quote:Originally posted by David B: This is a very intelligent discussion of such a politically charged issue.
Yes, strip out the emotion and reasonable discussion follows. When the name calling begins and emotions take over, rational thought departs the conversation.
quote:But we aren't alone with the problem. Some countries (and I don't mean Canada!) manage to offer their citizens decent healthcare, access to doctors and medicine and everyone seems to get along just fine - patients, doctors, hospitals and lawyers. No system can be perfect for everyone all of the time, but what are these countries doing that we can learn from?
This is agreed Dave, but I would like to emphasize that just because I am for approaching the problem by first eliminating waste and controlling costs does not mean that I am against everyone having access to healthcare. I don’t mean to infer that you are saying such, because I understand this isn’t your point, but this is typically the way the political battle lines are drawn; if you are for a financially prudent approach then you’re against healthcare for all. That’s nonsense. It’s quite the contrary. If it’s done in a financially tenable way, then it stands a chance of passing on the hill and more people get access at lower cost to we taxpayers.
quote:Originally posted by ktmike: Wow! I am really impressed with the thoughtful, intelligent replies. I do feel a little guilty for putting this out there in light of the fact that I don't have a grand scheme or any great ideas how to fix these problems.
Nothing wrong with that, just find a way of being part of the solution. It’s always easier to identify the problem than the solution.
quote:We have to figure out how we are going to come to a resolution that is palpable and safe for all of us. One way or another there are going to be some big societal changes from this problem whether we like it or not. I think this realization has to be the first step in deciding how we are going to proceed as a country.
-The political reality in a two-party system
quote:We can't begin to solve these problems until we decide, as a country, what our belief is about the system of health care. The first decision we have to make is whether health care is a privilege (you can have it if you work hard, earn it and pay for it), or a right (any person living in a society as rich as ours should be able to expect to not have to worry about such a basic necessity as medical care). Do we believe that the more money you have to spend, the better your care should be, and the better the outcomes you can expect from treatment? Or should we all be able to expect the same high level of service as we do from our highway system, firefighters, police officers and other public safety systems? I think it is some kind of poetic justice that one of the systems described above is basically the Canadian system (where many of my family live), and the other is realistically the Mexican system (that living in South Texas I deal with the shortcomings of on a daily basis). How ironic that we are literally and figuratively "in between"?
My best guess on how this is all going to play out is something in the middle, as practiced in the past in the UK (where my wife grew up). Greatly simplified-a basic expected level of care that, if you can afford it, can be enhanced with your own supplemental insurance/money. Does this ensure equal care for all citizens? Absolutely not, but you are guaranteed a certain level of care and freedom from the threat of financial ruin from medical bills. Is there rationing involved? Absolutely, you are not guaranteed the latest wonder drug or procedure.
Woh, lot to chew on here. First, from a constitutional perspective, I don’t think the inalienable rights of life, liberty, and the pursuit (being the operative word) of happiness was intended to be a guarantee or grant there of to health care, 2.5 kids, fido,and a split foyer house. It was an opportunity to earn it, not be gifted it, and yes, in an increasingly globalized economy, we must be willing to earn our higher standard of living. Others in the world are willing to do more for less because they have less; much less. Best we accept this and move on.
quote:Will this UK type of system fly in the US where we feel like we are entitled to and expect the newest, fastest, most technologically advanced everything available "because we are Americans"? That remains to be seen.
Certainly not because we are Americans.
quote:There would have to be a change in attitude about the whole system. Whose job is it to tell someone they are not entitled (sorry, I love that word) to the most advanced, specialized treatment available? Unfortunately, I think the only entity that could pull it off would be the government.
Actually, I think it’s each and everyone of our responsibility to tell ourselves we are not entitled to that. We’re not entitled to have our lives prolonged at increasingly diminished quality of life and at a cost that often exceeds the life’s earnings in the last year of our life, and then place the burden for paying that expense for someone else; say our children for example. We’re simply not entitled to that because it’s unsustainable and will ruin us all. Am I insensitive? Don’t think so. Just lost my mother on December 23rd. She had a chronic condition that made her very susceptible to pneumonia. Landed her in the hospital for the second time in a year and after whipping the pneumonia, developed secondary infections as often happens from the stubborn bugs that live in the hospitals. I’ve had the full frontal view of the public healthcare system and it wasn’t my first time, and it’s not pretty. I had to research everything from her condition to coverage and stand in the face of the physicians and be the proverbial squeaky wheel so they would aggressively treat her instead of merely making her comfortable while she died. The first time around a year ago, it resulted in the bonus round for her and she was able to live independently for another year. After my intervening several times, after 6 weeks, she asked me to let her go, and this time she succumbed. Gut wrenching? Yes. But she was 78 and able to live independently her whole life. I would have liked to have had her longer but hope I can do it as well when my time comes. –So I know fellas. Not trying to spill my guts but I’m not just preaching here.
quote:I think it works in the UK because of different expectations and history of a strong class based societal system.
I manage a group of businesses for a UK plc and spend quite a bit of time there and hear their opinions. They (at least the ones I run with) don’t think it works; certainly not well. Same carps as here in the US; non-contributing immigrants sucking the financial life out of the system, long waits, poor quality of care, and they would never dream of stuffing their families through the public system. That’s part of the reason the work; for the bennies; just like us. –And the ones I’ve spoken to that are in the public system don’t like it either.
quote:Kelly-some of the worst business people I have ever met are doctors. In 4 years of college, 4 years of medical school and 3 years of residency I never had a class in business.
And level of educational debt you carry, and malpractice premiums, and long hours, are worthy of mention.
quote:We are trying to change that now in Emergency Medicine by including lectures in our residency program regarding the business aspects of medicine. It is the medical profession's own fault that we got taken advantage of by insurance/lawyers/government. In the past the profession saw itself as a calling. We thought we were "above" the business/legal/political aspects of medicine and let others deal with those aspects of practice since we felt our job was to just take care of the patient. Obviously this was incredibly short-sighted and arrogant or naive of us and we eventually let other people/government/organizations tell us how we had to treat the patient instead of what we knew needed to be done. Unfortunately that genie is out of the bottle. Organized medicine is not that organized, and like everything else today there are huge political forces at work.
To sort of circle back here (and since I’m now out of coffee and have shaken out most of the cobs) and tag a couple of simple premises; if you don’t have the time or expertise to represent the front line view, you still have the means to organize and to hire it. When I have a business need and not the skill or knowledge to execute it, that’s what I do. Then I try to learn it and institutionalize it so I don’t have to pay for it a second time. Other special interests with a lot less disposable income than the medical professionals manage to do it. People than can identify problems are certain useful but not as much as those that can identify and become part of the solution. –Get in the game everyone.
In my business experience, when we get the shop floor people involved in identifying the solutions instead of saluting mandates our mandates or condescending to them about improvement initiatives we get results. It’s because they see things we don’t because they live in it and have different perspective. It’s also a simple leadership premise. I sincerely believe the same principles apply here. We all need to do our part.
quote:Once again, I appreciate all your thoughtful comments. Thanks for listening. I'm glad there are people out there that can see through the political posturing and reactions and realize this is actually important and will affect all of us in the long run.
Agreed.
quote:P.S. My wife stumbled on these postings on my computer and said "Oh my God you got started on it again, didn't you".
Ah Mike, just wish her happy Valentines day and give her a peck on the cheek.
Best Regards,
Kelly