Patterico's Pontifications

5/21/2009

Democratic Healthcare: In Their Own Words

Filed under: Obama — DRJ @ 4:38 pm



[Guest post by DRJ]

Barack Obama and some Democrats want America to have single-payer healthcare:

A December 2008 Rasmussen poll found that 51% of American voters oppose single-payer national health care.

— DRJ

62 Responses to “Democratic Healthcare: In Their Own Words”

  1. *DIASTER*!

    Rod Stanton (dcb7b5)

  2. Democrats are masters of the trojan horse argument.

    HeavenSent (637168)

  3. I think it is a nice little piece of work.

    At least a few people were intellectually honest: “This is not a principled debate”, and “There is no Trojan horse, it is right there”.

    I have a suggestion. Let all of the politicians and public policy makers who want a single-payer system enroll themselves and their families into a US branch of the Canadian or UK health system and demonstrate for us how wonderful it is.

    Three questions:
    1. There is plenty to improve in the US health care “system”, but by what logic do we think the federal government will do a better or more efficient job of it?
    2. How can a larger and less efficient bureaucracy save money except by limiting use, i.e. rationing care?
    3. Where will the Canadians go when they are tired of waiting?

    MD in Philly (3d3f72)

  4. I had an interesting conversation today. A guy I know, an ER doc, broke his arm playing tennis last weekend. It was a bad fracture, comminuted and it involved the joint. He may have to have surgery but he is hoping it will hold and heal without. The orthopedic surgeon he went to has dropped Medicare completely. The surgeon who does the most hip replacements at Hoag Memorial has also dropped out of Medicare. They charge cash fees and have the patient sign an agreement to pay. They take no insurance. The patient can ask insurance to pay for the hospital admission but the surgeon is out of the system.

    When I was still in practice, I had a number of uninsured patients. Some, we did barter. I had a woman who needed a mastectomy clean my house for a while to pay for her surgery. My partner had an artist in Laguna paint him a picture in payment. It turned out she was famous and the painting was very valuable.

    It now seems that more and more physicians are “going Galt” and spurning the insurance and Medicare system. I don’t know how that will work in poorer areas than Newport Beach but I do know one geriatric specialist in central Iowa who has dropped out of Medicare and works for cash. She is making a living.

    Interesting times.

    Mike K (2cf494)

  5. Obama has implemented an impressive plan to accomplish his goal of universal healthcare. The more Americans lose their jobs, or the more those who have jobs find their paychecks are stretched thin, the more they will accept nationalized healthcare as the only way to guarantee minimal health care.

    I grew up in an America where most people believed in themselves and their ability to work and provide for their families, but that America is harder and harder to find.

    DRJ (f55947)

  6. Mike K,

    There are several doctors who have taken that approach in my town. They seem to make a decent living and I know their hours are better than most doctors’, but it’s really terrific for the patients. There’s no double-booking so patients rarely have to wait; paperwork is a breeze because there is no insurance — you just write a check or pay with a credit card; and the doctor’s staff/overhead is down-sized so the fees charged are about 1/2 or less compared to other doctors (although we experienced the same thing at the Mayo Clinic, so that may also be a side effect of practicing medicine where the provider can afford to be selective).

    DRJ (f55947)

  7. I missed reports where “Obama has implemented” his plan.

    His options are severely constricted.

    A December 2008 Rasmussen poll found that 51% of American voters oppose single-payer national health care.

    Scarcely more meaningful than an April Rasmussen poll contending “only 53% of American adults believe capitalism is better than socialism.”

    steve (df620e)

  8. I missed reports where “Obama has implemented” his plan.

    He’s not letting this crisis go to waste, steve.

    DRJ (f55947)

  9. The fees they are charging seem to be about what Medicare allows. Most surgery is about $1200 and the office visit is about $120. When I was doing trauma, I had a new orthopod assist me in a case where he was going to be doing the fractures. The patient had a ruptured spleen and ruptured diaphragm. I charged what I thought was a reasonable fee. When the orthopod’s office called for the fee (the assistant gets 20% of the surgeon’s fee) my office manager told them and he got on the phone and wanted to talk to me. He said if I was not going to charge for my services, don’t ask him to assist !

    The guy was a complete jerk and, needless to say, he never got a referral from me again. Those days are probably over and guys like that helped to end them.

    It will be interesting to see what happens. Doctors helped wreck the era of fee-for-service and I think we needed a character like De Gaulle who told the French doctors to stop squabbling about fees in 1960. He said, “I saved France on a colonel’s salary !”

    They still have fee-for-service although I have recently been told they are starting to get gate-keepers. They have the best overall system in the world and we should emulate those parts that work for us.

    I fear we won’t if Obama has his way.

    Mike K (2cf494)

  10. Mike K,

    It wasn’t planned but we had in interesting experiment in modern medical fees/outcomes several years ago. Our son was hospitalized with a serious illness in 4 different hospitals over a 4-month period. Each stay lasted less than a week and included one minor OR procedure (the same one) in each hospital. The small town county hospitals charged $15k-$20k; the large urban county hospital charged $38k; and the major private hospital charged $5k. The private hospital was the only one that correctly diagnosed our son’s condition so, among other things, it’s made me a believer in competitive health care.

    DRJ (f55947)

  11. Mike K,

    Good story about the orthopod referral. Unfortunately, over the last 30 years, I think there are many doctors and lawyers who let their desire for money overcome their judgment. They did no favors for their fellow professionals or their professions.

    DRJ (f55947)

  12. Why do you hate doctors steve?

    daleyrocks (5d22c0)

  13. Nothing DEMOCRATIC about it. Democrat, no doubt.
    MD in Philly, I totally agree. The hospital in Plattsburgh NY does a great business with Canadians. As does the malls when the rate of exchange is favorable.

    Javert (58b08c)

  14. There is an issue that many who aren’t docs may not understand. When I was doing cash cases, I remember one waitress who had bad hemorrhoids and no insurance, if my cash fees had ever come to the attention of Medicare, I would have been severely penalized. Medicare, and most insurance, set payments based on a fee profile. They paid about 50% or so and, if you charged somebody a lower cash fee, they would set your new fee profile at that and then discount 50% from there. It was a significant factor in fee inflation.

    New doctors got smart and set fee profiles very high when they first started practice. I wasn’t that smart and I found that new docs had much higher fees, paid by Medicare, than I did. My partner and I had the busiest practice in Orange County and we would go to the Surgical Society and hear guys complaining about fees that were almost twice ours.

    My last year in practice, when I was getting ready to retire, with the lowest fees in the community, two of us (a new guy) collected a million dollars. The guys who were complaining about fees far higher than ours, were doing two cases a week when we were doing 20.

    Medicine is a great way to earn a living but you have to understand that you will no longer get rich and the hours are crappy. Two divorces ensured that I would not end up rich. Still, the life was worthwhile and I think my kids missed out not following me. My first wife spent years complaining about how I was gone and convinced the kids that it was not what they wanted to do. We’ve been divorced 30 years and are friends. She recognizes that she didn’t know what it took to make your way in the world.

    I still encourage medical students. A few years ago, I was the speaker at UCI medical school graduation. One of the department chairs came up to me later and thanked me for being positive.

    We may see a whole new world in medicine if Obama does not get too coercive. If he will let people be free, the system may work.

    Mike K (2cf494)

  15. That is a pretty damn big “if”, given Teh One’s track record so far, isn’t it, Mike K?

    JD (97a98e)

  16. Fees…
    My Dentist as far as I know does not take Medicare, and positively does not take HMO’s.
    Cash only, but payments OK.

    AD - RtR/OS! (00ce61)

  17. Mike K:

    I have question, and it may help illuminate this discussion.

    When my daughter was born, 14 years ago, my wife delivered naturally. By that, I mean, she went into the hospital and gave birth to my daughter about 20 minutes later without any drugs or anesthesia.

    However, we were charged for anesthesia, attendant care and even for Tylenol that she did not take. The insurance company paid for it. And I’m grateful for that.

    Nonetheless, I still wonder why we were charged for services we did not use and why they were paid for?

    Ag80 (c86726)

  18. Mike K – if my cash fees had ever come to the attention of Medicare, I would have been severely penalized.

    Welcome to the WPA.

    Apogee (e2dc9b)

  19. Riight

    Talk about an avalanche of money coming into Republican coffers

    Dems nationalize healthcare – 1st it cuts their largest donors off from one of their sacred money troughs – suing doctors

    Hmmmm

    EricPWJohnson (e4f0d5)

  20. We’re going to get the Democrat’s version of single payer health care, whether we like it or not. It’s been one of their issues for so long that Republicans really have no one else to blame but themselves for not coming up with any alternatives to what will essentially be Medicaid writ large. We peeps won’t get anything near what Congress gets in the way of coverage…and the level of care most likely won’t even approach that available in the VA.

    What perhaps Republicans should have done was promote a form of single payer for children. I think most among us would agree that an 8 year old with Leukemia is deserving of the best care available. And for the same reason we provide education (flawed as it may be) to children, the rationale for providing healthcare follows the same logic. Today’s children are tomorrow’s pilots, engineers, doctors, scientists, etc. Personally I don’t object to the public providing health care to a child NEARLY as much as I object to providing it to a 43 year old (like myself). The adult (unless it’s a health issue brought about by service to the country) can pound sand as far as I’m concerned. But then that’s the cold, heartless conservative in me that thinks that an adult capable of providing for themselves damn well ought to.

    Plus, by providing healthcare to the kids their parents can continue to be productive members of society. Who among us with small children wouldn’t mortgage everything we had to provide for them?

    And interestingly enough, there’s already a long established model from which we could draw from. The Shriners have been providing world class care to children for decades through their pediatric centers. There’s no rationing of care for them…they solicit for patients.

    Instead, however, the Republicans, in obstinately refusing to find any middle ground on “socialized medicine”, will again cede control of it to the Democrats. We come up with cutsy “whatever we get Congress should get” ideas and compare wait times in Canada and the U.K. for routine things…like MRIs. You ever notice that no one is listening?

    KB (5a6552)

  21. Dental care is not covered by normal Medicare.

    HeavenSent (ac3026)

  22. Get the lawyers out of medicine and un-necessary procedures and diagnostic testing goes down by 50%.

    Tell that to Herr Obama.

    HeavenSent (ac3026)

  23. Pay PCP more money for small office procedures and eliminate unnecessary and expensive specialist referrals.

    Tell that to Herr Obama.

    HeavenSent (ac3026)

  24. If you want to use German, the title would be “Herr President Obama.” Not sure why you want to use German, though :/

    carlitos (a0089e)

  25. I can’t add anything more than what’s already been posted here in the macro sense, but during my cancer treatment my endless arguments with my private insurance provider regarding their unwillingness to pay for a drug trial already well into it’s final stages of becoming standard protocol spoke volumes about their reluctance to be proactive about many kinds of treatment. Because of their endless delaying actions, I had to undergo further treatments that cost them approximately $125K more in the end. IOW, if the hospital hadn’t been able to convince the drug company to provide the drug for no charge, I would have become progressively much sicker, thus costing the insurance company even more hundreds of thousands of dollars in future care. While I consider myself eternally fortunate that I was able to obtain any kinds of insurance before my illness, the system’s really in an Alice – in – Wonderland state at present.

    Dmac (1ddf7e)

  26. KB – The Dems desire to run roughshod over the healthcare industry is most certainly not the Republicans fault. And, being Dem-lite, or Dem but less expensive, has proven itself to repeatedly be a lousy strategy.

    JD (6e32db)

  27. Good point JD. The key to our arguments is not really to dissect the dems plan but to stress over and over again that they really have no interest in creating a better system, but rather to destroy the current one. It is crucial that we just assume that everything the dirty libs do is in an attempt to destroy our country and make God angry.

    Jeffrey Diamond (fccb0b)

  28. Go f*uck youself, you lying disingenuous Moby.

    JD (6e32db)

  29. Valid point, JD. Valid point. What else do you have to say about health care. I mean, go f-yourself is an excellent point, but what else can we say to defeat the dems?

    Jeffrey Diamond (fccb0b)

  30. Took the words right out of my mouth, JD.

    carlitos (a0089e)

  31. Not sure I would blame the repubs as much as you, KB. Many states, of which I think Pennsylvania is one of the first, has had for years a partnership between the state and Blue Cross/ Blue Shield that does exactly what you suggest for children. In fact, PA has done the same things for adults, but the number is limited and there is a waiting list (found this out when my 19 year old son who wasn’t in college and without insurance at the time developed appendicitis…)

    In addition, we all know where Social Security is headed, and I don’t think President Bush got very far when he suggested seriously looking at reform.

    I’ll second Dmac’s observation that the health system in the US often does things that look beneficial to some small component in the short run, but is just stupid in the long run and for the system in general. For example, many HMO’s have people very active in the hospital eager to tell the doc when they think the patient needs to be kicked out– I mean discharged. These people have incentives built in for performance. But last time I looked into it, there was no record keeping of the cost of readmission, ER visits, home care visits, or malpractice suits due to complications caused by premature discharge. (“Oh”, no one looked at the satisfaction or the quality of life of the patient, either).

    Some years ago I saw a study that revealed that internists who averaged 7 minutes with a patient had significantly less malpractice claims against them compared to those who averaged only 5 minutes. Another example of looking at one measurement that is thought to be a valid indicator of efficient care and finding it instead to give an incomplete picture at best. In the era of “evidence-based medicine”, what is generally looked at are surrogate markers for what someone thinks is important, because those can be counted and averaged and standard deviations calculated and an administrator can tell a doctor what to do. Whether it is a good measurement of good patient care is another matter.

    MD in Philly (3d3f72)

  32. Get the lawyers out of medicine and un-necessary procedures and diagnostic testing goes down by 50%.

    Tell that to Herr Obama.

    Comment by HeavenSent — 5/22/2009 @ 6:51 am

    Get the lawyers out of everything and buy a gun and learn how to use it. Court takes way too long, anyway. If some doctor messes you around, just blow him away. Moron!

    nk (a1896a)

  33. There will be a limit to lawyers and lawsuits against doctors. But not just yet. Socialization is a complex process and when doctors don’t need lawyers to keep them professional, lawyers will become redundant.

    nk (a1896a)

  34. nk, surely you realize that not all members of your profession have the same integrity as you do (I say this seriously).

    Bad actions need to be dealt with, unfortunate mistakes need to be compensated for, but looking at ill-fortune as the lottery or doing a litigation threat shake-down happens and is a problem. When doctors don’t have money to pay out lawyers will be redundant, too.

    Actually, that is another way for stealth implimentation of a national health care system. Not only will some people to sign up as patients, but somehow doctors will need to be recruited to take care of them. Let’s make a deal, work for the feds and your malpractice is covered (of course, you get less pay than you ever did and you’ve lost 95% of you autonomy in decision making, but what the heck).

    Then the lawyers will get jobs in the bureacracy of govt. run healthcare…

    I am for alternatives to court for dealing with conflict, though, just keep the dueling limited to the sword.

    MD in Philly (3d3f72)

  35. For example, since it appears Congress will not allow a “put up or shut up” challenge to Speaker Pelosi for her accusations of the CIA, I think the CIA Chief should challenge her for a duel to protect the honor of the agency.

    If that became standard procedure, maybe the federal government could get something done other than point fingers and trash talk.

    MD in Philly (3d3f72)

  36. First we have this gem from our own widdle Jeffwey:

    attempt to destroy our country and make God angryIt is crucial that we just assume that everything the dirty libs do

    To be followed up with this hilarious admonition after being responded to in kind:

    Valid point, JD. Valid point. What else do you have to say about health care.

    Jeffwey stamps his widdle feet and becomes so vewy, vewy, angweeey! As Tweety would say, “oooh! What a hypotwit!”

    Dmac (1ddf7e)

  37. For example, since it appears Congress will not allow a “put up or shut up” challenge to Speaker Pelosi for her accusations of the CIA, I think the CIA Chief should challenge her for a duel to protect the honor of the agency.

    Hitler took control of the German Army when Himmler falsely accused its Chief of Staff of being a homosexual. The Chief of Staff responded by challenging Himmler to a duel. One historian has described the challenge as “A peacock spreading his fan in front of a python”. (The Chief of Staff reenlisted and volunteered as a ranging target for the artillery.)

    nk (a1896a)

  38. I wonder how well Los Angeles County would run single-payer health care.

    Michael Ejercito (7c44bf)

  39. Comment by carlitos — 5/22/2009 @ 7:05 am
    Re: Herr President Obama
    Wouldn’t be easier to just shorten that down to
    The Caudillo?

    As long as doctors are independent practitioners, they will be a target for the Plaintiff’s Bar.
    Even Duh-1 doesn’t have the backbone to deprive the blood-suckers of their host,
    which he easily could do by conscripting all medical personnel into government service –
    you can’t sue the government all things being equal.

    AD - RtR/OS! (6a6a3b)

  40. Comment by Michael Ejercito — 5/22/2009 @ 9:59 am

    Been to King-Drew lately?

    AD - RtR/OS! (6a6a3b)

  41. KB (6:01 am), the Republicans did unite with the Democrats to create a universal health care bill for all children — remember the Kennedy/Kassebaum Bill of 1994 or 1995? The fact that it has largely failed to accomplish its major goal, ensure health care for all children, should clue us in to the limits of the government’s ability to “take care” of all of us.

    JVW (eabe68)

  42. Things done “for the children” are rarely actually done for the children, rarely provide a benefit for the children, and generally rarely have a passing relationship to anything actually have to do with the children. For the children is a slogan of scoundrels.

    JD (d4c917)

  43. “For the Children” is a nice slogan to cover the desire to create a new bureaucracy to provide fat gov’t jobs for public-employee union drones that will continually fail to accomplish the stated mission thereby requiring increased funding and more bureaucracy.

    AD - RtR/OS! (6a6a3b)

  44. #32, Were you referring to me as a moron? Just curious.

    HeavenSent (ac3026)

  45. Who exactly is not getting treatment now, KB? Forget about insurance. This is a huge country and we have a range of plans and options and safety nets. Why would a single payer and single bureaucrat system set up in DC be better? My brother gets care for his diabetes at a clinic operated by the local hospital for people without insurance. It is more effective to charge more to their paying patients and then to treat the indigent than to turn the whole deal over to some Bureau a thousand miles away. Some people will always fall through the cracks, but at least this way we have some control.

    Patricia (2183bb)

  46. nk-

    Well, there goes that idea. But I still think drastic measures may be needed to make Congress grow up.

    It had been the practice at least among some soldiers in Germany to have duels with “Sclager” blades. They more goggles for eye protection and I believe sat at opposing sides of a table, the head and upper body being the target. This was the reason many German officers used a monocle in one eye (think Colonel Klink). The goggles protected the eye itself, but often the lid and the levator muscle took the blade, making it impossible to normally raise the eyelid.

    MD in Philly (3d3f72)

  47. I studied fencing and nowadays saber is on your feet and very fast-paced. Imagine a rainstorm of blows. But it is a disqualification to hit below the waist. My teacher told me it was to avoid hitting the horse. I took it as a paradigm of the stupidity of “the rules of war”. (I am a follower of “War is cruelty. It cannot be refined.”)

    nk (a1896a)

  48. “Schlager” blades (put an umlaut over the a) are different from any of the typical weapons- saber, foil, and epee’. Yes, saber rules were meant to model sword-fighting on horseback, foil as infantry, and epee’ as in a duel. (My two boys were competitive fencers for awhile- one foil and one epee’). Yes, I suppose hitting below the waist would likely hit the horse, but I suspect it might also have to do with the fact if you’re going below the waist while your opponent is going for your head…

    I have no idea what German officer candidates were intending with duels using schlager blades.

    MD in Philly (3d3f72)

  49. I have no idea what German officer candidates were intending with duels using schlager blades.

    Comment by MD in Philly — 5/23/2009 @ 9:02 pm

    Ritual scarring?

    nk (a1896a)

  50. What we have at present is worthless and controlled by the insurance industry. What is proposed is still in working stages and will be modified, changed, added to and approved by Congress, not just the president. It will not be “socialism,” a world meant to scare us. In fact we will choose our own doctors. If you are so frightened of the govt, then bank without bank insurance and do without our military, minimum wage, medicare, social security etc etc

    harry angstrom (2935b8)

  51. Sod off, hairy.

    JD (7cda0f)

  52. I note where the common defense is allowed for in the Constitution. The rest of hairy testicle’s examples just show what happens when feelings and a desire to give people things with other people’s money triumphs over liberty.

    JD (7cda0f)

  53. JD, this is the situation, and it is one that needs to be hammered into every young person’s brain before the politicians replace their brains with cotton candy:

    F X S = k

    Freedom multiplied by security equals a constant. The more freedom, the less security. The more security, the less freedom.

    Eric Blair (0793db)

  54. But, hairy, Teh One told use we do not have any more money to spend. And he promised to offset all new dollars with savings from closing corporate loopholes. And he promised net negative spending.

    Eric – The increase in nanny-statism for people like hairy is a feature, not a bug.

    JD (7cda0f)

  55. Let’s go racing ! Gentlemen, and women, start your engines ! If you are watching the Indy 500, I am in the Turn 1 suites, wearing a white polo. I should be easy to pick out. Go Marco! And then, Junior will win the 600 tonite, wrapping up a perfectly great day of racing.

    JD (7cda0f)

  56. I have an off topic question: does anyone have that link to the study showing that vehicles subject to federal emissions standards account for only 1.2% (or whatever) of greenhouse gases? People were talking about such a thing on a recent thread, but I don’t remember which, and I wanted to show the statistic to my dad.

    Leviticus (46c548)

  57. JD, this is the situation, and it is one that needs to be hammered into every young person’s brain before the politicians replace their brains with cotton candy:

    F X S = k

    Freedom multiplied by security equals a constant. The more freedom, the less security. The more security, the less freedom.

    Comment by Eric Blair — 5/24/2009 @ 9:21 am

    Bush didn’t understand that as president. Cheney still doesn’t.

    Johnnee (ebcc16)

  58. F X S = k

    Freedom multiplied by security equals a constant.

    For the weak and dependent? That’s an equation that false in both its premises.

    Strength equals security and freedom.

    nk (e71733)

  59. If by ‘strength’ you mean the republican version, which basically involves weakening our armed services by thinning them out over two war-fronts, alienating traditional allies, and abandoning our veterans once they have finished laying their lives on the line for the crusty white guy party, then I guess you are right nk.

    Johnnee (ebcc16)

  60. More talking points…nice job, Johnnee.

    Thinning out our armed servieces over two war fronts is not nearly so effective at weakening them as cutting multiple divisions and closing bases.

    Which traditional allies have been alienated? Germany and France both moved closer to the US in recent years. And I’d say Obama has done more to alienate Great Britain than Bush ever did.

    Steverino (69d941)

  61. Cool, a new troll.

    SPQR (26be8b)

  62. That is less of a troll and more of a Leftist talking point regurgitator.

    JD (b3f947)


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