The Home of Steven Barnes
Author, Teacher, Screenwriter

Thursday, June 25, 2009

Unfortunately Correct?

When emotions run high, it is obviously difficult to actually hear what someone is saying. This is why it is so vital to speak to the people with whom you are in opposition: playing "telephone" under stress is just silliness: the meaning always changes between lip and ear.

Marty, I questioned the value of medical research in this sentence:

"What difference does advanced medical discovery make?"

And followed it immediately with this one:

ᅠ"Only if it has an effect on the population does it make any difference at all."

Didn't you read that? What possible objection to that statement can you have?

That's a little like hearing someone say "bullets aren't useful if they don't work" and not paying attention to the last four words, isn't it?


Erich quotes and says:

"... people are more afraid of dying than they are of not getting rich."

"You're unfortunately correct: they are more afraid of immediate risk than of the long-term likelihood that, if innovation is choked off, they will die of things which might have been curable if innovation had continued."

Huh? You aren't discussing fear of death versus profit motive. You're discussing short as opposed to long-term planning. Very different things. Certainly, you aren't saying that it is unfortunate that people care more about their lives than money...which an uncharitable person might conclude from your first clause.


You also suggest that socialized medicine only makes sense if you think we have already reached the zenith of medicine. I know of no one who thinks that, and medical research goes on in countries with universal health care. Now, what you are really evidencing is a belief that medical research is most effective within a commercialized system. This is a good argument, and I would be interested in seeing it debated.


I have to say that your comment that Democrats wouldn't want a pill that extends life is just the kind of "we rule, you drool" thinking one hears on both sides of the aisle on talk radio. Not your best argument, dude.


Yes, I can see reasons why a sane person might want less top-down control of medicine. But there's been only one comment that even obliquely addresses my main point: that the value of medical research/medical support can be measured in life expectancy and infant mortality, and we're starting to suck there, in comparison to countries with Universal care. That one comment is the belief that under such systems, research will suffer, and down the line people will pay for it. That is, as I said, a good argument if speculative. I'm not sure how to prove it, but note that I am more interested in truth than winning arguments: I published statistics that would seem to reinforce YOUR point of view (I would need to look more deeply into them, and speak to experts on both sides, of course, but you can hardly say that I'm only representing one POV, or hiding statistical data behind anecdotal evidence.)


I can understand how you might think I'm being too limited by looking at those pesky life expectancy and infant mortality stats. They don't tell everything, but I think they are less vulnerable to twisting and distortion than anything else I hear. People on both sides with a political axe to grind employ epicyclular logic and quote anecdotal evidence, and end up screaming at each other.

It seems to me fairly simple that if you have better medical care, you're gonna be healthier. If you're healthier, you live longer and fewer of your children die in infancy. I would have been fully prepared to agree our system was better, even if we paid more for it, if we'd been better on these counts. But we're not. I'm sure that if we were, there would be people on the Left who would offer complicated reasons why those stats should be ignored. I wouldn't have believed them, either.

However...I am interested in that question about what motivates medical research. Note that any argument you give, I will assume that that reflects your personal values. Fair enough?


BC Monkey:

We die of the same things our parents and grandparents died of. A specific researcher may not know what he or she will die of, but fear of death, and concern for loved ones, still would produce a spectrum of research covering most of the things that kill us--enough to impact statistics. And your comment about blind researchers shows that you mentally deleted part of my comments. Researchers have blind children, wives, husbands, mothers and fathers. Are you saying that only if you, personally, have a disease that you care about it? I doubt that very much. Are you saying that money would be more motivation to you than the health of your own child, niece, nephew, aunt or uncle? I doubt that too. And if it isn't...why aren't you willing to extend that level of humanity and ethics to others?


"In a proft medical system, as a patient, I am a profit centre.

In a socialized medical system, as a patient, I am an expense"

BC Monkey. That's one way to look at it, and here's another. To an insurance company, you are a customer. They want to extract the most money from their customers, and give the least back. They also have an interest in keeping you healthy so that you don't get sick in the first place. To a socialized medical system, you aren't just an expense: you are part owner of the system. Your tax dollars support it. So they also have an interest in keeping you healthy, and once you are sick, to helping you heal so that you can work and continue to pay into the system. In many ways, both have the same basic needs and goals. But the socialized system is part of the overall educational and public recreation/health complex that can actually affect your attitudes toward taking care of your body and mind. Both want people to take as little back as possible, but the Universal system has economies of scale and lack of profit motive: I fail to see why stockholder profits, enormous executive salaries, advertising and so forth help me stay healthy.

And again, without addressing the fact that life expectancies and infant mortality are NOT better under our system, you're going to have a very difficult time convincing me. The fact that you, as an individual, have a horror story (for which I am sorry) is simply countered by any one person who gives me a horror story about their HMO, or how a relative died from lack of medical care.

Anecdotal evidence won't convince me. Saying that scores of Canadians come to America for their care won't convince me without both specific, hard numbers (exactly how many? For what kinds of procedures?) and a refutation of the Harvard Medical School study that said that the average Canadian has health care equivalent to the average INSURED American. Add the uninsured in, and obviously, if one is to believe HMS, the Canadians are better off.


"If Obama's idea of change is to reduce the pain on one group, the poor by inflicting pain on another group, the elderly then how is he different from anyone who discriminates between groups."

True! But that's a big "if." Again, we could answer this simply by looking at the question of who gets better care and has better survival rates for every age group between America and various countries with Universal health care. My guess? The wealthiest Americans have better care, but the average American does not. I am open to seeing contrary statistics.

Have you any?


suzanne said...

healthcare everywhere
in every country
one way or another
is "rationed"

tell me this is a good thing about
the system as it "works"
in the US

to my view
this is
criminal behavior

Anonymous said...

"I can understand how you might think I'm being too limited by looking at those pesky life expectancy and infant mortality stats. They don't tell everything, but I think they are less vulnerable to twisting and distortion than anything else I hear."

A major problem with infant mortality stats is that infant mortality is measured differently in different countries, so nations end up measuring very different things. In the U.S., doctors often try hard to save premature babies who are not breathing, and if the baby dies anyway, it is counted as a life lost. In other countries, a premature baby who is not obviously breathing can be immediately counted as not having been born alive, and their death will not make it into infant mortality statistics.

Ironically, when we in the U.S. try to save prematurely born babies, the effort to provide better care makes our medical professionals' efforts seem inferior to those in other countries.


coxcrow said...

I thought I would try to find some stats for Canadians crossing over for health care in the US. While I didn't have time for an exhaustive search, I did find a few things presented below.

Generally I'm anti-government centralization but considering things from the opposite view point can be enlightening.

From Health Affairs

From the Connecticut Coalition For Universal Health Care
These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans.'_use_of_healthcare_in_the_u_s_.htm

Here's the conclusion from a study published in the Journal Of Pediatric Surgery.

Canada-trained pediatric surgeons practicing in the United States are more satisfied with patient care issues, whereas those practicing in Canada are more satisfied with the medicolegal environment and the system of health care reimbursement. There is no overwhelming preference for either system among surgeons who had experience in both.

In the pro status quo column...

From The Ottawa Citizen
By comparison, under the heading "Federal transfers in support of health and other programs," the Canadian federal government only spends about $33 billion out of $240 billion, or around 13 per cent, which includes support for higher education as well. On the other hand, American states are better off than Canadian provinces: Comparing the two most populous, in California "Health and Human Services" takes around $40 billion of $144 billion in spending or 28 per cent whereas in Ontario it's around $40 billion out of $96 billion or 42 per cent.

Personally I don't like the current system and I'll need a lot more convincing to vote for socialization but the debate here is interesting and has spurred me on to do more research.


Anonymous said...

I'd like to be wrong about my belief that the Democrats, given top-down control of all U.S. biomedicine, would discourage or completely suppress commercial development and free marketing of drugs aimed at slowing or ameliorating aging (to take a real-world example of a profoundly game-changing technology that's being pursued by for-profit biotechnology and pharmaceutical companies as I write this).

But I am not at all sure that I am wrong, because all the arguments I'm seeing for Obamacare seem aimed at providing universal access to basic care for the entire population at the explicit expense of innovation, by lowering or abolishing the incentives to produce new drugs and restricting or outright banning public access to new medical technologies.

You're not a paranoid if they really are out to get you; and it's not just "we rule, they drool" if I keep hearing from Democrats a steady parade of egalitarian arguments which more or less explicitly accept hobbling private-sector innovation as an acceptable side effect of that egalitarianism.

--Erich Schwarz

Daniel Keys Moran said...

I've been hearing variations of this argument my whole life. The idea that getting screwed is ultimately good for you is pretty much the core of Republican arguments in a variety of areas. It's fascinating the degree to which they've sold people on it.

Daniel Keys Moran said...

A more recent health care poll. Mike & I have been arguing two polls from, respectively, 6 months ago, and 2006. This one's from last week. Health care stuff's toward the bottom.

43% are satisfied with the health care system; 57 are not.

83% are satisfied with the health care they themselves receive; 16% are not.

But, and here's the # that's causing Republicans to lose this argument: 62% would support the creation of a government insurance plan (the "public option") to compete with private insurance.

Mike R said...

>83% are satisfied with the health care they themselves receive; 16% are not.<

Interesting. Although the drop compared to the previous surveys may be due to the different phrasing of the question (satisfied & unsatisfied vs excellent, good, only fair, and poor) rather than a feeling among people that they personally are receiving worse care than they were two years or six months ago. Hard to tell which is why one usually compares polls which ask the exact same question in the exact same manner.

And of course the broad trend still holds regardless of if it's 83 or 89 or 96%, the overwhelming majority of Americans are personally satisfied with the health care that they personally receive, while thinking things are bad for society as a whole.

>But, and here's the # that's causing Republicans to lose this argument:<

And here are a couple that will hurt the Democrats;

17. How concerned are you, if at all, that current efforts to reform the health care system will

a. Reduce the quality
of health care you
receive 81% total concerned (combination of very & somewhat)

b. Reduce your health
insurance coverage 82%

c. Increase your health
care costs 84%

e. Limit your choices
of doctors or
treatments 79%

So we have a situation where the overwhelming majority are satisfied with the health care they now receive and that same large majority is also overwhelmingly concerned that the current efforts to reform the health care system will personally effect them in a negative manner in a field as emotional as their own health. That's a tough hill to storm.

Marty S said...

Steve: I interpreted your statement as implying that you didn't think the research was affecting the population. My error. However, I have many problems with your life expectancy criteria.
1) because it doesn't take into account advances that affect the quality of life and
2) It doesn't into account factors other than medicine/health care which affect life expectancy.

As an one example of 2) the murder rate per person in the U.S. is three times that of the U.K. without compensating for this how do you compare the affect of the two health care systems on life expectancy. A second example is that Europe in general has better public transportation and rail systems. People drive less so while I don't have the numbers I would guess that this leads to a lower death rate from auto accidents. I'm sure there are other factors that need to equalized for before any valid comparisons of life expectancy are made.

Mike R said...

>2) the murder rate per person in the U.S. is three times that of the U.K. <

One way to count for this is to look at the life expectancy of low-crime states, like say Connecticut which has a life expectancy of 78.7 as compared to the United Kingdom's 78.7. There are of course other differences between Connecticut and the UK.

To me looking at the life expectancy of the various states is very illuminating. Same system, pretty much, but the difference between Hawaii and Mississippi is the around the same difference between Canada and Algeria. Why is this?

Hugh said...

"They also have an interest in keeping you healthy so that you don't get sick in the first place. "

This is slightly incorrect. They don't have an interest in keeping their customers healthy; they have an interest in keeping their healthy customers.

Look at what "rescission" means to the insurance industry; the washington post has an article up about it.

I find it somewhat amusing that the industry that invented preauthorization, pre-existing conditions, usual and customary charges, primary care gatekeepers, approved pharmecopia and lifetime maximum benefits is trying to make us afraid that the government is going to start rationing healthcare.

The argument that we measure infant mortality differently is correct, but loses power when you compare suburban and inner city mortality rates. We do fairly well until you look at areas of dense poverty. Saying that this is due to a higher premature birth rate there is misdirection; prenatal care reduces premature birthrates, and is one of the things people skip when paying for healthcare out of pocket.

Anonymous said...

Somebody wrote:

"The idea that getting screwed is ultimately good for you is pretty much the core of Republican arguments in a variety of areas."

But that's not a form of "we rule, you drool". It's only ad hominem when Republicans do it!

--Erich Schwarz

Anonymous said...

"I am open to seeing contrary statistics. Have you any?"

I already posted this link, along with this one; so I'll repost them, add one more link, and hope that this time somebody clicks through and actually reads them.

--Erich Schwarz

salina said...

i got dizzy for a moment, eerie reading this post that was written LITERALLY hours after the death of Michael Jackson...and the reports of cardiac arrest...

Hugh said...

I didn't actually see any statistics there, but they were relevant arguments.

I find Greg Mankiw unconvincing: survival rates for disease are for those diagnosed and treated. Life expectancy isn't an opt in pool; we measure everybody. He's discarding from his pool precisely those that are helped by more universal care.

Arnold Kling's argument is foolish in the extreme. Consumers are not in a position to decide what does or does not constitute necessary care. This was the basis of the pre-medicare/medicaid saying in hospitals: "A filled bed is a billed bed." The prospective payment model used by medicare and medicaid actually provided the hospitals incentives for reducing waste in care - and for improving outcomes, though that is a long argument. Basically, we go to doctors because they know things we don't - and he's demanding that we second guess them, while betting our financial future that they're right. We see this in operation with uninsured pregnancies - people skip prenatal care, because it may not be necessary. If they're wrong, they end up with a NICU admission, paying their annual salary for every day of care.

Dr. Sklar is right in every area I know about, especially in his fears of being punished for coding violations. That would be foolish; and any attempt to do so would be buried under the weight of too many false positives. Where I disagree with him is in his fear of the changes involved in a government program - he's already seeing reimbursement reductions, and the prime motivator for that is the discounts required to be an "in-network provider" on top of "usual and customary charges" - which translates to "what we feel like paying." One of the difficulties Obama himself acknowledged was that the primary care and family practice reimbursments are too low - and the money to raise them has to come from somewhere.

The big worry, and the most relevant fear raise by Dr. Sklar, is that like medicare and medicaid, payments will be slow, low, and unreliable. Any public option health plan that requires doctors to accept it must actually meet it's contractual obligations - and we haven't established a good track record in that regard.

Evan Robinson said...

If you're going to discuss Canadian health care, you almost need to read Mythbusting Canadian Health Care (part 1) (part 2) at Written by a futurist and American citizen living in Canada, it takes a lot of the common knowledge about Canada's health care system and tells you what's actually what.

As another American living in Canada I can tell you that the BC MSP (Medical Services Plan -- the provincial health care system) is one reason why I may never move back to the US. The fact that health insurance companies in the US are only legally liable for the cost of denied care (which means that if you die because they didn't give you a $10 pill, they're only legally liable for $10) is another.

Daniel Keys Moran said...


I'd stop saying things like that if Republicans would stop making arguments that could be characterized that way so easily ....

Of course, since Republican policies are almost wholly in alignment with those of their corporate owners, the odds of this happening are pretty small, so we'll just have to keep on as is.

And yes, I do support the supression of life saving drugs and treatments for purely ideological reasons. I'm blank at the moment as to the drugs and reasons, but if you'll fill me in, I promise to sign off.

Daniel Keys Moran said...


To me looking at the life expectancy of the various states is very illuminating. Same system, pretty much, but the difference between Hawaii and Mississippi is the around the same difference between Canada and Algeria. Why is this?

Man, you know how I'm going to answer this one, don't you?

Take note of where the states of the old Confederacy rank on this subject.

I could do this particular comparison in a hundred ways, but the fact is, liberal states are rich, and conservative states are poor, and this has been true for generations on end. Life expectancy is one expression of that.

Why anyone listens to conservatives on the subject of wealth creation is a pure mystery to me.

Steven Barnes said...

O.K., Erich, I read the links. Very very little of it was statistics. Most was talk, and a couple of insistences that we can't compare longevity stats in the U.S. and Europe because of obesity and lifestyle factors (as if those can't be affected by education and medical counseling!)
I find it very difficult to believe that if the life and birth stats were AGAINST Universal health care, that you wouldn't have contempt for liberals who tried to talk their way around those hard numbers. Of course...I also suspect that many liberal Democrats would try to do just that.

Steven Barnes said...

I really don't understand why people keep talking about how hideously expensive such a system would be, when other countries deliver care at a fraction of our costs per person. And nothing would stop people from purchasing riders for expanded care, of course. One of the links said that "everyone wants care without paying for it" which is just flat untrue, and insulting. I just want the commercialism taken out of it. I just know too many hard-working people who are suffering because of health care costs, and have talked to too many Europeans and Canadians perfectly happy with their system to believe any talk of it being a nightmare.

Steven Barnes said...

Quality of life...yes, that must be factored in. Anyone have stats on comparative life satisfaction related to medical care? I'm not sure how to quantify that one, but there must be a way.

Steven Barnes said...

Erich, you're right: sauce for the goose. Dan, your comment about Republicans convincing people to be screwed is probably on the same level as Erich's comment about Democrats being against cheap life extension. This issue is so incredibly important that there needs to be somewhere on the web we can discuss it with maximum care. Everyone here can be considered a diplomat representing their philosophical/political country. If we can't reason together, we're fucked.

Daniel Keys Moran said...

If Erich can come up with a drug or treatment that Dems killed, I will take note of it.

I can come up with a dozen Republican policies, off the top of my head, that are bad for most of the people who voted for them.

Working class social conservative in this country (the core of the Republican party, any more) have been relentlessly screwed by Republican policies, for generations on end. Post or two back I noted that conservative states are reliably poor, and liberal states reliably rich, also for generations on end. It's true, and it's not an accident.

Lobo said...

I couldn't get back to this discussion until now, so if you'll indulge me, I would like to respond to previous comments.

Mike, I'm glad your father is okay. My mom was diagnosed with cancer and while it didn't get her directly, it delayed treatment of another medical issue that did get her. I understand just how prickly a person can get when these kinds of discussions brush against their personal lives. But I'll ask you this as a counter to your father, how many people die from diseases that are much easier to treat than cancer because they didn't have access to health care? Perspective is everything.

To the people who are wringing their hands and gnashing their teeth over the prospect of socialized medicine: You do know that no one is actually talking about socializing medicine, right? About the most radical idea being discussed right now is a public option that people can buy into. Nobody is talking about disbanding insurance companies or nationalizing health care. When your arguments lean to that kind of weird rhetoric it makes it really, really hard to take you seriously. A public option will pretty much just force insurance companies to be more competitive. You can't get rid of insurance companies for no other reason than they employ hundreds of thousands of Americans.

Medical research. My previous comment was being generous by granting the argument that a public option would retard medical research. In reality, I don't see how it possibly could. Insurance companies don't drive research. If anything, they impede it by setting insanely stringent standards on the kinds of procedures they will pay for. They also impede it by charging doctors out the nose in malpractice premiums, making it extremely expensive to practice. Medical research is done mainly in three: University, Government, and private research companies. The kicker is that their research money is largely disconnected from what the hospitals are up to because day-to-day medical practice doesn't utilize the research until much later in the process IF the research actually pans out. Most research doesn't. Drugs are expensive because pharmaceutical companies have to pay for all the research that went nowhere. I also don't see how you can actually quantify medical technology advancement into the future. What exactly is the difference between four and five percent growth in medical technology advancement?

Anonymous said...

"If Erich can come up with a drug or treatment that Dems killed, I will take note of it."

They tried very hard in the 1970s to kill protease inhibitors for HIV.

Of course, they didn't know that they were doing that -- they thought that they were trying to save the world from the horrible dangers of recombinant DNA.

It took 10 years after that for people to realize that HIV existed, and another 10 years after that for protease inhibitors to be invented -- using the same recombinant DNA technology that the Democrats had been so eager to regulate and ban.

Yes, it's true. Look it up.

If the Dems had succeeded in banning recombinant DNA, we'd not only never have had the tools to develop effective protease inhibitors, we might not even have developed ELISA and the Western Blot, which kept HIV from completely contaminating our blood donor supply in the 1980s.

Innovation, by definition, is that which government bureaucrats and would-be nannies do not consider reasonable or even likely. I've seen this play out in my own profession already. And we've already seen it play out as a failed Democrat effort to ban drugs for HIV, once, already in our lifetimes.

That's one big reason why I'm really unenthusiastic about Obamacare.

--Erich Schwarz

Daniel Keys Moran said...

Useless link, which I suspect you know. Which democrats attempted to ban research into DNA, and when?

Anonymous said...

"Useless link, which I suspect you know."

Pardon me? Is it my fault that the documentation I'm citing is in a BOOK rather than a blog? And since when is your ignorance of my profession my fault?

"Which democrats attempted to ban research into DNA, and when?"

A majority of the Congress from 1974 to roughly 1980. And for a while they actually succeeded in making it unlawful to carry out what's now utterly routine DNA work. Had Jim Watson not been an effective enough political lobbyist to get the ban overturned, we simply could not have developed protease inhibitors against HIV, and it's seriously doubtful we'd have even developed Western blotting or ELISA (which collectively prevented the U.S.'s blood supply from becoming HIH-infected in the 1980s.

The DNA Story details the whole history of the 1970s ban at great length, which is why I recommend you find a copy of it in a public library or via and read it.

--Erich Schwarz

Anonymous said...


HIV-infected, duh.

--Erich Schwarz

BC Monkey said...

The question of what kind of system best drives innovation is still of great interest. I suspect that there is no way to resolve it absolutely, but it seems clear that those on the Right believe that profit is the greatest driving motivation for human beings in this arena. I personally believe that fear, compassion, and scientific curiosity are sufficient--people will stop seeking ways to prolong their and their family's lives when they stop being afraid of dying. No time soon.

But I don't know how this could be answered.

In the modern age of science we have already had this experiment. The communist world removed the "profit" consideration from its researchers for a period of close to 80 years. How many medical reseach breakthroughs came out of that?

I do think that your breakdown of innovation in counrties with socialized medicare vs. The US is missing a very critical factor. Right now any medical innovation which is made in a country with medicare is still made with the profit motive full in mind. Why? Because anything they produce can be sold in the US medical market for profit.

It's not correct to say that research in those countries is driven by altrustic concerns instead of profit. Once the US goes to a full on socialized medicare system, that chance for profit will be drastically curtailed. When you reduce the incentive for something, you're going to get less of it.


Talking about the levels of satisfaction in nations with different systems. I'm under Canadian medicare. No bill for insurance comes out of my bank account at the end of the month. (well, it does in my taxes, but it's not labelled as such) I don't have to pick health insurance coverage. I don't get documents detailing policy changes or anything like that. neither do any of my friends or family. Until I urgently need medical care, what's the likelyhood that I'm going to be dissatisfied?

Now if you're buying your own coverage and paying for it every month, you have to select your coverage, apply for it, get details of policy changes, etc, and so do my friends and family, what are the odds that I'm going to have some complaints and dissastisfaction before I need care urgently?

Oh, my premium went up. Dammed insurance!

(Compared to my "Oh, my taxes went up. Dammed taxes! Not, "Dammed medicare costs!" even although much of those taxes go to the medicare)

BC Monkey said...

you are part owner of the system.

How does that argument work out for you whenever you deal with the DMV or the Police? Why would a socialized health care system be different?

To an insurance company, you are a customer. They want to extract the most money from their customers, and give the least back.

But they also have an interest in keeping you as a client. If you don't like what they give back, you can go to the competition. When there's a socialized medicare system, you don't have that option. See again, the DMV.

To a socialized medical system, you aren't just an expense: you are part owner of the system. Your tax dollars support it. So they also have an interest in keeping you healthy, and once you are sick, to helping you heal so that you can work and continue to pay into the system.

If you are a patient on your deathbed, what incentive does the state have to keep treating you if you're not going to get better and contribute to the system?

Not much.

Of course, you're probably going "ahah! neither does the insurer!" True, but the hospital does have an incentive- their own profit. Keeping you alive is not only profitable, it's good customer service. Because they're going to profit by providing the service, you can be sure they're going to make it available.

With the socialized medical system, the insurer and the hospital are one and the same. And what is the decision going to be?

Reporting from Washington -- President Obama suggested at a town hall event Wednesday night that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care.
In a nationally televised event at the White House, Obama said families need better information so they don't unthinkingly approve "additional tests or additional drugs that the evidence shows is not necessarily going to improve care. He added: "Maybe you're better off not having the surgery, but taking the painkiller."

And who is going to decide which processes are too expensive and ultimately futile? Is it worth it to the state to take a 10% chance of a procedure working? How high does the % have to be before the treatment is allowed to be offered?

And make no mistake- these decisions will not be made by Doctors- they will be made by bureaucrats far away from the hospitals, far away from the people whose lives they impact.

(Links to the Obama quotes above: and,0,1978875.story)

BC Monkey said...

On the Patients as an expense in the socialized system.... Doctors are considered an expense too.

As family physicians practicing in Montreal, we feel that the current health care situation and lack of access to services in Quebec is appalling. In order for there to be change, we feel that the public needs to be fully informed as to the barriers that we as physicians face in order to practice in Quebec.

The Quebec government requires all family physicians to attain a special license called a PREM that permits practice within a specific region in Quebec. Since 2003, the government has actually been restricting the number of family physicians who are permitted to attain these licenses, thus limiting the number of physicians allowed to practice. What this has done is force many new family medicine graduates to move out of Quebec in order to practice.

The second barrier is the Quebec government regulation concerning special medical activities called 'AMPS'. In essence, the government has decided that only certain activities carried out by family physicians are priorities in Quebec and that each family physician must fulfill 12 hours per week of these designated activities. Examples of such activities are: emergency medicine, obstetrics, and work in an underserved region of Quebec. Nowhere on this list is primary care of patients in an office based setting. The bottom line is that if you are a relatively healthy person, between the ages of 0-70, the government does not feel that you are a priority requiring regular medical follow up. What these restrictions do is force the family physician to take on activities other then practicing primary care which therefore limits your access to these doctors.

The bottom line is that is that our government is restricting family doctors from working here once they graduate by only offering a small number of PREMS and for those who do work here, they are encouraging us to work in ERs or in northern regions, but do not recognize the value of being a primary family doctor.

To keep expenses down, Quebec’s Ministry of Health imposes surtaxes on physicians who make more than about $200,000 a year — gross of expenses. What with swine flu and all, it’s been a busy year for pediatricians. Some of those running the Tiny Tots Clinic apparently have already bumped up against their maximum income. As a result, they’re now going to be paid at 25¢ on the dollar for all the services they provide between now and the end of the year. Think of it as a kind of Tax Freedom Day in reverse. Tax Freedom Day is when you’ve earned enough in the year to pay all your taxes and can then start working for yourself. But if you’re a Quebec doctor, it works the other way around: As early as June, depending how hard you worked the first part of the year, you may start working almost entirely for the government.

Trouble is, 25¢ on the dollar doesn’t pay the clinic’s overhead. So the clinic has been restricting its hours while the doctors petition the Minister of Health for permission to be re-classified so they can keep working with full remuneration for the services they’re providing.