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democratreformed Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 09:17 PM
Original message
familydoctor, I have concerns about
Edited on Thu Oct-23-03 09:18 PM by democratreformed
national healthcare.

Sorry to post this on here, but I wasn't sure if you would welcome an e-mail. And, I can't seem to get the discussion going elsewhere.

Since healthcare is such a big issue in this election, I have some concerns and questions.

A. How should it be determined WHAT will be covered? Should a national healthcare plan cover expensive fertility treatments or other non "life-threatening" services?
B. What will happen to doctor's salaries under a national healthcare plan? Will they "hit the dirt"? If this happens, will most GOOD doctors go into other practices (plastic surgery,et al) to be able to make money? Will we, the people, be left with substandard doctors in charge of our vitality? Will we have to go "outside" the plan to actually receive GOOD QUALITY healthcare, thereby negating any positive effect of a national plan?
C. What should we look for in a healthcare proposal that will help us know that the proposed plan will actually benefit us "common folk" and not actually make things worse?

Thanks in advance for your reply.

I also welcome any comments from anyone else who would like to reply.
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burrowowl Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 09:22 PM
Response to Original message
1. Single payer
health care like in France and Germany.
I lived in France and your taxes go to something else rather than defense (really offense) and corporate welfare. England is trying to go the U$ route and is sending patients to France and Germany to do things cheaper and right.
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democratreformed Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 09:25 PM
Response to Reply #1
2. Can you explain more
about this? I have read the phrase many times but don't really understand what it means.

In theory, it seems really simple (if you take the meaning at face value). However, I suspect it actually means much more.
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pllib Donating Member (27 posts) Send PM | Profile | Ignore Thu Oct-23-03 09:41 PM
Response to Original message
3. what is ideal vs what is politically feasible
I am a family physician and have spent most of my career working with a patient population that is primarily covered by public insurance (Medicare or Medicaid) or uninsured, so I have pretty strong feelings about this.
Ideally, we would have a publicly financed system of health care, guaranteeing coverage for all. I don't this is politically feasible in our current environment - our health care system will have to "collapse" - where enough middle income families lose insurance, and enough providers (hospitals, physicians, et al) no longer receive adequate payments, because of growing uninsured, that radical reform becomes possible. Given are current rate of health care inflation (rougly 12% in private sector), and growing number of uninsured, this may take about 7 or 8 years. It is possible that tinkering with the edges of our current mix of public and private insurance will sustain our system longer. Answering your questions, though:
A. The Oregon model is a rational way to decide what should be covered - preventive services, diagnostic and treatment interventions for which there is good evidence of benefit. High cost items (eg, some of the more invasive fertility procedures)
would not be covered. Another way to ration care is by managing access - this is the old Kaiser model - and the Great Britain/Canada model - you have plenty of primary care physicians, allowing good access to primary care, and then determine how many cardiologists, etc., you need. Some people may have to wait if there problem is not urgent. Even with those constraints (and controlling for other socioeconomic factors) Canada and Great Britain (as well as every other developed nation in the world) have better health outcomes than we do. (Actually, we rank below countries as poor as Turkey in health stats - our health system is a disgrace.
B. Hard to know what will happen to Dr.'s salaries. There is plenty of administrative overhead in our system - 20 to 25% of health care dollars, compared to about 10% in Canada (Medicare administrative costs are about 2% - very efficient program). If physician training was better subsidized, and docs could graduate without $100,000 in debt for education, this might be less of issue. Certainly, quality of docs in Canada, England, France, etc. is comparable to here. Remember quality of care is as much a function of the system in which a physician practices as the physician. Public financing might allow for a more rational, better organized system.
C. What to look for in a health reform plan for the average Joe?
Needs to address access; quality of care; portability between employers; remove existing coverage exclusions; provides some mechanism for cost control that spreads risk and incentives between patient, physician, and payer. Does not make individual physician responsible for "rationing" decisions.
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democratreformed Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 09:52 PM
Response to Reply #3
4. Thanks for
your reply, pllb. You have given me some good information.
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Mel Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 10:06 PM
Response to Original message
5. have you seen this?
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democratreformed Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-23-03 10:12 PM
Response to Reply #5
6. Thanks
for the link, Mel. No, I hadn't seen it.
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Bread and Circus Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Oct-24-03 08:01 AM
Response to Reply #5
7. I am part of PNHP
but I think we need NHC single payor system
to be a 30 year goal.
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Bread and Circus Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Oct-24-03 08:03 AM
Response to Reply #7
8. On second thought...
maybe a 10 to 20 year goal, kind of like getting
off foreign oil and going with alternative energy.

I think our current system sucks but it is really
complicated to fix or change it.

If anyone promises you an easy, quick fix, they are
just whoring for your vote.
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democratreformed Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Oct-24-03 08:40 AM
Response to Reply #8
9. What are some
things we could do in the mean time to help those who do not have health coverage?

A couple of more questions:
In my state, we have county health clinics (I don't know if it's that way everywhere). When I was younger, these were used mainly as a means to obtain family planning and to obtain children's shots. Today, I have learned that they have expanded so that pregnant women can obtain prenatal care and also offer several other services. Could these be expanded even more?

Also, over the past several years, we have started seeing local medical clinics that treat patients and base payment on income. I'm not sure how these work as far as who actually pays for the care. I do know that the clinic here in our town is always booked up. If you call for an appointment, you are usually told that it will be a week or more.

I just spent two years without health coverage. Thankfully, I was able to enroll my children in our state's plan for them. I waited until both my husband and I were drawing unemployment and then I applied. (Is that wrong?) Another thing I don't understand is that after the first year, I didn't fill out the renewal forms because both of us had gone back to work and I knew we would no longer qualify. I was distraught. My son has ADHD. I talked the Developmental Center into not doing his yearly testing because I didn't think he was covered. Yet, when I went to the drug store, the state plan still covered his medication. I have since enrolled in my employer's health coverage (after a six month waiting period). But, the state plan continues to pay. I'm not sure what to do about that.
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Padraig18 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Oct-24-03 09:11 AM
Response to Reply #9
10. A friend of mine works for DHS (Public Aid)
She says her job is routinely one of massive frustration because of the uninsured, working poor, especially single working poor people. On an average of twice a day, she has to deny Medicaid benefits to working poor people who truly NEED the care they're seeking help with, but is prevented from helping them due to 'welfare reform'. She finds it especially ironic that most of these folks qualify for food stamps, because they don't make enough money to eat, but mysteriously make 'too much' to receive any type of free or subsidized health-care so that they CAN work or have a medically-decent quality of life. :eyes:
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