Socialized medicine

[C&CDean]

So you want Hillary Health care huh?

My parents just left this morning from a visit to the Deanarosa. They brought a retired British couple with them from London who they've known for many years. They were discussing how much $$ they've been "taxed" over their careers for insurance, pension, etc. I will just relay a few of the stories I heard sitting around the kitchen table.

"Our very dear friend was on the list for a hip operation for over 3 years and by the time they got to her, it had deteriorated to the point that they really couldn't do much with what was left of the bones. She is in a wheelchair now for the rest of her life."

"Our very dear friend died last week waiting for lung cancer surgery. The doctor said "it's just as well, it was going to be at least another 6 months before we could get to him."

"Bill's mother died from peritonitis (sic?) after her appendix ruptured. The doctor told her to "go home and take some bicarb my dear and we'll get you scheduled for a specialist."

There were many, many more stories.

Both of these people had full dentures (which fit terribly because they were clacking and whistling with every word) and have had them since their early 50's. Like most Brits.

What brought the whole thing up was my wife calling the doc about changing a dental appointment for me because I'd be out of town and the dentist said "sure, Tuesday next week would be fine, what time?" They simply couldn't believe you could actually call and talk to a doctor or dentist and change an appointment. They said they structure their lives around when they can finally see a doctor, and if they need to see a specialist, they cancel vacations, etc.

Sorry, but I'm out.

[Mjcpr]

Did they have any quack's rewiring their innards to where they started pooping from their nutsack? You don't even have to leave the SO to find one of those.

[TexasSooner01]

Didnt like HRC's idea on medical care in the beginning and dont like it now. She will NOT be getting my vote come November.

[SoonerInKCMO]

Socialized medicine <> subsidized universal insurance coverage.

You can certainly make arguments against Clinton's plan based on the increased taxes and spending it would require; but to say the plan is to institute a nationalized health care system as exists in Britain is ignorant at best and a lie at worst.

[sooner n houston]

Or its baby steps in that direction!

[tommieharris91]

So you want Hillary Health care huh?

My parents just left this morning from a visit to the Deanarosa. They brought a retired British couple with them from London who they've known for many years. They were discussing how much $$ they've been "taxed" over their careers for insurance, pension, etc. I will just relay a few of the stories I heard sitting around the kitchen table.

"Our very dear friend was on the list for a hip operation for over 3 years and by the time they got to her, it had deteriorated to the point that they really couldn't do much with what was left of the bones. She is in a wheelchair now for the rest of her life."

"Our very dear friend died last week waiting for lung cancer surgery. The doctor said "it's just as well, it was going to be at least another 6 months before we could get to him."

"Bill's mother died from peritonitis (sic?) after her appendix ruptured. The doctor told her to "go home and take some bicarb my dear and we'll get you scheduled for a specialist."

There were many, many more stories.

Both of these people had full dentures (which fit terribly because they were clacking and whistling with every word) and have had them since their early 50's. Like most Brits.

What brought the whole thing up was my wife calling the doc about changing a dental appointment for me because I'd be out of town and the dentist said "sure, Tuesday next week would be fine, what time?" They simply couldn't believe you could actually call and talk to a doctor or dentist and change an appointment. They said they structure their lives around when they can finally see a doctor, and if they need to see a specialist, they cancel vacations, etc.

Sorry, but I'm out.

Ahh, but how much does it cost ya and how much does it cost them? There's the problem with privatized health care.

I've heard stories like this about Canadian social health care, too.

[soonerscuba]

A question for the people who are against universal healthcare... what do we do with the 45m without access in this country?

[C&CDean]

A question for the people who are against universal healthcare... what do we do with the 45m without access in this country?

What do we do with them now? That's right, we take care of them. Well at least those of us who pay taxes do.

[C&CDean]

Ahh, but how much does it cost ya and how much does it cost them? There's the problem with privatized health care.

I've heard stories like this about Canadian social health care, too.

Let's see, I pay about $160 a month for health/dental/vision through my company's plan. They were "taxed" throughout their working careers at a 60+% rate. So, who pays more?

[C&CDean]

Socialized medicine <> subsidized universal insurance coverage.

but to say the plan is to institute a nationalized health care system as exists in Britain is ignorant at best and a lie at worst.

Do you really think so? You really think we can have it and not have all the problems that come along with it? How many people are gonna go to med school when they find out they're on a fixed $100K salary no matter how many patients they see?

[SoonerInKCMO]

Here's her plan (http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf). Show me where it puts physicians on a fixed income.

[Viking Kitten]

What do we do with them now? That's right, we take care of them. Well at least those of us who pay taxes do.

Absolutely we take care of them. Unfortunately, what happens is they go to emergency rooms for medical care. The taxpayers then end up paying eleventy-jillion percent more than we need to. There has got to be better way than that.

[tommieharris91]

A question for the people who are against universal healthcare... what do we do with the 45m without access in this country?

Well, if you give them some sort of public health system, things like what Dean just posted happens.

I personally don't think gubmint health care is the solution here. The associations who standardize the med school curriculum in the US are who to blame for this, IMHO. They are the ones who limit the supply of doctors, dentists, nurses, etc. Since they do that and more people need health care now than they did before, people here in the US can't afford to see a doctor at all due to increased fees, etc. If the number of certified practicioners increases, they cannot charge as much. Another reason why we're so fat and unhealthy is because we eat lotsa stuff with high fructose corn syrup nd other ingredients known to cause fun things like cancer. All the while, most med schools don't devote much time to studying nutrition as a preventative medicine. It's being helped a bit because we're eating healthier as a country, but our girth is still a problem.

Obviously, the tradeoff for slacking the admission requirements for med schools are more malpractice-related injuries. The problem with adding more nutritionists means less time for those devoted to repairative medicine.

At least that's how I learned it to be.

[C&CDean]

Absolutely we take care of them. Unfortunately, what happens is they go to emergency rooms for medical care. The taxpayers then end up paying eleventy-jillion percent more than we need to. There has got to be better way than that.

So the answer is to pay for them up front so they can go to a regular doctor and take a spot on the appointment book ahead of the guy who actually pays?

[tommieharris91]

Here's her plan (http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf). Show me where it puts physicians on a fixed income.

Well, physicians won't get put on a fixed income, but they better not make over $250k unless they wanna indirectly pay for work.

[SoonerInKCMO]

Ehh... $250k is plenty for 'em. ;)

Besides, if I'm reading it correctly, she's just talking about raising the marginal income tax rate for people that make $250k+ to what it was a few years ago.

[OUDoc]

Well, physicians won't get put on a fixed income, but they better not make over $250k unless they wanna indirectly pay for work.

What time do you want me there? :D

[Viking Kitten]

So the answer is to pay for them up front so they can go to a regular doctor and take a spot on the appointment book ahead of the guy who actually pays?

More indigent health care clinics would help. Incentivize doctors to staff them by helping them pay down their student loans, maybe? That's still subsidized health care. It sure would beat the hell out the way it's happening now though.

Look, I've never said socialized health care is the answer. I'm just saying we need to get a grip on this before the problem gets a lot worse.

[C&CDean]

More indigent health care clinics would help. Incentivize doctors to staff them by helping them pay down their student loans, maybe? That's still subsidized health care. It sure would beat the hell out the way it's happening now though.

Look, I've never said socialized health care is the answer. I'm just saying we need to get a grip on this before the problem gets a lot worse.

I won't disagree that there's a problem, but taxing the ever loving dog**** outta you and me so the scumbags can go to a regular doc instead of the ER doesn't make sense to me. We pay a lot now, yes, but we'll pay a hell of a lot more if we start footing their bill upfront, and working/paying people's healthcare will suffer as a side effect.

The point of my original post is that socialized medicine doesn't work. Never has, never will.

[yermom]

yeah, but it still needs to change. personally, i think it's too easy for employers to shortchange their employees on health insurance

[C&CDean]

yeah, but it still needs to change. personally, i think it's too easy for employers to shortchange their employees on health insurance

Dude, everything needs to change. But not for changes sake. And if you're worried about getting shortchanged, become the employer. Then you'll be the evil bastard who ****s on the little people.

[tommieharris91]

What time do you want me there? :D

So you would like to pay your employer? :confused:

...I think my sarcasm detector is broken...

[OUDoc]

So you would like to pay your employer? :confused:

...I think my sarcasm detector is broken...

No, I'd like 250K/year. I hoped you were hiring. :D

[yermom]

Dude, everything needs to change. But not for changes sake. And if you're worried about getting shortchanged, become the employer. Then you'll be the evil bastard who ****s on the little people.

not everyone can be a boss, someone has to do the **** jobs

why should the people stuck doing the **** jobs also not have insurance as someone else gets rich off of their work?

i know way too many people that don't have health insurance

[Frozen Sooner]

I thought it was kind of interesting that at my little brother's commencement for his graduation from Medical School, the Dean of the Medical School's address was about the necessity of a single-payer system.

[C&CDean]

not everyone can be a boss, someone has to do the **** jobs

why should the people stuck doing the **** jobs also not have insurance as someone else gets rich off of their work?

i know way too many people that don't have health insurance

Then the guys who don't have it need to find a job that offers it. Way too many people are running around with a huge sense of entitlement these days. Nobody said life was easy.

[C&CDean]

I thought it was kind of interesting that at my little brother's commencement for his graduation from Medical School, the Dean of the Medical School's address was about the necessity of a single-payer system.

Well hells yes the docs would be for a single-payer system. They could negotiate better rates from the insurance companies (or federal government if you lefties get your way). Plus, they wouldn't have all the overhead associated with non-payers (bill collection staff, etc.). Of course the specialists who actually do make the big bucks from the Hollywood types might not dig it much.

[yermom]

I thought it was kind of interesting that at my little brother's commencement for his graduation from Medical School, the Dean of the Medical School's address was about the necessity of a single-payer system.

single-payer?

[Cam]

I won't disagree that there's a problem, but taxing the ever loving dog**** outta you and me so the scumbags can go to a regular doc instead of the ER doesn't make sense to me. We pay a lot now, yes, but we'll pay a hell of a lot more if we start footing their bill upfront, and working/paying people's healthcare will suffer as a side effect.

The point of my original post is that socialized medicine doesn't work. Never has, never will.

Um, aren't we already paying for the uninsured with jacked up costs at hospitals. $2K an hour for an operating room, $300 for aspirin, $2K for anesthesia?

Aren't the insured already getting gouged out the wazzu so that hospitals can cover the costs of treating those without insurance?

The amount that hospitals/Dr's charge versus what insurance companies pay is out-fugin-rageous.

[yermom]

Then the guys who don't have it need to find a job that offers it. Way too many people are running around with a huge sense of entitlement these days. Nobody said life was easy.

but you can't have it both ways. no one is just willing to let people die if they are stupid or lazy, so we get to pay more in the long run

[yermom]

Um, aren't we already paying for the uninsured with jacked up costs at hospitals. $2K an hour for an operating room, $300 for aspirin, $2K for anesthesia?

Aren't the insured already getting gouged out the wazzu so that hospitals can cover the costs of treating those without insurance?

The amount that hospitals/Dr's charge versus what insurance companies pay is out-fugin-rageous.

yeah, i love how they charge someone with insurance less than someone paying out of pocket

[C&CDean]

Um, aren't we already paying for the uninsured with jacked up costs at hospitals. $2K an hour for an operating room, $300 for aspirin, $2K for anesthesia?

Aren't the insured already getting gouged out the wazzu so that hospitals can cover the costs of treating those without insurance?

The amount that hospitals/Dr's charge versus what insurance companies pay is out-fugin-rageous.

True story:

My kid got hit by a car when he was 6. Norman Regional, mediflight to Children's, 6 weeks in Children's ICU (3 in a coma), 5 weeks at Jim Thorpe in-patient and another couple months outpatient.

When all was said and done, the bill was about $500K. Know what I paid out of pocket? $50. And the only reason I payed that was because my insurance has a $50 copay for emergency rooms visits that don't result in hospitalization. I argued that he was hospitalized but they said "not at the emergency room hospital." So it cost me $50.

Of course I don't carry the insurance that requires a deductible, or only pays a % of the charges. I don't do claim forms, or anything else. Just give them my card, and pay the copay.

I can understand people's frustration with some of this, but making it all "equal" isn't making it equal at all. It just means that those of us who work and pay will still work and pay - just a hell of a lot more.

[Frozen Sooner]

single-payer?

A monopoly is granted in health care insurance, to which everyone subscribes.

Pros: Cuts down on paperwork for doctor's offices. Cuts down on confusion as to what is covered for how much. Still allows free-market competition between doctors for patients. Eliminates insurance incentives to only treat symptoms instead of underlying conditions.

Cons: Monopoly power could be abused to raise rates above competitive equilibrium. Eliminates the "rationally uninsured" choice.

[C&CDean]

yeah, i love how they charge someone with insurance less than someone paying out of pocket

Then quit being a gatdamn rebel and get a good job!!111:texan:

[Frozen Sooner]

True story:

My kid got hit by a car when he was 6. Norman Regional, mediflight to Children's, 6 weeks in Children's ICU (3 in a coma), 5 weeks at Jim Thorpe in-patient and another couple months outpatient.

When all was said and done, the bill was about $500K. Know what I paid out of pocket? $50. And the only reason I payed that was because my insurance has a $50 copay for emergency rooms visits that don't result in hospitalization. I argued that he was hospitalized but they said "not at the emergency room hospital." So it cost me $50.

Of course I don't carry the insurance that requires a deductible, or only pays a % of the charges. I don't do claim forms, or anything else. Just give them my card, and pay the copay.

I can understand people's frustration with some of this, but making it all "equal" isn't making it equal at all. It just means that those of us who work and pay will still work and pay - just a hell of a lot more.

So what you're saying is the government-provided health insurance works pretty well?

[C&CDean]

A monopoly is granted in health care insurance, to which everyone subscribes.

Pros: Cuts down on paperwork for doctor's offices. Cuts down on confusion as to what is covered for how much. Still allows free-market competition between doctors for patients. Eliminates insurance incentives to only treat symptoms instead of underlying conditions.

Cons: Monopoly power could be abused to raise rates above competitive equilibrium. Eliminates the "rationally uninsured" choice.

You shore got a purdy mouf....

[C&CDean]

So what you're saying is the government-provided health insurance works pretty well?

For someone who talks purdy you shore don't read purdy.

[Cam]

yeah, i love how they charge someone with insurance less than someone paying out of pocket

I'm not sure if they charge different rates or not, but they know that they're only going to get what the insurance companies will pay for those that have it and have met their deductibles.


True story:

My kid got hit by a car when he was 6. Norman Regional, mediflight to Children's, 6 weeks in Children's ICU (3 in a coma), 5 weeks at Jim Thorpe in-patient and another couple months outpatient.

When all was said and done, the bill was about $500K. Know what I paid out of pocket? $50. And the only reason I payed that was because my insurance has a $50 copay for emergency rooms visits that don't result in hospitalization. I argued that he was hospitalized but they said "not at the emergency room hospital." So it cost me $50.

Of course I don't carry the insurance that requires a deductible, or only pays a % of the charges. I don't do claim forms, or anything else. Just give them my card, and pay the copay.
That would succ!!!

Even though the bill was $500K, there's no way they got that much out of the insurance company.


I can understand people's frustration with some of this, but making it all "equal" isn't making it equal at all. It just means that those of us who work and pay will still work and pay - just a hell of a lot more.

I don't know that equal's the way to go, only that the system's kind of fubar'd right now.

[Frozen Sooner]

I'm sorry, is your family health plan not a group plan through your employer?

Is your employer not the US Postal Service?

Do you really think that your $160 per month (I think that's the figure you gave earlier) is the full cost of that group plan-particularly since it's covering a family?

[C&CDean]

I'm sorry, is your family health plan not a group plan through your employer?

Is your employer not the US Postal Service?

Do you really think that your $160 per month (I think that's the figure you gave earlier) is the full cost of that group plan-particularly since it's covering a family?

Of course not.

However, the USPS is not a "government agency" per se. Not a dime of taxpayers money supports it. All revenues are generated through sales and services. Just like a real company.

And I don't have to take the insurance I have. I could pick from a whole slew of companies who offer it. Or I could choose to not take it at all. You know, freedom of choice?

[C&CDean]

I'm not sure if they charge different rates or not, but they know that they're only going to get what the insurance companies will pay for those that have it and have met their deductibles.


That would succ!!!

Even though the bill was $500K, there's no way they got that much out of the insurance company.



I don't know that equal's the way to go, only that the system's kind of fubar'd right now.

Yeah, it did suck. And you are very correct when you said there's no way they got $500K out of the insurance company. We attended a meeting between the Jim Thorpe folks and our insurance company. I saw some figures that I wasn't supposed to see. I'm pretty sure they paid about 45% of the actual bill.

[Frozen Sooner]

Oh, I know that the USPS is happens to be self-supporting. However, it's still a civil service job, is it not? IIRC, they want you to take the Civil Service exam before going to work there.

And sure, you have freedom of choice in your insurers. Of course, your employer isn't going to subsidize those other insurance choices, making them really no choice at all. And it sounds like the insurer they went with did a pretty bang-up job for you.

[yermom]

i used to have good insurance, now i have Aetna. it kinda blows. i kinda wish i could choose someone else, but i'd have to pay out of pocket for it.

i'm just lucky that i basically never use it

[C&CDean]

Oh, I know that the USPS is happens to be self-supporting. However, it's still a civil service job, is it not? IIRC, they want you to take the Civil Service exam before going to work there.

And sure, you have freedom of choice in your insurers. Of course, your employer isn't going to subsidize those other insurance choices, making them really no choice at all. And it sounds like the insurer they went with did a pretty bang-up job for you.

No, it's not a civil service job. You take tests, but they're USPS tests.

Of course I am on the civil service retirement plan because I was hired prior to the dissolution of the Pony Express, however my wife isn't on the same plan. And yes, we do suffer from the bi-postal disorder.

[C&CDean]

i used to have good insurance, now i have Aetna. it kinda blows. i kinda wish i could choose someone else, but i'd have to pay out of pocket for it.

i'm just lucky that i basically never use it

Aetna was the company who paid my bills.

[yermom]

our plans aren't near that good, especially covering kids. i'd be paying way more than $160 out of pocket a month for that kind of coverage

[Jerk]

Question for libs:

Will public healthcare be better than public housing, public restrooms, or public schools?

Thanks.

[olevetonahill]

Hey Dean . I gota "No postage required " envelope. im gonna stuff it with a Lot Of junk and Mail it :D

[SoonerInKCMO]

Question for libs:

Will public healthcare be better than public housing, public restrooms, or public schools?

Thanks.

Hillary's plan isn't analogous to public schools; it's more like providing vouchers for private schools.

[Chuck Bao]

It would be great if everyone could find jobs with companies offering great health care benefits. But, that's not realistic. especially given the rising health care costs.

It seems that more and more companies are outsourcing to avoid this expense. Over the last two years, several of my friends were forced to switch over from being an employee to a year-to-year contract basis, losing all benefits, including health care and bonuses. They were told if they don't like it, they can find a job elsewhere.

My team lost health care benefits during the Asian economic crisis in 1997. It was one of the first things my company, the largest and state-owned Singapore bank, cut. I disagreed and eventually paid out of my own pocket the insurance premiums for my crew. I ask a lot of my team and I don't think they need to be worrying about how to pay for their medical bills should something terrible happen.

I am sincerely happy that some of you get great health benefits.

But, I have to wonder if the very high cost of the US health care is in fact resulting in some Americans losing their jobs or employment status.

On a side note, I have a lot of British friends and I have never heard any of them complain about the British health care system. Okay, they all live in Asia and pay no British taxes, so they like going home once a year and getting all the free meds.

[Jerk]

Hillary's plan isn't analogous to public schools; it's more like providing vouchers for private schools.


oh, so participation won't be mandatory?

(unless you're paying for it as a taxpayer, of course)

I can chose my own doctor?

[Okla-homey]

single-payer?

yes. and he's known as Uncle Sam.

Look, I realize people aren't "covered" in this country, but I've yet to hear a single documentable story from ANYONE anywhere on this Fruited Plain stating they or someone they loved was denied care they needed because they couldn't afford it.

Now, I know some people don't go to the doc when they would like to, but can someone show me where in the Constitution it says free doctor's visits are a right?

The way I see it, life involves some prioritizing. If a person can't afford a office visit when they're bad sick that costs under a hundred bucks (at least here in this market) perhaps they should consider ditching the cell phone bill, car note, cable TV, or fake nails, etc.

See, I contend this is mostly about people wanting it all. And that kinda thinking is eventually gonna bankrupt Uncle Sam. Just ask GM. they spend more on healthcare for current workers and retirees than steel.

Frankly, whatever we end up with, (and I think we'll end up with some kinda f'ed-up kluged-together compromise "single-payer" plan that will work about as efficiently as any other gubmint administered program and will p1ss EVERYBODY off) we better make damn sure there's a substantial co-pay for everyone, even if indexed to their ability to pay, or we'll end up with people going to the doctor's office for the MF sniffles.

See kids, if stuff is "free," people turn into hawgs.

end rant.

[SoonerInKCMO]

oh, so participation won't be mandatory?

(unless you're paying for it as a taxpayer, of course)

I can chose my own doctor?

If you'd read the plan I linked to, you'd know the answers to those questions.

[Vaevictis]

However, the USPS is not a "government agency" per se. Not a dime of taxpayers money supports it. All revenues are generated through sales and services. Just like a real company.

No, they're not paid through tax payer money at all. Instead, the USPS has statutory monopolies protecting it from private competition in certain areas, insuring that the USPS can turn a higher profit on those routes than if they did have private competition.

It's just a tax in another form.

[Harry Beanbag]

The vast majority of people that use the ER as their primary healthcare provider out here don't speak English, meaning they shouldn't ****ing be here in the first place.

[olevetonahill]

If you'd read the plan I linked to, you'd know the answers to those questions.

Im to lazy to read it all . Can the Gov give me an easy version ?

[TheBobbyTrain]

I've yet to see anyone point out the real root of the healthcare problem - America's health status as a nation. Health care prices would drop drastically if people would decide to quit being overweight fatasses and clog up the system with problems related to being overweight (and that list of problems is very, very extensive)

Miraculous things can happen when you're healthy and your immune system can fight off what it needs to. I haven't needed to visit a doctor for anything in 4 years. I don't have to pay anything if I don't need to go. I think that the root of the healthcare problem in America is the lack of proper health education and the prevalence of terrible food choices.

[tommieharris91]

I've yet to see anyone point out the real root of the healthcare problem - America's health status as a nation. Health care prices would drop drastically if people would decide to quit being overweight fatasses and clog up the system with problems related to being overweight (and that list of problems is very, very extensive)

Miraculous things can happen when you're healthy and your immune system can fight off what it needs to. I haven't needed to visit a doctor for anything in 4 years. I don't have to pay anything if I don't need to go. I think that the root of the healthcare problem in America is the lack of proper health education and the prevalence of terrible food choices.



Another reason why we're so fat and unhealthy is because we eat lotsa stuff with high fructose corn syrup nd other ingredients known to cause fun things like cancer. All the while, most med schools don't devote much time to studying nutrition as a preventative medicine. It's being helped a bit because we're eating healthier as a country, but our girth is still a problem.

The problem with adding more nutritionists means less time for those devoted to repairative medicine.

At least that's how I learned it to be.

:les: REED TEH TREAD!!!

[TheBobbyTrain]

:les: REED TEH TREAD!!!

:O

Just consider it reinforcement of your post.

:eddie:

[KC//CRIMSON]

There has got to be better way than that.

Send 'em all to the Wal-Mart Clinic!

[OKC-SLC]

If we go to a socialized (or even quasi-socialized) health care system, we will regret it. In a big way.

[AlbqSooner]

How it works now: In 2003 I was hospitalized from approximately 9:30 a.m. until approximately 7:00 a.m. the next day. Took an ambulance from the Drs. office, entered through the ER, admitted. Multiple blood tests and radiographic procedures done. Seen by my primary care physician, a neurologist, and a cardiologist. Final diagnosis - a mild stroke. (Trust me the are only mild when they happen to someone else.)

About 3 weeks later I get a statement from the Hospital. It lists everything I was charged for, not including the medical consults (Drs.) Total bill $26,000 plus. It said, DO NOT PAY FROM THIS STATEMENT - FOR INFORMATIONAL PURPOSES ONLY.

About a month later I got the same statement. However this one showed a credit for my $100 co-pay, a credit for payment received from my insurance carrier in the amount of $6,500, and a "Contractually absorbed" category showing the remaining portion of the original $26,000 plus.

If I had not had insurance, I would have been responsible for the entire $26,000 plus. Since I had insurance the hospital accepted $6,600.

Here is the rub. If I had been uninsured I would have probably taken bankruptcy or negotiated a write off by the hospital of a substantial portion of the billining. The hospital would show a write off of whatever was not paid, and THAT amount would be bandied about in Congressional committees to justify passing some sort of single payer system.

Smoke and mirrors in the halls of Congress if you can believe that.

[shaun4411]

either way, the term "Free healthcare" is a misnomer. someone will pay for it. people like us have healthcare through our employers because we are smart are relatively indifferent. the people that care the most are the poor people who have none, and want a shiny new card, the hypochondriacs that go to the ER for a sneeze, and the people who actually need it like terminally ill or constantly ill people who get a new disease every other week. the relative number of people who go into the poor house due to medical bills is pretty low. those stories are few and far between when put against the typical "i get a checkup every 6 months" story. yes, it sucks when an 8 yr old gets cancer and mom and dad are pitted with the $200,000 bill. yes it sucks when someone has to file for bankruptcy just to pay a medical bill. but it also sucks when someone loses his job and loses everything. or if someone contracts HIV through being raped and is forced to foot the bill for dr visits and medication. things like this happen. medical reasons are just *another* reason that tragedies of this nature occur.

yet here are the libs, playing to the tune of the minority like they did when they raised the minimum wage for the whole 6% of US taxpayers who actually earn that minimum rate.

[olevetonahill]

My Kid went to the Poteau ER . Cant remember If they told him why he thot he was Dying. They charged him like 2500 fer a visit and a few tests
He asked me to take Him to St Edwards In Ft Smith, They Tell Him why He thinks Hes dying, Give him some Meds after doing the same tests. send Him Home . They send him a bill fer 900 or so .
Some of the Things Ive read here Kinda explain the Vast Billin differance
Oh He was trying to Pass a KS :eek:

[C&CDean]

No, they're not paid through tax payer money at all. Instead, the USPS has statutory monopolies protecting it from private competition in certain areas, insuring that the USPS can turn a higher profit on those routes than if they did have private competition.

It's just a tax in another form.
You couldn't be more wrong if you were born with a penis and a vajayjay.

The only thing the USPS "monoplizes" is PO boxes. We are greatly penalized because we are still mandated by Congress to deliver to every address there is. Private companies only deliver to areas that are profitable.

If you send a letter to somebody out on the Ketchikan Penninsula the USPS has to deliver it. Mail is delivered by bush plane/snowmobile/dog sled/ and other creative methods - all for your 42 cent stamp (or whatever the hell postage is these days). How many private carriers would even bother delivering out there? At any price.

The only way you are "taxed" by the USPS is if you rent a PO box.

[StoopTroup]

One of the things I have a question about is whether or not a Health Plan that covers all Americans will end the Vetern's Health Administration. Ending this Governmental Glut on our Taxpayers and including it into the funds used for all Americans should help offset some of the cost associated with funding the new Healthcare for all Americans.

If it doesn't work to eliminate an already broken VA...I'd be against it.

I would hope that we work to give all Americans good coverage and develop a system that gets rid of Healthcare Professionals that abuse the system and those that are a danger to patients.

Changing our current healthcare systems is scary. I'm sure many folks won't react well to the changes at first either. Unfortunately I believe we need to create a better system.

This is America...we can do better for our taxpayers. IMO...every person that spends money is a taxpayer.

I also think we should probably eliminate some of the tax shelters for Religious Tax Shelters in our Country. You don't need Gucci Shoes and a Mercedes Benz to be a good Preacher.

[Mongo]

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

happiness is not a guarantee, nor is equal stature/possesions/health care/money/etc.

dont penalize the fortunate for the sake of a few

[Jerk]

If we go to a socialized (or even quasi-socialized) health care system, we will regret it. In a big way.


What the hell do you know? You're just a doctor.

:D

[Vaevictis]

You couldn't be more wrong if you were born with a penis and a vajayjay.

Really? So I guess 18 USC &#167; 1693-1696 and 39 USC &#167; 601-606 are just figments of my imagination, huh. 39 CFR 310 and 320, likewise, eh?

Nope, no monopoly there. Even better: http://www.usps.com/cpim/ftp/pubs/pub542.pdf


The Private Express Statutes (PES) are a group of federal civil and criminal laws that, for the most part, make it unlawful for any entity other than the U.S. Postal Service to send or carry letters over post routes for compensation unless appropriate postage is paid in an amount equaling what would have been paid had the letters been sent through the Postal
Service.

USPS gets to set price floors to protect itself from competition. AWESOME!

Price floors to protect a government department's ops are equivalent to a tax if the market clearing price is below that. Your argument:


The only thing the USPS "monoplizes" is PO boxes. We are greatly penalized because we are still mandated by Congress to deliver to every address there is. Private companies only deliver to areas that are profitable.

This is essentially just redistribution of wealth in another form. Use laws to keep prices artificially high for the cheapest routes so that we can afford to deliver on the more expensive ones.

[Frozen Sooner]

I'm relatively sure that I can FedEx something to Ketchikan.

And I know I can Gold Streak there.

Costs an assload, though.

[mdklatt]

The USPS has an advantage over everybody else because they can utilize commercial airline flights to carry mail. UPS and FedEx would probably be a lot cheaper if they didn't have to maintain their own fleet of aircraft.

[OKC-SLC]

One of the things I have a question about is whether or not a Health Plan that covers all Americans will end the Vetern's Health Administration. Ending this Governmental Glut on our Taxpayers and including it into the funds used for all Americans should help offset some of the cost associated with funding the new Healthcare for all Americans.

If it doesn't work to eliminate an already broken VA...I'd be against it.

Interesting that you (and others) cite the VA as an example of an inefficient federal entity. You are correct, mind you.

I spend/ have spent a fair amount of time at VAs, and I'm here to tell you that while Veterans have access to appropriate cares, the VA is indeed an example of how the Fed Govt is 0 for 1 in the health care business.

[Chuck Bao]

I have no idea about VA hospitals.

I do know Thailand and we basically have a two-tier system and I think it works.

We have state-owned hospitals and they charge a grand total of about $1 per visit, regardless of how long you stay in the hospital and the treatment. You have have to wait in a queue if you need immediate treatment. I haven't heard of anyone being delayed treatment.

Then, we have private hospitals. Some of them are like 4-star hotels. Thailand is really going big in the resort health care tourism business. My hospital even does that flags out front of all the different nationalities staying in the hospital thingy that some hotels do. I think someone mentioned that a medical procedure in Thailand costs one-third of that in the US, which, if US insurance companies would pay for it, would more than pay for a flight over.

I think we have the best of both worlds. The poor get their near free coverage and those with insurance or money get the best care possible.

[Rogue]

One of the things I have a question about is whether or not a Health Plan that covers all Americans will end the Vetern's Health Administration. Ending this Governmental Glut on our Taxpayers and including it into the funds used for all Americans should help offset some of the cost associated with funding the new Healthcare for all Americans.

If it doesn't work to eliminate an already broken VA...I'd be against it.


Show me a better healthcare system, public or private, than VA in the past 10 years. And bring data. Be careful, this isn't your Dad's Oldsmobile.

VHA is the best healthcare system in this 1/3 of my state. As a vet, with great private insurance, I choose to use VA. Except for dental...I'm not "eligible" for VA dental care. See, they are light years ahead of other systems in electronic records, performance measurement, performance pay, preventive medicine (makes sense since I'll be their patient forever), mental health, and deliver my meds right to my mailbox through Dean and VK's company which, BTW, uses the same retirement system as the feds and military, Thrift Savings Plan. VA also trains more doctors, nurses, and allied health students while contributing to more healthcare research than private sector systems.

Far from being a "glut," it's a benefit that is one of the few benefits promised to vets that hasn't been welched on. And it's already being rationed and restricted.

The broken piece of the puzzle is DoD healthcare. After a multi-decade downsizing, they just weren't ready for a war. I've been to Walter Reed AMC, and it's not nearly as bad as the media would have you believe. On the contrary, as with most military healthcare, they are making innovations out of necessity. The prosthetics labs onsite there are amazing.

[OKC-SLC]

Show me a better healthcare system, public or private, than VA in the past 10 years. And bring data. Be careful, this isn't your Dad's Oldsmobile.

VHA is the best healthcare system in this 1/3 of my state. As a vet, with great private insurance, I choose to use VA. Except for dental...I'm not "eligible" for VA dental care. See, they are light years ahead of other systems in electronic records, performance measurement, performance pay, preventive medicine (makes sense since I'll be their patient forever), mental health, and deliver my meds right to my mailbox through Dean and VK's company which, BTW, uses the same retirement system as the feds and military, Thrift Savings Plan. VA also trains more doctors, nurses, and allied health students while contributing to more healthcare research than private sector systems.

Far from being a "glut," it's a benefit that is one of the few benefits promised to vets that hasn't been welched on. And it's already being rationed and restricted.

The broken piece of the puzzle is DoD healthcare. After a multi-decade downsizing, they just weren't ready for a war. I've been to Walter Reed AMC, and it's not nearly as bad as the media would have you believe. On the contrary, as with most military healthcare, they are making innovations out of necessity. The prosthetics labs onsite there are amazing.
You are correct on many points regarding the VA's performance in measures. However, I see every day how the VA meets these measures, and to be honest with you, there is a lot of hoop jumping. This is the case in the private sector as well (see JCAHO).

And again I'll say that Veterans have access to the appropriate cares via the VA. However, the VA is not an efficient system. And the pay scale is not very competitive (for physicians anyway); that in combination with its designation as a facility which treats the 'underserved' results in employing many less competitive physicians.

The VA system is overall good and underrated. But if the fed govt were to take charge of health care for all 300 million of us, I have no reason to believe the quality, accessibility, and timeliness of care will do anything but decrease.

[StoopTroup]

Show me a better healthcare system, public or private, than VA in the past 10 years. And bring data. Be careful, this isn't your Dad's Oldsmobile.

VHA is the best healthcare system in this 1/3 of my state. As a vet, with great private insurance, I choose to use VA. Except for dental...I'm not "eligible" for VA dental care. See, they are light years ahead of other systems in electronic records, performance measurement, performance pay, preventive medicine (makes sense since I'll be their patient forever), mental health, and deliver my meds right to my mailbox through Dean and VK's company which, BTW, uses the same retirement system as the feds and military, Thrift Savings Plan. VA also trains more doctors, nurses, and allied health students while contributing to more healthcare research than private sector systems.

Far from being a "glut," it's a benefit that is one of the few benefits promised to vets that hasn't been welched on. And it's already being rationed and restricted.

The broken piece of the puzzle is DoD healthcare. After a multi-decade downsizing, they just weren't ready for a war. I've been to Walter Reed AMC, and it's not nearly as bad as the media would have you believe. On the contrary, as with most military healthcare, they are making innovations out of necessity. The prosthetics labs onsite there are amazing.

I just think we shouldn't need it if the Country is going to go the way of Universal Health Care.

If you don't think the VA system could be improved...then I think I'd be against changing any of it.

Also...if you think the VA system is an efficient way of spending our tax dollars...then I'd love to see the numbers on that.

I would never say the folks involved in the treatment and care of our Vets are at fault either.

There would be no need for both systems if Universal Health Care was going to be good for All Americans.

If it's a quick fix for political gain though...

We'll all regret it IMO.

Making sure people get the best care on Earth is my only aim. Pointing fingers as to what's wrong isn't.

[olevetonahill]

Im gonna Have to side with the Rogue.
10/ 15 Years ago the VA sucked donkey balls .
Its gotten better . I go every 6 months fer a check up .
My Dental and Vision are covered . Ive Not had to wait more than 15 Minutes for an appointment .
If anything , They Overdo , Like An xray , tests . but they re just being Preventive .
The Only thing Id bitch about (and I aint Bitching ) is the Use of PAs
seems Not enough Doctors want to stay around .
But If a Real Doc is Needed They get ya In fast to .

[Zbird]

Let's see, I pay about $160 a month for health/dental/vision through my company's plan. They were "taxed" throughout their working careers at a 60+% rate. So, who pays more?

But unless I'm mistaken, your plan is HEAVILY subsidised by US Tax payers.

[Zbird]

So what you're saying is the government-provided health insurance works pretty well?

Naw, Whut Dean wuz sayin iz "Ah got MINE" "Keep them cards and letters rollin."

[Okla-homey]

I'll say this. If we get socialized medicine, you better hope your cornhole stays healthy.

Think about it.

The only reason anyone endures medical school and residency and then decides to be a proctologist who specializes in afflictions and diseases of the anus, rectum and lower bowel is because they make loads of green. Mainly because there are so dang few of them. Cornholigists, not cornholes. Lord knows we got enough cornholes.

But I digress. Anyhoo, if you take away a man's ability to get rich doctoring on cornholes, I expect you will have eliminated the only possible motivation for that specialty. FWIW, ditto urologists.

Put that in your crack pipe and smoke it there HRC and BHO.

[Vaevictis]

But I digress. Anyhoo, if you take away a man's ability to get rich doctoring on cornholes, I expect you will have eliminated the only possible motivation for that specialty. FWIW, ditto urologists.

Naw, that's the only motivation you wish to countenance. I'm sure there are others.

[OKC-SLC]

Im gonna Have to side with the Rogue.
10/ 15 Years ago the VA sucked donkey balls .
Its gotten better . I go every 6 months fer a check up .
My Dental and Vision are covered . Ive Not had to wait more than 15 Minutes for an appointment .
If anything , They Overdo , Like An xray , tests . but they re just being Preventive .
The Only thing Id bitch about (and I aint Bitching ) is the Use of PAs
seems Not enough Doctors want to stay around .
But If a Real Doc is Needed They get ya In fast to .

I don't think Rogue, ST, and I are saying anything different, so I don't think there are sides at all, Olevet.

There's no doubt that the VA is much improved over what it was years ago. And I'll reiterate that Veterans thru the VA are getting the care they need. The system however is flat out not efficient--this is coming from someone who's been a physician or medical student in one of three different VAs over the last 8 years.

From your persective, this inefficiency can be seen in the long wait times--i.e., when was the last time you were seen within 15 minutes of your scheduled appointment time? When was the last time your doc/PA ordered a medicine from clinic for you to pick up and you didn't have to wait over an hour for the electronically processed prescription to be filled and your name to show up on the monitor? And when was the last time you were able to see YOUR physician (not another physician or a PA/ARNP) within 24 hours of having a semiurgent matter/problem? Olevet, these items may not apply to you as much because I know you likely get your care from a SE OK VISN satellite center, but trust me--these are issues in OKC, SLC, and KC. And what it if this happened in the 'real world'? How do we measure the cost of productivity if every patient young and old had to effectively take a day off to have their checkup? (I'm sure we can find a way to figure this out--we'll ask the people who figured out how much March Madness costs the US in lost productivity.)

From the inside, it is even more obvious that the inefficiency is real. Rogue cited the computerized medical records of the VA--"CPRS"--which indeed for my money IS the best electronic medical record out there, and I've worked with 5 other major ones. However, even though the VA has been 'paperless' for nearly 20 years, there are piles of papers in radiology scheduling offices, compensation and pension clinics, and surgery scheduling suites to name a few. These papers represent Veterans waiting to hear about their elective chest xray for follow up of a lung mass, Iraq Veterans waiting for a pension evaluation for 6+ months after having their damn arm blown off by roadside, and 40-somethings with symptomatic cholelithiasis waiting to schedule their cholecystectomy before they have another round of gallstone pancreatitis.

As you alluded to, Olevet, the outpatient health maintenance care at a VA, particularly preventive care, is actually quite good. A topic near and dear to me--colonoscopies for colorectal cancer screening--is an example. When you are 50 (assuming average risk) you get a colonoscopy at the VA. No haggling with insurance. You may wait 90 days or so (the current goal for waiting time at the VA for this service), but you'll get it. Same with immunizations, hepatitis C screening, depression screening, etc.

Indeed, if you walk into the ER at a VA hospital with chest pain, or vomiting blood, or a hot appendix--you'll get taken care of pronto, as it should be. But so does that illegal Mexican immigrant who sneaked across the border at 36 weeks' gestation with preeclampsia who walks into OU Med with seizures and abnormal liver tests at 38 weeks. So perhaps the current system isn't broken, but rather in need of improvements?

The VA is a model for what it does. But what it does isn't good enough for an entire industrialized nation.

[OKC-SLC]

I'll say this. If we get socialized medicine, you better hope your cornhole stays healthy.

Think about it.

The only reason anyone endures medical school and residency and then decides to be a proctologist who specializes in afflictions and diseases of the anus, rectum and lower bowel is because they make loads of green. Mainly because there are so dang few of them. Cornholigists, not cornholes. Lord knows we got enough cornholes.

But I digress. Anyhoo, if you take away a man's ability to get rich doctoring on cornholes, I expect you will have eliminated the only possible motivation for that specialty. FWIW, ditto urologists.

Put that in your crack pipe and smoke it there HRC and BHO.
Your point is valid. And I'm a gastroenterologist/hepatologist. If I had to do *** all day, you'd better load my wallet up.

[olevetonahill]

I used to go to the VA in Skogee. It did Take all day , But that was driving back and forth also. At Ft Smith . I can make a Visit In about 3 hrs Round trip .
My Meds are Mailed so I dont waot . I have had to wait befor. It does take fer ever .
I leave it to Yall that Know more about How things should work than I do .
I talked My Buddy Into trying the VA , After about 30 yrs . He finally went to the One In OKC , Closest to him . Hes Damn Happy He finally listened .
He was outa Pocket about 350 Bucka a Month fer Meds . Since he only gets SS retirement that was Killing him . He Now Just spends whatever Gas costs him to Go back and Forth . He says The wait On Meds Is the Longest Part But Hes Usually Done In less than Hr .
I dont Know ,

[Rogue]

VA has a ways to go, but it kicks butt in many areas that are the envy of private sector systems. The time it takes to get lung cancer dx confirmed needs fixed now.
The compensation and pension exams are partly VBA's problem, too. Compare to other disability rating systems, SSD exams, Workman's Comp, etc. and VA is better but far from where it needs to be. I don't care if it's an OEF/OIF vet just off the plane or a WWII vet that just came in for the first time, they should expect the best.

Problem is, VA is trying to do it all. Some specialties should just be paid for, IMO.
Radiology is a problem everywhere. VA has piloted some impressive distance-reading programs that, when they work, are slick. The technology needed is enormous and prone to glitches though.


WAMO 2005 Article (http://www.washingtonmonthly.com/features/2005/0501.longman.html)


…
Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be "significantly better."
Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.
It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.
Not convinced? Consider what vets themselves think. Sure, it's not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don't have service-related illnesses or who can't meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround. "The quality of care is outstanding," says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.
Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation's top health-care quality experts, praises the VHA's information technology as "spectacular." The venerable Institute of Medicine notes that the VHA's "integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation."
If this gives you cognitive dissonance, it should. The story of how and why the VHA became the benchmark for quality medicine in the United States suggests that much of what we think we know about health care and medical economics is just wrong. It's natural to believe that more competition and consumer choice in health care would lead to greater quality and lower costs, because in almost every other realm, it does. That's why the Bush administration--which has been promoting greater use of information technology and other quality improvement in health care--also wants to give individuals new tax-free "health savings accounts" and high-deductible insurance plans. Together, these measures are supposed to encourage patients to do more comparison shopping and haggling with their doctors; therefore, they create more market discipline in the system.
But when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality.
…..


Cambridge 2006 (http://journals.cambridge.org/action/displayAbstract;jsessionid=490F2D2DE682AF0ADCC27AA C98E2F119.tomcat1?fromPage=online&aid=416403)


Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).
(Published Online March 23 2006)





__________________________________
1999 Cost Study (http://www.lww-medicalcare.com/pt/re/medcare/abstract.00005650-199904002-00008.htm;jsessionid=LpdWQ3Z4dkS6lbBSfhC8vshmzMrPZ 7ZmLSsQw6kQh6hSt4nx4NMJ!-1858829228!181195628!8091!-1)


More or Less?: Methods to Compare VA and Non-VA Health Care Costs.
Developments In Cost Methodology
Medical Care. 37(4) VA SUPPLEMENT:AS54-AS62, April 1999.
Hendricks, Ann M. PhD ; Remler, Dahlia K. PhD ++; Prashker, Mark J. MD, MPH
Abstract:
Objective. To examine past comparisons of the costs of the Veterans Health Administration (VA) and of non-VA providers to determine lessons and data requirements for future cost comparisons, particularly those assessing VA efficiency and to determine whether VA should purchase care from non-VA providers.
Conceptual Framework. Over the past two decades, researchers have tried to establish how VA costs compare to those of non-VA health care delivery systems. Existing studies of overall acute care costs address one of two distinct questions: How do VA costs compare to costs in private sector hospitals? and Would it cost more to have VA patients treated in nonfederal hospitals? For both questions, the major factors underlying differences in health care costs are variations in outputs, input prices, and levels of efficiency. Health care cost comparisons across systems must also wrestle with accounting differences.
Conclusions. That review finds no convincing evidence that VA has been significantly more or less efficient than nonfederal hospitals in delivering care. However, VA costs do appear to have been significantly lower than fee-for-service charges that the federal government might have to pay if veterans were treated in private sector hospitals for the same diagnoses. Future comparisons of costs in the era of managed care will require better diagnostic and population data to control for observable and unobservable case-mix differences. They should also include measures of the quality of outcomes. Finally, consistent accounting practices, particularly in the treatment of capital costs, are needed.
(C) 1999 Lippincott Williams & Wilkins, Inc. __________________________________________________ _______________

http://www.va.gov/OCA/testimony/svac/22SE9810.asp

Dr. Kizer, largely credited with reforming the VA


__________________________________________________ ____

It's only gotten better since then (http://www3.interscience.wiley.com/journal/112159821/abstract?CRETRY=1&SRETRY=0)

By 2000, VA is outperforming private sector 94% to 90%.


Research Article
Performance-based budgeting in the public sector: an illustration from the VA health care system
KEYWORDS

performance-based budgeting • cost frontier • quality of care • access to care • hospitals
ABSTRACT
This paper estimates frontier cost functions for US Department of Veterans Affairs (VA) hospitals in FY2000 that are consistent with economic theory and explicitly account for cost differences across patients' risk, level of access to care, quality of care, and hospital-specific characteristics. Results indicate that on average VA hospitals in FY2000 operate at efficiency levels of 94%, as compared to previous studies on US private sector hospitals that average closer to 90% efficient. Using these cost frontiers, management systems potentially could be implemented to enhance the equitable allocation of the VA medical care global budget and systematically distribute funds across hospitals and networks. The paper also provides recommendations to improve the efficiency of delivering health care services applicable to public sector organizations. Copyright © 2005 John Wiley & Sons, Ltd.
________________________________________
Received: 28 July 2003; Accepted: 8 July 2005______________________________________________ ___________________

http://select.nytimes.com/2006/01/27/opinion/27krugman.html?_r=1&hp&oref=slogin

NYT Op/Ed - He gets some of it right. Dead wrong about insurance billing though.

__________________________________________________ ___

Yeah, it's a blog, but a well-referenced one. (http://healthypolicy.typepad.com/blog/veterans_affairs/index.html)


From the New England Journal of Medicine:

In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994–1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through
1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators.

The quality of care in the VA health care system substantially improved after the implementation of a system-wide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.
From the Washington Monthly:
The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care. It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.
Substantive research, along with patient satisfaction, shows that the care delivered at the VA, once the worst in the country, is now among the best.
Something else the VA has that rest of us non-vets don't? Electronic medical records, which have transformed efficiency and standards of care. It's the only example of in-the-U.S. totally government-run medicine, and it works. Bettter than Medicare, and much better than the private sector.

Thanks to Martin for digging up the NEJM article
__________________________________________________ _
VA -- more than fine
WaPo reports on the sixth year in a row that the VA has outperformed the private sector in customer satisfaction:
Inpatient care received a rating of 83 on a 100-point scale; outpatient care got a rating of 80. In comparison, a similar survey of patients receiving private care found they rated their satisfaction at 73 for inpatient care and 75 for outpatient care.
Nicholson attributed the high ratings to the changes in the system, such as implementation of electronic records to reduce the risk of errors.
"Our system has become not only much more efficient, but safer," Nicholson said.
The VA is the only completely insulated government-run system in the U.S. Medicaid and Medicare, although their growth of spending tends to be much more predictable than the private sector, still exist within it. They rely on our fractured care delivery system, lack of preventative care, and inefficient system of paperwork and hard copy medical records. In the private sector, that means to uncontrolled spending, bad health outcomes, and especially medical errors.
The VA not only routinely out-performs the private sector, it arrived at that level of quality after years at the bottom of the barrel. When conservatives harp about Medicare Part D and conclude "government can't do anything right" -- here's another direction to point them. The only truly government-run system in the U.S., and it provides better care than all the others. Or, you know, we can keep playing "Bush's vision of health care" and let insurance go the way of the drug benefit.__________________________________________ _____________________________


2006 Washington Post – Same as above…

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/19/AR2006011902936.html

__________________________________________________ _________________

More from Kizer, circa 1999 (http://www.nahit.org/cms/images/docs/Kizer_slides_on_quality_efficiency.ppt#401,1,QUALI TY AND EFFICIENCY IN HEALTHCARE: SOME EXPERIENCES IN THE U.S.)

Slides 26, 27, 28, 31-39,

_________________________________

[OKC-SLC]

Rogue, you've done a commendable job documenting the drastic improvement the VA has made over the last decade. I have had a front row seat to a lot of this change in three large VAs in three cities for the last 8 yrs. I was actually seated on a committee at the Salt Lake City VA which set up how we would improve our scoring on various performance measures including: 1) documenting that patients were reminded to stop smoking if applicable, 2) performance of blood cultures prior to initiation of IV antibiotics for community-acquired pneumonia, 3) discharging all patients with coronary disease (even if this wasn't their reason for admission) on aspirin, beta-blocker, and ace-i vs. ARB if indicated--or documenting in notes why they aren't discharged on them, 4) et cetera. These are some of the performance measures that come up again and again in the citations you listed. And there is no doubt about it--CPRS made this all possible with clinical reminders. These include prompts for the LPN or CNA checking the patient in for clinic appointments which force the LPN/CNA to checkmark the patient's answers to a depression screen, or HCV risk factor assessment, or flu shot query in the winter. If these measures sound like a game, it's not a coincidence. But intuitively and anecdotally, I think they do result in better patient care. The private health care sector could learn a thing or two from the VA on this front.

I guess my concern is more along clinical grounds. It's great that the VA performs so well on measures, but I have also seen with my own eyes that the VA physicians are not the strongest. This goes back to what I mentioned in an earlier post. I can site numerous instances both medical and surgical where I KNOW FOR A FACT that the wrong thing was done for a patient at a VA for no reason other than physician incompetence. Some of these had bad outcomes, and all were/are under review by appropriate committees. But this is the price you pay with a non-competitive medical environment. If your hospital pays its physicians much less than other hospitals, and you accept physicians with marginal credentials to compensate for the resulting small interested talent pool, you WILL have bad medical decision-making. Perhaps your hospital may score better on a diabetes performance measure, but your physicians may not know what to do when CPRS isn't there to prompt them through a protocol. And it is very hard to design a study which illustrates this.

For the Veterans, the VA is simply the best deal going fiscally. Of course, the Veterans have paid for it in other ways--ways John Doe won't have paid into a federalized health care program. Doe will pay for 100% of his health care in taxes, and I have doubts that a fed-run health care program can be self-sufficient and effective at the same time.

I hate that it sounds like I'm dogging the VA because I am not. If my dad were a Veteran, I would be pleased if he sought his care at a VA. I just don't think that positive press clippings and study reports tell the whole tale. Indeed, 15 years ago the VA didn't have nearly as much to be proud of. And 15 years from now it may be the premier place these clippings make it sound to be. I hope so, because I believe from the bottom of my heart that it should be.

[Rogue]

No doubt about it SLC, you usually get what you pay for in terms of staff and quality. I have to defend VA when it is made out to sound like medieval medicine. I, too have worked in VAs in several states. I consult with many more. Don't get me wrong, there are some VAs I wouldn't want to have to use, but by and large the system is strong.

Technology that VA pioneered, like Bar Code Medication Administration, reduced medication errors in a huge way.

I'm a pretty informed consumer and, no, I wouldn't pass by Duke, Birmingham, or Vanderbilt's UH to get to a VA. But either place I landed I'd pray that I didn't get stuck with a resident.

Someone, OV maybe, mentioned the problem with having too much reliance on NPs and PAs. Again, if a system could pay them more competitively and we were using the best and brightest, no problem. On the whole, I'd prefer to get primary care from an NP with 15 years experience than a new doc.

[Rogue]

I think the new performance pay system is a step toward better quality staffing. VHA is now recruiting better docs than in the past.

A better example, if the point is to show the problems with huge gov't run healthcare, is TRICARE.

[OKC-SLC]

Don't get me wrong, there are some VAs I wouldn't want to have to use, but by and large the system is strong.

On the whole, I'd prefer to get primary care from an NP with 15 years experience than a new doc.

Agree with both.

[OKC-SLC]

A better example, if the point is to show the problems with huge gov't run healthcare, is TRICARE.

I don't know much about Tricare. What's the downlow?

[Okla-homey]

I don't know much about Tricare. What's the downlow?


I'm eligible for both systems. I prefer TRICARE and have had no problems. You just have to find a panel of practitioners in your area who accept it, and you're all set. I ahve zero deductible and a tiny co-pay. Ditto my wife and kid. In fact, its better than the group policy my employer offers, therefore I waived my employer's plan.

[picasso]

Socialized medicine <> subsidized universal insurance coverage.

You can certainly make arguments against Clinton's plan based on the increased taxes and spending it would require; but to say the plan is to institute a nationalized health care system as exists in Britain is ignorant at best and a lie at worst.
it's a slippery slope.

I've been to many an Indian Health Clinic. It's free but you wait all day, you don't get to see the doc you want, and now you have to make an appointment, no walk-ins. About a 2 month waiting list.

[OU4LIFE]

the medicine man will see you now...

[OKC-SLC]

I'm eligible for both systems. I prefer TRICARE and have had no problems. You just have to find a panel of practitioners in your area who accept it, and you're all set. I ahve zero deductible and a tiny co-pay. Ditto my wife and kid. In fact, its better than the group policy my employer offers, therefore I waived my employer's plan.

Is Tricare government-run?

[C&CDean]

Naw, Whut Dean wuz sayin iz "Ah got MINE" "Keep them cards and letters rollin."

Pretty much.

[Rogue]

TriCare is akin to giving vets (retirees in this case) an insurance card and saying "good luck and thanks."

Downlow is that it depends on where you live and what type of care you need. In some cases, it's a great deal allowing you to choose your provider.
A real plus is the prescription plan. If you happen to live in a military-base town you're usually golden because it's THE insurance panel for docs to be in in many of those places.

Example of what's wrong: trying to find a provider can be difficult.
Thus the nickname "Try and get care."

2 years ago I was working with some young families of deployed troops. They needed some mental health work for the kids who were having trouble at school and a couple wives who were stressed to the max. I get in touch with TRICARE for 'em, and I'm provided with a long list of approved providers in the area. I called no less than 12 agencies and individuals on the list that were within 25 miles. Conveniently, none of 'em were taking new referrals. Some seemed confused that they were still on a Tricare approved list. Finally, I find a well-run and reputable agency with a decidedly pro-veteran stance. Problem was, they are just over 50 miles away. To their credit, not only did they accept referrals, they offered a volunteer psychologist to tag along with me and some other folks going to the family support groups to offer education, referrals, and comfort. Needless to say, I happily refer to them whenever I can now.

[Frozen Sooner]

So, so far we have three examples of U.S. government-provided healthcare in this thread: Dean's U.S. government-purchased private insurance, olevet's VA, and Homey's Tricare.

All three people have said it works well for them.

Hmm.

[Frozen Sooner]

it's a slippery slope.

I've been to many an Indian Health Clinic. It's free but you wait all day, you don't get to see the doc you want, and now you have to make an appointment, no walk-ins. About a 2 month waiting list.

There's a bit of the tragedy of the commons at work there. My friends who use the Alaska Native Tribal Health Consortium Clinic here in town (and brother, you should see this palace of health care-the place is beautiful) report long waiting periods for non-emergency care.

So amend my post above. Four examples, with one of them requiring a long wait time.

[shaun4411]

if we were all cyborgs, there would be NO need for healthcare. issue resolved.

[Harry Beanbag]

So, so far we have three examples of U.S. government-provided healthcare in this thread: Dean's U.S. government-purchased private insurance, olevet's VA, and Homey's Tricare.

All three people have said it works well for them.

Hmm.


I could be wrong, I haven't read every post that closely, but I think you may be confusing healthcare and insurance coverage. There is a difference in those things.

I don't really have a dog in this hunt other than the government pretty much ****s up everything they touch.

[Frozen Sooner]

And all three are different ways of paying for health care, which is what the real debate about health care in this country is.

[Okla-homey]

And all three are different ways of paying for health care, which is what the real debate about health care in this country is.

Honestly, what scares me and most folks I know, is the notion of only a single card game, with Uncle Sugar as the dealer. That'll mean everyone will have the same ante, the same number of hit options, and when the dealer calls, you gotta show or fold.

I don't like "one-size-fits-all" nothin' myself. And that is precisely the sitcheeashun lamented by Canadians. Frankly, I want the right to make private arrangements. And I damsure don't want some gubmint bureaucrat telling me when and under what circumstances I can be seen and by whom.

What's more, I continue to contend if there isn't a co-pay that really stings (even poor folks,) it'll get out of control in no time.

[C&CDean]

So, so far we have three examples of U.S. government-provided healthcare in this thread: Dean's U.S. government-purchased private insurance, olevet's VA, and Homey's Tricare.

All three people have said it works well for them.

Hmm.

Hmmm. That's the best you can do?

Last time I checked, Olevet, Homey, and Dean paid their ****ing dues. Big time. We've worked for lesser wages just so that we can have decent benefits. We've sacrificed potential big-buck opportunities just so we can insure our family's are taken care of health-wise.

So in your Utopia, we still sacrifice, only this time more, just so the people who aren't willing to suck it up a little get to go see the same doctor ahead of the guys who pay. Yeah, sounds ****ing great to me. Meh.

[StoopTroup]

I think it would be cool if everybody could get really good healthcare.

I also think we should have a draft where there weren't loopholes to get out unless you were medically unable to serve.

Unable to serve would mean you aren't able to work even in the private sector and were going to need to rely on assistance for the rest of your life.

If you ever got better and were able to fullfill your obligation...you would be put to work in the military shoveling poop, peeling potatos or even opening mail even if your 70 years old by then.

There is a job for everyone in my New Military.

:D

[JohnnyMack]

If the Government can require you to carry insurance on your car, why can't it require you to carry insurance on you, your babies and your babies momma?

And the Government doesn't pay my Allstate bill either.

[tommieharris91]

I think it would be cool if everybody could get really good healthcare.

I also think we should have a draft where there weren't loopholes to get out unless you were medically unable to serve.

Unable to serve would mean you aren't able to work even in the private sector and were going to need to rely on assistance for the rest of your life.

If you ever got better and were able to fullfill your obligation...you would be put to work in the military shoveling poop, peeling potatos or even opening mail even if your 70 years old by then.

There is a job for everyone in my New Military.

:D

Kim Jong-Il approves this message.

[tommieharris91]

If the Government can require you to carry insurance on your car, why can't it require you to carry insurance on you, your babies and your babies momma?

And the Government doesn't pay my Allstate bill either.

An odd though just popped into my head for this one... maybe the gubmint don't wanna pay your Social Security benefits and wants you to kick the bukkit before you retire.

Actually, this kinda legislation would make HMOs and health insurers very happy people.

[OKC-SLC]

Honestly, what scares me and most folks I know, is the notion of only a single card game, with Uncle Sugar as the dealer. That'll mean everyone will have the same ante, the same number of hit options, and when the dealer calls, you gotta show or fold.

I don't like "one-size-fits-all" nothin' myself. And that is precisely the sitcheeashun lamented by Canadians. Frankly, I want the right to make private arrangements. And I damsure don't want some gubmint bureaucrat telling me when and under what circumstances I can be seen and by whom.

What's more, I continue to contend if there isn't a co-pay that really stings (even poor folks,) it'll get out of control in no time.

The issue of complacency becomes very real in a one-size-fits-all health care scenario as well. Of course, this issue is big in any monopoly-style arrangement.

Competition is good. Rogue, you mentioned the example of not necessarily passing up Vanderbilt, B'ham, or Duke to go to the VA. There would be no choice if the fed govt monopolizes the industry.

Additionally, it's this competition that creates the innovations in medicine for which the US is famous and unrivaled.

[olevetonahill]

So, so far we have three examples of U.S. government-provided healthcare in this thread: Dean's U.S. government-purchased private insurance, olevet's VA, and Homey's Tricare.

All three people have said it works well for them.

Hmm.

Alls Im saying Is it took 40 years that I know of to get the VA where it is
So Leave It the **** alone ok ?
Just sayin

[olevetonahill]

Last werd From this Olevet
My Healthcare aint the Best, Its Far from the worst.
Yall want It Its FREE . Get Drafted Get shot to shart, then Come Home to 20 + years Of ridicule, spend 16 years getting rated 10%
Ya****ing Libs can Kissmyass.
Dayum that felt good !

[StoopTroup]

Last werd From this Olevet
My Healthcare aint the Best, Its Far from the worst.
Yall want It Its FREE . Get Drafted Get shot to shart, then Come Home to 20 + years Of ridicule, spend 16 years getting rated 10%
Ya****ing Libs can Kissmyass.
Dayum that felt good !

Werd. :pop:


BTW....

In my Military we would ridicule you get you ghirt to ghot then send you Home rated 100%.

We would put the libs on the front line so you could use them as sandbags when the real shart started coming in.

[olevetonahill]

Werd. :pop:


BTW....

In my Military we would ridicule you get you ghirt to ghot then send you Home rated 100%.

We would put the libs on the front line so you could use them as sandbags when the real shart started coming in.

We called them
" FRag Mags "
Sorry SSC :D

[tommieharris91]

I would like "human shields" brought back. And I sure ain't gonna be one. :D

[olevetonahill]

I would like "human shields" brought back. And I sure ain't gonna be one. :D

:rolleyes:

[def_lazer_fc]

i think dean put it best when he called pretty much anyone who doesn't have health insurance a lazy scum bag who should find a better job. lets, just for one day, lay off every person who doesn't get health insurance and see what happens. prob wouldn't have those fast food workers making that food that you so love to shove in your face. ;)

[olevetonahill]

i think dean put it best when he called pretty much anyone who doesn't have health insurance a lazy scum bag who should find a better job. lets, just for one day, lay off every person who doesn't get health insurance and see what happens. prob wouldn't have those fast food workers making that food that you so love to shove in your face. ;)

You saying those that work at Macvomit 22 Hrs a week
Never Mind ,One Of us is Stupid and I dont think its ME !

[Soonerus]

You saying those that work at Macvomit 22 Hrs a week
Never Mind ,One Of us is Stupid and I dont think its ME !

u reay to play..u

[olevetonahill]

u reay to play..u

You Hired Doleio as a spokesmen fer you ?
Good Jorb you Needed the Help

[Soonerus]

mm..beat u i m poker,,,,,boom....

[olevetonahill]

mm..beat u i m poker,,,,,boom....

So your saying Ya want Some "olevet" Juice ?
I can hook ya old drunkasss up lol

[Okla-homey]

If the Government can require you to carry insurance on your car, why can't it require you to carry insurance on you, your babies and your babies momma?

And the Government doesn't pay my Allstate bill either.

The gubmint can require proof of liability insurance because registering a car is a privilege, not a right. And remember, the state requires you to carry liability coverage to pay the other guy, NOT med pay to cover your own bills if you run into a tree or something.

OTOH, being alive, and being married, and having kids is a right. Thus, gubmint is unlikely to require people to purchase a commercial product by virtue of being alive.

Oh, and don't kid yourself, there are waaay to many uninsured vehicles on the road. Lots of losers get insurance just long enough to get their car registered, then promptly cancel it, or let it lapse. I'll tell you something else, the statutory min of 25/50 of liability coverage in OK people are supposed to carry can quickly become exhausted in a wreck involving several injured people. Not to mention hit and runs.

For all those reasons, don't take too much comfort in that notion the state requires people to have car insurance.

[JohnnyMack]

Oh, and don't kid yourself, there are waaay to many uninsured vehicles on the road. Lots of losers get insurance just long enough to get their car registered, then promptly cancel it, or let it lapse. I'll tell you something else, the statutory min of 25/50 of liability coverage in OK people are supposed to carry can quickly become exhausted in a wreck involving several injured people. Not to mention hit and runs.

For all those reasons, don't take too much comfort in that notion the state requires people to have car insurance.

Oh I don't. And the 2003 Honda Accord of mine that got trashed by exactly that kind of dude can serve as a perfect example. I miss that car.

[Vaevictis]

Five years ago, when her 5 year old daughter Kaitlyn was diagnosed with a connective tissue disease called juvenile scleroderma, Tammie Fischel says she was told to see a pediatric rheumatologist right away. But her daughter first would have to see a dermatologist in St. Louis -- a four-hour drive away -- and the first available appointment was in two months.
In its severe forms, juvenile scleroderma can weaken limbs, and damage internal organs. Terrified her daughter could suffer brain damage, Ms. Fishel says she broke down crying on a voice message system. The dermatologist relented, but Kaitlyn had to wait another month before she could be seen by the pediatric rheumatologist. "It was a very long month," Ms. Fishel says. Now stable, Kaitlyn is regularly making the drive to St. Lois for treatment.

Basically, what's apparently going on here is that there are specialties which simply aren't lucrative enough compared to others, resulting in shortages in those specialties and... waiting in line. And apparently four hour drives to your nearest doctor.

So uh, yeah. Shortages happen in the socialist systems. Apparently, they happen in the free market systems, too, due to crowding out effects. (And no, according to the WSJ, this is not a unique incident, just an example.)

Is there anyone who was previously screeching about the evils of the socialist systems for this very reason who now cares to screech about the evils of the free market system?

[Frozen Sooner]

Everyone knows that the WSJ is just a socialist mouthpiece.

Scleraderma sucks monkey balls. I know someone who is living with it now and is slowly dying from it.

[OKC-SLC]

Basically, what's apparently going on here is that there are specialties which simply aren't lucrative enough compared to others, resulting in shortages in those specialties and... waiting in line. And apparently four hour drives to your nearest doctor.

So uh, yeah. Shortages happen in the socialist systems. Apparently, they happen in the free market systems, too, due to crowding out effects. (And no, according to the WSJ, this is not a unique incident, just an example.)

Is there anyone who was previously screeching about the evils of the socialist systems for this very reason who now cares to screech about the evils of the free market system?

I personally haven't 'screeched' about anything, but I'll bite.

The relative shortage of pediatric rheumatologists is proportional to the relative shortage of demand for them. This is why it's tough to find someone who specializes in Porsche transmission management in Gotebo. And if you or anyone else thinks that a socialized health care system will create more pediatric rheumatologists, we will never understand each other.

The current health care system in the US is imperfect. There is room for improvement, for sure. Anyone can see that. However, the imperfections in the current system do not mean that a socialist or similar program is the default solution, and your WSJ reference does nothing to build or dismantle a case for a socialist/capitalist health care system, respectively.

In my opinion (of course, take it with a grain of salt, for I do not read the WSJ) potential roles of government in health care reform would be to create affordable options for health insurance via creating more pooled payors for small businesses/self employed, restructuring CMS to create reimbursement levels which are even and make sense (and are fiscally sound), and perhaps even subsidizing the health care of certain sectors of the population with exceptional cases (not unlike a judicious welfare program for health care geared toward NEED, not necessarily income level or socioeconomic status).

I simply do not believe that the way to create efficiency in health care (or really anything, for that matter) is to have the government take it over.

[OKC-SLC]

Everyone knows that the WSJ is just a socialist mouthpiece.

Scleraderma sucks monkey balls. I know someone who is living with it now and is slowly dying from it.
I know the first half of this was tongue-in-cheek.

But I strongly agree with both of your statements.


;)

[Vaevictis]

The relative shortage of pediatric rheumatologists is proportional to the relative shortage of demand for them. This is why it's tough to find someone who specializes in Porsche transmission management in Gotebo. And if you or anyone else thinks that a socialized health care system will create more pediatric rheumatologists, we will never understand each other.

I don't think socialized health care will create more of them. My point is that shortages happen in both systems, for various reasons.

Raising hell about shortages in socialized systems is just as pointless about raising hell about shortages in market systems -- in both cases, the problem is addressed by throwing more money at it.

The shortage issue is a red herring. It occurs in both systems. It's solved the same way in both systems.

That's all I'm saying.

[OKC-SLC]

I don't think socialized health care will create more of them. My point is that shortages happen in both systems, for various reasons.

Raising hell about shortages in socialized systems is just as pointless about raising hell about shortages in market systems -- in both cases, the problem is addressed by throwing more money at it.

The shortage issue is a red herring. It occurs in both systems. It's solved the same way in both systems.

That's all I'm saying.

I agree with 100% of this.