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RE: Before you Vote for Billary? - 2/13/2008 2:52:46 PM   
carlie310


Posts: 256
Joined: 9/23/2007
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quote:

ORIGINAL: DedicatedDom40

quote:

ORIGINAL: carlie310

It's payment for a service rendered, just like paying the auto mechanic pays for his time, equipment and expertise.

I'm just not seeing the problem here. 



That type of comparison is EXACTLY the problem.



So the problem is that the doctor expects to be able to pay for the building  and make a living at his job? Pay his staff a living wage, so they can pay their own bills? To replace the frayed and worn blood pressure cuff?   Purchase an x-ray machine so he doesn't have to send his patients somewhere else to have that done? 

Anyone going into medicine in the last few decades expecting high wage government employment hasn't been reading the news, either about the "high wage" part or "government" part. 

I think our disagreement is pretty fundamental here, so we're probably better off nodding and smiling, agreeing to disagree here.  You are arguing for a higher governmental involvement and a move to socialized medicine because health care providers should be doing their jobs for more altruistic reasons.  I believe they do have those altruistic reasons (otherwise they'd be lawyers, right?), and posted about that above.  Writing off balances from non- or under-insured patients isn't something that someone into medicine only for money would do.  

I'm a capitalist at heart, and I've spent more than enough time on the side of the "have nots".  No silver spoon or ivory tower in sight.  I believe in a safety net, but don't believe that the federal government is the answer. That role should be taken by the states.  I believe that a national health care would be so clumsily administered as to make the insurance companies look svelte. 

All that on top of the Constitutional issues. . .but we've wandered so far away from the premise of that document that I'm ready to let Benjamin Franklin Gates have the thing so maybe he can find us a treasure trove.

That's a long winded way to say I disagree with your premise, but do appreciate your civility in explaining it.





(in reply to DedicatedDom40)
Profile   Post #: 101
RE: Before you Vote for Billary? - 2/13/2008 3:11:59 PM   
LadyEllen


Posts: 10931
Joined: 6/30/2006
From: Stourport-England
Status: offline 		I've seen several times now a refusal to countenance your Federal government running any public health system - and alongside that a corresponding preference for the individual States to run such a system.

My view, for what its worth, for I'm not involved except as a spectator and commentator (though a welcome one I hope!), I feel this is probably the right way to go. The US is just too big to expect a single centralised administration of such a system to ever provide an efficient solution, and would be too distant to know, understand and provide for local situations in terms of demographics, economics et al

My question though then would be as to the relative wealth of each state and its corresponding ability to provide for its citizens through taxation based on that wealth. As I understand it, some states are quite poor by comparison to others in terms of incomes and wealth - and by this instance, some states would therefore not be as able to raise revenues for healthcare comparable to those possible to raise in other states - and so healthcare would not be equivalent across the US, even with a universal system. This would lead to the same situation we have had here - a postcode lottery as to whether treatment is available, except that there would be discrepancies between neighbouring states rather than neighbouring counties as here.

To provide a universally equivalent system across the US, it would require some mechanism whereby funding was allocated centrally - each state contributing into the pot according to its wealth, and this then being distributed out to the states according to their local circumstances - population certainly, but also geography and demography. This though would bring in the central government, raising the fears of inefficiencies - and also mean unfairness as far as citizens in wealthier states are concerned, in that they would be subsidising those in other states who cannot contribute as much.

An interesting problem

E

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RE: Before you Vote for Billary? - 2/13/2008 3:12:18 PM   
carlie310


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Joined: 9/23/2007
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quote:

ORIGINAL: LadyEllen

quote:

ORIGINAL: carlie310

To be accurate, the Preamble says that the Constitution is set up "promote the general Welfare." 

(snip)

To imply that the framers intended that phrase to be expanded to include a federally managed universal health-care is simply wrong.  This country was founded on that different political approach of individual responsibility that you seem to marginalize. 



Perhaps, but when the Constitution was framed, the general welfare of the people did not include education for all but did include slavery for some. Yet both those instances have been reexamined.

To follow the individual responsibility theme as you see it (and as indeed the constitution may intend - but it is an old document now), it is unconstitutional to have education, to have standing armed forces, provide public roads or have recourse to a police force. To pursue it further, it would not be beyond the realms of possibility to justify the enslavement of those unable or unwilling to fulfil the requirement for individual responsibility; bankrupt? then we'll sell you off to settle your debts.

Individual responsibility is important - its vital in fact to the proper functioning of the greater society; each is individually responsible to fulfil his obligation to be entitled to the benefits of the society. Perhaps then, the question is really about what benefits one would wish to derive from society, and whether one is willing and able to fulfil one's obligation.

That many people do not have school age children and yet contribute towards education, is indicative that the people see that the benefit of education to the society in which they live is important enough for them to undertake individual responsibility to pay towards it.

I really do not see how anyone, even those blessed with perfect health, could not see healthcare in the same light. If it is an individual responsibility to fund the education of someone else's children so that the society is improved for all, then surely it is an individual responsibility to similarly contribute to healthcare to the same ends.

E





In defense of the Constitution, it may be old, but it is flexible, and still (at least in theory) the basis of law in the USA.  It was flexible enough to have corrected the slavery mistake about 80 years in.  Some of what you list that must also be unconstitutional are actually mentioned within the document.  At the same time, others that you mention are NOT the responsibility of the federal government--or at least, they shouldn't be. 

Please understand, I'm not arguing against a governmental safety net for healthcare.  But that should be--for many reasons--the role of the state, not the federal government.  Just as education, police force, and for the most part roads either are or should be. 

My health is far from perfect, and as I said above, if my youngest UM had stayed in NICU for much longer, I'd have had to take advantage of the safety net provided by my state.  I don't object to more local governments doing this.  State, county, and municipalities here all have health care resources available without respect to ability to pay.  They are better able to respond to the needs of the populations they serve.  I do not see our federal government as the best solution to this problem.

ETA: Just read your latest response, and you have my primary objection in a nutshell.  Aside from the unconstitutionality of the idea, the possibility for bloat and pork barrel politics boggles my mind.  (I am easily boggled, though.)  I am not sure about the differences between states re: wealth, although my impression was that I was in one of the poorer ones, and my state does a good job of getting people covered. 

My reluctance is that I don't have the confidence in the government to manage universal coverage with an end result better than what we have now.  I believe that we need a safety net, that the insurance companies are corrupt (almost as much as the government). 

A few threads back, someone posted something about a "universal payor" system, that would streamline the paperwork.  I haven't done any research on that, but there's a possibility that could be a better solution. 


< Message edited by carlie310 -- 2/13/2008 3:22:47 PM >

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RE: Before you Vote for Billary? - 2/13/2008 3:16:10 PM   
LadyEllen


Posts: 10931
Joined: 6/30/2006
From: Stourport-England
Status: offline 		The principles are great Carlie - but I think history has shown that they are principles to inform policies, not policies in themselves.

E

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RE: Before you Vote for Billary? - 2/13/2008 3:56:59 PM   
OrionTheWolf


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Joined: 10/11/2006
Status: offline 		I was raised in a military family as well.

Wikipedia is a great thing.

The point I was making, is specifically about Hillary being able to be seen as Commander in Chief of the US Armed Forces, by the members of the US Armed Forces.

_____________________________

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RE: Before you Vote for Billary? - 2/13/2008 4:20:34 PM   
DedicatedDom40


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quote:

ORIGINAL: carlie310
You are arguing for a higher governmental involvement and a move to socialized medicine because health care providers should be doing their jobs for more altruistic reasons.


No Im not. Thats your interpretation, and its flat wrong.  Nowhere did I advocate socializing medicine. I lean libertarian on most issues. I DO think healthcare is a field where participation should happen for more altruisitic reasons. And if you dont like that, then go do something else, join the rest of the world that is already outside the protective bubble of government-financed private sector employment. Just because socialized systems (that incidentally are lower cost) also embrace a more altruisitc approach does not translate into my support for socializing medicine.

Im saying that the "money party" happening in healthcare is over, regardless of whether you want it to be or not.  Just like its over in other sectors of our economy. Manufacturing, Auto, IT, Real Estate, you name it. Complain about a doctor or nurse who cant make a living wage, and I'll show you thousands more in dozens of other industries outside the medical field who already know that pain.  The people IN MEDICINE simply dont know their party is over yet, primarily because the government is picking up the majority of the tab right now. And too many passers-by who hear the stereo playing from sidewalk outside are still entering the building looking for a free government-sponsored beer. All of it is an unsustainable path.  Considering the economic realities of whats happening elsewhere outside of healthcare, Im saying those in medicine with a money focus are their own worst enemy right now.

quote:

ORIGINAL: carlie310
I'm a capitalist at heart, and I've spent more than enough time on the side of the "have nots".  No silver spoon or ivory tower in sight.  I believe in a safety net, but don't believe that the federal government is the answer. That role should be taken by the states.  I believe that a national health care would be so clumsily administered as to make the insurance companies look svelte. 



The trouble is we dont have capitalism. We have distorted capitalsim. We have broken capitalism. We have "comfort capitalism" where investors cannot leave the safe zone of making money by speculating on oil supplies rather than actually practice true capitalism by assuming high risk to achieve the high rewards associated with building and creating new energy sources. We have dysfunctional capitalism that increasingly privatizes the rewards, but socializes the risk. That is exactly how our insurance system works. It privatizes the profit (by collecting preimums), and socializes the risk (by denying legit claims that pushes people to become medical wards of the state for treatment necessary to live). Broken capitalism! Broken! Broken! Broken!


< Message edited by DedicatedDom40 -- 2/13/2008 5:22:46 PM >

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RE: Before you Vote for Billary? - 2/13/2008 6:00:34 PM   
carlie310


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quote:

No Im not. Thats your interpretation, and its flat wrong.

I apologize for the incorrect interpretation.  I thought you were arguing for universal health care, and pointing to the altruistic motivations as a point in favor.  I'm not sure what you're arguing in favor of, but as I said, since I disagree with your premises, there's not much hope in agreement.  (I'm enjoying the discussion, though, and hope you are taking it as friendly debate.)

quote:

And if you dont like that, then go do something else, join the rest of the world that is already outside the protective bubble of government-financed private sector employment.


Are you saying that the current medical system in the United States is in a protective bubble of government finance? Based on what?  The doctors with whom I worked would love to get out from under the bootheel of government finance. 

quote:

I DO think healthcare is a field where participation should happen for more altruisitic reasons. 

My dealings on a professional level with  health care providers have shown me that they are in the business for altruistic reasons.

quote:

Im saying that the "money party" happening in healthcare is over, regardless of whether you want it to be or not.


Agreed--that money party has been over for a couple of decades.  Probably more, but that's the extent of my involvement with the medical business. 



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RE: Before you Vote for Billary? - 2/13/2008 7:52:53 PM   
DedicatedDom40


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quote:

ORIGINAL: carlie310

(I'm enjoying the discussion, though, and hope you are taking it as friendly debate.)


Absolutely!  And I apologize if thats not apparent in my discussion.



quote:

ORIGINAL: carlie310
Are you saying that the current medical system in the United States is in a protective bubble of government finance? Based on what?  The doctors with whom I worked would love to get out from under the bootheel of government finance. 


If you strictly had to rely upon private payors, you would not be better off. Maybe a short term jump, but the private payors bearing full financial responsibility would find ways to adandon their responsibilities beyond the degree already happening, or endorse free markets reaching farther into healthcare.  In fact, I believe the act of government being a payor for the poor and elderly (the costlier patients), and the de-facto subsidy it provides to the overall system by offloading a percentage of financial responsibility from the private insurance sector, is the only thing that has kept the private payors from demanding true free global markets be extended farther into your profession to the same degree it has elsewhere.

quote:


Agreed--that money party has been over for a couple of decades.  Probably more, but that's the extent of my involvement with the medical business. 




Everything is relative. And relatively to other areas of the economy, your party has not ended. If you think the party is over already, then we need to brace you for what happens when it really is over. :)

When we reach the point where private enterprise payors in the free market refuse to pay more than $10 total for a physician visit because chinese-educated physicians diagnosing patients from the end of a high speed internet link can do so on a volume basis for $10, thus driving physicians in this country to charge $10 instead of $80-125 per office visit to stay competitive (which obviously they can't), then the physicians here will understand what the rest of the country has been going through. Im talking about THAT money party being over. And no, the medical field hasnt seen that degree of downward price pressure for a few decades.

If free markets ever reached the medical profession to the degree it already has in other areas, you would be crying for a government payor to subsidize more than a $10 payment.

Your profession still lives in the fanciest house on the block, and you call it a dump?  :)


< Message edited by DedicatedDom40 -- 2/13/2008 7:54:05 PM >

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RE: Before you Vote for Billary? - 2/13/2008 8:01:51 PM   
hermione83


Posts: 393
Joined: 8/1/2007
Status: offline 		THanks for the info. I would just like to say to the one that said every county had a free clinic where he lives... it must be nice. The nearest one was veryyy far away that I found (hours) but they would not accept people who live where I live. The closest thing in another city supposedly had a sliding scale, and I went in and filled out the paperwork and saw the doctor there that day (who was like.. 20 something and without a clu eand said I should see a specialist, and gave me nothing, btw) ended up charging me more than just going and paying regular price somewhere... so as far as I can tell its yet another thing I don't qualify for and a scam. And most employers do not offer health insurance ... the only job I've had that did, didn't really cover anything but emergency stuff, and had a huge deductible and per month cost out of pay that I couldn't afford anyway (it was half a weeks pay cost per month.. and didn't cover normal stuff anyway..)

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RE: Before you Vote for Billary? - 2/13/2008 8:40:19 PM   
carlie310


Posts: 256
Joined: 9/23/2007
Status: offline 		First off, I'm not a doctor, nor do I play one on television.   (My house is a dump, but that's neither here nor there.) I worked in the business offices of several practices and as a consultant for the medical industry as a trainer for medical practice management.  I know the money side, but not the medical side. 

From your statements, I had thought that you would be much further away from me than your profile on the other side indicates.  A few miles to the south, things are not as dire as the picture you paint.  There are lots of industries doing belt tightening, but my experience as a medical office employee was pretty much the same as other industries, except you don't see many layoffs in medical.  Why? As of 8 years ago, studies had shown that by hiring one more person to handle the ever-increasing paperwork to get blood from a stone--or money from insurance companies--practices would actually be *more* profitable.

I disagree that the medical sector is still partying as Rome burns.  As a matter of fact, right now I'm re-entering the workforce after 8 years, and have decided NOT to go back into the medical business office.  Salaries there are just not the same as in other industries.  Someone doing skilled clerical work in another sector makes more money.  An office manager in a legal practice or insurance office or plumbing office makes more than the medical office manager.  I've crunched the numbers, because they have a very personal importance to me! 

You are correct in saying that the physician charges $80-125 for an office visit.  Medicare, however, forces a write-off that brings the range to $20.54 - $124.50--and if you code that high level office visit more than once or twice a blue moon, you'd better be sure that you're ready for the Medicare official to come visiting.  That scene would make an IRS auditor blush.  The majority of established patient office visits are in the 38.45 or 61.42 flavor.  Of that, they pay 80%.  That's from the 2008 fee schedule.  (I have the txt file, but lost the link--and honestly, unless you have medical coding experience, it's going to look like the gibberish it is.) 

How the private payor determines the fee schedule is a mystery, but there are various forms. You probably have received the odd EOB from the PPO plan with a comment that "your provider has agreed to accept this amount as payment in full."  (There's a reason they don't just charge that amount, called "Usual and Customary".)  There's the captitated plan--where the provider is paid a set amount for each member of the plan, regardless of who comes in.  

In most practices that I worked with, charges out-ran payments by a 2:1 ratio for government payors, and about a 4:3 ratio for private. 

If your scenario about the $10 patient visit comes true, the medical system will have already collapsed.  There's simply no way to do that and keep the lights on, much less afford alcohol swabs and tongue depressors.  However, there's a reason that medicine is considered an art and not a science at heart--there is no way a physician on the other end of a link could smell the "sweet" scent that marks a diabetic.  They couldn't palpate the abdomen to feel the edge of an enlarged liver. 

I don't know what the answer is to the broken system we have now.  I'm not for a moment trying to say it isn't screwed to the wall.  I agree with you that private insurance is a shell game and that they are corrupt.  But the federal government is at least as out of control as the private insurers, and at least as corrupt.  Probably more. 

In all honesty, it would probably be cheaper (and better for the medical industry, if not for the business office drones) if private insurance were abandoned save for catastrophic care.  Office visits could be between the doctor and the patient.  The practices could cut costs by laying off all of the people they hire to deal with the insurance companies.  I actually know of providers here who did that--opted out of accepting any insurance at all, dealt with the patients on a cash basis only, and were able to cut fees less than half. 

I need to investigate the single payor option that someone brought up here.  I just can't see the government as savior.



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RE: Before you Vote for Billary? - 2/13/2008 8:42:59 PM   
Gwynvyd


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Status: offline
quote:

ORIGINAL: OrionTheWolf

I was raised in a military family as well.

Wikipedia is a great thing.

The point I was making, is specifically about Hillary being able to be seen as Commander in Chief of the US Armed Forces, by the members of the US Armed Forces.


They follow rank and file. The President could be a monkey... hell for the last 7 years *has* been a monkey. They do not take thier orders from the President.. and they know that. They take orders from thier commanders. Any military personnel will follow those orders. There might be jokes at first but after some good leadership it should settle. I am sorry but just because it might unsettle some knuckle heads does not make me think it is a bad idea. You snap them back into line.. and they march in straight lines like always. Hell most of them get squicked by the idea of anyone but a White, Straight, Protestant, Male in office. Time to loosen up.. and realize the world is comprised of more then just that group of people.. and they can be fine leaders.

Gwyn

_____________________________

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Come for the boobs, stay for the brains.

Be the kinda woman that when your feet hit the floor in the morning the Devil says "Oh shit, shes awake..."
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RE: Before you Vote for Billary? - 2/13/2008 9:04:38 PM   
knees2you


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Joined: 3/15/2004
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quote:

Just wondering whether you truly believe that doing so is the mark of a good leader?

Just wondering whether you truly believe that male leaders dont prefer "jaw jaw" to "war war"?

Just wondering whether you truly believe that male leaders do not agonize over the decisions they must sometimes make, and wish there was some other way? (well, apart from Bush and assorted other "key planks" of world leadership)

Just wondering whether you heard of one Margaret Thatcher? Some "real men" down in Argentina thought that with a "weak woman" in charge of the UK, they could seize some of our territory - they soon found out that they had underestimated her and overestimated themselves by comparison. She was an absolute disaster for this country in almost every other way, but on that one aspect of her leadership, she did well - and better than the males around her who waivered at the prospect of war.

 
My Wife lived in England during those years Oh Boy
 
Next please.~~~~~>
 
As Always, ant



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RE: Before you Vote for Billary? - 2/14/2008 2:51:13 PM   
OrionTheWolf


Posts: 7803
Joined: 10/11/2006
Status: offline 		Gwyn, I completely understand what you are saying below, before you had to type it. So allow me to be more pointed then. What experience does Hillary have that would allow her to appoint a good staff to manage the military? I am not talking about all females here, I am talking about only one particular person, Hillary Rodham-Clinton.


quote:

ORIGINAL: Gwynvyd

They follow rank and file. The President could be a monkey... hell for the last 7 years *has* been a monkey. They do not take thier orders from the President.. and they know that. They take orders from thier commanders. Any military personnel will follow those orders. There might be jokes at first but after some good leadership it should settle. I am sorry but just because it might unsettle some knuckle heads does not make me think it is a bad idea. You snap them back into line.. and they march in straight lines like always. Hell most of them get squicked by the idea of anyone but a White, Straight, Protestant, Male in office. Time to loosen up.. and realize the world is comprised of more then just that group of people.. and they can be fine leaders.

Gwyn


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RE: Before you Vote for Billary? - 2/14/2008 5:47:40 PM   
Gwynvyd


Posts: 4949
Status: offline 		Hmm let me see.. actualy having *been* in the white house before... personaly knowing the key players at those high levels. Having personal contacts from being in Washington for 2 terms with her husband.. having her husbands contacts. Having her own contacts from her time in the senate.
She is the first New Yorker ever to serve on the Senate Armed Services Committee. She also passed legislation to track the health status of the troops so that conditions like Gulf War Syndrome would no longer be misdiagnosed. She is an original sponsor of legislation that expanded health benefits to members of the National Guard and Reserves. So appaerntly she does care about what is going on with the troops. Having served on the Senate Armed Services Committe that should help. She has a lot more experiance in office then her counterpart.

Gwyn

_____________________________

Self avowed Geek-Girl~
Come for the boobs, stay for the brains.

Be the kinda woman that when your feet hit the floor in the morning the Devil says "Oh shit, shes awake..."
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RE: Before you Vote for Billary? - 2/14/2008 9:58:01 PM   
knees2you


Posts: 2336
Joined: 3/15/2004
Status: offline 		If Elected,
Hillary wants to march in a gay rights parade.
 
quote:

"One by one they all fall down!"

 
As always, ant

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RE: Before you Vote for Billary? - 2/14/2008 11:44:16 PM   
Alumbrado


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quote:

If Elected,
Hillary wants to march in a gay rights parade.


Wouldn't that violate 'Don't Ask, Don't Tell'?

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RE: Before you Vote for Billary? - 2/15/2008 12:15:42 AM   
toddlefeet


Posts: 129
Joined: 11/8/2007
Status: offline 		Little miss Hitlery doesnt belong in office..I'm glad her ass is failing..and not soon enough. As for Mr Obama. I hope to god The old fart McCain wins and keeps the Islam out of the office.. Mr Obama has already publicly stated that if he is elected president..He will not put his hand on the bible once he sworn in. No no no..He wants the? Koran. Idiot..Keep that islam ass out of the Oval office! But A real American in there! and lets prey he doesnt kill over while on office.. Good lord.. 

Death to Islam.

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RE: Before you Vote for Billary? - 2/15/2008 12:55:11 AM   
angelikaJ


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quote:

ORIGINAL: toddlefeet

Little miss Hitlery doesnt belong in office..I'm glad her ass is failing..and not soon enough. As for Mr Obama. I hope to god The old fart McCain wins and keeps the Islam out of the office.. Mr Obama has already publicly stated that if he is elected president..He will not put his hand on the bible once he sworn in. No no no..He wants the? Koran. Idiot..Keep that islam ass out of the Oval office! But A real American in there! and lets prey he doesnt kill over while on office.. Good lord.. 

Death to Islam.


Claims that Barrack Obama is a Muslim or anything BUT Christian are untrue.

The UrbanLegends Obama page: http://www.snopes.com/politics/obama/obama.asp


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RE: Before you Vote for Billary? - 2/15/2008 4:06:13 AM   
SugarMyChurro


Posts: 1912
Joined: 4/26/2007
Status: offline 		Section VI of the U.S. Constitution states:
"...but no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States."

Do try to get with the program, toddlefeet...

I know sometimes it seems like we are in a post-constitutional era, but if you think that means the rest of us are going to allow people with completely idotic ideas to take over - well, think again.

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RE: Before you Vote for Billary? - 2/15/2008 6:03:00 AM   
LadyEllen


Posts: 10931
Joined: 6/30/2006
From: Stourport-England
Status: offline
quote:

ORIGINAL: toddlefeet

Death to Islam.


what a great idea!

tell you what, I'll shoot the adults when youve finished shooting the toddlers, OK?

eejit

E

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In a test against the leading brand, 9 out of 10 participants couldnt tell the difference. Dumbasses.

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