Impossible!

[monkeymd2b]

I consider it an improvement if a person goes from no access (or avoiding access due to inability to pay) to being able to go to the doctor with a lower burden of paying the cost. I don't think I said the health care would be improved, I just feel that if preventive medicine can be done at the primary level, which equal access would allow, then people would be better off. What costs more: the vaccination for polio or the costs of caring for a person who had polio? I view the system right now as only vaccinating those with insurance but in the end, having to pay 2-3 times more to take care of the people who contracted the disease because they couldn't afford or didn't have insurance to get the vaccine. Taking care of an infant with H. influenzae meningitis is so much more expensive than if the same baby had the vaccine (fortunately most if not all babies are immunized at birth). Many people die from the flu every year and the cost of treatment can be immense depending on how many complications arise yet the cost of the vaccine is minimal (relatively speaking). I just feel that if all people had access to primary prevention, there could be money saved that would have been spent on tertiary prevention. I know, idealistic and perhaps unrealistic but occasionally I can come out of this jaded state of mind that comes over me after working at charity hospital.

[monkeymd2b]

Okay I reread my last post I sound like one of those "Save the children" funds that show poor african kids with bugs flying around them then show them all dressed up in school thanks to "a few dollars a day." peace y'all, I need to study some neuro.

[dai bread]

EJA, thanks for the explanation about linking Israel with the U.S. I was thinking along more straightforwardly political lines. Treaties, pacts and the like.

What to do about the problem is exercising better minds than mine. IMO there is no short-term solution.

Re medical care: I wasn't going to draw your attention to this item from the NZ Herald, as it's bragging and some of you will feel I'm doing it at your expense. Nevertheless, since the subject has come up again, I'm posting a link and you can read the article for yourselves. I think it will particularly interest monkeymd2b.

Here

<small>[ 02-19-2004, 02:20 AM: Message edited by: dai bread ]</small>

[Selma in Sandy Eggo]

I've thought for a long time that the US would be better off with socialized basic health care. Care at the clinical level is always more effective in a disease process than hospitalization for the critically ill. The countries where it is available seem to have good luck with it, and I don't see where the bureaucracy associated with such systems is any worse than, say, my HMO. I have knots on my head from dealing with my HMO.

We also need to do something about the malpractice-suit industry. We have too many frivolous lawsuits and they bury the real malpractice cases in the courts. Anybody else want to chime in on the malpractice mess?

[Nicole Marie]

HI Selma-

To expand on your clinic vs. hospital topic. I've noticed more clinics popping up in my area. It seems many hospitals are picking up on this idea. St Francis Hospital which is right across the street from Beethoven has a woman's clinic next door to us. They filter all child and women health care to that clinic. Hartford Hospital has several Walk in type clinics in Hartford County to handle the "smaller" health care issues so the hospital can take care of major cases. This type of care is affordable for the hospitals and for also for people without medical insurance.

[haggis]

"Anybody else want to chime in on the malpractice mess?"

Selma, you’re about to hear me praise Europe, a rare thing.

The laws concerning lawsuits in every major country in the world EXCEPT the U.S. mandate that if a plaintiff (the "sue-er") loses the suit, they have to pay all of the defendant's legal costs.

In practice, if I sue my barber in the UK for a lousy haircut and lose, I not only pay my legal costs but his as well.

In typical lawsuits the defendants cost are multiple time more than the plaintiffs.

This provision tends to keep the number of frivolous and "jackpot justice" lawsuits to a minimum.

The lawyers and their lobbies in this country have successfully resisted changing our laws to a similar model outlined above.

Until we have something similar to that, I suspect its only going to get worse.

We’ve already seen two distinct reactions to the ruinous lawsuits that proliferate our courts now.

One, physicians in “lawsuit” friendly states (Nevada, New Jersey and Colorado are a few) are either retiring or moving their practices out of the state.
Two, physicians are "going bare."

This means doctors, not insurance companies, are responsible for legal fees and any judgments or settlements if they're sued. For patients it means potentially less money if their doctor botches the job.

Personally, I view this as extremely alarming and a sign that plaintiff attorneys are doing serious damage to healthcare in the U.S.

Oh, and BTW, if we DID have some form of nationalized medicine without changing the laws mentioned above, then the U.S. taxpayer would be responsible for paying for those lawsuits.

[Shapley]

RE:<<Sounds like you don't understand the UN.>>

Do not make the mistake of believing that, simply because I joke about very serious issues, I do not understand those issues.

There are those within the U.N. that have for years expressed their desire to have a military totally under U.N. authority. Since the U.N. has no country, it has nowhere to obtain this military except to select from the forces of member nations those who would swear loyalty to the U.N., even when contrary to the desires of their own nation.

When U.S. Marine officers were asked, via the now infamous questionaire, whether they would disarm U.S. citizens if ordered to do so by their superiors, while serving under orders to the U.N., I'm sure the number of negative responses was too high for the U.N.'s satisfaction. Their desire is to obtain a military force independent of nationalist loyalties.

So far, those desiring such a force do not comprise the majority, but their numbers are not small. Since the U.N. has, as I stated, no country, the purpose of such a body would only be for deployment in nations whose actions are contrary to the ruling bodies desires, such as a nation that invades another nation as a pre-emptive strike in a war against terror.

But of course, it couldn't happen here, could it?

V/R
Shapley

[haggis]

Shap, I think you might be a little overly optimistic (and paranoid?) concerning the UN’s ability to organize anything.

Nicole, I’m quite familiar with how the UN works, at least on the military side.

What I find hard to understand is how reasonable people somehow make themselves believe the UN has any credibility in the face of so much evidence to the contrary. How can you take the UN seriously when:

Libya is elected to chair the United Nations Human Rights commission?

Syria is elected president of the U.N. Security Council?

Quick question, name one UN military success, Or name a UN function that you believe is laudable. (and there are some, very few)

I was with UN forces in Somalia, Uganda, Rwanda, and Zaire. Guys who worked for me were with the UN in Serbia, Kosovo and Cambodia.

Without fail, in every case, the UN cut and ran in the face of any armed opposition.

Slaughters in Srebrenica, Rwanda, and Uganda only highlight the UN “peacekeepers” inability to do anything anywhere even when the UN is “in charge.”

Remember Srebrenica?

In July 1995 the United Nations declared "safe area" of Srebrenica in Bosnia-Hercegovina was allowed to fall to besieging nationalist Serbs.

Over 7,000 men and boys were massacred while the Dutch UN Peacekeepers were ordered to do nothing by the UN. Later, Two Dutch officers testified at a Dutch parliamentary inquiry that the French commander of UN peacekeepers, General Bernard Janvier had refused repeated requests for air strikes against Bosnian Serb troops. This, the Dutch officers said, allowed the massacre to be carried out unchallenged.

The Dutch government was so horrified at the slaughter they apologized to the world and, more importantly, changed their policy and procedures about deploying Dutch troops on UN peacekeeping missions in the future.


The concept of a “global military force” enforcing universally accepted ideals sounds good but it doesn’t work for both practical and political reasons.

”Between 1945 and 1999, two-thirds of the members of the United Nations--126 states out of 189--fought 291 interstate conflicts in which over 22 million people were killed. This series of conflicts was capped by the Kosovo campaign {in 1998} in which nineteen NATO democracies representing 780 million people flagrantly violated the Charter. The international system has come to subsist in a parallel universe of two systems, one de jure, the other de facto. The de jure system consists of illusory rules that would govern the use of force among states in a platonic world of forms, a world that does not exist. The de facto system consists of actual state practice in the real world, a world in which states weigh costs against benefits in regular disregard of the rules solemnly proclaimed in the all-but- ignored de jure system. The decaying de jure catechism is overly schematized and scholastic, disconnected from state behavior, and unrealistic in its aspirations for state conduct”

This is from a law review article by Prof. Michael Glennon, The Fog of Law: Self-Defense, Inherence, and Incoherence in Article 51 of the United Nations Charter, 25 Harvard Journal of Law and Public Policy 539 (2002).

I can assure you that no western country today will ever allow their troops to be under unilateral UN control.

I personally believe that any legitimacy the UN once had was squandered years ago and it is all but inconsequential in today's world, but that's just my opinion, everything else I mentioned above is fact.

[Nicole Marie]

Shap, I'm with Haggis on this, you do seem a bit paranoid.

As for the UN not being able to do it's job during military conflicts. Read the Security Council's functions and powers. They have 10 very detailed points they must follow when dealing with a country that is causing "problems". Only one of those 10 points is military action. They first try other means before resulting to that.

Many people think the UN's role is military. It's not; their first goal is to develop international law and to monitor world issues like the environment, AIDS, poverty etc. But when it does come down to military action you get so many different military groups taking part that it can be a bit confusing.

I was just reading an article from an Italian newspaper about the problem with translation in Iraq between the Italian, Polish and Iraq troops/police. Here in the US we often take for granted the efficiency of the military and do not understand that the military for some countries is not a high priority. So when US troops work with them, the US military often looks down on them.

The irony is we are talking about this on a day that the UN says they support the June 30 deadline to hand over Iraq to the UN. Like it or not they are a major role in the world and will be rebuilding Iraq very soon.

[Shapley]

Haggis and Nicole:

I didn't say I was afraid it would happen. I'm merely afraid of politicians who support the idea.

V/R
Shapley

[EJA]

Dai bread, what is frequently not understood about economics is that very few wealthy people are misers who sit on a great heap of cash money. In other words, very few of them have a very large percentage of their assets in liquid form. If their money is in a savings account, it is being loaned out to entrepeneurs to build business, or to young folks to buy homes. If it is invested in bonds, it is being used to build roads, fund public transportation, support civic projects, etc. If it is invested in mutual funds, it is being used to build businesses. Yes, wealthy people enjoy the benefits of their wealth, but so does everyone whom they pay for goods and services. Any shoe salesman knows that he likes to have wealthy customers. So, yes, I do believe in trickle-down economics. You could argue that wealth doesn't trickle down, but it surely doesn't trickle up.

Concerning your 100 man, 100 dollars straw man, If you have 100 men, one of whom has $100, I can pretty much assure you that he won't have the whole $100 for very long. He will buy cigarrettes, food, drink, a pretty shell, something before very long at all. Then he will have $99 and somebody else will have a dollar. On and on it will go, and eventually, those who pick up the most pretty shells, make the best or most food, find the cleanest or most water, or wrangle the best deal on cigarettes will be the wealthiest. There is an element of "fortune" in wealth, yes, but the chief element is exertion.

Another thing that is commonly not understood about economics is that the only thing that truly adds value to an economy is production, namely, combining land (natural resources) with labor to increase the well being of mankind. All the stock market speculation, etc., doesn't build wealth; it merely shuffles it around. But the stock market is geared to shuffle wealth to those who are most productive, and will therefore put that wealth to work to produce. When they produce, their well-being is increased, but so is that of all mankind.

Let me try another analogy on you. Suppose that you work very hard in academia and achieve a 4.0 GPA. Now, suppose there is another individual in the class who is lazy and spends his time chasing girls and drinking beer, and only achieves only a 2.0 GPA. Would you be willing to share your GPA with him so that each of you would then have a 3.0 GPA? No, and we wouldn't want you to, either, because we don't want to encourage the type of behavior engaged in by the 2.0 student. However, the 2.0 student may be benefitted by your academic excellence when later on he buys the car with the technical advancements that your academic achievment enabled you to design. Now, consider a 2.0 student who works very hard, but lacks the intelligence to get grades as good as yours. Should you share your 4.0 with him? No, because then you would have only a 3.0 and you would be passed over by the automaker and end up working as an engineer at a chicken-waterer factory where your genius would not bring nearly so much benefit to mankind. It is the same in the economic realm. To attain the maximum benefit for mankind, reward must be proportional to effort and ability.

Monkey, I agree that increased availability of primary care would reduce costs, but I don't think that making health care a social service would improve the availability of primary care any more than making medicare available to the elderly has improved the health care received by them, or any more than government subsidies have improved the productivity of American agriculture. One thing that would help the primary care problem is a higher proportion of doctors who go into medicine to help their patients rather than to help their pocket books. I'm told by a number of older people that there was a time when a doctor would treat someone regardless of their ability to pay -- WITHOUT jacking up the price on paying customers. In those days, of course, being a doctor was not as lucrative an occupation as it is now. I guess with the price of malpractice insurance these days, though, the heyday is over.

I think that there is a serious racket going on in this country with health insurance companies. I'm not sure I have pieced out all the details, but I'm sure that it is a racket.

Haggis has hit another nail on the head. Lawsuits exascerbate both the doctor motivation problem and the insurance company racket problem. We desperately need tort reform in this country. Perhaps we could start with a lobotomy for a bunch of judges so as to ensure that they never sit on a bench again. The tort suits that take place in this country would be humorous if they weren't so pathetic. Plaintifs paying court costs would certainly help, but some common sense with respect to judgments is what seems to be most lacking.

[barfle]

Originally posted by Nicole Marie:
...Here in the US we often take for granted the efficiency of the military and do not understand that the military for some countries is not a high priority...

One of the most telling quotes about the "efficiency" of the US military is, "they also serve who only stand and wait." And wait, and wait, and wait, and eventually are discharged.

I also seem to recall some very expensive wrenches, toilet seats, etc., not all that long ago. While I understand that some applications require special products, I don't understand how a supply depot can be out of, for example, dishwashing soap for six weeks, as ours was when I was told to pick some up there. Maybe it's better now; I really can't say, but one word I wouldn't use to describe the units I served in is "efficient."

[Nicole Marie]

Thanks for keeping me in check barfle. I stand corrected.

[barfle]

One issue regarding the cost of medical care I don't see addressed is the power of the doctor's union, the AMA. Nobody can practice medicine in the US (write prescriptions or perform surgery, to name two particular activities) without membership in the AMA.

That artificially restricts the supply of practicioners to an elite "in" group.

While the AMA clearly has high standards of professionalism (although I've run across my fair share of quacks), I don't always need a full medical doctor to simply remove a mole or read an X-ray.

When I was stationed in Germany, I was friends with a gentleman who owned the biggest shoe store in town (it was a very, very small town). One day I came to visit, and he was doing some major cutting on a woman's foot. I asked him if he was also a foot doctor, and he replied that he was. My knowledge of German medical terms was and still is a bit deficient, so I wasn't real sure what he was up to, but it seemed like he was working on a plantars wart. Remember this was in 1968 or 1969, so some of the ointments available now weren't then.

What I'm getting at is that there are any number of medical procedures that could be performed by someone who isn't drawing a 200,000 per year salary, without endangering the public. I suppose mmd2b might have an opposing view, so I'm ready to hear it.

[haggis]

Barf,

"Nobody can practice medicine in the US (write prescriptions or perform surgery, to name two particular activities) without membership in the AMA.

Absolutely untrue. In fact many doctor who used to belong are quiting because they disagree with some of the AMA's more radical positions.

The AMA's a professional organization, not a union.

[haggis]

Nicole,

” Shap, I'm with Haggis on this

Nicole’s agreed with me twice in one year, I’m getting Goosebumps.


I only mentioned the military side of the UN because I am knowledgeable enough to defend anything I said in that post.

As for the rest, I believe you’ll notice that I did not (totally) condemn the non-military side.

Yes, the UN does some good things, most often in spite of their best attempts to screw them up. I think the UN had wasted its legitimacy mostly because of good old garden-variety fraud, incompetence, mismanagement and bureaucratic foolishness.

I suspect most people do not realize that each part of the UN (UNESCO, etc) are separate legal entities and are not responsible to the UN in financial matters as well as management or direction. That’s one of the key reason the U.S. quit paying its dues several years ago, in addition, of course to the political side of it.

The U.S. Congress was demanding that some type of independent auditor or inspector general be appointed that could investigate those organizations. To the best of my knowledge, none has been appointed. Did you know that Americans working for the UN in New York don’t have to pay income tax in the U.S.? Have you seen the wage scales of UN employees? Believe me, they are high enough that I would probably be hypocritical and take a job there if offered.

I think, as the largest dues paying member of the UN, the U.S. should be able to have some accounting of where the money’s going. But, this time it almost all my opinion.

Barf

I’m sorry you served in inefficient military units; I think I would have been crushed had I ever been assigned to one.

Your cheap crack about expensive hammers, et al have, unfortunately, enough truth to them to keep them going, but it never was or is as bad as many people talked about. For instance, remember the expensive toilet seats? (it was actually the entire toilet unit, but “expensive toilet seat” made better press) They were for the C-5A aircraft. There were only 150 ever made. Just a good example of economies of scale.

That’s why everyone wants to produce and buy in volume. The maker can reduce the manufacturing cost and the buyer can get a better deal.

The expensive hammers? Well, yeah, you’re right, that was fraud and the government sued the supplier.

Did you ever see the price of tools for the SR-71 “Blackbird”? Every tool used on that beast had to be made of tungsten because so many of the components of the airframe are made of tungsten and (for technical reasons WAY above my comprehension level!) if you use stainless steel tools on tungsten it….I don’t know, weakens the tungsten or something. Some of those special speed wrenches cost about the same as [joke Dai Bread] the New Zealand GNP [/joke Dai Bread]

[monkeymd2b]

Ahhhh...malpractice. Let's just say that my classmates and I got an eye opening day o fun about this topic. Our school has a Foundations in Medicine course for T1s and T2s - it's supposed to keep us human. Well, there's an all day event in spring where T1s-T4s get together and discuss various things like ethics and medical decision making and hot guy who was taking care of the elephant pit (did I mention we have this thing at the zoo?). ANyway, when I was a T1, the topic was medical malpractice and we learned all about the harsh realities but the small benefits of malpractice in louisiana. The good thing here is that there's a cap. I could be sued for 4 billion bucks but all that ever can be paid out is $100,000 (or something like that). And there's a review board where the plaintiff can bring a medical expert, I can bring a medical expert, and then there's a panel of appointed experts in whatever field the defendant is in. All malpractice suits come through here. No matter who wins this stage, a suit can still proceed but if the doc wins, the case usually stops there and never goes to court because during the actual trial, the fact that the doc won the review board usually helps him win the trial as well. I hope a national cap is in place. I personally feel that if indeed a wrong was done, then yes, the doc should be responsible but this "pain and suffering" money is crap. No amount of money could console me if a loved one was dead as a result of what a doc did. I'd pay for the medical costs that resulted from my wrong doing but a couple mil just cause of the emotional hardship is wrong and grossly overused in these lawsuits.

Oh and here's the other annoying thing. In a criminal case (like if I murdered your mom in cold blood), in order to find me guilty, it would have to be beyond a reasonable doubt or say 99% sure and the burden is on the prosecution. In a malpractice suit where I am accused of doing (or not doing) something that resulted in the death of your mom, the jury or judge only needs to be 51% sure I did wrong and often the burden is on the defendant. Of course, relatively speaking, the punishment is not as severe in the malpractice suit except if I were to lose my license. Hmmm...could I then sue the person who sued me for my "pain and suffering" as a result of not being able to practice anymore and the social humiliation I'm suffering?

I don't know what fairy tale you're living in but medicine isn't exactly a gold mine in terms of salary...at least not primary care. Sure, maybe the neurosurgeon and those other specialists can live it up but they are the minority. Will I be making more than my parents? Sure, but I also will have spent 7 more years in school and a hell of a whole lot more money to get my job. In fact, I'll probably be in my 40s by the time all my loans are paid off unless I can get into some loan repayment program. I don't think I'd go bare. And when it comes down to it, medicine is a business. Just as businesses raise the price to reflect inflation and whatnot, so too has the price of seeing the doc. Otherwise, a private practice couldn't last for too long. Some docs do occasionally give free care to those in dire need and no funds but obviously just not anyone you know has benefitted from this. I saw several patients who were on a barter system - they brought in shrimp and other sea critters to my attending for services he rendered.

[Nicole Marie]

Hi Haggis- Well I guess three strikes and your out... I have to disagree with you on the UN funding.

I think if you give money to the UN you give it with the understanding that all countries are different and how the money will be used may not fit in with your view. For example one of the main reasons the Bush admin stopped giving to the UN was China. The UN gives money to China to help with population growth. That means money for birth control programs. Of course that does not fit in with the Bush admin policies. (Just look at what he did with birth control programs for low-income women in this country. But that's another story.) What has happened in China is they have seen a hike in the rate of baby girl deaths (un-natural) and abandonment. Girls are not as prized as boys in China. And now that birth control programs in China are strained, small infant girls are suffering.

The point is if we had a different admin. in US office, money would still be directed to the UN. It seems a bit one sided to me.

[barfle]

While it wasn't the only reason I left the service at the end of my term, the total lack of a definable mission, and the total lack of support for the equipment we had where I was stationed certainly opened my eyes to just how foolish the military can be.

I'll admit that the US Army had other priorities (Viet Nam, in particular) at the time, but during the 15 months or so I was stationed in Prüm, Germany, I was unable to get service on five of the six radios in my rig, and the one that did work was incapable of operating on the frequencies our network control station monitored. So, in spite of undergoing nine months of training to be a radio-teletype operator, I ended up washing trucks, lubing trucks, changing tires on trucks, painting trucks, driving trucks to supply depots that were out of stock, and in general wasting my time and your money, with no interest on the part of management on getting any return on their investment.

I admit that I had it pretty easy. Promotions came rapidly, and I got out of the barracks and into a 2-man room. I wasn't getting shot at, and with the fact that my radios didn't work a matter of record, I wasn't being blamed for my inability to do what little assigned work I had. But I could not see putting in 20 years in an organization that either ignored clear operational deficiencies, or was incapable of correcting them.

[Shapley]

Nicole,

I think one of the issues is that there is no accountability for where the money paid to the U.N. goes.

The other issue is that the money is used to undermine the agenda the U.S. espouses. If the stated goal of the U.S. is to promote democracy, and the U.N. is using its funds to undermine such efforts, then the U.S. is obligated to withhold its share of the funding. The same is true with such issues a abortion, gun control, freedom of religion, etc. We, as Americans, should not be supporting those who actively work contrary to our causes.

[Message edited by Shapley to reduce flammability.]

<small>[ 02-20-2004, 10:46 AM: Message edited by: Shapley ]</small>