Official Luthiers Forum!

[QUOTE=Shane Neifer] Hey Brock, ya have to know that Canada has a fair share of innovation as well! In luthiery alone think Laskin, Manzer, Larrivee and our very own Proulx, just to name a few. Regardless, our medical system is not the best either and it certainly is not free. Nothing works that way. It is just a matter of WHEN you pay. Our health care is federally mandated and provincially operated, the bulk paid through our taxes and the rest either subsidized (if you can't afford it) or typically covered by group insurance through work. I think my monthly bill for my family of four is about $75. But I probably pay close to 50% tax by the time the dust settles when you pay taxes on all you buy along with your income tax. I have had very recent experience with a major medical incident. Both my wife ad I are quite healthy and use the system very little. Our 1st son is the same. Then came number two, a thriving young lad that did great but would then all of a sudden plumet into a bad flu like illness that would land him the hospital for 6 to 7 days of IV to rehydrate the little gaffer. A few months of this and it was finally determined that his liver was failing. It turns he had a rare (as yet undescribed) gentic defect that resulted in the pre-programming of the genes in his liver to just shut down. So a year ago last March, he was 16 months old then, we were shipped to a hospital in Alberta, we live in British Columbia, where they took a chunk out of my liver and put it in him. Six weeks in the hospital for him and another two weeks of hanging around before we could start to head back home. I don't have clue what the costs would have been to have some of the worlds best surgeons open each of us up and start swapping organs around, but I bet it is more than my entire worth (in money anyways). Leith's ongoing medicine costs about the same per month as your insurance rates (about $12-1400/month) but is covered by Government funding somehow, we only pay to have it couriered to use every 3 to 4 weeks. The moral is, even if you are otherwise healthy, non-smoking, not entirely over-weight, somewhat fit, these things can still sneek up on you. Then on the woodwork side, 25 years in the shop, seen the doctor once. I am thankful for our Canadian system but it is also riddled with tremendous flaws that keep it as one of our countries great debates and a consistent election issue. But, hey, any Luthiers want to come to Canada, you are most welcome, especially if you are innovative! (Just throwing you a jab Brock! but it's a slow one...)

Shane[/QUOTE]


Sorry to offend you Shane... ok... let me shave a finer point on my thought.   

I am not saying CANADIANS (or frankly any other people) are less innovative than Americans. What I am saying is that we LEAD the world in venture funded research.

This is the engine that creates new drugs, gamma knives, and other science fiction type devices. Once these new products are created they are usually absorbed into our healthcare system and adopted by the rest of the world -- at least the industrial world (but lets not go down that road...).

This is the engine of innovation -- it is not a statment of our people are smarter than your people -- the world is full of smart cookies. (And, yes Canadian luthiers are great -- I can name lots of them without even thinking hard.)

I think at some level, and particularly with the healthcare system, when it is obvious that the market isn't serving the needs of its customers the mob mentality is to say "Someone's just gotta do somethin' about this!" and frequently it manifests into "Someone needs to get control over that situation" and everyone starts talking about socializing it.

The problem with this is that all that does is essentailly shift the problem from one buauracracy to another. This is no guarantee that anything is going to improve. The problem is HOW TO PAY FOR affordable healthcare.

Again, I think structuring the system to make us better consumers of healthcare should be our first and foremost goal. I bet 99% of people walking in to receive care has NO IDEA what the cost of service is or the cost of perscriptions. As consumers of healthcare we should ask ourselves -- is this really necessary? Is there a wiser way to approach this? Maybe yes, maybe no. But the thought should be there. We should not continue to use these services as if they are free. Because they most certainly are not.

I am rarely ever sick, and I can't remember the last time I saw a dr. However I know people that will run to the dr at the first sniffle. That is bad consumerism, and I think we need to raise the publics conscience to this as priority one (regarding healthcare).

Then I think we should figure out a way to give insurers the power to manage their risk in more creative ways. The only "pools" that my small business can plug into are a joke. They offer no benefit. And considering that only 11% of the population works in a large corporation then most of our employer funded citizens are on policies similiar to what my business offers.

I think there are lots of things that have not been tried and would make a significant difference. But, and I say this with the strongest of cautions, if we start monkeying with the market system that drives innovation we will be sorry for it later.

Without the promise of "striking it rick" investors will not pour BILLIONS AND BILLIONS into the new companies that are advancing care.

As soon as any kind of government instituted program limits the returns, sets price caps, nationalizes the effort, whatever.... progress will slow to a trickle (if not stop entirely).

It is a nice thought to say that healthcare is a basic right. But the truth is it is not. Whose obligation does it become to provide this right? The physicians? The tax payers? The researcher who has spent a lifetime in school and now would like to earn a decent wage? The school teacher who invests her money in medical mutual funds hoping that MAYBE someday she can afford to retire. Exactly who are we going to sacrifice to provide this "right"?

Again... it is a nice thought and it shows that at least our heart is in the correct place, but it is not a "right". We need to put our BRAINS on this problem, not our hearts. I am confident that if we do and we can let the market "do its thing" with less restriction -- not more that we will conquer this problem.

But now everyone is just in a big squabble about what to do.

The hunger and promise of reward are what drives our most creative people. That MUST remain in tact for any solution to truly work.

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Brock Poling
Columbus, Ohio
http://www.polingguitars.com

Over the years I've turned down an number of jobs in the US (I did take one at Cornell for a year). I couldn't even consider working in a country where the provision of healthcare was a commercial operation rather than a socialised one, free at the point of delivery on the basis of need alone. I have no doubt that commercially based healthcare can provide cutting edge medicine at the top end, it's those people at the bottom of the income pile that suffer under this system even with the supposed safety nets. I know socialism is a dirty word to many but socialised healthcare is the truly civilised system.

Colin

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I don't believe in anything, I simply make use of a set of reasonable working hypotheses.

Colin, I agree with you 100% and I am a dyed in the wool
libertarian and have an extreme dislike of social programs. There just seems to be something imoral about health care for profit.

[QUOTE=jwsamuel] [QUOTE=Brock Poling] I am confident that if we do and we can let the
market "do its thing" with less restriction -- not more that we will
conquer this problem.
[/QUOTE]

I disagree with you somewhat on the above, Brock. One of the problems
we have with a totally market-driven system is that the private sector is
driven in its own self-interest, not by what is best for the population as a
whole.

Last year's flu vaccine problem is a perfect example. There is a reason
that no US pharmaceutical firms were producing the flu vaccine last year. It
was not profitable for them to do so. There was no reason for the pharma
companies to spend their resources producing a vaccine that people
would get one time. Instead, it is better for them to spend their resources
producing medications that people will take on an ongoing basis.

In much the same way, a lot of the rising cost of healthcare in this
country has been driven by the phramaceutical companies who are
producing expensive new drugs and marketing them directly to
consumers. In many cases, there are far less expensive drugs that will do
the same thing but when doctors try to tell patients that, the patients see
them as being uninformed and just move on to another doctor.

Hospitals are the same way. Without regulation, hospitals are all quick to
purchase expensive new equipment to keep up with their competiton. In
many cases, the equipment is not needed in the market area, so the
hospitals then have to work to build demand for services that are not
really needed.

MRIs are an example. There was a study a couple years ago that showed
there are more MRI scanner in the Philadelphia area than in the entire
country of Germany. We just don't need that many MRIs in this city, but
too many hospitals and MRI centers have spent millions of dollars on the
equipment and they then have to build demand for the scans, at $1200
-1500 each.

Jim[/QUOTE]


I don't think we disagree that much. I openly admit our healthcare system is broken.

Yes, I also agree that the market is in it for its own self interest, but generally speaking when this occurs this usually creates new opportunities that get exploited by more "efficient" businesses. I see the flu shot problem to be more of a short term aberration of the market. One that will either get fixed by raising the price of the vaccine, or as the demand for the shots increase a market worthy opportunity will be created.

Again, I am not saying that even my "perfect capitalism" model is not without its drawbacks. Healthcare is a complex beast.

I also agree with you on the MRIs and hospitals feeling that that have to keep up with the jones'. I don't know about where you live, but I live in a place that have 3 hospitals who each claim to have the "World's Best Cardiac Facility". I suspect you do too.

That is bad consumerism and silliness.

And if you really want to get a spirited debate going... Start talking to hospital administrators about Surgery Centers. They will drop their clipboards and pummel you.   

_________________
Brock Poling
Columbus, Ohio
http://www.polingguitars.com

[QUOTE=Paul Schulte] Colin, I agree with you 100% and I am a dyed in the wool
libertarian and have an extreme dislike of social programs. There just seems to be something imoral about health care for profit.[/QUOTE]


There is no free lunch. Someone has to pay.

Again, progess costs money... lots of it. And if you don't give the opportunity to investors to earn a return you must ** take ** the money from someone else.

And that is not immoral?

Again.. I understand the emotion that drives these comments and I think the compassion is well founded, but it is not the solution (at least as I see it).


But you know..... now that I think about it.....

I do see one thing where I think the government should step up. And that is in stockpiling enough vaccine to make the threat of biological terrorism impractical...

but I am not sure if this is a health issue or a defense issue.... and I don't want to wander into even deeper political water.

Brock Poling38645.4943171296

_________________
Brock Poling
Columbus, Ohio
http://www.polingguitars.com

Whatever happened to the days where a doctor would take a bushel of corn in exchange for services rendered?


Yes someone must pay for progress, and certainly every company out there making medical suplies, be it gauze or surgical machinery and equipment is looking to make money on selling their product. That's part of what drives the economy. But the weird twist is that they can set whatever prices they want, amnd make as much profit as they want because the competition isn't huge in the industry, and a lot gets paid by...you guessed it...us and our insurance companies when we require the services rendered.
But health insurance is only one thing that shows how out of control our economy is. Have you folks looked at real estate the last five years or so? My home was just recently appraised at FOUR TIMES what we payed for it only 8 years ago. Four Times. Everything is going up...utilities, insurances, property. Everything that is, except wages for the lower income and lower-middle income workforce. I see huge bonuses and incentives for executives and management, while the raises for the lower levels are held back, (I'm not talking about where I work currently). I love the way increases at many places are percentage increases. That's just wonderful for lower-paid people. Really gives them a leg up.      
The former president of BCBS of RI was forced to leave because he ripped off the general public, and given a multi-million dollar severence check. What gives?
How about some REAL trickle-down $ Corporate America? Something more than a drop or two for America's worker's parched lips would be great for a change...

I agree that you have to allow profitabilty in the medical world, but perhaps if anything, the government should limit it to keep costs down for the general good. There has to be some balance. There is none currently.

_________________
"I want to know what kind of pickups Vince Gill uses in his Tele, because if I had those, as good of a player as I am, I'm sure I could make it sound like that.
Only badly."

Terence for PRESIDENT !

_________________
"I want to know what kind of pickups Vince Gill uses in his Tele, because if I had those, as good of a player as I am, I'm sure I could make it sound like that.
Only badly."

Honestly, Brock, I don't see any 'major advances' being created in the health care provision system. Legislating it more strongly, placing limits on it as a huge returns investment opportunity...I say 'so what, who cares?' if the net result is better health care for more people. Advances in medicine are a seperate issue to what is and isn't covered by basic insurance.

You rightly say there is no free lunch, but basic care can be paid for by the consumers at a not entirely insane cost (and frankly, some of the numbers quoted here are really quite crazy). It would limit huge investment profit opportunities in the field of healthcare provision, but not in the field of healthcare innovations, therapy, etc. Frankly, I see nothing immoral about that. There's no moral or ethical perogative that states that financial returns must be available in every human endeavour. In this case, the returns would be rather less tangible, but no less real.

Ultimately, I believe innovation will continue regardless, because research, clinical trials, biotechnology, pharmaceutical development, etc. is a seperate world, a seperate structure from the health insruance and provision biz. They both deal in medical technology and care, to a degree, but they're wholly seperate financial worlds. Even doctors who do research do so in addition to their patient care. Income from one is not linked to income from the other, in any way.

The current NL system is only state controlled to the extent that there's a predefined level of care that everyone is entitled to, and that everyone has to pay for. It's a public policy decision. Add the fact that a significant portion of insurance companies here are not publicly traded, and do not operate to satisfy stock holder desires, and there's no huge problem there. The companies that do, still have the lucrative supplemental insurance market open to them, the potential for working with specific private clinics, and hospitals themselves are free to innovate in the agreements they make with any and all insurance companies. Groundbreaking research is still funded from the same sources it always was, and is unaffected, as is the drive. Right now (although I fear that may change), medical specialists are often private entrepreneurs working within hospitals, and charging per performed intervention, meaning that those who work harder get paid more, and that's one of the main reasons I don't see moving towards a strict 'salary' system as working.

You claim that the system would crumble with stronger government involvement, but I'd say that there's no evidence it would. Plenty of solid, strong research is undertaken in other countries, and the reason the US remains an engine of innovation, frankly, is because it's a good place to do business, and has legislation and tax levels that benefit investment and corporations strongly.
At least we all agree the current system ain't doing what it needs to do, eh?

At least everyone agrees the system is fairly broke, eh?

;-)

Anyway, I think that's about the last thing I'll say about it.

[QUOTE=Brock Poling]
Sorry to offend you Shane... ok...[/QUOTE]

Brock, I don't think any offence was inteneded on your part and absolutlety no offence was taken. We can debate these things without getting feelings hurt and we should be able to express our feelings without the concern about who will stomp off into a corner! Right?

A couple of other points, my wife is Physical Therapist, her second degree, she is also a marine biologist. We have a lot of discussions on issues such as private versus public health care. One significant issue about private practice(and most Physiotherapy in BC is no private, although my wife works as community physio so is public) is that in order to pay the rent and for the equipment and admin staff, your own wages etc. you have to pump the people through, another patient (is this right one Lance? ) every ten to fifteen minutes. In the context of a doctors practice a lot of cases such as minor flu, minor cut, minor infection, etc. could be addressed in that amount of time. But if the service is expensive then people will start to self diagnos and medicate so won't be coming to have these issues addressed. So the issues that are more complex may not get the appropriate attention they require/deserve as the system is then driven by the buck!! This is one the big struggles we are facing in our countrie's debate, where is the fine line and how do you walk it?

Not having two degrees like my wife, I always struggle with the arguement about investment in education and the right this gives you to make huge salaries. It kind of inferrs that only people with the financial ability/support to attend college/university have really taken the time to fully understand their "trade" and therefore DESERVE the much higher return. I am a journeyman carpenter, I have a college diploma in fish and wildlife management, I am presently working in occupational healh and safety and am published in such prestigious journals as Occupational Medicine out of the UK. I don't have a great degree of advanced education, just lots of experience and I think thoughtful insite and investigation abilities, but I feel that myself and others like me and different than me, contribute just as much to the WHOLE of society as doctors and hospital administrators. Where would these people practice without carpenters, electricians, plumbers etc? How could they maintain their buildings without garbage collectors and window washers? How would they find peace without luthiers and muscians? That is what society is all about, you diversify your peoples so that all aspects of your communitie's requirements are covered off. Some people have more responcibility than others and should be paid more for that, but formal education alone doesn't, in my books anyway, give you the right to higher wages. I could tell you the story of the family doctor that delivered (I should attempted, thank the heavens for nurses!) our first son. She came up from the US, academically superior, practically?....I wouldn't let her carve the turkey! I don't know where she is anymore but hopefully none of you have experience that type of thing.

Thanks for the great debate! I am off to bend guitar side now....

I remain.....Shane

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Canada

Shane: plumbers and electricians make very, very good hourly wages, y'know. And I know of plenty liberal arts majors and scientists who make a whole lot less ;-)

I think, when it comes to doctors, that they 'deserve' the healthy salaries for several reasons: 1) the years of training required. Most don't start earning until they're in their late twenties, early thirties, meaning they have 'lost' income to make up for, and often large loans to pay off, 2) the burden of responsibility, often life-and-death decisions, 3) the expertise, and cost of maintaining said expertise, and 4) the hours worked (80+ hour workweeks are still all too common, although this is hardly limited to medical professionals.) Of course, this doesn't mean all docs are created equal, but hey, y'know, they're just human.

Yes, it looks to me that there are lots better and easier ways to earn a physician's salary.

_________________
Brock Poling
Columbus, Ohio
http://www.polingguitars.com

Brock, I do agree that doctors and mfgs. of health care
products deserve to profit from their services. To state more clearly I think some costs can be saved by removing the insurance middle man. Insurance companies are solely driven by profits and conribute nothing to overall health care but increase overall health care costs.
      There are other aspects that contribute to the overall cost of health care (at least in the U.S). One is the liabilty insurance (that insurance word again) that doctors are forced to pay because of the sue happy
society we live in.
            Two, is the American Medical Associations lobby in Washington which controls
how many students are accepted into medical school in order to keep demand high (and therefore prices for their services) they operate what is essentially a cartel. There is no reason why there shouldn't be a doctors office right next to the local 7 Eleven.

I agree with you on the insurance companies. I suspect that is where the bulk of the problem lies, but I can't confirm that.

Pork barrel politics + Insurance = Unaffordable medicine

Just a thought though on the malpractice insurance. My brother is a malpractice defense attorney (he defends insurance companies, hospitals, drs, etc.) and you wouldn't believe the cases he gets. He mostly gets the "unwinnable" ones because he has a special talent for pulling a rabbit out of a hat and winning them (or settling them cheap), but some of these people deserve big damages.

And, my dad got hurt at work a few years ago (run over by a semi truck) and ultimately died of complications related to it. The company was nothing but jerks to him. Denied every claim at least 3 times, and were just real pricks.

So I have kind of come around on the tort issue. I am much more in the middle now on this subject.

So while I agree the world is sue crazy, some of those people really have been wronged and should be entitled to significant damages.

_________________
Brock Poling
Columbus, Ohio
http://www.polingguitars.com

Life isn't fair to all. It never has been. It never will be. But we should keep trying to make it better. The only problem is that those who have the power to effect change don't see the problem at the level of the typical person. They're clueless. They're part of an unspoken Cast system in the U.S., and too frequently they can't relate to those who struggle to stay ahead of debt. I know someone who complains about how hard their life is, and yet the purchase a new BMW every 2 years. Some say it's all a matter of perspective. I say let's put everyone on the bottom for a year and see how they view life afterward. We would have a different society. Our values would change.
Hey...did you know that some basketball players now want a stipend to pay for the clothes the NBA wants them to wear to look professional? Where have we gone so wrong?

_________________
"I want to know what kind of pickups Vince Gill uses in his Tele, because if I had those, as good of a player as I am, I'm sure I could make it sound like that.
Only badly."

Legitimate claims are necessary, its the 90% (made up figure, but probably close) greed claims, spurred on by money hungry litigation lawyers that are piling on the costs of insurance.
We live in a very greedy society that has its priorities totally screwed up. Like everything else, though, the pendulum will swing back eventually, but a lot of damage will be done, especially to the middle and lower class, before it happens.



The Golden Rule would allieviate a lot of our problems.

Ron old man38645.729537037

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OLD MAN formerly (and formally) known as:

Ron Wisdom

Somewhere in the middle of Arkansas......

We've got free healthcare.

Though lately they're encouraging private insurance if you can afford it. So if you want to choose your doctor, have a private room with ensuite, not go on the waiting lists etc, then private is the way to go. My sister had one kid under the private scheme, and one under free healthcare, she had to pay the hospital $300 under the private scheme that the insurer wouldn't pay. She had a nicer room but the level of care was the same.

Seems like your health care system could use some of that innovation Brock was talking about.

Paul, how is it paid for? There has to be high income tax, or property tax, or something to foot the bill.

Ron

_________________
OLD MAN formerly (and formally) known as:

Ron Wisdom

Somewhere in the middle of Arkansas......

Jim for President!!!!!!

Ron

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OLD MAN formerly (and formally) known as:

Ron Wisdom

Somewhere in the middle of Arkansas......

It's paid for by taxes (naturally ). They tack on a "medicare levy", a percentage (I think it's about 1.5% above a certain threshold) of your taxable income, and they deduct it at tax return time so it's kinda painless. It means people on low incomes get the same treatment as the wealthy, and pay very little if anything for healthcare that's as good any in the industrialised world.

Of course, most of our hospitals are government owned (paid for with other taxes) which helps the system run.

Did I mention that we're at the top of the list of the most highly taxed in the industrialised world , but I guess you get what you pay for.

[QUOTE=jwsamuel] [QUOTE=Brock Poling]
So I have kind of come around on the tort issue. I am much more in the middle now on this subject.

So while I agree the world is sue crazy, some of those people really have been wronged and should be entitled to significant damages.

[/QUOTE]

The key is not to outlaw damage awards, as the insurance companies want, but to put some accountability on the people bringing the suit. Right now, anyone can file a malpractice suite and if they lose or it gets dismissed, they suffer no financial loss.

Now, the "Jim Samuel Plan" would require the person bringing the suit to post a bond equal to 10% of the amount for which they are suing. If they win the case, the bond is returned. If they lose, the bond is forefeited and goes to the defendant.

Now, your first thought is that such a practice would prevent poor people from filing legitimate suits. I would allow bondsmen to put up the money for a plaintiff in exchange for 15% of whatever award the plaintiff won. I would also limit the attroney's percentage to 25%, though attorneys could post the bond themselves to get the additional 15% ad get themselves back to the 40% they now take.

What my system would do is force attorneys to carefully evaluate a claim before they filed suit and to only file suits that they would have a high probability of winning. They would no loner file the baseless suits in hopes of gettign a settlement because they would risk losing their bond.

Jim[/QUOTE]

That works for me.      Seems very reasonable.

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Brock Poling
Columbus, Ohio
http://www.polingguitars.com