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	<title>Comments on: Socialized Medicine Debate</title>
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	<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/</link>
	<description>A blog from inside the emergency department</description>
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		<title>By: PMH_Doc</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10191</link>
		<dc:creator>PMH_Doc</dc:creator>
		<pubDate>Sat, 18 Jul 2009 16:40:55 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10191</guid>
		<description><![CDATA[&quot;You might like to learn that only about 20% of uninsured are illegal immigrants, which I wouldn’t term a “large number.” 

You dolt....Only 15% of Americans are uninsured (47 million divided by 300 million total population), so by your logic we don&#039;t have a health coverage problem.

I just want to know where the public thinks they are gonna find doctors to work in this new system.  There&#039;s always talk of making it more European, but then you also need to pay for my medical education like they do in Europe.  I have $300,000 of med school debt and cannot start paying it back until I actually start practicing at age 35....you bet I care about money.

Mass, how many hours per week do you work for free?]]></description>
		<content:encoded><![CDATA[<p>&#8220;You might like to learn that only about 20% of uninsured are illegal immigrants, which I wouldn’t term a “large number.” </p>
<p>You dolt&#8230;.Only 15% of Americans are uninsured (47 million divided by 300 million total population), so by your logic we don&#8217;t have a health coverage problem.</p>
<p>I just want to know where the public thinks they are gonna find doctors to work in this new system.  There&#8217;s always talk of making it more European, but then you also need to pay for my medical education like they do in Europe.  I have $300,000 of med school debt and cannot start paying it back until I actually start practicing at age 35&#8230;.you bet I care about money.</p>
<p>Mass, how many hours per week do you work for free?</p>
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		<title>By: DaveyNC</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10174</link>
		<dc:creator>DaveyNC</dc:creator>
		<pubDate>Sat, 18 Jul 2009 03:46:38 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10174</guid>
		<description><![CDATA[One reason that each of the countries you named can afford the health care systems that they have is that in every case, the US either provides military protection outright, or subsidizes it for them.  Canada essentially has no real military.  Britain and France do, but we provide heavy support through NATO and other, more direct involvement such as military bases in Europe.  We still have a large military presence in Germany and always will have, so long as Russia remains a potential belligerent.  This fact gets lost in this debate.  There is more to this than just the medical/insurance part of it.  We have obligations around the world that we cannot simply ignore; Canada, France and Britain couldn&#039;t afford their medical systems, either, if they had to protect their own asses.

As much as I would like to think that we could withdraw militarily from Europe, our experience in the Balkans back in the &#039;90&#039;s makes plain that Europe either cannot or will not police their own neighborhood.

Yeah, yeah, I know--this is a medical blog, not a military or political blog.  This issue is inseparable, though, from our ability to pay for such niceties as single-payer coverage for all.]]></description>
		<content:encoded><![CDATA[<p>One reason that each of the countries you named can afford the health care systems that they have is that in every case, the US either provides military protection outright, or subsidizes it for them.  Canada essentially has no real military.  Britain and France do, but we provide heavy support through NATO and other, more direct involvement such as military bases in Europe.  We still have a large military presence in Germany and always will have, so long as Russia remains a potential belligerent.  This fact gets lost in this debate.  There is more to this than just the medical/insurance part of it.  We have obligations around the world that we cannot simply ignore; Canada, France and Britain couldn&#8217;t afford their medical systems, either, if they had to protect their own asses.</p>
<p>As much as I would like to think that we could withdraw militarily from Europe, our experience in the Balkans back in the &#8217;90&#8242;s makes plain that Europe either cannot or will not police their own neighborhood.</p>
<p>Yeah, yeah, I know&#8211;this is a medical blog, not a military or political blog.  This issue is inseparable, though, from our ability to pay for such niceties as single-payer coverage for all.</p>
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		<title>By: DaveyNC</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10173</link>
		<dc:creator>DaveyNC</dc:creator>
		<pubDate>Sat, 18 Jul 2009 03:33:51 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10173</guid>
		<description><![CDATA[I will see your Nobel Prize winning economist and raise you one more acclaimed economist.  Operative quote comes from Gary Becker:  

&quot;The President wants to establish government-run health insurance companies to compete with private companies. This is a bad idea because experience from government-owned enterprises in other sectors conclusively shows that that they are run inefficiently, in good part because of political interference. Moreover, government enterprises do not compete fairly since they generally are subsidized, often generously and in hidden ways. Private health insurance companies in the US compete very strongly, although they are hampered by mandates and other regulations that frequently have nothing to do with effective and honest coverage of health needs.&quot;

Full post here:  http://www.becker-posner-blog.com/archives/2009/06/health_care-bec.html

Don&#039;t be coming in here with Nobel prize winners.  They&#039;re all over the place, I can find one in a minute.]]></description>
		<content:encoded><![CDATA[<p>I will see your Nobel Prize winning economist and raise you one more acclaimed economist.  Operative quote comes from Gary Becker:  </p>
<p>&#8220;The President wants to establish government-run health insurance companies to compete with private companies. This is a bad idea because experience from government-owned enterprises in other sectors conclusively shows that that they are run inefficiently, in good part because of political interference. Moreover, government enterprises do not compete fairly since they generally are subsidized, often generously and in hidden ways. Private health insurance companies in the US compete very strongly, although they are hampered by mandates and other regulations that frequently have nothing to do with effective and honest coverage of health needs.&#8221;</p>
<p>Full post here:  <a href="http://www.becker-posner-blog.com/archives/2009/06/health_care-bec.html" rel="nofollow">http://www.becker-posner-blog.com/archives/2009/06/health_care-bec.html</a></p>
<p>Don&#8217;t be coming in here with Nobel prize winners.  They&#8217;re all over the place, I can find one in a minute.</p>
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		<title>By: steve</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10141</link>
		<dc:creator>steve</dc:creator>
		<pubDate>Fri, 17 Jul 2009 09:42:54 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10141</guid>
		<description><![CDATA[I have lived in australia, worked as a MD in their system,a nd have trained and worked with lots of UK docs.  if you think that universal healthcare a&#039;la england or australia is the way to go, then you are sadly delusional. 

First off, there are horrendous wait times.  GP&#039;s (PCP&#039;) get paid 20 bucks per visit if they take the universal option, so most try to see 10 to 15 patients per hour to try and make a decent hourly wage.  One I know works 7am to 10p every day except sunday.

the other alternartive is to have &#039;private&#039; insurance, which charges an arm and a leg, gets you seen faster, but also charges a huge amount in copays for anything.  my mother in law had a hip replacement. she could barely walk.  cost over 10000 private insurance, or she could have waited, almost bedbound for 2 years to have one on the public system

the other problem with this system is physician pay.  I dont want to come off a a money hungry doc, but I invested years into my training, specialization. I incurred huge debt.  if my pay gets slashed, what happens to those things.  do I foreclose my house, just give up my car.  take my daughter out of private school.  and on top of that, we still have the possibility of being sued by some crackpot lottery malpractice attorney.  I guarantee you this is something that would not happen in australia or england, but about which not one work has been mentioned in our current debate]]></description>
		<content:encoded><![CDATA[<p>I have lived in australia, worked as a MD in their system,a nd have trained and worked with lots of UK docs.  if you think that universal healthcare a&#8217;la england or australia is the way to go, then you are sadly delusional. </p>
<p>First off, there are horrendous wait times.  GP&#8217;s (PCP&#8217;) get paid 20 bucks per visit if they take the universal option, so most try to see 10 to 15 patients per hour to try and make a decent hourly wage.  One I know works 7am to 10p every day except sunday.</p>
<p>the other alternartive is to have &#8216;private&#8217; insurance, which charges an arm and a leg, gets you seen faster, but also charges a huge amount in copays for anything.  my mother in law had a hip replacement. she could barely walk.  cost over 10000 private insurance, or she could have waited, almost bedbound for 2 years to have one on the public system</p>
<p>the other problem with this system is physician pay.  I dont want to come off a a money hungry doc, but I invested years into my training, specialization. I incurred huge debt.  if my pay gets slashed, what happens to those things.  do I foreclose my house, just give up my car.  take my daughter out of private school.  and on top of that, we still have the possibility of being sued by some crackpot lottery malpractice attorney.  I guarantee you this is something that would not happen in australia or england, but about which not one work has been mentioned in our current debate</p>
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		<title>By: WhiteCoat</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10130</link>
		<dc:creator>WhiteCoat</dc:creator>
		<pubDate>Fri, 17 Jul 2009 03:56:11 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10130</guid>
		<description><![CDATA[Good point about the taxes. 
Still, the tax rate in Great Britain is 40%, including all medical care, correct? Makes you wonder where all the money in the US is going. 
I&#039;m interested to know - because I have read conflicting reports. 
With high-expense items such as cancer treatment or treatment for liver failure, are all treatment expenses still covered? I&#039;ve heard stories about people having to mortgage their homes to pay for cancer care. How about dialysis? How about end of life care? 
You&#039;re a valuable resource and I&#039;d like to tap your knowledge. 
Thanks for contributing!]]></description>
		<content:encoded><![CDATA[<p>Good point about the taxes.<br />
Still, the tax rate in Great Britain is 40%, including all medical care, correct? Makes you wonder where all the money in the US is going.<br />
I&#8217;m interested to know &#8211; because I have read conflicting reports.<br />
With high-expense items such as cancer treatment or treatment for liver failure, are all treatment expenses still covered? I&#8217;ve heard stories about people having to mortgage their homes to pay for cancer care. How about dialysis? How about end of life care?<br />
You&#8217;re a valuable resource and I&#8217;d like to tap your knowledge.<br />
Thanks for contributing!</p>
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		<title>By: MT</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10125</link>
		<dc:creator>MT</dc:creator>
		<pubDate>Fri, 17 Jul 2009 02:39:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10125</guid>
		<description><![CDATA[I am familiar with the English, French and Canadian universal healthcare systems, having used each one of them. There are large differences between them and yes, they are not perfect, but then, neither is our system.
 
One misconception here is that universal healthcare is free. It is not. Instead of paying premiums to a private insurance company, you pay your premiums to the government in the form of taxes. It is only a matter or terminology, but you still pay. And there are co-pays involved.

However, the difference between those systems and the American one is that in those countries, everyone has access to health care: the employed, the temporarily unemployed, the wealthy, the poor. No one is in that grey area of too much income to qualify for help but not enough to afford care.
I have yet to see anyone in those countries having to lose home and file for bankruptcy because of overwhelming medical bills, having to beg family and friends for financial help.]]></description>
		<content:encoded><![CDATA[<p>I am familiar with the English, French and Canadian universal healthcare systems, having used each one of them. There are large differences between them and yes, they are not perfect, but then, neither is our system.</p>
<p>One misconception here is that universal healthcare is free. It is not. Instead of paying premiums to a private insurance company, you pay your premiums to the government in the form of taxes. It is only a matter or terminology, but you still pay. And there are co-pays involved.</p>
<p>However, the difference between those systems and the American one is that in those countries, everyone has access to health care: the employed, the temporarily unemployed, the wealthy, the poor. No one is in that grey area of too much income to qualify for help but not enough to afford care.<br />
I have yet to see anyone in those countries having to lose home and file for bankruptcy because of overwhelming medical bills, having to beg family and friends for financial help.</p>
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		<title>By: Bookwyrm</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10111</link>
		<dc:creator>Bookwyrm</dc:creator>
		<pubDate>Thu, 16 Jul 2009 19:52:37 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10111</guid>
		<description><![CDATA[I&#039;m on limited time today so I&#039;ve only scanned the debate so far &amp; I hope this comment isn&#039;t too far off track.....  My Dad gets gov&#039;t health care through VA.  He had chest pain.  He had to wait 3 months for an appointment, then another 6 weeks wait for a stress test after which they scheduled a scan another 3 months out, which got rescheduled 3 or 4 times, thus extending the wait.  In the meantime he had to go to the ER, when he had his heart heart attack (that could have been prevented with timely care). Fortunately he survived &amp; got the referral for the immediate bypass surgery from the ER Doc.  THAT is the best we can expect from Obama&#039;s plan.  We&#039;d be better off addressing WHY health care is so expensive that insurance coverage is a necessity (unfunded mandated maybe?)

Personally, I&#039;d rather have affordable routine care that I can plan for  &amp; pay out of pocket with a medical savings account.  Then I only need have a catastrophic care policy for the major unexpected stuff like broken arms &amp; pancreatic cancer.  It may be an extremist statement, but I think the health care industry might actually be better off if both doctors and patients could avoid dealing with insurance companies...]]></description>
		<content:encoded><![CDATA[<p>I&#8217;m on limited time today so I&#8217;ve only scanned the debate so far &amp; I hope this comment isn&#8217;t too far off track&#8230;..  My Dad gets gov&#8217;t health care through VA.  He had chest pain.  He had to wait 3 months for an appointment, then another 6 weeks wait for a stress test after which they scheduled a scan another 3 months out, which got rescheduled 3 or 4 times, thus extending the wait.  In the meantime he had to go to the ER, when he had his heart heart attack (that could have been prevented with timely care). Fortunately he survived &amp; got the referral for the immediate bypass surgery from the ER Doc.  THAT is the best we can expect from Obama&#8217;s plan.  We&#8217;d be better off addressing WHY health care is so expensive that insurance coverage is a necessity (unfunded mandated maybe?)</p>
<p>Personally, I&#8217;d rather have affordable routine care that I can plan for  &amp; pay out of pocket with a medical savings account.  Then I only need have a catastrophic care policy for the major unexpected stuff like broken arms &amp; pancreatic cancer.  It may be an extremist statement, but I think the health care industry might actually be better off if both doctors and patients could avoid dealing with insurance companies&#8230;</p>
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		<title>By: Kim</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10082</link>
		<dc:creator>Kim</dc:creator>
		<pubDate>Wed, 15 Jul 2009 23:04:40 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10082</guid>
		<description><![CDATA[Yeah, the econ professor urban legend is pretty bogus. It also has no relevancy to anything but the right wing strawman version of current events (strangely often parroted by the D students who&#039;d have been buoyed by the likes of me).]]></description>
		<content:encoded><![CDATA[<p>Yeah, the econ professor urban legend is pretty bogus. It also has no relevancy to anything but the right wing strawman version of current events (strangely often parroted by the D students who&#8217;d have been buoyed by the likes of me).</p>
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		<title>By: Matt</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10069</link>
		<dc:creator>Matt</dc:creator>
		<pubDate>Wed, 15 Jul 2009 17:58:31 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10069</guid>
		<description><![CDATA[Mass, Krugman&#039;s Nobel, while nice, doesn&#039;t mean much in this debate unless it was in this particular area.  It certainly adds nothing to the merits of the debate.  Here is a well reasoned counterpoint to his, frankly, under-reasoned position:

http://meganmcardle.theatlantic.com/archives/2009/07/medicares_mythical_administrat.php

Here&#039;s just a short take:

&quot;Rather, private insurers have costs that Medicare doesn&#039;t have within the agency.  Private insurers bill.  Medicare does too, but the IRS has its own budget--hell, its own courts--which don&#039;t show up on Medicare&#039;s balance sheet.  Private insurers negotiate with suppliers.  Medicare does too, but most of the negotiation takes place between lobbyists and Congressmen who again, do not show up on Medicare&#039;s balance sheet.  The Federal government has all sorts of these little items which relieve government agencies of reporting certain costs.  But the costs remain.&quot;

Now, I&#039;m not saying that there aren&#039;t problems with the Heritage Foundation&#039;s report, which Krugman attacks, because they&#039;re a lobbying organization and like the AMA or ATLA they&#039;re going to put out stats that favor them, but you can&#039;t just buy one side&#039;s argument wholeheartedly.]]></description>
		<content:encoded><![CDATA[<p>Mass, Krugman&#8217;s Nobel, while nice, doesn&#8217;t mean much in this debate unless it was in this particular area.  It certainly adds nothing to the merits of the debate.  Here is a well reasoned counterpoint to his, frankly, under-reasoned position:</p>
<p><a href="http://meganmcardle.theatlantic.com/archives/2009/07/medicares_mythical_administrat.php" rel="nofollow">http://meganmcardle.theatlantic.com/archives/2009/07/medicares_mythical_administrat.php</a></p>
<p>Here&#8217;s just a short take:</p>
<p>&#8220;Rather, private insurers have costs that Medicare doesn&#8217;t have within the agency.  Private insurers bill.  Medicare does too, but the IRS has its own budget&#8211;hell, its own courts&#8211;which don&#8217;t show up on Medicare&#8217;s balance sheet.  Private insurers negotiate with suppliers.  Medicare does too, but most of the negotiation takes place between lobbyists and Congressmen who again, do not show up on Medicare&#8217;s balance sheet.  The Federal government has all sorts of these little items which relieve government agencies of reporting certain costs.  But the costs remain.&#8221;</p>
<p>Now, I&#8217;m not saying that there aren&#8217;t problems with the Heritage Foundation&#8217;s report, which Krugman attacks, because they&#8217;re a lobbying organization and like the AMA or ATLA they&#8217;re going to put out stats that favor them, but you can&#8217;t just buy one side&#8217;s argument wholeheartedly.</p>
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		<title>By: WhiteCoat</title>
		<link>http://www.epmonthly.com/whitecoat/2009/07/socialized-medicine-debate/#comment-10068</link>
		<dc:creator>WhiteCoat</dc:creator>
		<pubDate>Wed, 15 Jul 2009 17:50:09 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=3019#comment-10068</guid>
		<description><![CDATA[&quot;Money makes everything better, right?&quot;
Most plaintiff&#039;s attorneys I know seem to think so ... 
;-)]]></description>
		<content:encoded><![CDATA[<p>&#8220;Money makes everything better, right?&#8221;<br />
Most plaintiff&#8217;s attorneys I know seem to think so &#8230;<br />
 <img src='http://www.epmonthly.com/whitecoat/wp-includes/images/smilies/icon_wink.gif' alt=';-)' class='wp-smiley' /> </p>
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