patrick.net

Hell, Americans fly to India to get treatment under our current system!

I personally know a person how got surgery done in India - for little more than $15K. In USA it would have cost him more than $100K which was beyond his affordability.

touche

Patrick
this confrontation would have been much more lively with a YouTube video of you two shouting at each other :-)

Yes, I've descended to their level. :-( I'm a bit ashamed of the f-word, but otherwise at a loss for how to express just how stupid medical reform opponents are being. They seem perfectly willing to cut their own throats just to express their displeasure with:

1. Having lost the election.
2. Having lost the election to a black man.
3. Having lost the election to a black man who is ten times smarter than Bush.

Personally, I find it sad that the medical reform debate has descended to people shouting at each other, and both sides share equally in this sad display we see unfolding.

Lost in the shouting are legitimate questions regarding reform: What effect will it have on medical innovation, seeing as how the US currently carries the world's water in this area? Will we have enough doctors to service the increased demand? How will abuses (excessive emergency room visits, lifelong smoking, etc.) in the system be handled? Personally, I feel these important questions have not been answered, at least not to my satisfaction. Obama saying "it won't be a problem" just isn't good enough. Call me crazy, but I would prefer more evidence than a politician's campaign rhetoric.

At this time, I am admittedly an opponent of the current plan, but mainly because it seems like the Democrats seem more interested in a "victory" than an actual working plan. IMHO, ramming this bill through in a rush will result in yet another ill-conceived, problematic government agency. I would like to hear more from doctors and hospital administrators and less from politicians parroting talking points, and if the Democrats were serious about convincing reasonable people like myself, that is exactly who should have been doing most of the speaking at the town halls.

But I guess my thoughts on the matter make me just another bitter racist idiot....

Having lived under our US "For Profit" healthcare system, the US Governmental Healthcare system (US Army), and the Universal healthcare system in Japan, I believe a government option is a poor second choice to universal healthcare. The only time I had a problem with healthcare was a billing issue in the "For profit" system. Not only was I overcharged. I proved that I was overcharged. In addition, I took the disagreement to the CEO of the hospital and literally caught him in a lie (in writing). I testified before the CA Assembly regarding the entire incident. I maintain those all these letters just in case I ever have to dispute charges in the future.

Anyone who believes a for profit system is better than a universal healthcare system is sadly mistaken. Growing up, my father often distinguished between "book learning" and life experience. Often giving life experience more weight because it was practical. I have noticed many people who have talked with me about this issue lack the life experience of being in a universal healthcare system. So, they begin with no real experience. That leaves "book learning." I have noticed most of them do not actually read any books on the subject.

If it is not book learning or life experience that forms the basis of their opinion, then what is it? Unfortunately, the most likely source is the Boob Tube. My father had another saying when I was growing up: "Television rots your brain."

I feel like I woke up in 1950's during the 2nd Red Scare.
All of these crazy people screaming "socialism" and "Obama is destroying the constitution". Funny they weren't so afraid of Bush's warrantless wiretapping - but try and help them get a break on health insurance and all hell breaks loose.
I don't remember these bizarre tactics during the Clinton healthcare debate, not to say there weren't fierce opponents, but were they this cuckoo???

stillrentinginLA says

Funny they weren’t so afraid of Bush’s warrantless wiretapping - but try and help them get a break on health insurance and all hell breaks loose.

I remember in NPR radio one caller was saying "I am OK with govt wiretapping my phone, because it is helping govt to stop terrorists from bombing our malls. Otherwise my wife and children would be killed while shopping in malls."

Chris, if you get sick without insurance, you're dead. Certainly financially, and maybe literally.

1. It wasn't a very slim margin in most parts of the country, or even a slim margin. In Global polls, Obama won by a landslide.

2. Technically, he's bi-racial, but he's generally regarded and embraced as a black man. He doesn't downplay his white mother at all. In fact, she is central in his argument for health care reform, as he watched her go bankrupt before losing her battle with ovarian cancer.

3. All politicians read from prepared statements.

Perhaps some of those opposed to this do not believe that this is the roll of the federal government. Let us assume they can do it better and cheaper, does that make it the roll of the government? At what price do we sell our freedom?

Do I end this with a "FUCK YOU!" or "I am sorry your parents died?"

You do not go through life without losing ones you love, but for some of us the idea of living a life that is not free is a Zombie life. We are losing more and more freedom everyday.

Thank you for our time (Insert whatever boorish remark you desire.)

At what price do we sell our freedom?

Please define what freedom means to you within the context of this discussion.

Patrick Thanks for sanity in the forum world. Being without health, I am aware if I get sick, I am dead. I also realize if I paid into the system as an individual and got sick, same thing since they would drop me for not being able to pay because if I was sick, I could not work. Although lately I am reading they just drop you if you are not with an employer anyway.

I have wanted this for a long time but I want the non-corporate profiteering version. I want socialization of things. I like our Parks, roads, libraries, national parks, highways, firefighters, policemen, and other shared resources paid for by our socialist system.

Deregulation killed a lot of social networks. Cable companies charge outrageous amounts for the services we need.

I am sorry about your parents. I know your mom had passed but did not realize your dad too.
It is incredible in this country that people go bankrupt over medical care or die because the system is unwilling to treat them because they have no money.

Patrick, I've been following your blog for a very long time and appreciate that you've probably saved me $500K by convincing me not to buy a house 3 years ago.

I would also like to express my condolences for your loss. I'm sure that it's not easy to lose both parents in one year.

However, I am a bit puzzled about your comment that they were "bankrupted by the current system" when they had medicare. If they had Medicare, was it that it did not cover their medications because they did not have part D?

Although I believe that the current system is flawed, Medicare has major problems as well and if it replaced the current system as is without any reforms, it would be a total disaster. In fact, even Obama admitted that although he believes in a single payer system in principle, it would not work in the US under the current conditions, or at least it would cause major problems. I agree with this as well.

As a physician, I deal with many absurd rules in Medicare. For instance, I have a patient with severe asthma who has part D. Medicare will pay for a nebulizer, but her part D won't pay for any of the nebulizer medications. Medicare will pay for allergy injections, but won't pay for the serum(if it's made by an outside serum company which most allergy clinics now use). Medicare will not cover some bundled laboratory studies even though there are many conditions, such as diabetes, heart disease, hyperlipidemia, and hypothyroidism that require these bundled tests, so often patients end up having to get two separate blood tests on different days.

I'm not saying that private insurance companies are that much better, but often, if the insurance company denies a procedure that is necessary, I can provide a letter of necessity or submit supporting literature and it will be approved. You can't really do that with Medicare and any changes require years to implement.

As a provider, I've spent time maneuvering through our medical system of denials, appeals, limitations, prior authorizations, and dealing with insurance companies who make huge amounts of money on the suffering of others. Non-profits are no better, they all operate the same. As a patient with a serious medical condition, it's no better from this angle. My out-of-pocket expenses are amazing, my intent is questioned and my body hurts and doesn't work right.

Simply stated, as a provider the system sucks. As a patient, the system blows - thereby proving that it is possible to suck & blow at the same time.

Chrisborden, you should have a complete Physical asap. There are so many people with serious illnesses that have silent symptoms - by the time you feel pain or discomfort it may be too late to treat.

Constitutionalist says

So then by the logic of the Pro-Government Health Care crowd, America also owes me Car Insurance.
1. If my car is totaled, I cannot get to work
2. If I cannot get to work I will be fired
3. If I am fired, I will lose my health insurance
4. Without health insurance, I will die.
Therefore, if I am not given FREE Car Insurance .. I may DIE!
Health Insurance IS available, people. You just have to friggin PAY FOR IT!
Good Lord. When did this country get so ****ing LAZY?

Take the fucking bus and get over yourself.

DT says:
"However, I am a bit puzzled about your comment that they were “bankrupted by the current system” when they had medicare. If they had Medicare, was it that it did not cover their medications because they did not have part D?"

Medicare has co-pays; if one lacks supplemental insurance the copays can be astronomical. For hospitalization there are limitations, for rehab the copay is $133.50 per day for days 21-100. Under Part D - designed by "for-profit" drug companies, the co-pays & deductibles are such that many people still can't afford their meds. Especially in the "donut hole" where they'll have to pay thousands out of pocket before their meds are covered. Sure, labs are screwed up as you described and need to be fixed - but people are bankrupted by healthcare expenses and don't qualify for Medicaid until there is no money left.

Patrick....I Love You.
thx.

Having worked in many different types of systems, pure HMO, VA, private medical group, public hospital, it's very interesting how distorted and how much misinformation there is out there in the media about the various types of systems.

My feeling that is that the most cost effective system would be the VA system. Having said this, there some things that I hear that I think is more spin than reality. It's often quoted that the VA system has very high rates of satisfaction. I think this is very true. Veterans are by far the most appreciative patients that I have ever treated. If not for the very very low pay at VAs and my need to pay off $240K in loans, I would love to work at a VA. I doubt that if you took a bunch of Dot.com professionals(who tend to be very demanding) and Stanford professors(who are even more demanding) that they would appreciate the care they get at a VA. There are VERY long waits for everything. I once ordered a sleep study on a patient who almost certainly had sleep apnea. It was contributing to his obesity(which was contributing to his sleep apnea) causing worsening diabetes and hypertension. The first available sleep study was 18 months away!!! (In a private clinic, it can be done in less than a week). By the time of his sleep study, he forgot and missed his appointment. I called begging the sleep specialist to get him in sooner, and he got scheduled for 6 months. I can tell you story after story like this. Another drawback of the VA is that they have very poor ancillary services. Most VAs are fortunately staffed by medical residents who end up drawing blood, putting in IVs, sometimes administering meds, wheeling patients around the hospital. In almost all private hospitals, these are done by medical assistants and techs. VAs very strictly limit the amount and types of meds that are allowed to be prescribed. Also, because of the low pay, they also tend to be staffed by foreign medical doctors and since they are not well funded, the buildings tend to be older and more run down. But despite all of this, the VA hospitals do follow evidenced based medicine well, there is a reasonable amount of clinical research done, and considering their limited resources, do provide quality care. (Simpsons fans may disagree if they remember the episode where Monty Burns is shot and pronounced dead at a VA, then is taken to a "better hospital" and is pronounced alive.)

...and yet, there you are justifying why the govt should pay your car insurance.

I hope for you that your life continues on its perfect keel - that you never need to learn the horrors of pre-existing conditions, unemployment, and financial devastation. I hope for you that your attitude never needs to change because of personal tragedy - only that it changes because you gain compassion and understanding for others.

elliemae,

I am well aware of the "donut holes" as I often save up my samples this time of the year to provide these patients.

Medicare has many faults such as paying waaaay to much for procedures(the reimbursement systems was initially set up by an anesthesiologist who obviously valued procedures over things such as prevention and office visits) and next to nothing for office visits.

I guess this is my fear with a single payer system. Some individual or individuals, who likely hasn't or isn't practicing, will inevitably set the rules and decide what is allowed and not allowed.

To the supporters of Obamacare:

Is it too much to ask that I be exempted from the benefits and payments for the Obamacare plan? If you want to be a part of it then how about a special social security type tax just for those who want it and let the rest of us keep what we got. That sounds fair to me, anything else is wealth redistribution (also known as theft).

The insurance companies are a big problem but our elected leaders have been living off of the campaign donations of these corporations since at least the Nixon years, this new plan is not going to change that, it is just going to change which companies make more money.

So how about it, at least give us all a choice not to be a part of it.

cab said:
"It makes a world of difference to people which is why older Europeans often look so incredibly healthy."

I think the reason why Europeans often look so healthy is that they don't eat Krispy Cream every day, drive a block to go to work, and sit around watching TV all weekend like most Americans(including myself).

Yes, I’ve descended to their level. I’m a bit ashamed of the f-word, but otherwise at a loss for how to express just how stupid medical reform opponents are being. They seem perfectly willing to cut their own throats just to express their displeasure with:
1. Having lost the election.

2. Having lost the election to a black man.

3. Having lost the election to a black man who is ten times smarter than Bush.

You just brought race into it.

I've followed you for years expecting more and getting more from you. Sure I don't offer anything in return... but now that you've shown your colors, I'm deleting your bookmark and walking away shaking my head at someone I thought could offer logic and reason without race emotions.

2ndClassCitizen,

that's not a bad idea. Can I do that with other things like choosing not to have my taxes go towards paying for a statue of some obscure politician in Alabama, roads to nowhere, or bailing out AIG and Goldman Sachs? I'd be all for that.

DT:
I agree that a single payer system may have its faults. But it will be better than our current system, where people must go to the ER for anything if they lack insurance - and become critically ill before receive treatment. Any system should focus on prevention and ongoing care, rather than expensive procedures.

The VA works in the bigger cities, but sucks in rural areas without clinics. People must travel hundreds of miles to receive treatments otherwise available in their area. And medications can be hard to obtain - if a Vet is discharged from a non-VA hospital he must have his scripts rewritten by a VA doc in order to receive them.

We see many things the same - but I see Seniors on a daily basis who are sick because they can't afford their medications and/or the cost of medical expenses. It's a shame when people must choose between keeping their home or receiving medical care - by this I mean that in order to qualify for Medicaid (even short term) a patient's income is used as a deductible. The patient can't afford to maintain his apartment or home if everything he earns goes to the facility and has no savings - so he ends up staying in a nursing home long term. He no longer has a home to go to. What an asinine system.

Is it too much to ask that I be exempted from the benefits and payments for the Obamacare plan? If you want to be a part of it then how about a special social security type tax just for those who want it and let the rest of us keep what we got.

This is a pinhole point of view, and it also assumes that what insurance you got now is the same type of coverage you will always enjoy. It isn't.

Would you feel the same way about road repairs if you only drove once a month or not at all? Do you feel that way about the Fire Department, even though you've maybe never had a residence catch fire?

That sounds fair to me, anything else is wealth redistribution (also known as theft).

Wealth redistribution aka theft...kinda like Trickle Down Economics.

Must see this!

http://www.thedailyshow.com/watch/mon-august-10-2009/healther-skelter---obama-death-panel-debate

DT says

2ndClassCitizen,
that’s not a bad idea. Can I do that with other things like choosing not to have my taxes go towards paying for a statue of some obscure politician in Alabama, roads to nowhere, or bailing out AIG and Goldman Sachs? I’d be all for that.

We didn't pay for the road/bridge to nowhere. It didn't happen. The great state of Alaska just kept my (and your) money 'cause they could.

The problem with opting out is, when a person needs the medical coverage, he will expect that it is available to him and expect to receive the same treatment as though he had paid in. After all, he shouldn't be treated like a second class citizen...

Austinhousingbubble,

I take it your answer is yes. It is too much to ask that I keep what I have.

Just send your money and mine to Washington and everything will be OK.

Sounds like a pinhole point of view to me.

ellimae,

Go ahead treat me like my name says. I'm starting to get used to it. In fact that dog pictured on your postings probably gets more respect than most libertarians these days.

elliemae,

for the VA system to work, there would definitely need to be outreach clinics in rural areas. I had a patient who had to drive 200 miles to see me. Fortunately, he had a daughter in our area who he could stay with.

I think the single payer system(unless it's a single payer HMO system) would be a bit more advantageous for providers and probably for patients a well, but many countries that have single payer do eventually run into some cost issues since there is less rationing than in a system like the VA. The waits would definitely be less in a single payer system than in a system like the VA.

A simple google search shows that for my bracket, I pay 25% income taxes in the US. If I lived in Canada, I'd pay 22% and get this, they don't tax gifts, inheritances or lottery winners!

We spend too much on war and "homeland security." Why don't terrorists bomb Canada? The money is there and I'd much rather see it spent on an alternative health care method.

I find it ironic there's a Kaiser ad by google below....

Constitutionalist says

elliemae says

…and yet, there you are justifying why the govt should pay your car insurance.
I hope for you that your life continues on its perfect keel - that you never need to learn the horrors of pre-existing conditions, unemployment, and financial devastation. I hope for you that your attitude never needs to change because of personal tragedy - only that it changes because you gain compassion and understanding for others.

The car insurance analogy was meant to illustrate the absurd claim that anyone without health insurance will die. We are ALL going to die regardless. Sorry it went over your head, which was evident in your highly articulate reply to “take the fucking bus”.

Yes, we will all die someday, but your analogy was nonsensical and didn't apply - it certainly didn't go over my head. And thank you for pointing out that I'm highly articulate, I appreciate that you're one of my fans. However, I actually replied that you should take the fucking bus. I didn't reply to my own comment.

jessica said:

"Why don’t terrorists bomb Canada? "

Because there's nothing to bomb in Canada. Have you ever been there? There's nothing there. Just snow and ice.

It's pretty stunning just how much disinformation and outright lying has been hitting the airwaves lately on this subject. One of the talking points seems to be that the Democrats are staging a "power grab" in which the government "takes over a large chunk of health care". Never mind that the government already pays for 60% of all U.S. healthcare through Medicare/Medicaid and other programs. 60% of 2.4 trillion is 1.44 trillion - which the government ALREADY pays each year. In the worst-case scenario, in which the additional 1 trillion in costs over 10 years is not reduced by any sort of savings, this would mean an additional one tenth of a trillion per year, or a mere 6.5% annual increase in government healthcare spending - to ensure 50 million more Americans.

THAT is the massive "power grab"? And don't forget, we're assuming NO savings under the plan. We're taking the Republican PR at face value and assume that full 1 trillion is added to the debt over the next 10 years. And STILL, we would be increasing healthcare expenditures by a mere 6.5%.

Now the idea is that a public plan would work to drive down costs through forcibly injecting competition into an increasingly monopolistic marketplace. And somehow this is perceived as "socialist".
What the vast majority of us don't realize is that we are completely uninsurable in the individual marketplace if we have had any medical issues at all in the last ten years, no matter how small (my agent's real life example is a family rejected by all insurers on the basis of a diaper rash diagnosis). So if your employer decides to stop paying for your health care or decides to give you money towards buying your own care, you are S.O.L.

I have group insurance, but still have to keep private insurance, since my group coverage tends to lapse now and then due to the vagaries of a labor contract. If I were to go to the doctor under my group plan, I would be uninsurable and forced to pay for COBRA (a whopping $750 a month to cover just me). When that expired in 12-18 months, I too would be S.O.L. Thus I pay for double coverage as per the advice of every agent I have spoken with.

People who have employer coverage are simply shielded - for now - from how bad things are getting. The reason they are shielded? Big, bad government intervention (and massive tax subsidies). The government mandates that nobody be denied employer-based coverage. They simply have chosen not to do so for those with individual plans, in effect throwing the self employed and many small business owners under the bus first.

But make no mistake, that bus is gunning for us all, and with healthcare costs going up 17% a year, it is only a matter of time before employers can no longer foot the costs, and the rest of us are S.O.L. as well.

DT:
In order for a single-payer system to work, they need to get all of us in the room. US, the ones on the front lines who are providing the care or helping people to navigate the system. Almost every MD I've ever met has expressed frustration at the system, as do pharmacists, nurses, social workers, etc. It's the bean counters and profiteers that screw the whole thing up.

srla,

If health care costs are going up, they will reach a limit where no one can pay. At that point they will either level off or come down. Prices cannot go up indefinitely, that is what this housing bubble website is all about!!!!! See the connection??????????????? Should we subsidize housing to bring the cost down?

If you think that subsidizing housing is ridiculous, health care is even worse. Are you listening Patrick?

2ndClassCitizen,

I don't think Obama stated that the public plan would be subsidized. I think he hopes that it would be sustained with what is put in by subscribers.

But I do understand the fears of those who believe that it is a slippery slope and that once enough people have signed up and if it starts to lose money, the government may end up subsidizing it like they did for Fannie and Freddie.

Instead of a government option, the government could just mandate that all insurance companies must be non-profit(no shareholders), that it not spend more than what Medicare spends on administrative costs, etc. and in effect get the same thing. This is similar to healthcare cooperatives that have formed in some parts of the country. But considering how heavily the insurance industry funds the campaigns of some of the major players in the healthcare debate, that is very unlikely to happen.

Constitutionalist says

Yes, we will all die someday, but your analogy was nonsensical and didn’t apply - it certainly didn’t go over my head. And thank you for pointing out that I’m highly articulate, I appreciate that you’re one of my fans. However, I actually replied that you should take the fucking bus. I didn’t reply to my own comment.

No worries. Your HealthScare Reform is dying on the vine … I will be back to gloat once it meets with resounding defeat in October. See you then

Aww, don't go away mad. Just go away.

This is a serious issue that provokes serious thought. That you would gloat if our healthcare system overhaul fails is disturbing - the current system is a failure. That is, unless you're heavily invested in insurance companies (their profits continue to soar).