Instead of socialized medicine...how about

Great Debates
1

taking a market approach?

When I say this, people say, but health care is a NECESSITY. The government needs to control it.

Well, food is a larger necessity, and while there are federal regs on food handling and the like, I have a choice of at least 20 supermarkets near my home, all competiting with each other on prices, service, selection, and all in all, food is affordable and plentiful.

Why can’t we do this with healthcare? We are stuck with, IMHO, the worst of both worlds. We don’t have the universal coverage of socialized medicine, but we do have all of the bullshit that goes along with it: the government regulations.

Several changes I would propose:

  1. Get rid of medical board certifications for all except invasive procedures.

My mom is a nurse and can diagnose almost any illness I have, but she can’t do anything about it, because she can’t use hospital equipment or on to point #

  1. Get rid of the need for prescriptions except for antibiotic medication.

This would require legalization of drugs. which is a whole other thread, but think of the savings. For example:

I am on a controlled medication and will be for the rest of my life. Several doctors have told me that. I can’t just go to the store and buy the medication. I have to go to the doctor every two months to get a new script. I am fine with the meds. Were it not for the need for script refills, I wouldn’t have been to the doctor in the last 11 years.

Think of all of the savings to my insurance company if I could just get the drugs I medically need without paying the doctor, leading to point #3.

  1. Eliminate third party payments.

I pay $20 for a doctor’s visit. It seems reasonable and I don’t complain. But he bills my insurance $125. And since I have insurance, he does needless blood tests every six months (just to make sure everything is okay) and bills more and more. Most visits are just check weight, check blood pressure, how are you feeling, good, good, here’s a script, and out the door.

I have many more issues, but you get the general idea. Get the government out of medicine instead of socializing it. Now, I’m not talking about having the local drunk performing heart surgery, but I am saying get rid of the General Practitioners who are ripping people off for the “care” that they give.

Thoughts?

2

Why would you want to do that? If I seeing a specialist for a specific problem, I would like to be able to tell if he has some advanced training in the area of speciality.

I am uninsured. A local general practitioner is all the medical care I get, because I can (barely) afford his fees. What are you suggesting as an alternative to GP’s?

3

Who is advocating socialized medecine? Are you arguing against some politician’s platform or just against a philosophy?

4

Well, one of the most obvious differences is that people’s need for food is usually predictable, consistent, and affordable. You need a steady supply of minimally adequate nutrition which can be obtained from a large variety of food sources (including many that can be obtained almost for free by, e.g., fishing, hunting, and gardening). And obtaining and consuming food usually doesn’t incapacitate people in any way from being able to do their daily work and earn their living (except perhaps on Thanksgiving).

Healthcare, on the other hand, is something that most people usually need (and want) none of, but occasionally urgently need unpredictable quantities of, at an unpredictable cost. Moreover, it is considered socially unacceptable to deny crucial healthcare to desperately ill or sick people just because they can’t pay for it (not that it isn’t often done anyway, but it’s not something that can be openly admitted by the healthcare industry). And usually, the more badly you need medical care, the less likely you are to be physically able to earn the money needed to pay for it.

So right there you’ve got some major obstacles to handling healthcare in a purely market-based, direct-to-consumer approach. You’d be selling something that (almost) nobody really wants to consume more of than they absolutely have to, and that the vast majority of people can’t afford to pay market prices for when they do absolutely have to buy it. How are you going to make a profitable, effective free-market healthcare industry out of that situation?

5

I’m assuming you live in the US.
Gee, I have a lot more doctors offices near my house than supermarkets. Food is regulated, if you hadn’t noticed. We have a private, free enterprise system now. We have more expensive healthcare with worse results than in other countries. If something is failing, you don’t do more of it.

My wife is a biologist and medical writer, and she’s good at diagnosis also (she just diagnosed our kid at college’s Lyme disease over the Internet.) Her aunt was a nurse. Yet neither would claim to be as good as a doctor with lots of experience - and they’re not perfect either. Who exactly would get to do this? Nurses? Lab technicians? Guys who sweep up the doctor’s office?

And nothing will ever change? There is no chance of interaction? I’ve just started on Coumadin, and I’m back to a clinic (not a doctor) to check my progress until I stabilize. Ever see someone experiencing drug interactions?
Still, this could be an effective population control measure. And not all medicines require frequent revisits. I’m on synthroid, and get checked once a year. I don’t have to go to the doctor for a refill - it’s done on their website.

Think of all of the savings to my insurance company if I could just get the drugs I medically need without paying the doctor, leading to point #3.

You’ll feel different about this once they find something. I got half my thyroid out after a regular checkup, when the doctor felt it was too big. I felt great and all my blood tests came back fine. Anyhow, if you are on medication your entire life, I can certainly see why a doctor would feel six month visits are required. I’m getting on in years, and just went to yearly checkups. Maybe, just maybe, your doctor knows more about this than you.

BTW, our insurance just eliminated the cap on preventative treatment, realizing that catching something early will save money in the long run. No government intervention there - only free market.

I’ve never had a GP rip me off. “socialized” medicine, at least as proposed in the US, is no such thing, and using the term is only poisoning the well. The goal of the proposal is to have affordable access to healthcare for everyone. Is Medicare socialism?

6

I would argue that society’s need as a whole for medical care is predicable and consistent. Now, the man that has a heart attack tonight, or the woman who finds out she has breast cancer tomorrow is in for a huge shock, the system is set up to handle these instances.

Perhaps insurance should still be there for catastophic conditions where you can’t work, just like fire and flood insurance for your home. But competition between specialists can keep the prices down.

And there are several other markets where no one wants to consume any more than they absolutely have to. Car repair is one that leaps out at me. We don’t need a multi-trillion dollar federal program for that one, even though some people NEED their cars as a lifeline.

And I agree that the “vast majority can’t afford to pay market prices”. That’s why with less regulation and increased competition, the prices would come down making them affordable…

7

I’m not saying it should be illegal to go to a GP if that’s what you choose. I’m just saying that it should be legal, for say, your wife, to set up a small clinic diagnosing illnesses. With full disclousure; everyone knows that she is not a doctor, but the pay rate would be less for that.

And, of course my doctor knows more than me, and it would be a good idea to do what he says. But, like everything else, because it’s a good idea shouldn’t be forced upon me as a matter of law, especially since I pay the money.

I don’t mean to steer the debate by calling it “socialized” medicine. Pick whatever term you like. I will use that…

8

Which will result in lots of dead people, who go in desperation to cheap “clinics” set up by people who have little or no medical knowledge, but plenty of greed and no ethics at all.

9

This is just like the system we have now. Poor people with no insurance can’t pay the $125 for an office visit that a GP charges for those without insurance, so they go to the ER who gives them whatever pill is easiest and push them out the door.

The small business owner in my example may very well be unethical and greedy, but they had better be good at what they do or they will be out of business. My supermarket, barber, mechanic, electronics store, restaurant, can all be the most unethical assholes in the world, but they had better do their job right or nobody will be back there.

And it just doesn’t happen in the real world. How many, let’s pick, car mechanics open up a shop and advertise (remember full disclosure was one of my standards) that they don’t really know much about cars except they put gas in them from time to time. But they only charge $20 for a repair!!! Would you go to them?

10

And who probably know at least something of medicine. And quite likely have some concern over whether you live or die.

And are required to have some actual training. So no, it’s nothing like you propose.

No, they can just move on to the next town and new victims.

People are less desperate, and therefore harder to manipulate about car trouble, than they are about they or their children’s survival.

And it does happen, all the time. Scam-and-move-on is an old, old tactic even when it’s illegal. It’s not going to be better if you create what amounts to a class of sanctioned scam artists.

11

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You will of course note that competition has done nothing of the sort to prices in the US already. Specialists elsewhere tend to be cheaper. You’ll also note that the market model has actually made healthcare more expensive than anywhere else in the western world.

And you want more of it?

12

That sounds like an argument for socialized medicine. If individuals can’t reliably predict or budget for their individual healthcare, but society as a whole can reliably predict how much healthcare they’ll need and how much it will cost, then it sounds like society as a whole should be handling healthcare financing, not individuals.

Not a very good analogy, IMHO. Car repair costs may not be precisely predictable for individuals, but most of the time they’re in line with income brackets and other expenditures. Nobody needs to spend hundreds of thousands of dollars on car repair (unless they’re very wealthy with very expensive collectible cars), whereas it’s commonplace for a non-wealthy person to need a life-saving operation that costs hundreds of thousands of dollars that they can’t afford.

Moreover, it’s really a stretch to compare “NEEDING a car” (even if you throw the word “lifeline” in there) with the actual need for medical treatment to literally save one’s life or physical health. Going without a car is an inconvenience, sometimes a serious obstacle to cope with, but it simply isn’t in the same category with needing an appendectomy or a C-section.

Consequently, there’s no significant societal pressure on the car-repair industry to repair cars for people who can’t afford to pay for it, whereas that sort of expectation does distort the healthcare market.

And yet, despite the fact that car repair is a much more individually manageable need than healthcare, and thus naturally better suited to a free-market structure, we still have to have a whole bunch of legal regulation to oversee auto insurance. And you imagine that healthcare, a far more complicated and non-market-friendly commodity, could be handled in a free-market structure? That’s a pipe dream if ever I heard one.

Really? How much less regulation on medical services and prescription drugs do you think the average healthcare consumer is going to be willing to put up with? How much will that regulation cost? How are you going to combine cutting costs on regulation with heavy social pressures in favor of safe and trustworthy drugs and medical treatment?

Look, the classic definition of a truly competitive free market is well established, and it just doesn’t match up in many important respects with what a society needs in terms of healthcare. A competitive free market has low barriers to entry and exit. Providing competent healthcare, on the other hand, takes years of study and training and usually investment in expensive equipment. In a competitive free market, there’s equality of information between producer and consumer. Are patients ever going to know as much as their doctors about what medical treatment they need or about the products they’re buying from them? No way.

Imagining healthcare in a purely market model may be a nice fantasy, but a fantasy is what it is. Pretending that healthcare is fundamentally no different from food and complaining that it isn’t cheaply available in lots of competing establishments is just denying reality.

It already is legal. Anybody can call themselves a “faith healer” or “alternative therapies practitioner” or some such name and offer whatever kind of allegedly medical services they can get the marks to pay for. They’re just not allowed to pretend that they’re qualified medical practitioners.

Which won’t be the case for many people under your proposed system, who would be constrained to choose between affordable quacks and competent, well-equipped doctors whose fees they can’t afford.

13

I trust you’re aware that certified doctors are not something that existed in the past? Do you understand why most countries decided to regulate physicians? Would your clinic have malpractice insurance? (Won’t be so cheap then.) If the cut rate diagnostician screws up and someone dies, what then? How are we going to prevent those without a clue from setting up shop - won’t charge much, though. How to prevent them from wreaking destruction and then leaving?

How about regulated for safety medicine. As opposed to your proposal, which I’ll call anarchy.

But there is one advantage to your proposal. It would kill off the gullible and stupid. Unfortunately, probably also the poor who might use this facility because it is cheaper.

14

I’m still waiting to hear what you want to replace the General Practitioners with.

And as for your mother being a nurse, my husband is an RN but he doesn’t do my pap smears.

15

Cite? I’ve been to the ER a few times when my kids got sick after hours. You do wait (when my wife was in an accident we didn’t wait at all, so I don’t mind) but I found that the doctors gave excellent care.

I’m not sure how you can be an unethical barber - in any case no one’s life depends on their haircuts. Supermarkets that are dirty and dangerous can get shut down by the health department, ditto for restaurants.

Hell no. What kind of parts are they using? You get your brakes done by someone charging $20 and your name will be John Q. Corpse. You clearly know nothing about business.

Mechanics have a natural price cap - the value of the car. (Which decreases as the need for repairs increases.) Plus, if you can get a used car cheaper than the repairs, you’re going to. If you decide your life is worth no more than $3,000 bucks, it would make sense to go cheap. But pretty soon you won’t have to worry about the decisions.

16

And yet even with all that competition, there are still people who can’t afford food, so we have programs in place to subsidize food for those who need it.

Even if you bring down the price of health care, some people still won’t be able to afford it, especially if we eliminate insurance and make everyone pay cash, as you suggest in point #3. (You can save all you want, but if the right tragedy strikes, it’s still going to bankrupt you.) What do you have in mind for them?

17

What “market model”? There is no free market in health care in the U.S. Not even close. It is the most regulated industry in the nation, tax policy has led to the horrible practice of employer-sponsored insurance, and the government pays for around half the health care spending in the country. The problems we have in health care today are a result of too much, not too little, government involvement in the industry.

18

That’s very much my point. Some of my details may need tweaking, but I think the market idea is far better than a government controlled solution.

19

Here’s the thing - having government pay for all society’s medical bills is about the worst way to manage health care.

The second worst way is to have insurance companies pay for all of society’s medical bills.

Yet we keep talking about those two options, or splits between them, as the only way to pay for health care.

The real problem with health care is that we want to eliminate purely voluntary, private funding from individuals. Somehow we’ve got it in our heads that no one should have to pay out of pocket for health expenses.

Let’s look at auto insurance industry as an example. Auto insurance works, and it’s mandatory and universal. That’s led some people to claim that this shows that a mandatory insurance system for health care can work. But what’s the big difference? The difference is that auto insurance is very limited in coverage, and has deductibles that force people to pay the first part of any costs.

Imagine the disaster that we’d have if auto insurance covered every expense associated with a car. Worn tires, inspections, blown engines, transmission repairs… If insurance paid for all of that, it would be a bureaucratic nightmare. The paperwork involved would be immense. There would be pressure to mandate that cars not be able to drive fast, inspections of tire wear patterns to see if you were abusing them, etc. Some drivers who don’t maintain their cars or are otherwise at risk of constant costs would be ineligible on their own, so companies would have to offer group auto insurance to their employees. Leaving your job would mean losing your car.

In fact, it would look a lot like the U.S. insurance-based health care system.

If you want a ‘fix’ for health care, stop covering so damned much of it. Set up health insurance like auto insurance - catastrophic coverage, major surgery, drug costs for chronic conditions. Put a high deductible on it - you always pay the first $500 of any medical treatment. Maybe put a sliding scale on that, so poor people have less of a deductible, or give them government credits to help with the cost. Governments can set up tax-sheltered health accounts to encourage people to save money for such out-of-scope treatments.

Make THAT insurance mandatory. Very basic coverage that ensures that no one will be bankrupted by emergencies, cancer, or diabetes. Then let everyone fend for themselves in the free market for the rest. Companies can offer supplemental insurance if they want. Governments can offer additional coverage or subsidies for private costs for low income individuals. But the bulk of health care remains completely private. If you go in to have a bunion removed, and it costs $400, there’s no paperwork, no hassle, no insurance claims. You write a cheque, and you’re done. Maybe you file a claim with your private insurance company and claw some of the cost back.

This is the way dentistry works here in Canada, pretty much. Major oral surgery is covered by government health care. But routine fillings and extractions are paid for privately, often supplemented with private, voluntary insurance. Same with vision care. If you have major vision problems, government health care will pay for it. But you fork over your own money for eyeglasses and contacts and LASIK surgery. Lots of companies offer supplemental insurance for these things, but typically at 80% coverage or so, so you still have to pay out of pocket. That gives people the incentive to not seek treatment frivolously.

Dentistry and vision coverage industries are very healthy. There’s plenty of supply, costs are reasonable, and the poor can get extra coverage from the government so they can get treatment.

It’s when you try to set up a universal system of complete health care coverage for every expense from cradle to grave that you wind up with bureaucratic horrors and inefficiencies - whether the government runs it or the insurance industry.

20

That’s interesting, because it seems like the countries with more government involvement have fewer problems, not more.

Indeed, there might not be any traffic either, or any sitting around in the waiting room reading People, because who’s going to go in anyway if it costs $400?

The co-pay I have now already provides an incentive not to go to the doctor for frivolous things. Paying out of pocket would discourage me from going in all but the most serious situations, and I’m not convinced that discouraging people from going to the doctor until the very last minute is a desirable outcome.