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Why I'm afraid of UHC

Loren Pechtel said:
https://www.usatoday.com/story/news...actice-claims-discipline-poor-care/909170001/

We have a good example of the problem here. The VA is in effect a UHC system. Treating the patient takes priority over treating the patient correctly--they're hiring doctors that lost their licenses for doing a bad job.
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Well, if their policy was to specifically hire doctors that lost their license, then I'd agree, that'd be worrisome, but not with regards to UHC. UHC doesn't just open up Government Clinics and staff them like VA.
 
Loren Pechtel said:
https://www.usatoday.com/story/news...actice-claims-discipline-poor-care/909170001/

We have a good example of the problem here. The VA is in effect a UHC system. Treating the patient takes priority over treating the patient correctly--they're hiring doctors that lost their licenses for doing a bad job.
Click to expand...

Well, just about every industrialized nation other than America has what you fear. Are your fears realized in those other countries?

If not, them your fears are out of touch with reality, and you have to find a new excuse for wanting America to pay more for healthcare than any other industrialized nation.
 
Also, a big part of the problem with the VA is that it's woefully underfunded, so you get the docs that can't keep a job elsewhere, and/or have slipped through the cracks in other ways. If the entire system were on a level playing field, you wouldn't have this kind of disparity. You're comparing apples to bing cherries here...not even close.

There is no reason why a honestly implemented (i.e. not implemented like the ACA where the GOP hoped from day 1 to cause it to fail) UHS system couldn't work in the US. It's one of the few things we could look at in civilized countries and try to emulate, learn from the good and bad that others have implemented. There's nothing about scaling it to the US that is inherently harder.
 
Underseer said:
Loren Pechtel said:
https://www.usatoday.com/story/news...actice-claims-discipline-poor-care/909170001/

We have a good example of the problem here. The VA is in effect a UHC system. Treating the patient takes priority over treating the patient correctly--they're hiring doctors that lost their licenses for doing a bad job.
Click to expand...

Well, just about every industrialized nation other than America has what you fear. Are your fears realized in those other countries?

If not, them your fears are out of touch with reality, and you have to find a new excuse for wanting America to pay more for healthcare than any other industrialized nation.
Click to expand...

Now why would Loren examine numerous well established examples when he can examine one thing that can tenuously be compared to what he's criticizing?
 
Loren Pechtel said:
The VA is in effect a UHC system.
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Nope. Not even close.
It's an isolated piece of national health care that attracts the worst practitioners (UNIVERSAL health care would involve ALL practitioners) and lacks the bargaining power accrued to the world's biggest customer (which UHC would be). And those are just the most obvious of the differences...
 
When the normal career path for a MD is to work in contexts where his or her patients will have their bills covered by an agency that pays a fixed rate for a given treatment, and one that's generous enough, that's where doctors, including good doctors, will want to work. When the normal career path for an MD is to work in a context where they can set the fee, and it's take it or leave it for the patients, then good doctors who are also half-way decent businesspeople will *not* work in those few niches that are organised otherways. In a segregated system like the one you have, you'll get three kinds of people working in VA: a small number of hopeless idealists, some idiot savant ingenious doctors who lack the social intelligence to sell their skills on the market, and some doctors who just aren't good enough to make it out in the wild.

When, on the other hand, sending their bills to the UHC provider is what doctors do and a private practice that doesn't have a contract with the UHC provider struggles to survive, the selection effects are almost the opposite: All normal and good doctors are going to work for UHC, and the ones that volunteer to stay outside are for the most part better businesspeople than doctors and selling what in most cases deserves the term charlatanry (plus some niches like plastic surgery UHC doesn't cover).
 
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Worldtraveller said:
Also, a big part of the problem with the VA is that it's woefully underfunded, so you get the docs that can't keep a job elsewhere, and/or have slipped through the cracks in other ways. If the entire system were on a level playing field, you wouldn't have this kind of disparity. You're comparing apples to bing cherries here...not even close.

There is no reason why a honestly implemented (i.e. not implemented like the ACA where the GOP hoped from day 1 to cause it to fail) UHS system couldn't work in the US. It's one of the few things we could look at in civilized countries and try to emulate, learn from the good and bad that others have implemented. There's nothing about scaling it to the US that is inherently harder.
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Yes. Exactly. Most of the fears I hear expressed by Americans about UHC boggles my mind, because I live with UHC and have all my life and wouldn't give it up. Yes, we have triage and you will indeed wait months for a non-essential procedure, but the reports of people dying in the streets because of waiting lines are false. Unqualified doctors also false, though maybe that would happen in a two tiered system. Is that what you have with the VA? In Canada you are a doctor in the universal system, and there is no other option (unless you do something like cosmetic surgery) so you don't have all the best doctors in one system and thew worst in another.

Perhaps that is an argument for universal single payer instead of Obama's "public option" concept? I don't pretend to know much about US health care system other than it lines the pockets of for profit health insurance companies that shouldn't exist.
 
I have some grave concerns about government run UHC in the US ONLY because I don't think that health care should be politicized AND because currently, Medicaid and increasingly Medicare reimbursements do NOT cover the cost of actually providing care to patients.

If you think that health care wouldn't be politicized in the US, ask any woman of reproductive age or anyone who actually cares about a woman of reproductive age and they will explain all about how many people--including posters in this forum--flipped out over women getting free birth control.

Anyone who works in health care will tell you that there is grave concern about the continued ability to provide excellent health care when costs are not adequately reimbursed. For quite some time now, health care providers have been working very hard to reduce costs. It's a serious issue.

THAT is what I find worrisome about Govt UHC in the US. I know other countries don't have the same issues. I wish I believed the US would not.
 
So we've got two examples of poor hiring practices contrary to VA policy out of the thousands of doctors at the hundreds of VA facilities and that makes the idea of UHC untenable. Great logic you got there, Loren.
 
By a similar token, wouldn't Medicare be, in effect, a UHC system, but mostly just for the elderly? Pretty sure it has quite a different track history than the VA.
 
Samhain said:
By a similar token, wouldn't Medicare be, in effect, a UHC system, but mostly just for the elderly? Pretty sure it has quite a different track history than the VA.
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It's not universal, and lacks the bargaining power that UHC would have. It also allows docs to opt out. By definition, UHC would have to be the only game in town, so comparing to Medicare or the VA is misguided.
 
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Toni said:
If you think that health care wouldn't be politicized in the US....
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It you think health care isn't politicized in Canada, France, England, Germany, Australia, and every other country that has UHC, I have a nice bridge to sell you.
 
Loren Pechtel said:
https://www.usatoday.com/story/news...actice-claims-discipline-poor-care/909170001/

We have a good example of the problem here. The VA is in effect a UHC system. Treating the patient takes priority over treating the patient correctly--they're hiring doctors that lost their licenses for doing a bad job.
Click to expand...

A true UHC that meant a reduction in average pay for doctors would mean more competent doctors would be willing to work for VA rates. Market forces and all that, you know.

It might be more practical to do something about an education system that leaves a newly minted MD with a half million dollar student loan debt, but that's just crazy talk.
 
Worldtraveller said:
Also, a big part of the problem with the VA is that it's woefully underfunded, so you get the docs that can't keep a job elsewhere, and/or have slipped through the cracks in other ways. If the entire system were on a level playing field, you wouldn't have this kind of disparity. You're comparing apples to bing cherries here...not even close.

There is no reason why a honestly implemented (i.e. not implemented like the ACA where the GOP hoped from day 1 to cause it to fail) UHS system couldn't work in the US. It's one of the few things we could look at in civilized countries and try to emulate, learn from the good and bad that others have implemented. There's nothing about scaling it to the US that is inherently harder.
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^^^ That 10000%
 
UHC is a no-brainer. The only thing standing in the way is the prejudiced, us vs. them punishment mentality of right wing authoritarian followers. That is literally the only reason so many people in this country have healthcare worries - because some stunted minds believe, among other things, that poor=undeserving and that they, the stunted minds, are the ones who judge who is deserving.
 
Angry Floof said:
UHC is a no-brainer. The only thing standing in the way is the prejudiced, us vs. them punishment mentality of right wing authoritarian followers. That is literally the only reason so many people in this country have healthcare worries - because some stunted minds believe, among other things, that poor=undeserving and that they, the stunted minds, are the ones who judge who is deserving.
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exactly
 
ZiprHead said:
So we've got two examples of poor hiring practices contrary to VA policy out of the thousands of doctors at the hundreds of VA facilities and that makes the idea of UHC untenable. Great logic you got there, Loren.
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This is what I was reading. The story was thin on useful information.

I'll take any healthcare system where a profit motive is absent. Regardless of how many poor doctors that may be in the VA healthcare system versus civilian healthcare (and we damn sure didn't find out in this article), medical professionals who can go about their jobs without concern for efficiencies administrators are breathing down their necks, is a preferred healthcare system for me.
I've had the opportunity to compare both civilian and military/VA healthcare systems. I still have both available to me. I've seen these efficiencies firsthand and prefer the VA.
For all these horror stories, consider, the VA arguably takes care of the most broke-dick people in the United States. Horror stories are easy to come by.
 
Worldtraveller said:
Also, a big part of the problem with the VA is that it's woefully underfunded, so you get the docs that can't keep a job elsewhere, and/or have slipped through the cracks in other ways. If the entire system were on a level playing field, you wouldn't have this kind of disparity. You're comparing apples to bing cherries here...not even close.

There is no reason why a honestly implemented (i.e. not implemented like the ACA where the GOP hoped from day 1 to cause it to fail) UHS system couldn't work in the US. It's one of the few things we could look at in civilized countries and try to emulate, learn from the good and bad that others have implemented. There's nothing about scaling it to the US that is inherently harder.
Click to expand...

But even if UHC systems start out properly funded the funding doesn't keep up with the need.
 
Loren Pechtel said:
https://www.usatoday.com/story/news...actice-claims-discipline-poor-care/909170001/

We have a good example of the problem here. The VA is in effect a UHC system. Treating the patient takes priority over treating the patient correctly--they're hiring doctors that lost their licenses for doing a bad job.
Click to expand...

You have to consider the alternate to a government financed health care system. (I am giving you the benefit of the doubt that you didn't mean a universal health care system, that you meant a government financed health care system, that is Medicare for all. Lots of folks tell us that we already have an UHC system right now, that no one is denied treatment, that the uninsured can just go to the emergency room.)

What we have now is a ridiculously expensive health care system in no small part because we rely on for profit insurance companies to deliver us our medical care. And not only do the for profit insurance companies markup medical care costs by 25% when they decide how much to charge for their premiums, compared to 2 to 3% added administrative costs of Medicare, they have an incentive to increase the costs of medical care, rather than to lower the costs of medical care. For every 10% in increased medical costs, they earn an additional 2.5% of profit without any additional risk, without any additional investment. Is there any mystery why costs spiral out of control when we rely on for profit insurance companies to contain costs? See Fox/Henhouse.
 
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