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Author: cobrafang Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 90287  
Subject: Isn't for-profit health care wonderful? Date: 11/9/2007 8:25 PM
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Woodland Hills-based Health Net Inc., one of the largest health insurers in California, “set goals and paid bonuses” for employees “based in part on how many individual policyholders were dropped and how much money was saved.” Between 2000 and 2006, the company “avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies” while paying “its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies.”

http://thinkprogress.org/2007/11/09/health-insurer-rewards-dropping-sick-policyholders/

US health care will always be (much?) more expensive than in countries with "socialized" medicine as long as insurance companies are part of the system. The profit motive is pernicious for the provision of good health care, too: what doctors are allowed to do is affected, if not controlled, by insurance companies.

Greatly simpified bottom line (pun intended):

Insurance companies increase our health care costs in a variety of ways, most importantly:

*the profit slice, what? 10% at least.

*administrative costs, ditto.

Insurance companies reduce the quality of health care.

I don't think we'll be rid of these parasites any time soon. Until we do, though, US health care will cost more and have worse outcomes.
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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70479 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/9/2007 9:22 PM
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I don't think we'll be rid of these parasites any time soon. Until we do, though, US health care will cost more and have worse outcomes.


as a practicing physician, i feel like we are in the worst of both worlds:

half my caseload is medicare, so i basically work for the government now

yet the other half is private pay, so i have to jump through the managed care hoops too

and nowhere is there any security
we're at the whims of both government and private payors, without much negotiating power with either type of entity

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Author: goofnoff Big funky green star, 20000 posts Top Recommended Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70482 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/9/2007 9:51 PM
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How bad does malpractice insurance hurt you?

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Author: bjchip Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70488 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 5:51 AM
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The invisible hand is strangling us... (well you actually, I moved out of that hell years ago)

BJ

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70495 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 10:49 AM
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as a practicing physician, i feel like we are in the worst of both worlds:

half my caseload is medicare, so i basically work for the government now


Question, are physicians legally required to accept Medicare patients, or do you have any option to decline to accept Medicare patients? I.e. if they are not profitable for you to treat based on whatever Medicare pays you, could you decided not to accept Medicare patients?

yet the other half is private pay, so i have to jump through the managed care hoops too

How different are the requirements between Medicare and private insurance?

and nowhere is there any security
we're at the whims of both government and private payors, without much negotiating power with either type of entity


Query, what was your taxable income from your work as a physician in 2006? I.e. not AGI, which includes adjustments to income, which can widely vary on an individual basis; I mean what number prior to adjustments to income? What kind of car do you drive and what year was it purchased? What's the fair market value of your primary residence, and where do you reside?

Unless your responses are 1) less than $100,000.00; 2) a 10-year old Honda Civic; 3) less than the median for a single family home in your area;

I'm not inclined to have too much sympathy.

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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70497 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 12:30 PM
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Query, what was your taxable income from your work as a physician in 2006? I.e. not AGI, which includes adjustments to income, which can widely vary on an individual basis; I mean what number prior to adjustments to income? What kind of car do you drive and what year was it purchased? What's the fair market value of your primary residence, and where do you reside?

Unless your responses are 1) less than $100,000.00; 2) a 10-year old Honda Civic; 3) less than the median for a single family home in your area;


because of your disrespect, I won't bother to answer all of your questions,

but i do drive a 10 year old acura that i've had for 7 years, and have the lowest priced house on the block. the house across the street is 2.5x my home's value.

i hang out on TMF

you do the math and others can draw their own conclusions, jerk

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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70499 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 12:37 PM
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Question, are physicians legally required to accept Medicare patients, or do you have any option to decline to accept Medicare patients? I.e. if they are not profitable for you to treat based on whatever Medicare pays you, could you decided not to accept Medicare patients?


i believe medicare is all or none, but i live in a rural area and do have an obligation to treat sick people, something you probably wouldn't know much about

i hope either you or some of your family are on medicare. you can then go enjoy the best socialized, centrally healthcare has to offer.

read up on "CMS Medicare erythropoietin" on a google search and learn about some of the great advances causing our best biotech products to go underused and going back to the 1980's style of transfusion blood to cancer patients, causing shortages that any of us might suffer from if ever in a trauma in a time of a strained blood product.

don't bother answering, read up and learn first.

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Author: JustWhoIAm Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70500 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 3:57 PM
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Query, what was your taxable income from your work as a physician in 2006? I.e. not AGI, which includes adjustments to income, which can widely vary on an individual basis; I mean what number prior to adjustments to income? What kind of car do you drive and what year was it purchased? What's the fair market value of your primary residence, and where do you reside?

Unless your responses are 1) less than $100,000.00; 2) a 10-year old Honda Civic; 3) less than the median for a single family home in your area;

I'm not inclined to have too much sympathy.


I'm not a physician; however, I will say that I exceed 1 and 3, drive a 6 year old minivan (not sure how that fits in), and I have a lot of sympathy for doctors. My family's GP of 14 years is now retiring. Her main reason for selling off her practice and getting out of medicine is the paperwork. She was an independent so she and her small staff had to do all of the paperwork. I believe that some months she spent more time on paperwork than with patients -- much of that paperwork is required just to get paid a reduced amount for her services.

Keith

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70503 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 6:03 PM
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because of your disrespect, I won't bother to answer all of your questions,

Nothing I posted was disrespectful at all. You entered a discussion about the medical profession as a doctor, state some assertions/propositions, complaining about your situation, then feel yourself immune from being questioned on the bases for your assertions.

A doctor you surely must be, since you believe that being asked relevant questions is a sign of "disrespect."


but i do drive a 10 year old acura that i've had for 7 years, and have the lowest priced house on the block. the house across the street is 2.5x my home's value.

You deliberately evaded the important questions: Is your annual income from practicing medicine, before adjustments, less than $100k? Your failure to answer implies that your income exceeds this sum. You don't drive a 10 year old Honda Civic. An Acura is a much nicer vehicle. You didn't answer whether your home is worth less than the median in your area. You state that the home across the street is 2.5x your home's value. That's highly unlikely, in fact virtually impossible, if your home is of essentially the same type, size and condition as the home across the street from you. You didn't actually answer the question I asked about your home; yet rather than remaining silent, you chose to answer a different question, designed to imply that you have significantly less income/wealth than others in your neighborhood. In sum you are being intellectually dishonest.

i hang out on TMF

So?

you do the math and others can draw their own conclusions, jerk

I don't think your a doctor. If you are, you richly deserve whatever treatment you are getting from Medicare and/or the insurance companies. I could FA your post for its obvious incivility but I won't. Instead I will leave it up as an indicator of why doctors don't deserve the sympathy they seek when they whine about insurance companies and Medicare.

Perhaps you could do everyone a favor and retire from the medical profession.

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70505 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 6:14 PM
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i believe medicare is all or none, but i live in a rural area and do have an obligation to treat sick people, something you probably wouldn't know much about

You are definitely not a real doctor. I don't know who you are, but a real doctor in your situation would be well-versed in whether or not Medicare requires you to treat Medicare patients, or whether that is optional. Since you complained about that, and all. How can you possibly say that you do not know what the Medicare regs require, yet claim to be a competent practitioner?

The fact that you live in a rural area, and presumably make in excess of $100k from your medical practice (implied by your failure to respond about this when asked), further indicates that in comparison to the patients you say you treat, you are relatively well-off.

In terms of treatment of sick people, I know that good and competent professionals, doctors or of any other kind, don't call other people "jerks" as you did to me and don't adopt such an arrogant attitude.

i hope either you or some of your family are on medicare. you can then go enjoy the best socialized, centrally healthcare has to offer.

In other words, what you're saying is that medicare patients get poor treatment from physicians. Yet you also have said a substantial part of your own alleged practice is medicare patients. Whom you treat poorly?

No legitimate, real doctor who believed in the Hippocratic oath would wish illness or poverty on another person. Yet you just did.

The reason I asked you whether it was mandatory for you to accept Medicare patients was because if it is not, and you don't like to have to do so, then you should not accept medicare patients as part of your practice. Especially someone like you, who apparently seems to believe that medicare patients do not deserve a high level of care, and whose idea of wishing someone else ill is to wish that they needed medical treatment while on medicare.

Your response was that you didn't even know whether or not as a physician you had to accept medicare patients. You sir do not appear to be what you claim to be.


read up on "CMS Medicare erythropoietin" on a google search and learn about some of the great advances causing our best biotech products to go underused and going back to the 1980's style of transfusion blood to cancer patients, causing shortages that any of us might suffer from if ever in a trauma in a time of a strained blood product.

This paragraph does not even make any sense. What is your point?

don't bother answering, read up and learn first.

Again, sir, I do not believe you are authentic. Your responses clearly indicate that you are not a medical doctor, certainly not one who has ever graduated from an accredited United States medical school.

You are clearly not an M.D. Are you a chiropractor, an osteopath, or perhaps a practitioner of homeopathy?

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70507 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 6:20 PM
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I'm not a physician; however, I will say that I exceed 1 and 3, drive a 6 year old minivan (not sure how that fits in), and I have a lot of sympathy for doctors. My family's GP of 14 years is now retiring. Her main reason for selling off her practice and getting out of medicine is the paperwork. She was an independent so she and her small staff had to do all of the paperwork. I believe that some months she spent more time on paperwork than with patients -- much of that paperwork is required just to get paid a reduced amount for her services.

Keith



I am glad for your GP that she had the financial wherewithal, presumably due to the privilege of having been able to practice in the medical profession, to retire on her own terms.

Now tell me again why she deserves any sympathy for having been forced to engage in a lucrative profession which allowed her to retire basically as she pleased.

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Author: FCorelli Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70509 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 7:16 PM
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You are clearly not an M.D. Are you a chiropractor, an osteopath, or perhaps a practitioner of homeopathy?


I don't know. He does sort of sound like a Dr. He seems to think everybody should just fall for what he says just because he's a Dr, and anybody who's not a Dr must be stupid

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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70512 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 7:37 PM
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You are clearly not an M.D. Are you a chiropractor, an osteopath, or perhaps a practitioner of homeopathy?


i do not recall stating my credentials
why do you make so many assumptions?

In other words, what you're saying is that medicare patients get poor treatment from physicians. Yet you also have said a substantial part of your own alleged practice is medicare patients. Whom you treat poorly?

if medicare is equivalent to poverty, then we have a very poor country

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Author: steve203 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70514 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 7:48 PM
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meanwhile, dragging this thread back on topic:

US Among Worst in World for Infant Death

The rate at which infants die in the United States has dropped substantially over the past half-century, but broad disparities remain among racial groups, and the country stacks up poorly next to other industrialized nations.
----------
The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.


http://apnews.excite.com/article/20071111/D8SR4JOG2.html

Steve

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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70515 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 7:49 PM
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US health care will always be (much?) more expensive than in countries with "socialized" medicine as long as insurance companies are part of the system. The profit motive is pernicious for the provision of good health care, too: what doctors are allowed to do is affected, if not controlled, by insurance companies.

that's the best argument i've heard yet against our style of healthcare

the very presence of insurance companies requires a class of people to profit from the illness of others, with profits directly tied to minimizing expenditures

(note, the govt would also have the same incentives.)

the motives of the insurance company run directly counter to the best interest of the insured. an apoligist could say that long-term, insurance companies need to provide quality care. maybe. but it means quality care while spending the least money on the patient while maximizing their shareholder returns

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Author: DoctorOptimist Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70516 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 7:50 PM
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I don't know. He does sort of sound like a Dr. He seems to think everybody should just fall for what he says just because he's a Dr, and anybody who's not a Dr must be stupid

i am so sorry for chiming in on a thread about which i probably have more personal knowledge than anyone else

would it be better for me to just go away?

is the community better off with people providing input from personal experience?

do you want a real dialogue?

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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70521 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 9:33 PM
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the very presence of insurance companies requires a class of people to profit from the illness of others, with profits directly tied to minimizing expenditures

(note, the govt would also have the same incentives.)

the motives of the insurance company run directly counter to the best interest of the insured. an apoligist could say that long-term, insurance companies need to provide quality care. maybe.


i don't think so .

• "govt" has an incentive to be more profitable, but the individuals don't

• individuals in corp. "insurance" do -- higher profits, higher stock price, more money for the execs (that they can pass on as bonuses to the workers)

•• there isn't real competition among corp 'insurers' .. if you get your ins through employer, employer makes the choice. If you're on your own, you don't know what you're getting for you money until you get sick. then you have 'pre-existings' and no other company wants you.


but it means quality care while spending the least money on the patient while maximizing their shareholder returns

i tell the story that when i went on Medicare (after years of blueShield), i asked my Doctor whether that was 'good for me, good for her, or none of the above' ..She did a little happy dance "Good for both of us. they pay low and slow, but NEVER say 'no'" She's a bit of a poet as well as Doctor.


=--

....... a bit surprised at some of the 'attacks' on you

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Author: JustWhoIAm Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70522 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 10:50 PM
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I am glad for your GP that she had the financial wherewithal, presumably due to the privilege of having been able to practice in the medical profession, to retire on her own terms.

Now tell me again why she deserves any sympathy for having been forced to engage in a lucrative profession which allowed her to retire basically as she pleased.


She's retiring from medicine. I believe she will still be working. She is leaving medicine because the pay does not make up for the extra crap she has to do. We are losing an excellent doctor to the administrivia that the insurance companies and the government have put into place.

I do agree that most doctors do make good money; if they did not, fewer people would go into the field.

Keith

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70523 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 11:51 PM
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i do not recall stating my credentials
why do you make so many assumptions?


You claimed in an earlier post to be a "practicing physician." That's a credential, and you stated it, as the basis for any of us to credit your opinions.

And I assumed nothing. On the contrary, I challenged the legitimacy of your claim to be a "practicing physician." And your response now is to reverse course and claim not to have made any claims about your "credentials."

No, I do not assume anything--including that you know what you're talking about.

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70524 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/10/2007 11:57 PM
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The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

http://apnews.excite.com/article/20071111/D8SR4JOG2.html

Steve

**************************

I looked at the linked article and there was no research report referenced that could be reviewed to determine whether the scary headline was accurate.

Steve--does it strike you as very likely that the U.S. is among the worst of developed nations in infant survival rates? Does that seem reasonable or logical?

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Author: emtwo Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70525 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/11/2007 12:08 AM
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I looked at the linked article and there was no research report referenced that could be reviewed to determine whether the scary headline was accurate.

For the intellectually lazy...

http://www.savethechildren.org/publications/mothers/2006/SOWM_2006_final.pdf

regards,

Michael

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70527 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/11/2007 12:22 AM
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US health care will always be (much?) more expensive than in countries with "socialized" medicine as long as insurance companies are part of the system. The profit motive is pernicious for the provision of good health care, too: what doctors are allowed to do is affected, if not controlled, by insurance companies.


Of course this statement makes no sense, simply being "Socialism good--capitalist insurance companies bad!"

The above statement about the health care system is about as logical as saying that a system in which most people drive their own cars will always be more expensive than one in which everyone uses public transportation, as long as auto insurance companies are part of the system.

U.S. health care is expensive, frankly, because we get a lot of it, everyone wants more of it. Heart transplants are expensive. Caring for an elderly person with Alzheimer's is expensive. Treating a premature crack baby is expensive.

Does anyone ever say, "You know what, don't give me that kidney transplant, I'll just die and save the health plan $250,000.00"? Does anyone ever say, "You know what, grandma's 82, let her croak, that would save the insurance plan $100,000.00"? No. No one ever says that. Everyone always wants more, more, more.

We as individuals have numerous things we could personally do to dramatically lower health care costs. Everyone knows what they are. Stop smoking. Drink alcohol in moderation or not at all. Don't do drugs. Eat a healthy diet, and get regular exercise. Learn how to drive safely, and then practice that. Don't engage in hazardous activities. Don't have children if you are unmarried and unemployed. Do not engage in unsafe sex.

In America, the reason health care is expensive is because it is NEVER the individual's responsibility to look after their own health.

Why is it the insurance company's fault that people are stupid?



that's the best argument i've heard yet against our style of healthcare

the very presence of insurance companies requires a class of people to profit from the illness of others, with profits directly tied to minimizing expenditures



Wow you really don't understand economics, maybe you are an M.D.

In anything you do, regardless of whether it's a capitalist economy or a socialist one, keeping costs down is necessary to preserve those resources for other uses. Why is it bad to minimize health care expenditures? On the one hand, you complain that U.S. health care is too expensive. Then you say the insurance companies are bad because they try to minimize health care expenditures. Well, guess what? You can't make something less expensive unless you reduce expenditures. Unless you've thought up some other way.


the motives of the insurance company run directly counter to the best interest of the insured.

Again you are wrong because you do not understand economics. Assuming that health care is a scarce resource, which one must, since it is expensive, that means there is a very competitive market among consumers of health care to obtain it. In other words the consumers of health care are in effect competing against each other to obtain it. That means the interests of the consumers of health care in many circumstances conflict with one another. If we all want the same scarce resource, that demand will drive the cost of the resource up. Insurance companies serve as a mediator for that competition.

an apoligist could say that long-term, insurance companies need to provide quality care. maybe. but it means quality care while spending the least money on the patient while maximizing their shareholder returns

Again wrong. The function of an insurance company is not to provide medical care; it is to spread out risk. In other words one needs medical insurance because most individuals cannot actually otherwise afford to pay for, say a heart transplant.

Paying returns to shareholders (i.e. profits) are necessary in order to attract sufficient capital so that the insurance company will exist in the first place. Otherwise there would be no insurance, and society would be the loser.

The idea that government could do a more efficient job of allocating medical care than private insurers is laughable. You are the one who complained so bitterly about medicare. Do you actually think we would be better off if everyone was forced to go on medicare and there was no private alternatives? Do you think your paperwork burden would be greater or less if every one of your patients was on medicare?

There will be a high risk pool and/or the impoverished that must be on public assistance, so be it. Why does that mean the rest of us should be forced into the same system--with no private alternative?

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Author: BlackOpsWarrior Three stars, 500 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70528 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/11/2007 12:28 AM
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She's retiring from medicine. I believe she will still be working. She is leaving medicine because the pay does not make up for the extra crap she has to do. We are losing an excellent doctor to the administrivia that the insurance companies and the government have put into place.

Well get out the violins then. She doesn't like to do paperwork? Neither does anyone else.


I do agree that most doctors do make good money; if they did not, fewer people would go into the field.

Keith


On the whole, the medical profession is compensated well above-average. Obviously there is a spectrum of incomes as with all other work.

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Author: kentm401 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70532 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/11/2007 7:33 AM
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Which - this year - happen to be the places recommended for US Vacationers to get the most out of the ever shrinking US$ exchange rate....;o)

last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.


Wonder if there's a tie in here?

KBM (juz thought I'd throw that out.....;o)

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Author: JustWhoIAm Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 70550 of 90287
Subject: Re: Isn't for-profit health care wonderful? Date: 11/11/2007 12:42 PM
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On the whole, the medical profession is compensated well above-average

Are you recommending that they get paid at average or below?

Keith

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