SES is a factor now which contributes sinificanltly to health disparities. Why is it so hard to belive that given limited resources, someone will step in and say that the "poor elderly man" can't have that triple by-pass??

We ALL have expenses. Mortages, car payments, student loans, ect. Why is a $500/month toward YOUR own health so unreasonable for those who can afford it? I get that not everyone can afford this, so maybe a sliding scale where people pay according to income AND current health status would work. In other words, I'm sick of "paying" for the health care needs of people who knowingly don't take care of themselves. Perhaps if people HAD to pay more for their healthcare, the desire to adopt a healthly lifestyle would become something people don't just talk about.

One final point about living capitalist society, there is little profit to me made when people are generally healthy, and big pharma along with the insurance companies know this.

exactly why we should get rid of the conflict of interest of making money and health care.

http://www.acponline.org/advocacy/where_we_stand/access/hr3200_faq.pdf

I like their viewpoint, i just hope that they will have some sway in DC

Here's an article that sums up what MD's and DO's are feeling these days:

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/19/AR2009081903189. html

That's a good article. I really like the "ask your doctor" part. I think he could have given a lot better examples of decreasing reimbursement -- the only financial example he gave was of increasing reimbursement (albeit not much of an increase). I hope Washington insiders will read it.

I hate getting involved in politics, but this one really has me steamed up. I definitely agree that everyone should be entitled to some basic form of healthcare. However, as pathdr pointed out, I don't think that I should have to foot the bill for people who refuse to take care of themselves.

I don't know what the right answer is, but the current bill is not it. I think that there is no ideal program out there, but a better system would be to provide a basic level of free, preventative care for all. Given the current situation with the shortage of primary care docs, this would best be achieved by instituting some form of tort reform, and increasing reimbursements so that primary care docs can actually take care of their patients properly. As a primary care provider, there are many issues that I could, and would like to take care of in my office, for less than it costs to send to a specialist. I don't, because It would actually end up costing me money to do so.

Above and beyond that, I think that everyone needs to chip in somewhat for their own care. How many $300 dollar bottles of tylenol are given out bec. it is free to go to the ER to get the prescription for the free med? If a primary care visit cost 50 cents and an ER visit was $1, people would think twice about going. Few people would hesitate to pay $1 in a true emergency, but the ER's would then no longer be primary care centers.

I grew up in an inner city neighborhood and work in an area where my population is 80% on public healthcare programs. I see the abuse that is going on. When everything is free, people no longer value it. I understand what it means to have no money and be scrambling for food and shelter.

This is why I think that basic preventative care should be free for all (yes, all--do not discriminate against the rich, treat everyone the same). However, we have now a second and sometimes third generation of people who are so used to living off of government handouts that they do not have any concept of the value of working or of money. We need to start reinstituting those values or the country will continue on the downward trend that it is going on. It is only a matter of time before the rich man's money will run out and the poor man will have no where to turn.

Again, this is not a full solution and has many problems with it, but the current bill is certainly not it.

Rydys, I think starting with free preventative health care would be a great start to health care reform. That should increase the demand for primary care specialists which would hopefully increase compensation these critcal professionals too.

We have a good system of federally-funded primary care clinics already in place in this country. The one in my town has two sites in town, and a satellite in the most economically depressed nearby suburb. The sites are within walking distance or a $1 bus ride of just about anyone in the area who needs help, and are staffed by competent, caring docs, midwives, NP's, and support staff. This program should be EXPANDED, based on infrastructure that is already in place. We do not NEED a whole new bureaucracy to get people the care they need. Use what we have, and create some sort of catastrophic insurance for hospitalizations. I would like to see Obama's trillions of dollars budgeted for national health care go to pay the med school tuition and a decent salary for primary care docs who staff these federally-funded clinics.

Anna, I don't know what the clinics are like where you are, but the ones in my area are horrible. The nursing staff is unionized and works the absolute minimum possible. The doctors are overworked and unable to keep up with demand. In addition, they are not really "free". They bill on a sliding scale.

I think primary care should be FREE for all, regardless of income. The government makes arbitrary decisions about what the cut offs are for sliding scale, which are often very far removed from real life.

I wanted to take my kids to one of the public dental clinics here, which has a sliding scale and also has really good dentists. My patients with medicaid go there and pay nothing. For me it would have been $200 per child just to walk in the door. Although my income looks good on paper, like many docs I struggle to make it through the month between malpractice, childcare, loan repayments and basic cost of living. For some of my patients, even $10 or $20 per child is really out of the range of what they can spare, but their incomes are just above the cutoff.

I really believe that basic medical care should not be discriminatory. The government should fund the basic primary care for all, at a realistic rate, regardless of income. If someone then wants to pay extra for extras, they can have that option.

I've worked and volunteered at rural and inner city health clinics, and I would personally HATE to have to use such places for medical services.

What I would really, REALLY want to see is simply tons of money poured into public health and everything else put on the back burner. If we were honest about saving health care dollars, we'd be focusing on keeping people healthy in the first place. If everyone in America stopped smoking, didn't drink and drive, and lost 10 pounds (if they had some to spare), there wouldn't BE a health care crisis! Instead we are squabbling over who pays for insulin shots and whether some people deserve health care more than others. grrr.

That's my take. I know, I'm crazy.