Guest Post: How To Cut America's Healthcare Spending By 50%

Tyler Durden's picture

Submitted by Charles Hugh Smith from Of Two Minds

How To Cut America's Healthcare Spending By 50%

The current sickcare system is financially unsustainable. Physician correspondent "Ishabaka" proposes practical ways we could cut costs by 50% while improving care.

Since sickcare is fiscally and demographically unsustainable, it will eventually be replaced by something that is sustainable. Our only choice is to either let the current system collapse and then start pondering sustainable alternatives, or begin an honest discussion of sustainable alternatives before sickcare implodes in insolvency.

In the spirit of openly discussing a variety of sustainable, systemic healthcare options, we present this essay by correspondent "Ishabaka" M.D. on how to cut our current (18% of GDP) healthcare spending by 50%. Ishabaka received training in Canada, so he has direct knowledge of the Canadian system from the inside. Having spent decades as a primary-care and emergency room physician in the U.S., he also has deep knowledge of the U.S. sickcare system from the point of view of a care provider to under-served (i.e. uninsured) Americans.

Here is Ishabaka's essay:

Some time ago I told you how I could cut health care costs in half and provide every American with the healthcare they need (not necessarily the healthcare they want!). Here goes. Some of my points might seem drastic, but we are facing a drastic problem.


1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE.


2. Like Canada, this will cover all doctor's office, E.R., clinic, hospital etc. visits. Unlike Canada (the biggest mistake Canada made), there WILL BE co-pays for routine office visits and visits to the E.R. that are NOT serious emergencies.


Here is why Canada's no co-pay system is wrong. A family physician friend of mine in London, Ontario had a family in her practice. The little girl got an ear ache, with a low-grade fever on a Saturday. The mother took her to an E.R. and got an antibiotic prescription. On Sunday the girl was feeling better with no fever, but the mother took her to a walk in clinic "Just to make sure everything was all right". The doctor said "Yes". On Monday the mother took her daughter, who was now feeling fine, to my friend's practice "Just to make sure the other doctors knew what they were doing". The ear infection was cured.


That was two totally unnecessarily visits the Canadian tax payers paid for, and the first visit should have been to the walk-in clinic, which is much cheaper than the E.R.


Co-pays have to be meaningful - not too much to dissuade patients from necessary care, but enough to make them think. That should apply to all aspects of healthcare.


Let me give you another example - right now, where I live, a basic ambulance ride (no drugs or treatments) is about $500. I have had a patient come in by ambulance for a TOOTHACHE. The paramedics should be able to say "No" and not worry about being sued.


3. Like Britain, every person will choose a primary care provider, who will provide their primary care. Referral to a specialist will require a request for consultation from the primary care doctor. In the U.S., there are no restrictions on seeing specialists who charge twice as much or more than a primary care doctor. I saw a guy who went to an ear nose and throat doctor to have his ear wax cleaned - a procedure any nurse can do!


4. Immediate tort reform. Not quite sure of the details, but I estimate that probably 50% of the tests done in the U.S. are to C.Y.A. against malpractice suits, and are medically unnecessary. What would probably be best would be a no-fault system. You are injured by the health care system, you are compensated a REASONABLE amount for your injuries, regardless of who was or wasn't at fault. You aren't really injured, you get nothing. This could be handled by arbitration panels which would take the lawyers out of the system.


Right now, it takes on average $50,000 to defend a doctor against a frivolous lawsuit - the doctor wins, but still $50,000 is down the drain. On the other hand I was involved in a suit where a patient died due to real negligence on the part of two doctors and the family lost the lawsuit and got nothing. This would cut malpractice premiums by at least 1/2 and drastically reduce the amount of testing.


5. We spend WAY TOO MUCH money on end of life care. We have to get together as a society and decide what we will and will not provide for end of life patients, and that doesn't just mean cancer patients, it also applies to end of life heart failure patients, emphysema patients, etc.


For example, a reputable study in The New England Journal of Medicine showed 0% survival from treatment of cardiac arrest on kidney failure patients on dialysis. Zero. I have had to do numerous "codes" on kidney failure patients on dialysis - they all died. A code costs thousands of dollars. The first code I ever ran was on a 38 year-old accountant having an acute heart attack. In the old days (1960's) I would have simply pronounced him dead. He lived, and was FINE, no brain damage from loss of oxygen, walked out of the hospital a week later and went back to work. That was money well spent. We don't have infinite money. We need to get the most bang for the buck.


The $90,000 chemo drug that extended terminal prostate cancer patients' lives by 6 months should NOT have been paid for by taxpayers' money. Patients who want it should have to pay for it themselves.


6. We have GOT to get the gold-bricks off disability and workmen's comp. If we did, we could put the truly disabled and injured-on-the-job folks in suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind boggling to see how many gold-bricks there are.


I really liked the system in Ontario, Canada. Any primary care doctor could certify a patient as disabled or off work for up to two months. After that, the patients had to be seen by a panel of specialists paid by the government. They had NO INCENTIVE to either certify the patients as disabled/unable to work or not. To make these specialists truly independent they should be salaried - and the government CANNOT fire them except for the reasons that would cause them to lose their license (sex with a patient, drug addiction, etc.).


7. All advertising immediately banned. We go back to the 70's. No doctor, hospital, clinic, drug company, can advertise to patients. Period.


8. All new drugs have to be compared to existing drugs (if there is a similar existing drug). ONLY if they prove superior to existing drugs should the FDA approve them. Every time a new drug is invented, all the other pharma companies copy it, change a molecule or two, and then study it compared to PLACEBO. We end up with 20 drugs that do the same thing. It's ridiculous.


9. Get rid of fraud and abuse - for real. This means doctors AND patients. You get caught committing health care fraud you pay in fines THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial - fraudsters MUST be made to do time.


Everybody's charges get audited by an independent panel. You charge for patients you didn't see, or wheelchairs you never provided to patients - you go to jail. It must be recognized that nobody is perfect, mistakes happen. A doctor accidentally charges for a patient they didn't see once in five years is not fraud - it's a mistake.


In the same way, patients caught "doctor shopping" for narcotics and selling them pay three times what they made and go to jail for a year. Same for patients selling blood pressure pills (this is a big racket for Medicaid patients) - doctors are usually suspicious of healthy looking patients seeking narcotics, but see a Medicaid patient who is on expensive blood pressure pills, says they ran out and can't contact their doctor - they will usually get a prescription. You can make a nice income on welfare doing this.


10. Eliminate health insurance companies, except for people who want to buy extraordinary coverage like for the $90,000 prostate cancer drugs. Do like we did in Ontario - fee for service with the fees paid by taxpayers via a Department of Health, the fees negotiated annually by either state or national medical associations.


11. Electronic medical records THAT WORK. Right now we are in the "pre-internet" era of EMR. There are a thousand different ones, they are very expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH OTHER. I worked for a long time in an ER in Florida in an area where elderly people from the north came to winter. They would get sick all the time and come in not knowing their allergies, meds, or medical history. It was a nightmare. If I hear "I'm on a little white pill for blood pressure" one more time I may scream!


With a national standard EMR I could find everything I needed to know with a few mouse clicks. It will be a disaster if this info is stolen or hacked, so the punishment must be severe - TEN YEARS in prison WITHOUT PAROLE, and a hefty fine. No excuses. Set up something with Interpol and the UN so this applies to all countries. And, since EMRs would benefit patients, doctors, and the entire country, doctors and hospitals pay half, the government pays the other half.


12. Get rid of the bad docs/nurses/hospitals/ etc. I'll just speak for the docs here - there are two kinds of bad docs - ones who are bad usually due to lack of knowledge or drugs/alcohol but WANT to be good, and those who are bad and don't care. The second ones are immediately banned from healthcare for life. The first group gets extensive education/rehab, whatever they need. Then close monitoring. In my experience, most of them will turn out to be good docs. A few won't, and get banned from healthcare for life.


13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats. We know they are poisonous. Again, minimum one year prison for the CEO and board of directors of any company that violates this law, whether it's a mom and pop shop or Kellogs or McDonalds.


That's it, except for a few tweaks. Fifty percent cheaper, everyone gets what they need.

Thank you, Ishabaka. Here is a story Ishabaka sent recently that highlights the consequences of fast-food on human health:

This is an article from the July 2, 2012 issue of Circulation, the journal of The American Heart Association. It shows how frequency of eating fast food per week increases the risk of heart attack - up to 80% if eaten four or more times per week! This is a highly respected medical journal, not some crackpot website.

Western-Style Fast Food Intake and Cardio-Metabolic Risk in an Eastern (Asian) Country.

Conclusion: "Western-style fast food intake is associated with increased risk of developing type 2 diabetes and of chronic heart disease (CHD) mortality in an eastern (Asian) population."


* * *

And this from Zero Hedge - want to live to 100? Here's how:

The Centenarian Diet

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JR's picture

Most of the immigrants I know work their asses off, flooding the economy with cheap produce and cheap services like landscaping – Dr. Acula

Anecdotal comments are always important, but they hardly overcome such frightening statistics. I could add my observations to your comments to say they reflect totally the opposite. We see the hard work but we see the lowering of wage scales for workers who will accept lower and lower benefit levels in order to get the jobs, erasing decades of advancement via labor negotiations by hardworking Americans.

Your comment, by the way, reminds me of an Asian executive of a US company speaking at a roundtable seminar in San Jose a few years back. He said that American workers needed to emulate Chinese laborers and work longer hours at less pay.

I also am reminded of a Lebanese union buster in a small Midwestern town where roofs had suffered hail damage.  Speaking to young white workers he’d hired to make heavy-lifting deliveries, he let them know who was boss in America:  White men won’t work.  We hire Mexican laborers to repair the roofs; they’re willing to work until 2 a.m.

And to supplement the displacement of American workers by government-induced foreign labor, according to Investors Business Daily, “As if being 'food stamp president' weren’t enough,  Barack Obama’s administration is partnering with the Mexican government to make sure Mexican nationals living in the U.S. don’t miss out.”

According to DemoMemo in January, “Non-Hispanic whites, not blacks, account for the largest share of people receiving food stamps--42 percent in 2010. Blacks account for 28 percent of food stamp recipients.”

The Supplemental Nutrition Assistance Program (SNAP) reports that from 2007-2011 spending on the food stamp program increased 135 percent to reach a cost of $78 billion last year (2011) alone.

Ay caramba!

dolph9's picture

Interesting article, perhaps misguided and much too influenced by the socialist mindset of the Canadians.

And the cacophany in the comments certainly adds to the confusion.

Reality check:  modern healthcare, everywhere, as part of the industrial system, is completely bankrupt.

If you think that ventilators and dializers are being "paid for" in Canada, I've got a bridge to sell you.

Healthcare is bankrupting everybody, it's just happening faster in America because we are generally incompetent and a whining, "I want it all" type of people. 

honestann's picture

It is a FACT that the lives of most people can be extended additional hours, days or weeks given the application of a sufficient number of wires, tubes and chemicals --- and a few million dollars.

That most human beings actually ADVOCATE spending several million dollars PER HUMAN in the country proves they are terminally insane.  Not only does this necessarily cause the complete destruction of mankind, but usually extends periods of terrible pain and suffering.

If someone WANTS to save several million dollars, and WANTS to consume it all during their last few hours or days, then they may do so.  They earned it.  Me?  I'd rather enjoy the fruits of my labors when I can actually enjoy them, then expire at the appropriate time (which is definitely before life becomes a living hell).

That human beings "buy into" the blatantly absurd arguments thrown around today to justify so-called "healthcare" proves that human beings are dumber than rocks, and as a species, FINISHED.

monad's picture

Totalitarianism: its good for ya. You can't have your pudding if you don't eat your meat! And meat is only for party members in good standing... have you greased up today?

honestann's picture

Clearly totalitarianism is what most people endorse.

Very true, and very, very scary.

MachoMan's picture

OK, sorry, but #4 is fucking hilarious.  You're trying to tell me that running patients through batteries of unnecessary tests is a function of merely CYA?  ARE YOU FUCKING KIDDING ME?  I think this ties back in with your #9...  When you do things that do not have pecuniary value to ensure that your ass is saved, then you're "covering your ass"...  however, when you do additional billing, just as you would if you were not trying to cover your ass, then you're just milking it...  period. 

In short, I would tend to believe your story a bit more if doctors were performing the additional services for de minimis fees...  as though this was some added/burden cost to their practice...  since when is merely covering your ass so lucrative?  We should all be so lucky.

PS, you want to know the #1 reason for malpractice suits?  Bad bedside manner...

loveyajimbo's picture

A huge first step is the simple action of ending ALL benefits to those in the country ILLEGALLY.  How could that even be contraversial?  Only the Obama reelection team could make any sense of paying OUR money to illegals.  THEY get votes out of it... we, the people, just get screwed in the ass. Put in an a national ballot and watch it pass 80 to 20.

honestann's picture

Yes, all benefits to illegals should end.
Also, all benefits to legals should end.
Also, all tax payments should end.

Ahhhhhh.  Now we can live our lives.

What a concept!

Diesel Seven's picture

Ok, WTF with #13??? Throw my wife in jail because she buys my (very athletic) kid a fucking Happy Meal one in awhile??? Yes, we know high fructose corn syrup and trans fats are bad for us, but what next, 50 lashes for making a prime rib, 2 years for making refried beans with lard. From a social cost, alchohol is probably more costly by some measures than unhealthy foods, so just a matter of time before prohibition is upon us again . . .

Miffed Microbiologist's picture

Feeding kids a happy meal once in a while is not the problem. When I was a kid in the 60s and early 70 s I begged for McDs and was lucky to get it once every few months. "Don't ask me for that crap" was the standard reply and that was before GMO corn and transfat. Hell, I bet that meal was far healthier than today. Kids today are so much fatter and are fed a steady diet of this garbage. In fact they have a strange build, skinny arms and legs with big protruding bellys, almost as if they have kwashiorkor. I'm not for the food police but where are the mothers protecting their kids and their health? This has always been under the watch guard of women and it appears they just don't care any more.


Don Levit's picture

Number 10 is on the right track.

We need to increase the deductibles to at least $25,000.

Doing so cuts the premium by 60%.

Increasing to a $50,000 dedictible, reduces the premium by 80%.

3 people and I are working with Milliman, an actuarial firm, on a plan design to show inerested life insurers, which funds the deductible, over 3 years.

It is set up as a break-even product, so that consumers will have more discretionary income to buy the life insurer's products.

Bu contributing $300 per month, one builds a paid-up policy each month.

After 36 months, the plan is designed to acumulate $25,000 of paid-up insurance, of which another premium is not due, as long as claims are not made.

Don Levit

smiler03's picture

I read somewhere that ill health is the biggest cause of bankruptcy in the US. 

Your suggestion would surely greatly increase the number of bankrupts. I suppose you would call that "shit happens". 

_SILENCER's picture

People are free to eat what they want, that's fine.  But most of what's available is straight up poison.  If you're too goddamned stupid to see that you're toxifying yourself through depleted fake food and sinister pharma drugs, you'll pay the ultimate price and whither, crumple, then die a busted heap of dusty bones....after the medical system has performed a tota Cashectomy.


I have zero health insurace, I don't trust the whitecoat priesthood.  I'm 50.  I look 35. I eat and drink clean, exercise, supplement with high octane vitamins and minerals. I go out in the sun. I drink clean, pure water, operate largely in cash, refuse to own a TV, and don't believe a goddamn word dinosaur media says. I'm far from perfect, I love whiskey and cigars, but I'll probably outlive the people that and feed from the drive thru and believe MD's and buy medical insurance, whis is, in my opinion, a bet that you'll be so ill, so decrepit, that you'll need assistance in taking care of your broken, toxic ass.


You can't cure stupid, you can ocasionally wake up a somnambulist. As I see it, the best way to not cooperate with the matrix is to take responsibility for your own well-being and not  participate in their "slow suicide for the serfs" agenda.

honestann's picture

Great post.  Wonderful to hear from someone with more than one functional neuron.

It may be true that "you can't cure stupid", but obviously the elitist predators sure know how to "create stupid".  I mean, how else could the overwhelming majority of human beings on earth become as stupid as is common today?

I absolutely refuse to have health insurance, though I can't argue against "catastrophic care" plans to pay expenses over $10,000 or $100,000 deductible --- for those who want them.  Frankly, I now understand that going to a doctor or hospital is almost always vastly more dangerous and vastly more unhealthy than NOT going.

Eating good, organic, healthy foods is not only the best health tip, but it tastes much better --- assuming you haven't already burned out your taste functions, which is possible.  Though sometimes it takes a couple or a few tries, natural herbs (or even foods, sometimes) have been vastly superior at dealing with minor discomforts or potential health issues for me.  Of course there is no substitute for taking charge, taking control, learning what you can, making your own decisions, running your own tests and experiments (with herbs and such), and finding your own answers.  Yes, the cost is high --- but in time spent investigating and experimenting, but not so much in monetary cost (good news for all those "poor folks" who are always the justifications for making everyone on earth a permanent slave to those oh-so-benevolent predators who always design, run, and get filthy rich on every health-care system).

And that "slow suicide" that people have been engaged in?  Well, it appears the pace is about to pick up substantially now that the predators have absolute, complete, total control of everything, including so-called "health care".

Question:  Are the vast majority of people today really so stupid that all predators need to do is slap labels like "free" and "health-care" on something, and people actually believe it is "free" and is in fact "health care"?

Answer:  Obviously so.

docj's picture

I don't have time to sort through the comments to see if this has been mentioned yet - but, sorry, bullshit.

There ain't no free lunch. Canada is a nation with a population roughly 1/8 that of the US and their socialized medicine is bankrupting them - as some Canadian colleagues once told me of their system, "It works great... until you get sick". Some decent stuff about tort reform, disability reform and end-of-life care but anything that starts with the premise that the way to go is to expand "Medicare for All" is simply non-serious.

How about this - you pay for whatever sort of medical care you want and think you need out of your pocket, or with HC insurance that YOU pay for out of YOUR after-tax dollars (simply done by ending the deductability of HC insurance costs for everyone). If you can't (or are not willing to) pay, you rely on family, friends and charity hospitals who receive their funding from VOLUNTARY donations. We've not had a "free market" in health care in the US for generations (at least not since 1965) - maybe we should try that before assuming that government, who's record of containing the cost of anything anywhere pretty much sucks, will be our savior here.

jmc8888's picture

#5 is completely fascist.  He gives a completely academic response to something that is not academic.  You don't know what person responds or doesn't respond based on pseudo-science.  An extra six months life is significant.  It condemns everyone who can't afford treatment to an earlier death.  9X percent of people couldn't afford that treatment, mostly because the fraudulent system we work under pays them crap. 

He's calling for death panels, plain and simple.  Lives unworthy to be lived or saved.  If you're old, you're screwed.  If it costs alot you're screwed.  If the pseudo science says only a few percent recover, you're screwed.  If the same says you get X amount of months in return, you're screwed.  So basically, everyone is screwed. But of course, cloak the whole thing in mystery, throw in some fucked up rationales, and put everyone in the same boat, and we're saved.  Of course, then we'll let the banksters screw us all over more, and steal from the system enough to put whatever we do at the brink for their gain.  Doesn't matter how far we move the goalline, the banksters will build a brick wall right in front of it.  The costs of medicine are out of control are only a symptom, a reaction to the policies of Wall Street banksters and who they serve.


The Reich's picture

So you've solved the problem?

fuu's picture

Charles Hugh Smith is sounding more and more like Simon Brusca.

boiltherich's picture

Eat your fucking peas!

malek's picture

As much as I generally agree on Ishabaka's general direction:

on 3.
This boils down to another "lowest common denominator" approach. Who should someone who knows what specialist he needs, for example after he badly sprained his ankle, first need to go to his primary care doctor to wait in line, get taken a quick look and be referred?

on 4.
Tort reform yes, but taking things completely out of the hands of lawyers and therefore out of the regular justice system, and put into the hands of unaccountable arbitration panels will only exacerbate the problems over time.

on 8.
Another thing that some instution/regulator miraculously becomes the "solution" - in this case the FDA of which we assume they always decide wise and honest.

RS2OOO's picture

Reading the post and then the subsequent comments has made me realise something. 

I'm proud and grateful of Britain's National Health Service.

Us Brits often give the NHS a hard time, but to me it seems unthinkable that millions live in a society where they can't go to the Doctor immediately on feeling unwell and obtain immdeiate treatment, at no immediate cost.

Obviously, the NHS does have it's problems, and we do pay for it through our taxes and National Insurance payments, but it's comforting to know that if I want treatment for an ailment, or if I have a heart attack right now, I can be in an ambulance on the way to a hospital within 10 minutes with no concern about how it will be paid for.

Most Brits don't visit the Doctors very often, we don't feel we have to get our "money's worth" because we were born into a system that pre-existed and is a normal part of life....

....And this is reflected by a common scene, you visit the Doctor's surgery waiting room and quickly notice you are the only British born person there, whilst the vast majority are those who originate from other Countries and take full advantage of every possible aspect of the service available, more often than not to obtain free prescriptions for medication that is available over the counter (Prescriptions are free if you are unemployed, under 16, or pregnant, $12 otherwise). It really grates me to see the same faces over and over again, visiting for the most trivial reasons, whilst most sick Brit's have to be forced to go by friends and colleagues because most of us are brought up to avoid visiting the Doctors unless there's absolutely no alternative.

honestann's picture

Only the Brits know how utterly worthless the so-called "care" is.  That's why they don't jam the waiting rooms.  Also, many Brits know they'll be injected with horrific poisons on orders from the predators who control the so-called healthcare system, and want to stay as far away from those poisons as they possibly can.  That's why the waiting rooms in private clinics in Singapore, Thailand and other places around the world are positively jam packed with Brits.  No coincidence.

Shankopotomus's picture

 Imagine having one hospital that you have to go to; meaning it's the only one within reasonable driving distance if your really serious about surviving a true medical emergency like a heart attack, which most people are I think anyway. Imagine that hospital owning all the clinics in the small towns ( six all with less than 4,500 people each) within a 50 mile radius of where it sits. Imagine that hospital recently completing a brand new 25 million dollar Emergency Room addition. Imagine having a really bad case of the hives starting at 10:00 A. M. on a weekday morning (it's Wednesday actually)  that you could probably have treated in one of the six clinics because they're usually not serious, but could be, so you'd want to see a doctor within say 4 hours or so just to be safe about it. Imagine calling all six clinics and having everyone of them tell you that they're all  booked solid for the day at 10:00 A. M. and can't get you in until the next day. Imagine having no choice  but to go to the emergency room now, because a bad case of the hives can be serious condition like I pointed out before. Imagine getting to the brand new 25 million dollar Emergency Room at the Hospital and finding it completely full of patients at 10:45 A.M. also. Imagine this actually happening to you like it did to my Wife (she was the one with the hives by the way) and I. How convienent, for the brand new 25 million dollar Emergency Room I mean, because it sure the heck wasn't very convient for us that's for sure. Now I'm not saying that it wasn't impossible for every one of those six clinics to be booked solid on that Wednesday morning at 10 o'clock, but after seeing the  brand new 25 million dollar Emergency Room stuffed to the gills with patients at the same time of the day  also, makes me wonder if they really were. 25 million dollars is an awfull lot of money to make up after all, meaning I'm pretty sure someone didn't build it for them for free.

honestann's picture

That only happens in a massively government-perverted system.  When people must PAY for their own care, they don't jam waiting rooms for minor aches or unimportant nonsense.  Furthermore, even in the totally screwed up system of today, few hospitals or clinics make serious cases wait forever behind others with minor problems.  Hell, in the real world, if your plight is visible or obvious, you might even find someone to give up their place in line.

Bottom line:  So-called "health insurance" of the type people have (and are now being forced to have) is a TOTAL SCAM and VERY DESTRUCTIVE.  It gives strong incentives for people to show up for minor if not irrelevant complaints.  What does make sense for many people is inexpensive "high deductable" or "catastrophic care" plans.

Not that I'd advocate ANY government-forced rule, I'll make my point this way.  If everyone who enters the doctor office must pay the first $100 ~ $250 of each visit, on the spot, then all those huge lines would VANISH.  If the AMA stopped artificially restraining the number of medical schools and medical students, the lines would shrink too.

The problem is, as always, predators DBA government and predators DBA organizations.

Shankopotomus's picture

I agree. In fact I agree so much that I think health insurance shouldn't be involved with healthcare at all, especially the kind you don't like. However, not allowing someone to sell or buy the kind of health insurance you don't like in a free market health care system; if they wished to so, would probably be just as big of a  violation of the free market system as the government making everyone buy it is. Don't ya think? In other words you can't have it both ways, which seems to be what alot of people on here want when it comes to this issue.

honestann's picture

Yes.  I would never PROHIBIT anyone from doing or buying anything - except directly, physically harming someone else.

Nels's picture

So his solution is to turn every health worrker into a government employee, and then get rid of the bad ones?

When has any federal, state or local government in the USA ever shown competence in getting rid of bad employees, or in reducing featherbedding.

You might as well wait for the Healthy Care Fairy to fix things

The fix is: Everybody pays their own way, or begs for charity. care.  If you didn't play your life such that you can afford a new heart, then you planned not to have one.

And just about everybody can plan to afford a new heart - pay for your own catastrophic insurance.  Pay attention to your own health.

If you need charity, this was a pretty charitable country before the government took over the function.  This countryt always did frown on folks who ran their life in  such a way as to depend on charity. If that's not true now, then we are simply screwed and there is no fix.

If you are a gang member & get shot, either the gang pays for a good doctor or the ER doctor takes big stitches (a M.A.S.H. reference, in case you are under 45).  If the gang doesn't have money, what was the purpose of joining?  You should have joined the Elks or Moose - they have good insurance policies for the members.

spooz's picture

Right.  Social darwinism.  I get it.  Do you also think girls only get pregnant when they liked getting raped?

honestann's picture

Bad things happen, therefore every human being on earth must be a slave to predators DBA government, predators DBA central banks, predators DBA financial institutions, predators DBA medical institutions, and predators DBA choose-your-fiction.

!!!!!  HOLY CRAP  !!!!!

Making every individual on earth a permanent slave is apparently the solution to everything, because that's just about all we ever hear.  Go jam it!

Yes.  Bad things happen.  And yes, sometimes to good people and innocent people.  When bad things happen, and some other individual caused the damage, we can and should try to [help the victim] locate them and make them fully compensate for their deeds.  And if you or others want to donate to victims, we will praise you, and we might help now and then, when we can, as much as we believe is reasonable and prudent.  PERIOD.

Turning individuals into slaves NEVER made quality of life higher in the past, and will NEVER make quality of life better in the future.  It does precisely the opposite, in spades.

spooz's picture

Nope.  I think I'd rather live in a country that has a social safety net, thank you very much.  It might be someone I love that DIES because keeping taxes low for the elites was more important than providing basic needs for the many.  If your version of freedom is throwing an increasingly large number of citizens under the bus, it doesn't sound very appealing.

honestann's picture

!!!!!  LISTEN  !!!!!

!!!!!  WAKE UP  !!!!!


Whew.  There.  Feel better now?  To GET your safety net, simply go select and purchase your own "health insurance" (which will not assure or insure your health, of course).

You are entirely free to have your safety net.  Go for it.  Really!

You are UTTERLY misguided.  It is precisely the "elites" who get rich on the backs of every honest, ethical productive individual when these so-called "safety-net" programs are implemented.  These "elites" get FILTHY RICH... on your dime, my dime, everyone's dime.

And then these "elites" get the best medical treatment in the world --- AND YOU DO NOT.

When I was a kid (and I'm not even "old" yet), and we got sick, the doctor would COME TO OUR HOME with his little black bag.  He'd figure out the problem, leave some pills when appropriate, and charge $10 to $20.  For THAT kind of personal service.  That was just before the federal government got really serious about screwing up the "healthcare" system.

This is NOT a coincidence!  If someone cannot afford $20, then they cannot afford to eat, and that is a VASTLY more serious risk.  This has to be obvious to anyone who is not terminally stupid or delusional.

I do not want good things for the elites!  They are predators, and deserve the worst any human could deserve.  But YOU and people like you make them strong.  YOU make them powerful.  YOU make them rich.  And because THEY (the elite predators) have brainwashed you so thoroughly, you PRAISE, SANCTION, DEFEND and SUPPORT them and their predatory scams.

I can guarantee you, beyond any doubt whatsoever, that you and those people you worry about would have VASTLY cheaper and VASTLY better healthcare if there were ZERO laws and ZERO regulations regarding healthcare (except total disclosure like on any business, to avoid fraud).  But because you and so many people SUPPORT and DEFEND the predators, the human race is finished.  You will live a miserable life, and die a miserable death, because you support predators.  I mean really.  What do you expect in a world totally controlled and dominated by predators?  That the predators would take care of you?  Are you serious?  Because that's exactly what you're saying.  Sigh.  Humans are hopeless.  Seriously.

Papasmurf's picture

Your answer doesn't work.  Insurance companies will not insure you if you require thyroid medication or any other chronic medication. 

honestann's picture

Hey moron!  If you really believe in healthcare, you would have healthcare for years or decades before you ever needed ANY medication or care.  So cut your overt, blatant, obvious, contradictory BS and get real.

Most important, STOP TRYING TO DESTROY MY LIFE and the lives of billions of other folks too.

What kind of vile, revolting cretins would presume to have any right to tell ME... and everyone on earth... how I ****must**** live my life?  Huh?  Do you expect me to return the favor?  Do you now expect me to force you to live your life in any way I deem appropriate?  Huh?  Well, you freak?  Do you?  Answer the question, scumbag, because I have a really spiffy list of requirements for you that I'm sure would make you sit up and take notice.

How can real, physical human beings BE this stupid?  How can human beings actually, with a straight face, tell me and everyone else on earth how WE must live our lives?  What products WE must buy?  What plans WE must have for our own lives, for our own illnesses, for our own final days?

How on earth can so many monkeys-in-clothes be brainwashed into advocating their own enslavement?  This is revolting beyond words!  What fate could possibly be appropriate for beings who actually, in fact, advocate the enslavement and destruction of billions of sentient beings?  This is not some small matter.  This is advocating the absolute, complete destruction of an entire species... your own species, morons!

That so many monkeys-in-clothes advocate the kind of insanity you advocate proves one thing without any doubt whatsoever.  Humans beings are finished.  Humans are clearly destined to spiral down the toilet of history as they should, and be spewed out the rear end of reality.  Bunch of completely freaking insane apes with scrambled brains.  Good riddens.

PS:  Do you even understand what you advocate?  Even vaguely?  You really should understand how absurd and blatantly insane any sane sentient being finds ideas like yours.  You claim that neither you nor I nor any other individual should be allowed to decide how to live his own life... AND... you also claim that "other individuals" should decide how that individual lives his life.

So, to simply a bit, I am the ONLY individual who has no right how to decide how to live my life, even though it is blatantly obvious that it is I who shall suffer the consequences of how I live my life.  And other individuals, who do not suffer the consequences of how I live my life, should have a right to tell me how I must live.  Boy, if that isn't blatant slavery speaking!

Do you have any vague notion how insane your ideas are?  I mean, blatantly obvious insanity?  Because you really should sit down someday and understand what you advocate.  And don't give us any BS about "it is only healthcare", and somehow "healthcare is different".  No, healthcare is not different, and is certainly much less crucial than water, food, air and other aspects of reality.  Anyone who believes ideas like yours is... well... bouncing-off-the-walls-clinically-insane.  In fact.  Of course, the predators do have control of fictitious "institutions" these days, so they will indeed certify exactly the opposite --- that yes indeed, THEY have a right to totally define what is sane and what is not, no matter how insane their proclamations may be.  And you support them, moron!  You support predators and overt insanity.  Congrats.

exodus11's picture

Oh yes, that's what I want. A trip to the doctor so they can cut, kill and poison me.

boiltherich's picture

There are some good suggestions in the above, but there are some that will not fly, like telling people what they can and can't eat, drink, or smoke. 

Cuba has universal comprehensive healthcare for far less than we do, like less than one tenth of 1% our healthcare expenses and nobody telling you how to eat drink or smoke.  Yet they have lower infant mortality, they live longer and healthier than we do, by almost any metric you can use to judge care outcomes their socialist system beats ours. 

That does not mean I am advocating communism to cure our medical disaster, but it does mean that greed and money are the foundation of the problem and until that is wrung out of our system you will have no chance of fixing anything.  Ending private insurance is the biggest first thing to do, they add nothing to quality or quantity of care but damage both while adding huge expense.  Ending the AMA's control over medical school admissions is next, they keep physicians in short supply and thus that much more expensive.  Every state should have at least one state run medical school with blind admissions.  And if you can't become a doctor because you can't afford the cost of school then you should be offered paid education in return for working for the government for a set amount of time.  All doctors, specialists included, should have to spend one working moth per year seeing patients outside of urban areas, that is one of the most critically short areas of care in the US.

I say give them all a salary, a good salary for sure, starting at 90k say, and up to a couple hundred thousand for good doctors that work hard with good results, and if they don't want to do the job for that let them quit and find another line of work where they can make more, I want my doctors to be in the profession because they love being a doctor and take pride in being a good one, not because they love money and have kickback schemes set up with drug companies and labs and diagnostic centers.  I estimate about half would quit. 

And why can't we be farming out a lot of our non emergency surgical cases to India and other medical tourist destinations?  They do the same operations for a sixth the money. 

Catullus's picture

Cuba has universal comprehensive healthcare for far less than we do, like less than one tenth of 1% our healthcare expenses and nobody telling you how to eat drink or smoke.  Yet they have lower infant mortality, they live longer and healthier than we do, by almost any metric you can use to judge care outcomes their socialist system beats ours.

Nothing that you just said is true.

boiltherich's picture

Great, post some kind, ANY kind of proof.  And the reason you would make such a simple and flat one line statement claiming mine to be untrue is? 

"...the impoverished nation has developed a world-class health care system. Average life expectancy is 77.5 years, compared to 78.1 years in the United States, and infant and child mortality rates match or beat our own. There’s one doctor for every 170 people, more than twice the per-capita U.S. average."

“In Cuba, a little over $300 per person is spent on health care each year. In the U.S., we’re spending over $7,000 per person,” said Drain, co-author of Caring for the World and an essay published April 29 in Science. “They’re able to achieve great health outcomes on a modest budget.” How does Cuba keep health care costs so low?

Paul Drain: Partly by keeping physicians’ salaries low. Obviously, given the government they have, they can do that. But they also emphasize primary care and preventive care, addressing diseases and problems before they become major. It’s a very different approach to health care.

Cuba infant mortality = #40 with 4.83 infant deaths per 1,000 births

US infant mortality = #49 with 5.98 per 1,000

That is from the CIA Factbook

List of countries by life expectancy...

Cuba #36 (tied with Denmark) females =80.6 years males = 76.2 years all people = 78.3 years

USA #38 Females = 80.8 years  males = 75.6 years  all people = 78.2 years


36 Denmark 78.3 76.0 80.6 36 Cuba 78.3 76.2 80.4 38 United States 78.2 75.6 80.8 39 Portugal 78.1 75.0 81.2 40 Slovenia 77.9 74.1 81.5


Cuba health care spending = 3.3 billion  US healthcare spending = $1.8 trillion  540 times as much per capita. 


By the way, Cuba (#1) has a 99.9% literacy rate as well, the USA  (#46) has a rate of 90%. 

Forbes's picture

Amtrak and the Postal Service are such models of efficiency, I can see why a Canadian doctor practicing in the US would recommend nationalzed healthcare. What I don't understand is why the doctor isn't practicing in Canada. I guess the working conditions and pay in the US must be better...

Buffalo, NY, next to Detroit, is pretty much  the armpit of the Great Lakes, but its Roswell Park Cancer Institute does bang-up business with Canadians. I wonder why that is, if Canadian healthcare is so superior...

honestann's picture

The solution?  Simple.  An absolute, complete, utter, 100% separation of healthcare and state.  Anything else will simply change which predators enrich themselves for destroying the health of everyone.

Oh, and how about you (and so many others) simply STOP trying to decide for me... and everyone else.  Where do people get this idea that there just MUST be SOMEONE who decides everything for me, you and everyone else?  Totalitarianism as a fundamental premise of reality?  Get your brain replaced.

Vlad Tepid's picture

Some compelling points but it's kindof hard to take advice from someone who's moniker is "Stupid Doctor."  

Sounds very much like he's proposing a modified version of the Japanese national healthcare system...the only problem is that system only treats Japanese - not 350 million monstrously obese, self-important jack-holes.

Jack Burton's picture

I live near the Candian border and near a US regional health care center. Sorry, but no Canadians are coming over the border to get that US health care. I know plenty of Candians, none of them want to US system.

I love reading the US folks slam Canadian health care, half the cost, much better outcomes. Ha, that is a fact folks. But US fools never let a fact get in the way of a life time of brain washing by corporate America.

I am also familiar with the UK and Swedish health care. Same thing, half the cost and far better patient outcomes with nobody going BK due to health care costs. More facts.

But Americans just love paying huge profits to their rip off health insurance companies. I bet the most anti Candian posts made here today were from people connected to the giant American rip off crooks who are otherwise known as the US private Health Insurance Industry.

We pay double for worse outcomes. WHat could be wrong with that, eh?

Vidar's picture

A much easier two-part plan that would reduce costs at least as much:

1. End the AMA cartel that reduces the number of medical schools and doctors and drives up prices,

2. End the prescription drug system that forces people who just want a specific medicine to pay a doctor to prescribe it (must be done in conjunction with ending recreational drug prohibition).

Those two alone would do as much as all of this and would reduce the influence of government rather than increasing it.

The only thing in this article that makes sense is tort reform, we should go to a loser pays system so that if you are sued and didn't do anything wrong you don't lose any money. Trial lawyers would have to risk their own money if they wanted to bring a possibly frivolous suit.

boiltherich's picture

Tort reform is bullshit, it is a tiny slice of costs and the only people to benefit will be that this would protect incompetent doctors and hospitals.

My mother was 69, a week from her 70th birthday, she called me and said she was low on food and missed her doctor appointment because my little sister had taken off in the car several days before and not come back. I got in my truck and drove the 135 miles down to the coast and when I saw my mom I was scared out of my mind, she looked terrible, swollen in the middle and gaunt, skeletal in the face, she could hardly walk. It had only been three months since I moved up to Oregon, such rapid decline. I got her to agree to go to the hospital with me to be seen.

When we got there the waiting room was filled with Spanish speaking people and their kids who use the ER as a primary care source on the government ticket, but then that was what we were also there doing because an appointment with a Medicaid/Medicare accepting doctor takes six months to get, IF you were lucky enough to even have such a doctor, for several years no doctor in the county has accepted new M/M patients.

Clearly the wait was going to be hours, so I told my mom I was going to leave for a while to find a place to stay for the night. That was the last time I saw her alive and speaking.

Everywhere I went the motels were full because it was the Thursday before Memorial Day. I ended up getting a campsite at a Forest Service campground 40 miles up the Smith River. By then it was dark and I needed to set up my tent, I had grabbed my gear as I was leaving for the coast because I know how hard it can be to get affordable rooms there after the beginning of May. I phoned the front desk at the hospital to see if mom was ready to be picked up and they put her on because she was still sitting in the waiting room right there. She said when she was done she would call a cab. I said I would see her in the morning then.

Around midnight I had a call from a guy who said he was a nurse in the ER, he called to say there was nothing medically wrong with my mom so they were releasing her, would I come get her, but I was way up the river so they said they would call a cab for her. At one A.M. the phone rang again but this time it was a woman, the ER doctor, she said there was a lot wrong with my mom so they were keeping her overnight. I wanted to know what happened in that hour to make them want to keep her, but the doctor would not discuss her condition over the phone. I said OK I would be there first thing in the morning.

The next morning I had a call from a cousin that is an RN at the hospital, she said my mom was on her ward and that she was gone for tests so don't hurry, I said I would pop back up to Medford to get cash and shut off the A/C at the apartment and be down later, I was practically half way home anyway. Later my mom called me, she said she had fallen in the lobby of the hospital, had to have stitches and had a bad bump on the head, but she was clearly out of it, dropped the phone, slurred words so I assumed pain killers. Thought her doctor was from Chico, turns out his name was Sheiko or something like that.

So I said I would come down the next day and pick her up when they released her.

The next morning I phoned to see when she was going to be let go and they said she had already been discharged from Med/Surg, and they did not want to discuss the matter. Turns out she had been discharged from med/surg and taken to ICU. She was in a coma on a ventilator. The hospital said she was simply "used up," that they could not make a single diagnosis, there was evidence of "an old stroke" they said. They said they had her in an induced coma but that we needed to gather the family and plan for the end. Two days later they asked for permission to unplug her from life support, ON HER BIRTHDAY for christ's sakes.

She had not just fallen and hit her head, she tripped on a rug and had stitches on her chin, cheek, and eyebrow. They HAD let her go from the ER because "nothing was wrong with her" the night I took her in to be seen and a NURSE decided to kick her out. That was when she fell and a doctor decided to keep her, of course now that she hit her head so hard she needed stitches in three places on her face. A week later she was dead. And all of that was on hospital lobby cameras which mysteriously the data was erased within 24 hours of her death.

Now, if ever there was a case of gross medical negligence this is it. According to the fuctards that want tort reform this is EXACTLY the kind of case lawyers drool over getting their hands on, the out of court settlements alone would be enormous. Not just a slip and fall, but a slip and fall resulting in death in a hospital where the staff had decided minutes before that she was fine to go home, they did not even wheel her out in a wheelchair as we all expect them to do. I was angry enough to want the asshole arrogant ER nurse that originally called me to regret the tone he used on the phone too. Nothing wrong with her, like she was a dog I found on the street.

No lawyer would even talk to me about the case. And her body was taken to the mortuary and cremated on the same day she died so no autopsy. Because she was considered indigent the county swiftly got rid of the evidence, and said we could not even hold a memorial service for her or we would be charged thousands of dollars for the disposition of her remains.

Now, the tort reform assholes want to even make it harder to sue for real wrongdoing, and then to cap any settlements or jury awards. That county is pretty right wing and the lawyers said they will not take cases because even when juries award money verdicts the awards are so little it is not worth their time to take the case. They said if it happened in Sonoma or SF they would settle OUT OF COURT for nothing less than a million. The cited a case where that same doctor had put a chest tube into a patients stomach and the patient suffocated before anyone figured out that the tube went down the wrong way, but because it was a kid the parents successfully sued, they got thousands of dollars for the preventable death of their child.

My mom should have lived another decade. That hospital should be shut down and a different company brought in. That hospital chain has a track record of killing people at a substantially higher rate than any other place in California, and of gross overcharges to Medicare/Medicaid patients, and for ER visits. They have been fined again and again. But, that does not get my lovely mom back does it? I let it go. But, the greed based system we have in this nation is obscene and I for one think we would be better off as a nation if we abolish it with or without a replacement system, the one we have now is BEYOND repair!


Jena's picture

Sorry about your mother, Boil.  That is an awful way to go and a lousy way to lose her.

You're right, that was gross medical negligence and there were many who had a hand in what happened to her.

honestann's picture

That is one sorry story, one that makes all good folk cringe and feel sick.  Unfortunately, you [hopefully] learned a very important lesson too late --- that hospitals are one of the most harmful and dangerous places on earth.  I've seen a couple friends killed by hospitals in vaguely similar ways, sometimes while I was there.  In one other case I refused to leave my friend in their care without me being present, and she survived.  Later the doctors admitted to me that my friend absolutely, positively would have died if I had not spent my full attention at every moment while she was in their care.

I don't know whether I can even convey how uncomfortable was my situation.  I know nearly SQUAT about conventional medicine, even though I am a scientist (but physical sciences, not organic).  So I was in a situation where I had to make command decisions, and forcibly and insistently overrule what the doctors advised.  And my friend was visiting from another country, and I could not reach her relatives.  In retrospect, that was good, because they would have said "let the doctors do whatever they think is best".  They would have killed her.  I knew that.  What I didn't know, was whether what I pushed/forced them to do was much more sensible.  And I certainly didn't know my decisions would save her life.  So it was incredibly, indescribably difficult to order them around so forcibly and insistently.

Previously I had done some dangerous mountain climbing, rock climbing and other activities where risky decisions clearly had to be made and executed... otherwise people would have died.  Perhaps those experiences give us the "power" to do what we believe is best, regardless of the many and obvious ways things could go wrong, and we ourselves could be killed in the process.  I can't be sure, but I took control.  They resisted, but I barged on, asking questions and FORCING THEM to give me answers (allowing their endless qualifiers, but also forcing real information from them too).  Eventually they were providing information, but I was making the decisions for them... even though they KNEW I was not family or related.

That was one of my first experiences with how horrible hospitals are.  I had two other experiences where I wasn't there [soon enough], and my friends died.  They were killed - by the doctors and nurses at the hospital.  Not by gunshot to the head, but by blatant carelessness and lack of willingness to do their job and take it seriously.  That was just as deadly.

For anyone reading this... listen up.  If anyone is in the hospital, stay with them.  I don't give a damn whether they are "very sick" or just "in for tests or procedures".  One of my friends who was killed (when I was out of town) was sent home from the hospital and told to come back the next day for further observation.  He objected, saying "no, I can tell something very serious is wrong with me".  They kicked him out anyway.  And yes, he HAD insurance... very good, expensive insurance, so it was just carelessness and maliciousness.  He died later that night, and was discovered on the floor of his home 3 days later by a neighbor.  The hospital, even after hearing his desperation and warnings about how serious his condition was, did not even call the next day when he failed to appear for follow-ups!  And believe me, this guy was no hypochondriac, and not someone people would tend to write off as a terrified wimp.  They had no excuse for tossing him out on his ass.

I believe most doctors and nurses used to care about their clients.  I'm sure a few with private practices still do.  However, the predators-DBA-government have so completely destroyed that industry, a majority of doctors and nurses (especially in hospitals) have given up.  They have been made so cravenly uncaring that they don't give a damn whether they heal or kill.  Either way, they get paid and room is created for their next victim.

My message is... if you possibly can... stay away from hospitals in the USSA.  If you can't, but have time for a plane flight, fly to singapore, thailand, malaysia, even ecuador or mexico for treatment.  And if you get stuck in a hospital, make absolutely certain you drag your most intellectually independent, self-conscious friend with you... with plans to STAY WITH YOU until you are released.

I know that sounds absurd.  In some cases, in many cases, your friend will not need to take charge and save your life.  True enough.  But the danger is much too high to go it alone.  And believe me, taking anyone except an intelligent, intellectually-independent, self-confident personality may not help you much if and when the SHTF.  They must insist on being given ALL relevant information, being told all possible responses, and they must take charge if they feel even slightly uncomfortable with the level of care and attention you are receiving.

Finally, if you have any brains, you'll do what I did 2~3 years ago... leave the USSA for good.  It is not just healthcare that is dangerous in the 4th reich.


Jena's picture

Sadly, you are completely right.  No matter the age or mental state of someone admitted to the hosptial these days, they ought to be considered endangered and in need of protection as one would a child that you cannot entrust to anyone else, certainly not the medical or nursing staff.  I know it sounds extreme but their lives or future ability to function may depend on someone being with them while they're inside that hospital.  Never be afraid to question whether what the patient is being given is necessary or even the best course of treatment.  It may ruffle feathers but if the idea can't be explained or defended, you're not dealing with the right people.  There is nothing wrong with being a little difficult.  

I sat with my dad for hours each day for five days in a medical ICU fifteen years ago when he had pneumonia.  The nurses were okay but not real quick to pick up obvious changes in his condition despite the warnings of all the monitors.  I'd let his nurse know that this number had strayed too far or that one, but she did nothing about it (didn't give the requisite meds for which she had the standing orders that would have stopped the shortness of breath, reversed the increasing chest pain, etc.).  When it got to be too much for me, I would give his doctor a call and he'd intervene.  Those ICU nurses were glad to see my dad and me go I am sure, but I suspect he'd have died a few times over if I hadn't intervened.  Maybe not.

Expect medical mistakes.  Most doctors and nurses don't mean to make them and feel really awful when they do but mistakes will and do happen.  Ask about any medication that comes your way.  They aren't always meant for you (or the person you're guarding.)  Ask about procedures before they happen.  Mark on the patient's body if surgery is planned so they don't operate on the wrong body part ("Not this side!" But don't mark where they are going to operate -- that may mess with the incision.).  And the simplest of things:  Make sure that every single person washes their hands before they touch you or the person you are guarding.  It is the best defense that you have for getting out of there without a hospital-acquired infection, especially in the days of superbugs that take extraordinary courses of antibiotics that have nasty side effects of their own.

Yes, staying away from doctors is a great idea.  Staying out of hospitals, as a general practice is even better.  But when a Mack truck hits you there is little choice but to go where your chances of being fixed is the greatest.

TheObsoleteMan's picture

This post' answer to a problem is just tinkering within an allready broken system. GET GUBMINT OUT OF HEALTHCARE, ED-JEW-CATION, BANKING AND MUCH ELSE. End medicare and medicaid. Do that, and you could pay for 90% of your needs out of pocket. Allow only catastropic insurance policies. Above all else, END THE FDA, it exist for the benefit of the industrial medical complex.

xav's picture

I am French living in the US..  this is not to say that I am particulary fond of the French socialist system.. but here is what strikes me here..

- I am a software engineer in the healthcare insurance industry.. what we do essentially is try to become the mastercard of healthcare payments and easily connect providers to the thousands of payment plans in the US. In a single payer world, there would not even be a need for this, and from my boss mouth "If we were in the UK we would not even be in business".

 - A lot of the people I know here work in something related to healthcare.. my wife for instance works for a medical device manufacturer, her ex-husband used to work until recently for a health insurance plan until recently. In France I barely know anyone who works in something related to healthcare.

 - Lots of payments never get collected.. payment collection at least in France is not an issue, we usually know how much we will have to pay up front.. and since it's usually cheap we will pay at the spot. In the US with the presence of multiple heath plans it is very difficult for the medical provider to figure out the patient's payment portion up front. 

 - When I walk into a medical office, I usually several staffers and lots of papers. Staffers usually make tons of phone calls to heath plans in order to find out whether a patient is eligible for coverage, or why a payment was denied by the plan. In France in many instances I would not see anyone work but the actual doctor.

 - In the past 3 years I received 3 letters from my health insurance.. trying not to pay a specific claim. So essentially they spend significant amount money trying to not pay coverage.. something one would not see in a single payer world.

 - I always hear lots of advertisement from health plans... Advertisement need in a single payer world would be 0.. 

These are my obervations..

honestann's picture

Those observations are ABSOLUTELY IRRELEVANT.

Let me make a few observations.  If we set off all nuclear weapons and kill off all human beings, there will be no more murder, no more suicide, no more cancer, no more heart-attacks, no more mass shootings, no more terrorism, no more... fill in 1000s of blanks.


It is like saying, "Obviously everyone should be a slave to some master of earth, because in this "single-decider" plan, nobody ever need be confused.  Nobody ever need struggle over difficult decisions.  Nobody ever need struggle with tradeoffs.  Nobody ever need decide what to do for a living.  Nobody ever need to decide what to eat, what to grow, what they enjoy doing, etc.

You have everything 100% backwards.  What we need is 7 billion individuals making 7 billion sets of decisions, taking 7 billion sets of actions, and enjoying/baring/suffering 7 billion sets of consequences.

Of course, I have exaggerated a bit.  People do tend to look around to see what consequences others enjoy/bare/suffer as a result of which decisions-made and actions-taken.  And thus people do tend to make decision and take actions that lead to consequences they imagine they'll enjoy (or know they'll enjoy).

Which is the point of individualism, is it not?

ANY and EVERY kind of centralization is BAD, EVIL, DESTRUCTIVE.  And in the real world, whenever humans create fictitious entities (governments, corporations, organizations, etc) that give power to some to control others, the obvious result always follows --- PREDATORS GAIN CONTROL OF THAT FICTION, suck everyone dry, and eventually cause horrific widespread debt, death, warfare, disaster and destruction.

The FACT is this.  If you elimiate ALL government rules and meddling in the so-called "healthcare industry", most people would not buy or have conventional healthcare insurance.  So everyone would pay at the counter, just as you said works so well.  That's what almost everyone did in the USSA before about 40 years ago, and it worked VASTLY better and cheaper than what exists today.  For one thing, people did not flood doctor offices for minor irrelevancies, or just because they have nothing better to do.

However, I still think there is room for health insurance --- the type that is sometimes called "catastrophic care" plans.  You flat-out pay the first $10K (or $25K, or $50K, or $100K) of your own healthcare expenses.  But if something "really bad/expensive" happens, after your "deductable", everything else is covered.  Those plans are not terribly expensive.

The biggest change in this system would be... costs would NOSEDIVE... and I do not mean some modest pullback.  Oh no.  Costs of medical care would drop 90% within a year.  Maybe 95%.  Maybe even 98%.  Nobody would worry about "paying at the front counter" for their medical care.

Humans: Stop advocating totalitarianism as the answer for everything!


boiltherich's picture
Eating egg yolks as 'bad as smoking'

“Eating egg yolks is as bad as smoking in speeding up coronary heart disease” the Daily Mail says, reporting that egg yolks contribute to the clogging up of arteries which, in turn, can increase the risk of heart disease.


So does this mean we are going to slap a $3 tax per egg on anything with a yolk?