How Should Your Doctor Be Paid? Part 1: Fee for Service
Published January 30, 2009 @ 04:31PM PT
The question of how physicians, nurses, hospitals and other health care workers should be compensated for health care has been cut-and-dried for most of the history of modern medicine. Doctors were paid a fee for a service. Need to get a broken arm set in a cast? That costs X. Need to have a mole removed? That costs Y. But despite the hallowed glint of tradition and custom, the times have clearly changed. We can't ignore the unintended negative consequences of fee-for-service in our Monopoly Money health care system, and we’ve been confronted with too many other competing ideas on how to pay for health care. As we push to overhaul our system, it’s worth taking a second to realize the answer to this question is, “We’re honestly not sure anymore.”
Fee-for-service makes sense on a gut instinct level. I go to my doctor for something – a physical, an X-Ray, a prescription. It makes sense to pay for health care like I was purchasing anything else. But under harsher scrutiny, that analogy breaks down. After all, when I buy almost anything else, I look for the price first. Not so with health care. Instead, I know I'm paying a co-pay which usually has little connection to the cost of my care, and my health insurance company pays for a fraction (hopefully a large one!) of the rest. In the event that they don't, I either fight with them in a costly battle, pay the difference myself or my doctor eats the expense. But suffice to say, that's not in my mind before I go to the doctor's (although perhaps it should be.) In 32 years when I’m on Medicare (and believe you me, I’m getting’ there, baby!), I’ll similarly be shielded from most of the costs of my care. As a consumer, it turns out I’m not really focused on what my care is. My main concern is just, “Will this make me better?”
But fee-for-service doesn’t take into account whether it actually makes me better. Whether the “service” was successful or not, the doctor or the hospital gets the same “fee.” Ditto whether the “service” is necessary or not – as the Dartmouth College study reminds us we spend $700 billion each year on care that does not improve our health outcomes. If you and I have the same condition, but my doctor needed to run two additional tests and an MRI on me “just to be sure” before he could diagnose me, my care will cost more than yours and with no better outcome. If I somehow wheedle my doctor into writing me a prescription for some drugs that he doesn't believe will actually help my outcome, but does it anyway to shut me up, my care still costs more but for no better outcome. It turns out my main criteria as a “health care consumer” doesn’t actually relate to the compensation that will be made in my name.
Fee-for-service also is no picnic for many doctors – particularly those who practice primary care. A plastic surgeon is doubtlessly fine with this structure – do a surgery, get paid, but house. Done and done. But a primary care doc trying to diagnose me in for the first time only gets reimbursed for my initial 15-minute appointment. She doesn’t get reimbursed for the time she spends going over my medical files, or if she decides to call my previous doctor for clarification (he wouldn’t get reimbursed for that either). She doesn’t get reimbursed if she takes extra-long with my exam or with the interview if it's not "usual and customary" to do so. She doesn’t get reimbursed for bouncing new ideas off a colleague, or following up with me by phone to see how the treatment is going, or to answer a question by email. She just gets reimbursed for that 15-minute appointment. As a direct result, doctors and hospitals rely on getting through as many such appointments in a day as possible. In the worse case scenario, the interviews become rushed. Your 15-minute interview becomes 5-7 minutes, and the doctor interrupts you 23 seconds in. There’s a huge incentive to get right to the tests, from the simple blood work to the complicated X-Ray, CAT scan, MRI, or what have you, because each of those services has their own fees – and in some cases, more expensive fees than the simple patient appointment and examination.
Doctors and hospitals don’t do this because they’re trying to fleece the system. But if you’re a family medicine doctor running a small practice with three other doctors, paying overhead (including health insurance for your own employees) and a staff involving one or more nurses plus people just to deal with the administration and paperwork and interfacing with every insurance company’s unique sequence of hoops, and in many cases fighting for compensation, it’s hard not to see the financial incentives in seeing a lot of patients and running a lot of tests in a short period of time as not so much an incentive as a matter of necessity. And that not only changes the way our doctors practice – it helps explain why an incentive to maximize the amount of health care dollars spent is, well, doing just that on a system-wide and unsustainable scale.
Next: If not fee-for-service, then what? We’ll take a look at some of the proposals on the table – including those mentioned by Tom Daschle, Sen. Max Baucus and President Obama himself.
(Photo credit: stopnlook on Flickr.)
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How Should Your Doctor Be Paid? Part 3: Salary
Comments (36)
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.
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I would like to see compensation directly related to outcomes.
Start with a set fee for all services. Then, after a period of evaluation, increase (or decrease) that fee based on patient outcome. A doctor, who lowers cholesterol in a majority of patients, or gets most of her patients to quit smoking, attain a proper weight, gets blood pressure down..... should be rewarded for good performance.
This is actually how the UK's NHS compensates it's physicians with the exception of the "fee", which under their system is non-existent. They are salaried, and salary is increased based on health outcomes.
I don't know how you do that in any other manner except in a totally nationalised system (which I favor), but I think it can be done. One way would be to have a sliding scale of insurance payouts, so the patient always pays the same co-pa no matter what the doctor gets for the service. This would channel patients to the best physicians, while providing the highest care to the patients.
If the incentive is good health outcomes, everyone benefits.
Bob
Posted by Bob Richards on 01/30/2009 @ 06:57PM PT
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So... you're saying that a doctor's salary should depend on patient compliance? Seeing as doctors aren't parents and, in the US, people retain the free-will to do what they choose with their bodies, it doesn't seem quite fair that a doctor's income should be determined by how well his patients decide to follow his advice.
Not to mention the social implecations of such a policy. Doctors would start neglecting the sicker, more difficult populations and start seeing only those with easily remedied cases.
Posted by Jack Summers on 02/01/2009 @ 01:09AM PT
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I watched a program the other night about the Canadian Healthcare system. Although they enjoy National Health coverage, it to, isn't without it's flaws. Long wait times, for routine procedures and MRI's..6 months to 1 year which can detrimental to the indivual's health. Comments were made made about the "broken" American health-care system which NO Canadian wanted any part of. Their solution was privatization. To avoid long waits, those that can afford the costs, paid for services at private clinics. The Canadian providers set their own fee schedules. MRI'S cost were about $650 Canadian-dollars, no wait times.
Posted by leatrice brantley on 01/30/2009 @ 08:32PM PT
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From retired primary care physician. Fee-for-service is fine if you call medical review, discussion of problems with patient (and all of their care givers, family etc.), review of medication outcomes and side effects, couseling about reasons for needing medication, counseling about actual surgical or other procedures planned ( to be performed and paid to another physician), treatment of depression (due to losing job etc)...services. Since the US medical system is based only on PROCEDURE payments the primary care physicians are not compensated at all basically. I know. I retired in December being unable to perform all the above services for my patients in the 10 minutes alotted. (Remember an internist has a patient load average age approaching 70 years old. My patients could not walk into the room in 10 minutes! Let alone understand the reasons they were taking 10 medicines..No in the US Patient CARE is not compensated. PROCEDURES are compensated ant that is based on whatever surgeons wish to charge. One of my ladies had a 4 hour surgery the surgeons bill was $148,000. During my 4 hours with her over the proposed procedures and compications etc. my fees were $500.
Posted by Lee Dorsey on 01/30/2009 @ 08:52PM PT
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Great discussion, thanks! An anecdote. About ten years ago I went to a group family practice doctor I hadn't seen before, about a problem (with the skin of a finger) I hadn't asked anyone about before. He looked at the finger briefly, told me his diagnosis and prescription, and when I tried to say that I'd already tried that drug and it had had no effect, cut me off, saying that he'd have to charge extra if he took a history. I must have been behind the times, thinking that looking into relevant history was an ethical obligation, not an extra! I was paying cash (though maybe he didn't know it), about $60 for what took no more than 5 minutes, probably less. Apparently he had a way to charge for the different components of what should have been, but wasn't, patient care. The outcome: I thought maybe he knew better than I, and tried the drug again, but it had no positive effect, just side effects, which still persist.In any event I couldn't agree more that paying for procedures can be bad both for patients and doctors.Also, I think that the system of payment by 'insurance' provides perverse incentives for all parties involved.So why not make it simple? Let people who want to, contract however they wish, but for the rest of us, let the government pay doctors salaries for blocks of their time. (Sure, you could build in extra incentives, though I'd be leery of compensation based on standardized determination of 'outcomes' - shades of standardized tests in schools.)
Posted by Stuart Ambler on 01/31/2009 @ 12:05AM PT
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What's wrong with doctors being paid a salary? It's a system that has long been used in the military, and is used in HMO-owned clinics. For the docs, it means they can really just focus on what most of them love to do--healing the sick, and keeping the well, well. Let others handle the administrivia. Leverage the organization (which is much larger than a typical 2-5 doc practice) to provide computerized records, referral to specialists, negotiation of discount pharmaceuticals, etc.
Posted by william newmiller on 01/31/2009 @ 05:35AM PT
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What if you just paid doctors by the hour or a salary based on x number of hours /wk...just like nearly everyone who goes to see them? If they're not good enough to fill their schedules, they make less, if they're in demand and want to make overtime, they make more. I left a doctor who charged me 25.00 to phone in a prescription from the golf course on a weekday. Insurance wouldn't pay for that. Doctors should be fairly paid. Patients should be treated with cairing, fairness and respect. Private insurance should be eliminated.
Posted by Jake Jacobs on 01/31/2009 @ 07:28AM PT
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Just wanted you all to know that post #2 on this topic, dealing with the "episodes of care" model, is up at http://healthcare.change.org
Posted by Timothy Foley on 01/31/2009 @ 09:32AM PT
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William, Bob and Stuart--
I hadn't planned to talk about doctors on salary, but you guys convinced me. Let me do a little digging, and I'll make sure that's in post #3, later today.
Posted by Timothy Foley on 01/31/2009 @ 09:33AM PT
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I agree with the comments that doctors should be paid a fixed salary. Doctors and their workers should be paid fairly and all treatment, tests, prescriptions already included in the insurance fee. Health should be a basic human right accesible to everyone.
Posted by tonatiuh nunez on 01/31/2009 @ 12:58PM PT
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Well I think doctors get paid the way they should right now, however I think the insurance companies are the problem here, it's not the hospitals. The hospitals and doctors are the insurance companies little puppets. They do what they have to do to keep their jobs and to make sure that insurance companies don't drop them.
Sorry (and this is my personal opinion) but I think it's stupid for one doctor to be payed the same as any other doctor.
First off that plastic surgeon you were talking about had to do more schooling than your GP. They do more in one given day than a lot of other doctors.
I think it's stupid that some doctor that might preform 80 surgries in one year get's paid the same as a doctor who preformes 130 surgeries a year. The doctor doing more work should get paid more. Doctors dedicate years and years and years of their time and not to mention a butt load of money for schooling to be able to do these jobs, some secialties require more schooling and more money for the schooling. And therfore they should be making a lot more money to make up for that.
I think it's bogus that people want to pay doctors a fixed rate. They should get paid on how they work and what area of medicine they are in. A cardio thurasic surgeon or a neuro surgeon should make more money than a dermatologist.
People that work harder and do harder jobs should be paid more. Like trauma surgeons should be paid more than GP's.
A GP doesn't specialize, a surgeon and some other doctors do.
I think if nero surgeon A does 20 more surgeries a year than nero surgeon B, then surgeon A should get paid more.
You have to understand some surgies can last hours and hours and hours at a time. So one more surgery can cause a doctor to work 10 more hours. It's like over time.
Plus you have to understand doctors work around the clock, one more surgery can mean another night without sleep. I think they are being paid in a fair mannor.
Jobs that reguire more schooling should get paid a lot more.
doctors who work harder should make more than those who didn't.
Posted by Connor D. on 01/31/2009 @ 02:14PM PT
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But then, we'd have a shortage of GPs... (Although we already do...)
Posted by Jae H on 01/31/2009 @ 04:59PM PT
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I think you're missing the whole point of the article. It is quality, not quantity. If two surgeons are in the same field of practice, one does 15 procedures in a day, the other does 30, which patient group is getting better care?
Posted by Dane Tidwell on 02/01/2009 @ 08:14AM PT
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Dane, Good question, and one that is difficult to answer. Medical procedures, like any motor skill (landing an airplane, playing basketball, etc.) require repetition to stay well-honed. Surely there is some optimum level of activity to maintain proficiency, but the relationship between quality and quantity will not be linear and will not be inverse.
Posted by william newmiller on 02/01/2009 @ 08:34AM PT
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Well, being married to a physician, a Nuclear/Interventional Cardiologist, I can say that I'm sick of people who have a sense of entitlement and feel they deserve healthcare just because they live in America. My wife went to school and trained seventeen years, thats one-seven, AFTER highschool, completed her training at age 35, and after paying over $120K back in student training and debt associated with education. Now some person comes strolling into her office and complains that his or her bill is X and you only saw me for Y minutes (or whatever), why should it cost so much? Well, 1. She can figure out what is wrong in a short time because she trained 17 years to do that, and to fix it quickly and thoroughly; 2. Malpractice insurance costs so much that (and because) EVERY doctor is afraid of being sued when they really are just trying to do the best for each person they see, though they may have their defenses up for some that seem 'sue happy'; 3. You cannot go to a government agency and complain that your mechanic charges too much to fix your car, when either you broke it yourself, or it's just breaking down/needs some work. You don't like the charge, don't get the work done. Go somewhere else. And just because someone else had 'the same thing done' and it cost less or more, well every human is different at every level and what works for one doesn't work for the other or may take longer, or may be more protracted, or........ If you think that healthcare should be free, then you're saying the MD has no right to charge you for his/her services (and that of the nursing and administrative staff), that the hospital should provide what you need to feel better so you can go back to smoking, eating bacon cheeseburgers, watching reruns on your bigscreen TV or whatever you do while the REAL contributors to the economy, the people who pay the most in taxes and do most of the work, go silently about their business. Not everyone who wants free healthcare is like that, I'm sure there are plenty of hardworking folks who just 'want help.' But nothing is free in life, and the Constitution provides for life, liberty, and the PURSUIT of happiness, not happiness itself. That means you gotta work to get it. Maybe you might have to work as much as seventeen years, but you might give up before then, especially if everyone around you has their hand out wanting a piece of you and your hard work for free. Then, all that work isn't really worth it.
Our son and I see my wife about 2 hrs a day before she falls asleep exhausted and starts another day. She works at a busy practice and puts in over 12 hrs everyday, 5-6 days per week, just to keep up. She earns every penny she makes. And I'm sure that she would do some pro bono work if there were a situation that came up. She is very giving. But there are too many people with too big a sense of entitlement, thinking they deserve something without paying for it.
If we go to socialized healthcare, do you really think you will get the same care that, say, Nancy Pelosi or Rahm Emmanuel gets? The elite will always be ushered to the front of the best line, past the velvet ropes that most will never see, and will get the best and newest treatments, in a private room with a view. You and I on the other hand, will wait weeks or months to be approved for a test only to wait hours or longer in a crowded room to get the test done if the gov't says you need it. If the gov't says you don't need it, well then you may become disposable as the cost of fixing you outweighs your possible productivity in the future (that means it costs more to let you live than to let you die). All you socialists and democrats crying out for free healthcare and healthcare reform don't really know what you are in for. What has the government EVER touched that it has improved???? When has the government ever taken over something and it got better?
And if you already are sick, and want gov't help/insurance, you don't really want insurance. Insurance is for when you are well, to protect you IN CASE you get sick. Now that you are sick, you want someone to help pay expenses that you can't or don't want to pay on your own, even though you want the services. Call it what it is, but it isn't insurance. Life isn't fair, and people get sick all the time. It rains on the grass just like the weeds. Bad things happen to good people. But just because you or I got some rain, doesn't mean that society owes us a single thing or we deserve anything free. Nothing free is worth having.
Posted by John Marshall on 02/22/2009 @ 11:19PM PT
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John, I'm the father of a physician and the husband of a psychotherapist, so I know something about the demands of a medical education and of treating the sick. As you point out the demands on healthcare providers can be heavy--that's only another indicator that our system needs repair.
As for socialized medicine, your analysis is misplaced. The defining feature of socialism is the assumption of the means of production by the government. Insurance is not socialism; rather, it is a way of spreading risk. Currently, our system of health insurance is also broken because it has been tied to employment, something that for many is increasingly tenuous. And because insurance companies in many cases have used their power to withhold healthcare rather than to provide it by reducing payments to physicians to levels that are less than sustainable.
Yes, bad things happen, but more bad things happen when we refuse to explore alternatives and seek improvement, when we despair at long hours and give into the temptation of the rant.
Posted by william newmiller on 02/23/2009 @ 06:03AM PT
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How should my doctor be paid?
My doctor should be paid IMMEDIATELY.
Preferably with the swipe of a smart card.
We could easily do that with a Single Payer Health Insurance Plan. In it, doctors would negotiate the price and method of payment. Fees for procedures could be standardized. Some doctors could be salaried.
Otherwise, without a National Health Insurance Plan, the question of how doctors should be paid is purely academic.
A single payer system will be managed by physicians organizations, hospital administrators, consumer advocates, and the fund's fiduciaries. The budgets of hospitals are already well documented. The costs of surgeries and treatments are easily itemized. Billing and compensation will occur directly. Monies will be also be earmarked on the basis of local needs for new equipment and expansion. Boards at the local level will have easy access to the experince of people already running the current system to make the transition to the new one. All this can be done wilth a minimum of displacement except for those now selling health insurance. The need to control costs means that tradional profiteers must go. Private hospitals can run as real non- profits. This transition will take time and money to buy out current stockholders. Research and developement will continue both in the private and public sector.
Posted by Martin Bring on 01/31/2009 @ 05:10PM PT
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William, Yes HMO doctors are paid salaries... based on the 10 minute per patient rule, because they have to collect from Medicare and that is how they pay. It is against the law if you accept Medicare to charge any other way. That is why primary care doctors are having to deny Medicare...and Insurances who pay the same, and just do 'boutique' medicine for the wealthy.E.G. Annual fee and for cash only visits.BUT here is where we get little services for our $$ in the US.Medicare's overhead is 7%. Most all private insurance companies make 25-35% profit, depending on how little they need to pay out to 'care' for you. That goes to company owners, eg shareholders...Good old American Capitalism. If that 30% were reduced to the 7% of Medicare the other 20-25% of spending could go to CARE!That is why I am a Physician for a National Health Plan.PS. It should be against the law for prescription drug makers to be able to advertise to the public!! Talk about wasted money.
Posted by Lee Dorsey on 01/31/2009 @ 06:38PM PT
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I believe doctors should be paid salary, through a single payer health care system. It would save money, and eliminate many of the problems you discuss in this article. NHS in England is a successful system. Their GPs (general practictioners), for example, are paid salary (and its more than suitable, for those doctors in the US who use "lower compensation" as an excuse), and receive commission for any health improvements in their patients (getting more patients to quit smoking, lower cholesterol, etc). The Canadian health care system has received a fair amount of criticism in the US, but their "long wait times" depend on the province, and most of the time their waits are as long, or even shorter, than ours. Ask any Canadian if they'd prefer our system, and they will laugh at you. We need a nationalized health care plan. We are wasting money and our citizens are suffering. We are the only major post-industrial country that does not have a national health care plan, and we have shorter life expectancies, and higher levels of illness. Thousands of our citizens die every year simply because they are not insured. I do not have health insurance and I can attest to that suffering personally. I have heard several doctors refer to me as a "customer," furthermore, which is ridiculous to me. I am your patient, not your customer. But this is the way we think of health care in this country. And it must end.
Posted by D W on 01/31/2009 @ 07:00PM PT
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Here, after you read through part 3 of Timothy's good series...This is the meat from the article he links to:healthbeatblog.org/2008/12/-insurers-expand-primary-care-an-argument-for-obamas-plan.htmlIn addition, the more I think about it, the more I realize that unrolling national health reform will be a process that will require many experiments. Some will succeed; some will fail. Disruptive innovation calls for a variety of players thinking outside of the box.After all, this is a big country and I’m becoming convinced that what works in one region may not work in another. That is what I have always thought. Let there be differences, interstate, intrastate etc. Then pick the best.
Posted by Lee Dorsey on 01/31/2009 @ 07:57PM PT
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*Babies* are born, currently, 33% by CESAREAN SECTION in this country. That's major surgery (and $17,000) to HAVE A BABY, as opposed to the $2000-$5000 it costs to have an unmedicated birth. (Which is the norm in all the other industrialized nations whose c-section rate is around 10%, which is WHO-standard.)
If Doctors were paid by: #1 pounds of live human ($100 for every pound, let's say); lack of epidural (double #1); lack of pitocin (double #1 again); lack of cesarean (double 1, 2, and 3 combined), that would give a whole lot more incentive to docs (and Insurance co's) to help women have healthy, unmedicated labors and births that cost EVERYONE a whole lot less. One proven way to increase "unmedicated" labors is also to choose midwives and doulas. Please see my petition to that end: http://womensrights.change.org/actions/view/doula_support_for_every_birth
And thanks, Mr Foley for your bringing this up!!!
Posted by Kayti Ricker on 01/31/2009 @ 11:35PM PT
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Mr. Foley,
We will have to agree to disagree if you accept that fee for service is wrong. Fee for service is how human beings conduct all business transactions. Whether it is paying a babysitter so you can take your wife to the movies, or General Motors paying an autoworker the hourly agreed upon wage for car assembly.
I do not agree with the premise that the healthcare system in the United States is broken. I agree that it could and should be improved. However the starting point for improvement is not a how doctors are compensated, but rather how do we reduce or eliminate costs within the system that are not related to actual healthcare.
Start with tort law for medical malpractice. Cap the lawyers fees for malpractice lawsuits. Limit damages for pain and suffering, and better regulate the malpractice insurance industry.
Regulate truth in billing. If a bandage costs the doctor or hospital 20 cents then that is what is on the bill. When itemized bills are given, if part of the fee is for administration say so, people will look for facilities that keep their overhead low.
I understand that some people are frustrated with the system. i also understand that other people are using that frustration to try and implement changes. I oppose any changes that advocate healthcare as a right, or implement nationalized care. I spent 20 years in the military receiving care for myself and my family from a government run system. I now have private insurance do to employment. The difference is night and day.
Posted by Brian Burke on 02/01/2009 @ 08:58AM PT
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I am replying to myself because I spoke to wife, and she told me I was not being particularly clear. So to revisit and make it clear: I don't believe healthcare is a right, but also it is not a privilege. The current system that does not deny people emergency care is good. Necessary healthcare is available. There are plenty of free or low cost preventative programs available too.
Posted by Brian Burke on 02/01/2009 @ 09:15AM PT
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Brian, I beat you by three years--23 years in the military. Your conception of fee-for-service seems broad enough to define the compensation you received for military service, which is salary-based, continues in war and peace, is the same in return for a 24-hour crew-duty day or 24-hour crew rest period, while engaging in combat or participating in a graduate education program. The fee-for-service system associated with compensation for physicians is quite different and needs to viewed within the context of healthcare delivery, a system that you wisely point out suffers from significant externally imposed costs. I suspect that an argument can made that our specific implementation of fee-for-service in the medical profession has produced (or contributed mightily to) an uncoordinated and expensive healthcare delivery system that many (though not you) do describe as broken.
I'll agree that military health care--like any delivery system--could be improved. But ask those who don't have your good fortune to receive health insurance from an employer if they'd like to have the government-run military system you now dismiss.
If healthcare is neither a right or privilege, then what is it? Let me offer a term that might suffice: a necessity.
Posted by william newmiller on 02/01/2009 @ 09:42AM PT
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Danr just because one doctor does more surgeries doesn't mean that their patients aren't getting better care.
The one that does more just might be a better surgeon.
William said that perfectly.
I don't believe in a single payer health care system, all it will do is cause more corruption and it will cost a lot more.
I think we need to make laws on the insurance companies from becoming greedy, money hungry, and dishonest. Which it already is. Insurance comapnies rob people blind. If we can find a way to make good health care affordable for most everyone in America then it would be a lot better than sinlge payer health care.
I haven't seen one country yet that has a better single payer health care system than what we have now.
Posted by Connor D. on 02/01/2009 @ 11:33AM PT
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Let me suggest that the jury is still out in America regarding a single-payer system. Most objections I've heard to a single-payer system seem to arise from ideological beliefs, and comparisons to other countries seem to ignore that those countries have fewer resources and less wealth than we have in the United States. Developing an empirically-based opinion that compares apples to apples is surely a challenge, but somehow we need to figure out how this can be done.
Posted by william newmiller on 02/01/2009 @ 12:14PM PT
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Bob I agree with your statement.
Even if one surgeon does more surgeries a year than another doctor, but the other doctor that does less surgeries has healthier patients when they leave the hospital and are getting better care and attention then a doctor should definatly be rewarded for that.
That's more of what I was trying to say.
Doctor's who do a better job should make more than the other ones that might not.
Posted by Connor D. on 02/01/2009 @ 11:38AM PT
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Can we please stop quoting CANADA as the standard for universal health care? The World Health Organization (WHO) ranked Canada 30th in the world, not much better than the U.S. (37th...). Let's look instead at the NUMBER ONE on the World Health Organization's list, FRANCE. Best in the world, it still has defects; but it costs half per capita than the $2.3 trillion we spend.
If we provided our people a system similar to France's, we could use the other half for fixing the parts of the French system that are unattractive to Americans: high physician salaries, for example.
The extra money could also go to improved systems such as your health history on a chip card, programs like smoking and drug prevention, nutrition awareness, general health incentives such as organic food subsidies or clean air and water, and other programs such as day care or promoting sports and physical fitness.
Posted by odile brock on 02/01/2009 @ 06:26PM PT
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I agree with the comments that doctors should be paid a fixed salary. Doctors and their workers should be paid fairly and all treatment, tests, prescriptions already included in the insurance fee. Health should be a basic human right accesible to everyone.Posted by tonatiuh nunez on 01/31/2009 @ 12:58PM PSTReport close Please report any offensive or inappropriate content.
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Posted by A J on 02/01/2009 @ 09:09PM PT
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Just because France was ranked #1 doesn't mean it's what's best for our country.
A lot of things are ranked #1 that a lot of people don't agree with.
I don't agree with single payer health care at all. I'm not going to pay for other peoples crap, more so than I am doing now.
Single payer health care will just cause more problems than we have now.
Why don't we leave it up for option? Those that want it can have it and those that don't want it can pay for their own.
I will always want to pay for my own health care because I want to know what kind of treatment I'm getting and I want to know that I'm taken care of.
I don't want a single payer health care system where if I get diagnosed with pancreotic cancer I have to wait 6-9 months for treatment and by then I'll be dead.
Sorry but I want to be sure that I am going to be taken care of.
Also I understand that we have more reseaurces and money than a lot of other countries, but that doesn't mean that we are going to use them.
Come on when has America spent our tax dollars the way they should?
I don't trust them to make a single payer health care system that is better than what we have now.
It's just going to cost people more money. America right now as far as I can see only cares about ripping off every dollar someone earns right now. even if we find a cheaper way of doing things all that means is the governement is just going to find something else to blow that money on. When what ever the government is saving should go right back into our pockets.
It's not the governments job to take care of everyone. They aren't there to be there in our lives every two seconds. People need to run their own lives and have the government stay out of it. I don't like the single payer health care because I don't want another reason for the government to step into my life.
They need to back off and let people take care of themselfs.
I think there needs to be a special health care insurance fund set aside for those who are very poor and can't afford it. So that they are taken care of if they get sick. It may not cover everything, but at least they will have some form of health care.
But those who can afford health care should be paying for it as we do now. But we need to set up laws that prevent insurance companies from stealing our money as they do now.
Most people that don't have health care make enough to pay for it, they just don't. I'm sorry but they are out of luck if they don't want to spend the money, that's a choice they make, and if they get sick well then they pay for that mistake.
Posted by Connor D. on 02/02/2009 @ 10:36AM PT
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I would call this attitude narcissism.
So, let's see. The fire department shouldn't service you unless you have fire insurance; and oh yes, police should not respond to you because you can take care of yourself. If you are in need of rescue, the coast guard should let you drown unless you have rescue insurance. Who needs FEMA? Buy your own flood and disaster insurance. See how absurd this sounds?
BTW, things WERE that way with fire departments. There were many, and you bought "protection" from one. If you had no fire protection the responders would watch your house burn unless you had their emblem on the building. Now why should I pay for YOUR fire, police, rescue protection? Not to mention your public schools? I have no kids, why should I pay? Oh, I don't drive either, why should any of my taxes pay for YOUR roads? Private toll roads only!The absurdity goes on and on.
Civilized societies, composed of civilised people, recognise the concept of the "public good". Services which benefit society as a whole. Universal health is such. If your neighbor suffers from typhus because they don't have access to health care, it affects YOU as well. I am sure you would be the first to complain if a leper lived next door. If the house next to you burned down because of lack of fire insurance, that would affect the value of your precious property wouldn't it?
How is a healthy society any different than a safe one?
As far as choice is concerned, I would entertain the concept of allowing individuals to opt-out of ALL public services if they wished, but I wouldn't support allowing them to pick and choose. Either you are a member of the group, or you are not. If you choose not to support my health care, I should be equally free to not support your fire/police protection as well. What's fair is fair.
Bob
Posted by Bob Richards on 02/02/2009 @ 11:38AM PT
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Connor, you ask, "Come on when has America spent our tax dollars the way they should?"
For starters:
1. Winning WWII
2. Rural electrification
3. The interstate highway system
4. Sponsoring polio vaccine for all
5. A national postal system
6. A national air traffic control infrastructure
7. A national system for educating citizens
8. The Internet
My guess is that others can add a lot more to the list.
Posted by william newmiller on 02/02/2009 @ 12:31PM PT
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Bob you have a valid point.
I'm not saying I don't want to pay for anyones care but my own. When it comes to health care I guess that the case because medical coverage is far more exspensive than anything else.
But lets say some kid likes to light fires and he burns his house down. Sucks for him I don't want a dime of my hard earned money going to that. Just like I don't want to pay for a smokers lung cancer treatments. I'll pay for any other persons cancer treatments, but not one where cancer was a choice.I just don't like the idea of universal health care, I would feel out of control of something very important in my life.
I want to be able to know what I am getting out of my health care. I want to know there will be enough treatment for everyone, I want to know they will have enough resources. I just want to know what's going to happen to me if something happens, I don't want to just let the government take care of it, because I don't trust this system. I can't trust that if I get sick they won't turn me away because they don't have the ability to treat every person comming in.
I have been to a free clinic. And when I imagine free health care I think of a free clinic, I'm sorry but that's not what I want for me or my family or anyone for that matter.
In my mind if we have free health care it's going to be poor health care for everyone. I don't want that.
I don't trust my government to take care of me. Sorry but I don't.
Posted by Connor D. on 02/02/2009 @ 08:37PM PT
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I understand your distrust, Connor. But think about the millions of Americans who literally cannot afford health insurance (I am one of them; and yes I am employed and no I can still not afford it). And think about the many millions more who are underinsured, or who have been denied essential medical care because their insurance company wants to save X amount of money, or who have been laid off and lost their health insurance and do not know what to do. None of these people have the luxury of your distrust. Look into the eyes of someone who has lost their job, their home, and their savings because of a debilitating illness and tell them you disagree with universal health care because you distrust it. Could you do that?
Also, your worry about the quality of "free health care" is understandable. But the free clinics and programs you speak of exist within our current system, and are often poorly funded, which naturally affects the quality of care they can provide. Universal health care would be completely different, from its budget, to its policies, to the way it would be managed, therefore the quality of care could not logically be like the free clinics we see today.
Bob Richards made some very oood points in his response to you. There are many social services in this country that we have grown to take for granted, and when members of our government grumble about socialism whenever someone mentions universal health care, I want to laugh. Fire stations, police stations, the public school system, post offices... would you like to begin paying for these services as well? Because clearly, you want the government to "back off." It makes no sense to me why someone would say they are against universal health care because they disagree with government involvement, when they have enjoyed so many public services their entire lives. We all have. So please tell me why our school systems are public, and our health care is not. Every single person I have met from a country that has universal health care tells me they feel sorry for us because of our incredibly broken system that profits few and harms many.
This is literally American lives we are talking about when we debate this issue, and I wish that people (policticians in particular) would remember that.
Posted by D W on 02/03/2009 @ 01:19AM PT
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Jack Summer:
I don't know where you got your crystal ball from. But your predictions are totally contradicted by known facts. None of your doom-sayings exist in systems which have national health care. Have a look at the French system, rated number one by the WHO. See: http://www.nyu.edu/projects/rodwin/french.html
Bob
Posted by Bob Richards on 02/03/2009 @ 03:41AM PT
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I believe we need to have a special health care system for those who can't afford it. Like I said above, I just want to pay for mine.
I know is Australia, they have made some discoveries that circumcision "may" lower the chances of getting and STD or HIV. Well they say because everyone is paying for the health care here it's cheaper to circumcise baby boys than it is to treat HIV later in life. So they want to see if they can make it madatroy for all young males to be circumcised because of this claim. This claim hasen't even been proven. No study has been sucuesfully been able to prove any of that claim, the only thing they have been able to do is make correlations that it "might" be true. Plus the only place they have been able to find these correlations is in Africa. The same studies done all over the world have failed. So Because of their national heealth care system they are going to try to come in here and take away peoples human rights just because of some "prediction". That's BS! Circumcision greatly reduces sexual feeling, and takes away a mans human rights when done without his consent. What else are they going to try to do to people with more medical advances? America can't do that crap now because the government doesn't control our health care. I don't want that kind of control taken over here. I don't want my government taking away my human rights (well they already have) I don't want them taking them away from other people just because everyone else pays for their health care. I hate smokeing more than anything but I would be extreemly upset if the government took away smokers right's to smoke because they are more likley to get conditions everyone else has to pay for. I'm just saying I don't want the government taking control of health care and taking away peoples rights.But I do know that we need to come up with a different way of doing things than we do now, I just personaly don't like the national health care system.Thanks Bob I'll look at that.
Posted by Connor D. on 02/04/2009 @ 08:19AM PT
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