My Take on the Health Care Crisis - Part 1
Here are the two major problems with our current health care system that have everyone in a tizzy:
1) The poor folks in America have limited access to health care services
2) Health insurance (and American medical care in general) costs too much
First, let's get something straight: anyone who is honest and who has even the most basic level of medical knowledge should admit that the quality of healthcare in America is the best in the world. Rich people didn't get that way by being stupid, so when they get cancer they aren't flying to Europe or Canada to get treated....they are going to MD Anderson or the Mayo Clinic.
The same thing can be said about heart disease, diabetes, musculoskeletal disorders, or any other medical problem you can think of: America treats these conditions better than anyone else in the world. When a multimillionaire pro athlete needs a complicated operation to save his career, he turns to American surgeons. When a wealthy foreign dignitary needs a heart bypass, he comes to America. Say it again, repeating as often as necessary until it sinks in: America provides the highest quality medical care in the world.
We also have the best medical training in the world. Physicians from other countries are lined up at our gates, hoping against all odds that they might be accepted into any one of our residency training programs. Only the best will be accepted. Our physicians accept training positions in other countries only as a last resort, because for the most part they are well-known to be inferior.
Of course we also have the best medical technology in the world. We have more advanced medical technology concentrated in 1000 acres in Houston than most other nations can even dream of. Do you really think the average Cuban is likely to get an insulin pump or an LVAD? How about a liver transplant?
Because we have the best physicians, the best medical training, and the best medical technology in the world, we also do some of the most important medical research in the world. Wealth begets wealth.
So why does American health care cost so much? Because it is the best. Why do our poor people have limited access to health care? Because they can't afford it. If we gave it all away, we wouldn't have the best quality healthcare anymore. Other countries ration healthcare by making everyone wait for it equally. That's why wealthy Canadians fly down here to get their hips replaced and upper-class Brits fly over here to get treatment for their breast cancer. They don't want to wait. We ration care by limiting access to those who can't pay for it.
Don't misunderstand and don't buy the baloney the frantic lefties are trying to feed you....poor people in this country still get better care than in any other country. I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month. Both got the highest quality surgery the world has to offer the very next day.
Yes there are barriers to care for the poor. These people couldn't just walk into the Mayo Clinic and ask for a PET scan. And they will still get a huge bill they will be unable to pay. But they will ultimately get the care they need, thanks to EMTALA.
But our current system is unsustainable over time, as more people discover the EMTALA loophole and the willingness (and ability) of the insured to pay for the care of the uninsured gets stretched to the breaking point. So what is my solution? Stay tuned.
Part 2
1) The poor folks in America have limited access to health care services
2) Health insurance (and American medical care in general) costs too much
First, let's get something straight: anyone who is honest and who has even the most basic level of medical knowledge should admit that the quality of healthcare in America is the best in the world. Rich people didn't get that way by being stupid, so when they get cancer they aren't flying to Europe or Canada to get treated....they are going to MD Anderson or the Mayo Clinic.
The same thing can be said about heart disease, diabetes, musculoskeletal disorders, or any other medical problem you can think of: America treats these conditions better than anyone else in the world. When a multimillionaire pro athlete needs a complicated operation to save his career, he turns to American surgeons. When a wealthy foreign dignitary needs a heart bypass, he comes to America. Say it again, repeating as often as necessary until it sinks in: America provides the highest quality medical care in the world.
We also have the best medical training in the world. Physicians from other countries are lined up at our gates, hoping against all odds that they might be accepted into any one of our residency training programs. Only the best will be accepted. Our physicians accept training positions in other countries only as a last resort, because for the most part they are well-known to be inferior.
Of course we also have the best medical technology in the world. We have more advanced medical technology concentrated in 1000 acres in Houston than most other nations can even dream of. Do you really think the average Cuban is likely to get an insulin pump or an LVAD? How about a liver transplant?
Because we have the best physicians, the best medical training, and the best medical technology in the world, we also do some of the most important medical research in the world. Wealth begets wealth.
So why does American health care cost so much? Because it is the best. Why do our poor people have limited access to health care? Because they can't afford it. If we gave it all away, we wouldn't have the best quality healthcare anymore. Other countries ration healthcare by making everyone wait for it equally. That's why wealthy Canadians fly down here to get their hips replaced and upper-class Brits fly over here to get treatment for their breast cancer. They don't want to wait. We ration care by limiting access to those who can't pay for it.
Don't misunderstand and don't buy the baloney the frantic lefties are trying to feed you....poor people in this country still get better care than in any other country. I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month. Both got the highest quality surgery the world has to offer the very next day.
Yes there are barriers to care for the poor. These people couldn't just walk into the Mayo Clinic and ask for a PET scan. And they will still get a huge bill they will be unable to pay. But they will ultimately get the care they need, thanks to EMTALA.
But our current system is unsustainable over time, as more people discover the EMTALA loophole and the willingness (and ability) of the insured to pay for the care of the uninsured gets stretched to the breaking point. So what is my solution? Stay tuned.
Part 2
Labels: health care crisis
posted by scalpel at 5:00 AM
35 Comments:
I am very interested in why you think u.s. health care is so much better than in western europe?
I trained at a major east coast center and had many opportunities to interact with european-trained residents who were visiting. The quality and rigor of their education left my jaw hanging open. I don't think we can assert that US training is better than elsewhere. Good? Certainly. Superlative? Let's leave it as good.
Ditto with the over-broad "America has the best health care in the world." Really? You've been to (say) the Netherlands? Are you seeing lots of Flemish millionaires coming to your hospital for their bypasses? Truth is that there are lots of tertiary and quaternary care centers in Europe that serve as international magnets, but most Americans are so self-absorbed not to know about them. An oil magnate from Dubai is just as likely to get his bypass at the Sorbonne or the Royal College as at the Cleveland Clinic. So not a knock on our system, but again, I don't think we can support that assertion.
And this applies also to research: when I read the literature, I see lots of ground-breaking stuff coming from overseas. I think that we have a clearer lead on the rest of the world in this category, though, due to the amount of capital we put into it.
What we do have that nobody else can match is the capital investment in medical infrastructure. In terms of high-tech stuff -- MRIs, PET scanners, linear accelerators, 64-, 128-, 256-slice CT scanners, etc -- we are light years ahead of the rest fo the world. It's not clear that this really translates into better outcomes on a societal scale, but certainly seems to enhance care.
I'm not arguing that American medical care is the ONLY good medical care in the world. Nor would I assert that there aren't isolated centers of excellence around the world that might be just as good at certain things. Obviously there are. The French hand transplant comes to mind.
I too trained with some outstanding brilliant FMGs, and as Chief Resident I also interviewed many more candidates than were actually accepted. The difference is that we probably have as many high quality medical schools in this country as exist around the rest of the globe.
In terms of overall excellence, depth and breadth, I stand by my assertions. And part of my reasoning was simply to get the liberal naysayers to abandon their recent meme and admit that we are just as good.
Mission accomplished. :)
Scalpel-
Frantic Leftie here.
What piece of health care that you ER docs miss is those who *don't* show up to the ER. EMTALA covers them, for better or for worse (I'm certainly not an EMTALA champion).
But when I see an uninsured 50 year old vasculopath in my office with 2 hours of chest pressure, SOB, and diaphoresis who refuses to go to the hospital because to do so would mean a several thousand dollar bill and he's got a house payment and 3 kids at home, we've got a problem.
When I see a 52 year old with positive hemoccults that can't afford a colonoscopy, we've got a problem.
When I see a 40 year old patient with Crohn's disease and active bleeding for 3 months who needs a colectomy but has no insurance and works as a park ranger, we've got a problem.
I don't pretend to have the answers to the health care crisis. But make no mistake, for lots of folks - working folks - it is a crisis.
I'm looking forward to part 2.
As someone who is training in a foreign country (Mexico), let me offer my views. There are individual doctors here that are unsurpassed in their fields. They may not be able to publish as much as US doctors because they lack the support structure that allows them to take "time out" to write articles, but they are no less worthy of recognition.
As I alluded to, however, the health care infrastructure here, with the exception of a few hospitals in the big cities (like where I am), sucks. You can look at the average OR theater or ICU and think, "Thank GOD I'm not a patient here." But outcomes are not as bad as would be expected. In fact, they are quite comparable with the rest of the Western world in many areas in spite of the aging equipment, substandard (to the US) facilities, etc. So whatever your proposed solution is, it has GOT to be able to bridge the gap between the amount of money thrown at the problem and what actually is bought for that sum.
My personal feeling is that the US healthcare system reigns supreme in quality, quality control, and consistency. You are just as likely going to get good quality baseline care in BFE as Manhattan because of the laws, accreditations, etc. that ensure minimum compliance to basic standards. While Mexico and other countries have similar measures, how they actually get enforced is another matter. Having a law on the books is useless if it's not followed through. Compliance, for all the pain in the ass that it is in the US (and, yes, things still fall through the cracks), does ensure a far greater consistency that definitely puts a patient's mind at ease.
(written by liberal lefty whose feathers are not ruffled, btw)
Looking at your link to the US News rankings (for whatever they're worth) I see my hospital is in the top 20 in at least one specialty, and I know for a fact that if you show up in my ER, no matter who you are or your ability to pay, and you need to see that specialty, you will.
I am a bit shocked to see that you think we pay the most for health care because we receive the best health care in the world. Several WHO and other studies have indicated otherwise.
We are #1 in health care spending per person in the world.
We are #72 in the world in life expectancy, lagging behind powerhouses such as Albania, Armenia and Croatia.
However, we are doing quite well in terms of "responsiveness", defined by the WHO in this study as "respect of persons (dignity, autonomy, confidentiality, prompt attention) and client orientation (quality of basic amenities, access to social support networks, choice of providers).
So in typical American fashion, we are paying the most to get really good customer service. But the product is more expensive than it's worth.
I'm not saying that the quality of American health care is lesser than in other countries. I am saying that we spend nearly DOUBLE the amount per person per year than in the next leading country on the list, and yet we are not reaping measurable benefits.
And the reason health care in the United States is so expensive is NOT because it is the best health care in the world. It's because patients are not paying for procedures directly ("my insurance will cover it...I want an MRI for my knee sprain!") and doctors have no reason NOT to order such tests since they aren't paying a penalty for ordering unnecessary tests. (Quite the opposite--defensive medicine is another reason for skyrocketing costs.)
I'm not for social medicine by any means, but are we really okay with the fact that American citizens who *are* working hard to earn a meager living are having to decide between feeding their families and paying for the hypertension medication that will keep them from stroking out or going into renal failure, costing the health care system more money in the long term? I've certainly seen, working in the ER, second-rate care given to those who didn't qualify for "VIP" status. It's the epitome of injustice.
Sorry, make that "socialized" medicine. Sometimes I wonder if I have two cells to synapse.
Laurie-if you work in the ER, you should know where to get the cheap appointments and the cheap drugs. This "people choose between food and drugs" line is tired, not necessarily applicable, and can be reversed at least to some extent with proper teaching and research.
I know I personally get people to be compliant by telling them specific prices for things like drugs and appointments. People have it in their heads (no thanks to the liberals who make it seem you have to drive to Canada to get cheap meds) that drugs and doctors are always expensive so they just opt to do nothing other than calling around to figure out who is cheaper.
A rule of thumb is Wal-Mart, Costco, and Sam's Club are usually cheaper than most other places. At least in my state, CVS and Walgreens are sometimes 4 or 5 times as expensive.
My hospital is relatively close to a Wally World like most hospitals in the country, and I sometimes will print off a list of the $4 meds for my patients who have a hard time affording things. What the Hell, I'll be a Wal-Mart advertising source when they offer the cheapest stuff in town if it gets the patients to be compliant.
If they're on long-term meds, I encourage them to call the MD's office and see if their more expensive BP med can be switched to a generic available for $4 etc. If it means being on no BP med or a different one they can afford...
There are also numerous prescription assistance programs available through drug companies or the state or even individual health care corporations that can help too.
After all that, there will still be patients that would rather spend their money on smokes and crack, and there's little you can do for them.
Wal-Mart's $4 prescription program alone has cut in excess of 600 million dollars of health costs in this country.
I was waiting for someone to bring up the WHO statistics, zelda. Thank you.
Of course, I am going to discount them, because they have zero bearing on the quality of healthcare that is available for those Americans who are willing and able to take advantage of it.
We also have among the most sedentary lifestyles and are more obese than most in the world, we work more hours and take fewer vacations than most, we have a huge undocumented immigrant population and high levels of violent crime and illegal drug use. I shudder to think what our WHO statistics would look like if our healthcare system wasn't as good as it is. Besides, we probably pay 10 times as much on expensive end-of-life and futile care than anyone else in the world.
I've never seen statistics on it, but I also wonder what the statistics would look like if only our suburbanite healthcare consumers were compared to these other countries. You may not think our healthcare system is "fair" because we ration care differently than other countries, but it is what it is. We define "better" at least partially in terms of convenience and it's more important to those paying the bills for the best care to be the best than for everybody's care to be pretty good.
Of course you are right that high administrative costs are responsible for much of the cost, but Americans demand good customer service. Our customers would be quite upset if they had to wait several months for their cholecystectomies or their cancer workups or if they couldn't get their CT scan for little Chase who bumped his head on the nightstand. And of course, we have to be able to file lawsuits if anything goes wrong. So we have lots of extra documentation and CYA expenses too.
Nurse-K,
I think we can both agree that, unfortunately, not all hypertension patients are candidates for the $2.50-a-month diuretics. There will always be those who choose to take advantage of our current entitlement system, but it's been my experience that those who easily dismiss the "meds or bills" question are those who've never had to ask it.
Nurse k, why is it that you always compare the American public, in general, to crack or meth addicts? There are many ill people in this country who are not drug addicts. Does it make your job easier to consider all the patients are drug addicts? I bet you are the ER Doc's, and the patients, worst nightmare!
...it's been my experience that those who easily dismiss the "meds or bills" question are those who've never had to ask it.
A little ingenuity goes a long way. When I was a Type 1 diabetic with a kid, a drunk husband, no money, no heat in my house, and no insurance, I learned how to get around my barriers to care. I wasn't able to have an insulin pump, but I was able to get R and NPH insulin ($22 per bottle after calling every pharmacy in town), a free meter (widely available at most health clinics, but you have to ask for them) and a good supply of free strips.
Part of the problem is that people like you give up on people before you even give them a chance. Patients who go to the ER, especially for primary care, are looking for someone to help them get what they need and you, instead, cop out with the "food or drugs" or "you don't know what it's like Nurse K" line (I do know what it's like and I also know how to get around some of these obstacles).
You have fallen into the mindtrap that people without insurance can't get health care in this country without some government intervention and that's too bad. If someone really can't afford both food and meds (and they've eliminated all extraneous bills like cable, cell phone, car, car insurance, DSL, high rent), then they likely qualify for public assistance, and you can make sure they've applied.
Cheap blood pressure meds are just as effective as expensive blood pressure meds...they just have more side effects and less convenient dosing schedules.
My once a day BP med costs $2 a day copay, but if I was pinching pennies you can bet I'd be on a diuretic first. Most hypertensives should be on one anyway.
Poor people aren't entitled to expensive new medications any more than they are entitled to government-sponsored Lexuses. That's actually a free preview of one of the foundations of my solution to the "crisis."
To anon 7:54, believe it or not but there are indeed plenty of crack, meth, heroin, PCP, alcohol, and tobacco addicts in this country, and they do drive down our statistics and raise the cost of care for everyone else. It may be convenient for the idealists to ignore them, but we see them every day.
And no more personal attacks or mischaracterizations please.
There are more than 50-year-old diuretics on that list, Scalpel.
There are many beta blockers, many ace inhibitors, various combo pills (eg HCTZ/lisinopril), etc etc. Of course there is a selection of those with rate/afib problems, angina, etc too. Click my link; you doubters will be impressed enough to be slightly more hopeful.
Most patients could do well on their selection based on the med lists I have to do continuously morning, noon, and night.
I agree. I could easily manage over 80% of all outpatients using only that list. And the mortality rate wouldn't be affected by the other 20%, it would be purely symptomatic/patient preference issues.
Nurse K:
So you made it through all of that yet you still have no compassion?
Not everyone can survive a situation so dire even after trying their best. You are seemingly under the mindset that if you can do it, so should everyone else. Tut Tut to that argument. Come back to reality, it's not so pleasant here.
Also, the last time I checked, not every patient in the ED was a drug addict, ETOH patient, or psych pt. I have worked in one, I know the patient population. I therefore second anonymous 7:54 on your negative outlook.
I've been reading your blog for several months and I see you have a pattern. Is blogging just an outlet for you? Do you hold different perspectives in "real life"? I would ask on your own blog, but you have blocked comments from non- bloggers.
Scalpel:
Other countries have the same exact technology as we do, they however manage their money and testing necessity better. Studies have shown that the more testing done does not equate to better care. Conversely , it increases mortality. Maybe they have something on us there...
Also of note, there seems to be a point at which a certain amount of money will get you no further in progressive health care. Other countries seem to be aware of this and spend less, but not too little.
I know several Working middle class Americans who would love to access health care. If only they could afford deductibles while raising a family.
To me, it appears that middle class America is quickly disappearing. That leaves the haves and the have nots.
I am interested in hearing Part 2.
Oregonian: Compassionate people in healthcare, in my opinion, empower those to do for themselves when possible. I can treat your emergent problem, and I can give you the resources to keep it from happening again. Many in the ER just treat the problem, give some prescriptions, and send the patients away. This is a missed opportunity.
I like to think my 1-2 minute crash course on "where to get stuff you need for good prices and how to work the healthcare system" helps people and encourages people to seek out good deals and to take control of their health care (a skill many uninsured people lack).
A simple suggestion like "go out to the free phones in the lobby, use the yellowpages and call around to see which pharmacy has it for cheapest" seems obvious to me, but many people have never price-checked drugs or medical services. Next time they get a script, maybe they'll do the same thing.
If you think my attitude of "you can" is ill-advised and not compassionate, I'll never be able to get you to like what I'm saying. Sure, some people may have trouble meeting their needs with generic prescriptions and trips to the cheaper-care clinic (I go to the cheaper-care clinic I recommend to others, BTW, because they're pretty good, in my 'hood, and I consider my kick-ass insurance coverage to be a little bit of a charitable donation).
One group that comes to mind whose incomes oftentimes don't meet their needs for medical treatment through no fault of their own are the chronically seriously mentally ill. Risperdal, seroquel, abilify....those are all expensive drugs for anyone and the cost of therapy, psychiatrist services, and the once-yearly trip to the hospital all make for a big problem. Thus, there needs to be a safety net.
Luckily, many uninsured people are relatively healthy and work, so my advice can do them some good, I hope.
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I read a study done recently that compared the treatment of an MI in Canada and in the US (I can't remember where it was published). In general, a patient in the US was more apt to have invasive procedures and surgery performed than one in Canada (probably due to several factors; including lack of resources and a different litigation climate).
The Canadian patient was far more likely to have drugs prescribed and lifestyle changes initiated instead of procedures/surgery. Interestingly, the study found no significant difference in the outcomes between the two countries.
I think that part of what you're talking about is a culture of care in the US, which tends to interventions and procedures, compared to other countries which may not treat quite as agressively. That is not to say that the less agressive approach is bad medicine, it's just different medicine.
Actually, I see the real problem as something completely different than as stated here .
We have a profit driven healthcare system wherein profit is defined solely by dollars. (Whereas I would define profit in healthcare as health.)
So long as corporations are making money off healthcare, there will be no change to the system. Healthcare will first have to become unprofitable, thereby eroding the power base of the political health lobby, before any real reform can be put into effect.
I don't expect to see improvements in cost or accessibility for a very long time.
And just because we're the best doesn't mean we can't or shouldn't improve. There are many areas where we could do better.
M
Nice to see that at playtpus' hospital a patient can see a specialist regardless of ability to pay. That is not true in the 3 hospitals I work at, none of which are in the top 100 in the nation, let alone, top 20.
For the most part, it is a constant struggle to get a patient into see a specialist. I have spent hours trying to get patients who do not need admitted but need further evaluation for Cancers, fractures, etc and then inevitably have to refer them to the county ER just to get them into the system. Right, the EMTALA prevents an ER from turing the patient away, but everyone else can refuse care.
It took me 5 frikkin' weeks to get someone to see a uninsured legal secretary breast cancer pt after her free mammo and needle bx was done.
Walk a night in my shoes in a free clinic I run and you will find out very quickly that health care is not that accessible.
Last night, I babysit a man for four hours in a free clinic for asthma exacerbation because he refused to get another $17,ooo bill for his asthma (spent less than 24 hours in the ER for that). He has a job working for a non-profit (finds housing for the poor) that does not give insurance. He pays his bills and is still working on the last one.
For my diabetics, yes, I can give them a free glucometer BUT only with 10 test strips and lancets. I can put them on Metformin to start for $4 but they often need way more.
I live and breathe the $4 Target list 5 nights a week and have even blogged about it (I hate Walmart, but whatever works for the patient is fine). I signed 3 patients up today on PPARx to get free Advair,refer to clinical research studies, use Abbott to get free DM supplies, my friends get me samples from their cushy Family Practice offices, I beg,plead, borrow and steal from everywhere to get patients help - it is just ain't that simple.
And, many, many patients could be you or me, just no insurance. Currently, I am seeing a huge influx of uninsured computer geeks, real estate and mortgage people. Yeah, they can afford some care, but an admission will wipe them out. And, lots and lots of people hold jobs and do work on payng their bills and doing the best they can to manage their money.
There is definitely a crisis in teh American health care system.
Yeah, they can afford some care, but an admission will wipe them out.
I'll bet you never suggested a high deductible health plan and a health savings account?
It's politically incorrect to suggest someone plan ahead for health care and liberals don't like to promote a program George Bush championed, I know, but a self-employed person could do well on these high deductible plans at least to cover that unexpected whatever and prevent financial ruin.
Refreshing Scalpel - good to here the positive for a change. Perplexing too because there are serious concerns for patients and providers.
Well, you're certainly going to get traffic on this one. I'm looking forward to the rest of it. I assume you might agree with this: the best care is available in this country. The problem -- other than cost -- is that it's unavailable to so many within it. The destitute, as you said, are not the problem. It's those who fall into the broad zone of being too poor to afford coverage, and who make just enough to disqualify for aid. Well, yeah, there's always bankruptcy... And of course, as has been said, the fact that Bill Gates or you can get a liver transplant doesn't mean the whole country has the best care. When our lifespan and infant mortality rates are better than other countries, yes, ok. I'd think it's the overall picture that's dispositive in terms of calling one country or another "the best."
I’m happy to read opinions about this. Now, I’m not a doctor or an economics major, but doesn’t the US spend more than other countries on end-of-life care as well? It is my understanding that quite a bit of money is spent on that type of care, wouldn’t trying to ration such a thing bring in a headache of ethical concerns, plus impact the way we train doctors?
I know we need a reform, but I don’t agree with the current UHC plans (from what we know, and I say that because I’m not sure young Americans will be able to properly sustain it over the years considering student debt is on par with the inflation health care scenarios, social security issues, etc.). Just a thought, but would more funding of Medicare and Medicaid do any good (short term), as they have the lowest pay schedules, but the insurance companies go off of those pay schedules. So, if the government pumped some more money in, the insurers would have to pay more, and possibly the uninsured wouldn’t end up making up for such an discrepancy in cost? (making them seeking their PCPs more)
I’m not sure if that would work, but I would be interested in hearing how people with backgrounds in such fields and keen understanding of the problems would address health care reform, if not through a UHC plan.
NURSE k WROTE: I'll bet you never suggested a high deductible health plan and a health savings account?
Actually, Nurse K, my free clinic patients always see a volunteer "insurance evaluator" before they reach me. This person goes over all their options and high deductibles and HSAs are one of them - all in writing for the patient. Unfortunately, by the time one reaches 35 or 40, they often have a pre-existing condition that will rule them out. Our whole goal at this clinic is to get patients into a system - we are a temporary aid offered to the patients by the hospital. My staff is certified to get patients on both Medi-caid and some county programs.
Yes, we do have lots of success where we can assist patients on to various programs, particularly children. But, I assure you, there are countless people who will not qualify for anything, ever unless it was via an employer.
And while I admire the fact that you personally overcame your barriers, you are intelligent and resourceful. Not everyone has that talent or the know-how to do the same.
"I'd think it's the overall picture that's dispositive in terms of calling one country or another "the best."
I always appreciate your comments Sid, and there is certainly room for differences of opinion in matters of semantics. By extrapolating your definition, Hershey's might well be considered the best chocolate by many folks too, since it is so widely available and relatively inexpensive.
Others (like myself) would disagree. If Hershey's is the only chocolate available, then it is admittedly pretty darn good. But it would be a shame if we couldn't choose to buy the fancy stuff if we were able and so inclined.
I don't get your analogy, and I'm trying hard to fit it into the argument. I'd say this: if, say, Scharffen Berger is better chocolate but only 10% of the population can afford it, and if Hershey is less perfect but reaches 95% of the people, then in terms of providing decent chocolate to the populace, clearly Hershey is the best. I agree that the best of the best medical care can be had in the US, and that kings and shieks come here to get it. But given that it's (using your examples, the Mayo Clinic, or MD Andersen) not available to very many people, and given that there are important areas in which the US lags behind other developed countries (life span, mortality rates), then it's hard to argue that, in terms of caring for an entire nation, the US system is better than, or even as good as, many other countries. So it seems to me.
The success of our country depends upon those who work hard, make money, and pay taxes. I think those individuals deserve the highest quality (tier) of medical services, because it's important to keep them healthy and get them back to work as soon as possible. Besides, they are paying their own bills.
I think it's honorable for our citizens to provide medical care, education, and social services to support the less productive members of society, but the return on investment is often disappointing.
It just isn't important to me to be able to say we provide the best of everything to the masses. What our country provides (better than any other country, I would add) is the opportunity for anyone to be as successful as their ability and desire allows.
You really should read Bill Whittle.
Wow. Ayn Rand we be so proud of most of you.
Clearly we live in different worlds, ideologically speaking.
I would like to spend hours responding to all of this, but instead I'll just offer up my blog for you to go take pot shots, if you like.
Please click on the topic links on the right for specific issues.
http://cmhmd.blogspot.com
Cheers,
Sorry:
Ayn Rand would be so proud of most of you.
Cheers
We be so happy you made that clear.
Cheers.
Dr. scalpel is extremely delusional. For the average citizen, the US health system is incomparably worse than most of those in Western Europe. Sure, for a few fancy rich folk you have the best specialists in the world with the best equipment, but when it comes to caring for a population, the US is way behind. In my opinion, scalpel's insistence that the medical establishment should serve only the interests of the wealthy goes against all the principles for which doctors are normally respected. That he even became a doctor attests to the inability of US medical education to attract and foster ethical doctors.
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