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[Incognito]

that loki post(6,300 words and 25 pages when double-spaced in MS word) is the funniest thing i've seen in quite a long time.

oa salutes you, loki.

:lol :lol :lol

 

[Saturnman]

BUMP for Loki.

 

[Loki]

You don't have to bump anything; I've been constructing my reply here and there, I just haven't had a big chunk of time to devote to it to button it up. Probably sometime tomorrow if I can swing it. I have some shopping to do.


Don't worry-- there's something coming for you, too, Sman.

 

[Saturnman]

"I've been constructing my reply"

"there's something coming for you, too"

 

[ZombieSupaStar]

man I need to pay loki to write my term papers.

 

[Loki]

Azih:

All of this would have been unnecessary if you had noted my opening sentence of:

Well fair enough. I have resorted to skimming through your posts and you did address them so great.

Quite honestly, when I came home and reopened the thread, I scrolled down to our first exchange and reread your initial post (the one that begins with "Bah Loki, you keep on hating on socialized health care", and then goes on to inquire as to my ethical problems with it), since I had planned on responding to it and wanted to have your words in front of me. I also saw Doug's post just below. I did not see Saturnman's post below Doug's, or else I would have responded to him, since he painted a very unflattering picture of me (viz., that I want to "screw over my fellow citizens"). This is the reason why I addressed you and Doug in my post but not Saturnman. Do you really think that I would let such a gross mischaracterization of me go unspoken to? Really? :lol


Unfortunately, this also means that I did not see your next post-- the one that you keep quoting ad nauseum, which was supposed to obviate my entire huge post-- since it was below Saturnman's. Now, you're free to not believe this, but I think that you'll admit that it would be highly unlikely that I would allow someone to attempt to impugn my character (Saturnman's post) without addressing it, considering my general manner of behavior. So I didn't see that post at all until just now, actually, when I went back to look at it, because I was confused as to how I could have missed such a comment. I then saw your next post after Saturnman's (and Saturnman's post) for the first time. Just now.


So that explains that. For anyone who doesn't believe me, open up that page in IE on a 17" monitor with a resolution of 1024X768, scroll down the page using the wheel on the mouse until you come to post #77 (Azih's post), and then scroll the page down (again, using the wheel) until his entire post is visible at the very top of the page. You'll clearly see four posts on the page, including Doug's post on the bottom (#80). You will not, however, see Saturnman's post, nor the subsequent posts. This is assuming that all wheels scroll an equal amount, which I'm uncertain of (I'm not a computer person).


I just don't want anyone to think that I'm making this stuff up to "get out of anything". Anyone who believes that I, of all people, would allow someone to make the comment that Saturnman did (which I consider an affront to me, quite honestly) without commenting on it is deluding themselves. Let's be realistic here. But anyway...


As for the rest of your post:

But I already did. Yesterday! You bickered! Upto this point everything you've said was already taken care of by two single line sentences in my post! Gragh!

Dealt with above.

And dammit I don't know what perception you have of my use of the verb 'hating' but I used it to mean 'see problems with'. So whatever the heck you *think* I meant, change it.

My operative definition of the phrase "hating on" is precisely the same as yours. This is why I stated in my post that you must believe that the system is perfect, or at least that it's "the best possible system". Because, looking only at my post (#76) and your initial rejoinder (post #77), it appeared that in taking me to task over supposedly "hating on" socialized medicine, you were implying that there are no rational grounds for disagreement with it, which I obviously disagree with, and which my long post on the previous page was intended to illuminate.


You stated that I was "hating on socialized medicine", yet felt that I "never articulate the reasons why"; I felt that I had already explained some of my reasoning, and then focused in on your request for information regarding my ethical objections. I read Doug's post on the bottom and began my reply; it's as simple as that.


As for the rest of your post:

Where I did acknowledge that I had made a mistake and you had articulated your reason why. In this case two seconds of care would have prevented a few dozen minutes of typing and mistaken impressions.

Dealt with above.

Well hey you can retract this statement now.

Dealt with above.

*cough* *ahem*

Never glossed over the problems actually, there is no perfect system after all. Every system has it's pros and cons.

Dealt with above.

Only quibble I have with this is that the Canadian government doesn't 'renge' on obligations it just clearly specifies what procedures are covered and what aren't. This varies from province to province. Edit: I thinkt his has to do with your arguing against insurance driven healthcare while addressing government driven healthcare for some odd reason.

First off, allow me to ask what procedures "aren't covered"-- I'm assuming it's elective stuff such as plastic surgery and perhaps in vitro fertilization?

Secondly, are you honestly going to sit there and say that rationing does not occur, and that attempts at cost containment never take precedence over the needs of the patient? That's flagrantly dishonest, and it has nothing to do with me somehow conflating managed care and socialized medicine-- as I quite rightly noted, any time a third party gets involved, it will necessarily at times have different aims in mind than what is in the best interests of the patients. Physicians in your own country have stated as much, as have Canadian newspapers and lay people in public opinion polls, so I don't get why you're acting as though I'm fabricating stuff here.


The fact is that these things occur, and for precisely the reasons I alluded to (profit-hording in our system, cost containment in yours). It happens much more frequently in socialized systems than in the US, though, and this is a fact. This is inarguable-- though I doubt that'll stop you from doing so. And it is the presence of third parties that leads to such situations in every instance, be that third party a government as in Canada or insurance plans or HMO's in the US. Again, any person who's interested can do their own looking and find out the truth of the matter for themselves.

Of course prior to that you had the ethical dilemma of poor people dying without any health care at all (see Dickensian England). Pros and Cons.

Yes, I'm well aware of that. But in case you didn't realize, nobody was dying in the streets in America from 1930-1985, which is when insurance companies began making inroads into the health care system (and they still don't even now-- nobody can be denied emergency care for any reason). Pointing out that socialized systems "fix" such an injustice doesn't mean much when one considers that other systems fix it as well.


I never questioned the ethicality of socialized systems in that way (re: their humanity and sense of compassion, which is commendable), but rather attacked it on other grounds.

As long as you don't consider 'no money no care' unethical.

Actually, for the better part of the 20th century in the US, thousands of physicians provided charity care regularly on their own time, and churches and civic organizations set up free hospitals for this very purpose which were staffed on a rotating basis by doctors who freely gave of their time and care. Doctors also took on charity cases routinely in their private practices. Contrary to what you might believe, nobody went wanting for lack of necessary care from 1930 onward. Ask any American over the age of 60.


And actually I do find the concept of "no money no care" to be unethical, as do most US physicians (who routinely provide free and subsidized care and actually lose money on many patients). Had you cared enough to ask, you'd have realized that the system I advocate would have no place for a "no money no care" mentality, as it is, quite frankly, odious.

In the real American world sure those are valid examples, I don't see why you generalise the actions of American HMOs to the rest of the world. Hell American HMOs frighten the heck out of non Americans (in the other developed nations). My experiences are markedly different (what with being in a different county with a different system entirely) and since my mother is a senior citizen and goes to the doctor regularly I have plenty of them.

Again you're tacitly asserting that the conflicts of interests that I alluded to, along with the resultant constraints on care, do not exist in socialized systems (including Canada's); this is the only inference that can be drawn from this statement. Allow me to say it again:

Socialized systems by their very nature lead to:

- rationed care

- waiting periods for services such as surgery or chemotherapy that often exceed what is medically appropriate

- a lack of technology including diagnostic equipment due to underfunding


These are the facts. I'm not going to sit here and cite the hundreds of articles, analyses, commentaries, and studies from Canadian newspapers, journals, magazines, and public opinion polls that will attest to these very facts. if you assert that these issues do not exist-- and exist to a more significant extent than in the US-- you're basically arguing that the sky is green in order to portray your system in a more favorable light, and I'll quite frankly have none of it. It's disingenuous, Azih.

An issue here in a lot of your points is that not only do you highlight the issues of socialised medicine (as you should) but you also generalise and apply the failings of American HMOs to them. The problems faced are to a large extenet *distinct* so don't take your 'this is how the real world works' and apply it to socialised healthcare. It's myopic, short sighted, and inaccurate. Edit: It pops up again and again it seems like. This confusion might stem from the fact that I DON'T UNDERSTAND WHY you rail against HMO's when speaking about socialised healthcare. FOCUS.

See above. You're quite boldly lying if you're asserting that issues such as I've noted (not the HMO-specific ones, but rather the constraints on care as a result of government interference) do not exist to a significant extent in Canada. In fact, one of the aims of my posting some links and articles was to illustrate that these issues do in fact exist up north. I didn't do it to get into a pissing match where you try to criticize every source I provide (though many of them you wouldn't be able to discredit) and I try to do the same for yours-- I didn't want the conversation to devolve to that.


My point in posting was to show that serious issues exist within socialized systems as a result of third-party interference, and to express the reasons for my disagreement with the system. Allow me to be very clear when I state that I'm not asserting that the Canadian government actively and explicitly denies care in the manner that the insurance companies I mentioned in my post do in the US; rather, denial of care and constraints on care follow necessarily from the nature of the system (i.e., from the involvement of a third party with interests frequently distinct from one's own).


As an illustration:

New Brunswick announces that they will send cancer patients south to the United States for radiation therapy. New Brunswick, a small maritime province, is the seventh to publicly announce its plans to send patients south. In the best health care system in the world, the vast majority of provinces now rely on American health care to provide radiation therapy. Provinces do this because the clinically recommended waiting time for treatment is often badly exceeded. Ordinarily, oncologists suggest that there should be a two-week gap between the initial consult by the family doctor and the referral to the oncologist, and then two weeks more from the oncologist to the commencement of radiation therapy. In most Canadian provinces, we exceed that by one to two months, sometimes three.

Why is this? Isn't it in the patient's best interests to be cared for in the time frame deemed appropriate by medical professionals? Of course it is. But the Canadian government's hands are tied because they simply do not have the requisite equipment (or enough of it to meet demand, at least) and personnel, and this is a direct result of the fact that they are fiscally constrained. Now, in instances such as this (which are broad circumstances which affect thousands of people in Canada), whose interests prevail? Clearly it is the payor's (i.e., government's) interests that prevail, or else the Canadian government would never allow the situation to deteriorate to the point where they're sending patients across the border for necessary care-- they'd just purchase more equipment and hire more physicians, right? Well, they would-- if there was any cash left in the system to do so.


Again, small towns in the US of populations less than 30,000 have more MRI machines than all of Canada (pop. 30 million)-- why do you think that is? Seeing as how people in Canada frequently wait months and months for diagnostic tests such as MRIs, wouldn't it only be proper to purchase more machinery? Well, not when the cost for a single MRI machine is $2-4 million (this is the actual cost of an MRI machine as related to me by a radiologist in my family, in case you didn't know)-- those would eat up those provincial budgets mighty quick, wouldn't they? Note that despite the interests of the patient dictating a certain course of action (i.e., the purchase of more equipment), budgetary constraints compel government to do otherwise; note also that such constraints would not exist, or would be minimized, if individuals paid for their own care within reason and infused money into the health care sector (personal participation in payment would also address overconsumption on the part of patients, which is the other reason behind queues, the other being inadequate equipment/personnel). As Canada's (and Europe's) population ages and expectations increase among all cohorts, they are increasingly coming to grips with these realities, as, for instance, in Canada, people over age 65 consume over 43% of health care expenditures while accounting for only 12.5% of the population. It's a problem that is only going to get worse...


These are simply facts, Azih; to deny them, or attempt to minimize them, is risible. It's equivalent to someone trying to explain away or minimize the importance of the oft-touted "44 million uninsured" in the United States. Like the issues with the Canadian system that I have elaborated upon, this, too, is a grave issue that needs to be resolved. But so are the issues with your system; this is all I've stated. My personal belief is that a system intermediate between the two is the best possible solution-- it retains the humanity and universal access of socialized systems as well as the greater conformity with economic reality and American culture that a privatized system affords.


You seem to believe that I "have it out for" socialized medicine, and that I am arguing against it and arguing for the American system-- I am not. I stand against both of them equally (though for different reasons), as I feel there is a better way to do things which melds the core elements of both. Period. Is that difficult to understand? Difficult to respect and allow to stand as a legitimate opinion, to the point where you don't have to constantly attack it? I would hope so...



Fully 79% of Canadians polled feel their health care system to be in "crisis", with 71% stating that changes were necessary because the system is not meeting patients' needs. Note: Canadian people, not "extreme right-wing sources". Now, before you quibble about how "change" could mean many different things (which indeed it can), note that nearly 80% of Canadians believed their system to be "in crisis". Pretty strong terminology, wouldn't you say? (FYI, the number in 1989 was only ~20%) Now, obviously, there can be a disconnect between public perception and reality, and between the subjective experiences of patients and the (at least somewhat more) objective estimations of Canada's physicians. In attempting to speak to this, allow me to quote a paraphrasing of an annual survey of Canadian physicians done by the Fraser Institute:

The Fraser Institute, a major think tank in Canada, does a survey of 2,300 physicians across 12 specialties and asks them to estimate the wait time between the initial visit with the family doctor to the surgical therapy. They do this every year. Right now, the average wait time is 14 weeks. What's very impressive is the extent to which that has grown; 14 weeks marks a 5.3 percent increase over the last year, despite the fact that government spending in health care has grown by 22 percent over the last three years.

The Fraser Institute not only asks physicians how long patients wait, but they ask doctors how long they think patients ought to reasonably wait. In every single category, patients wait too long, in the opinion of the physicians.

...and also a five-country survey done by the Harvard School of Public Health:

There was a recent five-country survey of health care by the Harvard School of Public Health. They asked specialists across these nations if they felt there was a decline in the quality of health care. Canada has the dubious distinction of having highest response rate in the affirmative, 63 percent.

The Harvard researchers also looked at wait times, where Canada fared poorly. There were a variety of scenarios that were given. One of them was a 50-year-old woman with irregular breast mass, without lymph node involvement. Obviously, this woman needs a biopsy. In Canada, patients typically waited the longest; 19 percent waited longer than a month for a biopsy. That was the highest percentage of the five countries. Just to put that in some perspective, in the United States, 90 percent of patients are biopsied within a fortnight.

These are the people in the trenches doing the work, whose professional opinions on medical matters must be given some weight, not dismissed as the ramblings of partisans, as you seem to desire to do for every piece of data I dredge up. This is not to say that these physicians, or the Canadian people, desire to abolish socialized medicine-- indeed, there is broad support for retaining it despite the grim picture painted by these numbers; however, despite an abiding belief in socialism's core principles (the very same principles I myself have lauded), 74 percent of Canadians polled supported the idea of imposing user fees (i.e., paying out of pocket) for those who could afford them. What's more, contrary to what is commonly held, this support for privatizing certain aspects of the health care sector was actually stronger among poorer respondents, with 85% of those earning less than $25K CDN supporting user fees. The reasons for this broader support among the impecunious are myriad, and beyond the scope of this topic; suffice it to say that the more affluent, well-educated, and articulate members of the populace have been found to be able to manipulate the system more ably than poorer folks are in order to minimize waits and receive necessary care. However, it is the numbers themselves that are striking.


There are three essential elements to any health care system: cost, quality, and access. Each of these involves tradeoffs; thus, in order to control costs and keep quality relatively high, access to care has to be rationed (as indeed it is). American government, with its Medicare/Medicaid programs, wanted universal access as well as high quality, and thus costs soared; these principles are inviolable, and are tied to immutable economic maxims. The problem is structural, and cannot be ‘solved” simply by throwing more money at it, as socialized nations are increasingly learning. One need only peruse the periodicals from these nations to see that this is the case.


Some random clippings:

A recent flu epidemic in Toronto expanded the waiting times to see a family physician to five to six weeks - so far in the future that most patients either would have recovered from their illness and no longer need to see a doctor or would have become critically ill and gone to an emergency room

At Vancouver General Hospital, "Maureen Whyte, a hospital vice president, estimates that 20 percent of heart attack patients who should have treatment within 15 minutes now wait an hour or more."

"Last summer, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians' Hospital in Plattsburgh, New York."

The average total waiting time between referral from a general practitioner and treatment rose from 13.3 weeks in 1998 to 14 weeks in 1999.

Waiting times between specialist consultation and treatment (which excludes the time between seeing a general practitioner and getting in to see a specialist) increased from 7.3 weeks in 1998 to 8.4 weeks in 1999.

Waiting times for diagnostic tests also experienced some increases. For example, the median wait for a CT scan across Canada was five weeks in 1999, a 6.4 percent increase over 1998.

Again, my purpose in posting all of this data and citing all these sources is not to overload people with information, but rather to point out that there are very real problems with socialized systems (Canada's has been the focus here, but similar issues manifest themselves everywhere socialized medicine is enacted). Now, you pay lip service to the fact that you "admitted that there are problems with the system" (which you did, now that I went back and read it), and that you concede that "no system is perfect"-- yet you seem strangely compelled to attack every source I cite as partisan fear-mongering rather than admit that these issues in particular are those which comprise the bulk of "what's wrong" with Canada's socialized system.


This distinction is crucial: it's quite easy for anyone to say, "oh, sure, we have our problems"; it's another thing entirely for someone to be able to honestly examine precisely what those problems are and own up to them. In the former case, you implicitly minimize the gravity of these issues by not conceding their veracity, while in the latter, so long as you make a full and earnest reckoning of these problems, you can still make a legitimate case that you believe socialized systems to be the best of all possible systems in spite of these problems. You, however, seem content with option #1, and I will not allow you to keep behaving in such a manner, as if taking for granted that we're all subliterate and can't grasp the obvious implications of your posts.



Would you sit idly by while someone responded to claims of the very real problems with American health care by flippantly stating, "sure, we have our problems-- no system is perfect"? Or would you expect that person to make an honest account of said failings and propose ways to rectify them? Next time some braindead poster starts with the chants of "44 million uninsured, d00d!!!1", I'm going to mosey on in and simply state "of course we have problems, but we still have the best possible system"; when they quite rightly become irate, since lack of insurance in America is a serious issue, I'll just keep repeating that statement like a mantra, never offering anything substantive and never fully acknowledging the import of the issue. This is what you are doing, and quite frankly it annoys the shit out of me, which is why I'll sit here for hours upon end speaking on these things despite having dozens of better things to do with my time.


I prefer honest, open discourse on all sides; I will not sit around while someone subtly attempts to minimize legitimate issues present on their "side" while magnifying and incessantly whinging about the failings of the "other side". No. Let us be honest, reasonable adults here. It is for this very reason that I don't get involved in much political discussion on the forum, because, quite honestly, it's too partisan for my tastes, with both sides entirely unwilling to concede even the most basic of points, despite them being virtually self-evident.


Continuing...

First off, why are you linking to extreme right wing (fee.org, fcpp.org) commentaries and treating them like gospel? I have major issues with most everything that is said in the articles you linked but respoinding to them is frankly out of the scope of me responding to you. I could link you to a dozen studies and commentaries (from medical practioners no less) that are supportive of Canadian style health care just as easily, but it's all frankly distracting.

Again we note your tendency to attempt to discredit my sources as fringe elements with an agenda to push rather than speaking to the facts. Do yourself a favor (and I hope anyone else who is swallowing your bullshit about all my points being somehow wrong and/or partisan-- as if I'm a Republican :lol-- will do so also) and type the words "Canadian health care rationing criticism" into Google, and have fun discounting each of the 124,000 results you'll get. The implication of your method of discourse herein is that there are no legitimate, serious issues with socialized medicine, despite your ostensible admissions to the contrary. This is what's known as "sitting on the fence"; less astute readers might unwittingly let this slip by, but this is not acceptable behavior in Loki-land.


And I have no doubt that you could post just as many favorable commentaries and analyses of the Canadian system-- but this is besides the point. What you seem to have overlooked is the fact that my aim in posting all that information was not to demonize socialized medicine, but rather simply highlight certain grave issues with it, just as there are grave issues in the American system. If you don't believe that my characterization of your methods herein, as seen above, is fair, then consider the following hypothetical scenario:


You point out that the American system is riddled with bureaucracy, has serious access issues for non-emergency events (i.e., the uninsured), and is too expensive for the average American (all of which are legitimate criticisms, as I have granted); you present several sources which detail the ramifications of such systemic disorders, and conclude that socialism is preferable to the extant American system.


Now, instead of granting such self-evident propositions and continuing with a candid discussion of how best to remedy these things, I proceed to attempt to undermine each claim's legitimacy by pointing to the purported explicit and implicit "biases" of the sources cited-- I could say that they're leftist/socialist fronts, for instance. Or I could point out that I take issue with this-or-that point of fact-- I could say, for instance, that a great many people forgo insurance not because they truly cannot afford it, but rather due to improper prioritization on their parts in terms of their expenses, and thus dismiss these claims with a (disingenuous) wave of my hand.


Now, take note that true progress in the discussion cannot be made this way, in this style, with this flavor of discourse. Would any such artifice on my part change the fact that we have access issues in America? Would it change the fact that bureaucracy often funnels much-needed funds away from patient care? Would it change the fact that insurance is frequently too expensive for families? No, none of those counterproductive strategies mentioned would advance the dialogue one iota, because they’re simply dishonest tactics at base in that sense. Similarly, no amount of you "attacking my sources" or questioning the underpinnings of the facts presented changes the fact that the Canadian system features a paucity of diagnostic equipment and cutting-edge technology, that seven provinces as a matter of course send patients to the United States for routine care for chronic conditions, that surveys of both the general populace and physicians convey overwhelming apprehension about the future of the system (both in terms of its solvency as well as its level of care), that the Canadian system ranks near the bottom of the pack among even socialized nations in waiting times for surgeries and other specialized care, and that cost containment strategies often act against the best interests of the patients in the system.


All of these things are facts, not just the stuff on the American side; though we can both split hairs over this-or-that point of fact, does it really do either of us any good when discussing the broader issues at hand? I would contend that it does not, and in fact does the opposite-- it serves to antagonize and divide rather than promote true understanding and progress towards the best possible system. This is how I honestly see it.


My only aim in initially posting in this thread was to debunk some common myths about socialized medicine (viz., that it's a panacea; I hope I've made some question whether it's rather a nostrum ), since the drum beats loudly for it as of late. Usually I just let things slide, because I'm really not an argumentative person, contrary to what it may seem like, but the clamor for socialized medicine has just gotten too great for me to bear in silence. People on this board will interject health care discussion into totally unrelated topics, and it's clear that the majority (but not all) of these people have never given the issues much thought, but are rather parroting the prevailing sentiment of the day. If you'll note, I don't walk into any thread that mentions socialized medicine, or that derides the American system (because I happen to agree with criticism of our system), and just start calling people quacks. But every once in a while, I'll make my beliefs known, because people deserve to hear both sides of an issue, and I really don't think they get that on this board given its general political persuasion.


Is this really so evil and worthy of condemnation? Is it really so terrible that I can appreciate the evils and failings of both of our systems and honestly feel that there is a reasonable compromise to be had? (as Canadians themselves are increasingly demanding) No, I would like to think that the mere fact that I can acknowledge the ills of both systems speaks, at least somewhat, to my objectivity in these matters (though admittedly no one is truly objective when discussing politics).


To put it succinctly (yeah, I know ):


Problems with the American system:

- Affordability

- Ethical issues arising from the third-party payor system (insurance co's, in this case)

- Bureaucracy


Problems with the Canadian system:

- Lack of funds for the purchase of necessary equipment and upkeep of facilities

- Ethical issues stemming from the third-party payor system (gov't in this case)

- Unsustainability and eventual insolvency (this is inevitable without a mechanism to control consumption-- this is an immutable economic axiom)



There you have it in a nutshell. How best to address the failures of both systems whilst melding the very best core elements of each is beyond the scope of this topic, though in my previous post I linked to a thread that contained my personal proposal for a plan which, I feel, would eventually do just that.


As for the general philosophical sentiment that medicine "shouldn't be a business", well, I will admit that I'm sympathetic to it; ethically, it's certainly the most ideal stance to take. Sometimes our ethical precepts must be tempered by reality, however, as is the case in so many areas of life. We may hold that charity is the highest good, yet we do not propose that people give 100% of their incomes away to satiate their philanthropic yearnings-- where would society be then? Perhaps in a better place, perhaps not; the larger point to take from this is that we are inherently self-interested beings, however much we might (nobly) try to marginalize that self-interested nature. Similarly, history has shown us quite clearly that the societies which will flourish to the greatest degree have certain features in common, namely democracy, the rule of law, and capitalism (fettered to a certain extent, obviously, lest we stray too far away from our idealism).


And so long as medicine requires people to do work, and requires the purchase of material goods such as equipment, drugs, facilities and the like, it will forever be beholden to the same economic realities that everything else in the material realm is; it is not prudent to set one sphere of action apart without some rational underpinning (that is, some way to make it work materially)-- indeed, such a venture is doomed to failure by its very nature. Sure, at the beginning, things are great, particularly if a nation is prosperous. One cannot neglect economic law forever, though, and it will eventually bite you in the ass.


It is this fact that such a system as I've proposed would comport more adequately with than does either socialism or our current managed care paradigm in America. Consequently, the ethical dilemmas resultant from third-party interference would largely evaporate, since the third parties (both insurance companies and government) would be marginalized and only called upon to provide funding beyond a certain reasonable limit which would be proportional to one's income level (i.e., no one would have to remortgage their homes to pay a hsopital bill under my system).



Do not take my statements above as a defense of "free markets" (i.e., laissez-faire capitalism), which I have personally agitated against on this very board in discussions on corporate malfeasance. But "relatively free markets encumbered only by common sense, commensuration, and compassion" is an idea I'm fully behind, as its efficacy has been proven throughout history. I do not have to make any apologies for this. In fact, in my personal "best possible system" for health care, it wouldn't be a "free market" at all-- it would just be a free market so far as is reasonable. And just as I don't feel it reasonable that a person living below the povety line should be unable to procure medical services due to price concerns, I likewise do not feel it reasonable that people who can more than afford to pay for a service they've availed themselves of (i.e., medical care) should not have to pay for that service within limits, same as for anything else in life. This strikes me as eminently sensible, quite frankly. For a full discussion of my proposal, see this thread.


Hopefully, given what I've said, you will feel content to allow this to stand without continuing in your querulous ways. My intention was never to bicker, but rather to give my take on these issues and possibly bring a fresh perspective to the discussion that people hadn't considered before; I suppose that on this board, that's asking too much-- it seems that nothing, no matter how well-reasoned, is capable of being left to stand. And before you state that this forum is about debate, allow me to note that I personally have frequently allowed points to stand if I've felt them to be buttressed by adequate reasoning, even when I vehemently disagreed with them; that's because I can respect the force of an argument, and respect the reasoning of the person making it, without feeling the need to cut them down or attack their arguments in every instance. Why can't you do the same? Sure, you have no proof that I've "let things be", since it's characterized by my not posting, but ask yourself why I rarely get into it with -jinx-, or Drinky, or even Mandark, despite the fact that they often arrive at conclusions in their arguments that I disagree with (some more than others )-- it's because I can respect their arguments and admit that rational people will sometimes come to different conclusions in life, which may in fact be equally valid in the grand scheme of things even though I may personally disagree with them.


What have I said that is so deserving of being assailed that you just won't let it be and admit that someone (namely myself) can actually have come to a different conclusion than you have based on a consideration of the available evidence? If you find my reasoning herein to be inadequate, well, nothing will dissuade you from believing that, then. I'll leave it at that.



To address the rest of your post:

Oh I see, that's why you put up those links well that's prefectly reasonab.... OH WAIT! NO IT'S NOT. You know Loki the most frustrating thing about you isn't your length as much as it is that most of your length is made up of refuting statements that I NEVER MADE and hell NEVER THOUGHT and CERTAINLY NEVER WROTE DOWN. You just leap to half formed conclusions and prance about waving your hands in book length rants that end up NOT MEANING ANYTHING. Of course at least this time your misconceptions aren't the ENTIRE BASIS OF YOUR post as it has been in the past but this is still pretty damn bad.

This was dealt with at the beginning of the post. I never saw the post where you acknowledged that there are problems with the system prior to writing my long post on the previous page.

Not in mine. That's a lot of money and it goes a very long way in Canada.

Unfortunately, it's not a lot of money in America, and this goes to my larger point that unless we (America) are going to change our entire economic structure from the top down (i.e., flatten out the wage scales and lower our cost of living), $90K for the average physician and $160K for a freaking neurosurgeon is shamefully inadequate compensation; no amount of loan forgiveness (which will never happen, btw) or reduction in malpractice insurance-- the commonly proffered “solutions” to this issue-- will change this fact.


Have you ever worked in, or spoken to people who work in, a human resource department? There’s a little something called a “job analysis” that is utilized throughout the business world for all sorts of jobs—it delineates the requirements, responsibilities, and skills/expertise necessary for various jobs; it also determines acceptable remuneration based on what are known as “compensable factors”-- factors which include a job’s required training, the skills and specificity of knowledge possessed by the employee in question, the rigors of fulfilling the job’s requirements (i.e., gaining licensure/accreditation), and the breadth of responsibility inherent in the job. If you ever get a chance, seek out an American HR employee (or consulting firm) and ask them to perform a job analysis of a physician and tell you what, exactly, the proper compensation for them is based on the same exact standards used to compensate every other professional in the United States. Then ask them to do the same for a neurosurgeon, or a medical oncologist, and tell me what number they arrive at. I can guarantee that it will be at least twice (if not three or more) times higher than the Canadian numbers—the numbers you’re holding up as “adequate”, and “more than enough”.


Hint: It’s not more than enough, and that has nothing to do with physician greed and everything to do with the belief that people should be compensated commensurate with their expertise, responsibilities, the rigors of their training/practice, and their value to society. This is a principle that I am deeply committed to as an American; I’ve always noted that I am a meritocratic capitalist, and it’s something that I don’t have to apologize for, as it is only sensible that people are paid proportionately based on such criteria.



$160K is “a lot” of money (given our cost of living and wage scale, keep in mind) for someone who goes through a rigorous undergraduate science program, has to jump through various research-related and extracurricular hoops to satisfy the entrance requirements for medical school while still maintaining a > 3.7 GPA, has to prepare for and excel on the MCAT (the most difficult entrance exam out of the LSAT, GMAT, GRE, and MCAT, based on “failure” rates and the incidence of top performers on the respective tests) while honoring their academic and extracurricular obligations; they then proceed to the first two years of medical school, where they’re expected to learn the equivalent of what would be 4-5 years of graduate level science (in far greater detail, mind you) in 2 years, and then proceed to bust their asses in clinical rotations through various medical specialties at 6 AM at the hospital for the next two years (while still being expected to research and learn material independently on their own time, mind you). Shelf exams for the various specialties (consisting of written, clinical, and oral components) are taken at the end of each rotation, which is typically every 4-6 weeks and must be passed.


Oh, I forgot to mention that some time during the second year, they have to take Step 1 of the USMLE (US medical licensure examination), and some time during the fourth year they have to take Step 2 of the USMLE—all while keeping up with their regular studies (i.e., the exam is not given during “vacation” or time set aside), and, oh yeah, they typically have to perform research and publish articles/studies in accredited journals during all this as well if they hope to land their preferred residency spot. They then proceed to residency, where they work 75-100 hours per week (used to typically be 100-120) for 3-7 years depending on the specialty—7 years for neurosurgery—for nearly sub-minimum wage hourly (again, while being expected to stay current in their knowledge on their own time). After the initial year of residency, which is devoted to internal medicine, they are required to take the USMLE Step 3, which is a 2-day, 16-hour examination that tests scientific and clinical skills in a variety of simulated situations. They then proceed to the residency proper, which focuses on their chosen specialty for the next 2-6 years, during which time they have to pass a couple of written, clinical and oral board exams in order to be certified in their specialty at the completion of their residency. In addition, many doctors choose to continue on to 2-3 year fellowship programs in their respective fields.


Now, after all this, and after incurring between $150-250K in debt and finally being “finished” with their training at age 34 (assuming one graduates college at 22 and proceeds directly into medical school; this also neglects the constant continuing education throughout their lives), and after having to be recertified in their field every 3-4 years years (which means taking certification exams); after having given up the best years of their lives and having neglected their families, friends, spouses, children, and their own outside interests for almost all of that time—after all that, you’re going to tell me that this now-neurosurgeon doesn’t deserve to make significantly more than $160K annually based on the salaries and cost structure of the rest of our society? :lol You have to be shitting me, Azih. That a physician in general should not make more than $90K? This is absurd talk, quite frankly—be happy I even entertained it.


Again, any rational job analysis that can be made for these professionals will unequivocally show you that they deserve much more than what you here deem “more than enough”. I’m not asking for special standards to be applied, I’m asking you to apply the exact same standards that are applied to every other professional and employee when setting compensation levels. Your beliefs in this regard are entirely unjustifiable.



Let me ask you: if physicians swallow this huge income reduction, will the cost of housing in the United States decrease? Will the cost of food, clothes, utilities, and a college education for their children decrease accordingly? Never mind well-earned luxuries like a decent car or a yearly vacation for one’s family. No, the fact is that none of this will ever change, and thus your views are out of touch with reality in that regard. You know what else won’t change? Our (admittedly) horribly distorted wage/income scale, where braindead asshats like my cousin (I love him, but he’s not the sharpest knife in the drawer) make $190K, and people with mere bachelor’s degrees make upwards of $100K (I have several friends who do so), and holders of two-year MBA degrees make $160K+. My aunt writes software for a bank and makes $250K per year—she only had a bachelor’s degree and was largely trained on the job. My uncle never went to college and now runs a bank in Manhattan and earns $300K per year. None of the training for these jobs is anywhere near as rigorous as that for physicians, nor are these people possessed of anywhere near the amount of expertise, nor are their jobs anywhere near as valuable in the social sense, nor are their responsibilities for their jobs at all comparable to what a physician’s is. But a physician should make $90K? A neurosurgeon should make $160K? :lol Man, I can’t get over how risible that is…seriously.


You’re batshit insane if you believe this, and I have no qualms stating that. Note also that the answer is not “well, let’s make the training not as rigorous, then”, because then you’ll have quality issues that will have repercussions for people’s health. All things being equal, I want only the most capable people to have my life in their hands if something ever happens—I dunno about you. The fact remains that American society is not going to magically reshape itself to accommodate these new realities, and this is one of the reasons (the others are discussed throughout this post and my previous one) why I’ve sought a system that was more in accordance with our prevailing social and cultural milieu, since it would not inflict this tremendous economic injustice upon those who are perhaps the most deserving of remuneration.



Note also that despite the fact that any rational job analysis you can make will show that physicians should make quite a lot of money, I am not in favor of doctors making some ludicrous sum like $3M per annum or something like that, despite the fact that if anyone deserves it, they do. I am not in favor of such things for the same exact reason that I often give for many of my beliefs in the social sphere: the greater good. If all physicians were paid that much, it would constitute a tremendous burden on our health care system, and that would be to the detriment of the rest of society. And so we must balance what can be shown to be perfectly proper on its own (physicians earning lots of money) with the needs of the community at large. What I’ve proposed is a reasonable middle-ground in every sense of the word. Physicians earning CEO-type incomes is unacceptable (just as CEO’s themselves earning current CEO-type incomes is foolish ), but, likewise, your notions of financial propriety seem to be horribly malformed given the realities of the situation. Horribly.



Also, for anyone reading this, please realize that I am not arguing in a vacuum, as if physicians are the only people in this country that deserve more adequate compensation. I happen to believe that many jobs/professions deserve to be compensated more adequately (both based on a “job analysis” perspective as well as a social utility perspective), and that many jobs/professions deserve to be compensated less than they are currently based on these same criteria. People such as teachers, police and firemen, research scientists and other academics, and even social workers deserve quite a bit more than what they’re making; people such as $500/hour corporate lawyers, mutual/hedge fund managers, stock brokers, and high-level “administrators” likely deserve to make less, quite honestly. Though what is “fair” is inherently subjective (and I realize that I open myself up to charges that my own opinions are mistaken), I’ll stick by this statement. The technique of job analysis somewhat objectifies these things (and so I can back up most of my claims in an objective sense in that regard), and the notion of social utility is one which I have a strong philosophical affinity for and am fully capable of defending. So we’ll leave it at that…

I think pretty much exclusively about the Canadian system. I don't care about the French one.

The fact of the matter, as shown above, is that even the Canadian compensation for physicians is wholly inadequate based on any rational criteria one can evaluate it by. Yes, Canada happens to have the most adequate physician remuneration among socialized nations by quite a large margin (in Britain, for instance, average physician income is $65K USD), but that doesn’t change the fact that it is, in itself, indefensibly low.

How about the idea that your cousin is vastly overpaid.

Oh, you’ll get absolutely no argument from me about that. My cousin, along with hundreds of thousands of other people in the US—indeed, entire sectors of our economy—are vastly overpaid (and some are underpaid). However, this just goes back to my point that American society will not change (in either its wage scale or its cost of living), and that due to this fact, setting one group of workers apart and inflicting economic injustice upon them constitutes a breach of ethics in my book (in the sense that “compensation” and “work” are tied up in an ethical system that upholds society; note that this is entirely distinct from the “ethical dilemmas” I’ve been inveighing against throughout my posts, which have to do with the meddling done by proxies). It is a notion anathema to the meritocratic, capitalistic ideals that I, and presumably most of the nation, hold dear—ideals which are more than tenable, philosophically.

Your country has enough GDP to pay your physicians an extremely extremely generous salary in a public system. You'd just have to y'know decide to use your wealth to do so.

No argument here either (in terms of compensation). The thing is, socialized systems are unsustainable by their very nature due to the economic realities that I’ve touched upon. Certainly, if the proper measures were enacted (closing corporate and individual tax loopholes, a heavily progressive tax system etc.), we’d have adequate funds initially—and this is what makes socialized systems so appealing, particularly in prosperous nations, as I’ve noted. However, one can only circumvent economic law for so long before it catches up with them and bites them in the ass (and in all socialized nations, provider incomes have been the first things that were cut or allowed to stagnate for many years in order to avoid costs; this is simple politics-- government has a monopoly on health care, and thus providers have little leverage as laborers; further, a small subsection of society- viz. the providers- has little political clout as compared to the general public, whose demands for subsidized care will never wane; this is why there have been numerous physician strikes in socialized nations, yet in America, for all our faults, doctors have never walked out on the job).

Unless the consumption of finite resources is somehow limited (which ideally should be dictated by need, not politics or wealth) by way of a deterrent (of which there is none in socialized systems), then access issues will manifest themselves, and costs will eventually overtake the ability of a nation to sustain the program (and this to say nothing of shifting demographics and expectations which place an even greater strain on the system). But don’t take my word for it—come talk to me in 20 years and tell me how Canada’s “vaunted” system is faring. Or Britain’s (which may somewhat be saved by the fact that they’re increasingly privatizing certain elements). Or Germany’s.

I never derided you. I disagreed with you and gave you reasons why. Your misconceptions about what I said (<Azih> Universal HealthCare is PERFECT!) led to your feeling deried which led to this rant.

Again, I hadn’t see your post when I wrote my previous long reply. I see it now, so it’s cool.

Part of my disagreement with you lies in your contention of financial untenebility of the Canadian system. Now note here that whenever you deride healthcare I think about its implementation in Canada. I have no knowledge of any other system. Frankly I don't think it's financially untenable nor do I believe there is anything ethically wrong with it. THAT is the basis of any discussion we can have.

Well, you can “think” what you want, but as I’ve said, you’re arguing against history and economic law. As for ethics, I’ve already discussed the ethical issues that arise from third-party payor systems in general, and socialized systems in particular, towards the beginning of this post (viz., cost concerns taking precedence over the needs of patients, which manifests itself in myriad ways, as the sources I’ve quoted illustrate). If you still cannot see the ethical issues I am alluding to—despite the fact that I quite clearly spelled them out for you in this very post—then all I’ll say is that


It’s financially untenable (as measured by patient care; see my citings) now—what makes you believe that the situation won’t deteriorate further 20 years from now? Your health care sector is growing at a rate that far outstrips your annual increase in GDP; this is a recipe for disaster, yet you ignore this and other portents because it would mean admitting that (at least fully) socialized systems are unsustainable. The declension of your system has already begun, and all objective measures (public opinion, professional estimations, public policy- e.g., sending patients to the US- the availability of technology and facilities, the conspicuous lack of any sort of medical/pharmaceutical innovation etc.) point to this trend continuing despite pouring more money into it. These things don’t augur well for socialized medicine; ignore them at your peril.


And it’s not just Canada, as if Canadian ingenuity or shrewdness is somehow lacking—as I’ve stated, the problem is systemic; failing to address these underlying causes will only lead to eventual failure. Even in America, we’ve had socialist failings (on a far more limited scale): the perpetual insolvency of Medicaid, for one; “Tenn-Care” (Tennessee state’s recent statewide program of government health insurance which was remarkably similar to socialism), for another. I’d urge anyone interested in these issues to read up on the disastrous results of these two programs; there’s a good reason why Tenn-care was dissolved after but a couple of years and why Medicaid is often known as the “voracious sleeper” in our fiscal legislation. Again, this is not a problem of implementation, but of basic structure. Increasing the scope of such systems in order to “pool resources and risk” does little to mitigate the basic nature of the problem, as the same sort of issues arise on the national stage in all socialized nations, as noted (these problems vary in degree based on many considerations- e.g., population, wealth, cultural expectations, demographics etc., but all such systems are ultimately unsustainable).



I only seek a system that retain the best aspects of socialized medicine while largely avoiding its pitfalls. Likewise, I seek a system that retains the best of the American system while avoiding its pitfalls. The fusion of these two approaches can produce a viable, adaptable, humane, self-perpetuating system, yet there is no national discussion about such things. Why do you think that is, when the failings of both of our systems are clearly evident? It’s not a sin for me to believe these things…

Once again why oh why do you bring up examples of the problems with insurance companies as third party payer when you're talking against goverment as third party payer? There are problems in both systems but the problems are COMPLETELY DISTINCT. You can't bring up a problem with one when dicussing the other. It's useless detirus in your arguments. There's no commentary on government provided healthcare in that paragraph. It shouldn't be there.

Err, I quite clearly noted (in the portion of my post you quoted as well as throughout my previous post as well as this one) that the particular manifestations of the ethical dilemmas provoked by third-party payor systems are unique to each system (socialized vs. insurance company/managed care), yet in each instance the situation is ultimately reducible to a conflict of interest between the proxy and the patient; this is a feature of all proxy-payor systems, socialized and otherwise. If you’re not keen enough to grasp that, please don’t take it out on me.


Consequently, all such examples as I’ve mentioned illustrate the general principle no matter which market the example is drawn from. Regardless, I’ve detailed several Canada-specific, proxy-engendered ethical issues in both this post and my previous one, so you have no excuse to take me to task for drawing examples from both of our societies in order to illustrate the more general principle (and also so as not to unfairly malign the Canadian system and pretend that we do not have similar problems in the US—this is only fair, no?)

How about public education?

Wow, this one is almost as entertaining (and misguided) as Doug’s “government” analogy. In fact, this is even more spurious, for a couple of reasons:


One, public education features clearly defined boundaries in terms of its scope; these set limits on the extent to which people can avail themselves of this publicly-subsidized service. Can you require that an educator make themselves available to tutor you for free at 1 AM? Can you demand unlimited individualized attention (as with medical issues), or is the didactic methodology necessarily restricted to group work (i.e., classes) and some limited individualized attention from the instructor? Do you believe that the public education system would be sustainable if, instead of serving children for roughly 15 years, it was extended to serve people throughout their lives? What if it had to continue to educate (i.e., serve its purpose) despite the enfeebled minds of certain participants (e.g., the elderly), who would require disproportionate attention and resources in a manner similar to the medical sphere? What if in order to adequately educate children you needed state-of-the-art equipment (i.e., school supplies such as books, visual aids, some computers etc.) such as the provision of quality medical care entails? Sure, books are expensive (and PC’s even more so), but they’re not $2-4 million a pop like an MRI machine. Just think of all the increased demands and strains on the system that would arise if all of this came to pass…if all of this was expected—nay, demanded.



Now, I don’t know about how it is in Canada, but even given the much more limited scope of public education (which by its very nature controls demand- i.e., “consumption of resources”), and the more limited demands placed on the system, the United States public school system is definitely not known for its fiscal solvency, quality of materials (i.e., supplies and facilities), or quality of outcomes. In fact, it’s a perennial financial sinkhole, with educators and bureaucrats demanding ever more of our tax dollars for diminishing returns. Books are frequently tattered and outdated, buildings dilapidated, test scores invariably trend downward, and bureaucracy expands at an exponential rate. Moreover, the one area of public education that does place greater demands for resources and individualized attention on the system (nothing like in medicine, but it will suffice as an example) is special education. In NY city, the special education budget consumes upwards of 35% of the overall education budget, despite the fact that the number of special education students is only ~150,000 out of a student population of 1.4 million. So roughly 10 percent of the students consume 35% or more of the resources—largely because of the need for more individualized attention and greater resources. Now magnify this dynamic by a factor of ten and you’ll have the insatiable public healthcare systems we witness in Canada and Europe.


This is not to make a case for privatizing education, though it should be noted that we, as well as Canadians, allow private schools to exist alongside public schools; yet the very notion of allowing private practitioners to operate alongside publicly funded physicians and hospitals is an idea that is commonly portrayed as running counter to the Canadian ethos—never mind the fact that these private schools serve as an effective safety valve and supplement for the public system, and never mind the fact that their quality is generally an order of magnitude higher than their public counterparts. But Canadians are loathe to permit the same for the practice of medicine, however beneficial it would be for all involved parties. They deplore the notion of “two-tier” medicine, yet see nothing wrong with its educational analogue; apparently, no Canadian is entitled to what would undoubtedly be better health care, quality-wise (even if they desire to pay a premium for it), yet most see nothing at all wrong with allowing certain children to obtain higher-quality educations (else private schools would be verboten). Hmmm…smells fishy to me. Let it also be known that the above is a mischaracterization in a sense, as most recent polls show that a majority (70+%) of Canadians are in favor of imposing user fees (i.e., partial privatization, a la Britain)—I’m pretty much here addressing the common sentiment of Canadians of the “Azih” stripe, those who are hostile to any notion of a “mixed” health care system.


And once you concede the benefits of a mixed system (indeed, concede its necessity, else there wouldn’t be an outcry for it), you’re only a stone’s throw away from the sort of system I personally espouse (the details of which can be seen by clicking on the link provided previously). We can then reason like men, not fruitlessly quarrel like children.



Also note that I did not intend to attribute all the ills of US public schools to the fact that they are “socialized”—far from it. There are various cultural and systemic factors at work which serve to undermine the vision of the good and qualified people who work in these schools. However, the fact that such features and inefficiencies abound in our public school system takes most—if not all—of the force out of your analogy. In other words, when I think of what I want our health care delivery system to be like, the last thing that comes to mind is the public school system.


I am aware of the fact that perhaps you were not explicitly analogizing health care and public education beyond the fact that those working in public schools are likewise not making what they would on the free market. The crucial difference, however, is that teachers can also work in private schools and command higher fees, and can contract independently with students outside of school for $40-60/hour, as my sister does for tutoring; no such option is left open for physicians in socialized systems-- in fact, it's frowned upon, and all physicians are expected to become part of the government apparatus. Further, even teachers in public schools are not suffering the same degree of economic injustice that physicians in socialized systems do (as discussed below); despite these minor points, your comment on public education proved useful in that it helped to illustrate certain pitfalls inherent in socialized systems in general.


Secondly, I hope you were not comparing the rigors and requirements involved in becoming a physician to those involved in becoming a teacher. To be certain, teachers are underpaid, as I mentioned earlier. Here in NY, they start out at around $40K, whereas I feel that in an ideal world (and assuming proper education and dedication on the part of the teachers) they would start at around $55-60K. So they are currently paid at around 70% of what I feel their market value would be based on a job analysis and their social utility (educating children is, after all, a very important charge). However, based on that very same job analysis and social utility, and using the $90K per physician/$160K per neurosurgeon figure you deemed “more than adequate”, I’d venture to guess that physicians would be compensated at roughly only 20-35% of their fair value. Would doctors get 3 months vacation each year, too, btw? The demands of the job, as well as the training, are not at all comparable in terms of their rigor and scope. Hell, if you wanted to pay physicians 70-80% of their market value (remember, they don’t have 3 months off) under a socialized system-- as is the case with teachers in public schools-- then hey, that’s great. It’s still an economic injustice, but it’s nowhere near as severe—especially when one considers that most physicians don’t make anywhere near 70% of their market value even in the United States. But anyway, all of this is academic.

Crazy thing is that you guys are rich enough to have minimal issues with crap like that. If only you chose to spend your wealth in that direction

Yes, provided that we adequately funded it, it would be wonderful…at first. Much like Canada’s system was and somewhat still is (though the cracks are showing even as the government allocates more and more funds to the health care sector; recall that this problem is structural, and most Canadians can perceive this as evidenced by their support for partial privatization). Indeed, socialism is deceptively alluring for that very reason; since it’s not based on sound financial and ethical principles, however (outside of the ethical principle of compassion), it is ultimately destined to fail. Why people feel we should adopt it when a cursory examination of the issues proves its fate is beyond me—especially when, as I’ve repeatedly stated, there is a better way to be had.

This is completely and absolutely false. Priority treatment is judged by need and this is determined by a physician.

Very well. The source I culled that snippet from did not footnote that information, so I was not able to check on its veracity. It should be noted, however, that it is de facto policy in socialized nations to ration care on the basis of age as illustrated by the rest of that quote regarding Britain (which was documented); so the larger point holds, if not specifically for Canada. I know that this is de facto policy for Spain and France as well.

You put out an arguemnt you'll get a challenge. To see it as being assailed is over sensitivity on your part.

Yes, and that “argument” was simply that I don’t feel that (exclusively) socialized medicine is “the best possible system” (and apparently Canadians don’t either). Instead of accepting the fact that someone else could have arrived at a different conclusion than you have based on the evidence and their own thought process, you proceeded to call me a “hater”, and insisted that I had never articulated the reasons for my disagreement with socialized medicine, implicitly asserting that there are no rational grounds for disagreement (recall that I had not seen your post #82 at that point where you conceded that the system has its flaws).

Further, the tone of your “Canadian healthcare proves that it's far from financially untenable so there's that argument gone (we have universal healthcare AND A SURPLUS 111!!!one!!!)” comment seemed to be hinting that there were no financial issues with the system, which I feel I have shown to be demonstrably false.


Btw, if you have a surplus, why don’t you purchase some more equipment or invest in cutting-edge drugs or research so that you don’t have to send patients down to the US regularly for advanced, chronic care (which seven provinces in Canada do as a matter of policy). Seems that one of us is mistaken here, wouldn’t you say? A “surplus”, yet Canada still has as many MRI machines per capita as Mexico and Colombia, and fewer than many American cities with populations less than one-thousandth that of Canada? :lol A “surplus”, yet they can’t build more hospitals to alleviate overcrowding and queues, despite the fact that in many hospitals patients routinely sleep in hallways due to inadequate space? Why do people still wait "far longer than is medically indicated" for specialty care, surgery, and chemotherapy as stated by Canadian physicians themselves? All of this strikes me as odd, but anyway…I’ll let people do their own digging.



This concludes the “Azih” portion of this post; I hope we can leave it at this, agree to disagree (if that’s still the case), and let interested readers come to their own conclusions based on the reasoning and information presented on both sides as well as their own investigation of these matters.




Saturnman:


Do me a favor:


Be sure to read this entire post, plus my previous one, and then read my views on how I feel health care should be run in this thread (I'm sure you have the time, what with all of your "drawings"). After that, you hopefully won't have the audacity to ever attempt to insult my character in any way without good reason. You seem to be of the mind that just because I disagree with certain aspects of socialized medicine, that I want to "screw my fellow citizens", as seen in your post here:

If Loki wants to keep his precious status quo and have only a minority of people afford the 'best health care system in the world' for the sake of his politics, then let him screw his fellow citizens.

Either you did not take the time to read what I was proposing, and have not read my posts, or you are intellectually challenged. I can see no other reason why you would believe that I, of all people, want to "screw over my fellow citizens for the sake of (my) politics". It is absolutely wrong, and a gross mischaracterization of what I'm saying. Pro-Tip: In my ideal system, nobody would be denied any sort of care based on an inability to pay, nor would anyone be expected to pay for care beyond what could reasonably be expected of them.


Is that humane and compassionate enough for you? Humanity is my overriding consideration, and for that reason such provisions for care would be built into any "plan" I could get behind as a person. It is not, however, my only concern-- one must also account for other realities in addition to one's humanitarian beliefs (which include, interestingly enough, other sorts of ethical beliefs of the type discussed herein).


In short: please don't ever say or imply anything like that about me again, unless you have a very good reason to. I've never had a problem with you, and in fact considered you a "friend", as far as friends go on these forums. We've exchanged PM's in the past and have discussed things amicably despite our sometimes opposite takes on many issues; consequently, I will readily admit that I feel somewhat betrayed that you would jump to such a conclusion about me as a person when you were clearly not in full possession of the facts (as evidenced by your belief that I want to maintain the status quo, when nothing could be further from the truth if one has read my posts).


Such a rush to judgment (not only judgment, but public expression of that judgment in the form of your unflattering remarks) is indicative of how you see me as a person and, quite frankly, and I am offended. Your conditional "if" statement does little to mitigate the implications of your post, because it's basically stating that "if one disagrees with socialized medicine, then one will be willing to screw over one's fellow citizens for the sake of their politics, since that's the only option if one disagrees with socialized medicine." (I disagree with it, and so by implication I would readily screw over my fellow citizens; interestingly, my disagreement has little to do with my politics except in the broadest philosophical sense)



Think before you speak next time, please.




I will not respond to this post (yes, I realize I said that last time), so anyone who takes issue with anything I've said is invited to do their own research and thinking on these issues. There are some other issues that I really wanted to touch upon, mainly of a philosophic nature (namely addressing the possible non causa pro causa fallacies present in such arguments-- e.g., how do we really know that the attendant features of each of our respective systems are a consequence of the inherent natures of the systems in a causal sense; this is an incredibly broad topic, however, and given the absurd length of this post already, I felt it would be best if I left it unaddressed. It's an important topic, though, and one that people should examine on their own time)



Toodles.

 

[Fifty]

I don't like just posting smart ass comments, but Og-Lok, that's 28 pages long!

 

[fart]

Azih:

Quite honestly, when I came home and SNIP


Toodles.

OH MY GOD

 

[Saturnman]

I will not respond to this post

Oh really?

In short: please don't ever say or imply anything like that about me again, unless you have a very good reason to. I've never had a problem with you, and in fact considered you a "friend", as far as friends go on these forums. We've exchanged PM's in the past and have discussed things amicably despite our sometimes opposite takes on many issues; consequently, I will readily admit that I feel somewhat betrayed that you would jump to such a conclusion about me as a person when you were clearly not in full possession of the facts (as evidenced by your belief that I want to maintain the status quo, when nothing could be further from the truth if one has read my posts).

What the...

Is this the same Loki? The OA veteran who gets baited, misquoted, called names and swarned, yet comes back for more with an abundance of smilies? This same Loki can not take a bit of classic forum hyperboling to the chin (and hit me back in kind)?

If I mistook you for another Loki, then I'm sorry and will try to be more gentle with you next time.

I felt that I had already explained some of my reasoning

I hear lots of talk (emphasize on lots), some mischaracterization, but little in the way of backed-up facts.

These are the facts. I'm not going to sit here and cite the hundreds of articles, analyses, commentaries, and studies from Canadian newspapers, journals, magazines, and public opinion polls that will attest to these very facts.

I think Azih and I would be willing to debate, but you must back it up first. Summarize a point then provide links to sources explaining it/proving it.

It would make your posts easier to read and provide necessary extra info should someone choose to visit the links. You don't have to write it all.

Now, in instances such as this (which are broad circumstances which affect thousands of people in Canada), whose interests prevail? Clearly it is the payor's (i.e., government's) interests that prevail, or else the Canadian government would never allow the situation to deteriorate to the point where they're sending patients across the border for necessary care-- they'd just purchase more equipment and hire more physicians, right? Well, they would-- if there was any cash left in the system to do so.

Many of those problems stem from heavy cutbacks in the nineties where the entire government purse needed some tightening. Health care was one of many sectors affected. Health care is financed by provinces and the federal government. Some of the richer provinces could probably do without federal funding (Alberta in particular), but many others still need it and it is Ottawa's role to provide it and they do have the money. Lots of it. It's the subject of lots of political wrangling in the last few years.

If there wasn't any money, they wouldn't send those people to the States to that expensive health care system.

Again, small towns in the US of populations less than 30,000 have more MRI machines than all of Canada (pop. 30 million)-- why do you think that is? Seeing as how people in Canada frequently wait months and months for diagnostic tests such as MRIs, wouldn't it only be proper to purchase more machinery?

"The two greatest problems with the current Canadian system, those that are often pointed out by the American right-wing media, waiting lists and a shortage of MRI machines, are a direct product of this lack of flexibility. "

"In Canada, increasing demands for health care, due to the ageing population, must be met by either increasing taxes or reducing other government programs. Both of these are being done in Canada to great acrimony and debate, and since governments are very reluctant to raise taxes, there is a tendency to delay until a problem is critical before acting. "

http://www.bambooweb.com/articles/c/a/Canadian_and_American_health_care_systems_compared.html

Not terribly efficient, but getting the job done eventually.

Like the issues with the Canadian system that I have elaborated upon, this, too, is a grave issue that needs to be resolved.

Perhaps so, but the Canadian system is far more likely to meet up to these challenges than yours can. There is no reason why Canadian health care absolutely needs to be the most socialized health care in the world (over 98% of it is, I believe). Canada's health care is ranked 30th (US is 37th ) while France is the very best in the world, according to the WHO.

There's room for improvement. If public financing can not be increased up to one point, reform will have to include some form of privatization, it could hardly be more socialized anyway (could be like those publically financed private hospitals in Ontario). :lol

Government already has most of the levers to institute change and it's not like the private sector would oppose it contrary to the pharmeucitical, insurrance and health care lobbies in the US, all deadly opposed to anything close to threatening their interests. Canada and its bureaucracy may be a bit slow to address the issues but we'll get there.

Fully 79% of Canadians polled feel their health care system to be in "crisis", with 71% stating that changes were necessary because the system is not meeting patients' needs.

"Americans are more dissatisfied than citizens of other nations with their basic health care even while paying more of their own money for treatment"

"One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16% of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed."

"In no country is the majority of adults satisfied,"

http://my.webmd.com/content/article/96/103596.htm

Your point, Loki??

Oh wait, there's more! I love not having to write it all.

"While Canada's health system is cheaper, it compares well with the American one statistically. Life expectancy in 2002 was about two and a half years lower in the United States than Canada. With Canadians living to an average of 79.8 years and Americans 77.3. Infant and child mortality rates are also markedly higher in the United States.

When comparisons of public satisfaction are made between the two nations' health care systems, the numbers for Canadians and insured Americans are almost identical. This holds true in average annual doctor's visits. While a good number of Canadians complained that they were unable to receive treatment due to long wait lists, overall Canadians had no greater number of people unable to receive treatment than insured Americans.

A much greater difference was seen, however, between uninsured Americans and Canadians. Overall the uninsured group was much less satisfied, less likely to have seen a doctor, and more likely to have been unable to receive desired care than both Canadians and insured Americans. This leads to numbers somewhat lower for Americans. "

http://www.bambooweb.com/articles/c/a/Canadian_and_American_health_care_systems_compared.html

Would you sit idly by while someone responded to claims of the very real problems with American health care by flippantly stating, "sure, we have our problems-- no system is perfect"?

It would probably be fun if someone did.

type the words "Canadian health care rationing criticism" into Google, and have fun discounting each of the 124,000 results you'll get.

Type those words:

"teen sluts like it hard"
"america sucks balls"
"Nintendo is dead"

You'll get even more hits. It's amazing. It must mean something.

Unfortunately, it's not a lot of money in America, and this goes to my larger point that unless we (America) are going to change our entire economic structure from the top down (i.e., flatten out the wage scales and lower our cost of living), $90K for the average physician and $160K for a freaking neurosurgeon is shamefully inadequate compensation; no amount of loan forgiveness (which will never happen, btw) or reduction in malpractice insurance-- the commonly proffered “solutions” to this issue-- will change this fact.

At least partially finance higher education and those neurosurgeons would have less debt to begin with. And don't bother saying government intervention in this respect would lower the quality of higher education as many of our graduates are tempted to go south of the border and reep the benefit of your outrageously high salaries. They're evidently good enough for US health care needs.

To me, a doctor or any medical specialist that gets his diploma is virtually assured of employment for life in his field, short of criminal behaviour or gross malpractice, of course. It's not something that can be outsourced, the graduates are not all that common and there is always a need on a local level. That kind of job security is rare nowadays and the high salaries are already the icing on the cake.

The fact of the matter, as shown above, is that even the Canadian compensation for physicians is wholly inadequate based on any rational criteria one can evaluate it by. Yes, Canada happens to have the most adequate physician remuneration among socialized nations by quite a large margin (in Britain, for instance, average physician income is $65K USD), but that doesn’t change the fact that it is, in itself, indefensibly low.

As far as Canada is concerned, it is only low compared to the United States as was mentionned before, your country is able to attract some of our graduates. Otherwise, your criteria for judging what one is enttiled to as a salary seems wholly arbitrary and subjective. You have no choice but to concede this point, Loki. Don't even try to argue.

It’s financially untenable (as measured by patient care; see my citings) now—what makes you believe that the situation won’t deteriorate further 20 years from now? Your health care sector is growing at a rate that far outstrips your annual increase in GDP

The cost of health care in Canada, combining both public and private funds, is still far lower than what your country spends on average per citizen (yours is over twice as much as in Canada). Will it require adjustments and hard choices down the line? Probably, but there is still much room to maneuvre for Canadian health care. I'm sorry, Loki, you will still have to wait for those commies from the North to humble themselves.

I only seek a system that retain the best aspects of socialized medicine while largely avoiding its pitfalls.

Good luck.

Now, I don’t know about how it is in Canada, but even given the much more limited scope of public education (which by its very nature controls demand- i.e., “consumption of resources”), and the more limited demands placed on the system, the United States public school system is definitely not known for its fiscal solvency

People complain, of course, but Canadian kids generally outperform American kids in those different surveys covering maths and such.

There are also variants from the different provinces, but private education is often partly financed by the state. In this province, the rationale seems to be to prevent the super elite to only have access to private education. That way, good students from the middle class can still attend private schools (since they reject students with bad grades, no matter how rich they are) and if the state didn't do this, they'd have to invest nearly as much in the public sector to accomodate those extra students.

We can then reason like men, not fruitlessly quarrel like children.

O...k.

In Canada, the population is divided into three age groupsùbelow 45; 45-65; and over 65, in terms of their access to health care. Needless to say, the first group, who could be called the ôactive taxpayers,ö enjoy priority treatment.

Never heard of this.

But I hurt my eye last fall and went to doctor to check it out. As I was in the waiting room, a father and his kid with a tummy ache showed up. They passed that crying brat before I did even though we're in the same age bracket as your example and I am a productive member of society contrary to this parasite. WHERE IS MY IMMIGRATION FORM FOR THE US?

I don’t feel that (exclusively) socialized medicine is “the best possible system” (and apparently Canadians don’t either).

It's the best system for the buck, it's the best system in an imperfect world and so far, it has been the better system on the continent for a couple of decades already.

"Conversely, the problem could be not poverty hurting health, but poor health causing poverty. Over a quarter of the American poor report chronic health difficulties, a level much higher than in Canada. This can make it far harder to find and hold a job and improve one's financial well being. Better overall health of the poor encourages social mobility and may play a role in it recently being easier to climb the social ladder in Canada than in the United States.

The economic effects of the differences in the two health system are hard to judge. Canada's higher taxes to pay for health care certainly have some negative impact on its economy. There are some benefits as well, however. Major corporations often find it cheaper to pay those taxes rather than having to provide expensive employee health plans as in the United States. This is especially true of the auto industry.
"

God bless... Canada. Treating all of God's children equally.

 

[iapetus]

Type those words:

"teen sluts like it hard"
"america sucks balls"
"Nintendo is dead"

You'll get even more hits. It's amazing. It must mean something.

Here are the results:

Canadian health care rationing criticism - 124,000 hits
Teen sluts like it hard - 986,000 hits
America sucks balls - 163,000
Nintendo is dead - 1,840,000 hits

So, to put that in perspective, Nintendo's deadness is twice as serious as the fact that teen sluts like it hard. That, in turn, is roughly six times as significant as the ball-sucking nature of the US.

Canadian health care rationing criticism barely registers on this scale.

 

[hyp]

i love how people conjure up what exactly an "american" is when there are so many different cultures in america alone.

what they're most likely being influenced by is american media that is played on foreign television networks, giving a false impression of who we actually are as individuals.

let hypocrisy reign... you can by no means pre-judge a country based on a few observations you think are commonplace. it's unfortunate that american culture is so ubiquitos nowadays and open to scrutiny. i say, live it and learn it before talking shit. because quite honestly, i work just as hard as the next man and to call me spoiled or patriotic is like telling a swede, african, australian, filipino, etc, etc... that they can't celebrate his/her own country.

 

[Pimpwerx]

I had to see what this thread was still around. Loki...respect for those two MONSTER posts. Azih...respect for those MONSTER replies. I had some long, rambling arguments with The Artful Dodger in the past, but these 4 posts put anything we did to shame. That's just too fucking much. Maybe it's time to call a truce. :lol PEACE.

 

[Saturnman]

My replies, like Canadian health care, are of similar quality, for less (words).

:lol

 

[BooM235689]

American>All

 

[IAmtheFMan]

Hmmm... I assume that Loki said everything that I would've liked to. So okay!

Buddy, if you ever decide to drop the pre-med thing and go into law, I'll look ya up. I think it'd be a good thing having you on my side.

 

[Manics]

Hate is not good, and it's generally spread through ignorance and lies. I don't hate anyone or any group of people in general. I may hate actions, but not the people who commit the actions. Afterall we're only human -- we'll all be dead eventually.

 

[Boogie]

American>All

"American(sic)>All"

"Salt Lake 2002"

....

Hmmm, let's see:

 

[BooM235689]

we beat the japs

 

[Boogie]

we beat the japs

Racial slurs? You'll last long.

 

[Loki]

I'm going to go back on my word (seems to be a habit of mine on the forum ), but I'll make it quick this time. I'm going to number the sections so I can refer you to them later:

What the...

Is this the same Loki? The OA veteran who gets baited, misquoted, called names and swarned, yet comes back for more with an abundance of smilies? This same Loki can not take a bit of classic forum hyperboling to the chin (and hit me back in kind)?

If I mistook you for another Loki, then I'm sorry and will try to be more gentle with you next time.

#1:

I can take a lot of shit, and can take lots of kidding around. But when someone tries to characterize mere disagrement as me desiring to "screw over my fellow citizens for the sake of my politics", I take exception to that, as it's an attack on my character. Sorry if you can't see the difference between these things.


I'm not fuming or anything, but I don't appreciate it, nor have I ever behaved in a similar manner towards you or anyone else when they express rational disagreement with an opinion of mine. I never question people's motives, as I believe most decent people desire basically the same things in life (and I would like to think that you believe the same)-- I only question their arguments and opinions.


You're a known atheist and religion-troll (jokingly most of the time, but still, you're something of a troll in religious topics, you must admit ). Would it be fair if the next time you your expressed your disdain of (or disagreement with) organized religion I stated that you wanted to physically harm all religious people? No, it wouldn't be fair, because you would have never stated or implied such a thing-- but still, if I wanted to act in a manner similar to how you acted, I could just say that "that's the only way that one can so virulently disagree with religion, is if they wish harm upon religious people". Bullshit, no? You'd take offense, no? Well, that's exactly what you did.


And to be perfectly honest, if everyone on this board had an IQ of over 130, I wouldn't have bothered to "defend" myself from such charges, because it's quite obvious that I never stated or implied that I wanted to screw anybody over in any way, or that my ideal system would somehow lack humanity. However, the denser among us may see my critique of socialism, probably disagree with it given the politics of the board, and then read your post and conclude "well hey, that MUST be it! He doesn't care about people!" Come on now.

I hear lots of talk (emphasize on lots), some mischaracterization, but little in the way of backed-up facts.

#2:

You have got to be kidding me. I've provided ample substantiation for everything I've said, and there are thousands more sources I could have cited; you, too, can cite thousands of sources stating that everything is roses in Canada and other socialized nations. The truth (about just how badly ailing Canada's system is, not certain points of fact, as discussed below) lies somewhere in the middle, yet even this middle ground you are unwilling to move to.


And, again, you've missed the very point I made in my previous post: does you discrediting certain sources mean that these problems don't exist? Does it change the fact that there is a dearth of diagnostic equipment? A shortage of hospital space? That over 60% of Canadian physicians state that people wait longer than they should for routine surgeries, chemotherapy, and specialty care? No, none of what you can say changes these facts, unless you'd like to go to the 2300 Canadian (note: not American) physicians surveyed and call them all "right-wing hacks". Or that the representative sample of Canadians polled all somehow managed to be "right-wingers", despite sound sampling methodology. You see, this is the partisan bullshit that I try to stay away from on the board, as I mentioned. You try to paint all disagreement, and all the folks pointing out flaws in the system, as "right-wingers", when that is anything but the case. The Canadian people, their physicians, and their own periodicals state these things-- I don't need to go to some extreme right-wing site to dredge stuff up.


But whatever-- if you want everyone to believe that everything I've stated herein, and all the sources that are stating the very same things I've stated, are somehow products of "extreme right-wing thought", then that's your prerogative. It's intellectually dishonest, though, and I'm sure you never stopped to think that the sources that are saying everything's peachy in Canada might-- just might-- also have an agenda, this time for the "left". Nah, that can never happen, right? :lol Leftist sources can be every bit as partisan and agenda-pushing as rightist sources. The only point I've tried to make is that regardless of all the sources cited (which we can both criticize ad infinitum), some things are facts, such as I've mentioned above. Trying to minimize them or pretend they don't exist only makes you look bad, the same way that if I tried to minimize the seriousness of the uninsured problem in America, or tried to explain it away as merely misprioritization on the part of citizens, you could rightly call me a lunatic. But I don't try to explain it away, minimize it, or insist that we have the best of all possible systems just because there are many good features about our system (just as there are for socialized systems). I try to give an honest account on both sides.


And you know what, Saturnman? That makes me fairer than you. I know, I know-- it must be shocking to you to think that an American could somehow be fairer and more candid than a Canadian, but alas, 'tis the truth in this case.

There's room for improvement. If public financing can not be increased up to one point, reform will have to include some form of privatization, it could hardly be more socialized anyway (could be like those publically financed private hospitals in Ontario).

#3:

Like I said to Azih, once you concede the benefits (and necessity) of a "mixed" system, then you're quite close to what my ideal system would be, so I don't know what you're bitching about. I take it you read my proposals in the threads I linked to? And make no mistake, a mixed system is an inevitability in Canada (and other socialized nations) or else the problems we see now will only grow worse as the years roll by.

Oh wait, there's more! I love not having to write it all.

"While Canada's health system is cheaper, it compares well with the American one statistically. Life expectancy in 2002 was about two and a half years lower in the United States than Canada. With Canadians living to an average of 79.8 years and Americans 77.3. Infant and child mortality rates are also markedly higher in the United States.

#4:

You did read the thread I linked to earlier that explain why citing the common WHO statistics (life expectancy and infant mortality etc.) on American "health care" is disingenuous, correct? ("health care" in parenthesis because many of the confounding variables which affect such statistics are totally outside the realm of the medical delivery system; some of it is also a direct result of our medical system, yet this is not a negative-- see the threads linked to for details)


At least I hope you read it. And I really hope that any other person who uncritically swallows those numbers and views them as gospel will read the thread I linked to as well, as it will give them a somewhat better understanding of why the numbers are misleading. It's not a full account of the factors that play into these things, but at least it's far more thorough (and honest) than what folks who just trot out the WHO numbers and laugh at the purported inefficacy of our system offer up (see: Saturnman).

Your point, Loki??

See #2.

Type those words:

"teen sluts like it hard"
"america sucks balls"
"Nintendo is dead"

You'll get even more hits. It's amazing. It must mean something.

My point had nothing to do with the number of hits, and you implying that this was my point only highlights how dense you're (purposely) being. Jesus, take one tenth of the results for all I care, then-- my point still holds. And that point was that attempting to discredit every criticism made of Canadian health care (many of which are made by the Canadian people, physicians, and periodicals themselves) on the basis of "source bias" is foolish, and cannot be done. Doing so is a tacit attempt to maintain that there's nothing wrong with the system-- or at least nothing seriously wrong with it. And this is patently false. Oh, wait-- only the American system can have serious issues affecting it. :lol

At least partially finance higher education and those neurosurgeons would have less debt to begin with. And don't bother saying government intervention in this respect would lower the quality of higher education as many of our graduates are tempted to go south of the border and reep the benefit of your outrageously high salaries. They're evidently good enough for US health care needs.

#5:

First, my argument about the fact that the rest of America will not change (i.e., wage scales will not flatten and cost of living will not go down) stands. There is nothing at all you can say against it, quite frankly; this is one thing I will not budge on, because there's no argument against what I stated in my previous post regarding these matters.

Note that despite the fact that I mentioned that "no amount of loan forgiveness" (i.e., government financing of medical education) would affect the arguments I've made-- and this is true. Yet it didn't stop you from making the argument anyway. Bravo. :lol


Secondly, I never stated that government intervention would necessarily lower the quality of physicians produced. Think I did? Try to find it, then. What I said was said in a very limited context, and was referring to what wage is "deserved" by, say, a neurosurgeon based on the rigors of their training, their expertise, and responsibilities. Those factors being what they are, a neurosurgeon would command an incredibly high salary based on the very same job analysis used to compensate every other professional in the US. Note that I'm (again) being fairer and more honest in my analysis than you are-- I am not asking that special remuneration standards be applied to physicians, whereas you (and Azih) are. Who's wrong here, again?


And it was within that context-- in elaborating upon the training involved and the pay that is proprtionate to such-- that I stated that the "answer" to lowering salaries for physicians could not (or at least "should not") include a reduction in educational and professional standards. Try to keep these things straight, Sman-- I know you can do it. You're the product of the vastly superior Canadian educational system, after all.


One more point:

You're really calling physician incomes here in the US "outrageously high"? :lol As I noted, any job analysis or social utility analysis will state that physicians should be earning quite a lot more than they are now in the US (never mind Canada); there's really no question of this. The facts aren't on your side, Sman-- give it up. If I had to hazard a guess, I'd say that primary care physicians (family doctors, pediatricians etc.) deserve to make roughly $250K or more (they currently average around $140K before taxes), general surgeons deserve to make about $400-450K or more (they currently make about $220K before taxes), and neuro- and cardiothoracic surgeons deserve to make about $500-600K (they currently make ~$300-400K before taxes).


By "deserve", I am referring to what they would earn based on the same exact criteria that are applied when determining the compensation levels of nearly every other professional in the United States. I'm not being inconsistent, nor am I being "unfair". You, however, are being grossly unfair when you believe that, after all the training I described in my previous post, a neurosurgeon deserves to make $160K, which, according to Azih and yourself, is "more than enough". :lol Really? Even when tens of thousands of people with not a fraction of the training, expertise, and social value are making two and three times that amount in the US? Spare me, Sman...


There really are no two ways about this issue. Either you believe that the same standards should apply to all people, or you believe that, for some undisclosed reason, physicians do not deserve to be compensated in the same manner (and to the same degree) as everyone else. Like I've said, the only argument that would be acceptable is if higher physician incomes were a burden on our health care system, causing costs to go up and impacting access. But this is not the case. Physician net incomes were several times higher in the 70's and 80's, and have been reduced by almost 45% in many instances over the last 15 years (since insurance companies came along-- go figure). Yet, health care expenditures have skyrocketed only since the insurance explosion of the early-mid 90's. So we have by far the lowest physician incomes in our history, yet drastically more money is tied up in the system now than ever before. Where is it going? Well, since I'm sure you're curious, I'll clue you in on the fact that administrative costs have increased over 500% over the past 10 years, and this is the primary reason for rising costs (the others being defensive medicine, technological advances and utilization, and cost shifting, all of which are discussed in the threads I linked to). Physician income has little (if anything) to do with the current unaffordability of health care.



Again, I'll state my opinion again: Any person who believes that a physician deserves to make $90K, or a neurosurgeon $160K (in America), is absolutely not sane. They're simply not well in the head, quite honestly. And this is based on the wage structure of the rest of society as well as our cost of living. Period. No two ways about it.

That kind of job security is rare nowadays and the high salaries are already the icing on the cake.

Except that $90K, or $160K for a neurosurgeon is not anywhere near "adequate", much less "high", based on what we pay EVERYONE ELSE in our society.


Look, I'm all for flattening out the income scale in the US (within reason), as I feel it would do society a lot of good to not be so top-heavy. But let's start at the top, then (you know, the really rich people), and let's also start with the people who least deserve to make that sort of money (based on job analyses and social utility), not the most deserving. Sounds fair, no? Sounds like it to me.


You do that and then I'll be fine with it. Oh yeah, address cost of living while you're at it.

Otherwise, your criteria for judging what one is enttiled to as a salary seems wholly arbitrary and subjective. You have no choice but to concede this point, Loki. Don't even try to argue.

"Concede it"? :lol Man, you guys are smoking crack.


How are my standards as to what compensation is merited "arbitrary" when there are techniques in place (namely the various job analysis methods) that are already used in all sorts of industries to determine proper compensation for all kinds of jobs, be they common, professional, and management? Does that strike you as "arbitrary", or does it strike you as "objective" (or "as objective as we can make it") and fair?


Argue against that and you might as well argue against the entire human resources industry while you're at it. Have fun.

The cost of health care in Canada, combining both public and private funds, is still far lower than what your country spends on average per citizen (yours is over twice as much as in Canada).

You're correct, and that's due to bureaucracy (which, if you'll note, was not part of my criticism of the Canadian system, but was mentioned as an issue with the American system-- gee, that Loki guy sure sounds fair to me! )


Also note that Canadian spending on health care is growing faster than your GDP is, proprotionally. You do know what that means, right? It means that insolvency is not an "if", but a "when". Again, this might not happen for many years (though even now the cracks are showing, as I've illustrated), but why would America want to rush into a system that is known from the outset to have these sorts of problems, both financial and ethical? Why not seek a more moderate system that would still guarantee care? Makes sense to me.

Good luck.

Err, no need to wish me "good luck", as I've already proposed a moderate system, and have full confidence that if it was implemented (which it won't be, but for argument's sake), it would retain the best elements of both systems while largely eliminating their respective drawbacks.

People complain, of course, but Canadian kids generally outperform American kids in those different surveys covering maths and such

Well that's great. Too bad they didn't teach you how to read critically, as evidenced by your comprehension problems noted above (see #'s 2, 4, and 5).

(oooh, that Loki is a meanie! He's just dishing it out! See, I can "come back at you", Sman )

It's the best system for the buck, it's the best system in an imperfect world and so far, it has been the better system on the continent for a couple of decades already.

You're nuts. American health care started having serious issues after the early 90's (which is when encroachment by third parties started-- coincidence?), so that's 12-15 years, tops. And, for the last time, there are many things that are better about the American system even now-- just as there are many things about the Canadian system that are better than what we have. So it really goes by how you define "best"; I personally prefer to speak not of which is "better", or "best" of the two, but rather look at "what is the best possible system we can create?"-- I feel I've spoken to precisely this in this thread (and the ones I linked to that elaborate upon my stance, which I'm sure no one read, especially you )

"Conversely, the problem could be not poverty hurting health, but poor health causing poverty. Over a quarter of the American poor report chronic health difficulties, a level much higher than in Canada. This can make it far harder to find and hold a job and improve one's financial well being. Better overall health of the poor encourages social mobility and may play a role in it recently being easier to climb the social ladder in Canada than in the United States.

No question that there's some validity to what this is saying, but the question is, "how much?" The fact of the matter is that the issue of poverty in the US is tied up in myriad cultural and economic factors; to dump it all at the feet of our health care industry is yet another instance of disingenuous reasoning (as with the WHO stats; see #4).

Treating all of God's children equally

So would my system. So I guess we're even. Or at least we know that God blesses me after he's done blessing Canada.



Ok, I'm seriously done with this topic. To be perfectly honest, it seems that nobody can hold anything other than a far-left opinion here without being jumped on (however cordially), whereas far-left opinions are routinely tossed out there with little to no substantiation and left to stand (in fact, the only leftist I've ever seen even remotely taken to task is Che, but that's because he's vacant); I, myself, have allowed many such statements to stand without arguing against them. I've also left well-argued statements that I disagreed with alone because I can respect the fact that rational people can come to different conclusions about things. That's just how I am as a person. That's not whining on my part, either-- it's just that sometimes it feels like I'm arguing with a brick wall, with people who do not want to hear what I'm saying. Yeah, you're free to say "that's bullshit, dude-- everyone gets the same treatment", but that's quite clearly BS. That's how this topic has made me feel-- I'm just being honest.


Example: Duane posts nonsense about Communism all the time, yet nobody ever utters a word in disagreement, despite the fact that most leftists on this board are not communists, and likely find communist ideology just as off-putting as I do (or at least they realize how untenable it is practically, as I do). This, in my opinion, is because communistic beliefs are part of this general leftist ideology. Ripclawe posts far-right shit about free markets and the virtue of corporations all the time and gets hosed for it (quite rightly). I myself have taken both Ripclawe and Duane to task over such comments, and I am consistent and non-partisan in that regard (I've also let many of their statements stand, because I just can't be bothered). I just feel that many other people here aren't consistent for whatever reasons. I only posited the "leftist ideology" stuff because I'm really at a loss as to how else to account for such discrepancies in conduct, not because I'm trying to stereotype the board or stir shit up (and if anyone has a different explanation, I'm all ears, because I like to believe the best about people-- namely, that we are all consistent in our reasoning). There are many other such situations I can point out, but I'll leave it at that.



Again, people are welcome to do their own investigating about both systems. Nothing I've stated herein is false, to the best of my knowledge (particularly not the analysis of the structure of socialist systems and the resultant systemic maladies and the philosophical issues I've highlighted; the only thing that may be false is the age group quote I cited).



End. Done. Over.


(OK, that wasn't so "short", but it was only a fraction as long as my previous post, so I'm making progress )

 

[fart]

look, most of us don't have the time to read your books loki, (OR SHOULD I SAY OLI-K), but did you just compare yourself with gimp humping coke snorting boy racer pothead duane? i mean, don't get me wrong, duane is awesome, but his "flagrantly communist posts" usually involve him laughing about the gimp he humped yesterday and how her tongue is still in his cheek (if you get my drift). of course people aren't going to cane him over a few odd comments. he doesn't take himself very seriously and neither should we.

 

[Loki]

look, most of us don't have the time to read your books loki, (OR SHOULD I SAY OLI-K), but did you just compare yourself with gimp humping coke snorting boy racer pothead duane? i mean, don't get me wrong, duane is awesome, but his "flagrantly communist posts" usually involve him laughing about the gimp he humped yesterday and how her tongue is still in his cheek (if you get my drift). of course people aren't going to cane him over a few odd comments. he doesn't take himself very seriously and neither should we.

:lol

Yes, I'm aware that he jokes around and laughs a lot, just like I do (usually-- "Mr. McGee, don't make me angry-- you wouldn't like me when I'm angry." ). But many times he says stuff like that in legit topics and in all seriousness.


Also, I wasn't comparing myself to Duane in any way-- no offense to Duane, of course.



P.S.- What's "OLI-K"? Olimario? Are you implying that I'm unwittingly making a mockery of myself (i.e., "Olimarifying myself")? Pffft, believe me when I say that I don't care.

 

[fart]

no i'm saying that you ARE OLIMARIO

YOU CAN'T FOOL ME I AM THE ALL SEEING EYE

 

[Loki]

no i'm saying that you ARE OLIMARIO

YOU CAN'T FOOL ME I AM THE ALL SEEING EYE

:lol

 

[Saturnman]

You're a known atheist and religion-troll (jokingly most of the time, but still, you're something of a troll in religious topics, you must admit ). Would it be fair if the next time you your expressed your disdain of (or disagreement with) organized religion I stated that you wanted to physically harm all religious people? No, it wouldn't be fair, because you would have never stated or implied such a thing-- but still, if I wanted to act in a manner similar to how you acted, I could just say that "that's the only way that one can so virulently disagree with religion, is if they wish harm upon religious people". Bullshit, no? You'd take offense, no? Well, that's exactly what you did.

But it's a forum after all and misrepresentations are common in (online) debates, to win argument or just to be obnoxious.

I also can view it as a flame bait and refuse to take it. You know, Loki, you must sometimes trust the silent lurking majority and just let an outrageous, unfounded statement to be judged on its own. Trust the intelligence of those people and don't try to interpret it for them.

This is a heavily moderated forum so a cheap attack will not necessarily lead to an onslaught from various posters, unless you're called Leguna or Serafitia or something.

And some of us just have a better composure when provoked.

And, again, you've missed the very point I made in my previous post:

That's because we're not having the same debate.

I, along with Azih probably, are happy to have the canuck system be maintained as it is as long as possible (and perhaps be improved upon, if possible) whereas you want to reform yours and cite the Canadian system as the model to avoid. You argue a lot with things in theories whereas we're living in it.

And I don't care what happens in your country and may even wish for it to go down the drain a little bit so watching the strong forces that keeps your health-care system as it is pleases me.

And you know what, Saturnman? That makes me fairer than you.

But I'm still right. It's not fair, I know, but what are you going to do?

Like I said to Azih, once you concede the benefits (and necessity) of a "mixed" system, then you're quite close to what my ideal system would be, so I don't know what you're bitching about.

First of all, I'm not Azih.

And second, I only concede to privatize if all else fails. From my POV, we're not even close to that point. Right now, it's re-investment to repair the damage from cutbacks and short-sighted decisions from the past.

You're free to dream about your ideal system in the meantime. The imagination is a wonderful thing. I definitely encourage that.

You did read the thread I linked to earlier that explain why citing the common WHO statistics (life expectancy and infant mortality etc.) on American "health care" is disingenuous, correct?
At least I hope you read it.

You actually mean for me for to sift through another essay, in the hope of finding a buried link leading to yet another essay where the point is adressed somewhere among a sea of words? And you call yourself fair?

Look, I understand you putting a relative spin to the stats but as much as you may emphasize outside factors affecting health, you can still not dodge the issue that health care as a very real and direct affect on such stats. Not an exclusive correlation, but a pretty big part of of the picutre. As was touched in my last post, despite some differences, both the American and Canadian health care systems are roughly equal in quality, but what really drags your stats down is the people without access to health care. You can not ignore this data nor the fact if all those uninsurred people somehow had access to your system, your stats would probably equal those of Canada or perhaps even exceed it.

First, my argument about the fact that the rest of America will not change (i.e., wage scales will not flatten and cost of living will not go down) stands.

So uncharacteristically fatalistic, Loki. I expect you to weigh the odds, highlights the possibilities, but not to say "NEVER!"

Secondly, I never stated that government intervention would necessarily lower the quality of physicians produced. Think I did? Try to find it, then.

I didn't claim you did. It was a preventive strike in order to stop you from even attempting to open another front. Mission accomplished!

As I noted, any job analysis or social utility analysis will state that physicians should be earning quite a lot more than they are now in the US (never mind Canada); there's really no question of this.

This is one of the advantages of a controlled system as you set the rules. There are limits to what you can do, but in the case of salaries, if you can still recruit the necessary personnel because it is available and willing to play by your rules, then the system works. No one forces any student to become a neurosurgeon in Canada nor can they stop them to move south of the border to earn more. It's a question of balance.

And yes, governments should negotiate for drug prices as well.

Again, I'll state my opinion again: Any person who believes that a physician deserves to make $90K, or a neurosurgeon $160K (in America), is absolutely not sane.

I embrace insanity with a big grin.

But let's start at the top, then (you know, the really rich people), and let's also start with the people who least deserve to make that sort of money (based on job analyses and social utility), not the most deserving.

Just don't give them tax cuts and loopholes for a start.

Also note that Canadian spending on health care is growing faster than your GDP is, proprotionally. You do know what that means, right? It means that insolvency is not an "if", but a "when". Again, this might not happen for many years (though even now the cracks are showing, as I've illustrated), but why would America want to rush into a system that is known from the outset to have these sorts of problems, both financial and ethical? Why not seek a more moderate system that would still guarantee care? Makes sense to me.

Because it is still not a problem, just a trend that might force adjustments and changes somewhere down the line. This is not quite the same as old people's pensions financed by an expected dwindling work force. You really have to plan ahead to be able to give the pensions people expect in the future.

This is just a quick suggestion, but I think your country would be better served by have a nearly completely socialized health care system just because you could afford it for a while, it would save lives and it would break the influence of many of the pervasive lobbies you have. You can still adjust it along the road to whatever mixed system you want. I mean, do you have anything on the horizon telling you your mixed system will happen? I follow your politics and I don't see it.

Duane posts nonsense about Communism all the time, yet nobody ever utters a word in disagreement, despite the fact that most leftists on this board are not communists, and likely find communist ideology just as off-putting as I do (or at least they realize how untenable it is practically, as I do). This, in my opinion, is because communistic beliefs are part of this general leftist ideology. Ripclawe posts far-right shit about free markets and the virtue of corporations all the time and gets hosed for it (quite rightly).

You know, OAS is there for you, where godless commies are bashed repeatedly. But you don't see me complaining about my enlightened left-wing brothers being lynched over there.

Ok, I'm seriously done with this topic.

I'm not convinced. And Azih still has to break his word and come back. You know you want him to.

 

[Loki]

I'm not convinced. And Azih still has to break his word and come back. You know you want him to.

No, I really don't-- not for my sanity's sake.


I'll address your post sometime late tomorrow night or on Wednesday. Classes have started and I should really be giving up this forum soon.


And yes, I expect that if you're going to keep blindly citing certain statistics, that you will follow the single link I provided (along with the freaking post # in the thread, for crying out loud) and educate yourself. This is what a person who desired the truth (as opposed to this "dude, our system is WAY better than yours" BS mentality) would do. It's an honest approach.


And you're neither being fair nor are you "right". But this is for later.

And some of us just have a better composure when provoked.

Must be in that Canadian water-- man, Canada's superior in every way! :lol


By the by, you don't get abused nearly as much as I do, either here or at <ahem> the "other" forum. And that's because I am forthright and I have strong opinions which I tend to stand by. Yeah, the periphrasis helps too, I'm sure...

 

[Crag Dweller]

For what it's worth Loki, if I ever found myself on the other side of a discussion than you, I would appreciate the way you state your case.