Uncut: Obama a proponent of single payer coverage

The problem is that you have a crappy policy that is a PPO in name only. it barely functions like a PPO.

I know...for a short time I had the same crappy coverage.

The overwhelming majority of PPOs are much better.

 

It sounds to me like the GPs you’ve been seeing aren’t very good. Why didn’t you try a different one? Are you restricted in that way? I do know that your system provides fewer choices in this regard.

Yes, but they should be right most of the time. They are highly trained, after all, and you should be able to seek a second opinion in any event. Perhaps the quality of care you’ve been receiving isn’t as high as you’ve been led to believe? In Canada you can always seek a second opinion, and you can shop around for a doctor who you can communicate well with and who understands you. Pretty well any doctor who has space for you is available to you here.

I don’t see the logic here. A specialist specializes in a given area, but he/she will likely know less about other aspects of your health than a GP. I can envision situations where one might go straight to a specialist and have some related or even unrelated issue missed because the specialist doesn’t have the same broad knowledge that the GP has.

I’m not clear on what a PPO is. Is it something like these? These are a bit controversial here, as the third link describes, but they are allowed. (Note that there is currently a shortage of doctors in Calgary but that’s a separate issue and one that is also a problem in the US and most other western countries as well, I believe. http://www.reuters.com/article/latestCrisis/idUSN21255541. And it's worse in Calgary than in other places because we've been booming and the added population has added to the problem. Lots more can be said about this but it's a separate issue.). I think you may be under the mistaken belief that premium services aren’t available in a single payer system. The single payer system covers medically required care as outlined in the Canada Health Act (see link below). Premium services are still available but you have to pay for them out of your pocket, or you have to have supplementary insurance that pays for them.
http://www.copemanhealthcare.com/index_page
http://www.provital.ca/
http://www.canada.com/edmontonjourn....html?id=11ea0e4c-384c-4d22-a2f5-dd46c0e9149c
http://laws.justice.gc.ca/en/showdoc/cs/C-6/bo-ga:s_3/20090805/en?noCookie#anchorbo-ga:s_3

Do you have a problem with your tax dollars being spent to provide fire protection for poor people, or police protection for poor people? Ultimately doing these things is good for society as a whole. Your society has already decided that it should provide some kinds of health care to people who can’t pay for it, so why not do this in a sensible and efficient manner? Remember that the profit motive of a private insurer relates to the bottom line of the company, and they will try to drop people who they’re not making a profit on, but this just shifts these costs to the taxpayer. This comes out of your pocket anyway, in other words, and no real savings are realized in this scenario, although profits for the company are increased so their objective is achieved. The government’s profit motive, otoh, is to maximize the productivity of its citizens, and thereby to maximise its tax returns and other related benefits to the country, and to make its citizens healthy and productive in the most efficient way possible. The difference between the two profit motives I think goes a long way towards explaining this:
http://www.oecd.org/dataoecd/46/2/38980580.pdf

 

Wouldn't that only happen in a single payer system? I don't think that's what's being proposed.

(actually -- technically, I think a single payer system is the opposite of an HMO, in that if there's no opt-out for doctors -- they've all opted in by default. There's no restriction on doctors under a single payer system (except for availability which is a separate issue). But I think I get what you mean -- that it becomes a big, bureaucracy run centralized health delivery system).

But you can ignore the horror stories you hear from Canada and elsewhere. Single payer is NOT being proposed for the US (old, out of context youtube clip not withstanding). So I won't wax on about the Canadian vs US systems. The Canadian system is not being proposed for the US (you get a made through committee much more complex and costly version ). And oddly -- those who embrace the horror stories they hear from other countries seem to be oblivious to the ones they hear from their own.

Sweet Lou (claims) he went from a crappy HMO to a good PPO. How? Why? Because there was demand that warranted the extra cost. That's not being removed. So at worse -- those without access to the better plans will get their universal crappy HMO's and those willing to pay (or who's company's are willing to pay) for 'better' plans will get those. Why would the supply of 'good' coverage be withdrawn because 'worse' coverage is provide to others? Why would people currently willing to pay for 'better' stop doing so?

You could argue that a national health care initiative is far too costly, or that access to health care must be 'earned' but those are quite separate arguments to those about quality or access.

The type of coverage and how to pay for it should be fair game.

But strawman arguments about disappearing access, no choice in doctors (that one's truely bizarre) and deteriorating service are simply fear mongering. I suppose they make the discussion a lot less 'cold hearted' -- but they're dishonest and inconsistent with what's being proposed.

 

I had one good general practicioner but she retired - she was my primary care doctor for many years. But even she admited that for most issues she would send a patient to a specialist. Yes, there are broad concerns that a GP is knowledgeable about - but at the same time, a lot of them (most) think their knowledge is much more sophisticated than it is.

Very few GP's actually keep their knowledge of current medicine up to date - meaning they last learned from their past residency. But now think about why you would go see a GP....

If you break your leg, would you need to go to a GP to have it diagnosed?

If you hurt your back, would you first go to a GP or would you just go see a back doctor?

If you had really bad allergies, would you go to a GP or an allergist?

If you had trouble breathing - GP or a Pulminary specialist?

If you had a skin growth on your arm would you see a GP or a dermatologist?

If your eye got red and started to burn, would you go to a GP or an ophthalmologist?

I like having the choice to skip a timely visit to a GP - which can take weeks to organize only to be told to go see a specialist. But that doesn't mean a GP isn't useful.

If I had chest pain that wasn't severe, i'd go see a GP. (If it was severe, i'd go to an ER). If I had a deep cut - GP. If i had an infection - GP. If I felt really run-down or felt nauesious, i'd go to a GP. In other words, if it was something general - the go see a GP. If you have tummy pain, go see a GP.

By the way, most specialists are aware of the other problems that can mimick the conditions they are specialists in. But I think for most people it's pretty obvious to know what to do.

So why make the GP the gate keeper? Why can't the patient be independent? Works for me.

 

So let me get this straight, if you need a service that's not covered by the insurance, you argue it's still there? you just have to pay for it?

Hey, everyone is insured then in america. They just have to pay for it out of their own pocket! It is the canadian system already.

That's a lot of theory you got there. Ok, the gov't doesn't have a profit motive. None what's so ever. It's motive isn't to make people productive, it's motive is to serve the political needs to it's appointed and elected officials.

I think people who are poor deserve some level of health care, but I don't like Obama telling us that by reforming health care we have to choose a HMO-type plan from a clearinghouse of plans. If that was only for the uninsured, i'd be fine with it. But that's not how it's being presented. It's be presented as health care for all people in the U.S. This isn't just for the 44 million people, it's for everyone. It's totaly reworking of the health care insurance industry. Everyone's plan will change.

I am against that.

I think you expand medicare and medicaid to those 44 million, and pay for it with a tax on unhealthy things. That way, people who eat unhealthy stuff get to pay for their own insurance.

It's fair, it gets coverage for folks, and it doesn't touch my PPO.

 

The GP ought to know more than you do, and they ought to be able to do a better job of pointing you in the right direction. If something is urgent, like a broken leg, then you go to a drop-in clinic or a hospital emergency room. I don’t know how things work in the US but a doctor here gains nothing by preventing you from going to a specialist. If they think you need to see one they’ll send you to one. Never mind this gatekeeper talk, I think it just makes the most sense to see your GP before going to a specialist.

 

No, you don't have it straight. There is a difference between medically required care and premium services, and I did give you the links that explain that difference.

Your posts always give me a headache. The government most certainly does have a cost motive. Strictly speaking it may not be a profit motive, but for our purposes that's a difference of no consequence. And it's motive is also to provide good care, especially in single payer systems because health care issues are often prominent election issues. You also didn't tell me whether the Copeman and Provital links I gave you are services that are similar to your PPOs. This is a key point because if they are then that means that the deluxe service you've been holding up as something you don't want to lose is actually available in a single payer system like Canada's.

 

Obama isn't behind it, however, there is a single-payer bill that will be voted on. Unfortunately, no chance for it to pass.

http://thehill.com/leading-the-news...gle-payer-vote-on-house-floor-2009-07-31.html

 

I agree. Unless it is an emergency situation, it makes sense to have a doctor look at or talk to you before sending you to a specialist. No matter how little they have learned since their residency, they still know a LOT more about ailments and their treatment than people who have not been through med school.

 

Those links just go to the home pages of clinics - nothing about the difference in care.

I am talking about care such as getting MRI's or advanced treatment, not "delux" facilities.

GP's are not great. They are a step above PA's. You can put your health into their hands if you want, I for one don't trust them. They have guided me wrong many times and usually I just accept their advice and do what they say because it's obvious stuff. I eat well, excercise a lot, and am very into health. As a former athlete I have alot of joint issues and I find GP's don't know what the heck they are talking about - i've seen about 20 to 30 in efforts to understand what was going on until i finally did my own research, identified a specialist, and had my elbow corrected.

I don't think there's a difference between American or Canadian or any kind of GP. They are jsut generalists - and they don't know a lot of things. They send you to specialists that are "in-network" or that they have relationships with.

There's just not a lot of good doctors, and the day I had the ability to pick which specialist i wanted to see - and could do my own research on who i wanted to see - that's when i finally had things like my elbow corrected.

Oh, and it worked out to be CHEAPER in once instance where a special i was reffered to by a GP wanted to do surgery, and looked up the condition he described on the internet, found a better doctor who treated it non-surgerically and have never had a problem since for over a decade.

So whatever - if you think that's luxury care - that's fine.

If you think that me resisting to take lesser care so taht the poor can have the same lesser care is the same as objecting to fire and police protection, you have no idea what you are talking about.

I can come up with the same stupid analogies to defeat that kind of thinking, and if your posts give you a headache - don't respond, because i find that your posts spam a bunch of links with no useful information and you expect me to dig through them to understand your point. Forget it, i find it arrogant and unhelpful and really annoying.

 

And beyond that your GP will likely know something about you personally. You probably will have seen them a few times and they will have some familiarity with you, whereas to a specialist you are more likely to be just another warm body walking through the door for the first time.

 

If you have hip pain it makes sense to see an Ortho as opposed to getting a referral. If you are having severe allergy problems it makes sense to be able to hit up HENT or another sinus specialist instead of going through a GP.

 

They do offer a difference in care, for an additional fee, but I’m having trouble pinning down what kind of additional care your PPO gives you so I’m not sure if these are equivalents or not. MIRs are available to anyone who needs then here. If a doctor says that an MIR scan is needed to help diagnose your problem then you’ll get one, free of charge to you. If a doctor doesn’t think you need one but you think you’d like to have one then there are private clinics where you can go and pay to have one done yourself. These are the same clinics that provide many of these services to the public system, btw. The difference is that when a doctor in the public system orders the test Alberta Health pays the bill. So these are private clinics that service both the public system and private individuals.

It sounds to me like you have some specific issues which have fallen through the gaps. That’s unfortunate but it seems to me that a GP who was familiar with you ought to have clued into this after it happened once or twice, and known to send you to a specialist the next time a similar issue cropped up. One of the benefits of having a family or personal doctor is that they get to know your medical history and to know you a bit. Medical problems are a bit of a puzzle and if you are someone who is aware of his body then you will have a lot more information from that standpoint than any doctor will have, and the trick then becomes finding someone you can talk to, and who will listen to you, and who you can work with using his medical knowledge and your first hand experience with your own body. I do agree that that this kind of doctor is too rare, however, and that probably has to do with the way they are trained, but that’s a separate issue as well.

What you’re talking about isn’t lesser care related to a public or private system, however. You say that your ability to go straight to a specialist represents a higher level of care, but I think you’re talking about an isolated situation. I suspect that in many cases going straight to a specialist would result in an overall lower standard of care. And if at some time in the future we get to a point where the general public is educated enough to self diagnose that they need to see a specialist then the public system will adapt and allow that directly, because the public system is motivated to be efficient and effective. The Canadian system is adapting and changing all the time, and since the Canadian system is really made up of independent provincial and territorial systems they all learn from each other, and even compete with each other in some ways. Look at that oecd link and see the difference in per capita cost, and know that the overall quality of care is higher in these other systems that cost far, far, less, and that cover 100% of their citizens than it is in the US. There is a reason why every other first world country ditched their US style health care systems many decades ago. In Canada we switched in the 1960s. I think maybe you’ve bought into some of the disinformation that the people who get rich off your system have been spreading about ours and other single payer systems.
http://network.nationalpost.com/np/.../2009/05/12/health-care-lies-about-canda.aspx

 

Doctors are the same everywhere - because even in the U.S. - I have seen doctors from all over the world, trained in different places, etc. So i don't think the quality of doctors changes much....GP's are just that.

I disagree that they are highly trained. I think specialists are very highly trained. But to be a GP, you go to med school and then do a residency and there you are. And that's pretty universal. Some GP's are very good, but it's the exception not the rule.

That's my perspective...and there is no disinformation, or anything like that. I ask you to accept the possibility that what I say may be true, and is' not because of restrictive doctor choices (I can see any GP I want pretty much) or disinformation, or anything, but actual experience.

I can't say that should apply to everyone, but I care about what affects ME. And I refuse to give up PPO under any set of circumstances. It's the best way to care for oneself and one's family. Are their people who abuse the system? Probably a handful, but I think the majority of people don't want to cause trouble.

It's about saving time, not wasting it. Why go see a GP for something I know is better treated by a specialist. It takes time to make an appoint, take off of work, just to what? Be told to see a GP - or come back for more tests? It's a waste of time!

I have had many issues with foot, ankle, and knee. I got to a GP and ask for a cortizone shot for a bone spur that's hurting me and they say well, let's get it x-rayed and so and so. We'll send you to radiology - oh, and let's do some blood test why you are here. It's a waste of time.

I say that's ok, and i go see a podiatrist, he has a x-ray scanning - does the x-ray in five minutes - says yup, it'[s a bone spur, i can give you a shot or put you in a cast, or remove it surgurically - i think a shot is the best option right now. Gives a shot - and presto - i am all good to go and ready to do whatever.

Why would i give up that level of care? I won't. PPO saves time and hassle, and solves the problem without a lot of jumping through hoops.

It's the best care you can get in the world.

 

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The Glenn Beck reference is particularly cogent.

Is it just me or are most these winger nutjobs looking like they're getting ready for the nursing home?

 

Oops!?!? He just explained why this thread is irrelevant!





Please tell me you understand what I mean or ask me to explain if you don't.

 

Your "oops" video explains why that is wrong.

He feels and has always felt that a single payer system would be the best choice in theory. However, in practice he realizes that switching to such a system is not feasible for America right now. So, he is a proponent of these other reforms to help fix the system in a way that is feasible right now.

Does that make sense? Other than some confusing phrasing, the two clips support each other, they don't contradict each other. Do you disagree?

 

he's waiting for the talking points so he can answer this question.