IT'S TIME FOR UNIVERSAL HEALTH CARE

Funny you should ask, it was last month - and I made an appointment and was in and out in less then 10 minutes.

My point is that bureaucracies, while inefficient, do serve a purpose. I understand that it is incredibly frustrating to deal with them as they are often difficult to navigate and the overall goals are many times impeded by the personalities of those running the place, who usually are not the most intelligent people. Yet, they plod on and the services keep getting performed, year after year, after countless turnovers of administrations and ideological shifts.

While it may be satisfying to rail against them, I wonder, what is the point? Replacing bureaucracies with more efficient systems leads to situations which we don't normally describe as 'Democracies.' I have no doubt that if we put you in charge of the DoE, and let you ignore the various forces and tensions which constrain them currently, you could have our energy policy fixed up lickety split; but that wouldn't be the American way, and the consequences of this would not be easily predicted.

Cycloptichorn

.
The two points are not mutually exclusive, depending on who you mean by "we".

The reason is that the distribution of medical expenses among citizens is highly unequal. I don't remember the exact figure, but much of a developed nation's total healthcare spending goes to the top 1% of the distribution -- chronical, sometimes inherited illnesses, rare diseases requiring expensive treatment, rare injuries requiring expensive operations and rehabilitation, and the like. In a free market for health insurance, providers are free to deny policies to those one-percenters. Consequently, it may well happen that medical expenses per citizen are higher than under universal health care, and that medical expenses per policy holder are lower at the same time.

When we are talking about the general welfare, costs per citizens is the relevant figure. Costs per policy holders doesn't mean much in this context. All it means is that very sick people can't buy health insurance in a free market for healthcare.

USAFHokie80 wrote:

Diest TKO wrote:

Most of the funding for research at my university comes from commercial and industrial benafactors. Government grants are also significant.

My university does some biolmedical research, but I imagine this is mostly the same for the Univesity of Missouri - Columbia (Mizzou) which has a large medical program with lots of research.

I know when proposition A2 came up here in MO back in 2006 (a bill to allow for embryonic stem cell research) there were a great number of contributors to it's success. Most of the research is conducted on university campuses.

T
K
O

Didn't realize you were in the MO. Hiya neighbor.

Hokie, you are an engineer by trade correct? You live in STL? KC? Where did you go to school?

T
K
O

USAFHokie80 wrote:

Quote:

Basic, fundamental research - research which is not designed to create new products, but to learn new information - is rarely if ever performed by Pharma companies. Most of the revolutionary drugs we see today would have been 100% impossible to develop without the aid of gov't funded research. You would have to be pretty ignorant of how the scientific process works to claim otherwise.

In other news, the Pharma industry spends twice as much of advertising as they do on research. That's what is important to them: the almighty dollar. The bottom line. The investor's buck. Capitalists. If they were actually more interested in saving lives then making money, you would see these numbers reversed - heavily. The switch to consumer-advertising for drugs is a pox on our entire society.

http://www.sciencedaily.com/releases/2008/01/080105140107.htm

Cycloptichorn

everyone is so mad at drug companies for spending money on advertising... and they should be saving the world... blah blah blah. they have to make money so that they can research new drugs. i sometimes think it would be fitting for all the people who damn these companies repeatedly to be barred from using their products.

Actually, the entire enterprise could be run as non-profit. And why not?

But, that's not the point, really; the point is that you didn't respond to my contention that you don't understand the scientific and research process if you don't agree that a massive amount of the research which leads to these drugs comes from the Federal government, performed by Universities.

Cycloptichorn

georgeob1 wrote:

Well I've had a good deal of personal experience in my life with organizations of many types, military & government bureaucracies; academia; and business enterprises. My impressions, such as they are, are based on real experience, and I have seen nothing that would induce me to change them.

Regardless of its assigned role or mission the chief motivation of a bureaucracy is to preserve its role, budget, and authority, and to enforce its "rules" generally without regard to their effect on the results achieved (or more often than not) not achieved. Examples of this abound - you don't have to look hard to find them. (When was the last time you visited the DMV office?)

Funny you should ask, it was last month - and I made an appointment and was in and out in less then 10 minutes.

My point is that bureaucracies, while inefficient, do serve a purpose. I understand that it is incredibly frustrating to deal with them as they are often difficult to navigate and the overall goals are many times impeded by the personalities of those running the place, who usually are not the most intelligent people. Yet, they plod on and the services keep getting performed, year after year, after countless turnovers of administrations and ideological shifts.

While it may be satisfying to rail against them, I wonder, what is the point? Replacing bureaucracies with more efficient systems leads to situations which we don't normally describe as 'Democracies.' I have no doubt that if we put you in charge of the DoE, and let you ignore the various forces and tensions which constrain them currently, you could have our energy policy fixed up lickety split; but that wouldn't be the American way, and the consequences of this would not be easily predicted.

Cycloptichorn

If I remember correctly, health insurance premiums are based on age and industry. Young people sitting in offices will probably pay a much lower health insurance rate than those working in "hazardous" industries with older workers. Admittedly, they are the extremes, the that's how health insurance works. Group policies provides large companies with price breaks.

Is the data truly comparable? Are the services actually provided included in the cost comparisons? Are the reporting standards for cost (direct & indirect) the same in all countries?? I doubt it very much. Governments, in particular are very good at hiding their real costs.( I recognize you will probably provide me with some economic analysis that proves I am wrong.)

Whether that's how it should be is irrelevant to universal health care.

Because of the discussion about "premiums" based on georgeob's business, and his cost vs what others might be paying. Your statement about "reasonable" or "how it should be" is irrelevant to the discussion, and adds nothing to what's being discussed.

my unrelated comment doesn't really impact the discussion, except when you people harp on just how unrelated it is for an entire page. surely, you have better things about which you can complain.

Diest TKO wrote:

USAFHokie80 wrote:

Diest TKO wrote:

Most of the funding for research at my university comes from commercial and industrial benafactors. Government grants are also significant.

My university does some biolmedical research, but I imagine this is mostly the same for the Univesity of Missouri - Columbia (Mizzou) which has a large medical program with lots of research.

I know when proposition A2 came up here in MO back in 2006 (a bill to allow for embryonic stem cell research) there were a great number of contributors to it's success. Most of the research is conducted on university campuses.

T
K
O

Didn't realize you were in the MO. Hiya neighbor.

Hokie, you are an engineer by trade correct? You live in STL? KC? Where did you go to school?

T
K
O

Yes, an engineer @ Cerner. I'm in KC (downtown at the moment). I went to Virginia Tech. I just moved out here about 5 years ago...

I agree - our employees are not a fully representative sample. Moreover, we don't provide medical coverage to retired employees - the government does that.

Still the cost data for high end coverage is interesting. I am skeptical about the oft quoted data for total cost of medical care in various countries. Is the data truly comparable? Are the services actually provided included in the cost comparisons? Are the reporting standards for cost (direct & indirect) the same in all countries?? I doubt it very much. Governments, in particular are very good at hiding their real costs.( I recognize you will probably provide me with some economic analysis that proves I am wrong.)

Perhaps so However in (say) Canada the care actually provided by the national health service is limited by the government's budget for it; the list of approved pharmaceuticals; the availability of specialists and the like. Demand is in the hands of individuals, but supply is determined by government - not private individuals and the market. I agree that in terms of available average public health data the system works well, however these differences make direct comparisons of cost highly suspect.

To what extent do similar restrictions apply in Germany's insurance scheme?

Frankly taking your descriptions at face value, the systems in Germany and the US are similar indeed-- excepting only that ours is voluntary.

georgeob1 wrote:

To what extent do similar restrictions apply in Germany's insurance scheme?

In principle, these restrictions exist. In practice, they are almost never felt. I haven't yet researched the statistics, so I can only speak from personal experience. For whatever that's worth, I know quite a lot of people who needed expensive treatment, most of them because of old age, some of them because of chronic diseases, one of them because of a crippling accident. None of them was ever denied treatment, or even put on a waiting list.

From a public policy viewpoint, what healthcare systems ultimately supply isn't products like pills and hospital beds; it isn't services like operations and CAT scans. It is, in a word, health: Infants delivered alive, diabetics controlling their blood sugar, epileptics free from seizures, cancer patients diagnosed and treated timely, people immune to infective diseases ....

The 'greedy doctors' myth
After spending a decade in university, going $100,000 in debt and taking on life-or-death responsibility, doctors are wondering why they make the same salary as auto plant workers. Dave Rogers reports.

Dave Rogers
The Ottawa Citizen

Tuesday, October 29, 2002
CREDIT: Tim Fraser, The Ottawa Citizen

Mark Stevens, a skilled tradesman at the Ford plant in Windsor, earns about $90,000 a year. Workers willing to put in 56 to 60 hours a week at any of the Big Three auto plants can increase their uncome to up to $130,000 a year after completing a free apprenticeship program.


With take-home pay lower than some auto plant workers, no fringe benefits and increasing overhead, many family doctors are asking themselves why anyone would want their jobs.

"I essentially make what my plumber or auto mechanic earns once I have paid my overhead," said Daniel Maher, a Glebe physician who has been practising medicine since 1991. "Why spend nine years in university for all the responsibility and risk of lawsuits to make what a beginning engineer would earn?"

Frustration over pay, many family doctors argue, is leading some physicians to leave their practices for other work and is turning students away from a profession that once promised a healthy income. The result: there are not enough family physicians to go around.

The numbers tell the story. A university medical education takes nine years, usually leaving new doctors with $100,000 in debt plus office rent, support staff salaries, equipment expenses, insurance and other overhead costs that devour at least 40 per cent of their earnings.

A family doctor bills OHIP $54 for a one-hour patient checkup (the gas or fuel oil company can charge $110 for a furnace checkup). A doctor receives $25 for a minor assessment while paying an average overhead cost of $15 to $17 per visit.

Family doctors and general practitioners in 1999-2000, working a typical 54.7-hour week, on average billed OHIP $168,300 a year, according to Ontario Medical Association figures. Their average net earnings after overhead expenses is $99,300, the OMA reports.

That means their pay is less than skilled tradespeople willing to work 50 to 60 hours a week, plus some weekends, installing and repairing machinery at vehicle assembly plants in Windsor, Oshawa, Oakville and St. Thomas.

Other tradespeople can earn more than $75,000 a year, as much or more than a doctor working a 40-hour week.

Geof Botting, head of Ottawa's Regional Centre for Excellence in Skilled Occupations, says efficient drywall workers, carpet installers and automatic transmission rebuilders can earn more than $80,000 annually. The centre is a partnership among area school boards and community colleges to promote skilled trades as a career option.

Mr. Botting said good auto-body repair workers earn $70,000 to $80,000 a year.

Skilled autoworkers willing to work 56 to 60 hours a week, plus some weekends, at General Motors, Ford or DaimlerChrysler can earn up to $130,000 a year after completing a free apprenticeship program, according to John Bettes, a Canadian Auto Workers spokesman.

Tool and die makers, electricians, industrial mechanics and millwrights working at auto assembly plants earn $34 an hour.

"The average guy makes $70,000 to $75,000 a year, but there can be extremes where people make well over $100,000 a year," Mr. Bettes said. "If you worked every third weekend you would get $100,000 and if you worked two out of three weekends you would probably get over $130,000." These workers need to have done a four-year, 8,000-hour apprenticeship, plus continual upgrades, with auto companies, parts suppliers or aerospace corporations. The schooling is paid for by the corporations.

Being a doctor, on the other hand, is not nearly as lucrative as most people think, Dr. Maher said.

"I know a lot of people working in the government with a bachelor's degree who do little most of the time and make $60,000 a year plus benefits. I make $75,000 a year with no benefits. There is no pension, no sick days, nothing."

Most doctors work extra hours if they can to earn extra income, he said. He said a family doctor working an average 37.5 hours a week will gross about $132,000 a year and spend at least a third of his income on overhead.

Walk-in clinics take an average of 43 per cent of doctors' incomes for overhead costs, Dr. Maher said.

"Three years ago, when the Coalition of Family Doctors of Ontario asked people what they thought their doctors earned for seeing them, they estimated it was $120 for a physical examination and $50 for a cold. The real answers to those questions are $54 for the physical and $27.50 for the cold.

"It is half or less of what people think we are making. When people think we earn $150,000 a year, it is only $75,000. I know a lot of engineers fresh out of university who earn starting salaries of $70,000 a year plus bonuses."

Dr. Maher said when he travels to visit doctor friends in the United States and explains he makes the equivalent of $55,000 U.S. a year, they don't believe him because that is what nurses earn there.

"When it comes to negotiations, the government says we are just greedy doctors," Dr. Maher said. "The average person just nods his head and says we earn $200,000 a year.

"The government is paying GPs $105 to $110 an hour. If you take off the overhead of $35 an hour you are left with $75, which is what I am making. Who is going to spend nine years in university, run up a $100,000 debt and accept all the stress and responsibility to make what an electrician is making?"

It will take a salary of $150,000 a year without benefits for a 37.5-hour week or $130,000 salary with benefits to attract more Ontario doctors into family medicine, Dr. Maher said.

Ottawa's Doctor Shortage - Queueing for Health Care
© Copyright 2002 The Ottawa Citizen