Originally Posted by djplong

What I learned, first and foremost, is that it took us over 50 years to get into this mess and we're not getting out of it all at once. There are a large number of things that have to be attacked ALL AT ONCE in order to *really* solve the problems - and those are only the problems as I saw them (and see them now). I am, by trade, someone who looks for answers and solves problems (I do it with computers, I design, write and implement software, databases, etc).

Malpractice. This got so bad in the late 1980s and early 1990s that, if you lived on Cape Cod and got pregnant and didn't already have an OB/GYN, you could not get one. There were NONE accepting new patients. That's just the bad example we had locally. Out in the midwest I heard of worse horror stories. One thing that a "public option" would do is cut the cost of malpractice awards since, in a sense, the victim would no longer need a huge award to cover the cost of care for the rest of their lives.

Supply/Demand. I hear this a lot. It's one of the contributing factors to high medical costs. Did you know that the government regulates the supply of doctors? Probably the most shocking thing I learned at Beth Israel was how the teaching hospitals get the grant money that, quite frankly, is their bread and butter. The government basically says "you will graduate this many GPs, this many heart surgeons, this many neurosurgeons, etc, or you won't get the grant and research money". For the record, and those who don't know, Beth Israel Hospital is now Beth Israel/Deaconess and, as far as I know, is still affiliated and part of Harvard Medical School.

Payment. Insurance companies pay a set price per day per patient. It doesn't matter if you're in for an aspirin or bypass surgery. If you're in overnight, the insurance companies pay $X/night for you. And the hospitals are at their mercy if they want to be on the insurer's "approved" list. Now, these number are quite old, but we were going through budget cuts at BI trying to figure out how we could continue to provide our level of care at the $1600/nt rate that we had negotiated with several companies. The next year they started coming in at $1200 and we were in meetings lamenting about how we would LOVE to have the old "hardship" prices.

You read that right. At a time when premiums were going up 10-20% per year, the insurance companies were cutting what they were paying to hospitals. I have no doubt this is continuing. Where is that money going? Look at the balance sheets.

Class Envy. If you're going to have a "public option", then you're going about it all wrong in how to pay for it. Sure, you're going to get savings from cutting fraud and I'm all for that. (Someone elsewhere said to trash Medicare because of all the fraud - that's throwing out the baby with the bathwater) But one is naive to think that'll pay the whole way. I'll get back to this part in a bit.

I hear people screaming that they don't want to ruin the best health care system in the nation. Problem is, they're defending a ghost. Depending on who you talk to we're ranked around 37th in the world. Not that the UK NHS (National Health System) or the Canadian single-payer system is the best (though they're ranked around 17th and 7th, respectively). But actually *France* seems to be top-rated and they have a combination public and private system setup.

We *do* however, pay more than anyone else does. Part of that is due to the fact that we are the R&D center for the world Drugs cost more here (to recoup the R&D costs) than they do in other countries and, to be honest, I'm getting tired of that. It's time for other developed nations to foot the bill we've been covering.

Which brings me back to paying for whatever system comes up. In Canada they have what is basically a sales tax. Pure and simple. No pitting the middle class against the rich or the poor - everyone pays. Period. If you have to have "progressivity" in the system, you can make an allowance in the income tax structure for the poor. If you're unemployed, well, then, there's an incentive to get employed again - but at least you still have access to health care. Of all the pungent methods of paying for health care, this seems to be the least painful. Cry me no croccodile tears for this being on the backs of the poor with sales taxes being regressive because, as I said, you can rectify that in the income tax code and, let's face it, the poor also make poor decisions (smoking, drinking, poor health choices). Quite frankly, if the poor had access to proper care and didn't have to use the ER as their primary care physician, those that are NOT making bad choices but ARE victims of circumstance would probably be in better shape to improve their lot.

Everyone talks about the cost involved. But, I'm sorry, that can't be taken seriously when we have a situation where we have spent over $36,000 for every man woman and child in Iraq (over a trillion dollars before this year is out, depending on which accounting you pay attention to) destroying and rebuilding that country.

If we got our spending priorities realigned, cost would be a non-issue. We operate 160 bases overseas and I think it's time that the countries who's bacon we've saved start paying the freight.

It's not just a "Can Medicaid handle the influx" question. We already ARE handling it. These people, no matter what the number, are in our Emergency Rooms. They're staying sick when they could be getting better and (presumably) being more productive. They're spreading illnesses instead of getting innoculated. Their lives are being shortened because they can't afford preventative care.

We are the country that put a man on the moon. Why are we now the country that CAN'T do anything? Why can't we look at what France, Canada and the UK have done and say "we can do that better"? Why do we have people saying "keep government out of Medicare" (showing their ignorance)? Why are people saying medical decisions should stay between a doctor and patient when that DOES NOT EXIST NOW? (Those decisions are between your doctor and an insurance clerk) Why are we protecting a system that encourages hospitals to torture the sick just to help their bottom line (ok, that was my personal experience, I grant you)?

Do I have all the answers? Certainly not. But I *do* know that jingoism and sloganeering isn't going to solve the problem. It'll only make it worse.