I've come to realize that the newer buzzword seems to be "Universal Coverage" instead of "Socialized Medicine". The plans that I read about seem to want to construct a government mandated system that incorporates all the HMOs and insurance companies.
I think this is wrong. One of the problems with our system is that it's got too many fingers in the pie. I'm in favor of a single payer, British style system or else keeping the present free for all we have now. I think the Democrats, who are the most likely to be in favor of a big government program like this, are too afraid to take on the powerful lobbies of HMOs and Insurance companies.
If we come up with a hybrid system like is being proposed, we are in for even more regulatory confusion and mess than we are even seeing now.
I think a single payer, government run socialized system is the best option. I also think that there must be strict tort reform that goes along with it to protect healthcare providers from frivilous lawsuits.
I like the comment that someone made back a few pages that healthcare should be thought of as the same importance as roads, bridges, and other infrastructure that the government funds. The health of individuals is important for society as a whole, since we are all interlocking and interdependent parts of humanity.
Health care isn't the same thing, except to the extent of government involvement. In this case, government involvement would CREATE just the problem meant to be avoided by government involvement in your examples. At issue isn't the need to ensure more or less global involvement to achieve a community outcome. Health care is an individual need, in the same category as food and shelter.
As such, the purpose of government funding would be to subsidize some care at the expense of others. Essentially, I could live with that. Gov't restricted health care goes further. It's not just about ensuring access, but ensuring more or less 'equal' access. Most that advocate federal involvement believe it is an issue of fundamental fairness. I disagree that the government can ensure 'fairness' without also ensuring mediocrity.
However, if 'fairness' is the issue, then there can be no ability to 'opt out' of the government's scheme. First, the government would cost over-run and be forced, in short order, into a massive escalation of taxation that would crowd out any ability to opt out for all but the extremely wealthy. Even so, the ACT of opting out would be viewed by the new health care regime as 'unfair', and so, limited.
It's not about subsidizing care nearly so much as it's about limiting available options, in the name of so-called 'fairness'. It doesn't seem very fair to me.
The chief problem with treating health care as a 'common' resource is that the act of doing so will ultimately destroy the resource. Services like roads, defense and postal service are subject to more or less unlimited use by maintaining the infrastructure. Health care, however, is a finite commodity. As such, treating it as a 'common' resource would subject it to a social trap called the 'tragedy of the commons':
Essentially, by making a resource 'free', the effect is to encourage its overuse. For example, the EMTALA law essentially made access to Emergency Rooms 'free' if somebody is determined not to pay. The result? Over-utilization of our EDs. It's a 'tragedy of the commons'. UHC will only make all health care resources over-utilized and worse than EDs (because for some of us that actually have to pay a co-pay to use the ED, it is still a guarded commodity - we watch how we use it. Under UHC, that wouldn't be the case, for anybody.)
Those that advocate the collectivization of resources believe that, given the opportunity, people will be generally altruistic. I do believe people to be relatively altruistic, as a rule. However, in reality, people will generally act in their own best interests, even at great cost to the community. Or, as one of my former teachers that lived in the Ukraine used to quote about communism, "So long as they pretend to pay us, we'll continue to pretend to work." It's a basic issue of human motivation. We are motivated by our own best interests and that rarely changes if we are asked to take the community into account. It's a nice sentiment that we would all look out for each other, but such relationships must be individually negotiated and will not and cannot occur due to government compulsion.
Health care isn't the same thing, except to the extent of government involvement. In this case, government involvement would CREATE just the problem meant to be avoided by government involvement in your examples. At issue isn't the need to ensure more or less global involvement to achieve a community outcome. Health care is an individual need, in the same category as food and shelter.
As such, the purpose of government funding would be to subsidize some care at the expense of others. Essentially, I could live with that. Gov't restricted health care goes further. It's not just about ensuring access, but ensuring more or less 'equal' access. Most that advocate federal involvement believe it is an issue of fundamental fairness. I disagree that the government can ensure 'fairness' without also ensuring mediocrity.
potentially the systemc could continue in the US as itis except it would all be single payer....
equally once it;s moved to single payer 'fixed price' procedures / admissions may become the norm meaning some of the mechanisms of chargeing could be removed / scaled back
However, if 'fairness' is the issue, then there can be no ability to 'opt out' of the government's scheme. First, the government would cost over-run and be forced, in short order, into a massive escalation of taxation that would crowd out any ability to opt out for all but the extremely wealthy. Even so, the ACT of opting out would be viewed by the new health care regime as 'unfair', and so, limited.
except of course the evidence base from elsewhere in the world doesn't suggest this, traps are well known - and often were a function of a vast under-provision prior - under provision of plant , equipment and to some extent staffing isn't an issue in the US (as seen by the stories of people being given time off due to low census...)
It's not about subsidizing care nearly so much as it's about limiting available options, in the name of so-called 'fairness'. It doesn't seem very fair to me.
'want' vs. 'need' comes into it
opting out is not impossible in the Uk but quite why anyone wouldwish to opt out of the emergency care provision or the provision for potentially extremely costly treatment is not based in rational thought - yes opting out to beat the 18 week target is self centred and ultimately an expression of consumer choice ...
yes the NHS doesn't cover some stuff but when we are talking aobut comestic procedures for none- clinicla reasons or repeated attempts at assisted conception interventions - should the tax payer be payifg for this anyway as there is no clinical need ?
The chief problem with treating health care as a 'common' resource is that the act of doing so will ultimately destroy the resource. Services like roads, defense and postal service are subject to more or less unlimited use by maintaining the infrastructure. Health care, however, is a finite commodity. As such, treating it as a 'common' resource would subject it to a social trap called the 'tragedy of the commons':
Essentially, by making a resource 'free', the effect is to encourage its overuse. For example, the EMTALA law essentially made access to Emergency Rooms 'free' if somebody is determined not to pay.
EMTALA would hav to be redrafted under UHC - becasue paying for ED care wouldn't be an issue - and everyone would have 'free at the point of delivery ' access to primary care... so it is then safe and approrpaite to direct those with none emergent problems to other providers
as an example in the Uk we often redirect 'minor illness' that presents to the ED out of office hours to the ' out of hours' Primary care service that PCTs are manadated to provide...
discharge prescriptions whether fro mthe OOH primary care service or the Ed wouldbe charged at the standard NHS primary care prescription charge ( assuming the patient isn't one ofthe large numbers of peopel who areexempted or have a 'season ticket')
The result? Over-utilization of our EDs. It's a 'tragedy of the commons'. UHC will only make all health care resources over-utilized and worse than EDs (because for some of us that actually have to pay a co-pay to use the ED, it is still a guarded commodity - we watch how we use it. Under UHC, that wouldn't be the case, for anybody.)
assumes that there would be no change to systems other than a move to single payer rather than the single payer taking control off access and response for primary care to provide a sensible service in a timely manner 24/7/365
Those that advocate the collectivization of resources believe that, given the opportunity, people will be generally altruistic. I do believe people to be relatively altruistic, as a rule. However, in reality, people will generally act in their own best interests, even at great cost to the community. Or, as one of my former teachers that lived in the Ukraine used to quote about communism, "So long as they pretend to pay us, we'll continue to pretend to work." It's a basic issue of human motivation. We are motivated by our own best interests and that rarely changes if we are asked to take the community into account. It's a nice sentiment that we would all look out for each other, but such relationships must be individually negotiated and will not and cannot occur due to government compulsion.
~faith,
Timothy.
an almost Godwinian moment there where once again UHC gets compared to leninist/ stalinist Communism
perhaps the site needs a version of Godwin's law for UHC discussions - the first person to mention leninist/ stalinist Communism loses ...
an almost Godwinian moment there where once again UHC gets compared to leninist/ stalinist Communism
perhaps the site needs a version of Godwin's law for UHC discussions - the first person to mention leninist/ stalinist Communism loses ...
Not at all. Godwin's Law normally refers to Nazism. But to the extent it might deal with communism, it doesn't prevent direct comparisons when direct comparison are on point. Both concepts deal with forced collectivization of resources. It's more than perfectly reasonable to point out the abject failures of previous attempts to implement similar ideas.
It's not hyperbole, and certainly not extreme hyperbole to compare apples to apples. Socialism is what it is, whether you are talking about Lenin or health care. It is subject to the same flaws. At least in GB, y'all aren't afraid of CALLING it socialized medicine.
americans pay the highest health care taxes in the world. we pay for national health insurance, but don’t get it.
(woolhandler, et al. “paying for national health insurance — and not getting it,” health affairs 21(4); july / aug. 2002)
i personally would rather see all of us pay a 2% income tax and have everyone covered. (with medicare we are already paying a 1.2% tax. why not replace that and the existing health insurance premium structure with a simple efficiently collected payroll tax?)
workers up to 200% of poverty pay a medicare tax and yet are unable to purchase medical insurance through their employers.
in the conservative nanny state mythology, the government is run by
hopelessly inept bureaucrats who bury everything they touch with red tape. as a
result, almost by definition the government is wasteful and inefficient. the term
private insurance costs 25% at best to administer while medicare can be administered for 3% which is replicated in other countries with uhc. i just don't think that the private sector can manage this efficiently enough.
Specializes in LTC, assisted living, med-surg, psych.
Let me ask you this, why would nobody be able to 'opt out'? If it's such a good idea, why couldn't it compete for a place at the table? Or rather, if you have to compel participation, aren't you admitting that it's not really a good idea for those you would compel? Aren't you really pointing out the inherent flaw of such a system, that it could only be supported through compulsion?
~faith,
Timothy.
This isn't a very good argument against universal health care. By law, we have to do a number of things we wouldn't do if we had a choice. Do we get to choose whether or not to purchase auto insurance? Hardly---every state has some sort of compulsory insurance law. Do we get to choose whether or not to pay taxes? Are you kidding? And we certainly don't get to choose where the money goes.....my taxes go toward all sorts of things I don't believe in, but I pay 'em. So why shouldn't yours go toward providing health care to every American citizen?
Unless, of course, you want to talk about getting rid of the income tax entirely, which is something we would more than likely agree on.
Let me ask you this, why would nobody be able to 'opt out'? If it's such a good idea, why couldn't it compete for a place at the table? Or rather, if you have to compel participation, aren't you admitting that it's not really a good idea for those you would compel? Aren't you really pointing out the inherent flaw of such a system, that it could only be supported through compulsion?
~faith,
Timothy.
Actually, I think you answered your own question here:
From you earlier:
"Those that advocate the collectivization of resources believe that, given the opportunity, people will be generally altruistic. I do believe people to be relatively altruistic, as a rule. However, in reality, people will generally act in their own best interests, even at great cost to the community. "
So, no, I don't think it's admitting an inherent flaw upfront. I think it's attempting to close a loophole that, frankly, too many people would step right up to take.
In the end I applaud this inclusion. Too few polticos want to talk about the numbers of people who CAN afford insurance but just won't. Why should they? It'll be covered through ER visits/etc. and everybody else ends up paying for it in the end.
Me? I guess I'd rather pay a bit more up front then pay on the back end with higher costs of everything else because Joe Shmoe wanted to play the odds or was just too irresponsible to do the right thing.
I personally would rather see all of us pay a 2% income tax and have everyone covered.
Is that 2% before or after the trillion dollar cost overruns?
Is it before or after Americans, used to services on demand, - DEMAND an end to rationed care? You can't end rationed care. It must be rationed, by dollars or waits. Unlimited demand = unlimited supply (an impossibility) or, rationed supply.
In fact, if you use Medicare as an example, you aren't even close. In 1965, proponents of Medicare predicted that it would NEVER cost more than 1% of income tax and would cost 9 Billion by 1990. In 1990, we spent 67 Billion on Medicare, a cost overrun of 700 PERCENT.
This isn't a very good argument against universal health care. By law, we have to do a number of things we wouldn't do if we had a choice.
But ALL of those things are designed to solve the free rider problem of economics: ensuring those that would not pay voluntarily to pony up for public projects.
In the case of UHC, you would CREATE the free rider problem by socializing it.
There is a difference in making sure that all drivers pay a share for the roads and using the welfare state to ensure/enforce a substandard level of care for all. One is a public project and the other is essentially a direct transfer of wealth at the expense of a far superior system: the free market.
I wouldn't suggest revolution, just a return to the Federal model of our Constitution. State and locals are more responsive because they are more local. THE MORE LOCAL you make the implementation of a program, the more responsive it must be. It is the difference between depending upon 25,000 votes to win election and 2 million.
Those 25,000 votes matter oh so much more.
This is why progressives hate the concept of anything short of Federal control. They know that Washington isn't responsive to the people. They count on it.
Progressives are very afraid of having their ideas held accountable to the people. This was directly said in the recent thread about poverty being bad for your health. Somebody directly said that it must be federal because they didn't TRUST the people to make the right decisions. Exactly.
The idea of remoteness to Washington is designed to get 'we the people' as far out of the process as possible. After all, we're all a bunch of idiots. If we weren't, we wouldn't need Washington watching over us, in the first place. Right?
~faith,
Timothy.
RNs have a long and proud history of social advocacy in the best interest of individual patients, families and communities.
WE proudly continue to work locally as well as nationally to fulfill our obligation to advocate for the public good.
The people of California and many others appreciate our advocating on behalf of our individual patients individually, on the unit, at the facility, in our towns and cities, our state, our country, and to do our part to improve health.
Registered Nurses have the professional obligation and therefore the right to act as patient's advocate.
RNs must always act in the exclusive interest of the patient. The RN duty constitute a fiduciary duty, so that every aspect of the nursing process from patient assessment to intervention and evaluation must be for the exclusive benefit and interest of the patient, uncompromised by conflicting interests or consideration.
No person has the authority or the moral right to interfere, restrict or encumber in any way the RN's duty and right of patient's advocate. Not the CEO, the Governor, the President, or corporation.
WE must ensure no one has the legal right to interfere with our sacred duty and right to act in the best interest of our patients.
In California we have achieved laws and regulations codifying:
-The right as well as the responsibility to advocate in the exclusive interest of the patient.
-Freedom of speech during and after working hours.
-Right to engage in collective action.
-Safe staffing standards based on individual patient acuity with direct care RN-to-patient ratios as a minimum.
-Whistle blower protection with major fines against the employer and the individual retaliating against a caregiver, patient, or family member who reports a violation. Full reinstatement, lost wages, benefits and cost
-The adoption of a uniform excellent standard of care, including safe staffing standards based on acuity/ratios.
-The building of an independent direct care RN social advocacy organization.
-Patient, job and license protection
-Immediately invoke the duty and right to advocate in the exclusive interest of the patient.
-Direct care RN nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one direct care RN at any one time.
-The same ratios apply to all shifts.
-Patient Classification Systems shall include:
-The severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment and design, implement and evaluate the patient care plan, the ability for self-care, including motor, sensory and cognitive deficits, the need for advocacy intervention, the licensure of the personnel required for care, the patient care delivery system, the unit's geographic layout, and generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the acute care hospital's patient population.
Lillian Wald RN and Lavinia Dock RN protest unsafe conditions at the Shirtwaist factory
California direct care RNs and community supporters advocate for safe staffing law
Specializes in Spinal Cord injuries, Emergency+EMS.
Is that 2% before or after the trillion dollar cost overruns?
Is it before or after Americans, used to services on demand, - DEMAND an end to rationed care? You can't end rationed care. It must be rationed, by dollars or waits. Unlimited demand = unlimited supply (an impossibility) or, rationed supply.
'care on demand' is there in UHC system , just perhaps not what the USA is used to ...
EMTALA came about to prevent WABC practices (wallet, airway breathing circulation) as well as religious hospitals refusing people who didn't meet their standards of behaviour ...
if there is unviersal access to primary care people won't need to use the ED for primary care , and if they present they can far more safely be 'turfed' to primary care
other aspects of 'care on demand' will remain if peopel are willing to pay over and above ....
however the picture painted by many posting on the board is of a system which doesn't provide 'care on demand' with p[rolonged waits for primary care consultations and prolonged ED ' holds' being the norm ...
there is also the aspect of the amount of specialist time and effort spent on "the worried well' becasue there is no 'gatekeeping' of referrals to secondary care and no incentive for primary care to develop their services
In fact, if you use Medicare as an example, you aren't even close. In 1965, proponents of Medicare predicted that it would NEVER cost more than 1% of income tax and would cost 9 Billion by 1990. In 1990, we spent 67 Billion on Medicare, a cost overrun of 700 PERCENT.
~faith,
Timothy.
what does 9 billion 1967 dollars equate to in 1990 dollars?
ZASHAGALKA, RN
3,322 Posts
Infrastructure is dealt with by government because of the 'free rider' problem of economics. http://en.wikipedia.org/wiki/Free_rider_problem
Health care isn't the same thing, except to the extent of government involvement. In this case, government involvement would CREATE just the problem meant to be avoided by government involvement in your examples. At issue isn't the need to ensure more or less global involvement to achieve a community outcome. Health care is an individual need, in the same category as food and shelter.
As such, the purpose of government funding would be to subsidize some care at the expense of others. Essentially, I could live with that. Gov't restricted health care goes further. It's not just about ensuring access, but ensuring more or less 'equal' access. Most that advocate federal involvement believe it is an issue of fundamental fairness. I disagree that the government can ensure 'fairness' without also ensuring mediocrity.
However, if 'fairness' is the issue, then there can be no ability to 'opt out' of the government's scheme. First, the government would cost over-run and be forced, in short order, into a massive escalation of taxation that would crowd out any ability to opt out for all but the extremely wealthy. Even so, the ACT of opting out would be viewed by the new health care regime as 'unfair', and so, limited.
It's not about subsidizing care nearly so much as it's about limiting available options, in the name of so-called 'fairness'. It doesn't seem very fair to me.
The chief problem with treating health care as a 'common' resource is that the act of doing so will ultimately destroy the resource. Services like roads, defense and postal service are subject to more or less unlimited use by maintaining the infrastructure. Health care, however, is a finite commodity. As such, treating it as a 'common' resource would subject it to a social trap called the 'tragedy of the commons':
http://en.wikipedia.org/wiki/Tragedy_of_the_commons
Essentially, by making a resource 'free', the effect is to encourage its overuse. For example, the EMTALA law essentially made access to Emergency Rooms 'free' if somebody is determined not to pay. The result? Over-utilization of our EDs. It's a 'tragedy of the commons'. UHC will only make all health care resources over-utilized and worse than EDs (because for some of us that actually have to pay a co-pay to use the ED, it is still a guarded commodity - we watch how we use it. Under UHC, that wouldn't be the case, for anybody.)
Those that advocate the collectivization of resources believe that, given the opportunity, people will be generally altruistic. I do believe people to be relatively altruistic, as a rule. However, in reality, people will generally act in their own best interests, even at great cost to the community. Or, as one of my former teachers that lived in the Ukraine used to quote about communism, "So long as they pretend to pay us, we'll continue to pretend to work." It's a basic issue of human motivation. We are motivated by our own best interests and that rarely changes if we are asked to take the community into account. It's a nice sentiment that we would all look out for each other, but such relationships must be individually negotiated and will not and cannot occur due to government compulsion.
~faith,
Timothy.