicine instead of cover our ass medicine.  This measure will be huge, but will take maybe a decade or more to see its full results as we are trained to protect ourselves and this is a hard habit to break.
4) Stop providing end of life care to the brain dead.  Last I read, end of life care is 28% of the CMS budget.  We need to stop keeping the grandpa if he eats through a tube in his stomach and hasn't moved or said a word in years.
5) Allow physicians to institute DNR (do not resuscitate) at will.  It will allow us to stop bringing the braindead back to life like grandpa I alluded to in #4.
6) Stop performing Chemotherapy on those that have minimal chance of survival.  Chemo is ridiculously expensive and causes a lot of discomfort.  Allow people to die with dignity.
7) Outside of real emergency services, allow medical practices to compete in the open market for their clients and the services they provide.  Competition is great at hedging prices.  When I say Emergency services I don't mean going to the ER when you have a cough.  I mean heart attacks, strokes, surgical infections and the likes.
8) To make #7 work, we need to eliminate a ton of the bearocratic bullshit primary care doctors deal with so that they have more time to open up their schedules and see a patient in a timely manor when they are sick.  Today most offices will tell the patient to just go to the ER.  Great idea, lets convert a $100 visit into a $3000K visit.
9) Eliminate the 3rd payer model and eliminate this friction from the transaction.  The costs of the third payer is placed directly onto the consumer.  Lets cut out the middle man.

These ideas aren't so terrible.  Hold onto your backlash and hear me out.  None of these things would occur as succinctly as EnjoyIt puts it.  A doc wouldn't just walk in, do a lightning set of rounds, sign 3 DNRs and play a round of golf.

From my own experience, let me assure you doctors often put their entire heart and soul into single patients along the way.  I watched dad work 40+ hour shifts... then go home and sit in a chair and do nothing but think about the one complicated patient.  Doctors have the idea they can fix everyone.  That's part of the makeup that keeps them moving.  Unfortunately, they can't. 

If a Doc could write a DNR, I can assure you: it would go through a staff presentation and review before it happened.  It wouldn't be taken lightly.  It would be a doc presenting a failure to his peers and asking for mercy.

Long, involved deaths are hard on everyone: patient, family, doctors... everyone.  I just recently went through one.  In retrospect, I wish the doctors had given up sooner.  But there was always one with a plan that sounded hopeful.  And it's easy to grab onto hope.

[Schaefer Light]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

[bacchi]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

There are plenty of people in the US willing to become doctors. However, the "strongest trade union in the USA,"* in conjunction with the federal government, has effectively limited the number of doctors.

Before we hear about how we shouldn't let stupid people become doctors, medical school graduates have decreased in proportion to the population since about 1980. In other words, the supply/demand of physicians is an artificial scarcity.



* Milton Freidman about the AMA

[Schaefer Light]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

There are plenty of people in the US willing to become doctors. However, the "strongest trade union in the USA,"* in conjunction with the federal government, has effectively limited the number of doctors.

Before we hear about how we shouldn't let stupid people become doctors, medical school graduates have decreased in proportion to the population since about 1980. In other words, the supply/demand of physicians is an artificial scarcity.



* Milton Freidman about the AMA

My point wasn't going to be so much about scarcity as it was about rights and what the government must be willing to do if something is truly a right.  In my opinion, the government can only take away your rights.  It can't provide them.

[tipster350]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

There are plenty of people in the US willing to become doctors. However, the "strongest trade union in the USA,"* in conjunction with the federal government, has effectively limited the number of doctors.

Before we hear about how we shouldn't let stupid people become doctors, medical school graduates have decreased in proportion to the population since about 1980. In other words, the supply/demand of physicians is an artificial scarcity.



* Milton Freidman about the AMA

My point wasn't going to be so much about scarcity as it was about rights and what the government must be willing to do if something is truly a right.  In my opinion, the government can only take away your rights.  It can't provide them.

The same would be applied to teachers. We have to educate every child. Teaching has become a sucky profession lately. Maybe we won't have enough?. Let's round up some citizens and get 'em trained!

[Sailor Sam]

<request for clarification>

<discussion>

Okay, good. I hadn't realized you were still including some sort of medical insurance. I agree that even in a totally out of pocket system, Tiny Tim would probably be saved through donations. I don't think the same level of donation would appear for adults with knee injuries, but I could have leaned on my family and friends, and gone into debt. They in turn, could expect to lean on me. A system of barter that would (theoretically) be net neutral for monies, and probably good for community connection.

I did have insurance fix my knee. Tricare Prime. I was going to say the injury cost me nothing monetarily; but thinking back I did spend some gas driving to appointments, and I bought a couple ice packs. All told, no more than $100.

I won't be able to poke holes in your scenario to your satisfaction, because we don't agree on the first premise about 50-year-old medical procedures truly being access to medical care. As Telecaster pointed out, even dropping the window down to 15 years knocks out a huge portion of a doctor's arsenal. I agree that the ACA seems to be a many headed beast, and probably needs to be overhauled wholesale. I don't agree that your 50 year drag will make the market competitive. 

[randymarsh]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

Why does this insane hypothetical get brought up so often? In what universe is this even a possibility? Even it was, the government wouldn't need to force anyone. They can just sweeten the pot with things like loan forgiveness. The idea the police are going to put a gun to a surgeon's head if we institute healthcare as a right is a complete fantasy.

[Schaefer Light]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

Why does this insane hypothetical get brought up so often? In what universe is this even a possibility? Even it was, the government wouldn't need to force anyone. They can just sweeten the pot with things like loan forgiveness. The idea the police are going to put a gun to a surgeon's head if we institute healthcare as a right is a complete fantasy.

My whole point is that health care is not a right.  It may be a service that the government chooses to provide, but we shouldn't confuse it with things that are truly rights.

[randymarsh]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

Why does this insane hypothetical get brought up so often? In what universe is this even a possibility? Even it was, the government wouldn't need to force anyone. They can just sweeten the pot with things like loan forgiveness. The idea the police are going to put a gun to a surgeon's head if we institute healthcare as a right is a complete fantasy.

My whole point is that health care is not a right.  It may be a service that the government chooses to provide, but we shouldn't confuse it with things that are truly rights.

You're correct, we don't need healthcare to be a right to have a universal system. I'm just saying that if it was a right, that doesn't mean we're going to have doctor slaves. Just like the right to own a gun doesn't mean the government can force anyone to manufacture them.

[Schaefer Light]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

Why does this insane hypothetical get brought up so often? In what universe is this even a possibility? Even it was, the government wouldn't need to force anyone. They can just sweeten the pot with things like loan forgiveness. The idea the police are going to put a gun to a surgeon's head if we institute healthcare as a right is a complete fantasy.

My whole point is that health care is not a right.  It may be a service that the government chooses to provide, but we shouldn't confuse it with things that are truly rights.

You're correct, we don't need healthcare to be a right to have a universal system. I'm just saying that if it was a right, that doesn't mean we're going to have doctor slaves. Just like the right to own a gun doesn't mean the government can force anyone to manufacture them.

I would go a step further and say that the government also doesn't have the power to force anyone to be a doctor...or manufacture guns.

[FIRE me]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

I would say, pay doctors better. Make their education cost less to them. Then larger numbers of suitable people will want to be doctors.

I think you are more interested in making up imaginary issues, than solving actual problems. 

[monstermonster]

So I was ignoring this discussion for a bit because it got a bit more personal and attack-y than I would've liked but I wanted to throw this in here:

So I take a drug that is not required for me to be alive, but very likely makes the difference between me being on disability in my early 30's vs being a contributing working member of society paying taxes.

My drug costs $2800/month. About 1/3 of that cost is paid for by the drug manufacturer through their patient assistance program, and 2/3 of it is paid for by my employer-sponsored health care provider. I max out my out-of-pocket maximum 3 months into the year, and the rest of my care for the year is paid for by my insurance company.

"Specialty drugs" like mine make up less than 1 percent of all prescriptions for all of CalPERS (california state worker insurance) members but accounted for 30 percent of the total drug costs in 2014.  Specialty drugs specifically like mine (preventing/reducing disability for those with arthritis/chrones/lupus but not "saving my life") cost every person with insurance about $89 last year. (Insurers use a measure known as "per member per year".) As autoimmune disorders are on the rise, these drugs are expected to be used by more and more people.

Under a reformed health care system, should I be subsidized by other members? Other than this drug, I am an otherwise healthy young person who is contributing $20,000 of taxes each year (plus I like to believe the work I do is valuable).

Without it, I would cost more than this amount of money in SSD or other low-income assistance programs because I would be severely limited in my ability to hold a full-time job.

[EnjoyIt]

Why does this insane hypothetical get brought up so often? In what universe is this even a possibility? Even it was, the government wouldn't need to force anyone. They can just sweeten the pot with things like loan forgiveness. The idea the police are going to put a gun to a surgeon's head if we institute healthcare as a right is a complete fantasy.

Sweetening the pot via increased pay.  This is through loan forgiveness or increased reimbursement.  Which by the way will increase cost.

I have a nice example of this.  About 15 years ago Texas was losing its physicians due to low reimbursement rates and high rate of malpractice cases.  In 2003 Texas made a few changes which drastically cut lawsuits and increased reimbursement.  Doctors have been coming back to Texas since then.  The prospect of increased compensation once out of residency would definitely entice more people to go into medicine.  But this will take decades to see this plan reach fruition.  First the changes must be voted into law, followed by news to reach the US population.  Then a few years of increased reimbursement allowing college students to desire going to med school.  Schools will need to open its door to new trainees.  BTW, it costs about $100K to train a resident every year.  Obviously that cost will increase as well. 

Personally I think it is a great idea but it will cost money and take a lot of time to implement.

I think we need options today.  I thinking decreasing the bureaucracy of medicine, cutting the risk of law suits, and allowing allied health professions to do more as long as they are under the supervision of a physician can have some real benefits today.

[randymarsh]

You're correct, we don't need healthcare to be a right to have a universal system. I'm just saying that if it was a right, that doesn't mean we're going to have doctor slaves. Just like the right to own a gun doesn't mean the government can force anyone to manufacture them.

I would go a step further and say that the government also doesn't have the power to force anyone to be a doctor...or manufacture guns.

I don't think anyone said they did.

[randymarsh]

Under a reformed health care system, should I be subsidized by other members? Other than this drug, I am an otherwise healthy young person who is contributing $20,000 of taxes each year (plus I like to believe the work I do is valuable).

Of course. I'd say that regardless of how much tax you pay. That's just my view on morality though.

[Cassie]

My parents watched their own parents die slow and painfully in hospitals and did all the paperwork to make sure that did not happen to them.  They also had DNR's when the time was right. People don't need doctors to make these decisions.  I see among my friends with terminal illnesses that they have used hospice.  As for the person's basic medical plans to only cover stuff that was done 50 years ago that is just plain stupid and is like having no insurance at all.

[onlykelsey]

What sort of reform efforts are talked about in the medical education field?  I'm vaguely up to date on the NP/PA/CNM moves, and know that DO is getting more popular in part because it's a shorter and cheaper path.  Are there any proposals to, I don't know, create a single 7-year BA/MD program a la 6-year BA/JD programs?

[EnjoyIt]

What sort of reform efforts are talked about in the medical education field?  I'm vaguely up to date on the NP/PA/CNM moves, and know that DO is getting more popular in part because it's a shorter and cheaper path.  Are there any proposals to, I don't know, create a single 7-year BA/MD program a la 6-year BA/JD programs?

DO schools are just as long and actually much more expensive.  Usually the people who go them can't get into US medical schools.  This does not make them inferior physicians. Their residency training which is most important is side by side other MDs. 

[onlykelsey]

What sort of reform efforts are talked about in the medical education field?  I'm vaguely up to date on the NP/PA/CNM moves, and know that DO is getting more popular in part because it's a shorter and cheaper path.  Are there any proposals to, I don't know, create a single 7-year BA/MD program a la 6-year BA/JD programs?

DO schools are just as long and actually much more expensive.  Usually the people who go them can't get into US medical schools.  This does not make them inferior physicians. Their residency training which is most important is side by side other MDs. 

Interesting! I live near an OD college? center? university? and interview potential roommates, and they've all mentioned that the science pre-reqs are easier and it's a bit shorter.  I assumed the Caribbean medical school thing is also for folks who can't get in/are more competitive in that applicant pool?

To be clear, I wasn't saying above there shouldn't be any MDs.  If I end up with gestational diabetes, or were 5 years older, or pregnant with triplets, or needed a c-section, I'm very glad there are MDs around.  Just seems like so many of our day-to-day concerns don't need someone with half a million of training.  Out of curiosity, is there something about insurance reimbursement or culture or fiscal incentives or other requirements that mean MDs need to see more patients?  I feel like I've always spent more time with NPs and PAs (and now my CNM) than with my MDs.  I don't generally need handholding, but the CNM has been great for my first pregnancy since I have approximately 23944 questions.

[Daleth]

Healthcare fundamentally isn't a right. The ACA isn't a public good provided to everyone like parks and roads, it's a government transfer from the taxpayer to a special interest group, in this case the person who wants to pursue leisure at someone else's expense.

What about the person who wants to start their own business? Thanks to the ACA, they can now get affordable health insurance for themselves and their family. Before the ACA, they couldn't, so most of them--certainly most of those with families--would've just stayed in whatever soul-sucking job they had just to keep benefits. By leaving their job and starting a business, which is now possible thanks to the ACA, they can not only contribute more to the economy and the world, they free up whatever job they left (and potentially, with their new business, create still more jobs) for other people.

[bacchi]

I have a nice example of this.  About 15 years ago Texas was losing its physicians due to low reimbursement rates and high rate of malpractice cases.  In 2003 Texas made a few changes which drastically cut lawsuits and increased reimbursement.  Doctors have been coming back to Texas since then.  The prospect of increased compensation once out of residency would definitely entice more people to go into medicine.  But this will take decades to see this plan reach fruition.

There is no evidence of Texas losing physicians before tort reform.* While tort reform did decrease malpractice costs, it did not decrease health care costs.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2047433
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635882


* Look at the numbers; not the press releases.

[Schaefer Light]

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

Train more doctors.

And what if no one wants to be a doctor?  Does the government have the right to force people to be doctors?  It seems that they would if health care is truly a "right".

I would say, pay doctors better. Make their education cost less to them. Then larger numbers of suitable people will want to be doctors.

I think you are more interested in making up imaginary issues, than solving actual problems.

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

[randymarsh]

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

People get the difference. People don't understand why you think healthcare-as-a-right leads to enslavement of physicians. Whether healthcare is a right or not, that isn't going to happen. So stop using it as an argument against.

[Yaeger]

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

People get the difference. People don't understand why you think healthcare-as-a-right leads to enslavement of physicians. Whether healthcare is a right or not, that isn't going to happen. So stop using it as an argument against.

Because fundamentally rights are not provided by taking property or liberty from someone else. The right to bear arms doesn't involve the using government tax dollars to buy weaponry for private citizenry. Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

This is Justice Thomas' dissenting opinion in the abortion case yesterday that I found to be pretty interesting talking about the political relativity of these rights:

"Eighty years on, the Court has come full circle. The Court has simultaneously transformed judicially created rights like the right to abortion into preferred constitutional rights, while disfavoring many of the rights actually enumerated in the Constitution. But our Constitution renounces the notion that some constitutional rights are more equal than others. A plaintiff either possesses the constitutional right he is asserting, or not—and if not, the judiciary has no business creating ad hoc exceptions so that others can assert rights that seem especially important to vindicate."

[randymarsh]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

I'm not sure I understand what you mean by an "actual" amendment. Isn't the right to say, marry, just as equal as the right to own a gun even though there's no specific marriage amendment?

[beltim]

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

People get the difference. People don't understand why you think healthcare-as-a-right leads to enslavement of physicians. Whether healthcare is a right or not, that isn't going to happen. So stop using it as an argument against.

Because fundamentally rights are not provided by taking property or liberty from someone else. The right to bear arms doesn't involve the using government tax dollars to buy weaponry for private citizenry.

Do you consider national defense a right that citizens are entitled to?

[Yaeger]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

That's exactly what it'll do and that's what the argument is. What do you think classifying healthcare as a right entitles people to, and why do you think it's important that people recognize it as a right?

[Yaeger]

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

People get the difference. People don't understand why you think healthcare-as-a-right leads to enslavement of physicians. Whether healthcare is a right or not, that isn't going to happen. So stop using it as an argument against.

Because fundamentally rights are not provided by taking property or liberty from someone else. The right to bear arms doesn't involve the using government tax dollars to buy weaponry for private citizenry.

Do you consider national defense a right that citizens are entitled to?

No, but I recognize it as a legitimate and explicit role of government in maintaining a national defense force as spelled out in the Constitution Art 1 Sec 8 to protect the citizenry's right to life and liberty. Healthcare is not, and it's regulated to the states as a 10th Amendment issue.

[tonysemail]

That's exactly what it'll do and that's what the argument is. What do you think classifying healthcare as a right entitles people to

I'm kind of jumping in here randomly.
But there are many countries which have one payer system and nobody is conscripted into the medical profession as slaves.

We really don't need to theorize here.
The proof exists in the real world that many people still want to be doctors even with far lower wages than paid in the US.

[beltim]

Nope.  I'm simply interested in making sure that people understand the difference between rights and government-provided services.  The two are not the same.

People get the difference. People don't understand why you think healthcare-as-a-right leads to enslavement of physicians. Whether healthcare is a right or not, that isn't going to happen. So stop using it as an argument against.

Because fundamentally rights are not provided by taking property or liberty from someone else. The right to bear arms doesn't involve the using government tax dollars to buy weaponry for private citizenry.

Do you consider national defense a right that citizens are entitled to?

No, but I recognize it as a legitimate and explicit role of government in maintaining a national defense force as spelled out in the Constitution Art 1 Sec 8 to protect the citizenry's right to life and liberty. Healthcare is not, and it's regulated to the states as a 10th Amendment issue.

Interesting.  So you don't think that health care falls under the "general welfare" of the people?

[ooeei]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

I'm not sure I understand what you mean by an "actual" amendment. Isn't the right to say, marry, just as equal as the right to own a gun even though there's no specific marriage amendment?

You have the right to own a gun.  This doesn't mean someone must provide a gun to you, it means that nobody can stop you from buying a gun.

He's saying there is a right of access to healthcare, in that nobody can stop you from buying it.  What you SEEM to be saying (but maybe you're not) is that there is a right to healthcare in that if you are sick you get treatment whether you can pay or not.  This means you have the right to force someone else to give you treatment.

That's the difference.  Access vs provided to you.

[Yaeger]

Interesting.  So you don't think that health care falls under the "general welfare" of the people?

Nope. I'm not willing to throw everything under the sun into a vague statement that's followed by specifically enumerated powers directly below it. I don't believe healthcare, education, social security retirement, welfare programs, housing, food subsistence, drinking water, EPA guidelines, everything else under the sun, NONE of that stuff falls under that clause. Those things were problems in the 1700's and 1800's, and between the arguments of Madison, Hamilton, and Jefferson they didn't include them then. They specifically wrote the 10th Amendment to ensure that the states would have the power over the things which Art 1 Sec 8 didn't cover.

Moreover they're considered descriptors of the powers granted in the Constitution, not grants of general legislative powers.

[Schaefer Light]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

I'm not sure I understand what you mean by an "actual" amendment. Isn't the right to say, marry, just as equal as the right to own a gun even though there's no specific marriage amendment?

You have the right to own a gun.  This doesn't mean someone must provide a gun to you, it means that nobody can stop you from buying a gun.

He's saying there is a right of access to healthcare, in that nobody can stop you from buying it.  What you SEEM to be saying (but maybe you're not) is that there is a right to healthcare in that if you are sick you get treatment whether you can pay or not.  This means you have the right to force someone else to give you treatment.

That's the difference.  Access vs provided to you.

Thank you.  Exactly the point I was trying to make.  You did a better job, though.

[beltim]

Interesting.  So you don't think that health care falls under the "general welfare" of the people?

Nope. I'm not willing to throw everything under the sun into a vague statement that's followed by specifically enumerated powers directly below it. I don't believe healthcare, education, social security retirement, welfare programs, housing, food subsistence, drinking water, EPA guidelines, everything else under the sun, NONE of that stuff falls under that clause. Those things were problems in the 1700's and 1800's, and between the arguments of Madison, Hamilton, and Jefferson they didn't include them then. They specifically wrote the 10th Amendment to ensure that the states would have the power over the things which Art 1 Sec 8 didn't cover.

Moreover they're considered descriptors of the powers granted in the Constitution, not grants of general legislative powers.

Fair enough.  That's a well established position, although not the position of the Supreme Court for the last 80 years or so.  Thanks for answering.  Anyway, we're getting a bit far afield of the discussion.

[Gin1984]

Caveat: I haven't read most of the back-n-forth arguing.  I always skip those bits.  I generally come to this site to find things I have in common with folks.  When arguments break out, I start ignoring/skipping threads.

That said: I did see you were a physician.  I grew up in a physician's family and I can generally see things through my Dad's eyes.  I understand your frustration in this.  I am also a pretty extreme Capitalist/Libertarian type.  I am not pro-ACA.  But... I do take the subsidies.  I take them because the market changed in such a way that it was sort of impossible not to.  It is my unprovable theory that this was the intent... to make the market tip in such a way that uniform healthcare seems the only viable option. 

I am FIRE'd and living in a state with no income taxes... so I would pretty much be one of the freeloaders people are complaining about.  If my calculations are correct, I think I'll be paying no income tax this year.  I can't say I like the system, but it's the one we have.  Being Libertarian puts me in the serious minority for effecting change.  Outside of voting Libertarian and sending them money, I'm sort of out of options.

I too am more libertarian leaning.  I as you being human would take the subsidy.  You would be a fool not to take the free cash.  Especially since without it your costs actually 120%.  You may be correct that the long standing plan is to make our system so intolerable that the only option is a one payer system.  I just fear that this system will be as poor as medicare/medicaid which will drag down the quality of our physicians.  This fear is just one more reason why I save as much as I do so that I don't have to rely on the government for my paycheck.  And you know what, if at that point I am offered a subsidy for my health insurance.  I sure as hell will jump right on it.  Even though I despise the whole system.

The economic term that you are looking for here is "transaction friction".  There is a relatively high overhead on transactions & settlements in our current, insurance dominated, health care access system.  (Health care is not a human right, but access to health care probably is.  A free person always has the right to engage in business, including the business of providing or consuming health care services)  Obamacare didn't improve this 'friction', and seems to have made it worse overall.  Single payer would actually improve this portion of our system, which is overregulated and seriously outdated.  There is no rational reason that, in the age of the Internet, I shouldn't be able to know exactly how much a given service will cost me and from whom. 

Right on, thanks for the terminology.  I believe your assessment is exactly what is going on.  I can call 3 surgeon buddies of mine and ask them how much to remove my gallbladder and not a single one will know without running numbers through their collection service.  BTW, this service isn't cheap and adds to the cost of my procedure.

If the single payer is our government, then I fear it will come with increased bureaucratic red tape and the same pathetically low reimbursement drastically altering the lives of many physicians in this country.  Some would have to close their practices since Medicaid covers about 80% of the cost of the service. Also, look at how horrible the government handles medical care via the VA. I have worked in a VA hospital and their documentation and bureaucracy is much worse than the private sector.  We all had a saying "everything takes longer at the VA."  I hated working there so much.

A few ways we need to cut costs is:
1) Stop incentivizing patient satisfaction.  This leads to unnecessary testing. Which costs more and leads to false positive results and increased risk of unnecessary procedures which also increase cost.
2) Stop incentivizing pain control financially.  This has created a slew of opiate addiction in the US also  costing a fortune.
3) No more lawsuits unless there was malicious intent while allowing peers to scrutinize practice methods and enforcing continuing medical education or revocation of licensure if no improvement in quality of care.  Eliminating the fear of lawsuits will allow us to practice evidence based medicine instead of cover our ass medicine.  This measure will be huge, but will take maybe a decade or more to see its full results as we are trained to protect ourselves and this is a hard habit to break.
4) Stop providing end of life care to the brain dead.  Last I read, end of life care is 28% of the CMS budget.  We need to stop keeping the grandpa if he eats through a tube in his stomach and hasn't moved or said a word in years.
5) Allow physicians to institute DNR (do not resuscitate) at will.  It will allow us to stop bringing the braindead back to life like grandpa I alluded to in #4.
6) Stop performing Chemotherapy on those that have minimal chance of survival.  Chemo is ridiculously expensive and causes a lot of discomfort.  Allow people to die with dignity.
7) Outside of real emergency services, allow medical practices to compete in the open market for their clients and the services they provide.  Competition is great at hedging prices.  When I say Emergency services I don't mean going to the ER when you have a cough.  I mean heart attacks, strokes, surgical infections and the likes.
8) To make #7 work, we need to eliminate a ton of the bearocratic bullshit primary care doctors deal with so that they have more time to open up their schedules and see a patient in a timely manor when they are sick.  Today most offices will tell the patient to just go to the ER.  Great idea, lets convert a $100 visit into a $3000K visit.
9) Eliminate the 3rd payer model and eliminate this friction from the transaction.  The costs of the third payer is placed directly onto the consumer.  Lets cut out the middle man.

These ideas aren't so terrible.  Hold onto your backlash and hear me out.  None of these things would occur as succinctly as EnjoyIt puts it.  A doc wouldn't just walk in, do a lightning set of rounds, sign 3 DNRs and play a round of golf.

From my own experience, let me assure you doctors often put their entire heart and soul into single patients along the way.  I watched dad work 40+ hour shifts... then go home and sit in a chair and do nothing but think about the one complicated patient.  Doctors have the idea they can fix everyone.  That's part of the makeup that keeps them moving.  Unfortunately, they can't. 

If a Doc could write a DNR, I can assure you: it would go through a staff presentation and review before it happened. It wouldn't be taken lightly.  It would be a doc presenting a failure to his peers and asking for mercy.

Long, involved deaths are hard on everyone: patient, family, doctors... everyone.  I just recently went through one.  In retrospect, I wish the doctors had given up sooner.  But there was always one with a plan that sounded hopeful.  And it's easy to grab onto hope.

But it is not up to a doctor or his peers to kill someone.  Because that is what Enjoy is wanting.  Taking someone's life, which is what a DNR is doing, without their consent is murder.  The fact that this is acceptable to a doctor and frankly to others sickens me.

[abhe8]

No, letting someones die is not the same as taking someone's life. One is murder, one is inevitable. No patient has the rightt to demand a treatment or medication and receive it. That is why it takes a doctor's order for a rx med . Precisely because it is thought someone without a medical license could not safely decide if the med should be used or not.

[tonysemail]

irony : what one person perceives as murder is seen by another as an act of compassion

[randymarsh]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

That's exactly what it'll do and that's what the argument is. What do you think classifying healthcare as a right entitles people to, and why do you think it's important that people recognize it as a right?

No, it won't. Healthcare is a right in numerous European countries and there are no doctor slaves. This idea is like the claim that the ACA created "death panels". It's fear mongering that has no basis in reality.

I never said we should recognize it as a right. I said IF we did, it would not lead to the enslavement of doctors. I cannot believe this is controversial. Australia and Japan have universal systems but have not declared healthcare a right. That's fine with me as well.

[MoonShadow]

1)  If a medical procedure, service or medication existed in any documented fashion 50 years prior to January 1st of the current year, they are covered by the national, taxpayer supported, single payer system.  Period.  No committee debates about what should be covered, and to what degree, etc.  If the wealthiest person in the United States could buy the medical procedure 50 years ago, it's covered, but modern substitutions are not.  For example, the system would pay for the cost of a leg cast in the fashion that existed 50 years ago, but if that method is no longer in use, the system does not pay for the modern waterproof, exothermic, quick-setting version that is in common use today.  Not even at a partial degree.  If your doctor doesn't have the old method, or refuses to use it because it's antiquated, there is no payment at all from the national system

So no digital x-rays, no MRIs, no treatments for HIV/AIDs, no rubella or mumps vaccines-- actually quite a number of vaccines wouldn't be covered-- no arthroscopic surgery, no lithium battery powered pacemakers, no life-saving heart attack drugs like  tPA, no minimally invasive robotic surgery, virtually no fertility treatments, no statins...

Not yet, anyway; at least not on the dole.  Again, all of the systems that we presently have would still exist, the 50 year baseline rule is just a backstop for those who "fall through the cracks" or otherwise choose to gamble with doing without medical insurance for a time, and lose that bet.

Sounds like a dystopian hell hole of a medical system, based on blind dogma instead of science. 

Sounds like you don't have any idea what I was talking about.

Here's an idea:  If the public is going to pay for public health care (which we already do) then the focus on actually providing cost effective health care, instead of focusing on creating a completely arbitrary standard (must be 50 years old!).

I just can't wrap my brain around the fact that cost and effectiveness should have no role in public health care.  I would put those measures at the very top.

If you actually understood what I had just done with my rules, you'd realize that is exactly what I just did.  The US medical system used to be the highest quality care available in the world (we can leave aside the argument about whether it still is for now), but it remains the most expensive.  It is expensive, because quality is expensive.  The 50 year baseline rule (it could be 40 or 30, whatever.  Just has to be several years longer than the longest possible patent term, to give the generic market an opportunity to mature the market for that service/product and establish an accurate labor time and/or common cost) exists to establish that as the minimum standard of care, and gives doctors & other service providers the option to provide for the minimum quality care, or not.  I suspect that most would simply refuse to do so, and would generally provide the best care they could in most cases.  So I am attempting to maximize two desirable variables here at the same time; cost effectiveness and quality.  The key to doing this right is allowing for variation, and letting the public gravitate towards the best for them.  Over time & across the country, the medical industry would shift towards maximizing value, which is literally the combination of optimizing both cost & quality.

Also, there wouldn't need to be a payment structure.  This could all be paid for by documenting these minimum standard treatments, and then settling up with the government on tax returns.  Said in a more familiar way, payments for the minimum standards of care could be claimed on a doctor's, nurse-prac's or hospital's tax returns as a refundable tax credit.  The only snag is that such claimable care could only be claimed by a registered medical professional, and the documentation requirements might be a burden unto themselves.  Fortunately, we already track most medical professionals, so no problems there, unless someone wanted to claim a homebirth to pay their (not licensed) midwife.

[Shane]

Caveat: I haven't read most of the back-n-forth arguing.  I always skip those bits.  I generally come to this site to find things I have in common with folks.  When arguments break out, I start ignoring/skipping threads.

That said: I did see you were a physician.  I grew up in a physician's family and I can generally see things through my Dad's eyes.  I understand your frustration in this.  I am also a pretty extreme Capitalist/Libertarian type.  I am not pro-ACA.  But... I do take the subsidies.  I take them because the market changed in such a way that it was sort of impossible not to.  It is my unprovable theory that this was the intent... to make the market tip in such a way that uniform healthcare seems the only viable option. 

I am FIRE'd and living in a state with no income taxes... so I would pretty much be one of the freeloaders people are complaining about.  If my calculations are correct, I think I'll be paying no income tax this year.  I can't say I like the system, but it's the one we have.  Being Libertarian puts me in the serious minority for effecting change.  Outside of voting Libertarian and sending them money, I'm sort of out of options.

I too am more libertarian leaning.  I as you being human would take the subsidy.  You would be a fool not to take the free cash.  Especially since without it your costs actually 120%.  You may be correct that the long standing plan is to make our system so intolerable that the only option is a one payer system.  I just fear that this system will be as poor as medicare/medicaid which will drag down the quality of our physicians.  This fear is just one more reason why I save as much as I do so that I don't have to rely on the government for my paycheck.  And you know what, if at that point I am offered a subsidy for my health insurance.  I sure as hell will jump right on it.  Even though I despise the whole system.

The economic term that you are looking for here is "transaction friction".  There is a relatively high overhead on transactions & settlements in our current, insurance dominated, health care access system.  (Health care is not a human right, but access to health care probably is.  A free person always has the right to engage in business, including the business of providing or consuming health care services)  Obamacare didn't improve this 'friction', and seems to have made it worse overall.  Single payer would actually improve this portion of our system, which is overregulated and seriously outdated.  There is no rational reason that, in the age of the Internet, I shouldn't be able to know exactly how much a given service will cost me and from whom. 

Right on, thanks for the terminology.  I believe your assessment is exactly what is going on.  I can call 3 surgeon buddies of mine and ask them how much to remove my gallbladder and not a single one will know without running numbers through their collection service.  BTW, this service isn't cheap and adds to the cost of my procedure.

If the single payer is our government, then I fear it will come with increased bureaucratic red tape and the same pathetically low reimbursement drastically altering the lives of many physicians in this country.  Some would have to close their practices since Medicaid covers about 80% of the cost of the service. Also, look at how horrible the government handles medical care via the VA. I have worked in a VA hospital and their documentation and bureaucracy is much worse than the private sector.  We all had a saying "everything takes longer at the VA."  I hated working there so much.

A few ways we need to cut costs is:
1) Stop incentivizing patient satisfaction.  This leads to unnecessary testing. Which costs more and leads to false positive results and increased risk of unnecessary procedures which also increase cost.
2) Stop incentivizing pain control financially.  This has created a slew of opiate addiction in the US also  costing a fortune.
3) No more lawsuits unless there was malicious intent while allowing peers to scrutinize practice methods and enforcing continuing medical education or revocation of licensure if no improvement in quality of care.  Eliminating the fear of lawsuits will allow us to practice evidence based medicine instead of cover our ass medicine.  This measure will be huge, but will take maybe a decade or more to see its full results as we are trained to protect ourselves and this is a hard habit to break.
4) Stop providing end of life care to the brain dead.  Last I read, end of life care is 28% of the CMS budget.  We need to stop keeping the grandpa if he eats through a tube in his stomach and hasn't moved or said a word in years.
5) Allow physicians to institute DNR (do not resuscitate) at will.  It will allow us to stop bringing the braindead back to life like grandpa I alluded to in #4.
6) Stop performing Chemotherapy on those that have minimal chance of survival.  Chemo is ridiculously expensive and causes a lot of discomfort.  Allow people to die with dignity.
7) Outside of real emergency services, allow medical practices to compete in the open market for their clients and the services they provide.  Competition is great at hedging prices.  When I say Emergency services I don't mean going to the ER when you have a cough.  I mean heart attacks, strokes, surgical infections and the likes.
8) To make #7 work, we need to eliminate a ton of the bearocratic bullshit primary care doctors deal with so that they have more time to open up their schedules and see a patient in a timely manor when they are sick.  Today most offices will tell the patient to just go to the ER.  Great idea, lets convert a $100 visit into a $3000K visit.
9) Eliminate the 3rd payer model and eliminate this friction from the transaction.  The costs of the third payer is placed directly onto the consumer.  Lets cut out the middle man.

These ideas aren't so terrible.  Hold onto your backlash and hear me out.  None of these things would occur as succinctly as EnjoyIt puts it.  A doc wouldn't just walk in, do a lightning set of rounds, sign 3 DNRs and play a round of golf.

From my own experience, let me assure you doctors often put their entire heart and soul into single patients along the way.  I watched dad work 40+ hour shifts... then go home and sit in a chair and do nothing but think about the one complicated patient.  Doctors have the idea they can fix everyone.  That's part of the makeup that keeps them moving.  Unfortunately, they can't. 

If a Doc could write a DNR, I can assure you: it would go through a staff presentation and review before it happened. It wouldn't be taken lightly.  It would be a doc presenting a failure to his peers and asking for mercy.

Long, involved deaths are hard on everyone: patient, family, doctors... everyone.  I just recently went through one.  In retrospect, I wish the doctors had given up sooner.  But there was always one with a plan that sounded hopeful.  And it's easy to grab onto hope.

But it is not up to a doctor or his peers to kill someone.  Because that is what Enjoy is wanting.  Taking someone's life, which is what a DNR is doing, without their consent is murder.  The fact that this is acceptable to a doctor and frankly to others sickens me.

@Gin1984,

Is it possible you may have misunderstood what @EnjoyIt meant? His post that seemed to really upset you didn't seem offensive to me at all. Apparently others agree as well.

@EnjoyIt's ideas for lowering the costs of healthcare seemed like mostly good ones to me. I'd be much more worried about doctors giving me false hope and encouraging me or one of my family members to try endless invasive procedures like chemo or whatever, when in reality there is no hope of a recovery, than I am about a doctor telling me the truth that I or my loved one is going to die and the best thing would be to just go home and enjoy the remaining days as best as we can.

As someone mentioned above in the thread, doctors and other medical professionals generally report not wanting to die in a hospital, because they see how bad it sucks every day. If lay people knew what doctors and nurses know about end of life care, many more of us would probably choose to get a big DNR tatooed across our chests.

A Radiolab podcast called The Bitter End talks about the disparity between what doctors want for their own end of life care and what the general public generally want. It's a pretty interesting episode. If you listen to it, it may help you to understand a little more about where Dr. EnjoyIt is coming from... :)

[Yaeger]

No, it won't. Healthcare is a right in numerous European countries and there are no doctor slaves. This idea is like the claim that the ACA created "death panels". It's fear mongering that has no basis in reality.

I never said we should recognize it as a right. I said IF we did, it would not lead to the enslavement of doctors. I cannot believe this is controversial. Australia and Japan have universal systems but have not declared healthcare a right. That's fine with me as well.

Okay, so a non-right doesn't trump my Constitutional right that protects my property and my labor. So you have no argument in forcing people to pay for anyone else's healthcare in a universal or single-payer system.

Also, isn't the argument towards supporting a medicare-for-all system in creating a monopsony with the express purpose of giving the payer (government) more leverage over the providers to force them to accept additional conditions and restrictions for the benefit of the patient?

[goatmom]

I have a nice example of this.  About 15 years ago Texas was losing its physicians due to low reimbursement rates and high rate of malpractice cases.  In 2003 Texas made a few changes which drastically cut lawsuits and increased reimbursement.  Doctors have been coming back to Texas since then.  The prospect of increased compensation once out of residency would definitely entice more people to go into medicine.  But this will take decades to see this plan reach fruition.

There is no evidence of Texas losing physicians before tort reform.* While tort reform did decrease malpractice costs, it did not decrease health care costs.

Texas is now the hardest place to get a medical license.  They are very picky about who can get licensed.  This is due to the number of physicians that are moving there.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2047433
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635882


* Look at the numbers; not the press releases.

Texas is now the hardest place to get a medical license.  They are very picky about who can get licensed.  This is due to the number of physicians that are moving there.  Anything questionable on your record, not much of a chance of getting a license.

[Spork]

[ lots of quoted stuff removed for bevity ]
But it is not up to a doctor or his peers to kill someone.  Because that is what Enjoy is wanting.  Taking someone's life, which is what a DNR is doing, without their consent is murder.  The fact that this is acceptable to a doctor and frankly to others sickens me.

I believe what is being suggested is this:  The doctor, with peer review, should always be on the spot to be able to answer the question "Can we make this person better with the technology at hand?"  Sadly, for all of us, at some point the answer to this is "no."

This isn't "Hey, Doc, when you're done here can you run by Mrs. Smith's room and administer an overdose?"  Instead it is "If Mrs. Smith codes...  it is in her own best interest to not respond."
This is a very emotional (even for the doctors) decision that they've done all they can do.

People can and do live for a long time with a DNR.  My mom had one for a couple of years.  My dad was in the hospital for 3 months with a DNR before he finally was able to scribble "hospice" on a white board.  Dad was a doctor.  He DID NOT want to die the way he died.  It was very long and drawn out and emotionally awful.

[randymarsh]

No, it won't. Healthcare is a right in numerous European countries and there are no doctor slaves. This idea is like the claim that the ACA created "death panels". It's fear mongering that has no basis in reality.

I never said we should recognize it as a right. I said IF we did, it would not lead to the enslavement of doctors. I cannot believe this is controversial. Australia and Japan have universal systems but have not declared healthcare a right. That's fine with me as well.

Okay, so a non-right doesn't trump my Constitutional right that protects my property and my labor. So you have no argument in forcing people to pay for anyone else's healthcare in a universal or single-payer system.

Also, isn't the argument towards supporting a medicare-for-all system in creating a monopsony with the express purpose of giving the payer (government) more leverage over the providers to force them to accept additional conditions and restrictions for the benefit of the patient?

I'm not really sure what you're saying. Whether healthcare is a right or not, we could have universal system funded by taxpayers. There are numerous arguments in favor of this and they've been discussed over and over in many threads. I know you don't agree with them, but they exist.

Yes, I'd say one argument in favor of Medicare-for-all is higher leverage, particularly for drugs. I'm not sure what you're getting at. Doctors in other countries still make fine wages.

[MoonShadow]

Also, you're essentially saying that someone's non-Constitutional 'right' to healthcare is more important than someone's Constitutional right to their property, that whole individual property rights thing covered by an actual Amendment.

Where did I do that? That's not what I'm saying. I'm saying that if healthcare were a right, it would not lead to individuals being forced against their will to practice medicine. Just like how right now gun ownership is a right and it has not led to individuals being forced to manufacture weapons.

That's exactly what it'll do and that's what the argument is. What do you think classifying healthcare as a right entitles people to, and why do you think it's important that people recognize it as a right?

No, it won't. Healthcare is a right in numerous European countries and there are no doctor slaves. This idea is like the claim that the ACA created "death panels". It's fear mongering that has no basis in reality.

I never said we should recognize it as a right. I said IF we did, it would not lead to the enslavement of doctors. I cannot believe this is controversial. Australia and Japan have universal systems but have not declared healthcare a right. That's fine with me as well.

Open slavery, no.  But I would like to point out that doctors in the United Kingdom are, effectively, government employees.  Their jobs are so regulated, regimented & defined, that there is nearly zero variation in their jobs from one public hospital to the next.  It was only a month or so ago that the "Young Doctors" actually staged a national strike, mostly because their scheduled hours where so high, and their pay was suppressed.  So while "slavery" is a very charged word in this context, and you obviously can't wrap your mind around the comparison, the average doctor, too young to have a teaching position or tenure, does not have much control over his own destiny unless s/he moves to the United States.  Stop and think about this fact for a moment, how many English speaking foreign born doctors have you encountered in your life?

[Yaeger]

I'm not really sure what you're saying. Whether healthcare is a right or not, we could have universal system funded by taxpayers. There are numerous arguments in favor of this and they've been discussed over and over in many threads. I know you don't agree with them, but they exist.

Yes, I'd say one argument in favor of Medicare-for-all is higher leverage, particularly for drugs. I'm not sure what you're getting at. Doctors in other countries still make fine wages.

I'm not sure what value you give real rights then. From your arguments, and others, it seems like you're supporting the general concept of 'the ends justifies the means'. It also seems to fit the general notion that you believe a legitimate role of government is to more equitably redistribute income through various programs like healthcare based on whatever subjective criteria that corresponds to your political ideology.

[MoonShadow]

No, it won't. Healthcare is a right in numerous European countries and there are no doctor slaves. This idea is like the claim that the ACA created "death panels". It's fear mongering that has no basis in reality.

I never said we should recognize it as a right. I said IF we did, it would not lead to the enslavement of doctors. I cannot believe this is controversial. Australia and Japan have universal systems but have not declared healthcare a right. That's fine with me as well.

Okay, so a non-right doesn't trump my Constitutional right that protects my property and my labor. So you have no argument in forcing people to pay for anyone else's healthcare in a universal or single-payer system.

Also, isn't the argument towards supporting a medicare-for-all system in creating a monopsony with the express purpose of giving the payer (government) more leverage over the providers to force them to accept additional conditions and restrictions for the benefit of the patient?

I'm not really sure what you're saying. Whether healthcare is a right or not, we could have universal system funded by taxpayers.

Yaeger is saying that he has a constitutionally protected right to keep his own property, and therefore taxing him in order to pay for something that is not a constitutionally protected right would be theft from himself.