US Supreme Court Upholds Affordable Health Care Act

[kandrathe]

Either we are discussing apples and oranges, or you misunderstand the Canadian healthcare system and my opinion on how healthcare should operate in a first-world country. I cannot walk into my doctor's office and demand a free MRI just because "free healthcare". Doctors have the ultimate say on what treatment is administered (as I said more than once in my previous post).

I think it is the apples and oranges thing. Our doctors and hospitals don't work for the government.

For the best explanation we've seen of the real nature of America's health cost problem, read this great investigation by Harvard Medical School professor Atul Gawande. During the tense passage of the 2009 bill, Obama was rarely to be seen without a copy of this article. He cited it frequently and handed out dozens of photocopies to White House staffers. It provides the most direct insight we have into Obama's thinking on health care. It may make uncomfortable reading for many American doctors.

Great article! Thanks for the link.

To preserve a free market system, I think that having the patients experience a portion of the costs for every procedure would encourage them to be more informed about their morbidity and help to bring a balance to the consumer decision. If it is "free", then yes, I'd get whatever I felt like getting. If I had to contribute and make some trade offs, then I have to balance what I'd get with what I would lose. I think the article also describes how changing the market from free enterprise to government payer may not change anything either as long as doctors are paid according to the numbers of patients or procedures they perform. So, not only do patients need more of a financial stake in the process, doctors need to have less of a financial stake. Health care providers need to be given incentives for providing the right care, not more or less of it.

Otherwise, the trend is to remove the market entirely and turn over care and control of care to the government. I think that is what DeeBye is describing, only that under that white coat sits an employee of the Canadian government who is following their guidelines and quotas for treatment.

I don't really have a problem with doctors who serve patients well, getting well paid, but the article indicates that some (or maybe many) doctors are allowing money motives to shape their treatment advice. Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries

In contrast, I'd fear that if our doctors were government employees, we'd be treated as we are at the department of motor vehicles.

For reference on how my perception of government works -- let me describe my recent drivers license renewal which has to be in person for the photo and eye test: I went on a Saturday at just before 11am, and for reference the place closes at 2pm on Saturday. I stood in line for an hour before I got my number. Every form of license was issued from this office, so in the line were anyone from business, to marriage/divorce, boats, immigration applicants, and all forms drivers licenses. The number giver also spent time counseling each person or group on the forms they'd need fill out.

Then I sat in a huge waiting room and watched the bored people watching their children playing (and a horrifying drama where a young toddler kept dropping her lollipop on the carpet, then would return it to her mouth). Because I had received my number just past 12, it was provisional, meaning that if I didn't get called before one, I wouldn't get served that day. Well, that was what happened. Every time the workers would waste time having a little chit chat, or sand bag before calling the next persons it made me a little more frustrated. They missed my number by 2 people.

It wasn't that the workers were overtly negligent, or that having the cut off was a bad thing, so they could wrap up before close. It's just that there is no motivation for anyone to move faster, or serve people better. I went to a different office the following Saturday; this time arriving at 9am. It still took 2 hours for the 5 minute procedure, and I had to pay in cash since some recent kerfuffle between the State and Visa (a personal check, or Master Card is ok, but I don't have that).

Have you seen this article?

The soul-destroying search for a family doctor