Text 35904, 125 rader
Skriven 2009-09-10 07:14:50 av Robert Bashe (2:2448/44)
  Kommentar till text 35842 av Bob Ackley (1:300/3)
Ärende: (1/2) Universal health insurance
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Bob Ackley wrote to Robert Bashe on Tuesday September 08 2009 at 07:36:

RB>> Not to mention the freedom to financially gouge those in need of
RB>> care. I saw enough of that when I took care of my folks in the
RB>> States. Money, first, please - then maybe we'll have time to care for
RB>> your medical needs ;-/ Made me absolutely sick - and at times damned
RB>> mad.

BA> Contrary to the leftist propaganda spewing from proponents of the US
BA> government's attempt to take over the industry, people in this country
BA> are *not* being denied necessary care.  They may not (and probably
BA> don't) have the money to pay for it, but the care is provided.

Really? I have a different impression.

BA> Most hospitals in this country - the vast majority, in fact - are run
BA> by religious organizations, primarily Catholic but including Lutheran,
BA> Methodist and Jewish systems. A number of hospitals in this country
BA> are owned by a local 'hospital authority,' which is usually at the
BA> county level, or by a local government, again usually a county.  Most
BA> state universities own and operate at least one hospital.

So neither the population nor the government has any responsibility for health
care - "let the charities spend _their_ money, I'll keep mine". Sorry, that's
an attitude I just can't share. Particularly the extreme emphasis on _money_ in
the health care "industry" in the States is something I find distasteful.
Naturally, adequate financing is necessary, but when doctors and health care
personnel constantly hold out their hands before agreeing to lift a finger -
and that's something I've personally experienced with my parents - the system's
sick.

BA>>> The freedom to participate or not participate in a contract is
BA>>> included in that.

RB>> Which is a mistake, when you're referring to health care. That's just
RB>> not the same as buying a bushel of onions or serving people in a
RB>> restaurant. Sick or injured people _need_ health care, it's not a
RB>> matter of it "just being nice to have".

BA> Nope. It allows people to decide what they want - and what they want
BA> to pay for. Again, *nobody* in this country is denied needed care.

Again, I have my doubts. Not only my own experience, but also the stories told
by people living in the system are disconcerting.

However, I have to note that my personally ideal health care system would be to
legally require _everyone_ to have health insurance for a certain minimum
coverage (and make sure all health insurance is accepted by all doctors,
hospitals and health care workers), and to subsidize those who are too poor to
pay the premiums from taxes. The choice of health insurance, however, would be
left to the individual, keeping competition among insurance companies active.
And everyone would have the option, if desired, to take out extended coverage.
But basic health care would be guaranteed for _everyone_.

In the States, I would adopt the German system of valuating medical procedures
(with an option for using a multiplier for difficult cases) and making the
valuations binding for all health care personnel and hospitals. That would
eliminate price competition among doctors, and put the emphasis where it
belongs: the quality of the medical care.

The result would be a system of universal health care with more freedom than in
Germany and better coverage than presently in the States.

But naturally, I don't believe for one minute that such a thing will actually
come to pass.

BA>>> With fewer providers available, particularly in rural areas, the
BA>>> problem of finding a doctor that will accept you as a patient (if
BA>>> you're over age 64) is getting worse.

RB>> Another argument for universal health care. It's amazing to me that
RB>> people can simply ignore that.

BA> How does universal care - or a single payer - increase the numbers of
BA> physicians available?

It prevents age discrimination - or any kind of discrimination - in providing
medical care.

RB>>>> The story does, however, point out the shortcomings of the system
RB>>>> (such that it is) very nicely and gives the lie to people who rant
RB>>>> so emotionally against universal health insurance (which would be
RB>>>> worth the name and would be - must be - accepted by all medical
RB>>>> practicioners).

BA>>> So practitioners find another line of work.

RB>> Like repairing cars. That would be better for people who concentrate
RB>> on money instead of the patient. But naturally wouldn't make them
RB>> millions in a few years - life's rough.

BA> What do you propose to do when and if the physician shortage becomes
BA> critical?

It simply _won't_, Bob. There are enough people who believe in helping and
believe in their Hippocratic oath, and are willing to work for a reasonable
salary rather than trying to get rich on their patients. Germany, with a
universal health care system, has a much higher ratio of physicians to
population than the States. And don't think German doctors don't want to earn
enough to support themselves and their families, too.

BA> What happens when hospitals close whole departments (several hospitals
BA> have already closed their emergency departments) or simply close their
BA> doors completely (that's happened too)?

Without a change in the system, you'll never know. We have hospital closures
here, too - but they generally aren't major facilities, and the closure
certainly doesn't present any great hardship, as there are plenty left.

RB>> On the other hand, real doctors who believe in their Hippocratic oath
RB>> will continue to devote their efforts to the sick and injured - and
RB>> presumably be glad to get rid of the moneygrubbers who have sullied
RB>> their reputation.

BA>>> What do you do when you can't *find* a physician?

The question just doesn't arise, Bob, as I already mentioned. Maybe it does in
the States with the present system, but it certainly doesn't in Germany with
its universal medical care, not in any of the other EU countries with a similar
health care system.

Cheers, Bob

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