The Case Against Socialized Medicine

One of the greatest dreams of American liberals is a nationalized health care system similar to the one in Canada. They argue in favor of such a system because they believe health care is a basic "right," and because they believe the current system is flawed beyond repair. As with most problems, they advocate government solutions, not private enterprise solutions. Unfortunately, the government has an abysmal record of correcting problems, and American health care would be no exception.

First, let's examine the "right to health care" claim. Obviously, there is no right to health care established in the U.S. Constitution. However, we do have a moral right to health care, some will argue. Unfortunately, those who make this argument do not understand what a "right" is.

A "right" is the ability and autonomy to perform a sovereign action. In a free society founded on the ideal of liberty, an individual has an absolute ability to perform such an action - so long as it does not infringe upon the rights of another individual. Health care is not speech: In order for you to exercise a theoretical "right" to health care, you must infringe on someone else's rights. If you have a "right" to health care, then it means you must also have the right to coerce doctors into treating you, to coerce drug companies into producing medicine and to coerce other citizens into footing your medical bill. This is Orwellian. "Freedom" for you cannot result in slavery for others. Thus the concept of a "right" to health care is an oxymoron: It involves taking away the rights of other individuals.

Surely, though, we can agree that doctors, the pharmaceutical industry and insurance companies earn excessive profits, you say. Well, that depends on what your definition of "excessive" is. Doctors literally hold the lives of their patients in their hands. How much is someone who saves lives everyday worth? The same is true of pharmaceutical companies. While it has become fashionable to condemn their profits, the fact is that these profits fund medical research, which leads to more medicines being produced, and, consequently, more lives saved. Insurance companies spread the cost of health care among many people who might not otherwise be able to afford it, and thus make health care readily available for many.

While on the topic of profits, we should examine them. The word "profit" is considered to be a dirty word by many on the political left, but why? What makes a profit bad? Nothing. On the contrary, profits are very positive. When you come to class in the morning, there is a good chance you either drive a car or ride a bus. Do you think the bus driver and the workers who built your car or the bus did so that you could get to school on time? Of course not, they did because they wanted to make money. Yet their pursuit of a profit benefited them as well as you.

Adam Smith once said, "It is not from the benevolence of the butcher, the brewer or the baker, that we expect our dinner, but from their regard to their own self-interest." As we have seen, profits and self-interest are not bad things.

Let's pretend, for a moment, that the left gets its way, and the United States adopts a universal health care system. This profit motive will effectively be removed. Doctors will then be government employees, and, as such, have far less accountability, as well as lower pay. Could we still expect the best and brightest to strive to be doctors? Probably not. More than likely, they will pursue other careers where they can make more money.

Some love to bemoan the fact that the United States is one of the few industrialized nations without a government health care system. Yet they rarely note that the United States produces disproportional amounts of the new, life-saving drugs, largely because of the profits drug companies make. Will we continue to produce these drugs if we abolish the profit motive? Not likely. Chances are, they will not be produced at all, and more people will needlessly suffer and die as a result.

When we examine countries that have embraced socialized medicine, we find long waiting lists, expansive red tape and little concern for the individual. Do you really want to be told which doctor to go to? Do you want to wait years to have necessary medical procedures performed? If so, then socialized medicine is for you.

But if you believe in individual rights, competent healthcare and sound economic policies, we must get the government out of the doctor's office.

- John Brown is a senior in political science. He can be contacted at jbrown44@utk.edu.

Allow me to post some of my thoughts about the issue of whether health care is a "right", as well as related issues. These are all copied and pasted from my posts on other forums, because I really don't have the time to rewrite all of this; please forgive me if it's somewhat meandering or incoherent. Also keep in mind that some of it is in response to other people's arguments, and so may seem somewhat out of context (such as the "lawyer" stuff, which was in response to someone who pointed out that a defendant has a "right to counsel", and so they posited that the government DOES, in fact, compel another man to work for "free") , but on the whole, I feel that most people will be able to follow:

Health care is not a "right", for the simple fact that you CANNOT have a natural right that is contingent on the toil of another man. For instance, you have the right to free speech, but you do NOT have the right to have a newspaper commissioned for you to exercise that free speech, with workers manning the presses for "free". You have the right to assembly, but you do NOT have the right to force the owner of Madison Square Garden to allow your group in on a winter's night, providing "free" shelter and shouldering the heating and electricity costs himself. You have the right to the pursuit of happiness, but if your happiness comes through having people build homes or boats for you, you had better be prepared to ante up. Why is nourishment-- by anyone's account a more basic need than healthcare-- not sought by waltzing into some upscale dining establishment and compelling their master chefs to prepare meals for the indigent, as opposed to sending them to a soup kitchen or some such? If you'd argue that only some bare minimum threshold must be met with regards to food, speech etc., then why do you not understand that there are, in fact, such things as free clinics, where that same bare minimum will be met. It obviously won't be the same quality of care, but, then again, Manwich Meal isn't exactly [i]foie gras[/i] either, no (as in the previous example)? Why, then, are those things somehow different qualitatively? And why should we countenance such a notion? Particularly in light of the total injustices which would transpire under socialized medicine...

Water, sustenance and shelter are all more basic needs than healthcare, yet we don't hear any carping over people having to pay water bills, or having to pay for their own homes/apartments (good luck getting that house constructed for "free"). The entitlement culture that has developed in this nation (and around the world in regards to medical care) is truly appalling and rationally indefensible.

Think about every enumerated right as expressed in the Constitution-- not a single one's expression or realization hinges on the work of another man's hands, and for good reason. We have a name for such relationships as you seemingly espouse: indentured servitude.

Now, the reason why the argument about court-appointed attorneys for the indigent is not compelling in this instance is that you'd essentially be forcing [b]all[/b] physicians to suffer severe economic injustice. With the lawyer example, only a very small subsection of attorneys do public defense work, and even those choose do so [i]freely[/i]-- there is no coercive authority in place mandating that such and such attorney must perform his mandatory 5-7 years as a public defender. In a socialized system, [b]all[/b] physicians would be subject to economic injustice (and [b]severe[/b] injustice at that-- physicians are woefully underpaid [i]currently[/i]; never mind under socialized systems where they make $50-85K/year, which is laughable).

Also, ever wonder why the quality of public defenders is so notoriously shoddy? Well, perhaps the $35/hour going rate paid by the state has something to do with that. What's that? You mean to tell me that if you don't pay people commensurate with their abilities and station you're going to get (comparably- few attorneys are "incompetent" in the broad sense) only the most incompetent practitioners to fill those spots? Well I never would have guessed....no wait, I [b]would[/b] have guessed it had I performed even a cursory examination. If you believe that this same dynamic somehow won't hold in medicine, well, you're living in a fantasy-land, no offense.

Moreover, as mentioned in my quoted post, there is [b]already[/b] this "bare minimum" met with regards to health care, same as the public defense is the "bare minimum" met within the legal system-- they're called free clinics. Back in the day-- you know, when doctors were actually PAID commensurate with their expertise, value, and ability-- [b]numerous[/b] physicians performed charity care on the weekends and on their days off, and there used to be entire charity/church hospitals in this nation staffed by physicians and nurses volunteering their time. But then the situation devolved to what we have presently, where even those who can afford to pay feel this profound sense of entitlement despite having no rational basis for such.

"Free" care-- that is, the basic minimum of health care, same as for the ONLY other example you can proffer where the expression of a "right" is reliant upon the work of another's hands (i.e., a public defender)-- is provided at clinics all around the nation, and also in every ER in the nation. As the quoted post mentioned, if you'd point to the fact that the care people receive in such places is "inadequate" in some way, then allow me to point out that neither is Public Defender Joe Smith equivalent to Johnnie Cochrane. Please don't make me dredge up the conviction and acquittal rates for public versus private defense attorneys, because it really won't help your case.

And this is not to demean public defenders, or to assert that they do not serve a legitimate and necessary function-- because they do. I happen to have a great deal of respect for them. But please realize that these people do what they do of their own accord, and at any time are free to work under more traditional economic arrangements. Now, you can say that if we socialized medicine but still allowed people to seek privately funded care, that this would be an equivalent situation (to attorneys being able to leave public defense whenever they wanted), but that argument falls apart under scrutiny, since [b]no person[/b] is going to pay for care they can get for free, regardless of a difference in quality; the situation in Europe (< 8% of patients seek unsubsidized care) attests to that fact, as does our shocking entitlement mentality in [i]this[/i] country, where even those [b]who can more than afford to pay for medical care out of pocket[/b] choose to forgo this in favor of using third-party proxies such as insurance companies, who then reimburse health care providers pennies on the dollar. What's more, physicians will likely be [b]required[/b] to participate in the national program if it ever came to pass, since what good would it do the government to create this program and then have all the physicians in the US just say "too bad, we're not doing it". If you think that the statists (as well as our "entitled" populace) would allow that to happen, you're kidding yourself.

And keep in mind that this is only examining this issue from one angle; there are [b]numerous[/b] other troubling issues with socialized medicine (financial, ethical, interpersonal, societal) that go unspoken here. Socialized medicine is not a panacea, and in fact I don't even believe it to be the best possible compromise (for my own "best possible compromise", see the other thread ), and I believe that Europe and Canada are beginning to see the folly of it all as expectations increase, the population ages, funds dwindle, and human resources become more scarce due to high stress and low compensation (neurosurgeons in France make the same salary as postal workers-- shyeah, that's justice ). Once society starts sucking on the government tit, it's nigh impossible to wean them off of it once things start to become impracticable (as European nations are increasingly discovering). Entitlement is an insatiable beast, and any programs seeking to expand the sphere of entitlement need to be [b]thoroughly[/b] examined, not enacted based on mere platitudes and the weight of specious emotional appeals.

As for why economic justice for physicians trumps the "well-being of society" in this instance, well, the short answer is that it [b]doesn't[/b]-- not by itself anyway. But it's [b]incredibly[/b] compelling imo, and when combined with the other critiques of socialized systems (not mentioned here due to the ambit of the topic), the entire thing begins to sound entirely untenable and unsustainable, both philosophically and pragmatically. Economic justice for physicians is a compelling argument because [i]they're[/i] the ones who are actually [b]doing the work[/b]. Period. There's nothing more to it than that.

Yeah, I think it's great that the populaces of European nations receive "free" care-- I just think that there are other ways to ensure that which do not concomitantly generate as many other injustices (see the thread I linked to). Then, after I'm done admiring the fact that they have national care (because it [b]is[/b] a noble and worthy goal), I see that the average physician's salary is $65K (less in many countries; never more than Canada's $85-90K) and begin to laugh, because it illustrates that people are really only concerned about [i]themselves[/i] if they can allow such a [b]gross[/b] injustice to be done to the most expert, deserving, and dedicated professionals in the world.

There is a better way to do things imo, and it's a shame that no other alternatives besides [b]A)[/b] socialized medicine (blech), [b]B)[/b] continuance of the current managed care paradigm (double-blech), or [b]C)[/b] strictly free-market medicine (inhumane imo) are being explored, because if they were, it would ultimately redound to the benefit of all of society.

Now, for my proposal about what the "best possible solution" would be, along with commentary regarding it and responses to the arguments of others:

People should still have health insurance, but it will be more akin to catastrophic coverage (which has largely been discontinued for single payers, iirc, due to its lack of profit margin for the insurance co's). I would propose a model whereby people would have to pay for their health services up until a pre-set deductible, which would be based upon their income bracket. After that amount, insurance would take over and (hopefully) cover the rest, or at least a reasonable amount (unlike what occurs presently).

So, for example, take the following income brackets and what I feel a reasonable deductible would be for people in said brackets to pay to their physicians:

$15-20K Income = $150-250 deductible
$55-60K Income = $1000-1800 deductible (it's not proportional to the previous case due to sustenance costs which more greatly affect those in lower income brackets)

$85K Income = $2200-3500 deductible
$120K Income = $6500 deductible

I feel that this would be a fair system for several reasons: first, it would allow primary care physicians to finally have fee-for-service again, benefitting their bottom lines and allowing them to give the sort of care that all patients desire, rather than having to rush through patients assembly-line style in order to keep their practices solvent; secondly, those who are earning $60K per annum can [b]certainly[/b] afford to pay $1800 for their medical costs (realistically, the only time costs would ever get to that point would be the rare procedure or expensive diagnostic test, which would be needed perhaps once or twice per year if that). I say that they can afford it because these largely comfortable middle-class people don't hesitate in the slightest to shell out $400 for a battery of tests for their dog at the vet, or $800 for a new TV set, or $150 on a dinner, or $350 for their plumber, or $1000 when the coils blow on their car. Yet these same people, by and large, want to be able to go to their primary care physician and hand over the insurance card and a $10-15 co-pay. That is injustice right there, I'm sorry; it cannot be philosophically defended. A person's health is presumably more important than entertainment, or cuisine, or even their pet's health, yet they have no qualms in denying a physician, who is among the most skilled and dedicated of professionals, his due compensation. The sense of entitlement in this country is shocking, and that definitely contributes to this sentiment among the populace; also, however, I do not believe that the majority of people understand how primary care (and ER and other) docs are being squeezed at the moment-- if they did, I do believe that many of them would be more amenable to such plans, or at least with throwing some extra cash or a check their doctor's way after a visit.

It would also benefit insurance companies, as their payouts would decrease, if only due to the fact that they would no longer have to reimburse primary care physicians except in the most exceptional of cases where the cost of care ran over the pre-set deductible. Since the incidence of more expensive procedures such as surgery should remain relatively constant, insurance companies will be able to generate larger profit margins if they keep their premiums steady. However, what would most likely have to ensue is 1) sufficient education of the consumer/employee as to the reasons for the new cost structure, and 2) at least a slight reduction in premiums to account for the company's decreased financial liability for all sorts of primary care. I do honestly believe that most people would be accepting of such a system so long as they are comforted by the knowledge that their medical costs will never go beyond their reasonable means. For instances of extended hospitalization etc. (where costs would go quite far beyond the deductible, not merely a couple of thousand dollars), perhaps a system could be worked out where for every $X in costs incurred, the patient has to pay a certain amount. So, say, for every $10K in costs incurred above the deductible (but [b]only[/b] once cost has gone above $10K beyond the deductible), the patient may have to chip in another $1000 or so (this would, ideally, also be tied to income bracket in my opinion, so the less fortunate pay less and the more well-off pay more).

Also, those who legitimately cannot afford to pay even for primary care service-- either because their income falls below the $15K level or they are currently unemployed-- should not be denied care despite their inability to pay. I feel that if all of the above policies (conceived in haste, but that's the general idea) were implemented, most, if not all, physicians would not have any problem with treating the occasional non-paying patient. Hell, in many cases, they do so now, and actually LOSE money on the transaction with the insurance company. The problem with the current system is that, since [b]everybody[/b] is covered by these ludicrous plans, the physicians cannot recoup the costs anywhere else; in the proposed plan, they'd be able to recoup these costs from the people who can actually afford to pay.

I believe education is the key to this plan, and I've begun it in my own way by speaking to my family about the realities of the current system. My family's combined income is around $60-65K before taxes, and my mother is one of the aforementioned folks who will glady (well, not gladly, but she's done it) drop $600-1000 on my dog at the vet when he's sick, but still hands over a $10 co-pay at the doctor's office. Now, it's not because she's greedy, or feels entitled-- it's because she just doesn't know any better; I'd wager most people don't. I've already told my mother and father that it wouldn't kill them to throw another $20-30 (in addition to the $10 co-pay and the pittance the insurance co. reimburses the doctor) to the doctor when they have to see him once every 2-3 months. We're not going to starve. But medical professionals who've worked so hard for so long and are dedicated, caring (for the most part), and knowledgeable (and saddled with debt in many cases) deserve their due. I'm sorry.

Just my two cents.

This is not to say that such a plan is perfect-- no plan is. One legitimate criticism of it would be that people would say "why should I pay twice for my medical care-- once to my insurance co. and once to the physician?" My short answer to that would be: People did that for decades. Catastrophic coverage was the dominant paradigm for health insurance up until the early-mid 90's. What, precisely, about human nature, the concept of service provider/consumer/payment for services rendered, or the expertise of doctors has changed in that time which now entitles you to essentially "free" care on the backs of physicians who are making less and less after having dedicated, in many cases, nearly a decade in post-graduate schooling to their profession? Answer: Nothing has changed except people's biases and expectations, which is why they have to be re-educated on such matters. When the catastrophic coverage model was dominant, self-reported customer satisfaction with the medical system was actually at an all-time high, especially as compared with today. But my above system is by no means perfect; then again, is our current system perfect? Hardly. Can anyone propose a flawless system? Doubtful, but I'd be quite open to hearing it if you can. What I've outlined above is simply the fairest system I can conceive of for all involved parties; I feel it strikes an appropriate balance where there currently is none. Obviously all notions of "fairness" are inherently subjective, and so I clearly leave myself open to charges of bias and/or skewed notions of propriety. But I would argue we all do to one extent or another. :)

Some rebuttals to points raised "against" such a system, starting with a response to a "free market" advocate who was upset that my plan seemed to "soak the rich to pay for the poor":

Err, it's a concession to my humanity (of which you are obviously bereft). I can't see allowing people who [b]legitimately[/b] (key word) cannot afford to pay be denied medical care. This way, cash flows into the system from each strata, as opposed to what we have now, where cash goes up to the insurance companies but only about 40-50 cents on the dollar comes back down to the providers (if that).

Furthermore, in the "free market system" [b]you[/b] advocate (i.e., ZERO involvement of third party payors), someone making $120,000 would likely pay MUCH MORE than $6000 per year if they availed themselves of that level of services. That's what you're failing to take into account here, I believe: these deductibles are only paid IF a person procures that amount of services (i.e., it's not an insurance premium per year). If a person earning $120K doesn't get sick at all one year and just visits his PCP for a routine physical, then guess what-- he ONLY pays for that physical for that year (perhaps $100), [b]not[/b] the stated $6500. Under the "free market system" [b]you[/b] espouse, a person making $120K per year who happens to need a couple of MRI's and a week's stay in the hospital would [b]have to pay out of pocket[/b] roughly $15-20K (the cost of the services rendered), whereas in [b]my[/b] plan, they'd only have to pay $6500. So it benefits [b]both[/b] the indigent as well as the wealthy, though perhaps some more than others. Sounds fair to me...

It is [b]absolutely indefensible[/b] that someone earning $10M per year (say, a professional athlete) should be able to get arthroscopic surgery done on their knee and then hand over their insurance card, and the insurance company then reimburses the surgeons $5K for a $10K surgery, when the athlete could have paid that out of pocket and not even flinched. Likewise, it's [b]absolutely indefensible[/b] for my friend, who goes out every week and blows $120+ at the bars and clubs, to hand over an insurance card rather than paying his primary care physician $70 for an office visit. Fair is fair-- I'm not just attacking the rich, here. It's simply injustifiable to my mind, and this goes for ANYONE, rich or middle-class. People should pay for services [i]within their respective means[/i]-- I see nothing philosophically repugnant about such a stance.

As noted, the system is the fairest I can conceive of, whereas yours just sidesteps a legitimate and serious issue (people legitimately unable to pay) entirely.

Some comments to the point that deductibles should be determined by customer and insurer, rather than generally:

The problem I see with this is that fine, let's say that those of greater means opt for a plan with a lower deductible but higher monthly cost-- how does it guarantee that that money finds its way into the hands of providers? It doesn't. One of the stated (in other threads) aims of my plan is to infuse actual CASH into the system again, so that physicians and hospitals would at least be getting fair market value (i.e., 100% of what they charge) for [b]some percentage[/b] of their services, whereas they currently have to accept whatever cut-rates the insurance companies (and gov't) dictate (that is, they currently get 100% of what the charge on [b]no[/b] services). And when you get 100% of what you'd charge for a service, it ultimately helps your bottom line; this would be particularly helpful to primary care physicians, who've seen their bottom-lines erode beneath them since they never get anywhere near market value for any good or service. It would help the entire medical community as well, though-- and these people deserve to be compensated, [i]insofar as possible[/i], in the exact same manner that we compensate EVERY OTHER professional or service-provider: fee for service (within reason). The "within reason" part is, as I've mentioned, a concession to the intrinsic value of medical care (i.e., its special nature, being concerned with life and death and all) and the ethical quandaries that arise when discussing denial of care.

People should pay "within reason" because if they legitimately [b]cannot[/b] afford to pay, then, to a humane and decent person, there is no option but to give them subsidized care. Also, as for why "within reason" extends to those far above the poverty line, well, it's because [u]it is not reasonable[/u] to expect (for instance) a middle-class family earning $65K to have to sell their house in order to pay for medical expenses they've incurred, with the stated rationale being that "a house is not a necessity, so if medical care is so important, then get rid of all the luxuries first." No-- that's bogus reasoning, if only for the simple fact that medical expenses are SO inflated at the moment (due to all the subsidization going on AS WELL AS the third-party payor system, which never reimburses fair market value for anything) that it is not proper to attack the people rather than the system. Fix the system [b]first[/b], by implementing sensible reform, and then you'll be on solid ethical footing when you go after those who would attempt to circumvent it.

Make no mistake, however-- if a system such as the one I advocate were implemented, costs WOULD decrease over time, since there would be less "cost-shifting" as hospitals and physicians stop trying to recoup costs by raising prices, since they'll be getting a significant portion of their services paid for at market value. Eventually, medical costs would settle into their natural equilibrium.

There obviously has to be litigation and public information reform as well (along with the deportation of illegal immigrants, who in some states have caused a crisis in the health care system all by themselves), but strictly in terms of payment plans, I believe this to be the fairest one involved for EVERYONE, patients (both poor [b]and[/b] rich, as seen above) AND providers.

A response to someone who stated that their deductible under my plan would be > $13,000 per year (her family income is $270K per year), and they rarely used the doctor, so they would be better off investing that money and withdrawing it when needed (this was a misunderstanding of my plan):

You're making the same mistake that Jeff made above. The deductible numbers are [b]not[/b] paid "regardless", every year. Those are simply the upper limit to what a person in each bracket would be expected to pay out of pocket [i]if they availed themselves of that amount of services[/i]. So say you don't use ANY medical services one year-- guess what, you pay [b]nothing[/b] (besides your catastrophic coverage insurance premium, which would be substantially lower than healthcare premiums are presently to reflect the fact that companies would be less liable for all sorts of primary care up to the deductibles). You do [b]not[/b] pay "$13,000" if you only went to the doctor for a flu shot that year, you'd just pay $100 (or whatever it was).

This seems the most reasonable plan to me because of situations such as that related by an online acquaintance of mine:

He has cystic fibrosis, which frequently requires extended hospitalization. His family's income is roughly $280,000. His hospital bill for the first 6 months of the year came to [b]$100,000[/b]. Guess what his family paid out of pocket? $1000. 1% of the cost. This, despite the fact that his family could have [b]more than[/b] afforded to pay, say, $15-20K out of pocket towards that bill (for the year). Is such a situation just? Not in a million years...

As much as "free market advocates" try to demonize people such as myself simply because we have the human decency to admit that medicine is a "special case" (i.e., it's important in a unique way) and attempt to look for sensible ways to ensure that all of our population is taken care of (within reason), nary a [b]word[/b] of protest is heard when people who can [b]afford[/b] to pay instead use proxies such as insurance companies. Why? Third-party payors are NOT part of a "free market" system-- so are you a free market advocate or simply an advocate for the wealthy? Seems people are "free market" advocates when it suits their politics. Further, as I illustrated in my previous post, the system I proposed would be better than a "pure" free market system for [b]both[/b] the rich [u]and[/u] the poor-- both groups would reaize substantial savings, though perhaps not to the same degree.

Realize, however, that in a free-market system, your family (~$270K income)-- if they incurred $70K worth of medical expenses one year-- would have to [b]pay that $70K out of pocket[/b], whereas in [b]my[/b] system, you'd only have to pay ~$20K or so, with catastrophic coverage picking up the rest. So it'd help upper-class folks as well; I think people are ignoring this. This is [b]not[/b] about "hosing the rich"-- it's about each person engaging in the [b]traditional, normal[/b] compensation system for professionals (fee for service), just as they do [i]for every other service provider[/i], within their respective means.

A millionaire should be able to hand over a $10 co-pay to his primary care physician? [b]Hell[/b] no-- just as a person earning $75K per year should not be allowed to. They should have to pay for the visit out of pocket (assuming they have not surpassed their yearly [b]maximum[/b] out of pocket deductible, as stated). Now, if the millionaire and the person earning $75K end up in the hospital for a few weeks with a bill of $70K, obviously the person earning $70K should not be forced to sell his house to pay the bill, but rather should pay some [i]reasonable[/i] percentage of it, say, $2500. The person earning $1M per annum should [b]also[/b] pay some [i]reasonable percentage[/i] of the $70K bill-- however, in this case, what is reasonable for the multimillionaire is not the same as what is "reasonable" for the person earning $70K; this is inarguable. The person earning $1M/year should be compelled to pay the $70K bill out of pocket, unless they have already surpassed [u]their[/u] out of pocket deductible for the year (which is unlikely except in extreme circumstances). A fair deductible for a person earning $1M/year would be around $150K imo (again, keep in mind that this amount is [b]only[/b] paid if a person actually incurs $150K of medical costs for a single year, which is exceedingly rare).

Obviously, as I said in my initial post, what is "reasonable" is inherently subjective, and I cam obviously be attacked on this point. But I have yet to hear [b]anyone[/b] tell me, philosophically, why the people who can afford to pay for a good or service [i]should not[/i] pay for it out of pocket, within reason. I'm not asking a person earning $1M/year to pay $600K out of pocket if they (by way of some catastrophe) incurred that amount of medical expenses in one year. No-- that would be [b]unreasonable[/b]. The same way that it is [b]unreasonable[/b] to expect a person earning $20K/year to pay $7K out of pocket, or to expect a person earning $80K to pay $20K or so. As for why the deductibles are not proportional to income bracket, well, as noted, it's due to sustenance costs (food/rent/mortgage/basic clothes/utilities etc.) which more greatly affect those in lower brackets. This is [u]an entirely reasonable assumption[/u]. My rationale is not to soak the rich to pay for the poor, but rather to have a system wherein each person pays within their respective means; viewed in that respect, it is eminently sensible.

I can conceive of no argument against such a system, personally.

My response to someone who stated that my proposal amounts to a 3rd party socialistic system (whatever that means)-- keep in mind that I have already shown that these supposed "free market advocates" are really nothing of the sort, or they'd have no problem paying fee for service (i.e., a free market mechanism):

No, it really wouldn't be. In fact, it's [i]less[/i] "socialistic" in nature than the system we have presently, where cost-shifting and subsidized care is the norm. It's [b]not[/b] that those more well-off are "subsidizing" those of lesser means, but rather that each man is paying according to his means. Look at it that way and then tell me what's wrong with it. Because the present system is [u]entirely[/u] unsustainable, and is rapidly approaching critical status; I fear that, should the current trends continue unabated, a government-provided socialized system will be inevitable, and will be seen as the "saving grace" of the system when in reality it will place even HARSHER ethical and financial demands on providers, and will deprive patients of their autonomy and input into the course of their own care (since it'll all be dictated by gov't regulations based on cost-effectiveness rather than patient health).

You see, though, you're already viewing the proposal in the wrong light. What you're doing is creating (or partaking in) this adversarial class warfare mentality (e.g., when you mention "redistribution"). As I said above, my intention is NOT to soak the rich to pay for the poor (after all, the rich-- along with everyone else-- currently pay for the poor in myriad ways anyway; e.g., higher taxes, higher insurance premiums etc.), but rather to ensure that providers get [b]their due[/b] for services rendered as far as is reasonable. Sorry to belabor this point, but I feel it's a crucial one. Ask yourself why the third-party payor system has never been implemented in [b]any[/b] other sphere, for any other profession or occupation. If you point to the unique nature of medical care, you'll have only part of the answer. The other part is that [b]no other professional[/b] (not lawyers, not accountants, not architects, hell, not even mechanics) would [u]allow[/u] such a system to interfere with its normal business dealings due to the absolutely ludicrous situations which arise as a result of it, which we see every day in the medical field.

Fact: The [b]entire[/b] third-party payor system is [b]loathsome[/b]. In an ideal world, third-party payors wouldn't exist, as not only do they interfere with the normal economics of a business transaction (between physician and patient), but they also create ethical dilemmas for providers, who have to be concerned with the wishes of the PAYOR, rather than the interests of the PATIENT. This is repulsive imo, and in no other sphere of activity is such a system considered acceptable.

The effect of my plan (indeed, one of its intentions) is to marginalize and remove these third parties (insurance co's, gov't etc.) from the business transaction as far as possible. The deductibles ensure that insurance will becom involved in the system (and thus there will be less administrative/bureaucratic costs as well as fewer ethical dilemmas) [b]only[/b] when costs go beyond a person's means to reasonably pay, rather than being involved [u]all the time[/u], as they are now. The cost savings, as well as the obviated ethical conundrums (e.g., "my doctor says I need this MRI, but my insurance won't pay for it" etc.), will be [b]considerable[/b]. Disentangle the insurance companies-- and their attendant bureaucracy-- from the provision of medical services as far as possible, and you'll already have achieved a great victory for both patients AND providers. Fewer overstressed physicians, now not saddled with bureaucratic excess (paperwork, haggling with insurance reps on the phone etc.), can only mean better care for patients, as well as more productive and happier physicians. It's a win-win situation imo.

Now, insurance companies would obviously not disappear entirely, and this, as I've said, is a concession to the unique and important nature of medical care, as well as a concession to our common humanity, since nobody wants those [b]legitimately[/b] unable to afford care to be turned away. The insurance companies would not disappear, but would be relegated to the fringes of the system, in the provision of catastrophic coverage only; one should note that this was the dominant paradigm for [b]decades[/b] before the insurance companies insinuated themselves into the normal payment process, and it was the era when self-reported customer satisfaction with the medical system was [b]highest[/b] (as opposed to now). As I've stated, the problem with the current system is that there is [b]no[/b] cash coming into the system, even from those who can ostensibly afford to pay for the services rendered. The only "cash" that flows into the system comes from the gov't tit (or the insurance company's tit), and the amount is determined by fiat as opposed to what the market will bear (i.e., providers currently get fair market value for NONE of what they do). Allow providers to get fair market value for at least a percentage of what they do and you'll see the overall health (in terms of patient care, provider attitude, AND solvency) of the system improve [b]considerably[/b]-- to think otherwise is silly.

In response to his statement that these pofessional athletes and rich people pay higher fees for insurance:

And you're not understanding me when I tell you that it is [b]the third-party payor system itself[/b] that is broken, and which should not be tolerated. It makes no difference how much these multimillionaires pay for "coverage" to the insurance companies, because those insurance companies (yes, even the very best of them) then [b]dictate[/b] how much they pay to providers, which is [b]never[/b] more than 70 cents on the dollar (and that's being [i]extremely[/i] generous, as it's usually closer to 30-50 cents on the dollar, if that-- I'm assuming these guys have some sort of "super plan" that more adequately reimburses providers; note, however, that "more adequately" still does not equal "fair market value", as [b]every other professional and service provider in the world[/b] receives for their services-- therein lies the problem, and it's [u]inherent[/u] in the nature of the third-party payor system; it needs to be done away with as far as possible).

The system [i]itself[/i] (i.e., the very [b]concept[/b] of "third-party payors") is what's broken. It needs to go, [i]within reason[/i]. Less insurance company involvement is [b]always[/b] preferable to more involvement.

In response to a person who persisted with the argument that they would have to pay a "higher percentage of the costs" under such a system as I proposed (the person earning $270K):

You would NOT pay "more" unless you availed yourself of that amount of services. If you commission an architect to build a home for you, can you then turn around and tell him that you'll only pay him 50% of what he's asking? No-- but this is the evil that insurance companies inflict on physicians and hospitals regularly, and nobody has ever shown me precisely why it's acceptable in this sphere but not in every other one. If you can do so, then please do.

Also, if "paying more than others are" is the problem (which is an erroneous way to look at it-- you're paying what you owe to the provider, within reason, as is everyone else), then realize that there are MANY other spheres where such a situation obtains, yet where people don't bat an eye. College tuition, for one; welfare and other subsidies, for another. Why should YOU-- earning $250K-- have to pay full tuition? Why aren't you entitled to financial aid? Sounds foolish, no? Just as what you're here saying sounds foolish, no offense. Why should YOU-- earning $250K-- not be entitled to food stamps? Why should YOU have to pay full price for food while others pay cut-rates? Sounds foolish, no? Why should you-- earning $250K-- have to pay full price for rent or a mortgage while others are on rent control or get subsidized housing? Sounds foolish to ask, no?

Well, I think you get the point, or at least I hope you do. You should think about these things. As I stated, the plan is NOT perfect, but it is the fairest one I can conceive of. No other plan would address the encroachment of insurance companies and government upon patient and provider autonomy (both financially and ethically). And that is something that needs to be addressed imo.

And now for some posts all bunched together, since I don't have the time to format or group them properly right now. My apologies, again, if these seems meandering; I feel that if people read my reasoning regarding these things, however, they will get a more thorough understanding of what I'm proposing and why I'm proposing it:

No, that's the case. The thing is, it's not a compelling argument given the problems inherent in the current system, as well as the problems inherent in alternative solutions such as "socialized medicine" and/or expansion of insurance-company-provided coverage, since this comes with its own financial and ethical dilemmas.

Like I said, there is no perfect answer, and all solutions involve tradeoffs. I propose that a system such as I've proposed wherein people pay what can reasonably be expected of them is fairer and more just, overall, than either fully socialized medicine (check other threads for the reasoning) or a fully free market system wherein EVERYONE pays fair market value for services and those who cannot afford to do so get shafted. To suggest taking some middle-of-the-road solution, such as expanding traditional insurance coverage to all (or more) persons, is also untenable, since the entire system is already buckling under the weight of the third-party payor system-- to say nothing of the ethical quandaries which obtain under such regimes.

So is it better for you (an affluent person) to either pay the $12,000 per year deductible IF you procured that amount of services, with everything above and beyond that covered by insurance, or is it better-- as in a truly free-market system-- for you to pay EVERYTHING you're liable for in one year, which may be well beyond what is reasonable (say, $70K of expenses in one year)? Or is it better for you (an affluent person) to, under a socialized system, have to wait extraordinarily long times for doctor vists and diagnostic tests because health care workers are overworked and underpaid and there is NOT ENOUGH MONEY in the system to purchase equipment and pay for staff?

As you can see, everything is a trade-off, and it's a trade-off REGARDLESS of what income bracket one belongs to. The plan I proposed is the fairest I can conceive of for the reasons stated, but I'm not going to continue to belabor this point. If people disagree, then that's fine-- good luck coming up with a more equitable solution which still retains a shred of humanity and compassion while remaining true to our capitalistic, meritocratic ethos (i.e., that people should pay for services rendered-- proxies such as insurance companies are loathsome; ask yourself why they don't exist anywhere else in the economy).

Further, the whole rationale about paying more for the same service/good is a faulty one, and I mentioned several cases (and there are many more) where such a situation obtains (food stamps/welfare, financial aid for higher education, rent-control and subsidized housing etc.) yet where people DO NOT COMPLAIN about it, realizing that it would be improper for a person earning $250K to move into an apartment and apply for rent control, or to attend a private university and ask for Pell grants. Yet for some reason, it's appalling to you in the health care field, and I would imagine that this has a lot to do with our entitlement culture. The only reason you pay more than the poorer person is because it is reasonable to expect you to be able to, the same way it is reasonable to expect a person earning $30M per year to be able to pay more per year (again, ONLY IF they availed themselves of that amount of services) than you and your husband.

Nobody on this earth is entitled to the toil of another man without just compensation; insurance companies do NOT provide "just" compensation, seeing as how they pay pennies on the dollar. The most sensible way to remedy this is to ask people to pay a reasonable amount of their own expenses per year out of pocket.

Eveything is a trade-off, as I've said. Keeping the system as-is and just extending "coverage" to the uninsured will come with a HOST of issues (financial, ethical, interpersonal, stress-wise etc.) that are much worse than what would occur under a plan such as I've proposed. But you're free to choose...

I'm not going to defend these points any longer, as I honestly cannot fathom how a reasonable person could have any objection to what I've proposed. I don't mean to be snippety or condescending when I say that either-- I just honestly can't conceive of it, and so I'm unsure about how to address it. At any rate, thanks for the productive discussion, and I'm glad that I was at least able to get my thoughts out there, since I never see anyone proposing anything remotely like what I have (the recent trend towards higher deductibles is similar, but it doesn't go far enough imo), instead preferring to focus on the more "common" (yet more inherently troubling) reform of either A) socialized medicine, B) a completely free-market, or C) keeping the third-party payor system as-is yet extending coverage to the uninsured. All of these proposals, in the final analysis, are riddled with problems that make the "problems" you're attempting to create within my system seem absolutely trivial (no such problems exist, however; reasonable people do not gripe about paying what they owe just because someone of lesser means may be able to reasonably afford to pay less of what they owe-- it evinces a profound lack of understanding, commensuration, and compassion imo).

Anyway, I've explained everything as best I could. Feel free to continue to march down the third-party payor road, or the socialized road, or to beat the drum for a totally free market (ALL of which would adversely affect BOTH the rich and the poor MUCH more severely than the system I've proposed; the "rich" are already subsidizing the poor, as is the rest of society). One day people will realize that none of these options is feasible, and involve far more trade-offs and evils than what I've proposed. But hey, whatever floats everyone's boat. :)

First, please desist with the class warfare nonsense. It is eminently sensible that those who can afford to pay for something should, and as I've stated I have nothing against "the rich". I take it that your first sentence in the above quote is sarcasm, and is intended to show how the rich will, in fact, end up paying "ten times as much as poor people", since rich people do in fact get sick and have heart attacks. Well, instead of looking at it as them "paying ten times as much", why don't you look at it as them "paying what they owe by way of customary business relationship" (same as in every other sphere besides healthcare)? I'll tell you why you don't look at it that way: because you'd choose to perpetuate this nonsensical class antagonism rather than move towards sensible reform that would ultimately be in the best interests of all of society, rich and poor alike. But that's your choice to make, not mine...

The fact is that no other system proposed except the pure free market system (which is impracticable for reasons already stated) even attempts to extricate providers from the hassle of having to deal with the bureaucracy, constraints on care, and shoddy reimbursements of insurance companies. Are you denying that these companies inflict great harm on the system? If not, then why do you oppose the measures I've proffered? If you do deny that there's anything wrong with the notion of third-party payors (financially and ethically for both patients AND providers), then enjoy the way health care will trun out in about 10 years time. It's coming-- the current system is unsustainable, and it's NOT just because the "insured" are subsidizing the "uninsured's" care, though that is a part of it; it's because the only cash that currently flows into the system is whatever these proxies deem appropriate, which is never fair market value (i.e., 100% of what is being charged).

Change that and you change the bottom line of every private practice and hospital in the nation, enabling people to be treated more thoroughly and humanely (patients not rushed through in assembly-line fashion in order to see more patients to keep the practice solvent) and obviating the need for more expensive critical care down the road, since those of lesser means will be able to see their PCP again, and will be treated adequately by them, seeing as how the doctors will no longer be feeling such a financial pinch.

Fine, let's go with a stictly free-market approach, where the rich folks would have to pay for EVERYTHING out of pocket-- is that more palatable to you? Lemme guess, you're a proponent of a flat-tax, or maybe a national sales tax, and an exponent of trickle-down economics, too, correct?

Or...OR...let's go with socialized medicine, which would, above all else, ensure that rich and poor alike would receive the same ****ty level of care, and which would not AT ALL resolve the ethical dilemmas present when you have a person OTHER than the patient paying for their care (i.e., the interests of the patient and the interests of the payor should, ideally, coincide; they don't under "managed care"). At least my system addresses this disconnect for a substantial portion of the care obtained, whereas you seem content to avoid it entirely and pretend that it doesn't exist.

Or, let's keep the broken third-party payor system afloat and expand it to the uninsured, despite the fact that the system is already falling apart at the seams financially and ethically (e.g., "I need chemo, but my insurer won't cover it!"). Yeah, that sounds great...

Can you philosophically justify to me why it's ok for a rich person to pay $10K for a dress or a suit but not require that they pay their physician $70 out of pocket for an office visit? Is it that they're incapable of paying? No, of course it's not that-- so what is it? As I've said, money goes up to the insurance companies, but money seldom comes down to the providers; even when it does, it's only after much trouble and administrative wrangling. Can you tell me why my parents (yes, even my own parents are guilty and I've told them as much) are perfectly willing to pay $400 to the vet for my dog's care, yet see nothing wrong with paying a measley $10 co-pay to their physician? Or why my friend goes out to eat and party every week and blows $200/week and does the same? How are these situations philosophically justifiable? I'm all ears.

Insurance companies and other proxies (gov't etc.) should have either a very limited and specific role in the health care field (i.e., the provision of catastrophic coverage), or they should have no role at all. Period. I'm in favor of the former due to ethical considerations, as I've stated (i.e., I refuse to deny care to those who truly cannot afford to pay).

A sensible man never argues against paying what is due by rights-- only insensate persons do so. Something to ponder...

I know for a fact that if I made $1M per year that I would not complain at all if I had to pay $150K in one year for medical services that I've procured (i.e., one wouldn't pay that amount every year, but only under extraordinary circumstances), and that is because I was raised to be a sensible human being, and to not bitch about things that are reasonable and in the public's best interest. Unfortunately, there are a great many apologists for gluttony, foolishness, and inhumanity in our society, and, based on your querulousness, you appear to be one of them; these quiescent minds, unburdened by critical thought and compassion, tend to bark the loudest, incessantly promulgating their ill-considered views to all of society-- a society that, by and large, is itself not sensible or intelligent enough to grasp the pertinent distinctions or to appreciate reasonable, moderate reform even if it hit them square in the face. A match made in heaven, I suppose...

I will brook no compromise with unreasonable people on these matters-- the detritus of our once enviable healthcare system lies all around you, yet you are too blind, and too obstinate, to embrace meaningful, sensible reform. Very well-- see where this nation's health care system ends up in 10 years. This is not an idle threat, believe me. It's inevitable unless you address the issues I've mentioned in a substantive manner. But I don't expect you to believe that-- or even to consider it-- at all.

Riddle me this: why don't we have third-party payors for utilities, food providers such as restaurants and supermarkets, and rent/mortgages? (shelter is a necessity as well, as is sustenance)

Why don't we have that? I also like how you avoided all the other points.

By the way, it'd be nice if you laid your cards on the table. What do you support? Socialized medicine? Free-market system? Continuation of our present system? I'd just like to know so that I can ask you how you'd resolve the financial, ethical, and patient-care issues inherent in all these systems. Just a brief synopsis will do...

If you knew anything at all, and weren't in such a rush to pigeonhole people (as communists, as anti-rich etc.), you'd take the time to find out that I have been one of the staunchest proponents of increasing physicians' incomes across the board, as I feel they are currently woefully underpaid based on any rational job analysis that can be performed, and as compared to what we pay others in our society. I personally believe that NO doctor should be making less than $180K per year, and in fact should make quite a bit more-- and make no mistake, they would see an immediate boost in income (as well as contentment due to less bureaucracy) under my system. Neurosurgeons should NOT be making less than $450K under any circumstances imo, ditto for cadiothoracic surgeons.

But keep painting everything in black and white terms and trying to fit my views into your neat little categories-- it suits you. Imbecilic boolean thinking such as this is the province of lesser minds, and I will not lower myself by responding in kind. I have been very outspoken against both communism and socialism, but hey-- whatever floats your boat.

You here speak of HMO's, but you are aware that managed care plans (including gov't-sponsored programs such as Medicare/caid) inflict many of these same evils upon providers, right? This was precisely the reason I wanted to marginalize them and extricate them from the system as far as is reasonable ("as far as is reasonable", because there will always be a need for catastrophic coverage, unless everyone's going to earn $50/hour in your utopia ). And if you agree with more out of pocket payment, then why did you excoriate me for suggesting the same? Is it because I believed that it should be done based on a sliding scale based on income bracket? Well, that just strikes me as fair in a "social justice" sense (as opposed to an "everyone pays the same" sense, which is how "fairness" is typically conceived of-- I disagree with it in terms of taxation rates- e.g., a flat-tax- and I disagree with it here).

Please realize that in all cases of, say, surgery, the bill for the surgery would be $7K (for example). The more affluent among us could afford to pay this entire bill, while those subsisting in penury might be able to pay only $200 towards the bill, with their insurance company picking up the rest (just as the insurance company's catastophic coverage would pick up the tab for the rich person if costs exceeded what could be reasonably expected of them). So they are paying more de facto, while in actuality they are being charged the same as everyone else (also realize that over time the billed costs of medical care would drop from their currently inflated levels, so it wouldn't be as drastic a scenario as you are perhaps envisioning); in effect, all are paying the portion of the bill that they can legitimately afford to. This entire scheme is a concession to my belief that physicians deserve to be compensated for their time the same exact way that other professionals are-- I can conceive of no fairer and more humane way of implementing a fee-for-service model for medical services, since a totally free market system (i.e., everyone pays out of pocket for all the expenses they incur) would be finanically ruinous for both rich AND poor as well as ethically questionable.

In this case the interests of the providers-- you know, the people actually doing the work (i.e., doctors, nurses, and hospitals)-- supersede the interests of "the rich", who are merely taking advantage of the service of another man and then carping about having to pay what is due of them by way of barter, despite the fact that the amount being asked is within reasonable limits for all persons. To my mind, the interests of people doing the work will always take precedence over the spuriously justified "interests" (e.g., desiring to pay less than what is owed) of those availing themselves of a service or procuring a good produced by other men.

I agree with your malpractice proposals, except to say that caps should be placed sufficiently high in instances of genuine malpractice (e.g., paralysis caused by negligence etc.). Further, I believe that the entire medmal system should be taken out of the courts and first screened by independent panels consisting of judges, attorneys, and physicians (you know, the people actually qualified to determine what is proper in such cases); if a suit is deemed meritorious, it can then proceed to trial in front f a jury. I am not averse to paying someone up to $10M (above and beyond economic damages and medical costs) for something as severe as paralysis; $50M? No way. And it obviously must be a clear-cut legitimate case, as would be determined by the panel.

As I've stated, I am not a communist of any sort-- I am a meritocratic capitalist. I believe that those who are more valuable, highly skilled, and industrious deserve to make a lot more money than those who aren't; I am in full accord with this principle. What you're failing to grasp, however, is that doctors being paid commensurate with their expertise and value (which would be around $230K minimum and scale up from there based on specialty in my ideal world) is not just going to magically "happen" unless you first reform how physicians get paid (i.e., get rid of the insurance companies as far as possible).

Nobody is going to wake up one day and say, "you know what? Doctors should be paid more", and then proceed to provide all physicians in the US with their just compensation. Nobody has the authority to do something like that with the way things are structured currently, and, assuming that you don't want centralized/government control of the system (as I don't), the only way to affect physician remuneration is to endeavor to change the process by which they get paid. Towards that end, I've yet to see a better system proposed than the one I tendered for acceptance on the previous page. Such a system would also avoid the financial, ethical, and patient-care pitfalls inherent in all of the commonly proffered alternative systems (i.e., socialized medicine, totally free-market medicine, managed care etc.).

This is how I see it.

Again, why do you have no problem with this exact same phenomenon in spheres such as welfare, tuition aid, rent/mortgages etc.? Why should tuition be "one price" for the wealthy and "another price" for the poor?

It's the fairest and most sensible system you're going to find, all things considered, and the only one which addresses the issues I've raised (financial and ethical). The only one. This system has the least amount of injustice (this is not to say there is NO injustice), while any other system you can propose (socialized, free-market, continued managed care etc.) is riddled with injustices for EVERYONE.

But don't take my word for it-- get back to me in 10 years time...

And how will you ever lower administrative costs? By marginalizing the insurance companies and removing them from the process as far as possible, that's how. If you think that insurance companies are just going to magically "stop" requiring physicians and hospitals to make ridiculous amounts of documentation for every patient so that they can be reimbursed properly (and also to cover their ass), you're living in a fantasy world. And how do you stop that? By going fee for service again wherever possible and within reason, which is what I've proposed. The other cause of excessive documentation, which is fear of litigation, must be addressed separately and is not germane to this discussion.

Why do doctors "overbill", as you say? I assume you're referring to billing the insurance companies a much higher amount than they would charge a cash-paying customer, correct? Well, why don't you think about why they do that for a moment. Could it be because...oh I dunno...the insurance companies reimburse then 40-50 cents on every dollar claimed? And that these reimbursements barely cover costs, much less a reasonable profit for a highly trained professional? Yeah, that sounds about right to me. The related issue of why costs to uninsured patients are so inflated is likewise due to this very same phenomenon.

Pharmaceutical reform is also an entirely different issue, and would require too much time to discuss; I heartily agree with the need for reform, however. Ask yourself why there seems to be more of this impropriety among physicians vis-a-vis drug companies now than in the past. Could it be...oh I dunno...because we're not paying physicians what they're worth as a society (relative to what others make in our society) and they will therefore be more likely to accept those monetary (and other material) inducements to prescribe drugs, however improper? Sounds like it to me. This doesn't excuse such conduct, obviously, but let's be realistic if we're looking for motives.

No, it doesn't, no matter how many times you say it. It's all a matter of perspective; under my system, everyone would be paying what they owe to the provider (just as one pays a mechanic or accountant), within reason. Just as poorer people pay a smaller fraction of their tuition out of pocket, with various federal grants picking up the rest. In this case, the poorer person would pay less of their medical bill out of pocket, with their insurance picking up the rest. Ditto for the other scenarios I've mentioned.

So why is this same exact dynamic acceptable to you in one sphere but not another? You should go to Capitol Hill and implore Congress to repeal federal tuition aid-- or at least extend it to those making $300K/year or more. Tell them that it's unfair that poor people should be eligible for food stamps, able to buy food at reduced prices, while you cannot. Tell them that you deserve subsidized housing despite earning $250K. I can't wait to see how far you get...

High earners will not be responsible for subsidizing the low earners (at least not any more than they do now)-- they'll just be responsible for a greater portion of their own medical expenses out of pocket than they are presently. As for why people such as yourself are so concerned with what other people are paying, I'd say that it's because you're selfish (not just you, but many in our society; this is a habituation thing) and do not want to pay what you owe, but that's just me. I know for certain that if I earned $300K per year, I wouldn't kvetch about the rare instances when I would have to pay out $35K/year for medical expenses that I've incurred-- but that's just how I was raised, and what I believe. I wouldn't carp about doing what is best for society rather than strictly what is best for "me" (and, despite this, the plan would benefit the rich as well eventually). Answer me this one question: Why should people not pay what they owe to the provider of a service as far as is reasonable (i.e., nobody's asking anyone to pay an extravagant amount or to foreclose on their homes in order to pay)? If all your answer consists of is to say, "but everybody's not paying the same", then consider yourself unable to answer the question satisfactorily and please be big enough to admit as much.

Look at it this way (I mean, seriously look at it):

There is no system that will be everything to everyone. One cannot appease the rich, the poor, the middle-class, the providers, the patients-- it's simply not possible. And so we must have certain tradeoffs if we are to find a sensible system that's in the best interests of as many people as possible (patients AND providers)-- indeed, in the best interests of the nation as a whole. Currently, the major injustice is inflicted upon those unable to afford insurance and the providers of care (doctors and hospitals)-- and it is a great injustice, with many social costs. In my system, perhaps a case can be made that the "rich" would be suffering an injustice (I disagree, but to indulge you for a moment), but the other injustices (which currently exist) would largely disappear and/or be mitigated. Further, the "injustice" being "suffered" by "the rich" is really nothing of the sort-- for something to be an "injustice", it means that what is occurring is not just. To pay a person who is working for you what you owe them is just; it is only in these tangential concerns about "others not paying exactly the same amount" where one can posit "injustice".

Moreover, this "injustice" is limited in scope, since we'd only be asking the rich to pay what is reasonable, not some exorbitant, incommensurate amount. The proposal would address such gross injustices as our shamefully inadequate physician remuneration, provider stress (which leads to compromised care), bureaucracy, the plight of the uninsured, the solvency of our nation's hospitals, the current disconnect between the interests of the patient and the interests of the payor (insurance companies, gov't etc.) and its resultant ethical conundrums (which are very prevalent), overinflated costs, and many others.

All in all, I simply do not see a more reasonable solution that concomitantly addresses so many ills while inflicting a minimum of injustice (I don't view it as "injustice", but whatever). You're free to doubt me, or scoff, but believe me when I tell you that any other system you can proffer would feature more injustice, and more gross injustices at that, for all involved parties. Just wait and see what this nation's health care system looks like in 10-15 years unless you find a way to infuse cash into the system (again, at 100% of market value for a substantial portion of services-- not 40% reimbursement from proxy-payors).

I suppose we'll all see who's correct in good time, and that doesn't cause me dismay, because I've tried my best and said my piece. :)

And no, I don't expect anyone to read all that-- I just felt like getting my thoughts out there in case anyone did. :P

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