From: Peter on
"David J. Littleboy" <davidjl(a)gol.com> wrote in message
news:7aSdndejvpp9R0nWnZ2dnVY3goidnZ2d(a)giganews.com...
>
> "Peter" <peternew(a)nospamoptonline.net> wrote:
>> "David Ruether" <d_ruether(a)thotmail.com> wrote:
>>>
>>> I'm not much for conspiracy theories, but one of them does
>>> appear to stand out recently. The Republicans voted for the
>>> VERY expensive *unfunded* Medicare "Advantage" plan,
>>> and to me it appears likely to have been intended to bankrupt
>>> Medicare much sooner (the Republicans are not normally
>>> considered the party of public welfare...;-), and thus finally
>>> eliminate that "socialistic" program. Much as I personally like
>>> my Medicare Advantage plan (what's not to like about it,
>>> except what it would do to the future of Medicare funding),
>>> I would be quite willing to pay more for a "straight" form of
>>> Medicare, without the deceptions and nonsense. With the
>>> recent health care reform legislation, this change is likely to
>>> happen. I tend to see the financial area nonsense as a "Gee,
>>> how can we make it easy for our (rich) friends and us to
>>> make even more money, the industry (and country) stability
>>> be hanged!". Gosh, libertarian rapaciousness really CAN
>>> still operate even in a "socialist" economy...! 8^)
>>
>> To reform our Medicare system, just allow negotiation of drug prices. It
>> is outrageous that I can purchase my pharms in Canada for less money than
>> my co-pay here.
>
> Toss in single-payer and strict control of medical services fees (as done
> in Japan, where medical expenditures are 1/3 (per capita) those in the US
> and quality of care is better) and we can begin to make a dent in the Bush
> deficit.
>


Takes more than that. The issue is not so simple and fraught with political
pitfalls.
We also need to eliminate the need for defensive medicine.
Doctors, not insurance companies should control medicine.
We also need to maintain the right to see the doctor of our choice, provided
he/she is not so busy that patient care suffers. Some medical offices have
become factories. Medicine is not a commodity. Remember, the guy who
graduated last in his class in medical school is called "doctor."

--
Peter

From: David J. Littleboy on

"Peter" <peternew(a)nospamoptonline.net> wrote in message
news:4bd620a4$0$27728$8f2e0ebb(a)news.shared-secrets.com...
> "David J. Littleboy" <davidjl(a)gol.com> wrote:
>>>
>>> To reform our Medicare system, just allow negotiation of drug prices. It
>>> is outrageous that I can purchase my pharms in Canada for less money
>>> than my co-pay here.
>>
>> Toss in single-payer and strict control of medical services fees (as done
>> in Japan, where medical expenditures are 1/3 (per capita) those in the US
>> and quality of care is better) and we can begin to make a dent in the
>> Bush deficit.
>
> Takes more than that. The issue is not so simple and fraught with
> political pitfalls.

No, it really is quite simple: single-payer (with all the power and control
that implies, and that power and control being used to protect patients and
keep costs in control) and progressive (income-based) rates so everyone is
covered. Works great. But the political pitfalls bit is true.

> We also need to eliminate the need for defensive medicine.

This is basically wrong. The much ballyhooed (by the right) costs of
defensive medicine and malpractice insurance are a tiny (on the order of 1%
for the malpractive stuff) percentage of the costs. There simply aren't any
significant savings to be had. And to the extent that defensive medicine
reduces injury to patients, it's a very very good idea.

The reason that there are so many malpractice cases is that there's so much
malpractice and so many patients are hurt (the MGH killed my father through
a series of incredible stupidities). Lots of people are being hurt every
day. The doctors need to be doing their work a lot better. And the
malpractice system needs reform so that it provides compensation to a lot
more of the patients that are hurt: the two main problems with the current
system are (1) only a small percentage of hurt patients receive any
compensation, and (2) doctors who hurt patients aren't punished.

> Doctors, not insurance companies should control medicine.

No, a single-payer, income-tax-funded goverment agency should control all
non-elective medicine. It's too important to leave to a group with a vested
interest control. (It's also a problem that most doctors aren't really
scientists and most don't keep up with the literature. It's understandable,
since they need to put in long hours working. But they really don't have the
intellectual background to make the choices that need to be made.) We need a
strong committment to science-based medicine, and that won't come from the
working doctors. Or at least is getting a lot of opposition from them and
their conservative friends.

> We also need to maintain the right to see the doctor of our choice,
> provided he/she is not so busy that patient care suffers.

That's how Japan works. I take my insurance card to any private practice (or
other provider) I can lug myself to. (The major teaching hospitals try to
discourage walk-ins for minor things, but once you insist, they see you.)

Doing the insurance and control bit right does not preclude choice of
provider.

> Some medical offices have become factories. Medicine is not a commodity.
> Remember, the guy who graduated last in his class in medical school is
> called "doctor."

This is why doctors shouldn't control medicine. The good ones, the ones who
follow the literature, or who also have a PhD, or who work with scientists
on real science, are very good. But as a group, there's too much dreck.

--
David J. Littleboy
Tokyo, Japan


From: Ray Fischer on
Peter <peternew(a)nospamoptonline.net> wrote:
>"David J. Littleboy" <davidjl(a)gol.com> wrote in message

>> No, it really is quite simple: single-payer (with all the power and
>> control that implies, and that power and control being used to protect
>> patients and keep costs in control) and progressive (income-based) rates
>> so everyone is covered. Works great. But the political pitfalls bit is
>> true.
>
>Sorry. We disagree. My doctor friends and former clients will also
>disagree. Most people here will also disagree.

Why not simply annonuce that everybody agrees with you and skip the
bother of actually trying to justify your lunacy?

> Third party pay should be
>truly competitive.

And you "should be" a lot smarter.

> With a single payer, my life is in the hands of some
>bureaucrat.

Wingnut propaganda. Single-payer systems allow people to choose their
doctors and allow people to pay for extra services that they want.

> I will not accept that.

Unless that bureaucrat works for a corporation.

The difference is that the government employee ultimately works for
you while the corporate employee works for the shareholders.

> Yes, that type of system works very well
>in Japan.

It works very well in Canada and in Europe quite well also. In fact
the US system is the most expensive, by far, of any industrial nation
but with measurably poorer results.

--
Ray Fischer
rfischer(a)sonic.net

From: Peter on
"Ray Fischer" <rfischer(a)sonic.net> wrote in message
news:4bd7d490$0$1667$742ec2ed(a)news.sonic.net...
> Peter <peternew(a)nospamoptonline.net> wrote:
>>"David J. Littleboy" <davidjl(a)gol.com> wrote in message
>
>>> No, it really is quite simple: single-payer (with all the power and
>>> control that implies, and that power and control being used to protect
>>> patients and keep costs in control) and progressive (income-based) rates
>>> so everyone is covered. Works great. But the political pitfalls bit is
>>> true.
>>
>>Sorry. We disagree. My doctor friends and former clients will also
>>disagree. Most people here will also disagree.
>
> Why not simply annonuce that everybody agrees with you and skip the
> bother of actually trying to justify your lunacy?
>
>> Third party pay should be
>>truly competitive.
>
> And you "should be" a lot smarter.
>
>> With a single payer, my life is in the hands of some
>>bureaucrat.
>
> Wingnut propaganda. Single-payer systems allow people to choose their
> doctors and allow people to pay for extra services that they want.
>
>> I will not accept that.
>
> Unless that bureaucrat works for a corporation.
>
> The difference is that the government employee ultimately works for
> you while the corporate employee works for the shareholders.
>
>> Yes, that type of system works very well
>>in Japan.
>
> It works very well in Canada and in Europe quite well also. In fact
> the US system is the most expensive, by far, of any industrial nation
> but with measurably poorer results.
>



Once you start the name calling, the discussion discussion is over. Learn to
be civil!
Bye Ray!


--
Peter

From: David J. Littleboy on

"Peter" <peternew(a)nospamoptonline.net> wrote:
> "David J. Littleboy" <davidjl(a)gol.com> wrote:

>> "Peter" <peternew(a)nospamoptonline.net> wrote in message
>> news:4bd620a4$0$27728$8f2e0ebb(a)news.shared-secrets.com...
>
>>> Takes more than that. The issue is not so simple and fraught with
>>> political pitfalls.
>>
>> No, it really is quite simple: single-payer (with all the power and
>> control that implies, and that power and control being used to protect
>> patients and keep costs in control) and progressive (income-based) rates
>> so everyone is covered. Works great. But the political pitfalls bit is
>> true.
>
> Sorry. We disagree. My doctor friends and former clients will also
> disagree.

If the choice is a bureaucrat or an insurance company making health care
decisions, you want the bureaucrat. When push comes to shove, the bureaucrat
may be trying to save money, but s/he is also committed to getting good
results from the system (and the decisions on what to cover are a priori and
public). Insurance companies only care about the bottom line and thus impose
silly "rules".

Not only are the overall results of health care in Japan substantially
better than in the US, there is none of the amazing garbage that the
insurance companies inflict on people in the US. Everyone is covered.
Period. No one is refused care. Ever. Essentially no one goes bankrupt from
medical costs. If you get to an available doctor, you are treated. There was
a case here of a foreign woman who had been living here years without paying
her premiums. When she needed emergency surgery, she got it. The charge? She
had to pay her unpaid premiums (which came to a lot less than the cost of
the surgery). (Then the idiot foreigner activists went ballistic claiming
that that was unfair. ROFL. But I digress.)

> Most people here will also disagree. Third party pay should be
> truly competitive.

But it can't be competitive. When you need care, you can't change insurers;
it's too late.

Since single-payer just works, there's no need for letting the capitalist
pigs get their grubby paws on your life.

> With a single payer, my life is in the hands of some bureaucrat. I will
> not accept that.

You should not only acept it, but jump at it. That bureaucrat's main job
description is to make sure that you get the best care science can prove
works. As soon as there's an insurance company, the company's bottom line
becomes an issue. There really isn't time for that sort of BS when one is
sick.

> Yes, that type of system works very well
> in Japan. I'm sure you understand that, in many respects, Japanese people
> have different cultural characteristics than Americans.

Actually, I don't. At least in the sense that I've never seen an argument
based on "different cultural characteristics" that was anything other than
somewhere in the clear wrong to very silly to downright racist range of
things.

And cultural characteristcs hardly apply to the delivery of medical
servuces. There are things, like the lower level of obesity, that make it
easier to achieve better results. But

> e.g. How often have you heard of an American being decapitated by a train
> because he was bowing when getting off his cell phone. Another perhaps
> more
> relevant example: how many lawyers per capita are in Japan.

Americans can be pretty stupid, too. For example, this American almost got
decapitated by a Japanese train photographing it as it came into the
station. (Keeps this thread on-topic<g>.)

And while Japan has about 1/10 the number of lawyers they need, the US has
ten time what we need: we're both off by an order of magnitude. (I think the
US is erring on the right direction in this, though.)

>> The reason that there are so many malpractice cases is that there's so
>> much malpractice and so many patients are hurt:
>
> There is a vast difference between malpractice and honest error in
> judgment,
> or failure to perform some obscure test.

I'm not sure what your point is. Every serious study over the last 40 years
has concluded that malpractice is a major problem in the US (and that
frivolous cases are almost always rejected).

> A screening panel should be
> established to distinguish between the two.

Oops: You are advocating for more bureaucrats! (And you have a good idea.)

> Sorry about your father. Since I really don't know the facts, I cannot
> comment. However, most likely you sincerely believe what you say. You
> should
> ask if that colors your judgment on how best to reform the system.

It doesn't color my attitudes, at all (since father had Medicare, he had
single-payer). As you note below, it turns out that dealing with the medical
system requires that you or a relative or partner take charge, figure out
the problems involved, and make sure the doctors are doing their job. This
doesn't change with single-payer.

> Also, people must be proactive in dealing
> with their health care professionals. About a year ago my wife had a
> stroke. I suspected a stroke but the local ER doctor said they could not
> do
> a scan until Monday morning. (This was a Saturday night.) I insisted in
> immediate transfer to a
> different facility and after a somewhat heated discussion in which I
> threatened to take her in my car, they finally agreed. At the new hospital
> she received a proper
> diagnosis and prompt treatment. She has fully recovered and except for a
> slight limp has no signs of her stroke. Had she not received prompt
> treatment, the result may very well have been different.
> Did I mention that the argument used by the first ER was that the
> insurance
> would not pay for two ER visits in the same evening? I said I didn't care
> and no @#$! insurance company was going to dictate a medical decision.

Which, of course, proves my point. You really don't want commercial
interests involved in your medical care. Sure, the bureaucrat's job is to
keep costs down. But they do it a priori and transparently: what will be
covered is defined in advance (and is subject to public discussion), and all
you need is a doctor to sign off on it being necessary, which isn't a
problem since they get paid for running the procedure.

--
David J. Littleboy
Tokyo, Japan