You don’t put in place a system for 300+ million people when you only need a solution for 40+ million.

was a perfect line and I am going to shamelessly steal it for my blog post on this.

The real problem with health insurance is that people want it to cover everything. That’s not insurance. And there is no mechanism today in any heathcare scheme for rewarding better results or stimulating competition.

When I called you nutso, it was due to your willful ignorance. You think of yourself as very smart, doubtless, but lack critical thinking in the true sense.

Most states have already addressed these problems with laws prohibiting or at least controlling the practices you cite. New York, for example, restricts limitations on pre-existing conditions, prohibits excluding people from getting insurance at all because they have such a condition, and requires insurers (not just HMOs) with preferred-provider lists to have a mechanism whereby an insured can use a provider who’s not on the list by demonstrating a need.

In particular, I’d like to see the data supporting your claim that HMOs “often” cancel policies because the insured gets a major illness. In New York State, that’s illegal (it’s called guaranteed renewability). I’d be surprised if there are many states — if any– where this is not prohibited. Which states still allow it? How often does it occur in those states, on an annual basis? Links, please.

I’d love to see the data on which you base your idea that the government can do a “better job” than the private sector on its own when it comes to controlling health care costs. Is this based on Medicare, maybe? Have you looked at the cost of its prescription plan? Or Medicaid? Have you tried to find a doctor who will do the paperwork it requires and accept the payment it will offer in a major city? Many of the poor who turn to emergency rooms for basic care instead of private doctors HAVE INSURANCE in the form of Medicaid but have to go to the ER because they can’t find doctors who will accept it. How are you going to make those doctors take the reduced payments Obama’s system will require when there’s still a private system in existence that will pay them what the market will bear?

In my state, one reason insurance is becoming unaffordable is that the state government keeps adding requirements to what insurers must cover — acupuncture, chiropractic treatments, extended hospital stays after childbirth, cripes, for all I know, they’ll add homeopathy before too long. The result is that those who could maybe afford a Hyundai if insurers were allowed to sell it are told they must buy a Rolls Royce or do without. The effect of government involvement in this case is to escalate the increasing cost of coverage.

Once again you have supplied no data showing a causal relationship between the cost of our health care system and our “pretty poor health overall.” As already pointed out to you more than once, just because the two things co-exist does not mean that one causes the other. But if we’re going to talk about correlation as if it meant causation, please show me some data that overall health improved in Britain after the arrival of the National Health or in Canada after they instituted their system. Maybe it did. If so, I’d certainly like to know more about it.

the other major cost of healthcare is the cost of protection against liability. too much is being done to cover liability risks; too many tests, too many consultants. but since the lawyers control liability, and they are the ones becoming politicians, it is unlikely this will change. another aspect of the liability risk is the fact that patients wants more, demand more. they want a CT when plain films or ultransound would do. they demand MRI and the data for utility and effectiveness remain ambiguous.

physicians salary are not part of the cost. physican salary rise has been negligible compared to the cost of healthcare increases. physician salary account for less than 10% of healthcare cost.

when the government gets into healthcare, being the gorilla in the room in term of size and power, they will in essence set the standards for both service and coverage. already many insurance companies are following medicare/medicaid lead on what they will pay and will not cover. so it won’t matter if there are other payors or not, the result won’t be much different.

finally, when the government becomes a HMO, it will control cost just like any private HMO, by limiting care. that is how most costs will be controlled when third party pay rather than we ourselves out of pocket.

We also pay our doctors more in our country than doctors make in other countries.

Regarding cost controls related to use: studies have also shown that hospitals in major cities often use vast numbers of consulting specialists for a lot of conditions yet they show no improvement over care provided to people living in smaller cities for the vast majority of conditions. Clearly there are some efficiencies to be gained here. The problem with HMO’s, however, and their cost control efforts, is that they often do things like cancel your coverage entirely if you get a major illness, and you are also restricted to use just doctors within the HMO’s network, which may well be a small fraction of the total number of doctors available. If you get new insurance you’re often not covered for “pre-existing conditions” which are precisely the conditions you ought to be covered for. These problems clearly need to be addressed.

We are the only major country to have no form of universal health care. We spend vastly more than other countries, and we are still a country in pretty poor health, overall. Will THE GOVERNMENT be able to do something about this? Well yes, I don’t happen to believe that the private sector is always better than the government — I think the government can and should get involved in certain areas and it does a better job than the private sector on its own.

I want to emphasize that Obama’s plan is NOT a single-payer system like England’s. It retains competition in health insurance and if you don’t want the government plan you’re free to use your current private insurance.

I gravely regret my past tolerance of ideological diversity. The Gramscians are not just wrong. They are mean-spirited little Pol Pots. But they have defined the rules of the game, and I have become ready to get down in the mud and fight just as dirty as they do.

Your input on this forum, as a physician, is very much appreciated.

Doctors Goldberg and Charlesworth at CMC, Manchester, NH gave my Mom at least a 30% chance of not surviving the surgery. If she also had blockages (which amazingly she did not have) that bad odds would run to 50%. I am absolutely certain that under socialized medicine my Mom would have been given the morphine drip and we would have spent a few days watching her fade away.

Now, almost three weeks later, she is in rehab. It is going to be a long road back for her, but we had a far different Mother’s Day than what we were anticipating. All because of a talented surgeon, cardiologist, staff, and prayer. Oh my, now I’ve gone and done it. I mentioned prayer and God and the Blessed Mother… Major sin, as far as the metaphysical materialists are concerned.

Anyway, despite warnings from within the profession itself about shortages of physicians and surgeons, and the inevitability of rationing and long waits for procedures, the Marxists are going to go forward with this.

On all of the important issues of the day, the collectivists use a heavy hand to bare knuckle their will on the rest of us.

in the US, quality is usually not a problem.

in the US, access to care isn’t much of a problems either to the majority of the population. most medium to large hospitals provide free care all the time. rural areas may have problems with access and availability to hospitals but the US population has long shifted to urban areas. one can make an argument that access to preventative care is a problem but the real benefit of preventative care to those who do get it are of uncertain benefit anyway. And ultimately utilization of preventative care is a cultural issue (we don’t actively pursue preventative care) rather than an access to care issue.

the real issue is cost. ultimately there are only two ways to reduce cost. one is to decide to use less (a significant precentage of our health care is spent in the last 30 days of life). the other is to be told to use less, either by the provider or the payor. while some cost savings can be had through efficiency, there really isn’t that much fat to trim. any cost saving is more than offset by the administrative cost of compliance with regulations that doesn’t improve care.

when you get down to it, i would rather decide to forgo treatment than to be told i cannot have it. and that is exactly what will happen when there is a single payor like the government. they will restrict some care in order to save cost, and will prevent those who have the cash to pay for it themselve as this will generate an impression of rich vs poor care.