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On socialized medicine

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  • On socialized medicine

    I will toss out two examples of socialized medicine: Medicare and military hospital system.

    We do not have a health care system that is without flaws, and when I read about other countries, it is obvious that no country has a flawless system.

    The military hospital system is large and complex. Civilian hospitals have a mission of meeting needs of the population in its area, and it adjusts and sizes itself to meet those needs. So an area may have a fairly consistent capacity of beds which are always almost full. The military has two broad missions, readiness and care of beneficiaries (family and retirees) The readiness mission is closer to sports medicine with its mostly young and physically fit patient population. The brodaer mission of providing care to benificiaries is closer to civilian health care, with a full range of specialties needed.

    The military hospitals have a disproportionate number of military personnel providing care, in times of war we set up hospitals in distant theaters. And certain specialties are in high demand, such as anasthesiologists, emergency and trauma care. But not pediatricians.

    The military system uses an established and effective outpatient system of clinics. (I am not familiar enough with the beneficiary system). Its hospitals use different system of quality and efficiency standards, it is not formed around payment for procedure, instead relying on patient outcomes. And by those measures, it performs similar to civilian hospitals. The numbers of excellent military hospitals parallels the numbers of excellent civilian hospitals, (and similar for the less than excellent hospitals). Cost accounting is difficult, the military missions demand certain costs be built into the system, the military aircraft used to transport patients often have some combat role and so have more expensive hardware built into the system (which is why the military uses civilian rates, not real costs. Civilians planes don't have the expensive gizmos war planes need).

    Some call for an outright scrapping the separate system and incorporating it into the civilian health care system, others call for strengthening the system to handle all its missions in house by Department of defense. But most call for a slow incorporation, Tricare is a military insurance plan, and it operates, for some, just like any other insurance plan.

    On Medicare: Medicare shapes health care, its accounting, its rules, its procedures etc., since it plays such a large role in health care. Medicare sets a rule, and the hospital system accommodates it, and even private insurance follows suit. But is it the politicians who make the myriads of rules? No, it is a complex system of public administrators and medical people.

    Is Medicare the cause for the weaknesses in the system? I don't think so, the weaknesses are often tied to demographic and economic forces, which is why rural hospitals have higher reimbursement rates to keep the hospitals from disappearing entirely from rural areas.

  • #2
    Are you unfamiliar with the huge problems that veteran's hospitals have? They are fully government run from top to bottom and operate exactly as you would expect, with the efficiency of a DMV office and the compassion of the IRS, as the saying goes.

    Medicare is a little different because it's public money being spent on a private system, but the payout for Medicare patients is often far below what is needed for the system to break even, so it's ultimately unsustainable. Look to England and Canada as cautionary examples.
    Some may call me foolish, and some may call me odd
    But I'd rather be a fool in the eyes of man
    Than a fool in the eyes of God


    From "Fools Gold" by Petra

    Comment


    • #3
      The retirees and their dependents use civilian hospitals with Tricare for the most part. They don't have access to the military hospitals any more. They would have to use the VA if they didn't use Tricare. Tricare is pretty nice insurance but I read they are trying to cut back on the services and raise the fees because it is too expensive. That is the problem with socialized healthcare, the government will inevitably cut back on the quality and raise the taxes to try to cover the costs. They do the same to medicare/medicaid too.

      With private insurance you can always switch if they try that with you. Under socialized medicine you are stuck in one government run system and are at their mercy.

      And medicare isn't all that it's cracked up to be. Part A is free (no monthly premium) and covers your hospital and doctor fees (mostly free but you have to pay deductibles and copays when you use it). Part B covers outpatient doctor visits and tests) it has a monthly premium and deductibles and copays. Part D costs you money and covers your prescriptions (you have to pay a monthly premium and will have deductibles and copays) - Part C is using supplemental insurance that usually covers part B and D and provides extra services. It is private insurance basically, and it has premiums, deductibles and copays.

      So there is no free lunch with Medicare either. I calculate I will end up doubling my healthcare costs when I have to go on medicare over what I am paying now with my company sharing my healthcare costs. And get worse care.

      "Medicare for all" is just a pipe dream. If it is run like Medicare for retirees is, it will cost most people more than they are paying now.

      Comment


      • #4
        Originally posted by Sparko View Post
        That is the problem with socialized healthcare, the government will inevitably cut back on the quality and raise the taxes to try to cover the costs.
        As I like to summarize it:

        -High quality of care
        -Low cost
        -Everybody covered

        Pick two.
        Some may call me foolish, and some may call me odd
        But I'd rather be a fool in the eyes of man
        Than a fool in the eyes of God


        From "Fools Gold" by Petra

        Comment


        • #5
          Originally posted by Mountain Man View Post
          As I like to summarize it:

          -High quality of care
          -Low cost
          -Everybody covered

          Pick two.
          Yeppers.

          And since the pool of tax money isn't infinite, they have to cut quality in order to cover everyone. That is why the government keeps chopping away at social security and medicare. Even though they are mostly funded by payroll deductions. Too many people using a limited pool of funding.

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          • #6
            I think Simp is referring to military base/post medical centers for Active Duty folks, not veterans. I've been stationed at 10 military installations over my USAF career, and have had to go to the base hospital in all but 1 for something ranging from required vaccinations to dental work. Every single one was terrible. Heck, the hospital at Andrews is where actually passed out from the phlebotomist trying to draw blood from me. 6 failed sticks in my arms, and to the floor I went. Offutt AFB's dental clinic was the best of them, but I still had 2 fillings from there fall out 3-4 years later. Anecdotal, true, but my experience has not been positive with military hospitals.
            That's what
            - She

            Without a clear-cut definition of sin, morality becomes a mere argument over the best way to train animals
            - Manya the Holy Szin (The Quintara Marathon)

            I may not be as old as dirt, but me and dirt are starting to have an awful lot in common
            - Stephen R. Donaldson

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            • #7
              Originally posted by Mountain Man View Post
              As I like to summarize it:

              -High quality of care
              -Low cost
              -Everybody covered

              Pick two.
              A number of countries get all three right. See here for example, where multiple countries beat the U.S. when it comes to all three categories: quality and outcomes, cost, and coverage/affordability.

              Comment


              • #8
                Originally posted by Bill the Cat View Post
                I think Simp is referring to military base/post medical centers for Active Duty folks, not veterans. I've been stationed at 10 military installations over my USAF career, and have had to go to the base hospital in all but 1 for something ranging from required vaccinations to dental work. Every single one was terrible. Heck, the hospital at Andrews is where actually passed out from the phlebotomist trying to draw blood from me. 6 failed sticks in my arms, and to the floor I went. Offutt AFB's dental clinic was the best of them, but I still had 2 fillings from there fall out 3-4 years later. Anecdotal, true, but my experience has not been positive with military hospitals.
                I was raised as an Army Brat. Growing up we used the base medical and dental facilities. The doctors seemed nice enough, but the quality of the medical care wasn't top notch. Especially the dental. I had just about every one of my molars filled as a kid and every single filling has had to be replaced since then. My dentist even commented on the shoddy work he saw when one of my molars broke because of the way they filled it and the material used. And I still have trouble with my knee that I broke as a teenager and was taken care of at a military hospital. After my dad retired, we used Tricare and civilian hospitals. It was better care and great insurance.

                Comment


                • #9
                  Originally posted by CMD View Post
                  A number of countries get all three right. See here for example, where multiple countries beat the U.S. when it comes to all three categories: quality and outcomes, cost, and coverage/affordability.
                  In my experience, studies like that are rarely comparing apples-to-apples. One of the more infamous examples is infant mortality rates. The US generally ranks worse on that scale than European countries, but European countries don't count premature births when determining infant mortality, so their rates are artificially lower than the US. It is also far too easy to deliberately skew these kinds of studies with cherry picked and massaged data, which the Common Wealth Fund has a documented history of doing.
                  Some may call me foolish, and some may call me odd
                  But I'd rather be a fool in the eyes of man
                  Than a fool in the eyes of God


                  From "Fools Gold" by Petra

                  Comment


                  • #10
                    Things to keep in mind.

                    Computerized record taking among Doctors has a 12 percent error rate.

                    Doctors are leaving the profession due to the extensive 'paperwork' tasks involved.

                    A centralized medical system is not likely to cover many alternative care options. So we could lose the type of care we want ... or would be paying for other people's benefits while we pay out of pocket for what we need.

                    Comment


                    • #11
                      Originally posted by mikewhitney View Post
                      Things to keep in mind.

                      Computerized record taking among Doctors has a 12 percent error rate.

                      Doctors are leaving the profession due to the extensive 'paperwork' tasks involved.

                      A centralized medical system is not likely to cover many alternative care options. So we could lose the type of care we want ... or would be paying for other people's benefits while we pay out of pocket for what we need.
                      Can we go back to a "good old days" for the doctor-patient relationship? The trend is towards large practices with more than one doctor, occupying a small office building.

                      Americans are highly mobile, and one push for a computerized system is the immediate availability of patient records. Yes, there are errors, but there are also errors in the old paper charts. (which was another reason to push for electronic data).

                      I am not sure that it follows that a centralized medical system would not cover alternative care options. The barriers we have now to the alternative care or new options come from the medical establishment (when is a therapy efficacious), insurance companies (should insurance providers underwrite a novel procedure?), as well as the government run insurance plans like medicare and medicaid(s) (plural because each state has its own policies).

                      Comment


                      • #12
                        When I watch TV, I see commercials from lawyers looking for people to sue over the poor care in hospitals and nursing homes. Is there any hospitals which provide good care?

                        I did not address the VA system in the OP. But is the VA long term care really much different than other long term care facilities? The only real difference (from what I understand) is that the VA hospitals are not subject to the regulations of various states. And the other services by the VA were starved for funds, which shows a lack of commitment to the VA system from Congress; I think the DoD has requested more funds in the past. Who to blame?

                        How do we rate hospitals? Anytime we go to a hospital, we are at the mercy of the doctor's abilities and training; a full 50% of doctors are below average. The US military is competent on many things, can the Army, Air force, or Navy apply their readiness measures to medicine? The military does have doctors in those hospitals, who have a responsibility to offer quality care, as well as administering the hospital.

                        Some military hospitals have excellent ratings, and are on par with the best hospitals in the nation. The parallels between military hospitals and rural health care cannot be ignored, the problems in the rural hospitals are at play in military hospitals. The mix of cases is not the same, rare diseases or procedures do not come up often, so the doctors do not get much 'practice' with those procedures.

                        Comment


                        • #13
                          Originally posted by Mountain Man View Post
                          Are you unfamiliar with the huge problems that veteran's hospitals have? They are fully government run from top to bottom and operate exactly as you would expect, with the efficiency of a DMV office and the compassion of the IRS, as the saying goes.

                          Medicare is a little different because it's public money being spent on a private system, but the payout for Medicare patients is often far below what is needed for the system to break even, so it's ultimately unsustainable. Look to England and Canada as cautionary examples.
                          "Look to England and Canada" as examples to learn from: "The United States Spends More on Healthcare per Person than Other Wealthy Countries".

                          https://www.pgpf.org/blog/2019/07/ho...ther-countries
                          “He felt that his whole life was a kind of dream and he sometimes wondered whose it was and whether they were enjoying it.” - Douglas Adams.

                          Comment


                          • #14
                            Originally posted by Tassman View Post
                            "Look to England and Canada" as examples to learn from: "The United States Spends More on Healthcare per Person than Other Wealthy Countries".

                            https://www.pgpf.org/blog/2019/07/ho...ther-countries
                            One of the primary reasons is due to our legal system. For one example, John Edwards (the disgraced former Senator who was John Kerry's running mate in 2004) became famous for winning huge lawsuits by second guessing the decisions of doctors. If complications arose during childbirth he sued them for not having performed a Caesarean instead. This innovative tactic was quickly picked up by other lawyers which resulted in a increase in Caesareans nationwide as doctors sought to avoid being sued. Edwards was a master of making emotion-based pleas essentially arguing that someone got hurt so someone needed to pay for it and since doctors and insurance companies have deep pockets they can afford to pay even if they didn't do anything wrong.

                            There have been several attempts at tort reform but all have failed in that the Trial Lawyers Association's lobbies are very powerful (they've had a virtual stranglehold on the Democrats and have been gaining influence among Republicans every year).

                            I'm always still in trouble again

                            "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
                            "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
                            "Of course, human life begins at fertilization that’s not the argument." --Tassman

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                            • #15
                              Originally posted by Tassman View Post
                              "Look to England and Canada" as examples to learn from: "The United States Spends More on Healthcare per Person than Other Wealthy Countries".

                              https://www.pgpf.org/blog/2019/07/ho...ther-countries
                              The article (which contained many words....) noted that the inefficiencies and administrative burden is higher in the US. Much of that burden is rooted in the myriad of insurance plans.

                              In military hospitals, things like utilization rates and billable procedures are not widely used benchmarks as in civilian hospitals. Patient outcomes are the really significant benchmarks, which other studies have shown to comparable to US. The things which hit the news, like doctor shortages in Britain, are also a problem in US, where many counties have a real doctor shortage.

                              The largest real difference between US and other countries like Switzerland is cost, the Swiss receive good health care. And Canada has drawn patients from south of the border, things like favorable exchange rates, coupled with excellent doctors (and their procedures which sometimes outpace American medicine), has Americans looking north to Canada.

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