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Thread: Further discussion about Health Care as a "Right"

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    Further discussion about Health Care as a "Right"

    Notice: The following article is Copyright 1993 by Leonard Peikoff and is being distributed by permission. This article may be distributed electronically provided that it not be altered in any manner whatsoever. All notices including this notice must remain affixed to this article.
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    Health Care Is Not A Right
    by Leonard Peikoff, Ph.D. Delivered at a Town Hall Meeting on the Clinton Health Plan. Red Lion Hotel, Costa Mesa CA. December 11, 1993

    Good morning, ladies and gentlemen:

    Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea -- which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical -- it does not work -- but I hold that it is impractical because it is immoral. This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice. So I'm going to leave it to other speakers to concentrate on the practical flaws in the Clinton health plan. I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan -- not if it really is noble. The only way you can defeat it is to unmask it -- to show that it is the very opposite of noble. Then at least you have a fighting chance.

    What is morality in this context? The American concept of it is officially stated in the Declaration of Independence. It upholds man's unalienable, individual rights. The term "rights," note, is a moral (not just a political) term; it tells us that a certain course of behavior is right, sanctioned, proper, a prerogative to be respected by others, not interfered with -- and that anyone who violates a man's rights is: wrong, morally wrong, unsanctioned, evil.

    Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That's all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at Mcdonald's, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights -- and only these.

    Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want -- not to be given it without effort by somebody else.

    The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree.

    To take one more example: the right to the pursuit of happiness is precisely that: the right to the pursuit -- to a certain type of action on your part and its result -- not to any guarantee that other people will make you happy or even try to do so. Otherwise, there would be no liberty in the country: if your mere desire for something, anything, imposes a duty on other people to satisfy you, then they have no choice in their lives, no say in what they do, they have no liberty, they cannot pursue their happiness. Your "right" to happiness at their expense means that they become rightless serfs, i.e., your slaves. Your right to anything at others' expense means that they become rightless.

    That is why the U.S. system defines rights as it does, strictly as the rights to action. This was the approach that made the U.S. the first truly free country in all world history -- and, soon afterwards, as a result, the greatest country in history, the richest and the most powerful. It became the most powerful because its view of rights made it the most moral. It was the country of individualism and personal independence.

    Today, however, we are seeing the rise of principled immorality in this country. We are seeing a total abandonment by the intellectuals and the politicians of the moral principles on which the U.S. was founded. We are seeing the complete destruction of the concept of rights. The original American idea has been virtually wiped out, ignored as if it had never existed. The rule now is for politicians to ignore and violate men's actual rights, while arguing about a whole list of rights never dreamed of in this country's founding documents -- rights which require no earning, no effort, no action at all on the part of the recipient.

    You are entitled to something, the politicians say, simply because it exists and you want or need it -- period. You are entitled to be given it by the government. Where does the government get it from? What does the government have to do to private citizens -- to their individual rights -- to their real rights -- in order to carry out the promise of showering free services on the people?

    The answers are obvious. The newfangled rights wipe out real rights -- and turn the people who actually create the goods and services involved into servants of the state. The Russians tried this exact system for many decades. Unfortunately, we have not learned from their experience. Yet the meaning of socialism (this is the right name for Clinton's medical plan) is clearly evident in any field at all -- you don't need to think of health care as a special case; it is just as apparent if the government were to proclaim a universal right to food, or to a vacation, or to a haircut. I mean: a right in the new sense: not that you are free to earn these things by your own effort and trade, but that you have a moral claim to be given these things free of charge, with no action on your part, simply as handouts from a benevolent government.

    How would these alleged new rights be fulfilled? Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory?

    Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops -- it's all free, the government pays. The dishonest barbers are having a field day, of course -- but so are the honest ones; they are working and spending like mad, trying to give every customer his heart's desire, which is a millionaire's worth of special hair care and services -- the government starts to scream, the budget is out of control. Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split. A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist's work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc. In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters some of whom remember dreamily the old days when somehow everything was so much better.

    Do you think the situation would be improved by having hair-care cooperatives organized by the government? -- having them engage in managed competition, managed by the government, in order to buy haircut insurance from companies controlled by the government?

    If this is what would happen under government-managed hair care, what else can possibly happen -- it is already starting to happen -- under the idea of health care as a right? Health care in the modern world is a complex, scientific, technological service. How can anybody be born with a right to such a thing?

    Under the American system you have a right to health care if you can pay for it, i.e., if you can earn it by your own action and effort. But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.

    You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs.

    Some of you may ask here: But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all -- where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens' wealth, through taxation, deficit financing or the like.

    But, you may say, isn't it the "rich" who are really paying the costs of medical care now -- the rich, not the broad bulk of the people? As has been proved time and again, there are not enough rich anywhere to make a dent in the government's costs; it is the vast middle class in the U.S. that is the only source of the kind of money that national programs like government health care require. A simple example of this is the fact that the Clinton Administration's new program rests squarely on the backs not of Big Business, but of small businessmen who are struggling in today's economy merely to stay alive and in existence. Under any socialized program, it is the "little people" who do most of the paying for it -- under the senseless pretext that "the people" can't afford such and such, so the government must take over. If the people of a country truly couldn't afford a certain service -- as e.g. in Somalia -- neither, for that very reason, could any government in that country afford it, either.

    Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off -- charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

    But the fact is: You don't abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not President Clinton calls it a "right." To call it a Right when the recipient did not earn it is merely to compound the evil. It is charity still -- though now extorted by criminal tactics of force, while hiding under a dishonest name.

    As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand).

    I would like to clarify the point about socialized medicine enslaving the doctors. Let me quote here from an article I wrote a few years ago: "Medicine: The Death of a Profession." [The Voice of Reason: Essays in Objectivist Thought, NAL Books, c 1988 by the Estate of Ayn Rand and Leonard Peikoff.]

    "In medicine, above all, the mind must be left free. Medical treatment involves countless variables and options that must be taken into account, weighed, and summed up by the doctor's mind and subconscious. Your life depends on the private, inner essence of the doctor's function: it depends on the input that enters his brain, and on the processing such input receives from him. What is being thrust now into the equation? It is not only objective medical facts any longer. Today, in one form or another, the following also has to enter that brain: 'The DRG administrator [in effect, the hospital or HMO man trying to control costs] will raise hell if I operate, but the malpractice attorney will have a field day if I don't -- and my rival down the street, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, I can't afford to antagonize him, but the CON boys disagree and they won't authorize a CAT scanner for our hospital -- and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can't get a specialist's advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn't even take this patient, he's so sick -- after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges.' Would you like your case to be treated this way -- by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of some ninety different state and Federal government agencies? If you were a doctor could you comply with all of it? Could you plan or work around or deal with the unknowable? But how could you not? Those agencies are real and they are rapidly gaining total power over you and your mind and your patients. In this kind of nightmare world, if and when it takes hold fully, thought is helpless; no one can decide by rational means what to do. A doctor either obeys the loudest authority -- or he tries to sneak by unnoticed, bootlegging some good health care occasionally or, as so many are doing now, he simply gives up and quits the field."

    The Clinton plan will finish off quality medicine in this country -- because it will finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureaucracy.

    The only hope -- for the doctors, for their patients, for all of us -- is for the doctors to assert a moral principle. I mean: to assert their own personal individual rights -- their real rights in this issue -- their right to their lives, their liberty, their property, their pursuit of happiness. The Declaration of Independence applies to the medical profession too. We must reject the idea that doctors are slaves destined to serve others at the behest of the state.

    I'd like to conclude with a sentence from Ayn Rand. Doctors, she wrote, are not servants of their patients. They are "traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer."

    The battle against the Clinton plan, in my opinion, depends on the doctors speaking out against the plan -- but not only on practical grounds -- rather, first of all, on moral grounds. The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle: self- preservation. If they can do it, all of us will still have a chance. I hope it is not already too late. Thank you.


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    Copies of this address in pamphlet form are available for $15 per 100 copies or $125 per 1000 copies from: Americans for Free Choice in Medicine, 1525 Superior Ave., Suite 100, Newport Beach, CA 92663, Phone (714) 645-2622, Fax (714) 645-4624. Copies of Dr. Peikoff's lecture, "Medicine: The Death of a Profession" may be purchased in pamphlet form for $2.50 each (catalog number LP04E) from: Second Renaissance Books, 110 Copperwood Way, P.O. Box 4625, Oceanside, CA 92052, Phone (800) 729-6149. (Quantity discounts are also available: $1.85 each for 10-99 copies, catalog number LP66E, $1.50 each for 100-499 copies, LP77E; $1.25 each for 500-999 copies, LP88E; and $1 each for 1000 copies and over, LP99E.)

    Also available from Second Renaissance is the pamphlet "The Forgotten Man of Socialized Medicine: The Doctor," containing articles by Ayn Rand and Leonard Peikoff. (Catalog number AR10E, $2.95)

    Additional information on why national health care programs don't work is available from: Objectivist Health Care Professionals Network, P.O. Box 4315, South Colby, WA 98384-0315, Phone (206) 876-5868, FAX (206) 876-2902. This organization publishes a newsletter on health care and distributes a copy of it in their health care information package.


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    Almost ten years ago, Leonard Peikoff predicted that our medical system would be dismantled. Looking at the young people in the crowd, he remarked:


    "If you are looking for a crusade, there is none that is more idealistic or more practical. This one is devoted to protecting some of the greatest [men] in the history of this country. And it is also, literally, a matter of life and death---YOUR LIFE, and that of anyone you love. Don't let it go without a fight!"

    From "Medicine: The Death of a Profession" by Leonard Peikoff from concluding remarks from 1985 presentation with Dr. Michael Peikoff.


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    Dr. Leonard Peikoff, author of The Ominous Parallels and Objectivism: The Philosophy of Ayn Rand was a long-time (30 year) associate of the novelist/philosopher Ayn Rand and upon her death in 1982 was designated as her intellectual and legal heir. He received his Ph.D. from New York University in 1984 and taught at Hunter College. Over the years, he has served in the capacity of professor of philosophy, lecturer and chairman of the board of the Ayn Rand Institute and is currently one of the principal lecturers and instructors of the Objectivist Graduate Center. He has lectured extensively at such prestigious speakers' forums as Ford Hall Forum in Boston on several topics including philosophy and current events. Additionally, outside of academia, he has taught courses on philosophy, rhetoric, logic and Objectivism audio version of which are available from Second Renaissance Books listed above.



    I posted this for discussion purposes about the immorality of socialized medicine...while the topic is medicine, socializing any aspect of the economy/society reliant on individual efforts to provide would be similarly immoral.

    [QUOTE]As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand). [/QUOTE]

  2. #2
    Do you think Ben Franklin hoped that the insurance industry would dictate health care?

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    [QUOTE=cr726]Do you think Ben Franklin hoped that the insurance industry would dictate health care?[/QUOTE]

    Nope...

    But the answer is not to socialize medicine...that wouldn't have been Franklin's answer either.

    Citizens need to insist on de-socializing medicine, in conjunction with physicians, to keep state-of-the-art, world leading health care in the US.

    If not for yourself, then for the generation of Americans to follow.

  4. #4
    Do you mean full privatization? The insurance companies are screwing the doctor and the patient. What is the best way to rectify that?

    [QUOTE=Greenwave81]Nope...

    But the answer is not to socialize medicine...that wouldn't have been Franklin's answer either.

    Citizens need to insist on de-socializing medicine, in conjunction with physicians, to keep state-of-the-art, world leading health care in the US.

    If not for yourself, then for the generation of Americans to follow.[/QUOTE]

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    [QUOTE=Greenwave81]

    That is why the U.S. system defines rights as it does, strictly as the rights to action. This was the approach that made the U.S. the first truly free country in all world history -- and, soon afterwards, as a result, the greatest country in history, the richest and the most powerful. It became the most powerful because its view of rights made it the most moral. [B]It was the country of individualism and personal independence. [/B][/QUOTE]

    Honest question: The line in bold....do you not see where one of the problems lies, that individuality within the declaration has led to some problems? Is it not possible that the reason individuality was so grossly exaggerated was because of some of the "iron fist" ruling from the church that the first settlers were trying to escape?

    Is there too much emphasis on the individual and not enough on the collective? If so, how then do you propose a change, if needed? When you look at certain cultures, they fight this very kind of thing. They don't believe the individual can be held so high in esteem without it causing the whole collective to disintegrate. I think we see this in North American culture.

    What are your thoughts.



    [QUOTE=Greenwave81]
    I posted this for discussion purposes about the immorality of socialized medicine...while the topic is medicine, socializing any aspect of the economy/society reliant on individual efforts to provide would be similarly immoral.[/QUOTE]


    Immoral? No, I think that is a little heavy. Do I see your point about it? Absolutely. It is a difficult situation because while I like the concept about anyone being able to get medical attention who needs it, there are THOUSANDS who abuse the system. There has to be a happy medium somehow. This gentleman says it is immoral to socialize anything? It is immoral to not take action when people are in need as well. So where is the happy medium?

    Please, take the questions seriously. Coming from Canada, I do not, and cannot, fully understand the struggles you personally deal with in the medical field, so I am both asking out of wanting to know, and playing devil's advocate as well.

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    [QUOTE=cr726]Do you mean full privatization? The insurance companies are screwing the doctor and the patient. What is the best way to rectify that?[/QUOTE]

    Take them out of the equation.

    There are many instances where physicians are foregoing insurance companies....public and government. They take cash upfront, at reduced rates. They either cut out the middle man completely, or let the insured deal with the insurance company. Either way, the insured's cost is less.

    Look at it this way....

    Let's say that your employer pays $10K/year for your health care insurance to the insurance company (covering your family). Why not have them just pay for a catastrophic health care policy that covers all costs over an amount you choose....$5K, $7.5K, $10K..your choice. Let's say you can get that catastrophic policy for $2.5K/yr. The other $7.5k/ yr you put in a Medical Savings Account (MSA) to pay your bills, and negotiate directly with your chosen physician for sevices you may require. Anything you do not spend from the MSA either is invested and grows over time (your control) or you get to keep.

    Why do healthy 30 y.o. parents with say a 2 and 4 y.o. need to pay $10K year in health insurance? All they need is protection against catastrophic loss...anything else they pay is only subsidizing the insurance company for care for lesser 'healthy' individuals or subsidizing the insurance company themselves.

    I'd gladly take 50% of what I charge an insurance company for your care (as I only get about 60% anyway) if I get paid (like everyone else) immediately, without the hassle of negotiating yearly with the insurance company or fighting for non-payment.

    For those unfortunate individuals who are destitute, return to a system of 'charity' (oh! The horrors!). I don't make any money on Medicaid anyway, so if I'm going to provide the care for next to nothing, I'd rather provide it free and write it off as a loss (which I cannot do now according to federal regulations).

    For Medicare individuals, means test it. Those that can afford insurance should pay for it...there is no law that says that you get to keep the wealth you accumulated during life at death while others who are much younger, and not as wealthy, pay for your care. A simple fact of life is that the majority of health care expenditures occur in the last 6 months of life....and that is directly because of the fact that as medicare recipients have no direct responsibility for the true cost of their care, they frequently ask for heroic care in some ridiculous circumstances.

    The disconnect in the American Health Care System is that that the patients never see the cost of their care since it is paid by insurance.... and the patients that consume most of the health care dollars aren't covered by insurance anyway. Other patients with insuranced subsidize their care.

    My $0.02.

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    [QUOTE=CanadaSteve]Honest question: The line in bold....do you not see where one of the problems lies, that individuality within the declaration has led to some problems? Is it not possible that the reason individuality was so grossly exaggerated was because of some of the "iron fist" ruling from the church that the first settlers were trying to escape? [/quote]

    Not being facetious, but no, I do not see the problem. Left to individuals, most problems are resolved.


    [QUOTE=CanadaSteve]Is there too much emphasis on the individual and not enough on the collective? If so, how then do you propose a change, if needed? When you look at certain cultures, they fight this very kind of thing. They don't believe the individual can be held so high in esteem without it causing the whole collective to disintegrate. I think we see this in North American culture.

    What are your thoughts.[/quote]

    IMO there can never be too much emphasis on the individual...put to the struggle, the individual will be more sucessfull than the collective more often than not...it only makes sense, individuals are always more concerned with their well-being than the collective.

    [QUOTE=CanadaSteve]Immoral? No, I think that is a little heavy. Do I see your point about it? Absolutely. It is a difficult situation because while I like the concept about anyone being able to get medical attention who needs it, there are THOUSANDS who abuse the system. There has to be a happy medium somehow. This gentleman says it is immoral to socialize anything? It is immoral to not take action when people are in need as well. So where is the happy medium?[/quote]

    You seem to have a great problem with discussing anything in absolute moral terms...there are no 'grays' here.

    While you can argue that it may be immoral for a group of people to not do anything about certain people that cannot fend for themselves, that is a far cry from that same group of people demanding that another group of people provide the 'unfortunate' services for nothing.... or less than those services are truly worth. If the 'haves' want to provide services for the 'have-nots' collectively at cost, that would be a 'moral' solution...but that is not the case here in the US where the government has decided that they will demand these services at 20-30% of the cost with no negotiation.

    For a society to ask, or via government decree demand, that one group of people provide services to others for less than cost is immoral in every instance.

    [QUOTE=CanadaSteve]Please, take the questions seriously. Coming from Canada, I do not, and cannot, fully understand the struggles you personally deal with in the medical field, so I am both asking out of wanting to know, and playing devil's advocate as well.[/QUOTE]

    I always take your questions seriously....you always try to reason honestly and I respect your opinion as a neighbor from the North.

    But in this case we are arguing moral absolutes, so your standing has no ground.

  8. #8
    [QUOTE=Greenwave81]Take them out of the equation.

    There are many instances where physicians are foregoing insurance companies....public and government. They take cash upfront, at reduced rates. They either cut out the middle man completely, or let the insured deal with the insurance company. Either way, the insured's cost is less.

    Look at it this way....

    Let's say that your employer pays $10K/year for your health care insurance to the insurance company (covering your family). Why not have them just pay for a catastrophic health care policy that covers all costs over an amount you choose....$5K, $7.5K, $10K..your choice. Let's say you can get that catastrophic policy for $2.5K/yr. The other $7.5k/ yr you put in a Medical Savings Account (MSA) to pay your bills, and negotiate directly with your chosen physician for sevices you may require. Anything you do not spend from the MSA either is invested and grows over time (your control) or you get to keep.

    Why do healthy 30 y.o. parents with say a 2 and 4 y.o. need to pay $10K year in health insurance? All they need is protection against catastrophic loss...anything else they pay is only subsidizing the insurance company for care for lesser 'healthy' individuals or subsidizing the insurance company themselves.

    I'd gladly take 50% of what I charge an insurance company for your care (as I only get about 60% anyway) if I get paid (like everyone else) immediately, without the hassle of negotiating yearly with the insurance company or fighting for non-payment.

    For those unfortunate individuals who are destitute, return to a system of 'charity' (oh! The horrors!). I don't make any money on Medicaid anyway, so if I'm going to provide the care for next to nothing, I'd rather provide it free and write it off as a loss (which I cannot do now according to federal regulations).

    For Medicare individuals, means test it. Those that can afford insurance should pay for it...there is no law that says that you get to keep the wealth you accumulated during life at death while others who are much younger, and not as wealthy, pay for your care. A simple fact of life is that the majority of health care expenditures occur in the last 6 months of life....and that is directly because of the fact that as medicare recipients have no direct responsibility for the true cost of their care, they frequently ask for heroic care in some ridiculous circumstances.

    The disconnect in the American Health Care System is that that the patients never see the cost of their care since it is paid by insurance.... and the patients that consume most of the health care dollars aren't covered by insurance anyway. Other patients with insuranced subsidize their care.

    My $0.02.[/QUOTE]


    What happens to the 30 year old when he's 60 and has a variety of chronic health issues that may cost 100,000 per year?

    Where is the moral dilemma in people banding together to spread their health risk over a lifetime and negotiate rates as a group with the provider? I agree compelling someone to give you services at a fixed price may be compulsion/immoral however if you band together to limit the amount of customers for a service provider what it really does is give the customer clout to negotiate. Knowing what everyone else is willing to charge also gives you knowledge to negotiate. I don't think this is black and white at all. Your assuming that by banding together service providers will be told what to charge and people who have banded together will be unable to pay more for additional services. Why couldn't a doctor do something else if he isn't happy with what the market will provide for his services?

    A free market for services doesn't guarantee that your customers won't figure out a better way to negotiate price.
    Last edited by Winstonbiggs; 06-23-2007 at 07:12 AM.

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    Seriously....socialized medicine is bad. But some sort of universal health care for every citizen is not. Everybody should have to option for private health care that is tailored to their needs. But people who cant afford it should be provided a simple basic health care plan that fixes them if they get broke. For example....even poor Americans should be able to have limbs reattached w/o getting charged if they are involved in an accident. But, they should not get govt provided health care to cure their cancer caused by their years of smoking crack or tobacco.

    Look, I nearly cut off my thumb 7 years ago. I got charged to have it reattached. I had no health coverage, so Mr. Doctor is the one that ended up getting f*cked on that. Wouldn't it be in the govts interest to pay for my thumb reattachment since I will obviously generate more tax revenue for them for years to come if I have two working opposable digits? But if I choose to stuff my face with cake and pizza every night, people in general should not have their tax dollars go towards by stomach bypass surgery.

    I guess what I am trying to say is that there should be a system in place to pay for ER visits by people who cannot afford health insurance. Any elective procedures should not be covered. Only emergencies. Is that feasible?
    Last edited by PlumberKhan; 06-23-2007 at 01:32 PM.

  10. #10
    tort reform can save the current healthcare system

    too bad our government is run by lawyers.

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    [QUOTE=Greenwave81]

    You seem to have a great problem with discussing anything in absolute moral terms...there are no 'grays' here.

    [/QUOTE]


    WOW!!!

    That is the first time in my life I have had anyone ever say that to me. I am usually the one that gets accused of my unwillingness to admit life is "gray." I do believe in absolute morality, I guess I don't fully see your argument yet for this being one of those cases.

    My wife and I just visited Calgary for her convocation, and we stayed with her cousin. Her husband is one of the top Ears, Nose and Throat surgeons in Canada. She made a comment about our health care system, and how it needs to be reformed. She said it is not fair that her husband cannot charge what he wants, and accept payment however he wants, meaning, that if someone truly needs an operation but can't pay, he can't accept say chickens, or some kind of personal service to pay his bill.

    That being said, and since you are a doctor, how best can this be done? I believe that everyone should be able to go into an emergency room and get a thumb reattached, or get the medical treatment necessary from an accident. However, how do we incorporate everything else?

    I also think that having a family doctor is one of the ways Canada could cut out a tremendous burden on the medical industry. Why can't a GP charge say a flat rate (or whatever rate he wishes) for families and individuals so they can have a family doctor? This way, you don't have wait lists like we have to even get a GP, and if someone can't afford a GP, then that is what a free clinic is for. Why is this not fair? For some here in Canada, that isn't fair, but I don't see the logic in this. I don't have a problem with paying for health care (through insurance), however, I do believe that if someone is truly in need, they must not be turned away because they can't afford a treatment.

    Perhaps I just do not fully understand how your system works, since I have lived in Canada all my life.

  12. #12
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    [QUOTE=PlumberKhan]

    I guess what I am trying to say is that there should be a system in place to pay for ER visits by people who cannot afford health insurance. Any elective procedures should not be covered. Only emergencies. Is that feasible?[/QUOTE]


    I wonder that too. I like the idea that if you take a medical, you are overweight, smoke, drink excessively etc...you either pay an extremely high rate for medical insurance, or you run the risk of not being covered.

    I guess to play devils advocate, how then does this man get treatment if he suffers a heart attack and has no insurance because he has not taken care of himself?

    Could we not bypass the insurance companies altogether, and pay the government as our health care providers? That way, if you treat yourself poorly, you can always get health care, but your rates are just charged by the government in the form of a tax, compared to being rejected by an insurance company because you are deemed "high risk?"

  13. #13
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    [QUOTE=Winstonbiggs]What happens to the 30 year old when he's 60 and has a variety of chronic health issues that may cost 100,000 per year? [/quote]

    Tough question, but I would say that if that person has had continuous health care coverage, they shouldn't be able to be dropped. That's not saying that their rates aren't going to increase, but that coverage should be available from the original insurer based on longevity.

    An alternative would be for the government to set a maximum out of pocket for a catastrophic policy, with the government picking up the overage cost of the policy (not providing the policy itself).

    [QUOTE=Winstonbiggs]Where is the moral dilemma in people banding together to spread their health risk over a lifetime and negotiate rates as a group with the provider? [/quote]

    There is no moral dilemma in that...but that is not what is happening now.

    In the US, the people are 'banded together' and represented by the government...which arbitrarily sets rates (low, since they are paying) without negotiation and regulates that all must be cared for regardless of ability to pay.


    [QUOTE=Winstonbiggs]I agree compelling someone to give you services at a fixed price may be compulsion/immoral however if you band together to limit the amount of customers for a service provider what it really does is give the customer clout to negotiate. Knowing what everyone else is willing to charge also gives you knowledge to negotiate. I don't think this is black and white at all. Your assuming that by banding together service providers will be told what to charge and people who have banded together will be unable to pay more for additional services. [/quote]

    I'm not really sure whaat you are saying here....so I cannot answer.

    [QUOTE=Winstonbiggs]Why couldn't a doctor do something else if he isn't happy with what the market will provide for his services?[/quote]

    Aren't you listening? More Physicians are doing exactly that, day after day. More are going into administration, retiring early, or finding other jobs. The quality of the people applying for medical school is not the same as in years past. More and more care is being provided by 'physician extenders' whcih sounds great until they are taking care of YOU.

    And, what I am trying to say is that with regard to individuals who are covered by the government for their health care there is NO MARKET...a MARKET assumes people involved in the transaction can barter or negotiate. The government does NOT negotiate with physicians, they DICTATE.

    The problem with Doctors and 'changing professions' is that it takes 12-15 years after HS to gain credentials to practice, and costs in most cases >$250K. A Physician makes, when you consider the hours he works, significantly less than a typical college graduate (without a doctorate) until age 30 or later and leaves training with significant debt.

    [QUOTE=Winstonbiggs]A free market for services doesn't guarantee that your customers won't figure out a better way to negotiate price.[/QUOTE]

    Funny, I always thought that negotiation involved some sort of dialogue between participants...that ain't what we got here.

    In this case the 'customers' (i.e. medicare and medicaid recipients)have petitioned the government to steal services from the private sector under the guise of 'it's the right thing to do'.

    If someone holds a gun to your head, is that 'negotiation' or extortion?

  14. #14
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    [QUOTE=CanadaSteve]WOW!!!

    That is the first time in my life I have had anyone ever say that to me. I am usually the one that gets accused of my unwillingness to admit life is "gray." I do believe in absolute morality, I guess I don't fully see your argument yet for this being one of those cases.[/quote]

    'Life' has plenty of 'gray' areas, but failing to recognize theft is not one of them.

    [QUOTE=CanadaSteve]My wife and I just visited Calgary for her convocation, and we stayed with her cousin. Her husband is one of the top Ears, Nose and Throat surgeons in Canada. She made a comment about our health care system, and how it needs to be reformed. She said it is not fair that her husband cannot charge what he wants, and accept payment however he wants, meaning, that if someone truly needs an operation but can't pay, he can't accept say chickens, or some kind of personal service to pay his bill.

    That being said, and since you are a doctor, how best can this be done?[/quote]

    I've stated my opinion multiple times.

    If you have insurance (in the cuurent scheme), there is no problem.

    If you have no insurance and no money, then it is charity, and I should get o write it off as bad debt or a loss for my business at the least.

    If the government is going to accept responsibility for some citizens health care based on the citizens wishes, that's fine....but then they should not tell me to accept $0.20 on the dollar and not negotiate.

    [QUOTE=CanadaSteve] I believe that everyone should be able to go into an emergency room and get a thumb reattached, or get the medical treatment necessary from an accident. However, how do we incorporate everything else? [/quote]

    That depends on what everyone 'wants'...I want a vacation home in the Hamptons, but I don't expect the government to force someone to sell me one at an 80% price reduction. Everyone here in the US gets up in arms over eminient domain issues, protection of personal property...but when it comes to the government stealing health care services, no one bats an eye.

    [QUOTE=CanadaSteve]I also think that having a family doctor is one of the ways Canada could cut out a tremendous burden on the medical industry. Why can't a GP charge say a flat rate (or whatever rate he wishes) for families and individuals so they can have a family doctor? This way, you don't have wait lists like we have to even get a GP, and if someone can't afford a GP, then that is what a free clinic is for. Why is this not fair? For some here in Canada, that isn't fair, but I don't see the logic in this. I don't have a problem with paying for health care (through insurance), however, I do believe that if someone is truly in need, they must not be turned away because they can't afford a treatment. [/quote]

    This would be an excellent plan, if only the government hadn't intervened and outlawed it.

    And for those of you outside the US, I'm going to say this just to clear things up:

    [b]NO ONE IN THE US WHO NEEDS URGENT MEDICAL CARE IS EVER TURNED AWAY WITHOUT RECEIVING CARE.....IT IS THE LAW THAT ANYONE THAT GOES TO A HOSPITAL WILL RECEIVE CARE REGARDLESS OF THEIR ABILITY TO PAY[/B].

    I hope I made that clear.

    Now, they may get a bill for the service. If they have any assets, they will be asked to pay. If they truly have nothing, well as the saying goes, you cannot get blood from a stone.

    [QUOTE=CanadaSteve]Perhaps I just do not fully understand how your system works, since I have lived in Canada all my life.[/QUOTE]

    I hope the above discussions have informed you about health care here in the US.

  15. #15
    [QUOTE=Greenwave81]
    Funny, I always thought that negotiation involved some sort of dialogue between participants...that ain't what we got here.

    In this case the 'customers' (i.e. medicare and medicaid recipients)have petitioned the government to steal services from the private sector under the guise of 'it's the right thing to do'.

    If someone holds a gun to your head, is that 'negotiation' or extortion?[/QUOTE]


    What the Government does in setting rates is not much different than what insurance companies do to set rates. As you pointed out, if physicians aren't happy with the rate they can simply drop out of the system charge whatever they want or do something else.

    In the current "free market" system, my insurance company not only sets the rate but can deny me services which I have contracted for with them and they delay payments to my doctors for no reason other reason than to preserve cash flow. It seems to me in the current system both sides are getting screwed.

  16. #16
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    [QUOTE=Winstonbiggs]What the Government does in setting rates is not much different than what insurance companies do to set rates. As you pointed out, if physicians aren't happy with the rate they can simply drop out of the system charge whatever they want or do something else. [/quote]

    Umm...what the government does in setting rates is [b]entirely[/b] different than what the insurance company does.

    With the private insurers, we (Doctors) negotiate to set fees with the insurance company, every year....they propose a number, and so do we...and then the negotiation ensues. If I'm not happy with what they are offering, I can (and sometimes do) refuse to accept their plan.

    This is not the same with the government. With the government, this is how it goes:

    They (congress) pass legislation that every hospital must see people and render care regardless of ability to pay (making it illegal to turn anyone away).

    Doctors work at hospitals, and provide the hospital services. Hospitals contract with physicians for these services...I don't do anesthesia in my garage, I work at a hospital that is legally bound to give services to all comers. If I as a hospital based physician refuse to take any federal program for payment (and the government has once again refused to let Doctors pick and choose what federal program they will accept..either you take it all, or none) no hospital will allow me to work. Convenient, no?

    Also, the government does NOT negotiate with any service provider (or facility for that matter) for fees for health care....Congress, administrative committees (like CMS etc.) and others sit in back offices and make these decisions. Then, they publish the fee schedule and voila! ....it's done. No muss, no fuss, right? They don't care what your cost of doing business is, they only care about what it costs them.

    And, as a brief introduction (because a longer treatise here would take me all day to produce) to the 'federal health care system', these are the issues you deal with regularly for the privilege of having you services stolen:

    1. More regulations and paperwork than dealing with private insurers.
    2. Inept inefficiency, often requiring 6 months or longer to receive payment..and if they run short of money, heck perhaps they'll pay you next fiscal year (no interest of course). Why am I floating the government a loan for free?
    3. Yearly variations in scheduled fees for services making it impossible to predict revenue or payroll
    4. Different reimbursements for the same services in different areas of the country, different parts of the state etc.
    5. Differing reimbursements for different specialties as a percentage of actual cost.

    Even if you ignore all of the above, I am going to let you in on another dirty little secret....[b]the government uses the above tactics to dictate the parameters of health care services for everyone, private insurance patients too.[/b] These government decisions affect the health care choices for all patients, not just federal health care recipients.

    You now have a bunch of bureaucrats determining what they will pay for and whom they will pay it to. Further, by manipulating fees and coverages, they manipulate the physician pool, directing people into different medical fields not based on market needs, but based solely on arbitrary government decisions (which are usually wrong). Remember back in the Clinton years? The government thought that the specialists were costing too much, so they decreased the fees to the specialists, and increased fees to the primary care physicians...which of course led to a further shortage of specialists and a glut of primary care doctors and made the problem worse. Your government in action!

    [QUOTE=Winstonbiggs]In the current "free market" system, my insurance company not only sets the rate but can deny me services which I have contracted for with them and they delay payments to my doctors for no reason other reason than to preserve cash flow. It seems to me in the current system both sides are getting screwed.[/QUOTE]

    Yes, we are both getting screwed...I agree.

    But either you or your employer gets to negotiate your fees for insurance and provided coverage every year...or else you can choose another inurance carrier. I see both sides as both a physician who gets paid by insurance companies and as an employer, as I am a partner in a corporation that employs over 100 and who negotiates with insurance companies for employee coverage.

    I am always amazed that every year the insurance companies want to reduce my payments for services, but they never fail to increase the cost of our insurance policy for our employees.

  17. #17
    Greenwave,

    Why hasn't technology lead to a decrease in medical care like it has in almost every other field? Why can't we outsource reading xrays, lab tests, and other test to cheap skilled off shore labor? My doctor isn't performing these tests, why do I need to pay him to read them? Why aren't large hospital's being clossed that no longer serve a real function?

  18. #18
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    [QUOTE=Winstonbiggs]Greenwave,

    Why hasn't technology lead to a decrease in medical care like it has in almost every other field? Why can't we outsource reading xrays, lab tests, and other test to cheap skilled off shore labor? My doctor isn't performing these tests, why do I need to pay him to read them? Why aren't large hospital's being clossed that no longer serve a real function?[/QUOTE]

    As far as the technology thing goes, it is happening already....if you get an X-ray at night in my facility and it needs to be read pronto, it's read by someone in Australia.

    But that doesn't mean that that person or contracted service provider is not responsible for that read and is still fully liable legally...they are just as liable as a local Radiologist for it's accuracy. There are also a multitude of state and federal regulations that dictate the credentials of EVERY individual that provides health care in the various states and the country in general...so, if the X-Ray is read by a physician in another country, that person would still have to satisfy the local. state and federal minimum training requirements. It may be read elsewhere, but not by (we hope) a cut-rate quack.

    You don't pay your Physician to 'read' an automated lab report...you pay him to look at it, interpret it, apply it to your case and deal/manage your illness. The ordering physician is legally liable to do this...not the automated machine that reports an abnormality or a pathologist who looks at tissue (he's responsible for correctly intrepreting the specimen, not the care you receive after his interpretation/diagnosis).

    Medicine is an art...sounds hokey, but it's true. Machines now 'read' or interpret EKG's, and some XRays...but they are frequently wrong. People design machines to 'catch everything' even if they 'over-read' to be thorough. And, you often cannot look at a specific test and say it's abnormal in most cases until you apply it to the situation or patient at hand. I read 100's of pre-op EKGs a week, and if everyone who had an 'abnormal' machine read was sent to a cardiologist, there'd be a line out the door for the next 6 months with people waiting for a stress test who didn't require one...the machine, or someone in another country cannot apply the test to the patient.

    As far as 'large hospitals' not closing when they're not needed....can't answer that. You'd need to discuss that with the people that own them, either private, not-for-profits, or government. But, I do know that a LOT of training is carried out in large city hospitals that are affiliated with medical schools etc.

  19. #19
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    Here's another question for GreenWave:

    We have a few doctors in the family, and I am amazed at how they do not agree that our "health-care" system is really a "sick-care" system. What I mean is this.

    They are trained as doctors to heal the sick. When someone comes in with an ailment, or have injured themselves, their job is to "fix" them.

    However, when it comes to preventative measures (such as diet, exercise, alternative/homeopathic medicine, chiropractic) it appears they all have little training in this.

    Would it not make more sense to focus our efforts on ways for people to live healthier lives, which would cut down on health care costs to begin with?

    Also, do you feel, as a physician, that drug companies, not consciously anyway, try and defer this kind of thinking since the money they make comes more for treating patients after the fact then before the fact?

  20. #20
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    [QUOTE=CanadaSteve]Would it not make more sense to focus our efforts on ways for people to live healthier lives, which would cut down on health care costs to begin with? [/QUOTE]


    It would, wouldn't it?

    [IMG]http://www.bestweekever.tv/bwe/images/2006/09/pancakesausage.jpg[/IMG]

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