It’s the ICC as interpreted by the post FDR court-packing in 1937 that guts state control of commerce (even intrastate). Amendment X has been effectively non-existant for 72 years.
The Preamble to the Constitution says… we are to insure domestic tranquility, promote the general welfare, and to secure the blessings of liberty to ourselves and our posterity.
It seems clear that they felt we were in it together and should help each other. That we do have responsibility to the welfare of all Americans and we should share the blessing of the country with each other.
We had travel insurance, with plenty of money available for evacuation. We were going to Egypt, and if I fell off a pyramid or something I sure as hell didn’t want to have to stay there. But no one asked if we had it.
There are a lot of misconceptions about Canada’s health care system.
First of all healthcare is a provincial responsibility. This is how it works. The federal government passed a law called “The Canada Health act”. This sets out the minimum standards of healthcare that must be offered to the people of all the provinces. The government of Canada has a complicated reveue sharing agreement with all the provinces where by the province gets federal funding to a rate detirmined by the financial success or lack of by each province. The provinces are not required to put this money into healthcare as long as they meet the requirements of the federal health care act. Funding can be with held if they do not keep up the standard.
Each province has a ministry of health that has the overall responsibility for running their own system. Your average health care consumer has very little contact with the ministry of health. The Dr.s and hospital administrators pretty well run all the local health care in the various areas. They are the ones that must get more funding,resources, and facilities from the ministry of health if they desire. It’s a great system but the biggest problem is the tight fistedness of the Canadian governments in funding the system. We have problems within healthcare that reflect a lack of money. not all problems are a lack of money but some are. Canada spends just over one third per capita on our socialized system than the USA spends on their system. There is no question at all that we get way more bang for the buck in our system.
This is a philosophical question, and my answer is one that agrees with a first rank philsopher, John Locke. Government are instituted among men for the protection of life, liberty and property, which he then sums up in property. Seems to me that the government has to take property from one and give it to another for any health care system. The government should stop a free for all by outlawing, and then enforcing those laws, violent crime, and fraud. Its not a free for all to follow the constitution.
i got a letter from Medicare this week. My birthday is coming up and I qualify for 6 new preventative tests. They have a financial interest in keeping me healthy .
If I got a letter from a health insurance company it would be about dropping me , cutting coverage, denying a procedure or raising rates. That is the interest they have in me. They took my money for over 40 years . Now I might not be such a good business risk. They want me gone.
Who do you think cares about dangerous additives in food? Who wants to keep the people healthy, the one who has to cover, or the one who wants to drop people when they are not so profitable any more? Insurance companies want you to get sick and die beyond their coverage.
I am very leery of any changes to the Constitution.
This time the change may be something *you think is right. I hate to bring up the slippery slope argument but what if the next set of changes to the Constitution were decided by followers of Fred Phelps?
Slee
*Assuming the nutjob could get enough people to follow his lead. Stranger things have happened though…
If Phelps could get enough followers to change the Constitution, would it matter? Major shifts in popular opinion will drag the positive-law system along one way or another.
I’m not talking about a radical shift in the American legal system. I’m talking about one change in allocation of administrative authority in a document that is changed pretty often.
I have several other issues not yet raised. Governments do have a reason to control costs. They don’t have a reason to control their personal costs, however, only those which come from actually serving people. They are vulnerable to economic capture (and big corporations are no friends of free-market economics). These tend to mean declining service in the long run. Government services provide best when the mission is narrow and neccessary.
In every other developed country on the planet, medical and drug development has been retarded by govenrments not wanting to pay. Most other countries have some version of a single-payer plan, and this has destroyed the ability of any private insurance to compete. A combination of bad regulation and government pressure and that you get to pay for government insurance whether you use it or not has caused this.
Governments do use their power to push down the price of drugs, and they sometimes pass along this to consumers. However, it comes a huge price. Governments themselves are greedy and do not want to pay for drug development. Thus, they will pay only the cost of making the drug, but not developing it. But costs on development keep going up, and by not paying their share, they dimish the advantages of developing them.
New drug development used to cost about $200 million per successful drug. It’s since gone higher. That includes all costs. Yes, it includes marketing costs, but marketing means a heck of a lot more than advertising: it includes free samples, donations to poorer countries, and education.*
By not paying for the full cost of it, they foist it off on others. Namely, Americans.
*Some people hve criticized drug companies for pushing drugs to doctors. This is perhaps a fair criticism, except that doctors are not well-educated after school, and med school tends to create medically-conservative doctors. Few of them really understand the basic science and I’ve never, ever even heard of one who could adequately keep up with new drug developments.
A client of mine got a similar letter. It said that Medicare was going to reduce the reimbursement for certain procedures, increase the paperwork, and reminded him what they would do to him in Federal court if he forgot to follow any Medicare rules.
He stopped taking Medicare patients.
Another client got the same type of letter. He closed his practice and took early retirement.
He can only stop taking medicare patients because his lobby group did a great job of ensuring that there would be far more patients than doctors able to handle them. Again, we have one of the 3 lowest doctors per 100k ratios of any nation in the OECD.
woe; if only we all had the burden of deciding to retire early.
He HAD to stop taking medicare patients. There was no other decision in his business to make. Blaming one doc for the AMA’s actions is insulting.
This is even more insulting. Retire early meant, in this case, at age 69. Most doctors I know and work with like to work well past standard retirement, wanting to keep on serving. However, there comes a point when they can not afford to keep the doors open if too much of their practice is Medicare patients. Given that this particular doc enjoys, at best, an upper middle class existence - your attitude is misplaced.
Remind me again where GlaxoSmithKline, Hoffmann–La Roche, Sanofi-Aventis, Novartis, and AstraZeneca are headquartered? They’re the 3-7th largest pharmaceutical companies in the world. try again.
It’s not like they have recently been developing medically useful drugs, anyways; they research boner pills, pills for weepy housewives that have nothing better to do but bother everyone about how rough they have it, pills for fat people that refuse to exercise while consuming 3000 calories a day, etc. They’re all lifestyle drugs that don’t cure much of anything but bad habits. (this is somewhat T-I-C, so I don’t need tons of posts calling me insensitive to the needs of depressed people or those with heart disease; point is that socially useful drugs, i.e. the ones that cure ailments, aren’t exactly the drugs that keep the customers coming back to refill the 'scrips)
I’m sorry, how much money do we pump into research universities in this country? How much of that gets siphoned off by the “public/private” partnerships that swoop in and cherry-pick the most promising research programs?
No, the government (i.e. society) pays plenty by awarding patent protection which allows these companies to recover their costs. Extending patent protection has significant costs for society as generic manufacturers aren’t allowed to produce the drug, increasing costs, and thereby costing us money. Not that patent protection isn’t fair, but stop pretending that these companies receive nothing of value even where the state has monopsony power.
No, it means advertising. The marginal cost of a pill is about an order of magnitude smaller than a penny. Plus, don’t think that “free samples” are anything but really effective means to ensure that the next time the patient needs a drug, they’ll ask for the same “free” one they got the last time - except that this time it won’t be free.
So now we have to suffer higher drug costs (by way of education costs) because the doctors are too damn lazy to stay current on medical knowledge or their initial training was inadequate. Jesus, we may as well create a new civil service job category while we’re at it: doctor-fluffers.
I’m not blaming the doc - i’m congratulating him for being a member of a cartel so efficient that he can line his pockets while simultaneously refusing to see a large group of customers.
“Early retirement” has a standard meaning, y’know? Your (deliberate?) incorrect narration of this guys story is what was misplaced.
Your ignorance of the industry continues to show itself.
How so?
Doctor X doesn’t like the rules, regulations, and prices that come with a certain segment of his client base. So he stops seeing those patients. Because he’s got a ton of other clients who need his services. Because the AMA has artificially limited supply in this country. Q.E.D.
Businesses in every sector of the economy face significant costs in terms of regulations. Boo hoo that your profession has distinguished itself through medicare fraud and improper charging of taxpayers, and boo hoo that the government decided to make those actions have consequences. It’s the same je ne sais quoi that goes on when you piss and moan about paying out medical malpractice claims: you have some exceptionalism complex that makes the lot of you believe that you should have free reign over how you practice medicine, with no input from others who had an important say in the process of enabling you to practice medicine in the first place, and that none of you should ever be questioned or made to pay for your mistakes. Oh, now-i-know-quoi: it’s called your god complex.
Businesses in every sector face cost-cutting pressure from their consumers. It’s as if doctors don’t see themselves as another form of good and service subject to free-marketeerism.
Do you weep for the line worker at Widget Company X who just got laid off because Wal-Mart, Widget Company X’s main/only customer, decided that they wanted to pay 20% less for their widgets, and widget company X could only do that by firing the line worker? Yeah, didn’t think so.
Wow - you really hate doctors. You also have no clue who or what I weep for. When Wal Mart forces down prices that shuts down a textile mill in North Carolina, and then shuts down one in Tijuana the next year, then kills the one in Belize, and finally kills the one in China to head to Vietnam - I worry about the effect. However, I am smart enough to realize that medical care is not anywhere close to the equivalent of WalMart and Widgets.
If Wal Mart forces the prices so low that they can no longer carry pink t-shirts - nobody cares. If Medicare forces reimbursements so low that patients can not get coverage - it is a health crisis. Your analogy needs work.
The government sets prices with Medicare, then sets them so low that they do not cover rent, malpractice insurance costs, the latest equipment, and the necessary staff to handle the paperwork in many markets. This, in turn, has a market effect of reducing the amount / level of care available to the poor. But you don’t care about them as long as you can bash the big, bad doctors with their so called “God Complex.”
Doctors would LOVE to operate in a free market - but they are not allowed to. Their industry is highly regulated for a variety of reasons, some legit. However, the regulations have grown so complex that they are next to impossible to track. In addition, new laws are regularly written with minimal thought of all of the consequences. For example, it is illegal to discard a mammogram file without a death certificate. The result is a storage cost that will be passed onto other patients. Now, this was no doubt added for a good reason - but there was not a timeframe implemented with it.
It wouldn’t matter if AMA allowed more doctors. If you kept the intense 12-year educational workload exactly the same, that’s a built-in barrier in itself. If the IQ and 12-year commitment isn’t enough of a barrier, then the tuition costs for 8-years of college is another one. Would eliminating the AMA’s restrictions automatically quadruple the number of doctors? I don’t think so. Do you have a cite that proves otherwise? Even if we had 4x the candidates with the prerequisite IQ and tuition $$$, do we have quadruple the capacity in hospitals to handle and mentor the 3-year residency programs? It’s not just the AMA… the entire chain from medical schools to residencies to medical boards etc has to expand.
Everybody including your lowly brick layer has a “god” complex. In some circles, it’s called humanism. Maybe the subjects of Egyptian pharaohs or Chinese emperors didn’t think of themselves as special individuals but we’re long past that now. Picking on doctors is hypocrisy.
And the point of this is?
You’re not debating, you’re just spewing bitterness.
Medicare patients cannot get coverage in this instance because the doctors have plenty of other opportunity for revenue. because of low supply. what part of this aren’t you grasping?
and i’m not saying the net result isn’t bad for people - it is. but the blame lies not with the government seeking to exercise monopsony power.
Cite? And medicare isn’t for the poor. For someone who fling around statistics like the just-quoted part above, you sure make some big mistakes.
No, they really wouldn’t. They’d see their incomes plummet. Unless by free market you mean “non-regulated but still licensed and still the only ones that can issue prescriptions”?
If you pay less than what it takes to keep an office open, you kill supply. What part of this are not grasping? Many doctors will happily take a percentage of medicare/medicaid/medical (we often mix them in shorthand discussions - my mistake using this shorthand with people who have no clue how medical offices work). See - taking a medicare type patient won’t pay for everything, but it is often better than having an empty slot on the appointment list to help cover some of the costs. Once that percentage gets too big, however, you can not cover your costs.
When the government cuts reimbursements below the cost of delivery, the government is responsible for the loss of care.
Discussed above already, and I have not quoted a statistic. If I did, I would have numbers. Your focus on the big, evil cartel of physicians has you a bit confused.
Their incomes would not plummet, though they would drop in some markets. Very few are cut out for medical school, residency, and annual continuing education. I agree that the AMA has limited the numbers through some of their controls, but that is only one small part of the reason that docs make so much money in certain markets and specialties.