[Chex]

I see a lot of phobia in the use of terms such as communist, socialist and the sort - perhaps a source of disdain from an unkind past with regimes that claimed to uphold such values.

Socialism = advocating public ownership and cooperative management of the means of production and allocation of resources.

Of course socialism in the purest form will not gel with most people, but elements of this ideology exist in just about all societies. Having the term synonymous with Marxism predelicts it to common disrepute.

Communism = classless and stateless society structured upon common ownership of the means of production, free access to articles of consumption, and the discouragement of private property ownership.

We see this in housing commission estates, public parks and playgrounds as well as the services Gene mentioned. Again, the word brings negative connotations from what the world 'made' of it in the past, but elements of it also exist in society. This is what I was referring to.

The Defence force is a totally different issue which I won't get into here.
Health either as a public or private service is still a service rendered to 'clients' who have expectations of outcome and respect, but it's not going to be as simple or mechanical as a car tune up or repair.

Like all systems socialism and communism would work well, if you could only keep out the human greed factor.. which in turn destroys all models of society, even the model it drives (capatalism). It's too bad that greed and the almighty dollar are the driving force.. the only way to get rid of it I can see, would be to abolish all currency systems.. it would never work now days though.

[GeneV]

I'd like someone to point out how, if I need a repair, I can take myself back to the dealership.

Perhaps you need to talk to a Christian Scientist .

[Chex]

I think one of the scariest business models is that of the pharmaceutical companies. Probably as inhumane of a business as human trafficking IMO. I agree that greed/personal gain is the main motivator for progress, but not everyone is on that page.. look in other industries like indie film and music.. some won't sign with big labels etc.. in computers there are thousands of open source programmers who make terrific programs that are free (GIMP, Pigdin, all the programs at protableapps.com and many other sites...). Some people would like to make progress just to help people or better things like health care. The sad part is that big business works so hard against these people to protect their "assets".

[GeneV]

I think one of the scariest business models is that of the pharmaceutical companies. Probably as inhumane of a business as human trafficking IMO. I agree that greed/personal gain is the main motivator for progress, but not everyone is on that page.. look in other industries like indie film and music.. some won't sign with big labels etc.. in computers there are thousands of open source programmers who make terrific programs that are free (GIMP, Pigdin, all the programs at protableapps.com and many other sites...). Some people would like to make progress just to help people or better things like health care. The sad part is that big business works so hard against these people to protect their "assets".

The scariest thing about the Pharmaceutical Industry is that they never seem to "cure" anything. They just find drugs you will need for the rest of your life. Their model seems to be firmly rooted in crack sales.

[jolepp]

Related, about how and why the traditional single GP practice is being pushed aside: http://www.nytimes.com/2011/04/23/health/23doctor.html.

[reeftool]

Healthcare professionals are certainly not perfect. I don't think that is really the point of the thread. The point is more whether consumers can be expected to make intelligent decisions about health care the way they do about auto repair. I don't think that is possible to anywhere near the same extent.

I can decide the Jiffy Lube or Valvoline oil change franchise at a certain location does a good job, and take my repeat business there. If I make a wrong decision, I may lose some time and maybe some expense to fix my car. Make the wrong decision about a brain surgeon, and you won't be making any other decisions.

The only doctor that we really take any time picking is our primary care physician. He or she seems to have less and less to do with our actual care in our current system.

How do you decide on a surgeon, doctor or dentist? The same consumer practice you follow for any other service.
1. Your own experience. If you found him/her in the phone book and you are satisfied and trust the care you receive, you go back again. If not, you look for someone else.
2. The advice of others. If your friends and co-workers recommend the doctor, you are likely to go there. If your friends have bad experiences, you avoid going there.
3. The advice of another professional. If you need a specialist, like a brain surgeon, you will likely follow the advice of your doctor.

You follow the same steps in looking for any other service professional. There are issues with insurance in the healthcare industry which can limit your choices unless you want to pay more. Nonetheless, you are still a consumer. Even in the worse situation, where you can't find a doctor you trust, many people exercise the ultimate right of the consumer and don't go at all.

[jeffkrol]

How do you decide on a surgeon, doctor or dentist? The same consumer practice you follow for any other service.
1. Your own experience. If you found him/her in the phone book and you are satisfied and trust the care you receive, you go back again. If not, you look for someone else.
2. The advice of others. If your friends and co-workers recommend the doctor, you are likely to go there. If your friends have bad experiences, you avoid going there.
3. The advice of another professional. If you need a specialist, like a brain surgeon, you will likely follow the advice of your doctor.

You follow the same steps in looking for any other service professional. There are issues with insurance in the healthcare industry which can limit your choices unless you want to pay more. Nonetheless, you are still a consumer. Even in the worse situation, where you can't find a doctor you trust, many people exercise the ultimate right of the consumer and don't go at all.

How about "our they in your "system" or not.....will your insurance company pay them?
Will they pay for a "second" or "third" opinion..
Keep drinking the Kool aid..

Will your ins. co. decide if it's REALLY necessary.
After using it too much will they price you out or just cut you off...
Will THEY decide what it should cost based on what they want to pay...

[GeneV]

How do you decide on a surgeon, doctor or dentist? The same consumer practice you follow for any other service.
1. Your own experience. If you found him/her in the phone book and you are satisfied and trust the care you receive, you go back again. If not, you look for someone else.
2. The advice of others. If your friends and co-workers recommend the doctor, you are likely to go there. If your friends have bad experiences, you avoid going there.
3. The advice of another professional. If you need a specialist, like a brain surgeon, you will likely follow the advice of your doctor.

You follow the same steps in looking for any other service professional. There are issues with insurance in the healthcare industry which can limit your choices unless you want to pay more. Nonetheless, you are still a consumer. Even in the worse situation, where you can't find a doctor you trust, many people exercise the ultimate right of the consumer and don't go at all.

Having recently used the services of a brain surgeon, I'd have to say, no. I was taken to the hospital, had the surgery and then met the guy who did it when I woke up. I was in no shape to talk about it before the surgery, and my doctor was not consulted. Moreover, the choices we have in these matters are severely limited by health plans and locality. In a state of 2 million people, there is one group of neurosurgeons and one hospital where they practice.

I went to considerable care to pick my primary care physician, but other than some routine exams, he has had very little to do with most of my care. Despite my being fairly well insured, most of the actual care I have had in the last 10 years has come through the Emergency Room or Urgent Care. Why does this happen? 1) most acute problems don't seem to happen during the PCP's office hours and 2) there seems to be little that a PCP can do these days, so they don't even involve him.

I have no part in the price or payment, other than being asked for my deductible.

[wildman]

My personal experience with health system:

A few years ago I found my wife on the floor unconscious. She had suffered from two simultaneous brain aneurysms.

From the time I dialed 911 to the time she was discharged about a month later we were consulted on nothing medical except to determine if we were insured and by whom.

We had insurance with a $10000 deductible. The total cost for that month came to about $330000. All was paid by our insurance plus the out of pocket deductible.

Although I didn't know it at the time it was only afterward that I found out she was being treated by, perhaps, the finest neurosurgery unit in the entire world - Mayo Clinic in Rochester Mn USA. To the credit of Mayo Clinic her recovery has been 100 percent. She had two surgeons working on her in shifts one assisting and one operating for a period of seven hours.

Here's the kicker:
In the private insurance industry she was uninsurable because of a "preexisting condition". No private insurance company would insure her. The only reason she had any insurance at all was because she qualified for a State run program set up for people in her situation. It cost a bit over $700 a month with a $10000 deductible.

What an insane system.

[GeneV]

My personal experience with health system:

A few years ago I found my wife on the floor unconscious. She had suffered from two simultaneous brain aneurysms.

From the time I dialed 911 to the time she was discharged about a month later we were consulted on nothing medical except to determine if we were insured and by whom.

We had insurance with a $10000 deductible. The total cost for that month came to about $330000. All was paid by our insurance plus the out of pocket deductible.

Although I didn't know it at the time it was only afterward that I found out she was being treated by, perhaps, the finest neurosurgery unit in the entire world - Mayo Clinic in Rochester Mn USA. To the credit of Mayo Clinic her recovery has been 100 percent. She had two surgeons working on her in shifts one assisting and one operating for a period of seven hours.

Here's the kicker:
In the private insurance industry she was uninsurable because of a "preexisting condition". No private insurance company would insure her. The only reason she had any insurance at all was because she qualified for a State run program set up for people in her situation. It cost a bit over $700 a month with a $10000 deductible.

What an insane system.

I've been afraid that because of my accident and surgery, I am now uninsurable as well if I don't keep my current plan until the new healthcare laws kick in. Even then, who will insure and what will be the costs?

[ihasa]

I am very glad to hear she pulled through. My dad wasn't so lucky, but he did have the best of care - in Trondheim hospital, Norway, near the fjord where he was fishing when he suffered the aneurysm - at no cost. This included helicopter airlift, surgery, and weeks of intensive care. There are reciprocal agreements between the various healthcare systems in Europe, thankfully.

[ihasa]

Gene, the new health care plan appears to prevent insurers denying coverage or weighting premiums against people with pre-existing conditions. The principle of shared risk ought to insure you don't pay more than the next man, if they're doing this thing properly. I see that insurers WILL be able to raise premiums for tobacco users. I can see how that is desirable, but I wonder if we're going to see ludicrously high premiums for smokers, out of step with the actual increased risk.

[GeneV]

Gene, the new health care plan appears to prevent insurers denying coverage or weighting premiums against people with pre-existing coditions. The principle of shared risk ought to insure you don't pay more than the next man.

In 2014.

[jeffkrol]

I've been afraid that because of my accident and surgery, I am now uninsurable as well if I don't keep my current plan until the new healthcare laws kick in. Even then, who will insure and what will be the costs?

They'll just "rider" out anything to deal with your brain.. just like our politicians..

[Ash]

The health economists would be looking more at actual hospital visits, costs incurred and length of stay for smokers (all of which are significantly increased to that of a non-smoker) to make their calculations. You'd be surprised how much more a smoker costs the public health system here...

I do find those insurance cost figures quite staggering - I haven't seen the likes of it here, but I do know that even with top medical cover not all incurred costs are paid for by the insurance company - there are still out-of-pocket expenses for most comprehensive health insurance packages.

1) most acute problems don't seem to happen during the PCP's office hours and 2) there seems to be little that a PCP can do these days, so they don't even involve him.

Can't do much about #1 but #2 is more of an ethical issue - although your GP may be competent to deal with some of those medical problems, the more specialised service is readily available for most people. So a GP almost feels obliged to refer patients on to a gastroenterologist when coeliac disease is diagnosed (for example), leading to some deskilling and a reduced patient contact. This is different in more remote areas, but I wouldn't expect any different in the US.

As for pharmaceutical companies, they are a double-edged sword, and research shows that GP prescribing patterns are significantly altered by pharmaceutical rep visits. However, it can and should be a personal decision on behalf of the GP to *scrutinise* the evidence presented and practice evidence-based medicine. GPs have that moral and ethical responsibility, and clearly it's not going to be perfect, but without pharmaceutical reps a GP is limited in the knowledge and experience of new and effective medications available for the management of medical conditions, both acute and chronic (they're not all out to promote life-long prescriptions ).

GPs don't have the luxury of hospital doctors who have weekly grand rounds and regular topic-based seminars to present the latest and greatest developments in the field, so pharmaceutical reps play a significant role in providing information (and of course, they know that all too well...)