Socialized Medicine: How would you argue against? (vanity)

We all know the potential horrors if Socialized Medicine were ever made a reality in this country, but to someone who only sees the good, and none of the bad, it is difficult for them to see the truth.

In my discussion with a liberal friend I was having difficulty describing a parallel. We all can provide stories of long wait times, and lack of care experienced in other countries, but the answer always seems to be, "America will do it better". My point is that when a person has no responsibility to bear the costs of healthcare, he will not consider costs when pursuing healthcare, and the system will ultimately either fail economically or be forced to resort to rationing.

I was trying to think of a parallel that a person could see every day, and not simply disregard.

The only thing I could think of would be the Food Stamp program. Specifically, I was trying to remember if I have EVER seen a person using Food Stamps (or the debit card that some use) AND using a coupon or other similar discount. I DO remember seeing someone using one of those store discount cards, but those don't require any real effort.

I see this as a parallel in that the person who could benefit most from using coupons fails to make an effort to do so, but I don't want to misrepresent based on my own observation.

Looming Medicare Pay Cut Weighs Heavily on Physicians Practices Forced to Make Tough Decisions

By Sheri Porter 3/12/2008

Physician practices across the country are beginning to limit the care they provide for Medicare patients as Medicare physician payments fail to keep pace with the cost of providing health care to seniors. That's according to a study of more than 1,000 physician practices conducted by the Medical Group Management Association, or MGMA.

In a March 6 press release, MGMA said that nearly 24 percent of medical practices that responded to the survey said they had begun limiting or not accepting new Medicare patients as a result of the "financial uncertainty" created by temporary adjustments to Medicare physician payments and a pending 10.6 percent cut scheduled to take effect July 1.

About 46 percent of respondents said that they would have to stop accepting new Medicare patients or limit the number of Medicare patients their practices treat because of the expected payment reduction this summer.

MGMA members participating in the survey reported that they would "suffer further operational damage" as a result of expected double-digit reductions to Medicare physician payments. In addition, more than 50 percent of respondents were considering reducing administrative and clinical staff, nearly 70 percent were postponing purchasing decisions on new clinical equipment and facilities, and about 67 percent were delaying or foregoing investing in health information technology.

MGMA President and CEO William Jessee, M.D., reacted to the survey results by lambasting Congress for its failure to act. In an interview with AAFP News Now, he said, "The inability of Congress to solve the Medicare physician payment problem has reached a level of absurdity. How can physicians be expected to care for a growing number of Medicare patients and invest in e-prescribing and electronic health records when there is absolutely no predictability to their revenues?"

Jessee said that physicians who responded to the MGMA survey were doing what any rational small business would do: "They're restricting the number of Medicare patients they treat, deferring or avoiding investments in new technology, and reducing staff.

"This situation is a very sad commentary on Medicare," said Jessee, adding that the program "is rapidly failing to deliver on its promise of access to health care for America's seniors."

FPs Make Medicare Provider Status Changes

Physicians have options when it comes to Medicare. They can participate fully, become nonparticipating Medicare physicians, or opt out entirely. In these difficult times, family physicians are having to make tough choices in an effort to preserve their practices.

James Molloy, M.D., of Sheridan, Ore., told AAFP News Now that his practice opted out of Medicare in 2008 and instead is offering Medicare patients a 40 percent cash discount on practice fees under individual contracts.

"We made a decision based on what we had to do to make this practice survive," said Molloy.

He said Medicare patients constitute about 12 percent of his patient panel, and that 30 percent to 40 percent of those had signed the private contracts. More than half of his Medicare patients have left the practice, but finding physicians who take new Medicare patients could be a challenge for those patients.

Prior to opting out of Medicare, Molloy said he routinely turned away Medicare patients so desperate to find a physician that they offered to pay for charges out-of-pocket. Medicare, however, prohibits its participating physicians from collecting full charges directly from Medicare patients for otherwise covered services.

Molloy was steadfast and resolute in his Medicare decision. "I refuse to participate in a system that I consider to be a very broken system." He added that he was prepared to "opt out for the long haul" until the Medicare payment system is permanently fixed.

FP Steven Blair, M.D., of Yuba City, Calif., said his small group practice became a nonparticipating Medicare provider as of Jan. 1, 2008. The high cost of living and providing care in northern California already were making managing a practice difficult even before the proposed cuts, he noted. But Blair and his partners got angry enough to take action when the government strung physicians along late in December with the six-month 0.5 percent increase.

Much of the progress made in increasing Medicare physician payment during the past decade would be wiped out by a 10.6 percent reduction, said Blair. "The whole episode left a very sour taste in my mouth. A lot of physicians felt like they were left out to dry."

As a nonparticipating Medicare physician, Blair still sees his Medicare patients, but he can bill them about 9 percent more than what Medicare pays participating providers. The extra cost, which is borne by the patient, would offset most of the anticipated Medicare payment cut in July, said Blair. As much as 10 percent of Blair's Medicare patients have left the practice, however.

Uncertainty Leads to Frustration

"The most frustrating part for family physicians is this uncertainty of not knowing whether we'll have to deal with a 10 percent pay cut," said AAFP President Jim King, M.D., of Selmer, Tenn. "We already have a slim profit margin -- if any at all -- for taking care of our Medicare patients."

King said the Academy has received calls from family physicians seeking advice about their Medicare options.

"It's very frustrating because we like taking care of our senior citizens, and we want to continue to take care of our seniors -- but from a financial standpoint, some family physicians just may not be able to do so any longer if this payment mess with Medicare continues," said King. "The Academy is willing to work with the administration, Congress and CMS to find solutions," he added.

For John Saranko, M.D., of Plant City, Fla., the bottom line is whether or not his practice can afford to continue treating Medicare patients.

Late in December, with the government mired in indecision, Saranko and his partners voted not to accept any new Medicare patients in 2008. They also agreed that if the Medicare pay cut became a reality in July, the practice would opt out of Medicare in 2009.

Medicare patients make up about 57 percent of Saranko's patient panel, he said, and many of those patients are the kinds of old friends that come after 28 years in practice. He agonizes over dropping those patients, but if payments are slashed, Saranko said, he'll have no choice. "It's a business, and if I can't pay the bills, I can't survive," he explained.

Saranko said he's certain his practice would thrive without Medicare; he's consistently turned away younger patients in order to keep treating his Medicare population. "If I stop seeing Medicare patients, within three months, I'd be back up to where I am right now and maybe making more money," he said. That's because he likely could increase his daily patient load with a schedule full of younger patients presenting with simple, easily treated complaints. Older patients suffering from multiple chronic diseases just take more time, said Saranko.

I understand what you are saying about the “My Eyes Glaze Over” (MEGO) response.

How about I simplify it.

When I am old, and have saved enough money in my life to be able to enjoy my life, I will spend what it takes to buy insurance that will pay for the necessary life saving care I might need to extend my life. I do this because it is my decision to spend my money on what is important to me, which is my own health and life.

My life and health will be worth very little to the state, because I hope to be retired. I am not going to be paying a lot of taxes or doing any great productive things for society. I want to spend my days quietly on my hobbies, living simply and enjoying myself. In fact, with the estate taxes that will no doubt be coming back, I will be worth a lot more, to the state, dead than alive.

Unfortunately, if the state is making decisions on whether or not I get life-saving treatment, they will be able to make sure I die early, and thus save expenses associated with my dotage, save what ever entitlement payments they might have had to make, and get their hands on half of my estate.

If I am running a bank, I don’t hire a thief to guard it, because the thief will quickly figure out that it is more profitable for him to rob the bank than it is for him to guard it for the salary I am paying him. Similarly if I am an individual, with money in the bank. I don’t hire the government to make my medical decisions, because they will quickly figure out that it is much more cost-effective for them to let me die than it is for them to preserve my life in order to recover whatever I might pay in taxes.

To answer the question of a liberal who wants to adopt socialized medicine, you need to get to the issue of why the liberal thinks a transformation of health care is required.

In the United States, which has the closest thing in the world to a free market with respect to health care (note that the U.S. still has government interventionism of Medicare and other government programs), we have the best quality and availability of health care in the world. The problem with health care in the United States is COST.

To find a solution to the COST problem, we need to understand why the problem exists. Of course, the knee-jerk response of the liberal is that the “unbridled free market” has caused this problem. That response does not make any sense. Where the free market exists, prices are competitive, supplies are abundant and quality is good. Where government monopoly exists, prices are fixed by government and thus, supply and quality are negatively impacted. Thus, Europeans receive substandard care and if they have any resources, they come to the United States for medical treatment. In addition, the supply of medical care in European countries is inadequate and therefore, rationed. There’s a joke that you can tell a European from an American by the condition of their teeth. Sadly, this is only too true. In Cuba, Pepto Bismo is available only on the black market. In Canada, children in certain Provinces are entered into a lottery to determine who will get an annual well-baby or well-child check-up. The former leader of the Canadian liberal party came to California to have her breast cancer treated. In sum, the result of “universal health care” is low-quality care and rationing of medicine and medical care.

Thus, we get back to the issue of why the COST of health care in the United States is so high. Under our tax code, employers are permitted to provide health insurance to employees without including those benefits in taxable compensation. The effect is that people get a 100% tax deduction for health insurance premiums if those premiums are paid by their employers. Those same persons, however, are not permitted to deduct DIRECT purchases of health care or insurance unless those costs exceed 7.5% of adjusted gross income. That 7.5% AGI floor deduction is helpful only if an individual incurs massive medical costs. But, in terms of regular insurance premiums, it is far more economic for employers to purchase insurance policies (rather than individuals directly) so that the tax effect is a 100% deduction from AGI.

Thus, we have an employer-based health care system in the United States. And, costs are OUT OF CONTROL. Under our system, the recipient of health care services is NOT the purchaser and so, the provider is unresponsive to the recipient in terms of care, coverage and cost. As a patient, you call your health insurance company with a complaint and their attitude is indifference because you do not have the capacity to “take your business elsewhere.” As the purchaser, the employer has to make bulk purchase decisions on behalf of all employees and is not as price conscious as an individual consumer would be. An employer is unable to make decisions that an individual could make in order to achieve maximum return .... for example, I may not want vision care or fertility services or dental care included in my plan. Or, I might. Imagine if your employer was in charge of purchasing an auto insurance policy on behalf of all employees. Or, even more basic ... Imagine if your employer was in charge of purchasing your shoes. One size doesn’t fit all. The point is that the artificial separation of seller and consumer caused by the internal revenue code has resulted in skyrocketing health care costs and unresponsive insurance companies. In a free market, people could choose to buy a catastrophic health care plan and simply pay their routine doctor visits out of pocket. This would have a huge economic impact on the costs of doctor visits. No longer could a pediatrician get away with charging $300 for a doctor’s visit. This anomaly only exists where insurance comes into play. Everyone knows that an auto shop estimate for body damage is alot higher if the auto shop knows insurance is covering the tab. It’s simple economics. Moreover, people could “shop” the insurance companies, the doctors offices and the hospitals. The companies, doctors and hospitals would be rated for cost, options, customer care, etc... just like any other consumer good. In general, we do more diligent research and review before purchasing an LCD TV than we do before purchasing health care ... precisely because we are NOT the purchasers of our health care.

Thus, the solution to the rising health care costs in the United States is to allow individuals to shop for, negotiate and buy insurance and pay medical costs directly and then, deduct those costs (without the 7.5% AGI floor) in computing federal income tax. This would also alleviate the serious issue of portability that people complain about. The current system necessarily causes people to lose insurance when they lose their job. That is a sickening situation. Do we lose our car insurance when we lose our jobs? Of course not. If people purchased their health care directly, this situation would not exist.

Try this argument with your liberal friends. Or perhaps they want to live in a country where they would have to buy their Pepto Bismo in a brown bag from the local drug dealer….

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