patrick.net

Homeboy says

Insanity. I want to see a doctor who has actual training, not some random dude who CALLS himself a doctor. I am not going to some non-licensed bozo and get butchered. If you want to do that, move to a 3rd world country.

In a free market you would have to take responsibility to vet the credentials of the doctors you choose. Typically there would be services created to make this easy. Furthermore, there are many services that doctors do that an RN or other medical professional could just as easily do like diagnosing the common cold, testing for strep throat, etc... If the symptoms you are experiencing are more severe then you decide what level of service is required. If you are more comfortable always seeing an MD then its your choice.

JohnLaw says

Homeboy says

but healthcare does not lend itself to a free market solution

This makes no sense. Why do you claim this?

Healthcare is like national defense. It is hard to have a true market-based solution UNLESS we accept having people dying on the street.

(I have a market-based military "solution" too, but even I do not consider it sensible.)

But I love the certification as opposed to licensing idea.

chanakya4773 says

Peter P says

Healthcare is like national defense. It is hard to have a true market-based solution UNLESS we accept having people dying on the street.

you are wrong. there will be charity based hospitals which will pop and atleast not allow people die. ofcource they won't get the royal treament that they get in private emergency rooms today. mandating private hospitals is not the solution.

I rather have a single-payer universal healthcare system with a parallel private system.

Health insurance does not make sense because of the moral hazard of self-selection. Yet we do not want to bankrupt people randomly because of illnesses and accidents.

As most people here know, Market is like God to me, and I advocate the privatization of all roads and sidewalks (seriously).

Yet healthcare is something as problematic as national defense for the market to handle.

Chana - common sense, and root cause analytics. Have you reviewed the French or German health care system?

chanakya4773 says

We can always have insurance for catastrophic medical events. insurance for doctors visit ..etc does not make sense. Insurance should be only used for events which backrupt people and nothing else because insurance is a very in-efficient system. even in single payer universal health care system, it should be the case.

Ideally, yes. Let's see how much costs can be lowered. People should not have to spend $20K on scans and tests.

BTW, one more important thing: TORT REFORM.

Peter P says

Yet healthcare is something as problematic as national defense for the market to handle.

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

chanakya4773 says

WHEN DID WE TRY FREE MARKET SYSTEM ???
WE NEVER HAD ONE AND NEVER TRIED ONE

What the hell are you talking about? Are these government entities? No.

Unitedhealth Group
Wellpoint Inc. Group
Kaiser Foundation Group
Aetna Group
Humana Group
HCSC Group
Coventry Corp. Group
Highmark Group
Independence Blue Cross Group
Blue Shield of CA Group
Cigna Health Group
BCBS of MI Group
Health Net of California, Inc.
BCBS of NJ Group
BCBS of FL Group
Regence Group
BCBS of MA Group
Carefirst Inc. Group
Wellcare Group
HIP Ins. Group
Metropolitan Group
Unumprovident Corp. Group
Universal Amer Fin Corp. Group
Lifetime Healthcare Group
BCBS of NC Group

Your "idea" of removing all licensing requirements is utter insanity. How would there be any protection at all against "doctors" who are incompetent, scam-artists, etc? There have even been cases of doctors raping their patients, literally. I certainly would not want someone like that to still be able to practice medicine. For god's sake, you need a license to DRIVE A CAR, but you don't think people should have a license to render you unconscious and cut into your body with knives?

Ridiculous. Yes, we have for-profit medical insurance and hospitals. They get greedy and start overcharging so they can make obscene profits. It doesn't work. Not everything can be fixed by the free market. The military, roads, environmental protection, police, firefighting, etc. are not effectively handled by the free market. Nor is healthcare.

JohnLaw says

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

Boy the way Glen Miller played
Songs that made the hit parade.
Guys like us we had it made,
Those were the days.

And you knew who you were then,
Girls were girls and men were men,
Mister we could use a man
Like Herbert Hoover again.

Didn't need no welfare state,
Everybody pulled his weight.
Gee our old LaSalle ran great.
Those were the days.

chanakya4773 says

you are wrong. there will be charity based hospitals which will pop and atleast not allow people to die

Sure, just like magic.

chanakya4773 says

why do you have problem with certified doctors versus licensed doctors ?
you are free to go to CERTIFIED doctors who are trained according to your standards but allow other people to go to doctors who are trained differently

What the fuck are you babbling about now? You wrote that you don't think doctors should have to have a license, and I said they should. Don't confuse the issue with gibberish.

Do you honestly believe a hospital with good reputation will hire a doctor who is butchering people. Its a self correcting system. Hospital will only hire doctors who are best suited for the jobs without ruining hospitals reputation. Some third party ( like AMA) does not dictate the choice.

No, it's not a "self-correcting" system. What evidence do you have that it is?

Like I said, you are free to move to a 3rd world country if you are so intent on having incompetent doctors.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system

That's odd, I googled health insurance in India and got like 8-10 pages of companies selling health insurance in India. Could you please explain this minor discrepancy? Also I know for a fact that India has a public health care system, I've been there and talked to people involved in it. Is this also part of the free market?

India has 1 doctor for every 2000 people vs 1 per 300 in the us. The average Indian travels 77km to see a doctor. I'm not sure you could really hold this up as an example of health care US should be emulating. Care to try again?

chanakya4773 says

I am sure US was probably more free market driven in early 1900's when there was no insurance system.

Average life span was 36, would you like to go back?

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

chanakya4773 says

Homeboy says

chanakya4773 says

you are wrong. there will be charity based hospitals which will pop and atleast not allow people to die

Sure, just like magic.

Don't you read the posts before jumping in to conclusions.
Did you read the post by Johnlaw :

I completely disagree. Before the 30s there wasn't even such a thing as healthcare insurance. As a matter of fact, healthcare in the USA was totally private until 1965. Nobody was dying in the streets and there were numerous private, charitable organizations that took care of the poor.

even Ron paul said the same thing during republican primaries.

Yes, I read things and I ALSO determine if they are relevant to what I wrote. Do you? I still don't see any proof from you that the poor will magically be taken care of if the government doesn't.

Just because something was the case in the past does not mean it should be so now. Have you forgotten that we also had slavery and child labor. Did the "free market" fix that?

bob2356 says

Average life span was 36, would you like to go back?

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

Tee hee. You just got pwned, chanakya.

chanakya4773 says

We can always have insurance for catastrophic medical events. insurance for doctors visit ..etc does not make sense. Insurance should be only used for events which backrupt people and nothing else because insurance is a very in-efficient system. even in single payer universal health care system, it should be the case.

The first logical statement you've made. Health insurance should be catastrophic.

Single payer and universal/public heath care are very different things. Public health care is not insurance in any way shape or form.

chanakya4773 says

Also, like JOHNLAW mentioned US was also mostly insurance free before 1965 so you don't have to go too far to look.

bob2356 says

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

You're not paying attention.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system.

chanakya4773 says

There are lot of private health care insurance companies in india but 90% people don't use them

These don't seem to be complimentary statements.

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

chanakya4773 says

What the fuck are you talking about. can you explain why it worked in the past and it won't work now ?

It DIDN'T work. Are Bob's posts not showing up on your computer?

Homeboy says

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

Here's your golden age of medicine before they started bothering with silly things like licensing:

Once it was easy to become a doctor. During the nineteenth century the United States saw the emergence of an estimated four hundred proprietary medical schools. Set up to offer medical degrees as part of profit-making ventures, these schools generally had low standards of instruction, poor facilities, and admitted anyone who could pay the tuition. Since the proprietary schools competed with so many other for-profit schools as well as schools affiliated with universities, they advertised incentives to get students for their programs. One school gave free trips to Europe upon graduation to any students who regularly paid fees in cash for three years. Anyone who had the money could get a medical degree and practice medicine. In many of the private proprietary schools, degrees were granted after one year of courses that consisted chiefly of listening to lectures.

http://www.encyclopedia.com/doc/1G2-3468300573.html

1900s:

Most medical schools operated primarily for the benefit of their physician-owners and lacked libraries, laboratories, or even much clinical experience for students. Hospitals were few in number, located only in the largest urban areas, and served primarily the poor. Most surgeries were still done in the home. The nation was flooded with ineffective and sometimes dangerous patent medicines sold directly to the public by charlatans. Diseases such as yellow fever, typhoid fever, tuberculosis, pellagra, and hookworm ravaged entire communities. Government support of health care initiatives was weak at best.

http://www.encyclopedia.com/doc/1G2-3468300224.html

1910s:

Unhealthy Americans

The growing emphasis on medical examinations in the 1910s revealed that most Americans had some kind of health problem. Of 3.76 million men examined for service in World War I, about 550,000 were rejected as unfit; and of the 2.7 million called into service, about 47 percent had physical impairments. In one study examining 10,000 workmen, not one was reported in perfect health. Ten percent were slightly impaired, and the other 90 percent were in varying stages of poor health: 41 percent had problems requiring minor treatment; 35 percent had conditions requiring medical supervision; 9 percent had serious physical impairments requiring systematic treatment; and 5 percent had grave problems requiring immediate medical attention. Among 5,000 citizens of Framingham, Massachusetts, examined as part of a Metropolitan Life Insurance demonstration project to control tuberculosis, 77 percent were recorded as ill with some disease; two-thirds of the defects discovered were supposedly preventable. But Americans did not see themselves as unhealthy. The physicians' examinations found twelve times as much illness as did a house-to-house survey of self-reported sickness.

http://www.encyclopedia.com/doc/1G2-3468300562.html

You want to go back to that, huh?

bob2356 says

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

So he's saying that all healthcare problems started in the 1950s? Because this is how it was in the 1930s:

In the 1930s the biggest health concern of America was how to pay for medical needs. The national income was less than half of what it had been in 1929, and in several states as many as 40 percent of the people were on relief. Many Americans could not pay their medical bills, and visits to physicians and hospitals decreased. Before the Depression, physicians charged a fee-for-service on a sliding scale and collected their bills as best they could. They also saw some patients on a charity basis and passed the expenses along to those who could pay. Loss of medical services and reduced ability to pay meant lower incomes for physicians, too. While doctors as a group fared better than many other professions during the Depression, in many cases they also saw their incomes halved. Hospitals were in similar trouble. Beds went empty as patients could no longer afford a two-week hospitalization, which was the average in 1933. Bills were unpaid, and charitable contributions to hospital fund-raising efforts fell.

http://www.encyclopedia.com/doc/1G2-3468301278.html

Doesn't exactly sound like a utopia to me.

chanakya4773 says

What does all this have to do with licensing versus certification.
There was lot of disease before and its common knowledge...nothing rocket science. Technology and science has advanced quite a lot and improved things including health care. The aircrafts today are much safer than the once in early part of 1900s. It didn't happen because aircraft engineers were licensed versus cerified. it happened because of the progress in the field just like any other field. every field including medicine has advanced. there is no licensing in engineering but it still advanced. Do you think all the software engineers are licensed. why the heck then software field is advancing so fast ?

Did you not read the excerpt about how poor physician training was in this period of history that you seem to think was some sort of utopia that we should strive to return to? What's difficult for you to understand about that?

Software engineering is a very poor analogy to medical practice. Among many other things, if you botch a computer program, people simply won't buy it. If you botch surgery, you kill the patient. Free markets work great for some things, but not at all for others.

chanakya4773 says

how could have insurance system solved this problem ? this was a depression problem not a health industry problem.

You are turning things around. I did not claim that health insurance could solve this problem. YOU are the one claiming that a cash-for-service system would solve all problems. YOU stated that you believe the U.S. should return to whatever we were doing pre-1950s, because of your belief that it worked so well. But I have proven that it did NOT work well, hence your argument is not valid.

It is YOUR claim that government intervention is the source of all problems with the healthcare system in the US. I am simply disagreeing with your premise.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system

chanakya4773 says

The public health care system is for the poor and needy and is directly run by govt. its a very small percentage of the total hospitals that india has

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

chanakya4773 says

THERE ARE NO MANDATES ON PRIVATE HOSPITALS AND DOCTORS in india. The private industry is fully free market based.

Maybe you should read a little. Try transition.usaid.gov/in/our_work/pdfs/promise_reality.pdf for a starter. I read the whole paper about 5 years ago (it was a very, very long flight). Lots of interesting tidbits about government regulations on hospitals in India. Try page 40 hospital reimbursement by source. Let's see, 41% government, 35% insurance, 17% employer, 7% other/cash. If you care to read a little further you will find the 17% employer is from government mandated health insurance coverage in certain industries and self insurance by corporations with tax and other government incentives (page 84). So 41% of reimbursements to the hospitals by the government is "a very small percentage"???

Maybe it would be best if you discarded and drew new cards. What other country would you like to point to as a free market medical system?

bob2356 says

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

Well there is a difference between a roach infested motel in a crime ridden neighbourhood and Ritz Carlton in a nice neighbourhood. The former may be free-but do you want to stay there with your family.

In the US, the latter can be used by people with insurance and poor/illegals who just walk into the emergency room and get treated for free. The middle class-they can come after your assets. But the poor/illegals are judgment proof-they have no assets. So there is a difference with the mandates.

Now I understand the rationale, if you are in a car accident, or have a heart attack, the last thing you need is to be tossed aside by the emergency room, because you have no proof of insurance-you might have left proof at home. So that is a big problem. But hospitals do run up a big tab and the rest of us pay for it.

However I read somewhere that India is giving free generic prescritpon drugs to all of its 1.2 billion citizens, don't know if the law passed yet.

Bottom line is that the 51% found that they can use the government as a means of extortion. For now, they think that all of their needs can be achieved by this and life will be better as a government serf. We shall see.

chanakya4773 says

and you still believe GOVT is not a problem and you are a free citizen.
this is the worst form of tyranny.

Where did anyone say that the US government wasn't one of the problems with US health care, one of many? No one said anything even close to that. Try to read more carefully. Everyone is saying that your free market idea doesn't work either. If it does then please show us where it exists. India sure isn't it.

Why is the government forcing you to do any of these things? You are free to not have health insurance, just pay the penalty, No health insurance then the subsidy doesn't matter to you. No health insurance no payment for er's for you. No health insurance no payment for litigation for you. You are free to travel to any free market hospital in the world for your care. You don't even need a doc, just use the internet. You have all the access you want to foreign doctors, just cross the border.

Why are you and john law always a matched set of comments together? Curious coincidence.

chanakya4773 says

My idea of having a free market health care system and govt run hospitals for the poor and needy will work.

WTF???? After ranting against government involvement in health care for 20 or 30 posts now you want government run hospitals? Did you log onto the wrong profile by accident?

So where does this utopian free market health care exist? Got an example? I'd love to see it. Since 93% of the hospital income in India comes from government or insurance I really don't think you can say it's a free market.

chanakya4773 says

Do you think a person living in utah will cross the border to get a doctors visit. please me more practical.

You have the option, if it's practical is a different issue. Tyranny is when the government closes the boarders so you can't leave and confiscates your paycheck to give to cigna.

chanakya4773 says

Having a charity or govt run hospital for the poor and needy atleast allows us to control the money we will be shelling out to the free loaders.
These hospitals will be with bare minimum facilities to at least not let people die on streets.

Today , the free loaders have free pass to the private sector hospital emergency rooms and they are creating havoc in the system. the better option is to remove the mandate from private sector to service them in emergency rooms and create a govt run hospital for emergency services.
these will be similar to the services we provide for homeless people.

ofcourse the hospitals will be shitty but that's what you get for free.

The total cost that we will be bearing will be far low because we won't be giving them top of the line emergency services for free at our expense which is what is happening now. instead we will be giving them bare minimum services and we will control how much to spend on it as well.

You are such a compassionate soul. How did you ever become so considerate of your fellow human beings? You talk so much about India that I guess it must be Gandhi's influence.

chanakya4773 says

Are you f** crazy. you are googling all over the place to get some crappy data. talk to someone who has lived in india and you will know how indian health care works. some useless and incomplete document from web on indian healthcare system is not enough to prove that there in no free market private health care system in india. .Its a fact that most middleclass people in india have access to fully private free market based health care system in india.majority of them are direct cash payments.ofcourse there are some shitty govt run hospitals to service the poor who are completely broke but no middleclass person will dare to go there and nobody does. The Govt does not mandate the private sector to service a person irrespective of their ability to pay.
if a person tries to go to a private hospital and demands to be treated without paying them, they will cut his balls off ;-)

So you espouse having healthcare run by charities (or government, depending on how the mood takes you) if you are poor, and there are a lot of poor in India, and in the same breath say how shitty that healthcare is. Let's just summarize your argument - if you've got the cash, you get the healthcare you oh-so-deserve. If you're poor, you can basically just fuck off and take your chances because, well, you're poor. Like I said, you're a compassionate soul.

chanakya4773 says

Its a human thing not to let people die. if you don't have that..there is a problem with you. that does not mean you allow people to use that excuse to game the system and create a huge burden. I would any day donate a small sum to help a homeless who is really desperate or help save a life. that does not mean i'll write a blank check to everyone of them ( which is what is happening now).

Thats why charity based hospitals fit the model very well because the free money that people get are based on people's compassion which serves only the really desperate for their desperate needs and thus automatically control costs. we are giving too many very expensive freebies in todays system.

Have you actually taken a look at the WHO's list of the best healthcare systems around the world and their related costs? I think you need to.

chanakya4773 says

If you are poor and you are asking somebody else to pay for you...you only get what the other person is willing to give you on compassionate grounds . whats so difficult to understand here. anything else would be called extortion. do you like to do extortion ?

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you. I suspect that would be nothing in your case. I tell you what, let's go back to the days of poor houses and the like whilst we are at it.

chanakya4773 says

If a homeless guy comes to you for help ..would you like to have him "demand" money or would you like to give him whatever you thing is right on compassionate grounds ?
i know when i give him few dollars that he will be able to eat only eat very inexpensive not so great restaurant versus a steak house....but thats what i am willing to give away for free. anything wrong with that?

How about having a society that actually tries to prevent homelessness rather than just having people like you thinking they're doing the very best for them by tossing them a couple of dollars when/if the mood ever takes you?

chanakya4773 says

Bigsby says

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you.

well then go earn it. why do you want other people's hard earned money.
do you think they got it for free

Because not everybody is as fortunate as you so obviously seem to be. Personally, I'd much prefer to live in a society that tries to take care of every citizen's medical needs rather than one that is based on your philosophy of 'fuck you, I've got mine.'

chanakya4773 says

Bigsby says

How about having a society that actually tries to prevent homelessness

The best one known to man today : free market enterprise. If there exists something better, its definitely is not known yet.

Complete and utter bullshit.

chanakya4773 says

you need to understand something here.
there is only fixed amount of health care resources available in US. if you take something from it and give it away free to somebody. somebody else is not getting it. its called rationing. rationing should be the last resort. The focus should be to grow the pie . in this case, healthcare resources pie. one way to grow the pie is to make every person contribute money to grow the pie. that why you cannot just give freebies.

You need to understand something. The US ranks 38th on the WHO's rankings of health systems whilst spending the highest amount per capita by a long way - $2500 more (according to the OECD) than the next highest spender. This isn't an issue of money or lack thereof. It's an issue of how the country has decided to spend its money on healthcare.