I'm going to England for my medical care...

<div class='quotetop'>QUOTE(dbermanmd @ Jun 27 2007, 11:26 AM) [snapback]468854[/snapback]</div>

1. Deducting healthcare from your taxes.:

I disagree in principal and in practice. In principal, I'm against all deductions and credits. The tax code is not a carrot and stick for the the government to prod us in the way it thinks we should go. A straight income or sales tax please and I prefer a sales tax to encourage Americans to save instead of spend.

In practice, the poor don't pay much in taxes so allowing them to deduct healthcare cost isn't going to help much. Who it will help is those middle / upper class people that already purchase healthcare. It won't bring more people in, just benefit those already buying healthcare on their own.

2. I'm not sure how you can have a no fault and still pay out claims. Will the patients own insurance pay for the damage done by the doctor? What if the patent has no insurance? Most states that have tried no fault auto insurance have seen rates rise. I know my insurance in Michigan was a lot more than friends in surrounding at-fault states.

If you pay out the claim as an annuity then you just adding a different insurance company to make money on the deal. The company that get the lump sum and pays out the annuity will want a cut too.

I have no problem with attorney fees. Most attorneys take the case with no payment up front and only get paid if they win. 40% seems to be about right for that kind of gamble. If you want a better rate, pay the attorney by the hour like you would any other professional.

 

<div class='quotetop'>QUOTE(dbermanmd @ Jun 27 2007, 11:26 AM) [snapback]468854[/snapback]</div>

Addressing your bullets.
1. Tax deductions are a ploy for the wealthy to pay fewer taxes. I get to deduct my health insurance and get 15% back on my tax return for what I pay in health insurance, yet someone wealthy does the same and would get 35% back on his/her tax return for what they pay in health insurance. So the wealthy person's insurance is then subsidized by 35% from the US Government, but a middle income person's is subsidized at a lower 15%. And someone who is lower income, and doesn't pay personal income tax after other deductions, would have 0 % of a subsidy from such a tax law change. That is subsidizing more the people who need the subsidies less - sounds like a good idea to a republican.

1b. This could only go so far. Buying in groups can lower somewhat health insurance costs, but one would still have to be able to pay the costs to join in such a program, which would be unattainable by a lot of people. They would still have to pay a lot of out of pocket costs for medical treatment, if they could afford it. This would have a small effect on covering more people and lowering treatment costs.

2. From the limited knowledge I know about malpractice, I agree that something should be done, but I am not sure what.

 

I don't know why you guys bother discussing this with DOCTOR Berman. He has a vested interest in healthcare. It's like trying to convince an oil company to sell less oil and create more alternatives. "Why? we make a lot of money doing what we do. Why would we want to make less? For the good of the country? Yeah right!"

You ought to discuss this issue right around him.

 

<div class='quotetop'>QUOTE(Darwood @ Jun 27 2007, 12:29 PM) [snapback]468891[/snapback]</div>

I had to think twice before responding. But he brought up the two points that Bush and republicans like to throw out as 'solutions', and he did it without too much slander and unintelligible phrases, so I figured in this one case, he deserves a response

Speaking about the lawyers, it is interesting to me that a doctor comments on how much lawyers make. From my perspective, lawyers and doctors are two of the most overpaid professionals there are. They are both needed, but so are research scientists who usually make a third or less what doctors and lawyers make, even though research scientists typically go to school for the same amount of time and probably have a larger contribution to the well being of society.

 

Well said.
You've also hit on a difference between the two parties.
One is funded by a huge group of overpaid lawyers and one is funded by a huge group of overpaid doctors and energy companies.

Too bad we don't have an overpaid renewable energy industry to fund a third party. Well, I suppose some day they'll be the same guys that are now the overpayed energy companies. And we'll still have the overpayed doctors and lawyers.

 

people who need major medical care don't usually make a lot of money. it's kinda hard to make money when you're sick or disabled or the like... so deducting anything from severely decreased income isn't super helpful.

cost of medical insurance is one issue, quality of coverage is a vastly different one. most people can only afford to take what their employer has to offer- insuring yourself is usually much more expensive. employers don't want to spend a ton of money contributing to their employee health plans, so they pick high deductible, limited coverage plans. unless we mandate certain coverages as a minimum standard, you're still going to have a big disparity.

 

True.
That's why I think we need a hybrid system.
Basic coverage and prevention for all through an expanded Medicare (Along with increased Medicare tax). And then the current insurance system would (without any change other than a drastic cut in cost) act as the supplemental insurance for those who can afford it. This would ease the insurance burdon of all US companies, provide BASIC universaal coverage, yet leave alone the cash cow advanced healthcare system that does provide advanced healthcare (to those who can afford it). You'll never get away from the fact of life that the wealthy can find a way to buy better healthcare.

 

That's kind of what we have here, Darwood. There are private hospitals, there are consultants who perform private practice, and private health insurance is available, and fairly often made available as part of an employment package.

However, the NHS is good enough that people don't need to rely on private health insurance. And I suspect that private health insurance is cheaper here, because the NHS deals with the expensive, difficult and emergency stuff. Often you might end up just using your private insurance to pay for a private room instead of a ward, in an NHS hospital.

And I would take the stories about huge waiting times with a pinch of salt; this was certainly a problem 10 years ago, but the Labour government have worked hard to reduce them, with apparent success.

 

SSHHHHhhh!!!
You're going to steal DOCTOR B's thunder!

-Never F*** with a man's livelihood! :angry:

 

Sweet I could bilk the system for millions!

No really, that's a serious issue. But then again, we've been facing that issue for years already in the form of fighting insurance companies to pay claims. It's no different, except instead of poor, disabled people having to fight insurance companies, you'll have insurance companies fighting the government over whose responsibility a certain procedure is. I'd say a rough starting point is
Preventative, basic care, emergency room, child birth, disgnosis are basic coverage.
Chemotherapy, radiation, transplants, advanced disease fighting, new and experimental procedures, specialists of all types are covered by supplementals.
Sex changes, liposuction, facelifts, invitro, etc. should be cash only and not covered by anything.

 

<div class='quotetop'>QUOTE(Darwood @ Jun 27 2007, 02:00 PM) [snapback]468961[/snapback]</div>

So the working poor can be diagnosed with cancer for free but because they can't afford to pay the supplemental that covers the actual treatment they die.

In what way is that different than what we have now?

 

It would cover tha vast majority of situations where uninsured patients cost the system billions, and ups insurance cost for you, me and Dr. B.

It provides basic care to those with basic salaries. It's a nice thought that everyone can get every single life extending benefit possible regardless of cost, but this isn't utopia and never will be. And don't lecture me on the horrors cancer deaths. I lost my brother to cancer. At least the working poor could have a proper child birth or could go in to get stitches or a cast. By just giving the basics to everyone, it should eliminate a lot of red tape.

 

<div class='quotetop'>QUOTE(dbermanmd @ Jun 27 2007, 06:19 AM) [snapback]468742[/snapback]</div>

What does that have to do with the price of tea in China?

 

<div class='quotetop'>QUOTE(Darwood @ Jun 27 2007, 10:29 AM) [snapback]468891[/snapback]</div>

Objection. Some doctors are paid fee-for-service, some by capitation, some have financial interests in MRI machines that they refer people to for imaging..

and then some of us make a salary, plus a bonus if we work extra-hellaciously hard, and a penalty if we don't work hard enough, and aren't paid in any of the unethical ways that I just listed.

I'm *not* complaining about what I make, because I do very well. But I get paid the same amount, basically, to just "do the work." Although being a doctor is about a lot more than "doing the work," even in the state of things today.

Those of us who don't make our living doing procedures all the time (like pediatricians and family doctors, ie, me) are especially annoyed by the comparison you make, because it's sweeping, inaccurate, and uninformed.

We DO have a vested interest in healthcare... at least, I sure as hell do. But it isn't financial! Don't even get me started on the bloodsucking Big Pharma. I don't talk to them, or accept f**k-all from them. Nor would any legitimate doctor, in my opinion.

Talk to some English people about their healthcare system before you spout your ignorance. What you'll find is that like us, they have an imperfect system, too. A real analysis of those differences is a book -- not an article, not a Time magazine essay, not a sound bite on the evening news.

 

<div class='quotetop'>QUOTE(IsrAmeriPrius @ Jun 27 2007, 06:35 PM) [snapback]469077[/snapback]</div>

Oh come on...you know how he rolls. If he's losing an argument, it's time to shuck and jive. And redirect.

 

"Those of us who don't make our living doing procedures all the time (like pediatricians and family doctors, ie, me) are especially annoyed by the comparison you make, because it's sweeping, inaccurate, and uninformed."
-Zapronoth.

I apologize. I did not mean to lump all doctors togother, as I was referring to Dr. B specifically and his staunch stance against some sort of universal healthcare. I know that most doctors are hard working caring people.

 

<div class='quotetop'>QUOTE(daronspicher @ Jun 27 2007, 02:49 PM) [snapback]468952[/snapback]</div>

They want to create a "constitutional right" for healthcare and sling paying for the right onto everyones backs.

And why would my opinion matter - just because i am a physician i am not allowed to have an opinion - perhaps even an informed opinion? I guess they go to starbucks to service their Prii too.

For the record - whatever happens to the US healthcare system will make little if no difference in my income - we think here in Manhattan many of us would be doing much better in fact and without a lot of the current hassle we currently enjoy.

I am amazed by the lack of insight as to the significnat impact medical malpractice has on the US healthcare system - especially the costs. How can you have socialized medicine without doing away with the current med mal system -who is going to pay those med mal premiums - certainly not the physicians (how can an ob-gyn afford the $180,000 annual premium which is always rising?). How do you keep the current med mal providers in business? This alone is a significant issue that has to be addressed with or without nationalizing healthcare.

It is interesting that countries that now have nationalized healthcare are moving towards private healthcare. The Labour govt in england currently aspires to give patients a choice of 4 providers including one being a private physician and wants to triple the number of surgeries done by private physicians within two years. Sweden is contracting out 80% of Stockholm's primary care and 40% of total healthcare services. Germany is turning over the majority of its public hospitals to the private sector..... there are a number of HUGE lawsuits in Canada involving patients waiting for care that have serious illnesses including cancer...

Again, there is a simple way to tweak our current system:

1. Tax parity for healthcare insurance purchases
2. Nationally available policies

Either way - for those of you who want Wash DC to control your healthcare choices and safeguard your medical records and history - there are a lot of Americans who do NOT want it - if you want it fine and dandy - just dont drag us along for the downhill ride.



<div class='quotetop'>QUOTE(Darwood @ Jun 28 2007, 09:19 AM) [snapback]469331[/snapback]</div>

and you are assuming i am not caring or hard working?

 

<div class='quotetop'>QUOTE(daronspicher @ Jun 28 2007, 09:14 AM) [snapback]469326[/snapback]</div>

yeah, first i suggest you don't go betting on anything today.

i'm a graduate student. my group that goes to negotiate prices with the insurance companies is comprised of a few hundred people, so we don't have a hell of a lot of negotiating power. many of the under-24 group choose to stick with their parents' insurance until they're kicked off, and many of the married ones have a spouse who has better benefits. (i, unfortunately, don't.)

i don't get a "paycheck." i get a living allowance, along the lines of a minimum standard set by the US government for stipended grad students. i assure you it's no luxurious lifestyle kinda thing.

my husband is a mechanic. working at a dealership is extremely demanding as it is, but when it comes to the employee health plan it's just like the demands of the job- you take it or leave it, there is no negotiation.

yeah, we got stiffed. twice. hope you're not too shocked that people actually do get bent over in this world