Sunday, August 16, 2009

Conspiracy Monday: Doctors Want to You to be a Communist and Kill Your Grandmother!

The lies, distortions, and conspiracy theories being used to frighten Americans away from universal healthcare are really getting on my nerves. While there are some legitimate concerns about U.S. healthcare reform, the astroturfing efforts being carried out on behalf of corporate insurance interests are based almost entirely on scare tactics and misinformation. Just a few of the factoids that are floating around:

Socialized medicine is the slippery slope to socialism, or communism, or facism.
If you really believe this, it means you have been so thoroughly brainwashed by rightist propaganda that you're pretty much beyond hope of recovery. Nothing will convince you that health care is not just a privilege or a decadent indulgence, so I'm not even going to bother. Let's move on to arguments that aren't completely retarded...

The elderly will be denied care, or even euthanized against their wishes and/or the wishes of their next of kin. At best, doctors will pressure family members to let the patient die - to save money.

This would violate the whole Hippocratic thing they've got going on, but if you really insist on believing that most health care professionals are psychopaths in lab coats, there' s not much I can say that will convince you otherwise, is there? I'll just skip it. Here's the bottom line: Whether they're being paid by insurance providers, the state, or patients themselves, doctors still make a lot of money. Every service they provide puts more money in their pockets. So they don't want to talk their patients out of receiving more health care. If anything, Americans should be concerned about doctors providing more services than are strictly needed. Which brings us to the next argument...

People will take advantage of the system by seeking treatment for minor complaints, and/or become irresponsible about their health.

Good old-fashioned fear of doctors keeps most people from taking advantage of free health care. And people will not dance around on rooftops or stick forks into electrical outlets just because they know there's some free health care waiting for them. As for those of you who are concerned that AIDS patients will receive free treatment when they're clearly godless mucksuckers who should just die? Fuh cough.

Universal health care means fewer doctors, a lower standard of care, and longer waiting lines at clinics and hospitals.
No. Though Americans are being told horror stories about the endless waiting times at Canadian hospitals, the truth is that such lineups occur mainly in busy metro-area hospitals or clinics - just as they do in the U.S. and other countries. The average Canadian clinic is indistinguishable from American clinics when it cames to wait times and quality of care. Having grown up in the States and having lived in Ontario and Alberta for the past decade, I'm not just guessing. I have had no problem receiving timely, high-quality health care in Canada. And I don't have to live in fear of losing my insurance coverage.
As for doctors, where are they gonna go? The U.S. has been siphoning off our Canadian doctors for years, but U.S. doctors will just have to stick around, won't they?

Doctors will be told where to live. Show me a single Canadian or European doctor who has been ordered to live or not to live in a specific area, and you've won this one. Doctors can live where they please.

Taxes will increase. If tax hikes are more troubling to you than the lives of uninsured Americans, fine. You have to live with yourself.

Doctors will be told how they can treat their patients. Um, they already are. There are standards, regulations, and laws already in place to control how doctors treat their patients. A single-payer healthcare system isn't any different. No procedures will become off-limits just because taxpayers are picking up the tab.

Medical innovation will slow to a crawl or grind to a halt, because there will no longer be sufficient financial incentive. We might see fewer worthless pharmaceutical products like this one, but there will still be a huge market for life-saving and life-enhancing procedures and products. The major pharmaceutical manufacturers might make fewer billions for the first year or two as consumers adjust to the new system, but I think they'll survive.

12 comments:

NIP said...

While there is much not to like about universal, government administered health care (I'm Canadian, ask me how well that system really works for people with serious acute or chronic diseases), could the rabid objections to Obamacare be a smokescreen for the rabid anti-abortion, anti-contraception crowd? Yeah, it's "wrong" to murder abortion doctors, but "could anyone really blame someone who actually went and shot one, or firebombed a clinic, or stalked and harrassed clients?"

Not saying there's a conspiracy, but maybe see what vested interests besides the insurance companies might have a dog in this fight.

Yaron said...

"Show me a single Canadian or European doctor who has been ordered to live or not to live in a specific area, and you've won this one. Doctors can live where they please."

Ahem, so if I find a medical doctor in Canada or Europe who was put in jail (told where to live) or had a restraining order put against him (told where not to live) then you'd give up? ;-)

"Doctors will be told how they can treat their patients"..."No procedures will become off-limits just because taxpayers are picking up the tab."
That's sort of the only partially valid point (against) from what you list here.
My experience is mostly in Israel, where there is a small number (4) of "medical funds" that most doctors work with/for. And they do, over time, try to make it harder to perform complex/expensive procedures, and mandate that doctors will use cheaper medication when there are alternative that are a little more effective or convenient but also noticeably more expensive.
Which is all valid, this is after all a business. But the competition, however small, does slow this down and limit it. Patients can move to a different fund/provider. And a doctor who feels too fed up could also potentially move.
Once you only have a single provider who makes all the decision, and pays all the doctors, this little pressure would disappear as well.
So they won't remove good treatments, or require the use of only crappy drugs, since that will be going too far, and since they will still be in the business of keeping people alive and well. But they may more easily remove all those slightly better and nicer drugs. And all those treatments that improve things, but aren't life saving, so doctors won't do them once they're told that they don't provide any extra payment beyond the basic one of seeing a patient...
Not a very big issue, hopefully, but someone should think about this in advance when writing the laws, if you do go this way.

Yaron said...

(Something in my comment bothered me, and I just figured out what)
Err, when I wrote "if you do go this way", I meant "they", not "you".

Kagehi said...

Yeah. We get the same thing here Yaron, with respect to people "preventing" doctors from doing things they probably should have. Its called "private insurance companies, who would rather delay, derail, or deny, than pay for the cost of a procedure they deem 'unnecessary'." Its usually also something like preventative care (wouldn't want to prevent them needing even "more" money, now would we...), or test/expenses that are considered secondary to the problem. You know, like actually figuring out why the person is bleeding internally, instead of just repairing the damage, because finding a disease might cost the company more money, or refusing to supply catheters, once what ever crisis it was that forced the person to have to use them all the time was "over" from the perspective of the company, etc.

If people die waiting for treatment in the US, its pretty much certain that some pencil pusher either a) tried to delay them until they gave up, b) tried to prevent the test or treatment, or c) decided that it wasn't "cost effective" to give them something that they, having their business degree, and no medical expertise at all, thought was excessive and unnecessary.

Most of the crap these morons are whining about are things likely to happen *in* the existing system, and less likely under a program which makes guarantees that you will get treatment, instead of being told you either can't pay for it, so won't get it, or its too expensive, if you badly do need it.

Oh, and NIP. Never underestimate the unfortunate reality that some of the right are racists, and scared to death of anything that might "look" vaguely communist, so a liberal pushed bill, that isn't funded by multimillion dollar companies, introduced by a black man... The only thing that would have set these idiots off more would have been if he *was* a Muslim, or worse, and atheist, and proposed it. We are dealing, to some extent, on the last bastion of 18th century very intolerant of differences Christian religious rhetoric, and a vague, but seething, racism, and someone just told them that, to follow the local plumbing code, someone is going to need to add an 8 inch hole to one of the castle walls, to connect them to the sewer system. I.e., someone is invading crazy land, and threatening to breach the walls of god's fortress. Oh the horrors! lol

SME said...

NIP wrote: could the rabid objections to Obamacare be a smokescreen for the rabid anti-abortion, anti-contraception crowd?

Yes. Yes they could. And I suspect the same force is behind the rather flimsy allegations about adverse reactions to Gardasil.

Yaron wrote: Ahem, so if I find a medical doctor in Canada or Europe who was put in jail (told where to live) or had a restraining order put against him (told where not to live) then you'd give up? ;-)

Um, no. Not quite what I meant. It would only count if the doctor was jailed for refusing to pack up and move to a doctorless area, or for refusing to vacate a doctor-saturated area. But if you do know a doctor who has a restraining order against him/her, that's every bit as creepy as a doctor being told where to live....

Canada has cut costs by allowing "no brand" drugs on the market, but they don't seem to be inferior to the name brands in any way.
As for procedures being disallowed by the government, as Kagehi points out, that already happens in the U.S. - but it's the insurance providers making the call. So I don't think there'll be much of a change for the worse there.
Even socialized medicine remains somewhat competitive, because people still have their choice of clinics and hospitals. Bad clinics don't get the business.

Kagehi, the "waiting time" argument is the weakest of all, IMO. Aren't moderate wait times for a prodedure you know you're going to get infinitely better than not getting the prodedure at all because your insurance coverage (if you have any) isn't sufficient?

Kagehi said...

As at least one person put it "to" one of the people on national TV the last few days, the honest truth is that the people behind some of this where the same ones supporting the insanity of McCarthy, who liked Reagan's speech at the start of his time as president, when he said, "The government isn't the solution, its the problem.", and fought to try to prevent the passing of Medicare too, when it was proposed.

They want a government so small it can be steam rolled by their own interests, privatization of *everything*, and no social programs *at all*, which is funded by tax payer money. They are believers in a failed idea. Capitalism without *any* controls, with the financial and economic equivalent of the old Privateer ships, where if you are stupid enough to buy something that isn't what you expected, hurt you, or killed you, its your own damn fault. Worse, if you can't pay for the best, you don't deserve even the adequate.

They are literal believers in the idea that **no** social programs at all are acceptable. Basically, the same idiots that, a number of years back, apposed a school program, that wasn't even *funded* by the government, but by a local neighborhood group, because it gave "free" milk and cookies to underprivileged children, who often didn't get one good meal a day. We are, in a word, dealing with the political equivalent of Ferengi here.

In fact, I think I know which one this whole mess has been about:

#239 - Never be afraid to mislabel a product.

Or, one of the unofficial ones? - "A good lie is easier to believe than the truth."

Rick said...

I am going to stop on this one. I live in Alberta, and do not have employer insurance. Numbering your conspiracies 1 through 8, here is how I would address them:

1) uhm, yeah. socialized medicine is socialism. It isn't being called NON-socialized medicine, or capitaized medicine or whatever. The fascism/communism toss in is silly, most people cannot define fascism (other than it was bad. nice try). So this one is not a falsehood, if the first one is true.

2) well, I can tell you, when my wife was ill, I was given 15 minutes and was under a lot of pressure to pull the plug on her. which I did. and I have no idea if I did the right thing, only that I did the thing a doctor whom I had never met before told me to. and no discussion was given of any other possibilities. So this one is at least a real possibility, since I had it happen to me.

3) Well, if you provide a system that can be abused, it will be. people put homeless people in asylums cause it was cheaper, and got them out of their hair. I don't know how the abuse will look, since the details are where it happens, but it will happen.

4)See number 3. yep, will happen. I read a recent op-ed in detroit that they were concerned that wait times in ER had hit 1.5 hours. heh, last time I was in the ER it was 11 hours. my Friend who was sent by the local medicenter due to "the seriousness of your condition" waited 14 hours. now, even if the heart attacks get thru in 5, that is an average of 6 hours. If resources are not infinite, they will have to be rationed. the question here is: do you want the market to do it, or a bureaucrat? for different people, those are each boogey men. also, we keep hearing stories of pregnant women being sent to montana (of all places) to have babies cause our baby units are full. rationing is happening.

5) never heard this. seems insane. I know here, they offer bonuses to general MDs cause of not having enough coverage in rural areas. I also know my cousin (an ortho surgeon) can't get full time work due to lack of OR time. not sure how this works to this, one way or another, just added to the discussion

6) This is a legitimate concern. resources are not infinite. if you tax them away for health care, everything else will suffer. I can live with myself for being realistic enough to understand this.

7) ok...so the complaint about something bad is refuted by "bad things are already happening"? I think this is a legitimate concern. I have cousins in britain, and they often complain that treatments they want are available in the US "for too much money". this would appear to support the "factoid"

8) I am not sure how the financial incentives affect the development of new treatments, since you cannot plan a lot of the advances that come (ie: rogain seems to me was a heart treatment, viagra was for...hair loss? something like that, the final results were side effects.) but it does take a TON of money to do this, and the argument seems to be, lets make it more expensive/less rewarding. I don't think this will result in better treatments.

I know you are are used to taking on "whackjobs and weirdos" but there are a lot of quite legitimate concerns about the government (who does such a good job with the IRS and social security) running another 1/6th of the economy.

Not much of a whackjob

Rick

Monica said...

This blog is extremely entertaining, and I generally enjoy your articles a great deal. This one caught me off guard a bit, as I don't think the debate for our neighbors to the south is just about health care reform.

Your point #1: "Socialized medicine is the slippery slope to socialism, or communism, or facism".

The equivalent Canadian statement: "Privatized medicine is the slippery slope to 2 tiered health care, where the rich jump the line".

The statement you find most menacing depends who your bogeyman is- rich people or the government.

I believe a lot of the blowback we're seeing in the US right now is about the accelerating pace of borrowing, spending, and steamrolling unread bills through the legislative process (stimulus, cap and trade, now health care). I'd say if the Americans want to reform a system that currently works for most, they're not wrong for wanting to take their time and do it right.

While I don't think the American system is ideal, socialized medicine has some serious problems. For example, to treat many chronic illnesses, the expensive part is not necessarily the doctor visits (which the government pays for) but the prescription drugs and medical devices (generally not covered outside of a hospital). This burden affects lower income people disproportionately.

I'm also an Albertan, check out this handy government resource http://www.health.alberta.ca/documents/OOCHSC-Info-Sheet.pdf

As Colby Cosh says, "Canada doesn't have 2 healthcare systems. That panel's whole job is to deny treatments the monopoly does not happen to offer."

Monica said...

Oh, I forgot to make one other point regarding government health care where I live: when "rich people" don't get to use their resources to "jump the queue" to get access to the health care they want, people use their connections to get what they need.

When my husband was diagnosed with a rare genetic form of diabetes, the waiting list through our family doctor to see a specialist was 9 months. We mentioned this to a family member who also happened to be a doctor, and saw a specialist within the week.

Is "who you know" more fair than how much money you have, or how good your insurance plan is?

SME said...

Hi Rick, I thought I'd respond to your comment point-by-point, since you brought up some important issues:

1. All I'm saying is that socialized medicine does not necessarily presage the arrival of full-blown socialism or communism. The government can administer some services, like public schooling and healthcare, without everything being federalized.
As Monica points out, people are defending the current systems by opposing any and all proposed change, rather than learning to compromise. There's certainly no harm in taking the time to do this right - weigh options, make gradual changes, etc. I agree that jumping into universal healthcare quickly and with both feet isn't wise. I would just like to see more debate over the realities of socialized medicine, rather than all the fear-based rhetoric and bully tactics.

2. Obama's plans for reform originally included increased resources for end-of-life counseling and support for people in just that situation, but the scare stories about involuntary euthanasia and "death panels" so terrified Americans that this provision had to be yanked off the table. Ditto for living wills. That's a shame. With a living will, your wife's wishes would have been given primary consideration. And with end-of-life counseling you would have had the opportunity to make a more informed decision that you could be comfortable with.

3. There will, of course, be some abuse of universal healthcare. There is in Canada, as in the example Monica gave of people using their connections to jump the line. But being prepared for that and taking as many precautions as possible seems better than scrapping the whole idea.

4. There are measures being taken to reduce wait times. Again, it's not something that happens in every hospital every day of the week - it depends on the time and the place. But general shortages of nurses and aid staff are a major problem, and some provinces are now making it easier for healthcare workers who received their training overseas to be licensed in Canada. I'm guessing doctor shortages won't be as much of an issue in the U.S. than they have been here, because that's where all the doctors end up.

5. This one really is just silly, but it's been expressed by Reagan so it caught on with some folks. Of course the market will determine, in part, where you can practice, but you will not be assigned like a military recruit. That's just not how it works.

6. Paying for healthcare may mean the federal gov has to cut down to single-front wars in the future, maybe trim the defense spending and pork barreling a little, and maybe think about reducing the deficit. Is there really anything more important to a nation than healthcare? It doesn't seem that way. My entire life, I've heard Americans demand better access to healthcare. They've mostly been ignored, and now they're being shouted down or called godless fascists. It's absurd.

7. If there's enough of a need and a demand for a certain procedure or a certain drug, it will be available. In a free market, even socialized medicine has to respond to free market forces to a great extent. Otherwise, the system fails.

8. Canada and France have been at the forefront of pharmaceutical innovation alongside countries with "capitalized" healthcare (and since people insist on calling universal healthcare "socialized", why not call the U.S. system what it is - corporatized?). The demand for new and better drugs and procedures won't go away, and I see no reason to believe that the major pharma operations won't continue to make enough money to fund their research. Like I said, some of their more frivolous products (the ones that are developed intentionally, I mean) might go by the wayside for a while, but in the end there will still be a huge market for their stuff.

Anonymous said...

SME....the healthcare bill that passed here in the US has very little to do with socialized medicine. It was written by the insurance reps, it is a subsidy giveaway to the insurance firms.....

your article is mainly correct, but dont imagine that it relates to the bill that just passed.
it is a law to force citizens to buy from a private company something that they may or may not want.this law is illegal.

There is a mindset to limit care for the elderly....Tom Dascle wrote about how certain surgeries ought not be performed after a certain age , etc....

When the country is broke, the changes will result in rationing.

Anonymous said...

Adding 30-40 million new customers to healthcare plans....without adding new doctors, and even reducing the number of docs ( many will quit)....this, combined with myriad bureaucracies and budget cuts...will ration health, and will create a near death panel -esque scenario

the money the CEOs will make will be flushed down toilets in Fiji, Monaco, and Acapulco...