52293-Health Care Reform

[vorpal blade]

vorpal, i'd just like to say that i often have to make my gynecology appointments anywhere from a month to 3-4 months in advance because my doctor is alsways booked. it's not like americans don't wait to get appointments.

I agree that it is sometimes a problem getting an appointment to see a doctor in this country. Sometimes seeing the doctor of my choice can take a little while. In my town I have the choice of seeing the most popular doctor in a couple of weeks, sometimes less. No problem if it is routine. Or I can go to Urgent Care and take whatever doctor is available, if I am in a hurry. There I wait a few hours. Or I can go to the emergency room.

In a recent survey they found that on average in 15 U.S. cities the wait time for a first visit to an OB-GYN is 27.5 days. http://www.merritthawkins.com/pdf/mha20 ... survey.pdf In some cities it is quite a bit longer, and in other cities the average wait was only 5 days. As I understand it the wait time for established patients is less.

In Canada, however, you first see a general practitioner before you see a specialist like gynecologist. The average wait to see the gynecologist, after seeing the GP, is 60 days in British Columbia. http://www.fraserinstitute.org/commerce ... rn2008.pdf

If you had an emergency you could see a doctor with a shorter delay in both countries. If it was urgent you wouldn’t wait to see your preferred doctor. But how would you feel if you went to your doctor because you felt a suspicion lump in your breast. The doctor does some testing and confirms that you may indeed have breast cancer, but you first need to see a specialist. In Nova Scotia, for example, you would then have to wait on average 58 days to see a specialist. That’s 66 days if the GP believes you have stage 1 breast cancer, 53 days if stage 2, and 43 days if stage 3. After waiting one or two months you see the specialist and then you must wait on average another 25 days before receiving hormonal therapy, 33 days for chemical therapy, and 54 days for radiation therapy. http://www.nature.com/bjc/journal/v96/n ... 3523a.html
Keep in mind that you have no choice unless you go to another country for treatment.

[vorpal blade]

If I may be permitted to scoff... vague as a strategy? That sounds more like a cop-out than an actual valid strategy. That sounds like the kind of "strategy" I had for essays/papers just before they were due. Heck, it sounds a lot like what most politicians running for an office will resort to, making vague promises/goals that never come into an semblance of detailed fruition.

You have my permission to scoff.

I suspect we will see some detailed plan emerge in a bill 1200 pages long, that must be passed immediately before any congressman has had a chance to read it, and before real discussion and debate can be had.

[NerdGirl]

I do have some questions about the attitudes of health care workers in Canada. The government negotiates fixed fees, with the result that doctors in Canada earn only half of what they earn in the U.S. Do the doctors resent that? In a system where everyone feels entitled to “free” medical care, do people take advantage of it and see doctors unnecessarily? Do the health care administrative staff, who are paid the same whether there are patients or not, feel that patients are a burden and an unwanted increase in workload? Or are they glad to have patients to make their health care center profitable?

It's been my general experience that doctors truly aren't in it for the money and the Canadian doctors I know don't resent the fact that they could be making more money in the States. If they did, well, they'd probably move down there. It's probably the case that Canadians are more likely to go to the doctor for minor complaints because it's "free" (I haven't looked up any statistics on that, though), but I think that opens up a whole separate debate on the value of preventative medicine.

[NerdGirl]

In Canada, however, you first see a general practitioner before you see a specialist like gynecologist. The average wait to see the gynecologist, after seeing the GP, is 60 days in British Columbia. http://www.fraserinstitute.org/commerce ... rn2008.pdf

Can you see a specialist in the US without a referral from a GP? It's always been my understanding that most specialists require referrals from a GP for a first appointment, mainly so that they don't get flooded with appointments from amateur doctors who have been "researching" their symptoms on wikipedia. I've seen 3 specialists over the last year (an allergist, a gastroenterologist - thank goodness for spell check, and a dietician who specializes in celiac disease, which is what I have). I had to have a referral from my GP for the first appointments, but once I'd seen them once I was free to make any future appointments without a referral. As for gynecology, it's been a few years since I saw a gynecologist, but I didn't need a referral for that one.

If you had an emergency you could see a doctor with a shorter delay in both countries. If it was urgent you wouldn’t wait to see your preferred doctor. But how would you feel if you went to your doctor because you felt a suspicion lump in your breast. The doctor does some testing and confirms that you may indeed have breast cancer, but you first need to see a specialist. In Nova Scotia, for example, you would then have to wait on average 58 days to see a specialist. That’s 66 days if the GP believes you have stage 1 breast cancer, 53 days if stage 2, and 43 days if stage 3. After waiting one or two months you see the specialist and then you must wait on average another 25 days before receiving hormonal therapy, 33 days for chemical therapy, and 54 days for radiation therapy. http://www.nature.com/bjc/journal/v96/n ... 3523a.html
Keep in mind that you have no choice unless you go to another country for treatment.

It's interesting that you should mention Nova Scotia, as that's where I currently live. As they note in their discussion section, they only studied the wait times for one particular disease. Their study is also a few years old. Since I'm lucky enough to have several wait time data points of my own over the past year , I'll list them:

Wait time to see my GP - I usually get an appointment the same day I call, unless she's not working that day for some reason
Wait time to see allergist - 1 week, but to be fair, I had to keep a 7 day food diary for that appointment, so it really couldn't have been sooner
Wait time to see gastroenterologist for all kinds of fun tests - about three weeks, but I had to cancel that appointment and reschedule, and then I got one about a month later. That's a bit on the long side, I'll admit, but those tests involved an anesthesiologist, and I had to stop taking iron pills for two weeks, so the wait had to be at least two weeks.
Wait time to see dietician -
Wait time for a bone density test (because celiac can cause early osteoporosis) - two weeks, but that was because I had to stop taking iron pills for two weeks again

It seems like that list should be longer, but maybe that's just because I've had so many blood tests...

I'm not denying that Canada needs more equipment, doctors, and nurses (although the Alberta government is, but let's not start that rant). A big problem with getting more doctors is that in order to practice medicine in Canada, you have to have done a residency in Canada. In order to participate in the first iteration of the Canadian residency matching thing* (to use the technical term), you have to have gone to medical school in Canada. Pretty much all of the specialist residencies get filled in the first iteration, with just a few in family medicine left over. Because of those regulations, we can't just go get doctors from other countries to fill the shortages. So the government needs to increase the medical school class sizes (I say the government because there's really only 1 private university in Canada). Some medical schools are talking about starting some sort of incentive programs for students who commit to practicing in rural areas for some amount of time, which would also help the situation. It would also have helped the situation if the Alberta government hadn't been run for more than a decade by a drunk high school drop-out (http://en.wikipedia.org/wiki/Ralph_Klein for a fun read - I'm originally from Alberta and I grew up with that). They just cut funding to everything like there was no tomorrow. That's why that lady from Calgary a few years ago had to fly to Montana to give birth (I'm sure someone's mentioned that case on here) - the Klein government bulldozed a bunch of hospitals just so they could say "Look how much money we aren't spending!" Of course the public health care system doesn't work when you take away all it's money. And now I'm going to stop because I have way too much to say about Canadian politics, which was definitely not our original topic here.

*In both Canada and the US (I'm pretty sure it works the same way), medical students are matched with residencies using a system where, after doing a bunch of interviews, the applicants rank what residency they want and the programs rank what applicant they want. You commit to accepting the one you match with, and you're matched with the highest ranked one on your list that also has you ranked highly. It would be nice if the academic world adopted a similar system to match new Ph.D.s with postdoc jobs.

[Imogen]

nerdgirl,
here it depends on the doctor. i didn't need a referral to see my gyno (and i don't think i buy that you need to see a GP before seeing a gyno in canada either. is that true? getting a pap smear and all of that is just a routine check up. honestly, my GP gave me my first one. i didn't even see a gyno until a year later and only because she was a woman.) BUT you do need a referral for certain specialties, like endocrinology. just depends on what your needs are.

[NerdGirl]

Imogen- Yeah, that's pretty much how it works here. It just depends on the specialist. For a "routine" sort of specialist like a gyno, you don't need a referral. Some people might ask their GP who they recommend, but generally you can just call for an appointment on your own. But a lot of the women I know (myself included) just go to their regular doctor for routine gynecology stuff because they're more comfortable that way.

[vorpal blade]

I did some checking on wait times for medical treatment in Nova Scotia for the year 2008. According to the Fraser Institute of Toronto Canada the average wait times have generally been increasing each year in Nova Scotia and Canada. http://www.fraserinstitute.org/commerce ... rn2008.pdf The average wait time in Nova Scotia for surgical and other therapeutic treatments in 2008 was 27.6 weeks. On average the wait time between being referred by a General Practitioner and seeing a specialist was 12.2 weeks in Nova Scotia. The wait time after the specialist determines that treatment is required was 15.4 weeks.

Median patient wait times (weeks) in 2008 to see a specialist after referral from a GP: plastic surgery 40.0, gynecology 9.0, ophthalmology 10.0, otolaryngology 16.0, general surgery 8.0, neurosurgery 12.0, orthopedic surgery 51.0, cardiovascular surgery 8.0, urology 7.5, internal medicine 4.0, and medical oncology 3.0.

Median patient wait time (weeks) after appointment with a specialist before receiving treatment: plastic surgery 46.3, gynecology 8.1, ophthalmology 8.4, otolaryngology 13.6, general surgery 6.6, neurosurgery 11.0, orthopedic surgery 87.4, cardiovascular surgery (urgent) 1.4, cardiovascular surgery (elective) 5.7, urology 13.7, internal medicine 7.1, and medical oncology 2.6.

Sometimes personal experience is atypical.

[NerdGirl]

I just want to say that the Fraser Institute is know for having a very conservative agenda (and they don't try to hide it), and many people question their statistics and whether or not there stuff actually ends up getting objectively peer-reviewed. I'm not denying that wait times are longer in Canada, but I don't think the situation is as bad as people perceive it to be.

[vorpal blade]

It would also have helped the situation if the Alberta government hadn't been run for more than a decade by a drunk high school drop-out (http://en.wikipedia.org/wiki/Ralph_Klein for a fun read - I'm originally from Alberta and I grew up with that). They just cut funding to everything like there was no tomorrow. That's why that lady from Calgary a few years ago had to fly to Montana to give birth (I'm sure someone's mentioned that case on here) - the Klein government bulldozed a bunch of hospitals just so they could say "Look how much money we aren't spending!" Of course the public health care system doesn't work when you take away all it's money. And now I'm going to stop because I have way too much to say about Canadian politics, which was definitely not our original topic here.

Actually, this is precisely the problem we are dealing with. When you make health care a government function you are going to have politicians who will try to cut expenses so they can point to "savings," and the public is going to have to sacrifice in health care. Or you get politicians who will increase funding for health care, but at the expense of other government programs and needs, so taxes don't continually increase. As medical technology increases, what you can spend on health care increases much faster than inflation. Someone has to pay for it; there is no "free lunch" when it is taken over by the government. Do you really want government bureaucrats making the decisions for you?

I have quoted from the Fraser Institute. It is conservative, but other studies tend to back them up, like the breast cancer study I mentioned earlier. Sometimes people who would look bad if Canadian health care is seen in a bad light tend to downplay the problems.

Here is an example of what I was talking about when I said the government will decide who is worthy of health care. This is from an opinion piece in the Wall Street Journal February 9, 2009 (ultimately from the Fraser Institute) http://online.wsj.com/article/SB123413701032661445.html

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

[Waldorf and Sauron]

I have a lot to respond to and no time, but it may be interesting to note that that WSJ article's mention of Mr. Murray has a couple phrases bordering on plagiaristically similar to this article: http://www.fcpp.org/main/publication_de ... PubID=1526

And while I agree that the doctor, not the government or the insurance agency, should ideally pick the procedure, I should also point out that in the bit of research I did on hip resurfacing, the medical consensus seems to be to generally discourage hip resurfacing for those over the age of 55 because of changes in bone density. So in a place like canada which clearly has a shortage of specialists and, like any other system, is selective on who gets what procedures, it seems fairly reasonable given the circumstances to provide the surgeons services to those who are most likely to benefit the most from it. As I see it, the problem here is the shortage, not the way the canadian government is rationing care.

[vorpal blade]

In looking at various articles about the man who had the arthritic hip I did see a lot of the phrases repeated without much variation. I don't see it nearly so much in the article you referenced as I did in other sources. It would be interesting to find the original source or sources for this story. There are some unanswered questions.

Evidently the "Birmingham" hip resurfacing was recommended by the specialist who was treating Bill Murray. I know they can measure bone density, so I'm sure Murray's doctor was aware of whether or not this procedure was best for Murray. So who exactly denied Murray the procedure, and what was his stated reason? It seems unlikely it would be a doctor who was more familiar with Murray than Murray's own doctor. From the information I have it would appear that the government just didn't want to pay for the procedure. Perhaps they justified it on the basis that Murray would not be able to benefit from it for as many years as, say, a twenty year old. I would think an arthritic hip would be more common in older men than in younger men. Age 57 seems rather young for needing any kind of hip resurfacing surgery.

We agree that Canada has a shortage of specialists. Whose fault is that? Since the government controls who can practice medicine in Canada, and the government controls how many and what kind of residencies are available, it has to be the government that is responsible, wouldn't you agree? It's not that they have a shortage of applicants for medical school, and it is not that they have a shortage of medical school graduates who want to go into the specialties. Nerdgirl talked about this, and she was right. If the government of Canada wanted more doctors or specialists, they have a number of options.

But here is the thing. If the government makes the shortage go away, so that there are plenty of doctors and specialists, then more people will use the medical system in Canada instead of going to the States, dying while waiting, or just give up on the system. If you don't have to wait a long time for care people will go more often to see the doctor. And that will cost the government a lot more money. The way I see it, the doctor and specialist shortage in Canada is deliberately caused by the government as a means to control or reduce the cost of medical care. Money to pay the doctors and buy the medical facilities is always in short supply.

In other countries the system is selective in who gets the procedures based on your ability to pay for it. Who gets an expensive car, a huge house, and a lot of other things also depends on your ability to pay for it. Would you be in favor of letting the government decide who would most benefit from having cars, houses, and everything else? In my opinion it is not the government's business.

So, in Canada the government rations health care by creating shortages of doctors and services in order to keep the costs down.

[Waldorf and Sauron]

Vorpal,

I saw another version of the WSJ article with citations to the Carpay article I linked to, which is acceptable. I hope that as newspapers move online, they'll ditch the "space limitations" excuse and start citing sources.

I read a detailed article about what happened with Murray back when you posted it. http://www.albertaventure.com/?p=1956 Apparently, the provincial government approved 125 procedures, for people 55 and under (which, again, is medically grounded). So, Murray's inability to get the surgery was a result of statistical medical rationing of an experimental procedure. Which, given the lack of specialists, is understandable. It wasn't being decided on a case-by-case basis like it should have, but when you can only do so many procedures, it certainly makes sense to give them to those who can enjoy them the longest—not those who can pay the most, as it is in the USA.

Note that your insurance probably wouldn't have payed for the procedure either, as many insurance companies won't pay for "experimental" procedures, and the Birmingham wasn't approved until 2006, and Murray was denied in 2004.

I don't know the reason behind Canada's doctor shortage, but I'm not convinced by your arguments that the government WANTS long wait times. If you have any reputable sources to back that up with, I'd love to read them.

You say "In other countries the system is selective in who gets the procedures based on your ability to pay for it." We are the only developed country without universal health care. What other country's system would you like us to imitate? The difference between health care and big houses/expensive cars is that many people believe health care in a developed country to be a right, not a luxury. You can disagree with their opinion, but it really is the opinion of many. I believe it to be the right of all but the lazy unworking.

Health care rationing happens and always will happen, determined through either an insurance corporation, your ability to pay, or the government. I find the first two to be the least acceptable for the working poor, or the 46 million uninsured people in America. They can not pay the full cost of care and many can not afford insurance or have pre-existing conditions.

[vorpal blade]

I read a detailed article about what happened with Murray back when you posted it. http://www.albertaventure.com/?p=1956 Apparently, the provincial government approved 125 procedures, for people 55 and under (which, again, is medically grounded). So, Murray's inability to get the surgery was a result of statistical medical rationing of an experimental procedure. Which, given the lack of specialists, is understandable. It wasn't being decided on a case-by-case basis like it should have, but when you can only do so many procedures, it certainly makes sense to give them to those who can enjoy them the longest—not those who can pay the most, as it is in the USA.

As I read the article the issue was not that there was a lack of specialists. Murray had a specialist lined up to do it, and he was willing to use his own money. The problem was the government would not allow the clinic to perform the procedure because he was over 55 years old, even though his obtaining the procedure would not limit anyone else from having the procedure done.

Note that your insurance probably wouldn't have payed for the procedure either, as many insurance companies won't pay for "experimental" procedures, and the Birmingham wasn't approved until 2006, and Murray was denied in 2004.

At least I have the freedom in this country to pay for an "experimental" procedure out of my own pocket, if I choose. I can also switch insurance companies if the one I have isn't doing its job.

I don't know the reason behind Canada's doctor shortage, but I'm not convinced by your arguments that the government WANTS long wait times. If you have any reputable sources to back that up with, I'd love to read them.

You mean like getting a politician to go on record as saying, "We restrict the number of seats in medical school and in residencies in order to increase wait times and reduce the cost of medical care in Canada?" Well, that kind of quote might be hard to find. I'm sure the politicians are going to have other explanations, such as "ensuring the level of quality that Canadians have come to expect."

Canadians are not stupid. They know they can increase the number of doctors by making it easier for foreign trained doctors to practice medicine in Canada. If they are concerned about the training they have received they can devise a method to test them, or train them. Or they can increase the number of seats in medical school and the number of residencies. It is such a simple and obvious solution. In my reading I haven't come across any explanation of why they don't do this except a few words about quality and a lot of words about cost. One fear is that once they train a lot of doctors they will just lose them to America, or some other place. That also can be fixed by paying them a wage based on their market value. I'm sure most Canadians would rather live in Canada, all else being equal.

You say "In other countries the system is selective in who gets the procedures based on your ability to pay for it." We are the only developed country without universal health care. What other country's system would you like us to imitate? The difference between health care and big houses/expensive cars is that many people believe health care in a developed country to be a right, not a luxury. You can disagree with their opinion, but it really is the opinion of many. I believe it to be the right of all but the lazy unworking.

We have universal health care. You say that not everyone can get all the health care they want or need. Same is true in every other country. Anyone with a medical emergency can get free health care in this country. You say it is more expensive, but so what? I don’t say I like everything about our system, but it is unfair to claim that we don’t have universal health care. I would like us to imitate the system we had sixty years ago.

Everyone claims that what he wants is a “right.” The “right” to marry a person of the same sex. The “right” to a job. The “right” to a free education. We can debate whether or not our country should be involved in various activities, but please don’t call it a right unless you can point to a section in the Constitution that explicitly guarantees that right.

Health care rationing happens and always will happen, determined through either an insurance corporation, your ability to pay, or the government. I find the first two to be the least acceptable for the working poor, or the 46 million uninsured people in America. They can not pay the full cost of care and many can not afford insurance or have pre-existing conditions.

Some of that 46 million look at the cost of health insurance and make the decision that they would rather risk getting ill than pay the premiums. Would you deny them the right to choose? Some of them will not be able to afford the premiums, especially if they have pre-existing conditions. From the point of view of the insurance companies it doesn’t make good business sense to insure them, and it is unfair to force the others insured to pay for those you know in advance will be taking more out than putting into the system. Insurance is supposed to be about limiting risks; it is not a prepaid health program.

So, I’d rather live with the health insurance companies and the freedom to plan for my own future, than turn it over to the government. I think we need to be looking at what makes health care so expensive, so we can reduce the cost and make it affordable for all who wish to work.

[vorpal blade]

If I may be permitted to scoff... vague as a strategy? That sounds more like a cop-out than an actual valid strategy. That sounds like the kind of "strategy" I had for essays/papers just before they were due. Heck, it sounds a lot like what most politicians running for an office will resort to, making vague promises/goals that never come into an semblance of detailed fruition.

You have my permission to scoff.

I suspect we will see some detailed plan emerge in a bill 1200 pages long, that must be passed immediately before any congressman has had a chance to read it, and before real discussion and debate can be had.

This prediction seems to be coming true. President Obama is pushing hard for Congress to pass a health care bill in the next two weeks. Congressmen are not only being asked to support a long bill they haven't had a chance to read, but before it has even been written.

[Nanti-SARRMM]

This prediction seems to be coming true. President Obama is pushing hard for Congress to pass a health care bill in the next two weeks. Congressmen are not only being asked to support a long bill they haven't had a chance to read, but before it has even been written.

Actually it just left committee. And it'll cost 1.5 trillion dollars or so.

[TheBlackSheep]

That's nothing new, really. Congresswomen and men rarely read bills themselves. It makes it more exciting.

[vorpal blade]

That's nothing new, really. Congresswomen and men rarely read bills themselves. It makes it more exciting.

Say it ain't so, Black Sheep! I'm getting so disillusioned with Congress!

Okay, this seems to be true nowadays, but it hasn't always been true. There was a time when bills were discussed, debated, and time was given to digest the consequences.

I get the feeling that some people just want the power to take over a large segment of our economy, and they will figure out how to manipulate the law after it is passed so it keeps them in power, or they can ride to the rescue and "fix" the problems they created. They aren't going to make the system better without a lot more thought being put into it then they have. But then, the problem for some of them is not health care so much as it is that we have too much freedom.

[vorpal blade]

It seems to me that every time health care reform is discussed, the only options allowed to come to the table involve expansion of government control and power. In the name of “progress” our freedoms are chipped away, little by little. Incrementally we lose a little bit each year, because the only alternatives allowed for discussion lead in the state-controlled direction. Conservatives just want to be left alone, so the field is left to those who want to make changes, meaning people who want you to give up something so they can make progress toward their socialist agenda. So, I thought I would give some ideas of the kind of health care reform I would like to see discussed.

Make a license to practice medicine optional. Anyone who wanted to would be free to set out his shingle and see patients. The only requirement would be that the doctor must be honest and upfront in his claims. If he claims to have a medical degree from an AMA approved school, it needs to be true. People would be free to see the AMA approved doctors if they choose, or the foreign trained or not formally trained doctors if they wished. This would do away with the artificial shortage of doctors, and make the medical profession truly competitive. Doctors would not be able to charge nearly as much for their services as they do now.

Get the legal profession out of the medical field. A large part of the cost of seeing a doctor is in the malpractice insurance and unnecessary tests the doctor must specify to avoid a lawsuit. I would make it so that doctors could offer you services that are immune to lawsuits. If you wished to pay the doctor extra for some kind of guarantee of outcome, or insurance against mistakes, you and your doctor could agree to that. Otherwise you would rely on the doctor’s reputation and his desire to do the best he could.

Privatize the Federal Drug Administration. Having drugs and equipment approved for public use would be optional. If you wished to buy drugs, or have your doctor use only drugs that have been approved by the privatized FDA, you could choose to do so, and expect to pay many times what you otherwise would pay. Other testing companies could also offer to test drugs and give you some assurance or guarantee of effectiveness, and compete with the privatized FDA. The FDA holds drugs up for years, and cost drug companies billions of dollars for clinical tests. If you didn’t want to wait years for the latest drugs, or were willing to rely on the good name and reputation of the drug company selling the drug, you could take your chances. The privilege of suing, or a guarantee, would cost you extra.

Get the government out of the health care business. The government would not tax you for health care, such as Medicare. The government would not force any doctor, hospital, or clinic to take any patient that couldn’t pay for the services. If you didn’t have insurance, and you couldn’t realistically be expected to pay, you would rely on charity. There would be more competition for your health care business, and fewer non-paying customers to jack up the costs you pay.

Insurance companies would be able to offer plans available across the nation, and not just in one state. The insurance companies would not be required to cover anyone. Once they agree to cover you, however, the insurance company would be obligated to pay for the agreed upon services, as long as you kept paying premiums, which could not arbitrarily be increased. The insurance companies could offer reduced premium costs for those willing to accept “less qualified” doctors, hospitals, or clinics, and “less regulated” drugs and medical equipment. You could specify the level of qualification with which you are comfortable.

With my modest proposals health care would cost much less than it does now. With costs greatly reduced, insurance would only be used for truly catastrophic cases. Almost all health care expenses would be easily paid for out of pocket, thus reducing the power and influence of insurance companies.

I expect my ideas would meet with stiff resistance, particularly from special interests (medical profession, insurance companies, drug companies) who benefit from the current situation. That includes interests of those in the government who have an ideological interest in state control of our lives.

[TheBlackSheep]

Well, wow. That's one way to decrease the surplus population. But that's probably just my socialist agenda talking.

[Foreman]

It seems to me that every time health care reform is discussed, the only options allowed to come to the table involve expansion of government control and power. In the name of “progress” our freedoms are chipped away, little by little. Incrementally we lose a little bit each year, because the only alternatives allowed for discussion lead in the state-controlled direction. Conservatives just want to be left alone, so the field is left to those who want to make changes, meaning people who want you to give up something so they can make progress toward their socialist agenda. So, I thought I would give some ideas of the kind of health care reform I would like to see discussed.

Make a license to practice medicine optional. Anyone who wanted to would be free to set out his shingle and see patients. The only requirement would be that the doctor must be honest and upfront in his claims. If he claims to have a medical degree from an AMA approved school, it needs to be true. People would be free to see the AMA approved doctors if they choose, or the foreign trained or not formally trained doctors if they wished. This would do away with the artificial shortage of doctors, and make the medical profession truly competitive. Doctors would not be able to charge nearly as much for their services as they do now.

Get the legal profession out of the medical field. A large part of the cost of seeing a doctor is in the malpractice insurance and unnecessary tests the doctor must specify to avoid a lawsuit. I would make it so that doctors could offer you services that are immune to lawsuits. If you wished to pay the doctor extra for some kind of guarantee of outcome, or insurance against mistakes, you and your doctor could agree to that. Otherwise you would rely on the doctor’s reputation and his desire to do the best he could.

Privatize the Federal Drug Administration. Having drugs and equipment approved for public use would be optional. If you wished to buy drugs, or have your doctor use only drugs that have been approved by the privatized FDA, you could choose to do so, and expect to pay many times what you otherwise would pay. Other testing companies could also offer to test drugs and give you some assurance or guarantee of effectiveness, and compete with the privatized FDA. The FDA holds drugs up for years, and cost drug companies billions of dollars for clinical tests. If you didn’t want to wait years for the latest drugs, or were willing to rely on the good name and reputation of the drug company selling the drug, you could take your chances. The privilege of suing, or a guarantee, would cost you extra.

Get the government out of the health care business. The government would not tax you for health care, such as Medicare. The government would not force any doctor, hospital, or clinic to take any patient that couldn’t pay for the services. If you didn’t have insurance, and you couldn’t realistically be expected to pay, you would rely on charity. There would be more competition for your health care business, and fewer non-paying customers to jack up the costs you pay.

Insurance companies would be able to offer plans available across the nation, and not just in one state. The insurance companies would not be required to cover anyone. Once they agree to cover you, however, the insurance company would be obligated to pay for the agreed upon services, as long as you kept paying premiums, which could not arbitrarily be increased. The insurance companies could offer reduced premium costs for those willing to accept “less qualified” doctors, hospitals, or clinics, and “less regulated” drugs and medical equipment. You could specify the level of qualification with which you are comfortable.

With my modest proposals health care would cost much less than it does now. With costs greatly reduced, insurance would only be used for truly catastrophic cases. Almost all health care expenses would be easily paid for out of pocket, thus reducing the power and influence of insurance companies.

I expect my ideas would meet with stiff resistance, particularly from special interests (medical profession, insurance companies, drug companies) who benefit from the current situation. That includes interests of those in the government who have an ideological interest in state control of our lives.

Also: we should eat babies.