Health Care Reform [Archive] - Colony of Gamers

07-17-2009, 04:44 PM

Are government services typically run with the goal of producing a profit?
Government services are typically run with the goal of staying within budget. At least they are if they're run well. And if "staying within budget" is made easier by letting some people die, then there's an incentive for letting people die.

Ask any government employee, and he or she will tell you: they get a lot of pressure on costs, especially these days. Defense attorneys in my town can't get expert witnesses any more unless their clients can pay for them out-of-pocket. Courts are talking about moving to four-day weeks. Government agencies may not be efficient at limiting costs, but you're betting on the government being too incompetent to realize it can save money by letting you die, not on its indifference to costs.

I don't see the government worrying about profits above all else though. For evidence of that you can look at pretty much every social program that exists. If the government wanted to cut costs they could just end or severely restrict Social Security and Medicare and the like and save billions.

Ultimately the government is at least slightly beholden to the people. Health insurance companies are beholden to profits. You can't vote out the board of directors of Blue Cross when they enact policies that kill your mother.
Oh please. If you believe Blue Cross is likely to kill you or your family members, you will switch health insurers or stop paying for health insurance. There's no reason to continue paying for health insurance if it kills you.

But if you think a government agency might kill a family member, that's only one factor in a host of others governing your voting decision. Very few people base their entire voting decisions solely on the quality of government healthcare, and those few are often outnumbered by budget hawks. Remember welfare reform: although there was a large body of people who were effectively single-issue voters for increasing expediture on welfare, they were outnumbered by people who were tired of spending so much money. As for "beholden to the people," that's only good if your medical intervention is a popular one. Wait until you're eighty and need chemo because you smoked all your life, and see if the general sentiment isn't, "Serves him right."

johnperkins21

07-17-2009, 05:42 PM

That's where I think the real problem is. For me, providing health insurance is merely treating a symptom, and ignoring the disease: the inflated cost of health care. Unfortunately, it would seem one has enabled the other. And, on top of that, it's not as though it is free; this is coming out of taxes and, with the sort of costs the CBO is projecting, those are bound to go up.

This. The number one problem with health care is the wildly inflated price. We need to somehow get cost of health care down to a much more reasonable level before we even begin to contemplate national health insurance.

Seriously, why does a routine doctor's visit cost around $150 when they only see you for between 3 and 10 minutes? I'm sorry, but nobody's time is worth $900/hour.

digitalErich

07-17-2009, 06:00 PM

I think there a lot of ways they could really cut down on healthcare costs, a couple of these are pretty experimental (especially 3) so I would never consider them likely in the near future, but for the sake of discussion:

1. Cap litigation rewards. There would be scales of course and wronged patients would still be compensated, but the need for every surgeon to be paying hundreds of thousands of dollars worth of insurance per year is one factor driving up inpatient stay costs.

2. Related to the above, move medical litigation out of the courts. Set up some sort of patient services centers that can deal with 95% of medical disagreement. What they can't service would move up to the courts.

3. Institute government controlled prices for procedures, structured something like the federal reserve with knowledgeable people picked for lifetime appointments. No more over-charging with the expectation of partial payments or denial cat-and-mouse with the insurance companies. You can only be charged X for procedure Y and if that was a valid treatment the insurer would have to pay X if it's covered. In other words move medical decision making back to the realm of the providers via a single, unified fee schedule.

07-17-2009, 06:12 PM

1. Cap litigation rewards. There would be scales of course and wronged patients would still be compensated, but the need for every surgeon to be paying hundreds of thousands of dollars worth of insurance per year is one factor driving up inpatient stay costs.
Evidence is mixed that this is actually a major factor in healthcare costs.

2. Related to the above, move medical litigation out of the courts. Set up some sort of patient services centers that can deal with 95% of medical disagreement. What they can't service would move up to the courts.
Arbitration: been tried. The problem is that in medical litigation, the eventual damage awards depend heavily on how sympathetic a jury finds the plaintiff. That's very tough to predict, so the parties often have divergent notions of what's a "fair" settlement. You could compel non-trial outcomes with circumscribed damage awards, but that's basically the same as capping damages. Plus, you still wind up having lawyers and lawyers' fees for that, often on top of the lawyers' fees for the eventual jury trial.

3. Institute government controlled prices for procedures, structured something like the federal reserve with knowledgeable people picked for lifetime appointments. No more over-charging with the expectation of partial payments or denial cat-and-mouse with the insurance companies. You can only be charged X for procedure Y and if that was a valid treatment the insurer would have to pay X. In other words a single, unified fee schedule.
Price-fixing... there's a reason the Soviet Union fell. To wit: even knowledgeable people make mistakes. Take a look at the financial markets right now if you don't believe me. And you've given your experts a pretty tough job: they have to figure out thousands of prices and balance every one of them precisely so that (a) enough young people decide to go to medical school and enter those specialities and ignore their families to work long hours, while (b) the price of those procedures aren't in excess of their value to society or drive up the price of healthcare beyond which people can't afford it. It doesn't help much to make the government cover all medical costs, since now you're just replacing people's ability to budget for medical care with people's ability to budget for taxes to pay for medical care. Simply gathering the information the experts will require for this task -- career preferences for high school students, willingness of doctors and nurses to work overtime, the value to individuals and society of every medical procedure in terms of lost wages and life enjoyment -- is a staggering task.

digitalErich

07-17-2009, 06:17 PM

I'll give you #1, that is true that the evidence is shakey, especially as it applies across all care and specialties. As for #2 and 3, those are the arguments against them I expect, but they both boil down to "those are very hard to do." Yes, yes they are.

However, I think you are overstating the complexity of maintaining a unified fee schedule. It's hard, yes, but I think it's doable.

07-17-2009, 06:18 PM

In the sense that "just have everyone be super-rich!" is very hard to do, yeah.

ShivaX

07-17-2009, 06:19 PM

Oh please. If you believe Blue Cross is likely to kill you or your family members, you will switch health insurers or stop paying for health insurance. There's no reason to continue paying for health insurance if it kills you.

You seem to think they'll tell you up front that you're going to die. They take your cash and say you're covered until you need the treatment, then they send their crack team of deniers in to find a reason to say no. Once they do that you're fucked. What insurance company is going to pick you up once you tell them you have cancer?

They all do it, so its not like you're going to magically find one that wont do it to you. The best you can do is pay them, hope you don't get sick and if you do hope they can't find some bullshit "pre-existing condition" to get out of their end of the bargain.

07-17-2009, 06:22 PM

EDIT: Okay, strike that.

The best you can do is pay them and hope they don't screw you? Then you're playing the averages, aren't you? If Blue Cross screwed people 80% of the time, it probably would be wiser to invest your premiums in lottery tickets.

There are a lot of horror stories about insurers, and I don't mean to minimize them. Insurers will try to minimize their expenses as much as possible without losing too many customers. But government insurers will try to minimize their expenses as much as possible without bringing too much heat from Congress. Given how superlatively Congress monitors, say, the VA hospitals (http://www.washingtonpost.com/wp-dyn/content/article/2007/03/04/AR2007030401394.html), that might not be very different.

Yes, yes, I'm sure the VA hospitals have a fine aggregate record. So do people covered by private insurance. But both will screw you if they think they can get away with it.

digitalErich

07-17-2009, 06:25 PM

And what are you in favor of, the single payor concept?

ShivaX

07-17-2009, 06:26 PM

Hmmm, if only there were some way of people communicating to each other about their past experiences with particular health insurers... possibly some sort of global telecommunications network, say...

If only there were something along those lines out there. (http://attorneypages.com/hot/toc_707.htm)

ShivaX

07-17-2009, 06:30 PM

And what are you in favor of, the single payor concept?

I'm in favor of not allowing insurance companies to profit from killing/crippling people.

The whole system was setup to deny coverage to people who will die before they can contest it. If my car insurance refuses to pay for something, I can take them to court. It might be a pain in the ass, but I'll likely win. If I'm dying of cancer and my HMO says I can go fuck myself time is on their side. If I die I'll have a hell of a time making them give me coverage.

Single Payer might work, but it could easily go bad and we'll end up like Canada. Then again we're almost like that anyway except instead of waiting in line you just sit at home and die while arguing with pencil pushers on the phone.

07-17-2009, 06:31 PM

I'm not really in favor of anything in particular. Unlike everyone else, I seem to be the only person who realizes that some problems don't even have hard solutions.

Look, medical care is extremely labor-intensive: research, training, observation, etc. You're not going to see the equivalent of a McCormick reaper for doctors anytime soon. And medical labor is also highly skilled and requires a high degree of intelligence. Basically, you need a lot of people doing a lot of (often unpleasant) stuff, all of whom could be making a lot of money doing something else. Either accept that you have to pay through the nose for that, or get ready for shortages.

People like to think that the right government tinkering can just abolish the law of supply and demand. They think that, if the demand for medical care was somehow modified or the supply of it was different, medical care would be plentiful and cheap. But that's not the market to look at. Look at the labor market. That is the reason why the healthcare crisis cannot be solved short of slavery.

ShivaX

07-17-2009, 06:35 PM

I wont disagree with that, though we do pay more than any other nation (save one) for healthcare while not having the best healthcare out there. Something about that tells me our system has a critical flaw someplace in it.

digitalErich

07-17-2009, 06:36 PM

Well I'm not in favor of throwing my hands because the current system can't be fixed, outside of the billing world I think there are other things the US could do to change the way we practice medicine.

I think the US medical community could stand to make much better/more use of mid-level providers. I think market pressures will force our hand in this eventually but actively going after this has advantages in my mind. However, I think the biggest hurdle to this is the patient; public perception. My tow hurts and I want to see an MD damnit.

digitalErich

07-17-2009, 06:38 PM

I have yet to see a single payor model that doesn't work on FFS, and FFS runs counter to quality healthcare in my mind. Maybe there's a better single payor proposal out there, but I haven't seen it.

Generation ABXY

07-17-2009, 06:43 PM

Oh please. If you believe Blue Cross is likely to kill you or your family members, you will switch health insurers or stop paying for health insurance. There's no reason to continue paying for health insurance if it kills you.

Exactly. One of the reasons I love the free market is because you do have a vote, and it comes with each dollar you spend. If people don't like the decisions their insurer (or whomever else) is making, they can switch companies; if enough people do that, the insurance companies themselves will be forced to change in some way. Additionally, other companies are going to want you to switch to them, and (in an ideal world) that sort of competition can mean better price and services.

As for an insurer trying to screw you after the fact, I'm willing to say that is something that should be addressed. I'm not claiming health care doesn't need to be reformed, but that doesn't mean you have to replace it with another government run program. For a while now, Congress has been considering legislation to limit the questionable practices of credit card companies, but I don't see anyone out there calling for a government credit card.

EDIT: And, yeah, I'm a bit late in some of this - curse you, tabbed browsing!

07-17-2009, 06:44 PM

Part of that is simply that some of our people don't get medical care. If I live to 90, and my homeless neighbor dies at 50, we have an average lifespan of 70. If France's richest and poorest citizens both die at 75, it looks like a better system -- even though Americans with medical care are outliving Frenchies with medical care by 15 years.

Another part is that there's a huge free-rider problem. Consider the fact that global medical research spending is around $105 billion (http://www.scidev.net/en/opinions/global-health-research-counting-the-cost.html), of which $94 billion (http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/1767) is paid for by Americans. When a new drug is invented, it has high sunk costs (the research) and low marginal costs (actually making pills). Drug companies recoup their fixed costs in America then sell their pills abroad for a tiny fraction of what we pay. If other countries made a fair contribution to the true cost of their medical care which we unfairly shoulder, our medical care would be much cheaper and theirs would be only a little more expensive per capita.

There are also inefficiencies in our system, but almost none of the proposals I've seen are likely to squeeze much out and may make things worse. The evidence indicates early care is more expensive than late care. Electronic medical records haven't brought nearly the results advertised in any of the places where it's been tried. Single payor doesn't address the labor-market issue.

digitalErich

07-17-2009, 07:14 PM

EMRs have brought significant care benefits, but the financial ROI hasn't been as great, but this is more due to their cost. EMR packages are prohibitively expensive. Large institutions pay in the tens and even hundreds of millions of dollars just to implement them. Therefore, only wealth and well run (relatively) institutions can afford them. These places were less 'leaky' to begin with.

digitalErich

07-17-2009, 07:27 PM

Also, I wouldn't say EMRs have reached their potential, yet. The past 10 years has been about getting them in place. It's really only been in the last 2-3 years that institutions have started to leverage the wealth of data and mine meaningful results.

I read a health information tech blog pretty regularly and almost weekly you hear about an institution that has saved an estimated 100 lives here, 80 lives there and the methodoly is stupidly simple on most of these. 90% of the time it comes down to "we ran a report and indentified at risk patients and made sure they kept their follow up appointment or we sent a mailing out to make sure they come for their yearly checkup"

Case in point, most institutions only have the manpower such that patients with cardiac risk factors of 80%+ are aggressively followed-up with. I don't know about you but 65% risk of a heart attack is still pretty fucking scarey. I think it was Cleveland Clinic that, after having installed their EMR, estimated they are saving 200 lives a year (and saving on cost to boot due to less emergency surgeries) simply by having their EMR system send out automated letters to the 40%+ risk demographic that simply reminds them to come in for their regular check-up.

Over 15,000 people die each year due to someone misreading a doc's scribbled notes.

EMRs are expensive, but worth the high price tag IMO even though the tech itself is immature and silo-ed in many ways. Overall I think they're a win.

digitalErich

07-17-2009, 07:29 PM

If you want to talk about under delivering, talk PHRs...talk about putting gas in the car with 4 flat tires and no spark plugs.

Hemalin

07-17-2009, 09:06 PM

Government services are typically run with the goal of staying within budget. At least they are if they're run well. And if "staying within budget" is made easier by letting some people die, then there's an incentive for letting people die.

Ask any government employee, and he or she will tell you: they get a lot of pressure on costs, especially these days. Defense attorneys in my town can't get expert witnesses any more unless their clients can pay for them out-of-pocket. Courts are talking about moving to four-day weeks. Government agencies may not be efficient at limiting costs, but you're betting on the government being too incompetent to realize it can save money by letting you die, not on its indifference to costs.

Would you say this is really different than the police or the fire department? They could probably cut down on costs if they ignored 1 out of every 10 calls.

07-17-2009, 10:02 PM

Would you say this is really different than the police or the fire department? They could probably cut down on costs if they ignored 1 out of every 10 calls.
Yes, they could. And they realize that. And they act on that realization.

You think the police go after every criminal? Of course not. Lots of cases are dropped because they're not considered cost-effective. Judges impose light sentences because prisons are overcrowded and there isn't enough money to build more. Firehouses are closed down because it's more cost-efficient to have a few large houses, even if that means it takes a few more minutes for the engines to arrive on the scene. Nobody, not even the government, is immune from cost concerns.

Esquilax1138

07-18-2009, 02:30 AM

Single Payer might work, but it could easily go bad and we'll end up like Canada. Then again we're almost like that anyway except instead of waiting in line you just sit at home and die while arguing with pencil pushers on the phone.

For all the Americans bashing Canada's health care system, I'd like to ask what your personal experiences in Canada were. Or have you just heard what has been spewed on TV by corporate shills like I have been seeing? It fucking makes me sick to hear them run down Canada when they are no better and worse by far in my opinion.

I've had many dealings with my health care system and so has my family, it's fucking rocked hard. If you want gory details I can go into that, but leave it to say the horror stories you hear are cherry picked worst possible case examples, like the kind we hear about people dying on the ER waiting room floor in the US since they don't have coverage, or the ones they dump on the streets in hospital gowns, it goes both ways.

Hotcod

07-18-2009, 07:03 AM

All i have to say is that i know no matter what happens in my life if i'm ill i can go get care with out having to put my self in debt to do it and with out fear of being turned away. And if i do well and have enough money i could pay for private insurance if i wanted to and since that insurance is up against a free state system it's goals are to provide a better service and to treat me when i need it since they know i can stop paying and go back to the state system.

The insurance companies in the US have you over a barrel, you either are with one of them or you are risking not getting treatment. Which means they have no incentive to treat you well and are only worried about there profits and if they turn you down for treatment or cancel your plan when you need it you really do not have any choice but to fork out more money from your own pocket. The second that you have a universal health care program, even if it's not as good as something privately funded (when they bother to treat you) it takes a hell of a lot of power away from the insurance companies who now have to compete on price and availability and as such there standards and the number of people that they do treat WILL rise.

Ink Asylum

07-18-2009, 08:01 AM

Government services are typically run with the goal of staying within budget. At least they are if they're run well. And if "staying within budget" is made easier by letting some people die, then there's an incentive for letting people die.

There is a big difference between "staying within budget" and "making a profit," when the budget is just not spending more money than you take in. A budget is a hard line. As long as you stay under it, great. Profit is a limitless goal. Shareholders consistently demand higher and higher profits.

There's also the unique feature of government that allows it to spend a whole lot more than it brings in for a longer period of time than a private business. That's not a great option, because it leads to problems down the road, but it's there.

If you give someone $1000 to do a job and say "Do it as best you can with that money" you're going to get very different results than if you say "Do it and you get to keep whatever you don't spend."

07-18-2009, 08:15 AM

There is a big difference between "staying within budget" and "making a profit," when the budget is just not spending more money than you take in. A budget is a hard line. As long as you stay under it, great. Profit is a limitless goal. Shareholders consistently demand higher and higher profits.
Is a budget a hard line? People want lower taxes. There's constant pressure to cut expenditures in government. That sounds just as limitless as the profit motive. If a budget was a hard line, you'd never hear of cutbacks in government.

Moreover, government workers demand pay increases in line with their private-sector counterparts, despite not showing the same productivity increases as their private-sector counterparts. So staying within budget becomes harder and harder as time goes on. I don't think your distinction really holds.

There's also the unique feature of government that allows it to spend a whole lot more than it brings in for a longer period of time than a private business. That's not a great option, because it leads to problems down the road, but it's there.
Okay, let's step back for a second. What's the problem we're trying to solve? Are we trying to provide more medical care for more people, or are we trying to reduce the ever-growing portion of GDP that healthcare swallows up? If it's the former, I agree government provision may make sense. If it's the latter, this argument doesn't work.

Yes, a government agency can be a loss-making enterprise, but that simply means people get charged through a different mechanism: instead of charging patients, you charge taxpayers, either now or in the future. Charging future taxpayers for the healthcare of current patients only makes sense if you believe the burden will be easier to bear in the future. But since healthcare costs currently rise faster than GDP, precisely the opposite is true: it will be harder to pay for healthcare in the future than it is today. We ought to be creating a healthcare lockbox for the future, not borrowing to pay for it now.

DoctorFinger

07-18-2009, 08:55 AM

The insurance companies in the US have you over a barrel, you either are with one of them or you are risking not getting treatment. Which means they have no incentive to treat you well and are only worried about there profits and if they turn you down for treatment or cancel your plan when you need it you really do not have any choice but to fork out more money from your own pocket. The second that you have a universal health care program, even if it's not as good as something privately funded (when they bother to treat you) it takes a hell of a lot of power away from the insurance companies who now have to compete on price and availability and as such there standards and the number of people that they do treat WILL rise.And if the government decides that you don't get a given treatment under a single-payer system? Remember, under that system you don't have the option of paying for it out of pocket.

The US healthcare system isn't perfect, I could write for days about the problems with it, but what Obama is proposing would make it markedly worse. Ask someone who is on Medicaid, or uses the VA system for their healthcare. That is what a single payer system brings: everyone gets the same care, and that care is generally inferior to that under a private system.

Something has to be done, but I don't think this is the answer.

ShivaX

07-18-2009, 09:25 AM

For all the Americans bashing Canada's health care system, I'd like to ask what your personal experiences in Canada were. Or have you just heard what has been spewed on TV by corporate shills like I have been seeing? It fucking makes me sick to hear them run down Canada when they are no better and worse by far in my opinion.

I've had many dealings with my health care system and so has my family, it's fucking rocked hard. If you want gory details I can go into that, but leave it to say the horror stories you hear are cherry picked worst possible case examples, like the kind we hear about people dying on the ER waiting room floor in the US since they don't have coverage, or the ones they dump on the streets in hospital gowns, it goes both ways.

Actually I have relatives in Canada and my mother's side of the family is from there, so theres quite a few personal horror stories floating around. But like you said those horror stories sure aren't any worse than hospitals dumping people off on the street or just letting them die.

What always gets me is that the same people that tout American Exceptionalism seem to think we're completely incapable of making a system thats as good as say, the French, much less better than theirs. I'd like to think we could make a solid system that makes the rest of the world envious. But apparently the best we could ever hope for is to copy the worst aspects of everyone else's systems. Cause Americans are idiots apparently.

And just cause its topical:

America's health care system is neither healthy, caring, nor a system.

DoctorFinger

07-18-2009, 11:19 AM

Actually the French have one of the best healthcare systems out there. Everyone is covered under the basic gov't health coverage, but they're encouraged to get private coverage to supplement it. Whereas in Canada and the UK they have about 20% per capita of the advanced imaging facilities we do - MRIs, CAT scans, PET scans, etc - France has about the same ratio we do.

If we were moving to something like the French system I'd be much more supportive. But we're not, we're taking the Canada-UK-Swedish system which is, IMO, a huge step backwards.

Hotcod

07-18-2009, 02:25 PM

And if the government decides that you don't get a given treatment under a single-payer system? Remember, under that system you don't have the option of paying for it out of pocket.

The US healthcare system isn't perfect, I could write for days about the problems with it, but what Obama is proposing would make it markedly worse. Ask someone who is on Medicaid, or uses the VA system for their healthcare. That is what a single payer system brings: everyone gets the same care, and that care is generally inferior to that under a private system.

Something has to be done, but I do think this is the answer.

You still have the option of taking out privet health care and i'd much rather my government who are not making a profit out of me make the choice about what treatment i get then a insurance company who's interest is to make profit out of me. The point isn't so much that universal health care is going to provide better care than privet but if the privet health care industry has to compete with a system that charges much less and on which any of there paying customers can go to with out fuss or bother.

The UK system is currently a mess in a lot of ways, i'm not debating it, but i honestly can not understand the mentality that people would much rather be beholden to profit makers with little or next to no choice. I've not read up on the plans very much since they don't really effect me and i'm not going to argue that they are the best or perfect idea since i don't know but the underlying principle of a state health care system that every one can get treatment from is not a bad one. Like you pointed out in your next post the French system works really well... but the main point i'm trying to make is that simply by making insurance companies compete against a system that will give treatment and is run at cost will force them to act, well, less evil.

DoctorFinger

07-18-2009, 03:00 PM

You still have the option of taking out privet health care and i'd much rather my government who are not making a profit out of me make the choice about what treatment i get then a insurance company who's interest is to make profit out of me. The point isn't so much that universal health care is going to provide better care than privet but if the privet health care industry has to compete with a system that charges much less and on which any of there paying customers can go to with out fuss or bother.

The UK system is currently a mess in a lot of ways, i'm not debating it, but i honestly can not understand the mentality that people would much rather be beholden to profit makers with little or next to no choice. I've not read up on the plans very much since they don't really effect me and i'm not going to argue that they are the best or perfect idea since i don't know but the underlying principle of a state health care system that every one can get treatment from is not a bad one. Like you pointed out in your next post the French system works really well... but the main point i'm trying to make is that simply by making insurance companies compete against a system that will give treatment and is run at cost will force them to act, well, less evil.People keep saying that the gov't doesn't want to make a profit, and insurance companies do. They both want to keep costs down as much as possible, so I don't see the distinction between the two. They're both going to deny as many claims as they possibly can. The difference to me is that a private company who makes a profit can improve care by reinvesting the profits, whereas with gov't care there's no benefit to the cost cutting. The free market exerts forces on a private company which a gov't plan is immune to. An insurance company which is wasteful and inefficient goes out of business; a gov't plan with waste just keeps on trucking because there's no reason to trim the fat.

You also talk about the gov't system being more efficient than the free market one ("by making insurance companies compete against a system that will give treatment and is run at cost will force them to act, well, less evil"), well when in history is government ever more efficient than the private sector? Do you really want the people who run the DMV deciding whether or not you get an MRI?

Hotcod

07-18-2009, 03:43 PM

DoctorFinger

07-18-2009, 03:55 PM

When has the government been more effective than the privet sector? take a look at what has happened to the industries that have been privatised in the UK in the last 30 years. Then look at the banking sector, what a wonderful job the free-market has done there, really, freemarkets are freaking awesome. Lets put the health of out people economy and other key systems in the hands of people who have no intensives that last longer than they are getting paid and making money. There is a huge and fundamental difference between a system that exists to provide you care and is trying to keep in budget than a system that exits to make money out of you.Again, what makes you think the gov't has any more of an interest in keeping you healthy than a private insurer does? To both entities you're just a number: if you're healthy they want to keep you that way, if you're really sick then they're better off if you die and don't take up valuable resources. At least if an insurer does something really egregious there is the last recourse of suing them. What happens when the gov't says you're too sick to treat?

Which industries when from public to private in the UK the last 30 years? And how do they compare to the US version?

Ink Asylum

07-18-2009, 06:07 PM

Is a budget a hard line? People want lower taxes. There's constant pressure to cut expenditures in government. That sounds just as limitless as the profit motive. If a budget was a hard line, you'd never hear of cutbacks in government.

People want lower taxes but they don't want to lose government programs. When was the last huge cutback in government expenditures? We cut taxes but don't cut programs, because no one (at least not the large majority) really wants the government to do a whole lot less, they just say they do. Except Ron Paul. We fiddle around at the edges instead.

Ink Asylum

07-18-2009, 06:10 PM

The US healthcare system isn't perfect, I could write for days about the problems with it, but what Obama is proposing would make it markedly worse. Ask someone who is on Medicaid, or uses the VA system for their healthcare. That is what a single payer system brings: everyone gets the same care, and that care is generally inferior to that under a private system.

Ask someone who can't afford insurance, or cannot get private insurance because of preexisting conditions, if they'd take generally inferior health care over zero health care (until you go to the emergency room). I'm sure they'd jump at the chance.

Obama is not proposing completely replacing private insurance with a public system. His main goal is to insure the 45 million or so people who have no insurance.

You also talk about the gov't system being more efficient than the free market one ("by making insurance companies compete against a system that will give treatment and is run at cost will force them to act, well, less evil"), well when in history is government ever more efficient than the private sector? Do you really want the people who run the DMV deciding whether or not you get an MRI?

I don't want corporate executives deciding whether or not I get an MRI either.

Do you think our police, fire departments, military, roads, social security, disaster relief, etc. would be better run by free markets? Perhaps they would be more efficient, but I seriously doubt they would be cheaper or as widely available. There are some things that shouldn't be left to the free market, and health care is one of them.

Think about what you're buying when it comes to health care or insurance. In many cases it's your life. Can you put a price on your life? Or would you pay any amount possible to survive a disease or injury? Is there any other product or service you buy which is that valuable?

DoctorFinger

07-18-2009, 06:42 PM

Ask someone who can't afford insurance, or cannot get private insurance because of preexisting conditions, if they'd take generally inferior health care over zero health care (until you go to the emergency room). I'm sure they'd jump at the chance.

Obama is not proposing completely replacing private insurance with a public system. His main goal is to insure the 45 million or so people who have no insurance.If the goal is to simply insure the uninsured, then why not just raise the cap on Medicaid eligibility? Why go through the trouble of including a provision in the bill which would force people into the public plan (http://www.nypost.com/php/pfriendly/print.php?url=http%3A%2F%2Fwww.nypost.com%2Fseven% 2F07172009%2Fpostopinion%2Fopedcolumnists%2Fos_bro ken_promises_179667.htm)?as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17). I'll agree that refusing to cover pre-existing conditions is wrong, but that could be fixed without all of the other changes.

I don't want corporate executives deciding whether or not I get an MRI either.

Do you think our police, fire departments, military, roads, social security, disaster relief, etc. would be better run by free markets? Perhaps they would be more efficient, but I seriously doubt they would be cheaper or as widely available. There are some things that shouldn't be left to the free market, and health care is one of them.

Think about what you're buying when it comes to health care or insurance. In many cases it's your life. Can you put a price on your life? Or would you pay any amount possible to survive a disease or injury? Is there any other product or service you buy which is that valuable?Unless you pay everything out of pocket, someone is always deciding whether you get treated (or more precisely, they decide for any procedure costing more than $1,000, anything under which is almost always just approved automatically). If it's not a middle management exec, it's a middle management bureaucrat. To-may-toh, to-mah-to.

Disaster relief is overwhelmingly run by the free market in the US; most of it is from groups like the Red Cross who get gov't funding, but are private charities. In other words, who would you rather have assisting you in a disaster: the Red Cross, or FEMA? The other things you cite are things which the free market cannot sustain, which is something I've never argued against. But without some sort of private option, it doesn't matter how much money you have, you're not getting treated if the bureaucrats deny the procedure. That's why CEOs and politicians the world over come to the Mayo Clinic or Johns Hopkins for treatment, because that level of care simply doesn't exist even in many developed nations now, at any price.

digitalErich

07-18-2009, 08:48 PM

I'm with the Dr on supporting something akin to the French system. Create 6-8 government supported base packages that everyone is eligible for, but let us supplement that with the private plan of our choice.
You still have the option of taking out privet health care and i'd much rather my government who are not making a profit out of me make the choice about what treatment i get then a insurance company who's interest is to make profit out of me.
Speak for yourself, my coverage is kick ass. Granted, I'm covered under a not for profit HMO and the premiums are relatively expensive, but everything is provider driven for me. Outside of venture/elective procedures, if the doctors say "yes you need this", it's covered (and no this is not hyperbole). This is the exception nowadays, but just know there are systems out there (expensive ones) that are better than the current average and the proposed systems.

If you think trading one form of non-provider driven decision making model for another is going to be an improvement, I have a bridge for sale that you might be interested in. Simply making the government another payor (a very big one) addresses just one piece of the healthcare puzzle, and not in a smart way at that.

I'll be pretty pissed if I have to give up my coverage for one of these government managed-care plans, but I'm hoping this part doesn't go through, or is revisited soon and I'm thinking political pressures will force this, once it's more widely in the public's eye.

Generation ABXY

07-18-2009, 10:01 PM

If the goal is to simply insure the uninsured, then why not just raise the cap on Medicaid eligibility? Why go through the trouble of including a provision in the bill which would force people into the public plan (http://www.nypost.com/php/pfriendly/print.php?url=http%3A%2F%2Fwww.nypost.com%2Fseven% 2F07172009%2Fpostopinion%2Fopedcolumnists%2Fos_bro ken_promises_179667.htm)?I'll agree that refusing to cover pre-existing conditions is wrong, but that could be fixed without all of the other changes.

Interesting article. Now that I have a copy (of the bill), I'll have to check out some of those sections mentioned, especially the part about fines for non-participation. I've heard about that before, and the idea that there is no opt-out has bothered me greatly - it takes this legislation beyond the simply helping people and more into dictating their lives.

Hotcod

07-18-2009, 10:16 PM

Speak for yourself, my coverage is kick ass. Granted, I'm covered under a not for profit HMO and the premiums are relatively expensive, but everything is provider driven for me. Outside of venture/elective procedures, if the doctors say "yes you need this", it's covered (and no this is not hyperbole). This is the exception nowadays, but just know there are systems out there (expensive ones) that are better than the current average and the proposed systems.

If you think trading one form of non-provider driven decision making model for another is going to be an improvement, I have a bridge for sale that you might be interested in. Simply making the government another payor (a very big one) addresses just one piece of the healthcare puzzle, and not in a smart way at that.

I'll be pretty pissed if I have to give up my coverage for one of these government managed-care plans, but I'm hoping this part doesn't go through, or is revisited soon and I'm thinking political pressures will force this, once it's more widely in the public's eye.

Ok i've still got a lot of other things to reply to in this thread but this urks me a little since it's clearly not what we've been talking about. Firstly having universal heath care does not have to mean that the privet sector goes away. I don't know about the plans obama is making but i highly doubt that it would force you to give up privet care... given privet care is still available in every country i can think of that has a universal plan. On top of that one of the major points i've been making is that when put up against a universal government system insurers have to become, over all, less likely to abuse you given that they are no longer a necessity but a luxury for those who can afford it and are happy to pay.

As for how you are now it's grate for you. You can afford it and this reform is clearly no aimed at you at this time. But i wonder how your attitude might change if something unexpected happens like you lose your job and can't afford the payments for a while? Under the UK system if I had a good job and could afford it i would likely be happy enough to pay for privet care but if something unexpected happens to me where i can no longer afford it i know that i'm still covered by the NHS. All i can say is that health insurances is not something i think about all that much, it's not a worry and not a problem and while the NSH might not be the best service it is one that will always be there for me if i need it.

As for docs "one bean counter is like another", well, for me I think there is a clear difference. In the end i'd much rather some one who's job is about providing universal health care as best they can for the state deals with my treatment then some one who's job it is, in essence, to get as much money as they can out of my pocket with out giving me anything back. All i can say is that outside of very expensive treatments the NHS is unlikely to refuse me anything i need.

In the end doc, either system is better off with me dead once i'm ill. The difference is that the NHS exists to keep me alive as part of my rights as a tax payer and a member of the state and as such will go out of it's way to, with in it's budget, keep me alive... the other, well, has no reason to try and keep me alive at all and as such it's in there interest to go out of there way to find ways to stop paying for my care. The state is providing care to keep you alive as part of it's duty as the state, while the privet sector is providing care as a way to make people money. In other words the states beancounters job is trying to balance the books to keep as many people alive as they can where as the privet bean counters job is to make as much money as they can. So ya, if i had to pick i'd take the one who at lest has some interest in my life.

In case you don't know already my mother is an ex nurse, my dad is a docotor and GP, my little brother is a newly qualified nurse and my brother is setting up a breast cancer tissue back after doing a PHD with cancer research UK. A number of family friends are doctors and work with in the NHS.... and all i can say is even the management types see there job as providing the best care they can... and while the system has some huge flaws thanks to the governments of the last 50 years doing a few silly things it's still a system i'd much prefer to one which is fully free market. In fact the idea of a fully free market health care system scares the hell out of me.

digitalErich

07-18-2009, 11:01 PM

Actually the bills (see the linked articles by Doc) say just that. If it passes in that form, I would have to give up my current plan and be forced to use one of the government defined plans and all the red tape and rules they decide to throw in there with it. I would HAVE to take this as my plan and coverage.

That's hamfisted and is simply queuing up a whole slew of other problems. I must have missed where nationalizing healthcare meant making is socialistic.

And don't get me wrong, I'm all for a NHS, I'm in the industry myself in fact...which is why I don't like anything I'm hearing so far. It's rushed and not well thought out. We can do better.

Also you completely ignored my assertion that there are plenty of GOOD private systems out there. This idea that the entire private sector is out to kill us all is getting tired. I can guarantee you that whatever they come up with for a NHS, even in the best of worlds, I will still get better coverage and care under my current plan.

Generation ABXY

07-18-2009, 11:21 PM

It seems to me, both insurance companies and the government both have the same reason to keep me alive: to keep collecting my money (one from direct payment, the other from taxes). Tentatively, I'd agree that having a public plan and a free market could be the best option, but that's only because it offers more choice (essentially the key to the free market in the first place). Unfortunately, as has been noted, it seems the government (here in the U.S., that is) is intent on trying to take those other options off the table, including wording that suggests everything from fines on people who choose not to be covered to special rules that may force even those with private plans into the public one. In the absence of quality, I'd at least like to think I still had quantity.

Even if I can agree with the intent, though, I can't help but think they're trying to rush into something once more.

Ink Asylum

07-18-2009, 11:30 PM

On top of that one of the major points i've been making is that when put up against a universal government system insurers have to become, over all, less likely to abuse you given that they are no longer a necessity but a luxury for those who can afford it and are happy to pay.

This is a very good point. There should be a minimum level of health care made available to all Americans with two main goals:

A) Provide routine preventive care that keeps people from waiting until they need an emergency room visit to address a health issue. This is one of the biggest problems with allowing millions of people to go around uninsured. In a free market system if you don't pay for something you don't get it. That's not so with health care. We're willing to let people go without insurance but not willing to go all the way and say that if you have no insurance you get no treatment that you don't pay for upfront. For those people that use the emergency room and can't pay the bills the costs end up getting spread around anyway. Why not spread around the much cheaper cost of preventive care?

B) Provide insurance for catastrophic illness/injury. No one should go bankrupt because they had the bad luck to get cancer and decided to live instead of die. Allowing someone to go from a productive member of society to a debt-laden drag on the economy because of something they couldn't foresee or prevent hurts us all.

Even after taking care of those two things at a minimum level there is room for private insurers. Some people would want more frequent preventive care. Some people would want more elective health care. Some would want faster care or better doctors. But those people would be able to interact with insurance companies on a much more level playing field, one in which their lives aren't on the line.

digitalErich

07-18-2009, 11:37 PM

Also, FFS=fee for service (http://en.wikipedia.org/wiki/Fee_for_service). I kept referencing it without an explanation.

Generation ABXY

07-18-2009, 11:42 PM

Still, Ink, it seems if you address why costs are so high in the first place (which is not a simple question to answer, I'm sure), people might be able to handle their (at least basic) medical costs regardless of whether or not they have insurance. Maybe your goal should not be making sure everyone has it, but getting to a point where no-one needs it.

Ink Asylum

07-18-2009, 11:46 PM

Waiting who knows how long until we control costs to see if that might help the 45 million uninsured be able to afford care doesn't seem like a good plan to me. Why not get everyone insured first and then, once everyone's invested in the system, start working to bring down costs for everyone?

Generation ABXY

07-19-2009, 12:09 AM

Because you loose your leverage? Right now, we can look at it and say, there are plenty of people who need what you have, but without the means to obtain. If the government becomes the steward of our health, those people then have the need and the means and they (the government) becomes just another insurer. At that point, there are two ways of controlling costs: denying certain things from the people or denying everything from the businesses. The former has already been discussed, but do you really think the government is going to attempt the latter? Doesn't it rather defeat the purpose of having universal coverage for everyone in the first place?

Just because a solution isn't quick, easy or painless doesn't mean it isn't the best.

Ink Asylum

07-19-2009, 08:41 AM

Generation ABXY

07-19-2009, 10:49 AM

Allowing millions of people to go without insurance and letting thousands of them die as a result is a wrong way to leverage the system. The government's job is to protect its citizens, and that should include diseases, just like the government protects them from fires and natural disasters.

In hindsight, I don't think leverage was quite the word I wanted (but it was late, and I probably said to hell with it).

Once everyone is on the rolls that gives the government more leverage because their option can be set up to be cheaper and that will force private companies to lower their prices to compete.

"Their option." Are you still talking about insurance? I'm talking about adjusting the cost of health care - as in what it costs to get treatment in the first place. In that, the government doesn't have an option, and therefore nothing to set lower. They can fiddle with insurance rates all they want, but that's still not getting to the root of this problem (again, health care being so expensive it requires insurance to begin with), which was my point.

As for insurance (since we seem stuck on that), I personally prefer something similar to what McCain was proposing, and going about this through taxes. If you do it right, everybody can still be covered and have a choice, and the government doesn't have to be so directly involved (which cuts out a lot of the inefficiency, over-spending and corruption bound to occur otherwise). At least then, some of these across the board taxes (such as on soda, cigarettes, etc.) make sense – otherwise, if I'm paying for my own insurance or choose to go without, they shouldn't have any reason to so penalize me for my decisions.

Ink Asylum

07-19-2009, 11:53 AM

You're saying that the government will have no influence on prices at all? I would think a government would have a particularly strong ability to advance the needed changes on the health care system to lower costs since they'll be representing tens of millions of patients and billions of dollars as well as having the ability to legislate.

The easiest thing that can be done to reduce costs is to keep the emergency room from being the first and last place uninsured people go. Insure them to allow them to afford preventive care and encourage them to address health problems before they become even more expensive to treat and you've saved hospitals millions, savings which will help everyone.

Think about all the people who don't do routine car maintenance because they don't want to, or can't, pay for oil changes, new tires, new brake pads, etc. Then imagine that when their car finally has an expensive breakdown that they can take it to a mechanic, get it fixed with no money down, and when they can't pay after the mechanic has to soak the losses. That would force them to make their paying customers subsidize those costs.

DoctorFinger

07-19-2009, 01:50 PM

Generation ABXY

07-19-2009, 02:16 PM

You're saying that the government will have no influence on prices at all? I would think a government would have a particularly strong ability to advance the needed changes on the health care system to lower costs since they'll be representing tens of millions of patients and billions of dollars as well as having the ability to legislate.

Legislate they can (at the risk of what Doc mentioned just above), and I've already talked about that. However, their representation doesn't mean squat, and that's the point I was trying to make earlier. What are they going to do in the face of high costs, tell the doctors and drug manufacturers that they won't pay? They can try, but the other parties don't necessarily have to provide their services either (at least, not without money up front), and then the idea of having universal coverage essentially becomes a moot point.

Ink Asylum

07-19-2009, 04:45 PM

So the same thing would happen if you tried to lower costs under a private plan, wouldn't it? Guess we're just stuck paying high prices, then.

How would you propose lowering costs, then? And how is that only possible or easier under a private system that needs to have high profit margins?

DoctorFinger

07-19-2009, 05:57 PM

How would you propose lowering costs, then? And how is that only possible or easier under a private system that needs to have high profit margins?I don't have all the answers, but here are a few.

1) Reform malpractice insurance. In NYS, where I practice, the average OB/GYN makes $115,000 a year. Their annual malpractice premiums are $132,000. Which is why when surveyed not a single member of my med school graduating class said they hoped to enter that field. A ton of major hospitals are also simply closing their Obstetrics wards because it's too great of a liability to keep them open.

2) Offer low-cost/free tuition to any doctor, nurse, specialist, PA, etc, who agrees to work for 5 years afterwards in a medically under-served area. The biggest hurdle to becoming a medical pro isn't good grades, it's money. If you pay out up front, you'll save in the end by having more caregivers.

3) Tort reform. A few years back my father went to an orthopedist to get his bad toe examined. When he asked the doctor to also check his knee, the doctor refused, and told my dad he had to see a knee specialist. Why? Because fear of lawsuits is so pervasive that doctors have to spend more time ordering cover their ass tests and referrals than they do treating patients. Reform torts and you'll have fewer CYA tests and therefore smaller waits for those same tests.

4) Raise medicaid cap. One of the major problems now are the "too much, not enough" class. They make too much to qualify for public assistance, but they can't afford private care. By increasing the medicaid ceiling, you'll have many fewer people fall into this gap.

5) Affirmative refusal of health coverage. I worked in a Gamestop for nearly 4 years. In that time, of the 50 or so people who worked there, only one person ever bought into the company health plan, even though it was only $10 a week. Some of the people were like me, and already had coverage, but most were just unwilling to part with the $40 a month. They were technically uninsured, but could easily have had fairly good coverage. This happens a lot in the US. I would require anyone who wants to remain without any coverage whatsoever go to a gov't building every 2 years and sign a sworn affidavit affirming that they don't want coverage. They can refuse coverage, but they have to acknowledge that they're doing so. They then cannot complain when the time comes that they need care.

6) Reform of pharma patent process. Firmly enforce the 7 year limit on patents, no more of this "close enough to protect" crap. (to explain: the patent on a drug lasts only 7 years, but if a second "close enough" drug is patented - say Claritin-D after Claritin - then even though the patent on the original has lapsed, it is defacto covered by the patent of the derivative drug. That's how drugs like Viagra still don't have generics.)

Ink Asylum

07-19-2009, 06:01 PM

Good ideas, and for none of them would there be any difference if insurance were provided by private companies or public ones.

So let's get a public plan, get all those uninsured people into the system, an at the same time lower costs by doing all you mentioned above.

Johan

07-27-2009, 10:20 AM

I love Congress. (http://www.cnsnews.com/public/content/article.aspx?RsrcID=51610&print=on)

BTW: If you're fat, or old, you really have a duty to die and save us all the money. (http://online.wsj.com/article/SB124869340217883455.html) :rolling eyes of wtf with the Dems plans...:

Ultimately, if we're going to reign in costs AND cover the 15% of us who don't have medical insurance, there are only TWO ways to do it:

1. Raise taxes to pay for it.

AND/OR

2. Ration care (especially end-of-life care).

There's no other way. Obama won't admit this, of course, but Americans are wise to it. They know that you either have to have more money, or ration usage. Or both.

Slack3r78

07-28-2009, 01:25 AM

Ultimately, if we're going to reign in costs AND cover the 15% of us who don't have medical insurance, there are only TWO ways to do it:

1. Raise taxes to pay for it.

AND/OR

2. Ration care (especially end-of-life care).

There's no other way. Obama won't admit this, of course, but Americans are wise to it. They know that you either have to have more money, or ration usage. Or both.

Frankly, I'll take both. My father is a small business owner who pays out something to the tune of $1200/month for health insurance, has been fighting major illness for the past year, and every single fucking step of the way has had to fight with his insurance company to get them to pay for procedures that unequivocally have helped his condition that they preapproved.

Between the way he's been treated by his insurance now, and the similar crap they pulled before my mother died, the for-profit healthcare industry can't die soon enough for me.

On a related note, Congressional Democrats have apparently decided that they really are all a bunch of spineless scumsuckers and have decided to just drop the whole thing because they can't make the Republicans happy:

http://www.huffingtonpost.com/2009/07/27/senate-group-dropping-dem_n_245839.html

digitalErich

07-28-2009, 01:56 AM

Was anyone really excited or trusting of what they were rushing through anyway? I'd rather wait a few months if it means a better reform package. I fully realize this is easy for me to say as I already have coverage.

Or, in the middle of a sever economic downturn and at a time when the president is focusing in his big domestic push, the Senate could forgo or cut short their 5 week summer vacation, but that's just crazy talk I guess.

Also, I love this part towards the end of the article Slacker linked:
Negotiators also are considering fees on the manufacturers of medical devices and on the makers of both brand name and generic drugs coming onto the market.
Do they really think they can do this in any meaningful way and not have part (likely most) of it passed right back onto the patient?

Slack3r78

07-28-2009, 03:14 AM

Was anyone really excited or trusting of what they were rushing through anyway? I'd rather wait a few months if it means a better reform package. I fully realize this is easy for me to say as I already have coverage.
I'd have been fine with it if they said they needed more time for review. It seems, instead, that they're just throwing their hands up and saying they can't do it. Which basically means any shot at healthcare reform is probably dead now.

Ink Asylum

07-28-2009, 05:27 AM

Frankly, I'll take both. My father is a small business owner who pays out something to the tune of $1200/month for health insurance, has been fighting major illness for the past year, and every single fucking step of the way has had to fight with his insurance company to get them to pay for procedures that unequivocally have helped his condition that they preapproved.

Between the way he's been treated by his insurance now, and the similar crap they pulled before my mother died, the for-profit healthcare industry can't die soon enough for me.

Pretty much. The for-profit health insurance system does everything opponents of a public heath insurance option claim that will do. The majority of people don't realize that because the majority of people haven't gotten really sick yet. Most people don't have sufficient health insurance, just the illusion of insurance.

Johan

07-28-2009, 07:10 AM

Frankly, I'll take both.

If you think your dad will save money, and/or get better/cheaper care, under any of the Democratic plans being punted around Congress (they're trying to see which one will stick to the walls without smelling the place up too much), then you're off your rocker.

The vast majority of our health care spending is for the elderly. You don't control costs by adding 45 million people to the health care rolls. You control them by cutting people off from services at the end of life.

The elderly just need to die. CHEAPLY.

Generation ABXY

07-28-2009, 07:23 AM

On a related note, Congressional Democrats have apparently decided that they really are all a bunch of spineless scumsuckers and have decided to just drop the whole thing because they can't make the Republicans happy:

http://www.huffingtonpost.com/2009/07/27/senate-group-dropping-dem_n_245839.html

I suppose that's the inevitable outcome of having legislation even your own party won't sign on to, either out of legitimate concerns or for a lack of political cover.

Slack3r78

07-28-2009, 07:50 AM

If you think your dad will save money, and/or get better/cheaper care, under any of the Democratic plans being punted around Congress (they're trying to see which one will stick to the walls without smelling the place up too much), then you're off your rocker.
I have far less of a problem with realistic costs and results than I do with the outright scam that is health insurance in this country right now. Part of the fundamental problem is that most people rely on their employers for health coverage, which shields them from having any clue what it costs.

What outrages me isn't the fact that he pays this money out, but that he pays it out and the insurance company then does everything in its power to keep from paying out.

I've been through this with both of my parents now, and it's become clear to me that the problem isn't a fluke here or there, but a systemic failure of the system. Frankly, this is why the whole 'rationing' argument is absurd to me. We have rationing now. Rationing is performed by middle managers with a profit motive. It's an absurd way to run a healthcare system.

Ink Asylum

07-28-2009, 08:21 AM

I know neither choice is ideal and they both have their faults, but when it comes to matters of life or death I would rather have a public program than a private one.

I prefer a public military over private mercenaries.
I prefer a public police force over private security firms.
I prefer a public fire department, public disaster response, public safety regulations, etc.

The private market is great for a lot of things, but it does not have a good track record when saving lives competes against profit margins.

Public options aren't perfect, and they can't save everyone, but they have a much greater record when it comes to saving and protecting lives, even for people who can't pay.

Johan

07-28-2009, 10:51 AM

What outrages me isn't the fact that he pays this money out, but that he pays it out and the insurance company then does everything in its power to keep from paying out.

And what the hell do you think the government will do to reign in costs? Our current trajectory in Medicare/Medicaid/Social Security spending is unsustainable, and there are only bad ways to deal with it...lower benefits (rationing), or raise taxes/deductibles/out-of-pocket-expenses.

The vast majority of people are happy with their health insurance. Adding 45+ million people to the insurance rolls, while noble and moral, will NOT lower costs. The CBO has repeatedly shot to hell Democratic projections for bullshit savings.

The one thing politicians are good at is lying about reality. The fact is that Obama is lying when he says that people won't see any changes and can keep their plan/coverage. You don't lower costs by keeping everything the same and adding 45+ million people to coverage. That's fantasy-land. Either coverage will diminish for all, or costs will go up for all (deductibles, taxes, etc.).

Bush did the same thing. He pushed expanded entitlement benefits (prescription drug benefit) and spent like a drunken sailor on shore leave. Now, Obama is going to add further entitlement spending AND his own projections show him adding more to the deficit than ALL of our presidents in our nation's history.

It's a ridiculous sham. There are problems that can be fixed in our health care system, but he's not fixing them. He's adding to them.

George Will on health care reform. (http://townhall.com/columnists/GeorgeWill/2009/06/30/a_fix_well_likely_regret)

The president says his health plan is responsive "to all those families who now spend more on health care than housing or food." Well. The Hudson Institute's Betsy McCaughey, writing in The American Spectator, says that in 1960 the average American household spent 53 percent of its disposable income on food, housing, energy and health care. Today the portion of income consumed by those four has barely changed -- 55 percent. But the health care component has increased while the other three combined have decreased. This is partly because as societies become richer, they spend more on health care -- and symphonies, universities, museums, etc.

Slack3r78

07-28-2009, 11:28 AM

I guess I should make a couple of things clear:

A. I'm one of those rare Americans who is completely okay with higher taxes.

B. Higher total costs are a possibility, sure. I think a public plan would eliminates parts of the massive bureaucracy that exists in the private sector currently, though.

C. Either way, I have a massive moral problem with for-profit healthcare. The incentives are completely backwards. After my experiences with the private healthcare industry over the past ~5 years, I've come to pretty much reject the entire system as an amoral sham. I don't care if it's going to cost me more out of pocket via higher taxes because it's not a matter of dollars and cents so much as basic right and wrong for me.

Will there be failings with a public system? Absolutely. But they pale in comparison to the failings of the system I've lived through as-is.

Generation ABXY

07-28-2009, 11:54 AM

A. I'm one of those rare Americans who is completely okay with higher taxes.

On yourself, you mean, or just on the people you deem responsible for society's ills? I only ask, because I remember someone supporting like a 90% tax on the rich some months back...

Johan

07-28-2009, 12:08 PM

Will there be failings with a public system? Absolutely. But they pale in comparison to the failings of the system I've lived through as-is.

America's health care system is the envy of the world. It didn't get that way because we adopted a single-payer government system.

The plans being put forth won't lower costs, will raise taxes on most people, and won't even cover everyone.

What a load of bullshit. At least they're not going to bother to read the bill, whatever it ends up looking like.

Slack3r78

07-28-2009, 12:48 PM

On yourself, you mean, or just on the people you deem responsible for society's ills? I only ask, because I remember someone supporting like a 90% tax on the rich some months back...
Across the board. I do think this notion that a top tax bracket lower than it was under Reagan, let alone any other point in the 20th century is somehow oppressive is completely absurd, though.

America's health care system is the envy of the world.
Could have fooled me. The comments I've seen on the issue from people in countries with nationalized healthcare (which is, again, every other industrialized nation in the world) on the US system have generally ranged from sympathy to bewilderment.

ShivaX

07-28-2009, 12:58 PM

America's health care system is the envy of the world.

The Third World maybe, but not anyone else that I've ever heard of.

I mean yeah its kickass compared to what you'll likely get in Rwanda, but I don't see the French kicking down the doors of their government demanding they adopt a system like ours. Then again they actually have the best health care in the world. (http://www.photius.com/rankings/healthranks.html)

For that matter we are behind every single Western European nation. At least we're beating the Kiwis.

Ink Asylum

07-28-2009, 01:04 PM

Only rich people around the world envy our health care system, because they can come to America and pay for the best doctors, drugs, surgery, etc. That level of access and care, though, is completely out of reach for the vast majority of Americans, even those that have health insurance and think they're covered no matter what happens.

I'll take the second best health care in the world that is accessible to all citizens without bankrupting them over the best care available only to the rich.

astranoir

07-28-2009, 01:08 PM

Only rich around the world envy our health care system, because they can come to America and pay for the best doctors, drugs, surgery, etc. That level of access and care, though, is completely out of reach for the vast majority of Americans, even those that have health insurance and think they're covered no matter what happens.

I'll take the second best health care in the world that is accessible to all citizens without bankrupting them over the best care available only to the rich.

Well said.

digitalErich

07-28-2009, 01:29 PM

The thing is, I believe we can realistically have both.

Generation ABXY

07-28-2009, 01:51 PM

Across the board. I do think this notion that a top tax bracket lower than it was under Reagan, let alone any other point in the 20th century is somehow oppressive is completely absurd, though.

Personally, I'm a fan of the fair and flat tax (one or the other, of course). Everybody gets soaked the same amount and, in the case of sales tax, you even get those people earning their money - or avoiding taxes - through some underhanded way.

When it comes to providing quality, affordable health care for all, I'm of two minds. If this was just about children, I'd be on board in a minute. Kids, rich or poor, shouldn't have to suffer for the decisions their parents make. As for adults, I think the numbers are rather skewed by a number of factors. I mean, for every person who legitimately can't afford health insurance, you have one who can't because they're spending that money on something else (satellite TV, designer clothes, $30K car, etc.), are too cheap to buy it even if they can afford it, don't think they need it, aren't taking advantage of financial aide they're already eligible for, etc. Address those issues (and accept that some people are in that position by choice), legislate some standards (like denying customers) and remove some of the restrictions (like plans across state lines), and I'm not sure that wouldn't take care of most of it. After that, you could probably shore up the rest by expanding existing government programs and (as I've already said I'd be in favor of) possibly providing care for children.

Johan

07-28-2009, 02:03 PM

Then again they actually have the best health care in the world. (http://www.photius.com/rankings/healthranks.html)

Sorry...not buying your 'rankings.' (http://www.thefreemanonline.org/featured/ranking-the-us-health-care-system/)

RandoM51

07-28-2009, 02:24 PM

I see most of the problems with the healthcare industry as the result of problems in other industries like big pharma, and insurance. Unless you fix the problems in those industries first you're just slapping a band-aid on healthcare. You want to tackle big pharma it means you have to reform the patent office and the FDA first.

Meanwhile, any politician who takes a serious crack at any of these is most likely not going to get re-elected. Oh snap, now we need campaign reform and perhaps another look at term limits if we want politicians to do what is right instead of merely what is expedient.

If it were a house I'd say we were worrying to much about the siding and the kitchen appliances while termites were destroying the framing and the foundation was sinking and cracking.

ShivaX

07-28-2009, 02:28 PM

Sorry...not buying your 'rankings.' (http://www.thefreemanonline.org/featured/ranking-the-us-health-care-system/)

Hmm.... lemme think... random blogging by guy on a conservative website with an agenda or international organization with nothing to prove... this is a tough one... which should I believe... hmmmmmmmmm

From that same website I've heard that the Holocaust was Britian's fault (http://www.thefreemanonline.org/book-reviews/churchill-hitler-and-the-unnecessary-war/), FDR didn't do anything regarding the Great Depression (http://www.thefreemanonline.org/featured/fdrs-lucky-timing/) and tax havens are good (http://www.thefreemanonline.org/featured/in-praise-of-tax-havens/). Yeah thats a totally unbiased and even-handed rebuttal.

Doogie2K

07-28-2009, 03:54 PM

America's health care system is the envy of the world. It didn't get that way because we adopted a single-payer government system.

According to whom? I sure as fuck wouldn't want to get sick down there; I'd have to sell both my testicles on the black market for a fucking ambulance ride. Our waiting-room times may be obscene here in the Great White North, but at least we didn't need a second mortgage on our house in order to get quality treatment when my dad got cancer.

Generation ABXY

07-28-2009, 04:13 PM

Our waiting-room times may be obscene here in the Great White North, but at least we didn't need a second mortgage on our house in order to get quality treatment when my dad got cancer.

No, and sometimes people even get that sweet life insurance payoff. ;)

Johan

07-28-2009, 04:35 PM

According to whom?

According to the huge amount of worldwide pharmaceutical and medical investments, proportional to total worldwide spending as a whole, that are made here in order to allow the rest of the world to enjoy the medical advancements supported by Americans.

Doogie2K

07-28-2009, 04:49 PM

No, and sometimes people even get that sweet life insurance payoff. ;)

I understand the intention behind the joke, but it's less funny when that's precisely what happens. :(

According to the huge amount of worldwide pharmaceutical and medical investments, proportional to total worldwide spending as a whole, that are made here in order to allow the rest of the world to enjoy the medical advancements supported by Americans.

So because a lot money is spent, that means the system is necessarily better?

What if the people who need to reap the benefits of those advancements can't, because life or death decisions can be taken out of the doctor's hands and placed in those of a pencil-pusher? Seems to me, from the outside looking in, that's how American medical insurance works.

Johan

07-28-2009, 04:57 PM

What if the people who need to reap the benefits of those advancements can't, because life or death decisions can be taken out of the doctor's hands and placed in those of a pencil-pusher? Seems to me, from the outside looking in, that's how American medical insurance works.

That's exactly how the government would work if it controlled medical care, as well...because there isn't an infinite supply of money, or doctors, or equipment for the demand.

There will be rationing and costs involved, one way or another. In a free market system, you can leave one company for another. If the government controls it, there's nowhere to turn.

Also, the world can be glad we burn so much on health care. We pay a disproportionate share of pharmaceutical costs, as well as create advances that benefit others who haven't funded them.

Doogie2K

07-28-2009, 07:40 PM

That's exactly how the government would work if it controlled medical care, as well...because there isn't an infinite supply of money, or doctors, or equipment for the demand.

There will be rationing and costs involved, one way or another. In a free market system, you can leave one company for another. If the government controls it, there's nowhere to turn.

Also, the world can be glad we burn so much on health care. We pay a disproportionate share of pharmaceutical costs, as well as create advances that benefit others who haven't funded them.

I've never seen someone turned down for a proven, life-saving treatment because the Canadian government refuses to pay for it. Never. My father underwent two bouts of expensive chemotherapy, numerous CT scans and MRIs, and had Home Care nursing, permanent oxygen, and in-home pain management at the end of his life, and there was never a hassle, and we never had to pay a dime.

You do not know what you are talking about. You are creating a boogieman out of nothing.

Generation ABXY

07-28-2009, 08:01 PM

I understand the intention behind the joke, but it's less funny when that's precisely what happens. :(

That was actually the intention, and it's less funny because that's what people want us to switch to. Personally, I find it hard to fathom that a situation in which people dying because they have health insurance is somehow preferable to one in which they die because they don't. The latter has hope of improving, while the former has been in full effect for at least 25 years and still suffers the same criticism.

Johan

07-28-2009, 10:00 PM

You do not know what you are talking about. You are creating a boogieman out of nothing.

Bold font makes it true. :D

Fox News! OMG...it must be a lie! (http://newsrealblog.com/2009/07/20/fox-why-obamas-canadian-style-model-of-health-care-reform-is-a-mistake/)

ShivaX

07-28-2009, 10:04 PM

Johan

07-28-2009, 10:10 PM

We can do this all day and not get anywhere. (http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i)

I like your link.

Doctors are hurt financially by single-payer health care.
True and False.

Wait times in Canada are horrendous.
True and False again

You have to wait forever to get a family doctor.
False for the vast majority of Canadians, but True for a few.

Canada's care plan only covers the basics. You're still on your own for any extras, including prescription drugs. And you still have to pay for it.
True

This all sounds great -- but the taxes to cover it are just unaffordable. And besides, isn't the system in bad financial shape?
False. ...and true.

Thanks. That confirms my distaste for it. Most Americans oppose what Obama wants to do because most Americans, surprisingly, are happy with their current health care coverage and are worried, rightfully so, that a change will diminish their coverage.

You don't add 45 million people without either lowering coverage (rationing), or raising fees. Period.

ShivaX

07-28-2009, 10:33 PM

Most Americans oppose what Obama wants to do because most Americans, surprisingly, are happy with their current health care coverage and are worried, rightfully so, that a change will diminish their coverage.

Er... American satisfaction with health care is 40%. Thats not "most" no matter how you define it.

And if you read the details he basically debunks all the horror stories we're talking about.

That said, I don't think the Canadian system is the one to emulate. The French system is vastly superior by all accounts and is actually pretty compatible with what we already have in a lot of cases. Why we aren't looking at France as a model and seem to be skewing more towards the UK/Canada is beyond me.

Johan

07-28-2009, 10:38 PM

Er... American satisfaction with health care is 40%. Thats not "most" no matter how you define it.

Yes, actually...it is. This is just an example of people believing whatever they hear/read/want to.

85% of Americans are insured (around 45 million are not). For those who are insured, a poll a few years ago said: (http://abcnews.go.com/sections/living/US/healthcare031020_poll.html)

Among insured Americans, 82 percent rate their health coverage positively. Among insured people who've experienced a serious or chronic illness or injury in their family in the last year, an enormous 91 percent are satisfied with their care, and 86 percent are satisfied with their coverage.

People are concerned with costs, but insured Americans are rightfully concerned that Democratic proposals will worsen their health care coverage, or increase their costs.

A majority dislikes the plans circulating in Congress. (http://www.upi.com/Health_News/2009/07/17/Poll-US-adults-dislike-healthcare-bill/UPI-32711247812846/)

ShivaX

07-28-2009, 11:06 PM

But Fox News disagrees (http://www.foxnews.com/story/0,2933,136990,00.html).

Then theres stuff like this (http://www.commondreams.org/archive/2008/07/30/10693).

Like I said we can do this all day.

Johan

07-28-2009, 11:13 PM

Like I said we can do this all day.

Which is exactly what's happening in Washington on the issue, and that's making me happy, because their paralysis means they won't fuck it up, which is all they're generally good for!

So...yes! All day, every day! :)

ShivaX

07-29-2009, 01:35 AM

Which is exactly what's happening in Washington on the issue, and that's making me happy, because their paralysis means they won't fuck it up, which is all they're generally good for!

So...yes! All day, every day! :)

Well given the direction they've been leaning with the reform I think we can agree on this at least.

National Kato

07-29-2009, 09:16 AM

ShivaX

07-29-2009, 09:31 AM

Bill Kristol was on The Daily Show discussing healthcare reform (http://www.thedailyshow.com/watch/mon-july-27-2009/bill-kristol-extended-interview) and I was surprised to hear his thoughts on the medical care our military receives versus the private care the rest of us have access to, given his longstanding opposition to universal care.

Do I believe that our men and women in uniform deserve the best healthcare that money can buy? Absolutely. Do I think they should be the only ones? No. On top of that, he seemed generally caught off guard by the fact that this care, which he states is 'the best' available, is provided by the government.

Thats because he got caught in a Catch 22 of his own ideology.

The government provides good health care to the military, but he wants to say that government health care is, by its very nature, not good. So his options become: A) Admit that the government provides good health care or B) Say that our troops are getting poor health care (which he knows isn't true) and should be dumped into the market like everyone else (which his ideology says is superior to any government plan).

The reality of it is he basically screwed his position by openly admitting that the government can do a good health care plan, but it will just cost more than he wants to pay. Hes willing to pay it for soldiers, but not for civilians, which changes the whole argument from Government Bad/Government Good to something more akin to "How much is the life of an American worth?"

Ink Asylum

07-29-2009, 09:46 AM

Jon expertly trapped Kristol. Conservatives like him like to say that the government can't run anything well but they laud anything done to support the military. This leads to a lot of contradictions that they can get caught on, like Jon did.

A similar thing happened during the stimulus debate. You had Michael Steele saying that government never created a job but try and cut mitary spending and you'll hear conservatives howling about lost jobs.

Johan

07-29-2009, 11:47 AM

The government provides good health care to the military

They do? :confused: We must be talking about different countries.

The VA is a nightmare of poorly sterilized colonoscopy equipment, molded/rotted facilities, and missed diagnoses...as well as refused coverage and the like.

Anecdotally speaking, a military friend of mine has a daughter who has had eleven hip surgeries in her eight short years of life because the brainless military pediatrician missed hip dislocation from birth...one of the easiest diagnoses to make (I even know how to check for that one, and have with each of my kids, as well as having the pediatrician check it). When caught early, it's simple to solve. Caught later, it means hip replacement surgery every few decades of your life.

ShivaX

07-29-2009, 01:59 PM

Well he actually cited the VA as something he wasn't sure was the best. I think it was more a matter of soldiers in the field/on duty, which is typically handled differently than VA from what I understand.

Once they get home and aren't actively serving they tend to get dropped into the cesspool with the rest of us or worse.

Generation ABXY

07-29-2009, 02:59 PM

I'm one of those who would say the government has a tendency to screw things up (or, at the very least, be very inefficient), but I'm far from the sort who would applaud the medical care of the military. For one thing, the military is only a fraction of this country, and there are still a fair number of fuck-ups. And, as Johan mentioned, there are the problems with the VA hospitals – hell, even the general practice doctors on base aren't that great (if they were, my life might be a bit different).

However, even beyond that, there are a couple of key differences. First, there's a sort of paternalism in the military, meaning the government can make a great deal of your medical choices for you since you are under their care (and essentially their property). And, second, rather related to that, the government has shown little or no compunction about using experimental treatment in the field, sometimes with questionable results. As it stands, though, the current legislation isn't quite proposing this, so the whole thing is a bit apples and oranges.

So sure, with dictatorial control, the government might be able to run health care (and every other aspect of your life) just fine, but I'd rather hope none of you are suggesting that. I mean, I'm sure I'll be accused of fear mongering, but I don't want them deciding my medical treatment and I sure as hell don't want to be any more of a guinea pig than I already am. Thanks to disproportionate costs, the world owes a lot to our health care system and, thanks to a lack of informed consent, we certainly owe a lot to our soldiers, but I think that's a tricky balance to maintain.

TL;DR: You're using a government's absolute control over certain people as an example of their efficiency.

Ink Asylum

07-29-2009, 03:03 PM

So you get to make all the decisions regarding your medical treatment under your private plan? Doubtful.

So many of the fears about what a government plan would be like already happen under private plans.

Generation ABXY

07-29-2009, 03:09 PM

1) Yes, I do...but that's mostly because I don't have a private plan. (I pay out of pocket, and my doctors have been convinced to make the charges reasonable.)

2) At least people have a choice with private plans. In fact, I'm not sure how that's much of an argument: “Well at least you can't decide who dictates your medical decisions under the government plan!”

Ink Asylum

07-29-2009, 03:14 PM

1) If only everyone could do that, but the extreme costs of medical procedures for people that need more than just routine care make that impossible.

2) People have a choice under Obama's plan, too. No one will be required to take the public option, they can keep their private plans if they love them so much. Obama's plan actually would give someone shopping around for insurance MORE choice than they have now.

Generation ABXY

07-29-2009, 03:19 PM

1) You have no idea what kind of care I need, but I take your point. Cheap preventative care could go a long way though, if people are only willing to work for it.

2) Well, if you look, you'll see that I was saying people don't have much of a choice in the military and that we don't seem to be suggesting that as a reasonable alternative (at least, I hope not). I was more explaining why it wasn't a fair comparison to make.

Ink Asylum

07-29-2009, 03:30 PM

1) I wasn't implying you didn't need any extra care, but it's still impossible for many people to afford their lifetime health care costs out of pocket, no matter how hard they work or how much preventative care they get. Preventative care cannot stop all cancer, or a thousand other diseases and failures of the body that can strike anyone. Nor can prevantative care prevent injuries from accidents or other events.

I do agree, though, that preventative care helps alot, but even that can be out of reach for someone with a very limited income. Choosing between preventative care that might help you down the road and food or rent you need right now is it any surprise that the uninsured put off routine care? Then when they need expensive problems addressed they go to the emergency room, and since they certainly can't pay that tab we all pay it as the hospital spreads the cost around. So if preventative care is cheaper that's all the more reason to make sure everyone gets it, even if it means socializing the costs, because the cost is going to be socialized at the end anyway, only then it's more expensive.

Generation ABXY

07-29-2009, 03:40 PM

Oh, I agree that health care is in dire need of reform. I think we just envision different ways of reaching that goal. Well, that and people seem hung up on freakin' insurance, which is only a symptom of the greater disease here (but that's government for you).

Oh, and are we cool on the second point, Ink?

Ink Asylum

07-29-2009, 04:59 PM

I now realize what you're saying.

I, however, would be perfectly fine with a single-payer system, which is what it would be like if the military system were extended to all Americans. I have no problem with the government providing a minimum level of routine care to all Americans as well as coverage for catastrophic disease/injury. Then allow for private insurance for people who want to pay for more.

That option, however, is a non-starter in Congress, so I tend to limit my discussion here to what actually has a chance of passing.

Generation ABXY

07-29-2009, 06:28 PM

Just because Congress won't do it, doesn't mean I'm going to jump at the first thing they do offer. That's one of the reasons I don't like that they're trying to rush into this - it doesn't give us anytime to hear the alternatives, or at least work through some of the more worrisome kinks.

Ink Asylum

07-29-2009, 06:32 PM

I'm not jumping at the first thing they give us. A public option is fine with me. It's not exactly what I want, but I can support it easily.

Johan

07-29-2009, 11:24 PM

Whatever plan gets put in place, if it ends up happening, Congress damn well better use it themselves.

Getting elected to Congress is like winning the pension/health care/sweet mortgage rate/perks galore lottery. No wonder many of them end up staying for decade after decade. :(

Doogie2K

07-30-2009, 02:07 PM

Bold font makes it true. :D

Fox News! OMG...it must be a lie! (http://newsrealblog.com/2009/07/20/fox-why-obamas-canadian-style-model-of-health-care-reform-is-a-mistake/)

No, bold font means emphasis. And anger. Because you really don't know what you're talking about, because you don't live here and have never experienced nationalized health care. It's not perfect, but it's not what you make it out to be, either. And as has been discussed elsewhere, Canada's isn't even particularly good nationalized health care, and it's still not what you claim it is. If it was, my father would've died two years earlier, and none of us would've seen it coming until it was too late.

Johan

07-30-2009, 03:45 PM

Because you really don't know what you're talking about

When has that ever stopped anyone on the Internet, ever? :D Also, that's your opinion!

Slack3r78

07-31-2009, 09:38 AM

sTh-Yu9RfF0

I may have a new favorite Congressman.

roboninja

07-31-2009, 10:12 AM

When has that ever stopped anyone on the Internet, ever? :D Also, that's your opinion!

Opinion? He lives in Canada, and has experience with our health care system. If that is only opinion to you, well, I do not know what to say.

One thing I will note. I have read several articles from Canadian newspapers this week, and people are pissed about Americans misrepresenting and disparaging our health care system during this power struggle in DC. Ours may not be the best in the world, but we we cringe when we see what passes for health care in the USA. I have lived in the US, so I have experience in both. Hell, we voted the man who started our health care system as the greatest Canadian ever.

The whole socialist, government-inefficiency angle boggles my mind. Police, education, etc. are important enough to be available to all and publicly run, but not health care? The cognitive dissonance is astounding.

Johan

07-31-2009, 10:23 AM

He lives in Canada, and has experience with our health care system.

Anecdotal information is anecdotal.

Ours may not be the best in the world, but we we cringe when we see what passes for health care in the USA.

So glad you don't have to endure it then! It would be horrible if we impacted your health care in any way. (http://www.csustan.edu/manage/harris/industry1.html)

Approximately 36% of research and development is conducted by U.S. pharmaceutical companies followed by Japan with 19% of worldwide research. Of 152 new drugs introduced into the world market between 1975 and 1994, 45% were introduced by American companies, 14% by British companies and 9% by Swiss firms with the balance divided among corporations around the world. U.S. firms lead in their ability to patent their innovations, globalize products, and develop new products through biotechnological research.

The United States accounts for 40% of worldwide pharmaceutical sales, Europe 32% and Japan 24%. Other areas of the world account for 4% of sales and this segment of the market is expected to rise as pharmaceutical companies expand their sales in developing countries.

I get a kick out of people who decry the American system of health care while enjoying the fruit of it. Our pharmaceutical spending, for example, allows you access to medicines that aren't possible without MONEY invested in creating them. You might as well stand next to a tree with an axe, hacking at it's trunk, while eating the tasty fruit that falls from it, all the while complaining of how much the guy who owns the land pays to water/fertilize the tree so the fruit can be sold worldwide for less than the locals pay.

:rolling eyes:

The cognitive dissonance is astounding.

I agree. You may need to reconsider things. For starters, refuse to utilize any medical technology or pharmaceuticals created/developed in America. After all, our system sucks.

07-31-2009, 10:33 AM

The whole socialist, government-inefficiency angle boggles my mind. Police, education, etc. are important enough to be available to all and publicly run, but not health care? The cognitive dissonance is astounding.
You know, food is pretty important too. Actually much more important than law enforcement, education, or healthcare combined. Most people can survive a couple of months without any of those things, but lack of food will kill you in a few weeks.

Yet neither Canada, nor most successful countries, have nationalized their farms, grocers, and restaurants. The mere fact that a good or service is "important" doesn't dictate that it be government-run. Can we at least reach common ground that "importance" is irrelevant in the debate over whether government or private provision is desireable?

Johan

07-31-2009, 10:36 AM

Krauthammer on why Obama's system-reform has died. (http://townhall.com/columnists/CharlesKrauthammer/2009/07/31/obamacare_not_waterloo,_just_a_tactical_retreat)

Reforming the health care system is dead. Cause of death? Blunt trauma administered not by Republicans, not even by Blue Dog Democrats, but by the green eyeshades at the Congressional Budget Office.

It died because Obama lied and dodged on the facts of its cost. Period.

National Kato

07-31-2009, 10:46 AM

I may have a new favorite Congressman.

That was pretty strong, Slack3r!

roboninja

07-31-2009, 11:08 AM

You know, food is pretty important too. Actually much more important than law enforcement, education, or healthcare combined. Most people can survive a couple of months without any of those things, but lack of food will kill you in a few weeks.

Yet neither Canada, nor most successful countries, have nationalized their farms, grocers, and restaurants. The mere fact that a good or service is "important" doesn't dictate that it be government-run. Can we at least reach common ground that "importance" is irrelevant in the debate over whether government or private provision is desireable?

Okay, fine, maybe importance is not the right word. I ask you then, Ox, why should police and education be publicly run and available to all, but not health care? What is it about health care that requires it to be in the private sector?

Ink Asylum

07-31-2009, 11:43 AM

ShivaX

07-31-2009, 12:30 PM

You know, food is pretty important too. Actually much more important than law enforcement, education, or healthcare combined. Most people can survive a couple of months without any of those things, but lack of food will kill you in a few weeks.

But... the government gives people food all the time. Foodstamps are pretty much everywhere. And I'd argue that the way our food is subsidized is very much the government taking a role in food production. If anything its price/supply manipulation.

Slack3r78

07-31-2009, 12:39 PM

As a southerner, I'm pretty much totally unsurprised by those poll numbers.

roboninja

07-31-2009, 12:39 PM

See? This is why I am not a master debater like Ox. I conceded the point outright. :)

Ink Asylum

07-31-2009, 12:42 PM

As a southerner, I'm pretty much totally unsurprised by those poll numbers.

I believe you may be in the wrong thread, sir.

Generation ABXY

07-31-2009, 12:51 PM

sTh-Yu9RfF0

I may have a new favorite Congressman.

Yes, Medicare is remarkable...remarkably bankrupt. Screw it, if I was there, I'd vote for it. I say cover the current stock of recipients (or soon-to-be), provide a refund for the rest and just bite the bullet on the cost – it'll be much less painful than trying to sustain an unsustainable program.

And, honestly, this fellow's little screed is exactly why we need term limits. He practically admits that the only reason Congress isn't addressing the problem is because they won't get elected again otherwise. Take away the ability for this to be a cushy, life-long appointment and our public servants might be willing to make tough decisions that do more than just serve themselves.

BlackPete

07-31-2009, 02:49 PM

I got a kick out of this woman (http://www.facebook.com/ext/share.php?sid=121203343952&h=adO4A&u=FyoYK&ref=nf):

Shona Holmes has appeared in U.S. ads saying she had to go to the Mayo Clinic in Arizona to be treated for a rare type of cyst at the base of her brain — a Rathke's cleft cyst. She mortgaged her home and paid $100,000 to be treated there because getting care in Canada involved a six-month wait, she said. She is currently suing OHIP to recoup those costs.

So she had a benign non-critical tumour and decided she was too impatient and skipped the queue, and now she's sueing Ontario for the costs for her own stupidity. Brilliant!

And this was the best the anti-reformers could do when looking for examples to use in their ads. Double brilliant!

Doogie2K

07-31-2009, 02:49 PM

Anecdotal information is anecdotal.

Whatever you say, friend. I'll take my personal experience over your rhetoric any day.

I agree. You may need to reconsider things. For starters, refuse to utilize any medical technology or pharmaceuticals created/developed in America. After all, our system sucks.

For Christ's sake. There's a world of difference between primary care and corporate or academic research. You're smarter than that.

07-31-2009, 03:39 PM

Okay, fine, maybe importance is not the right word. I ask you then, Ox, why should police and education be publicly run and available to all, but not health care? What is it about health care that requires it to be in the private sector?
Education isn't entirely publicly-run, either: while there is guaranteed free primary and secondary education, even government-run tertiary education is usually fee-based and quite expensive. What's more, we generally concede that our government primary and secondary schools are often critically subpar, while their private-sector counterparts achieve better results with less money. As a proponent of a single unified government-run healthcare system, the very last thing you should do is analogize it to education.

Moreover, I don't claim there are no good arguments for single-payer systems. But the sheer foolishness of saying that all important things ought to be provided by government-run institutions requires refutation.
But the US, and I would assume other first world countries, does provide food stamps and other ways for the poor to maintain a minimum level of sustenance. People still slip through the cracks but government does provide, if not food directly, the ability to buy specifically food to many who are unable to do so themselves.
True. But consider what foodstamps are: vouchers for people to purchase private-sector product on the open market. There isn't a special "foodstamp store" where the prices are lower and the government uses its great power to compel farmers and grocers to offer discounts. The government doesn't directly employ farmers or grocers. Nor are middle-class people entitled to foodstamps: it's highly means-tested. In short, foodstamps are analogous to Medicaid. Of course, anyone suggesting that government healthcare should be limited to Medicaid will immediately be derided as an idiotic Glenn-Beck-worshipping Randian who hates people and wants them to die.

And I'd argue that the way our food is subsidized is very much the government taking a role in food production. If anything its price/supply manipulation.
If you argue that, then you don't know the first thing about US government intervention in food production. The US government's interventions are entirely designed as price supports: it artificially restricts supply of food to drive prices up. Should the government do the same thing for healthcare: pay doctors not to treat patients? That is a radical proposal.

Johan

07-31-2009, 04:31 PM

Whatever you say, friend. I'll take my personal experience over your rhetoric any day.

For Christ's sake. There's a world of difference between primary care and corporate or academic research. You're smarter than that.

You mean you'll take the gigantic American investment in medical care through our hybrid private/public system (http://www.csustan.edu/manage/harris/industry1.html) which leads to drugs and treatments that the rest of the world pays less for, while claiming superiority in your own system? :D

Okay. Gotcha.

Generation ABXY

08-01-2009, 11:29 AM

No doubt it won't convince anyone and we'll probably here the same rebuttals, but, what the hell, I'll post it anyway:
gdx_2cuPgQQ

Shrinn

08-01-2009, 12:52 PM

Johan

08-01-2009, 04:23 PM

No doubt it won't convince anyone and we'll probably hear the same rebuttals, but, what the hell, I'll post it anyway:

Interesting video. Must be a load of complete garbage, though. After all, Pelosi knows who to blame. (http://www.reuters.com/article/politicsNews/idUSTRE56T4CZ20090730?feedType=RSS&feedName=politicsNews&rpc=22&sp=true)

She's such great fun...every day is a new adventure in stupid with her. Any injured veteran could tell you, for example, how difficult it is to get appropriate medical benefits/coverage from the government.

Ink Asylum

08-02-2009, 09:08 AM

.True. But consider what foodstamps are: vouchers for people to purchase private-sector product on the open market. There isn't a special "foodstamp store" where the prices are lower and the government uses its great power to compel farmers and grocers to offer discounts. The government doesn't directly employ farmers or grocers. Nor are middle-class people entitled to foodstamps: it's highly means-tested. In short, foodstamps are analogous to Medicaid.

Every public service is run differently. Police and fire departments are paid through taxes and everyone, ideally, gets the same level of service without additional cost. Roads are paid mostly through taxes but also through tolls, so people who use roads more pay for them more.

So if a public health option will be run and funded differently than all other current systems, so be it. That's not am argument against doing it.

Of course, anyone suggesting that government healthcare should be limited to Medicaid will immediately be derided as an idiotic Glenn-Beck-worshipping Randian who hates people and wants them to die.

No, I would just ask "Why does it have to be limited to Medicaid?". I might also ask, "If you are so against a public health care option why aren't you calling for eliminating Medicaid?"

Nice strawman, though.

Johan

08-02-2009, 09:43 AM

Drug rationing. (http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html)

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

Doogie2K

08-02-2009, 04:26 PM

Why is the waiting list in Canada so high? Is it because too many people are going to hospitals? There's not enough hospitals? From the wording in that video, it sounds like everything is overcrowded. Is that the fault of the government run health care?

Well, I know here in Alberta, a lot of it is the slash-and-burn budgets of the 90s. Then-Premier Ralph Klein drastically cut spending on all programs in order to balance the budget and pay down the province's debt. I think the ultimate repayment of the government's debt is less to do with that and more to do with $70-120 oil, but then I've always thought King Ralph was a drunken twat, anyway.

The legacy of those budgets, though, is that infrastructure, education, and health care were severely neglected. In that time, university tuition has skyrocketed, public schools have been closing left, right, and centre, health care waiting times have gotten ridiculous (dynamiting a full-size hospital in your largest city will do that), people in the big cities can't find a regular family doctor without a recommendation and a fucking job interview, and road projects have been perpetually delayed or seen huge jumps in cost relative to what they would've been a decade earlier, which has made it much harder to accommodate the massive growth in traffic that comes when you attract dozens of business head offices out of Montreal in the post-referendum period, and then draw even more business activity with the oil boom of a few years ago.

And yet somewhere, he found $400 for every living Albertan, from cradle to grave, to "stimulate" an already bustling economy. Because we couldn't have used that extra couple of billion at all for any of the myriad projects that would better serve the government's attention, nor could it have been saved for economic downturns like this to shore up the budget. No, sir, that's not the Progressive Conservative way.

Shrinn

08-02-2009, 04:47 PM

So it's less the fault of the system itself and more of a result of just poor budgeting all around. I see.

Doogie2K

08-02-2009, 10:15 PM

So it's less the fault of the system itself and more of a result of just poor budgeting all around. I see.

I would probably guess it's more like, "a little of A, a little of B," looking at it across the country (and I certainly don't know every province's situation, by any stretch), but certainly in my province, budget cuts played a huge role.

Shrinn

08-03-2009, 06:46 AM

Thank you. I wasn't really aware. The talking point is "Oh no, Canada, you'll be having a heart attack in the waiting room for six months until you're helped!" but I've never seen a reason for it or an explanation of a cause for it.

DoctorFinger

08-03-2009, 07:40 AM

On the other hand, in a private sector health care system your care wouldn't be effected by the decision to reduce the debt load.

Ink Asylum

08-03-2009, 07:43 AM

Nah, it'd just be effected by the need to boost profits for highly paid executives.

Johan

08-03-2009, 07:44 AM

Let's at least be honest about his intentions, shall we? (http://www.breitbart.tv/uncovered-video-obama-explains-how-his-health-care-plan-will-eliminate-private-insurance/)

Where did the transparency go? The honesty? Liar.

Doogie2K

08-03-2009, 11:47 AM

On the other hand, in a private sector health care system your care wouldn't be effected by the decision to reduce the debt load.

Nah, it'd just be effected by the need to boost profits for highly paid executives.

Beat me to it.

Generation ABXY

08-03-2009, 12:24 PM

Yes, but the latter is something there's still hope of addressing. At best you're trading profit motive for cost reduction, but how likely do you think the government is going to be to address problems when they're the ones responsible for them.

Ink Asylum

08-03-2009, 12:34 PM

So tell me how I'm supposed to address the problem of a health company denying me an expensive procedure before it kills me?

DoctorFinger

08-03-2009, 12:39 PM

So tell me how I'm supposed to address the problem of a health company denying me an expensive procedure before it kills me?You go through the appeals process and try to get them to pay for it, or pay for it out of pocket. As opposed to a gov't run system in which there are no appeals, and there is no way to pay for the procedure OOP.

Ink Asylum

08-03-2009, 12:41 PM

DoctorFinger

08-03-2009, 12:47 PM

Depends on the government run system. There's no reason a public plan can't include an appeals process or allow for patients to pay for their own procedures out of pocket if they aren't covered by the public plan.
There's no reason they can't provide that. Except that in all of the systems being touted - England, Canada, Sweden, Japan, etc, - there are no appeals and no way to pay for procedures out of pocket without coming to the US.

Generation ABXY

08-03-2009, 01:55 PM

You go through the appeals process and try to get them to pay for it, or pay for it out of pocket. As opposed to a gov't run system in which there are no appeals, and there is no way to pay for the procedure OOP.

Exactly. I'm not sure how, “but at least now you'll have no options” is supposed to win people over.

Ink Asylum

08-03-2009, 02:06 PM

I'd be interested in hearing what the odds are of getting into that kind of situation in Canada or elsewhere and how that compares to the odds of having expensive treatments rejected by private insurers in America. Having the options of a slim chance to fight for an appeal while you're suffering from a disease or having to go bankrupt to pay for it out of pocket aren't all that attractive if they're happening fairly often compared to a government system where it's much rarer to have treatment rejected and everything else is taken care of.

Generation ABXY

08-03-2009, 02:22 PM

Even if rejections are a small number here, they are still something that can (and, I think, should) be addressed in our current situation. While it would certainly require more nuance than I'm presenting, I'd be fine with legislation that tells insurance companies, “Hey, if you take on a customer, you have to cover them.” I mean, do all the tests you need to in order to make an informed decision, but if you take 'em on even after that, you're responsible.

That's not really an avenue we'll have open when its the lawmakers themselves who are deciding what services should and should not be provided.

Ink Asylum

08-03-2009, 02:34 PM

Except, you know, that you can vote them out of office if they're doing a bad job. Lawmakers do not have the ability to do a shitty job taking care of people without repercussions.

Considering the huge influence private insurance dollars have in shaping past and new legislation they can practically be considered lawmakers themselves. A health insurance executive certainly has much more influence over policy than the average voter.

Generation ABXY

08-03-2009, 03:06 PM

I fully recognize the role our elected official's greed and cowardice plays in government's inaction, Ink Asylum. Hell, we got a good dose of that the other day, with Anthony Weiner's little ultimatum to Republicans (I'm talking about Slacker's video, where he basically threatened their jobs). And, as with that, I think congressional term limits would go a long way towards fixing many of our problems, or at least opening up the door to do so.

On the other hand, if we believe their intentions are true, the fact that the government is working towards health care reform should give hope that they can just as easily go about it in other ways. If not, shouldn't the fact that the health care industry plays such a big role and D.C. be enough to ward you away from the current legislation? I mean, it wasn't formed in some place far outside corruption's reach, but rather in the same place where you claim it is already rife.

Ink Asylum

08-03-2009, 03:20 PM

While there is plenty of health insurance money screwing up the process, I believe that the status quo is worse than the current state of the legislation. The health care industry would love if nothing emerged from Congress. Since something is forming they're trying to water down the harm it will do to their profits as much as possible, but I still believe there are enough Senators and Congressmen actually working for their constituents that plenty of good will come out of whatever passes, even if it's not the perfect bill I would prefer.

I think this moment is the best chance we've had in a long while to get any kind of positive health care reform passed. I would love it if there were another half dozen progressive Senators and a couple dozen more progressive Congressmen so that we could get a much stronger public option if not the single-payer system I would like, but I won't let the perfect be the enemy of the good, as they say.

Generation ABXY

08-03-2009, 03:35 PM

Doogie2K

08-03-2009, 04:27 PM

You go through the appeals process and try to get them to pay for it, or pay for it out of pocket. As opposed to a gov't run system in which there are no appeals, and there is no way to pay for the procedure OOP.

An appeals process that can be dragged out until you're dead, no?

DoctorFinger

08-03-2009, 04:59 PM

An appeals process that can be dragged out until you're dead, no?It can, especially if you have to sue over coverage. But at least there's a chance with an appeal/suit.

Ink Asylum

08-03-2009, 05:01 PM

So, there are enough honest, well-intentioned politicians to shake free the temptation of the evil health care industry and write up legislation you approve of and trust (even if, by your own admission, it's not perfect), but not when it comes to fixing health care in a way that doesn't lead to single-payer (no matter how clear the solutions may be)?

I'm not sure exactly what you're asking there in the second part.

My fantasy health care system is largely single-payer, so I would prefer fixing health care in a way that eventually leads to that.

Ink Asylum

08-03-2009, 05:02 PM

It can, especially if you have to sue over coverage. But at least there's a chance with an appeal/suit.

What are the treatments that get routinely refused by Canadian care, or other similar government run systems? Are they treatments without which the patient would die?

Generation ABXY

08-03-2009, 05:03 PM

I'm not sure exactly what you're asking there in the second part.

My fantasy health care system is largely single-payer, so I would prefer fixing health care in a way that eventually leads to that.

But if we can fix health care in a way that doesn't put it in the hands of the government, why not go that route...do you hate being responsible for yourself that much?

Ink Asylum

08-03-2009, 05:14 PM

Should I also desire being responsible for my own protection from criminals, fire, natural disasters, and the armies of other nations?

Of course not, so myself and other citizens support and uphold a government that can better protect us from those dangers because it socializes the costs and consolidates the system of defense.

I would like the same for health care.

Private health insurance isn't being responsible for myself, either. Being responsible for myself would mean no insurance and paying for everything out of pocket.

Doogie2K

08-03-2009, 05:38 PM

What are the treatments that get routinely refused by Canadian care, or other similar government run systems? Are they treatments without which the patient would die?

None that I'm familiar with, and between my dad's cancer, my grandfather's failing heart and kidneys, and various elderly relatives suffering dementia or Alzheimer's in their waning years, I've seen a few potentially expensive situations, and a few experimental treatments/procedures.

Generation ABXY

08-03-2009, 06:00 PM

Should I also desire being responsible for my own protection from criminals, fire, natural disasters, and the armies of other nations?

Certainly you take precautions, though? I rely on those same services, but I also have an extinguisher, a gun, home insurance, etc.

Of course not, so myself and other citizens support and uphold a government that can better protect us from those dangers because it socializes the costs and consolidates the system of defense.

I would like the same for health care.

I think this may be the core difference between you and me (or our respective parties/political leanings). You seem to think the government is there to help people, whereas I believe it is there to prevent harm.

Private health insurance isn't being responsible for myself, either. Being responsible for myself would mean no insurance and paying for everything out of pocket.

Okay, first, if we address the cost of health care, paying out of pocket (or paying for insurance) wouldn't be such a terrifying concept. And, second, you are paying for it – you do realize that, right? You may not be writing a check each month, but it's coming out of your taxes (or out of your children's), so it's still being payed for. But, out of sight, out of mind I guess.

Ink Asylum

08-03-2009, 06:17 PM

Certainly you take precautions, though? I rely on those same services, but I also have an extinguisher, a gun, home insurance, etc.

And I eat healthy, look both ways crossing the street, and don't smoke. But I can still end up getting a brain tumor or fall down a flight of steps no matter what I do or how careful I am.

I think this may be the core difference between you and me (or our respective parties/political leanings). You seem to think the government is there to help people, whereas I believe it is there to prevent harm.

What's more harmful than dying from cancer? The government hasn't been able to completely prevent it yet so why is it so bad if the government tries to prevent it from killing me if I do get it? Or any other disease?

Okay, first, if we address the cost of health care, paying out of pocket (or paying for insurance) wouldn't be such a terrifying concept. And, second, you are paying for it – you do realize that, right? You may not be writing a check each month, but it's coming out of your taxes (or out of your children's), so it's still being payed for. But, out of sight, out of mind I guess.

Paying out of pocket for routine medical care and preventative medicine wouldn't be that bad, for the vast majority of people, but that's not what bankrupts people. It's the treatments and hospital care that cost thousands and thousands of dollars that are terrifying. You're never going to reduce those costs down to something that's manageable for all Americans, or even the majority.

Yes. It's coming out of my taxes, and out of the taxes of millions of other people. So that the random minority of people that end up needing prohibitively expensive treatments have the cost spread out amongst the majority that don't. Since there's a chance I'll be in that minority I'm perfectly fine paying those increased taxes. That's what socializing a cost is all about.

It's not all that different from private insurance, except in a public system you wouldn't have to skim millions and billions off the top for high paid executives and shareholders.

Generation ABXY

08-03-2009, 06:37 PM

And, if the government uses the resources it has at hand to legislate the health care and insurance industry, it could do the same thing without having a vested interest in it.

When it comes to that, they then become just as bad as the insurance companies. Both strive for cost reductions, one for profit motive and the other to keep in budget. At least with the former, there's some incentive to provide better service – that's the driving force behind countless medical advances, just as it is in any other field. When it comes to the latter, however, you stumble into territory where the people you're counting on to protect you are the very ones telling you you should think about ending your life after denying treatment for your cancer.

You want to socialize that cost and spread it around? I suppose I can acquiesce to that, but I say do it through taxes. Give credit to everyone, and let them pick and choose a service for themselves. Someone's going to want that money, trust me – and if you couple that with the solutions we talked about earlier (that is, the whole if-you-accept-them-you-accept-all-of-them thing), you've addressed the same problems while still being able to have a watchdog. The existing free market system can not only be improved, it can be improved to the point where it can be better than anything the government could ever possibly offer.

Ink Asylum

08-03-2009, 07:23 PM

And, if the government uses the resources it has at hand to legislate the health care and insurance industry, it could do the same thing without having a vested interest in it.

What's wrong with the government having a vested interest in the health of the populace? If it can do it cheaper and more efficiently, by eliminating the need for obscene profits and consolidating the system into one payer, why not?

When it comes to that, they then become just as bad as the insurance companies. Both strive for cost reductions, one for profit motive and the other to keep in budget.

At least when you're trying to keep under budget as opposed to making a profit more of the money goes into providing health care, allowing you to cover more people and more treatments.

At least with the former, there's some incentive to provide better service – that's the driving force behind countless medical advances, just as it is in any other field.

The government doesn't have an incentive to provide better service so they won't do research towards medical advances? That's absurd. It has an incentive to improve care so it can save money, and it has an incentive to provide results so voters will continue to support the expense. The government spends tons of money on scientific research, why can't it do the same for medical research, and again do it cheaper than for profit business?

When it comes to the latter, however, you stumble into territory where the people you're counting on to protect you are the very ones telling you you should think about ending your life after denying treatment for your cancer.

Thank heavens no insurance company has ever denied anyone treatment for cancer. Are you buying into the nonsense about the government helping the elderly plan for the end of their life being the same as the government telling people they should just die? The same government that runs Medicare and Social Security? You do know that the last people that private insurers actually want to cover are the old and the sick, don't you? They want the young and the healthy on their rolls. You think the private market wants to protect you? They want your money, and they don't want to have to spend it once they have it.

You want to socialize that cost and spread it around? I suppose I can acquiesce to that, but I say do it through taxes. Give credit to everyone, and let them pick and choose a service for themselves. Someone's going to want that money, trust me – and if you couple that with the solutions we talked about earlier (that is, the whole if-you-accept-them-you-accept-all-of-them thing), you've addressed the same problems while still being able to have a watchdog. The existing free market system can not only be improved, it can be improved to the point where it can be better than anything the government could ever possibly offer.

I simply don't believe that. There are things the government can do better than private industry, and health insurance is one of them. The government protects us from crime, fire, disaster, and war, why not disease? Do you believe that we could privatize all those aspects of government and it would be cheaper and better than the public systems we have now?

Generation ABXY

08-03-2009, 08:32 PM

Again, you seem to be saying a single-payer system is no worse than traditional health care, but it is, because it is accountable to no-one. No matter their location, the people in Washington are still just people and that means they're susceptible to all the same pitfalls – you said so yourself. Hell, half the reason things have gotten as bad as they have is because these politicians haven't been doing their job, just keeping it safe. And for that you want to put them in charge of even more? When they make a decision that is not in your best interest (whether for cost reduction or simply to line their own pockets), you won't have anyone to turn to then...unless you think they're suddenly going to turn over a new leaf once they're responsible entirely for your wellbeing.

Also, you didn't address the aspect of tax credits. Do you have any stance on that, since it should serve well to address your want to “socialize” the cost?

Ink Asylum

08-03-2009, 09:14 PM

08-03-2009, 09:31 PM

The government doesn't have an incentive to provide better service so they won't do research towards medical advances? That's absurd. It has an incentive to improve care so it can save money
Um. Isn't the defining characteristic of most new medical technology these days that it is more expensive than the old treatments? Did I miss a class or something?

There are things the government can do better than private industry, and health insurance is one of them.
I'm open to the possibility that government-run healthcare could theoretically be more efficient than private-sector healthcare. But I am very concerned about your reasoning. You cite two reasons why GRHC would be more efficient:
1. No "obscene profits."

2. A single payer means everything is consolidated.

The problem is that this reasoning applies with equal weight to every industry. I assume you don't mean to argue that every industry would be more efficient if it were nationalized (if you are arguing that, I'm happy to discuss counterexamples). I was under the impression that Democrats weren't really Communists, that they generally accepted that markets are good for providing most products and more efficient than government bureaucracy in most circumstances. When we start talking about healthcare, though, the arguments seem to reveal a complete contempt for markets in all circumstances. You don't identify any unusual aspects of the healthcare market as justification for GRHC, but rather present an argument for nationalizing the entire economy. I don't think you are a Communist, but the more I argue the more I wonder why you aren't one.

Ink Asylum

08-03-2009, 10:03 PM

Um. Isn't the defining characteristic of most new medical technology these days that it is more expensive than the old treatments? Did I miss a class or something?

The brand new technology is more expensive and the slightly older technology becomes cheaper. That brand new technology will then become cheaper when a newer technology is discovered. When you research how to do something better you also discover how to do what you do now cheaper. It's why I have an iPhone that's hundreds of times more powerful than the computer I had when I was six yet costs a tenth as much. The same goes for medical treatments.

The problem is that this reasoning applies with equal weight to every industry. I assume you don't mean to argue that every industry would be more efficient if it were nationalized (if you are arguing that, I'm happy to discuss counterexamples). I was under the impression that Democrats weren't really Communists, that they generally accepted that markets are good for providing most products and more efficient than government bureaucracy in most circumstances. When we start talking about healthcare, though, the arguments seem to reveal a complete contempt for markets in all circumstances. You don't identify any unusual aspects of the healthcare market as justification for GRHC, but rather present an argument for nationalizing the entire economy. I don't think you are a Communist, but the more I argue the more I wonder why you aren't one.

The unusual aspect is that it's a need, something you would die without, not a want. I believe the taxpayer supported government should provide a basic level of needs to every citizen so that they can survive without going bankrupt no matter what their financial situation. On top of that, the private industry can go to work and make whatever profit they can off of the wants.

It's very hard to have a fair market transaction between a company and a consumer for a life or death need, because most of us will pay any amount of money to not die. It's not like a car, or a delivery man, or a video game, which has an upward limit to what people would be willing to pay for the product or service.

So, in my mind, the free market is great at providing products and the government is great at providing needs, and I don't believe that "not dying" should be classified at a product.

ShivaX

08-04-2009, 12:11 AM

It's very hard to have a fair market transaction between a company and a consumer for a life or death need, because most of us will pay any amount of money to not die. It's not like a car, or a delivery man, or a video game, which has an upward limit to what people would be willing to pay for the product or service.

So, in my mind, the free market is great at providing products and the government is great at providing needs, and I don't believe that "not dying" should be classified at a product.

That pretty well summerizes how I feel about the whole thing as well.

Free market is great unless your product is someone else's life.
How much are you willing to pay to not die or not have your loved ones die?

08-04-2009, 02:33 AM

The brand new technology is more expensive and the slightly older technology becomes cheaper. That brand new technology will then become cheaper when a newer technology is discovered. When you research how to do something better you also discover how to do what you do now cheaper. It's why I have an iPhone that's hundreds of times more powerful than the computer I had when I was six yet costs a tenth as much. The same goes for medical treatments.
That's not how technological progress works. Your iPhone is so much cheaper per megabyte because the fab plants have gotten insanely efficient: producing a chip with a certain number of transistors on it is very much cheaper than it used to be, so it's very cheap to assemble dense chips together into iPhones.

Medical progress isn't developing vastly more efficient means of curing people, or even of manufacturing doctors, hospitals, or drugs. Older medical treatments are no more efficient to produce than they used to be (or only very slightly), it's just that demand for them has fallen as people moved on to the more advanced (and even harder) medical treatments. The one exception is patented drugs, which (a) make up about 15% of U.S. healthcare costs, and (b) are really subject to changes in legal circumstances rather than manufacturing efficiency. Your answer is glib and seriously flawed.

The unusual aspect is that it's a need, something you would die without, not a want. I believe the taxpayer supported government should provide a basic level of needs to every citizen so that they can survive without going bankrupt no matter what their financial situation. On top of that, the private industry can go to work and make whatever profit they can off of the wants.
This is a very strange response. Why should the market provide our wants? You've just explained that you genuinely believe government bureaucracy is more efficient at providing all goods and services, because it is not plagued by the profit motive and because it can consolidate the fragmented economic actors. Why should we tolerate the market's obvious inferiority in the production of our "wants" (as if you can separate "needs" from such obviously optional products like food, housing, clothing, soft drinks, toothpaste...)? If you're going to be a Communist, don't be some half-hearted Gorbachevian one.

It's very hard to have a fair market transaction between a company and a consumer for a life or death need, because most of us will pay any amount of money to not die.
Obviously untrue. When people purchase cars, how many buy Volvos and how many buy Kias? How many people take a higher salary in exchange for a more dangerous job? We sell our safety all the time, and almost nobody has a truly infinite willingness to spend money for additional lifespan. If nothing else, people wish to leave estates for their children. How often do people create living wills or pull the plug on their relatives? How often do we debate whether hospice care is best and most affordable for our parents? When was the last time you had one of those conversations and anybody said, "Money is no object, I'm willing to spend anything and everything for even a little more time with Grandma"?

And so what? Let's say people really can't draw any sort of line when it comes to life and death. Does government provision eliminate that problem? Only if you are exceptionally stupid. The doctor still wants a nice car and to put his mistress up in a fancy hotel; the nurse still wants a fair wage for dealing with bodily fluids all day; the administrators and staff and janitors and secretaries and everybody else wants their pay. All of them are likely going to try to drive a hard bargain about their wages with whomever employs them. If government is as responsive to the voters as you say, it will spend any amount of money the medical staff demand -- a public sector union that people can't even contemplate refusing. Or else the government is going to threaten to say no to people, in which case the unfair market transaction is just happening between the government and the medical staff -- where neither of them really care that much about poor old Grandma, anyway. I don't know where you get this notion that, just because the government is doing the negotiating, somehow everything winds up being fair.

Ink Asylum

08-04-2009, 06:41 AM

That's not how technological progress works. Your iPhone is so much cheaper per megabyte because the fab plants have gotten insanely efficient: producing a chip with a certain number of transistors on it is very much cheaper than it used to be, so it's very cheap to assemble dense chips together into iPhones.

And that never happens with medical technology?

This is a very strange response. Why should the market provide our wants? You've just explained that you genuinely believe government bureaucracy is more efficient at providing all goods and services, because it is not plagued by the profit motive and because it can consolidate the fragmented economic actors. Why should we tolerate the market's obvious inferiority in the production of our "wants" (as if you can separate "needs" from such obviously optional products like food, housing, clothing, soft drinks, toothpaste...)? If you're going to be a Communist, don't be some half-hearted Gorbachevian one.

Because when it's a need it's a lot harder to walk away completely from a certain market than when it's a want. Choice and competition make the market a better producer of wants, but only because one of your choices is to abstain from making a choice at all without adverse harm happening to yourself. If you have the easy choice to walk away from a deal then the free market is better at producing a superior product that the government.

It's not a half-hearted distinction at all, it's how our own government tends to operate when you take a look at what the government does vs what they leave up to the free market. Considering how many people are fine with a socialized police/army/fire department/disaster relief yet don't want socialized video games it would seem like plenty of Americans agree, even if they don't realize exactly why they make that distinction.

Obviously untrue. When people purchase cars, how many buy Volvos and how many buy Kias? How many people take a higher salary in exchange for a more dangerous job? We sell our safety all the time, and almost nobody has a truly infinite willingness to spend money for additional lifespan.

And we have government agencies that make sure those wants have a certain level of safety. Again we trust the government over the market's self-regulation when it comes to protecting our lives. Those are also examples of choosing to put your own life at risk, something you can abstain from, not having to choose a free market option to avoid death. They're completely different.

If nothing else, people wish to leave estates for their children. How often do people create living wills or pull the plug on their relatives? How often do we debate whether hospice care is best and most affordable for our parents? When was the last time you had one of those conversations and anybody said, "Money is no object, I'm willing to spend anything and everything for even a little more time with Grandma"?

The willingness to spend obscene amounts of money to keep on living does begin to fade as death becomes more inevitable and the time you are buying is greatly decreased, but that doesn't mean it still isn't completely unbalanced compared to wants.

All of them are likely going to try to drive a hard bargain about their wages with whomever employs them. If government is as responsive to the voters as you say, it will spend any amount of money the medical staff demand -- a public sector union that people can't even contemplate refusing. Or else the government is going to threaten to say no to people, in which case the unfair market transaction is just happening between the government and the medical staff -- where neither of them really care that much about poor old Grandma, anyway. I don't know where you get this notion that, just because the government is doing the negotiating, somehow everything winds up being fair.

A government isn't perfect or fair, but it is much more fair to people more consistently in matters of life and death than a for profit company exactly because of what you've described, the government acts as a more powerful bargainer than small pockets of consumers can be for getting citizens what they need. It works, because we have a police force and we don't have all police refusing to do work because they're demanding obscene paychecks because they're the only ones who can do the work. We have fire departments that do the same. They have unions yet the government deals with them daily.

08-04-2009, 08:10 AM

And that never happens with medical technology?
I'm trying to think of an example. Apart from patented drugs, as I said, I can't think of a single medical technology or technique from the past 100 years that is dramatically easier to manufacture or perform. Even appendectomies -- a surgical technique that's remained almost unchanged since it was developed soon after the invention of anesthesia -- take approximately as long, and require about as much trained staff, as they did when they were invented. Am I missing a bunch of glaring examples?

Because when it's a need it's a lot harder to walk away completely from a certain market than when it's a want. Choice and competition make the market a better producer of wants, but only because one of your choices is to abstain from making a choice at all without adverse harm happening to yourself.
How does that work? You've said that government can produce things more efficiently because it's consolidated and it doesn't care about profits. Doesn't that mean it would be a better producer of wants as well?

And how does this abstention option make all the difference? Certainly in the classic models of a market (including the Marxist model), there's no difference for the producer between you choosing to go with a different provider and you choosing to go without. So, according to the classic models, abstention is no different from shopping around and isn't a valid distinction between needs and wants. So unless you're using a completely novel economic model that probably entitles you to some sort of international prize, this is an irrelevant distinction.

Finally, I love the notion that you can walk away entirely from a want market with no adverse harm. Because it's so easy to do without a house, car, clothing, food, job, telephone, toilet, etc. Everyone needs to live somewhere unless they want to be arrested and freeze in the winter. Why isn't the housing market one of coercion, just like healthcare supposedly is?

It's not a half-hearted distinction at all, it's how our own government tends to operate when you take a look at what the government does vs what they leave up to the free market. Considering how many people are fine with a socialized police/army/fire department/disaster relief yet don't want socialized video games it would seem like plenty of Americans agree, even if they don't realize exactly why they make that distinction.
That's actually not how our government operates, as I've demonstrated. And you know as well as I do that most Americans support the status quo not out of any dimly-perceived philosophy but because it's the status quo and people are naturally conservative about that sort of thing. Police/army/fire department are, incidentally, public goods: a market for them couldn't really exist and have them resemble their current form, because the free-rider problem is so acute. Is there a major free-rider problem in American healthcare? Are there a lot of freeloaders who are basking in the benefit of my having seen the doctor without chipping in on the bill?

And we have government agencies that make sure those wants have a certain level of safety. Again we trust the government over the market's self-regulation when it comes to protecting our lives. Those are also examples of choosing to put your own life at risk, something you can abstain from, not having to choose a free market option to avoid death. They're completely different.
Oh, okay. So being paid to accept a potential for death is "completely different" from abstaining from purchasing medical care, but the National Transportation Safety Board is exactly the same as an American NHS. I must really suck at analogies.

The willingness to spend obscene amounts of money to keep on living does begin to fade as death becomes more inevitable and the time you are buying is greatly decreased, but that doesn't mean it still isn't completely unbalanced compared to wants.
So people ought to be more willing to face death? Isn't this just a value judgment from someone who probably hasn't ever personally stared death in the face? I spent a lot more money on chemo than I did on my first car, but the chemo was a heck of a lot more valuable than my first car. I really wanted the chemo, but I really wanted the car, too. Ultimately, I think I more than got my money's worth on the chemo but I got ripped off on the car. You're not arguing from theory or even experience so much as from divine revelation now.

A government isn't perfect or fair, but it is much more fair to people more consistently in matters of life and death than a for profit company exactly because of what you've described, the government acts as a more powerful bargainer than small pockets of consumers can be for getting citizens what they need. It works, because we have a police force and we don't have all police refusing to do work because they're demanding obscene paychecks because they're the only ones who can do the work. We have fire departments that do the same. They have unions yet the government deals with them daily.
They don't strike, in large part because strikes are illegal. But they are very expensive, and there's plenty of economic evidence to suggest that they may be hugely overpaid. They routinely (http://news.bbc.co.uk/2/hi/uk_news/7203839.stm) get above-inflation pay increases, despite typically showing a below-average productivity growth. The government is a much worse bargainer than the individual, because its actions are large and visible: rather than simply choosing to see a different doctor, the government has to conduct massive layoffs and then hire new personnel if negotiations break down. With the exception of the air traffic controllers' strike, that rarely happens in public unions.

Honestly, you're now claiming the government is better at holding down wages for its own employees than the private sector is? That's not even Communist anymore, it's just completely disconnected with any experience human beings have ever had on this Earth.

Ink Asylum

08-04-2009, 09:04 AM

I'm trying to think of an example. Apart from patented drugs, as I said, I can't think of a single medical technology or technique from the past 100 years that is dramatically easier to manufacture or perform. Even appendectomies -- a surgical technique that's remained almost unchanged since it was developed soon after the invention of anesthesia -- take approximately as long, and require about as much trained staff, as they did when they were invented. Am I missing a bunch of glaring examples?

Any technology that is used. Or do we not use machines to improve the quality of health care? There are plenty of machines during the diagnostic process that get cheaper and cheaper because of research. Drugs are made through processes and machines that get cheaper. Machines are all over an operating room and those steadily get cheaper.

And how does this abstention option make all the difference? Certainly in the classic models of a market (including the Marxist model), there's no difference for the producer between you choosing to go with a different provider and you choosing to go without. So, according to the classic models, abstention is no different from shopping around and isn't a valid distinction between needs and wants. So unless you're using a completely novel economic model that probably entitles you to some sort of international prize, this is an irrelevant distinction.

There is a difference between abstaining and shopping around when the consumer can't abstain without dying. When that's the case the customer may shop around but in the end they'll have to make a decision between buying one of the offered insurance plans or death. That's a comfort that most industries don't have, and it means they can get away with abuses that other industries wouldn't as long as they can prevent a public option, because people would rather have shitty health care than die.

Finally, I love the notion that you can walk away entirely from a want market with no adverse harm. Because it's so easy to do without a house, car, clothing, food, job, telephone, toilet, etc. Everyone needs to live somewhere unless they want to be arrested and freeze in the winter. Why isn't the housing market one of coercion, just like healthcare supposedly is?

The government recognizes the minimum level of many of those needs. It provides housing for the homeless, food stamps for the hungry, public telephones, public toilets, public transportation. It also provides welfare, unemployment, and other funds to the poor that are intended to pay for a variety of basic necessities. It strives to provide the bare minimum to satisfy the need for those things in a modern society. You might not get everything you want (although maybe you will, I'm very happy with my public transportation), but you'll be able to live and function. If you want more than the minimum the government provides then that's a want, not a need, and you can pursue that in the free market, or taxpayers can support an improved minimum level from the government.

That's actually not how our government operates, as I've demonstrated. And you know as well as I do that most Americans support the status quo not out of any dimly-perceived philosophy but because it's the status quo and people are naturally conservative about that sort of thing.

So do you believe that we'd be better served by privatizing the police/military/fire departments/etc? Do you support them because they're the status quo or because you believe the government does them better than private industry?

Is there a major free-rider problem in American healthcare? Are there a lot of freeloaders who are basking in the benefit of my having seen the doctor without chipping in on the bill?

Yes. Hospital emergency rooms and calling 911. People get emergency treatment before having to demonstrate an ability to pay. When they can't pay that cost gets shuffled around to everyone else. They're free riders, even if it means they're left with huge hospital bills they'll never get around to paying. If our nation decided we were comfortable refusing emergency treatment to huge numbers people without insurance or the ability to pay out of pocket then we'd have no freeloaders, but at the moment we do.

How are police/fire departments/disaster relief public goods but health is not? Health effects how a nation operates to a huge degree. Keeping people healthy means they can continue to work and at a higher degree of efficiency than when they're sick or injured. Healthy people are happier and contribute more to the public mood. Keeping people from going into bankruptcy or accumulating huge amounts of debt through medical bills means they continue being consumers and keep the economy running. Identifying and curing ailments early on through preventative care saves huge amounts of money in the long run over letting health issues get to the point of emergency care. It easily ranks up there with reducing crime, preventing fires, and protecting people's lives during disasters.

08-04-2009, 10:07 AM

Any technology that is used. Or do we not use machines to improve the quality of health care? There are plenty of machines during the diagnostic process that get cheaper and cheaper because of research. Drugs are made through processes and machines that get cheaper. Machines are all over an operating room and those steadily get cheaper.
Well, I guess that is an example. How much of medical expenses is accounted for by the manufacturing costs of those machines? I think you're talking about a pretty tiny fraction.

The government recognizes the minimum level of many of those needs. It provides housing for the homeless, food stamps for the hungry, public telephones, public toilets, public transportation. It also provides welfare, unemployment, and other funds to the poor that are intended to pay for a variety of basic necessities.
Public telephones are kind of an extremely weird example, since I'm pretty sure they aren't provided by the government. As for the rest: as I said, that's all equivalent to Medicaid. If you want to provide stuff for the poor out of a sense of charity, that's a value judgment and purely political. But don't make the mistake of saying that foodstamps are a more efficient mechanism for feeding people than the market, or claiming that middle-class people ought to get foodstamps as well. Subsidies for the poor are well-established to be inefficient, but we tolerate the inefficiency because we think it's worth it. Your efficiency claims are double-dealing.

I mean, the government doesn't directly provide housing to most of the poor. Most of them either find the money some way or wind up on the street. Those who do get government assistance usually get it in the form of a Section 8 voucher. But why don't the landlords exploit the poor and demand all of their meager worldly goods in addition to the voucher?

So do you believe that we'd be better served by privatizing the police/military/fire departments/etc? Do you support them because they're the status quo or because you believe the government does them better than private industry?
In circumstances where police and fire departments can exist in the private sector (e.g., company towns), I think they are often as good or better than the government versions. Sometimes they're worse. In most cases, however, police and fire present far too many externalities for private provision to be socially optimal: the government would have to subsidize them so much they would be nearly free at the point of service. Indeed, for most crime victims, police intervention is actually of negative utility, which is why police have to compel witnesses to attend court. The fire department usually doesn't manage to save a lot of the house that's on fire; it's the surrounding houses that benefit.

Fire departments are interesting because, of course, they got started as private companies and only later got nationalized. I don't think anybody argues that government fire companies are better at fighting fires than private ones, only that they are more fair because they fight fires even for the poor. But you seem very explicitly to be making an efficiency argument, not a fairness argument (at least at times).

Yes. Hospital emergency rooms and calling 911. People get emergency treatment before having to demonstrate an ability to pay. When they can't pay that cost gets shuffled around to everyone else. They're free riders, even if it means they're left with huge hospital bills they'll never get around to paying. If our nation decided we were comfortable refusing emergency treatment to huge numbers people without insurance or the ability to pay out of pocket then we'd have no freeloaders, but at the moment we do.
How many of those people who use the ER as their primary care physician pay any income taxes? Remember, 41% of people don't pay income taxes. I'm assuming that the very wealthy tend not to be using the ER if they can avoid it. Yet those are the people who are going to be taxed for it. You've still got a free-rider problem, you've just given it an imprimatur.

We tolerate that for things like police, etc., because usually there would be no police force unless there was government provision. But surely you acknowledge that we do have a healthcare industry in the United States. Expensive, inefficient, frustrating, but hardly in the same class as police or fire or disaster relief.

Identifying and curing ailments early on through preventative care saves huge amounts of money in the long run over letting health issues get to the point of emergency care.
This is simply wrong (http://content.nejm.org/cgi/content/full/358/7/661), as I've mentioned before.
Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.

What's interesting is how radically you've shifted ground. You started off claiming that government provision of medical care would inherently be more efficient, for the reasons I described as Communist. When I asked you for a more thorough discussion of this economic analysis, you shifted to a morality-based one: that it's right or fair for the government to provide medical care to everyone. Fine, but don't dress up your politics as economics.

Generation ABXY

08-04-2009, 10:47 AM

Elected officials are accountable every 2-6 years to their voters. I'm not one of those people that believes incumbents are invulnerable. We've seen a huge swing in the make up of Congress in the past decade due to voters getting fed up with Republicans. If Democrats botch up health care and create a system people don't like they'll get kicked to the curb next.

Oh, but if government screws up, people could die! Isn't that your whole problem with insurance companies? Honestly, would you potentially want another Bush in charge of this program?

At least the police don't ask for a credit card number when I call 911.

No, they just get first dibs on your paycheck.

Tax credits for a private health insurance system when the government could provide it directly means less bang for your buck, because some of that credit will have to go towards insurance company profits.

Company profits? Perhaps not, but a portion of your money is still going to be wasted, paying for cushy seats on the various boards and panels that are going to be making medical decisions for the whole country.

The government recognizes the minimum level of many of those needs. It provides housing for the homeless, food stamps for the hungry, public telephones, public toilets, public transportation. It also provides welfare, unemployment, and other funds to the poor that are intended to pay for a variety of basic necessities. It strives to provide the bare minimum to satisfy the need for those things in a modern society. You might not get everything you want (although maybe you will, I'm very happy with my public transportation), but you'll be able to live and function. If you want more than the minimum the government provides then that's a want, not a need, and you can pursue that in the free market, or taxpayers can support an improved minimum level from the government.

And there's also medical aide available for those who can't afford it. Whether or not people take advantage of it is another story altogether. And, yes, there are people who put a price on their health – for some, peace of mind is less valuable than a few hundred channels, unlimited minutes or whatever else it is they use to fill up their time.

Healthy people are happier and contribute more to the public mood. Keeping people from going into bankruptcy or accumulating huge amounts of debt through medical bills means they continue being consumers and keep the economy running.

Oh yeah, use happiness as a barometer for what should and should not be nationalized. There's no way that'll go wrong! ;)

Ink Asylum

08-04-2009, 11:04 AM

Public telephones are kind of an extremely weird example, since I'm pretty sure they aren't provided by the government.

There are government programs, though, to provide cell phones to the poor and homeless to help them find and maintain jobs.

As for the rest: as I said, that's all equivalent to Medicaid. If you want to provide stuff for the poor out of a sense of charity, that's a value judgment and purely political. But don't make the mistake of saying that foodstamps are a more efficient mechanism for feeding people than the market, or claiming that middle-class people ought to get foodstamps as well. Subsidies for the poor are well-established to be inefficient, but we tolerate the inefficiency because we think it's worth it. Your efficiency claims are double-dealing.

There are plenty of instances where the public option is the more efficient one, though. Just because food isn't one of them doesn't mean it's never the case. Do you believe having competing law enforcement or fire departments or armies would be more efficient than having one public option?

I mean, the government doesn't directly provide housing to most of the poor. Most of them either find the money some way or wind up on the street. Those who do get government assistance usually get it in the form of a Section 8 voucher. But why don't the landlords exploit the poor and demand all of their meager worldly goods in addition to the voucher?

I would assume it's illegal to do so, but maybe I'm wrong. The government generally works to prevent the gross exploitation of the poor, though that wasn't always the case, and exploitation still happens though we try to prevent it.

In circumstances where police and fire departments can exist in the private sector (e.g., company towns), I think they are often as good or better than the government versions. Sometimes they're worse.

The times when private police or fire departments perform better is probably because they're being paid more and are better funded, and have to deal with a smaller region or population.

In most cases, however, police and fire present far too many externalities for private provision to be socially optimal: the government would have to subsidize them so much they would be nearly free at the point of service. Indeed, for most crime victims, police intervention is actually of negative utility, which is why police have to compel witnesses to attend court. The fire department usually doesn't manage to save a lot of the house that's on fire; it's the surrounding houses that benefit.

What are those externalities? Why aren't there similar externalities when it comes to protecting from disease and injury?

Also, the fire department saves lives, not just property. They're pretty damn good at that, I believe.

Fire departments are interesting because, of course, they got started as private companies and only later got nationalized. I don't think anybody argues that government fire companies are better at fighting fires than private ones, only that they are more fair because they fight fires even for the poor. But you seem very explicitly to be making an efficiency argument, not a fairness argument (at least at times).

A private fire company may be better at putting out a fire if you can pay their higher fees, but that doesn't mean they're a better option for a large population. Is more capable of eliminating a fire better if the cost becomes too high for you to afford? Efficient doesn't mean the best service period, it means the best service possible for a certain level of cost. We could put a cop 24/7 on every corner in a city and that would do more to decrease crime, but it wouldn't necessarily be better or more efficient than the current system if we bankrupt ourselves trying to do so.

How many of those people who use the ER as their primary care physician pay any income taxes? Remember, 41% of people don't pay income taxes. I'm assuming that the very wealthy tend not to be using the ER if they can avoid it. Yet those are the people who are going to be taxed for it. You've still got a free-rider problem, you've just given it an imprimatur.

We tolerate that for things like police, etc., because usually there would be no police force unless there was government provision. But surely you acknowledge that we do have a healthcare industry in the United States. Expensive, inefficient, frustrating, but hardly in the same class as police or fire or disaster relief.

As you acknowledge, we had for-profit fire departments before we shifted to public ones. You could have said the same thing at the time when we made that shift, but that's not an argument for maintaining the status quo. Weren't you just saying "most Americans support the status quo not out of any dimly-perceived philosophy but because it's the status quo and people are naturally conservative about that sort of thing"? Perhaps people who are satisfied with private health insurance are only conservatively supporting the status quo, not because they're philosophically in favor of privatized health insurance. The existence and possibility of a private option does not mean we shouldn't shift to a public one if, as I and others believe, it would be better, both economically and morally.

Also, why would there be no police if the government didn't provide them? I imagine that if the police vanished tomorrow and all the taxes that supported them were refunded to taxpayers that people would begin hiring private security to police their homes, buildings, or neighborhoods. Would they be better? More efficient? Perhaps, perhaps not, as you conceded before, but they would exist. People aren't just going to let their homes get raided and their family killed.

What's interesting is how radically you've shifted ground. You started off claiming that government provision of medical care would inherently be more efficient, for the reasons I described as Communist. When I asked you for a more thorough discussion of this economic analysis, you shifted to a morality-based one: that it's right or fair for the government to provide medical care to everyone. Fine, but don't dress up your politics as economics.

It can't be both? I believe it can. It's cheaper to provide a minimum level of insurance to all Americans for preventative care and catastrophic illness, and it's right for the government to do so. You certainly haven't convinced me otherwise, and my drifting into discussing morality is not surrender on the subject of efficiency. So what if the conversation shifted? That happens all the time when we're talking about such a broad topic.

Johan

08-04-2009, 11:10 AM

This is simply wrong (http://content.nejm.org/cgi/content/full/358/7/661), as I've mentioned before.

Facts are easily disputed on the Internet...with opinion. Everyone's got one. :)

The idea that we can add 45 million people to government health insurance, keep everyone else's insurance coverage the same, lower costs, AND avoid taxes on any but a small sliver of the rich, if that is even necessary...

is so fucking preposterous that it amuses the hell out of me.

Americans are skeptical because most of them are quite content with their current coverage, understand that you can't do what Obama wants to do without SOMETHING giving in the list of items above, and also are aware that he actually favors a single-payer government takeover through a push for a government initiative/plan that would begin the process of accomplishing his goal over time.

08-04-2009, 05:44 PM

There are plenty of instances where the public option is the more efficient one, though. Just because food isn't one of them doesn't mean it's never the case. Do you believe having competing law enforcement or fire departments or armies would be more efficient than having one public option?
Historically speaking, the positive pressures of competition almost always outweigh the drawbacks of the duplication of administrative overhead (which is often lower for a large number of small actors anyway). Obviously it's not practical to create genuine competition in a market, but in instances where it is possible, that almost always results in a more efficient outcome.

I would assume it's illegal to do so, but maybe I'm wrong. The government generally works to prevent the gross exploitation of the poor, though that wasn't always the case, and exploitation still happens though we try to prevent it.
HUD calculates how much the family can afford to spend on rent, and how much rent usually costs in the area. It then gives the family a voucher for the difference. Since HUD deliberately underbids the fair market value, especially in high-price areas, it's often hard for those families to find a landlord willing to rent at HUD prices. Those families have to top up the HUD voucher out of pocket.

Is that exploitation? There's only so much housing to go around. If a landlord thinks he can get a higher price from a private-sector renter, it's not obvious to me why it would be "gross exploitation" for him to demand a similar price from a government-subsidized renter. HUD could simply nationalize all housing or use its tremendous market power to force landlords to offer lower rental prices for the poor. But all this would do is disincentivize people from building housing appropriate for the poor: there's been a trend over the past few decades of developers being reluctant to build even middle-class housing in some markets for fear of being shaken down by HUD. So poor people get a lot of vouchers and the muscle of HUD but there are no landlords for them to beat up. I guess HUD has done a great job of preventing exploitation of the poor, but it's hard to see how the poor are any better off. I guess that's not the point.

What are those externalities? Why aren't there similar externalities when it comes to protecting from disease and injury?
For certain things. Infectious disease is clearly an instance of massive externalities, which is why most economists strongly favor government subsidy of vaccination and the CDC. Heart disease in a retiree is an instance with far lesser externalities, and consequently far less justification for government intervention on efficiency grounds. Almost every economic transaction has some externalities, of course, so the question is whether there are adequate incentives for the actors to participate in the market, or whether they will drop out of the market and therefore make others worse off. Since you believe people will do anything and everything to get medical care, you can't make the externality argument.

Weren't you just saying "most Americans support the status quo not out of any dimly-perceived philosophy but because it's the status quo and people are naturally conservative about that sort of thing"? Perhaps people who are satisfied with private health insurance are only conservatively supporting the status quo, not because they're philosophically in favor of privatized health insurance. The existence and possibility of a private option does not mean we shouldn't shift to a public one if, as I and others believe, it would be better, both economically and morally.
Okay, many people on both sides don't think very hard. You keep bringing up what "most Americans" think, which sort of sounds like an attempt to hide in a crowd. Have courage in your convictions! One man in the right makes a majority.

Also, why would there be no police if the government didn't provide them? I imagine that if the police vanished tomorrow and all the taxes that supported them were refunded to taxpayers that people would begin hiring private security to police their homes, buildings, or neighborhoods. Would they be better? More efficient? Perhaps, perhaps not, as you conceded before, but they would exist. People aren't just going to let their homes get raided and their family killed.
You're forgetting a crucial factor in law enforcement: prosecution. Prosecution usually provides no benefit to the victim, but it is useful for society. As it happens, the UK has a partially privatized system of criminal prosecution: for many crimes, including very serious felonies, the Crown refuses to pay for the prosecution, and the victim must raise the funds to hire a private attorney if he wishes to see justice done. Obviously, the only real motive for doing so is revenge, and even the victims of very serious crimes usually aren't so filled with lust for revenge that they're willing to spend that kind of dough (which speaks well of them). But it means that there is nobody with an incentive to finance the prosecution, so there is a socially suboptimal level of prosecution.

It can't be both? I believe it can.
Okay, but cut me some slack. I know better than to try to convince you that universal healthcare isn't a great moral crusade. I still think there's a possibility that you can realize your economic arguments suck. So I'm trying to confine my discussion to the issues on which we might have a productive discussion.

Johan

08-04-2009, 06:50 PM

I love the way Ox ends his posts. :)

Ink Asylum

08-05-2009, 02:11 AM

Okay, but cut me some slack. I know better than to try to convince you that universal healthcare isn't a great moral crusade. I still think there's a possibility that you can realize your economic arguments suck. So I'm trying to confine my discussion to the issues on which we might have a productive discussion.

If you want it to be more productive you could be a bit less insulting when making your points. That usually doesn't lead to productive conversation.

If you solely want to discuss economics I'm afraid that's not going to be possible, for the following reasons:

1. If you have a different goal that changes how you measure the efficiency of a system.

2. As much as you would like to separate morality from the discussion, that's not going to happen. Your particular morality determines what your end goal is, and thus the most efficient way to get there.

My goals include having everyone insured for basic routine care as well as against extremely expensive medical bills, among other things. A system that needs to meet those moral standards is going to seem inefficient if you're okay with leaving people uninsured and allowing them to be bankrupted by medical expenses.

I'm curious what your ideal system involves. In order to compare efficiencies between the two it's impossible to leave out moral discussions. However, if you'd instead just like to discuss how to best achieve my goal then we can limit the discussion to just economics.

Ink Asylum

08-05-2009, 02:23 AM

Oh, but if government screws up, people could die! Isn't that your whole problem with insurance companies? Honestly, would you potentially want another Bush in charge of this program?
My problem with insurance companies isn't that they "screw up," it's that they consciously deny claims and kick people off their rolls in order to increase already obscene profits. I'll take the occasional government screw up over cynical profiteering.

A well-designed system will be able to resist even the worst President. Try as he might Bush wasn't able to break down Social Security, among other things.

No, they just get first dibs on your paycheck.

I'll take a regular, predictable hit off every paycheck over having to pay a cop out of pocket before he saves my life. That's the whole reasoning behind any kind of socialized system.

Company profits? Perhaps not, but a portion of your money is still going to be wasted, paying for cushy seats on the various boards and panels that are going to be making medical decisions for the whole country.

Still cheaper than private executives. And I prefer the people making decisions to be elected officials that I can vote in and out of office, not rich CEOs and board members.

Oh yeah, use happiness as a barometer for what should and should not be nationalized. There's no way that'll go wrong! ;)

When you're deciding what is and isn't a public good, you should. You don't want a government to do things that make the society, as a whole, more miserable. That kind of defeats the point.

Generation ABXY

08-05-2009, 07:57 AM

I'll take a regular, predictable hit off every paycheck over having to pay a cop out of pocket before he saves my life. That's the whole reasoning behind any kind of socialized system.

And, if we fix health insurance (that's to say nothing of health care cost themselves, mind you), you can still have a regular, predicatable hit off of every paycheck...you just have to sign a piece of paper and mail it out yourself.

Still cheaper than private executives.

Any proof of this? The CBO has be predicting some pretty incredible costs for some of these things. And we've all seen how things work with Congress, where they approve their own pay raises, increase travel funds, take pointless trips, etc.

And I prefer the people making decisions to be elected officials that I can vote in and out of office, not rich CEOs and board members.

While I may be able to vote people in and out, I have no say over who gets appointed to what board. Hell, I haven't seen the first poll for one of the 30-some czars Obama's trying to appoint...have you?

(Oh, and if we do it right, you can vote with your dollar.)

When you're deciding what is and isn't a public good, you should. You don't want a government to do things that make the society, as a whole, more miserable. That kind of defeats the point.

Unfortunately, different things make different people happy. I'd be happy if people were more proactive about their own lives, and weren't afraid to make a bad decision or have someone else make a better decision (the thought that someone else might have something nicer and more of it just gets under some people's skin). And yet, here we are, talking about government-run health care, which makes you happy.

Ink Asylum

08-05-2009, 08:16 AM

And, if we fix health insurance (that's to say nothing of health care cost themselves, mind you), you can still have a regular, predicatable hit off of every paycheck...you just have to sign a piece of paper and mail it out yourself.

I'd rather pay the government, even if we fix the health insurance industry. I'd be happy just to have that choice, the public option. People who still want to trust a private company can trust the private company, I'll trust the government. Of course, the insurance companies are fighting to deny me that choice.

While I may be able to vote people in and out, I have no say over who gets appointed to what board. Hell, I haven't seen the first poll for one of the 30-some czars Obama's trying to appoint...have you?

You vote for the President who appoints the czars. Many of the President's appointees also have to be approved by Congress, giving you more of a voice. And when it comes to Congress you certainly can make your voice heard concerning who gets appointed to what board. That's part of what you can base your support and vote on.

(Oh, and if we do it right, you can vote with your dollar.)

Once again, I'd like to vote with my dollar and give it to a public health insurance option. Why can't I have that choice?

Unfortunately, different things make different people happy. I'd be happy if people were more proactive about their own lives, and weren't afraid to make a bad decision or have someone else make a better decision (the thought that someone else might have something nicer and more of it just gets under some people's skin). And yet, here we are, talking about government-run health care, which makes you happy.

Shockingly, my desire for government health care isn't about resenting people who have made some kind of "better decision" than I have, since you have no knowledge of what decisions I've made in my life. I'm doing all right for myself. I'm looking to help people who have less than I do get something that I believe should be a basic government service, protection from the unpredictable nature of disease and injury, just like we protect them from criminals, fire, war, and natural disasters. That would make me happy, what a selfish bastard I am.

Generation ABXY

08-05-2009, 08:51 AM

I'd rather pay the government, even if we fix the health insurance industry. I'd be happy just to have that choice, the public option. People who still want to trust a private company can trust the private company, I'll trust the government. Of course, the insurance companies are fighting to deny me that choice.

Have you read some of the stuff in the current bill? There are a fair number of restrictions on getting into and maintaining private insurance once this thing gets put into place. On top of that, while I accept that they're going to take out taxes, I don't see the point of hitting me up for more if I don't have insurance or don't have a plan they approve of.

Seems like Congress is denying me a choice ,too.

You vote for the President who appoints the czars. Many of the President's appointees also have to be approved by Congress, giving you more of a voice. And when it comes to Congress you certainly can make your voice heard concerning who gets appointed to what board. That's part of what you can base your support and vote on.

Considering there have only been like, what, three czars before now, I'd hardly say most people expected Obama to jump into office and start side-stepping Congress with the creation of dozens of other positions (even if they haven't all been filled yet). I don't really recall hearing anything about it on the campaign trail either, but I digress.

Once again, I'd like to vote with my dollar and give it to a public health insurance option. Why can't I have that choice?

Because when your public option is as bent as the one currently working its way through the powers that be, it takes away from my choice. I'm saying, at the very least, this thing is half-baked – you're saying I'm hungry and that's good enough for me, serve that bitch.

Shockingly, my desire for government health care isn't about resenting people who have made some kind of "better decision" than I have, since you have no knowledge of what decisions I've made in my life. I'm doing all right for myself. I'm looking to help people who have less than I do get something that I believe should be a basic government service, protection from the unpredictable nature of disease and injury, just like we protect them from criminals, fire, war, and natural disasters. That would make me happy, what a selfish bastard I am.

In regards to fear and resentment, I wasn't talking about you; if you recall, we did that awhile back. I was making a point that different things make different people happy.

aVaKus

08-05-2009, 01:19 PM

I really don't know much about what's been going on with health care reform (can't say I've really looked into it that much), but this thread has been very informative. I just wanted to post this Olbermann video, I found it very interesting.

IbWw23XwO5o

Johan

08-05-2009, 01:37 PM

I just wanted to post this Olbermann video, I found it very interesting.

It's comforting to know that nobody "owns" the Democratic Party. At least one of our parties hasn't sold its soul for some silver.

Do I really need the plum? They've both been bought and paid for; it's called politics. Olbermann just happens to like the ideas of those who have bought the Democrats off more than those who have bought the Republicans off. O'Reilly (another talking head) happens to like the ideas of those who have bought the Republicans. It's that simple.

Generation ABXY

08-05-2009, 02:28 PM

I can't stand that man, no matter what he is talking about.

ShivaX

08-05-2009, 02:31 PM

I can't stand that man, no matter what he is talking about.

I always want to slap him, even if I happen to agree with what he might be saying (which doesn't happen often anyway).

Johan

08-05-2009, 02:32 PM

I can't stand that man, no matter what he is talking about.

He was absolutely awesome in the '90s on ESPN. I loved watching SportsCenter back then.

Edit: Hey Keith...COUGH! (http://www.npr.org/templates/story/story.php?storyId=111596391)

08-05-2009, 10:31 PM

If you want it to be more productive you could be a bit less insulting when making your points. That usually doesn't lead to productive conversation.
Are you upset I called you a Communist? I didn't mean to offend you, and I'm sorry. But I still think your reasoning is identical to that of the Communists, and if you had the courage of your convictions, you would be one.

My goals include having everyone insured for basic routine care as well as against extremely expensive medical bills, among other things. A system that needs to meet those moral standards is going to seem inefficient if you're okay with leaving people uninsured and allowing them to be bankrupted by medical expenses.
That's actually progress. There are two major issues in the healthcare debate: the ever-increasing costs of healthcare and the lack of complete coverage for everyone. Many people, including the President, argue that you can simultaneously expand coverage dramatically and reduce overall costs. You claim that there is a trade-off there, and expanding coverage dramatically is necessarily going to result in even higher costs whatever else we do. That's a very big concession.

Which warrants a corresponding concession on my part. If possible, I would like for both basic routine care and catastrophic care to be available and within the means of all Americans. I'm even willing to tolerate a great deal of inefficiency in order to achieve that goal. I just think it's easier to discuss what we're willing to sacrifice for universal healthcare if we're all as honest as you and acknowledge that there will be sacrifice. In a further spate of honesty, I'll point out that I'm more wishy-washy on this than you probably are: I'm more likely to bail on the goal if the costs rise too high or (especially) if I think my own healthcare may decline even as others' increase. As someone who consumes A LOT of healthcare, there's a limit to how self-sacrificing I'm willing to be in the name of charity.

So, we've agreed that our goal is the same: we want universal coverage for many medical procedures and treatments at the lowest possible cost and with the least degradation of care for people who already have access to it. You've asked me for my ideal solution, which I've repeatedly stated I don't have: I think this is a fundamentally insoluble problem, although I'm sympathetic with your desire to solve it. My suggestions for marginal improvement would be twofold, however:

1. For the portion of the healthcare market that's a market, make it resemble ordinary markets more. Healthcare in America is plagued by two problems: fragmentation (you can't just go to the store and pick from all the plans available to somebody) and information asymmetry (it's hard to tell which doctors, insurers, etc. are best). Permitting interstate competition, separating employment from health insurance, and creating either information bureaus or a more transparent contractual regime would all be great steps. For the problem of insurers denying care, here's a thought off the top of my head: have the FDA create categories of medical treatments, from A (cheap, highly effective, only approved treatment) through Z (experimental, expensive, unlikely to be very effective). Compel insurance contracts to specify which categories they'll cover (A through T, say), now and in the future. If some new treatment comes along and gets slotted into category T, and your insurance covers category T treatments, your insurer must cover it no questions asked. This is purely off the top of my head, so I encourage reasons why it's stupid so long as you cut me a little slack for the stupidity.

2. For the truly poor, we have Medicaid. If you want to expand eligibility for Medicaid or partial Medicaid coverage, I'm willing to consider that so long as it doesn't wind up swallowing the entire healthcare market. That market is responsible for most of the medical advances of the past century, and I don't want to destroy it.

Slack3r78

08-05-2009, 10:51 PM

God dammit, Ox. I spent this Wednesday evening working on beers and spreadsheets, sorting through a mindnumbing array of numbers trying to get a business off the ground. I came here half drunk, seeing that you had posted, and gleefully scanned through your post looking for Latin phrases so I could tell you that you're NOT SO FUCKIN SPECIAL OKAY?? only to be let down.

Next time, use more Latin. For the lulz, my friend. For the lulz.

08-05-2009, 11:11 PM

Tui optatio mei imperium est.

Johan

08-05-2009, 11:23 PM

08-05-2009, 11:30 PM

Okay, Johan is right. That didn't sound very much like an apology. How's this:

I still believe your stated reasoning is identical to that of Communism. This presumably means that you have some additional proviso or reasoning that distinguishes you from a Communist, but that you either haven't stated it specifically or I've missed it. I did not mean the comparison as an insult, but if you were offended by it, then I have chosen my words poorly and I apologize.

Johan

08-05-2009, 11:33 PM

You went and ruined it. Dammit.

Ink Asylum

08-06-2009, 12:04 AM

Are you upset I called you a Communist? I didn't mean to offend you, and I'm sorry. But I still think your reasoning is identical to that of the Communists, and if you had the courage of your convictions, you would be one.

Nah. The Communist cracks don't bother me, because despite your twisting some of my statements to make it seem like I think government can do better no matter the market, I still have a distinct separation between what the government can do better and what private business can do better, the need/want line. But I don't feel like getting into that argument again.

It's more your condescending tone sometimes. I don't mind having my arguments challenged, but I don't enjoy being personally insulted in the process. I think you're above making comments like "I still think there's a possibility that you can realize your economic arguments suck" and "Isn't this just a value judgment from someone who probably hasn't ever personally stared death in the face?" I try my best to stick to the topic and avoid getting personal, which is why I've stopped replying to a certain person on the board that makes it hard to live up to that standard, and I would appreciate the same courtesy.

That's actually progress. There are two major issues in the healthcare debate: the ever-increasing costs of healthcare and the lack of complete coverage for everyone. Many people, including the President, argue that you can simultaneously expand coverage dramatically and reduce overall costs. You claim that there is a trade-off there, and expanding coverage dramatically is necessarily going to result in even higher costs whatever else we do. That's a very big concession.

I will concede that there will be a large initial cost increase to kick-start the changes, but I still believe that in time making sure everyone is covered to a certain degree and protected from going bankrupt over medical bills will lower costs in the end.

Which warrants a corresponding concession on my part. If possible, I would like for both basic routine care and catastrophic care to be available and within the means of all Americans. I'm even willing to tolerate a great deal of inefficiency in order to achieve that goal. I just think it's easier to discuss what we're willing to sacrifice for universal healthcare if we're all as honest as you and acknowledge that there will be sacrifice.

I appreciate the honesty and hadn't realized we were so close in our goals, if not in our approach.

For the problem of insurers denying care, here's a thought off the top of my head: have the FDA create categories of medical treatments, from A (cheap, highly effective, only approved treatment) through Z (experimental, expensive, unlikely to be very effective). Compel insurance contracts to specify which categories they'll cover (A through T, say), now and in the future. If some new treatment comes along and gets slotted into category T, and your insurance covers category T treatments, your insurer must cover it no questions asked. This is purely off the top of my head, so I encourage reasons why it's stupid so long as you cut me a little slack for the stupidity.

It's an interesting concept. It could work, but it won't as long as private insurers can still reject people or deny them treatment on the basis of pre-existing conditions.

The biggest problem I have with private insurance is they make the most money by getting people to pay insurance for years then denying treatments customers thought were covered. It's extremely disturbing to me that part of my insurance payment will go towards paying an insurance company employee whose sole job is figuring out how to screw me out of coverage the moment I get terribly sick.

I don't think anyone needs a definition for "Pre-existing condition." In some cases it prevents people from being able to get insurance at all, and if they do get it the premiums will be exorbitant. In other cases someone will have decent coverage but as soon as they get sick their company will find some way to play the "Pre-existing condition" card and deny treatment.

While there are some diseases people bring upon themselves, such as through poor diet or smoking, so much of what wrecks our bodies is unpredictable and unavoidable. I do not believe that being born into a body that is more likely to break down, or suffering a bad roll of the cancer dice, should doom someone to being uninsurable or extremely overcharged for insurance. We don't get to pick our bodies like we can pick a car. It's a decision that's largely made for us. It shouldn't be used against people no more than someone's race or gender.

We simply won't achieve anything approaching universal and fair coverage in the private market unless A) customers can't be denied insurance or treatment due to pre-existing conditions and B) customers can't be charged radically more because of pre-existing conditions. Then we could probably institute a system like you described, where not every treatment automatically gets paid for, but people have a better idea what their insurance is and isn't covering.

2. For the truly poor, we have Medicaid. If you want to expand eligibility for Medicaid or partial Medicaid coverage, I'm willing to consider that so long as it doesn't wind up swallowing the entire healthcare market. That market is responsible for most of the medical advances of the past century, and I don't want to destroy it.

When I talk about a public option my ideal is one in which people that have the ability to pay for most or all of their insurance have the option of paying into the government program instead of into private insurers. While a large part of government provided system will support those who can't manage on their own, there's no reason we can't set up a public insurance option that middle-class and richer people pay into like they would pay into private insurance.

What better way to actually test the efficiency and customer satisfaction with either system? People will be free to pay into whichever system they believe will work better for them. Over time one will prove more attractive than the other, and they will react to the situation and change. Perhaps one will prove so effective that the other will wither and fail, but at least there will be an actual test.

08-06-2009, 12:38 AM

It's more your condescending tone sometimes. I don't mind having my arguments challenged, but I don't enjoy being personally insulted in the process. I think you're above making comments like "I still think there's a possibility that you can realize your economic arguments suck" and "Isn't this just a value judgment from someone who probably hasn't ever personally stared death in the face?"
Those are personal insults? Okay, I'll try to rein it in. I hardly intended to imply that your relative good health is something to be ashamed of.

It's an interesting concept. It could work, but it won't as long as private insurers can still reject people or deny them treatment on the basis of pre-existing conditions.

It's extremely disturbing to me that part of my insurance payment will go towards paying an insurance company employee whose sole job is figuring out how to screw me out of coverage the moment I get terribly sick.
This is inevitable regardless of the system we use, isn't it? Every government agency employs fraud investigators. Every government agency imposes limits for eligibility and enforces those limits. Obviously enforcement almost always comes into play when the agency is asked for a disbursement. Regardless of the system, there will be a bureaucrat whose sole job is to figure out how to screw you.

I don't think anyone needs a definition for "Pre-existing condition." In some cases it prevents people from being able to get insurance at all, and if they do get it the premiums will be exorbitant. In other cases someone will have decent coverage but as soon as they get sick their company will find some way to play the "Pre-existing condition" card and deny treatment.
Surely we've got to have some level of restriction on people's ability to move from one tier to another upon diagnosis of a major illness. I believe you've said before that you're not demanding perfectly equal medical care, and that it's okay for people to purchase gold-plated or top-up insurance. We can't have people doing that the day they get diagnosed, or the whole concept of "insurance" becomes even more meaningless than it is already. If there are outright violations of contract, there are ways to impose greater penalties and step up enforcement. If the contracts are vaguely worded, then we can tighten up language.

While there are some diseases people bring upon themselves, such as through poor diet or smoking, so much of what wrecks our bodies is unpredictable and unavoidable. I do not believe that being born into a body that is more likely to break down, or suffering a bad roll of the cancer dice, should doom someone to being uninsurable or extremely overcharged for insurance. We don't get to pick our bodies like we can pick a car. It's a decision that's largely made for us. It shouldn't be used against people no more than someone's race or gender.
You don't have to convince me that one's health is uncorrelated with one's moral worth as a human being. But you seem to want to wave away the disadvantages of being sickly. Let's face that this isn't going to happen: people who are born ugly have to spend money on hookers, and people who are born sick have to spend money on medicine.

Again, your argument is much broader than you realize. I didn't deserve to be born sick, but John didn't deserve to be born stupid, either. Why should he suffer poverty and mockery for God's injustice? Why should we permit people who are born smart to have so much more respect, wealth, and success than the stupid? It's no more just than the disparity between sick and healthy, yet we celebrate it when the smart are unjustly rewarded and the stupid unjustly suffer.

You're demanding equality of outcome, or at least equality of outcome as close as we can practically achieve. Really, the most effective way to do that is to round up all the healthy people and irradiate them until they're as sick as I am.

I use a lot more medical care than you do. No, it's not my fault. But what's the sense in saying I shouldn't pay any more than you? It's not your fault that you have two kids and need a bigger house, or that my skills don't warrant a high wage, or that your investment decisions turned out lucky and mine didn't. We don't allocate resources to people depending on whether it's their fault or not.
What better way to actually test the efficiency and customer satisfaction with either system? People will be free to pay into whichever system they believe will work better for them. Over time one will prove more attractive than the other, and they will react to the situation and change. Perhaps one will prove so effective that the other will wither and fail, but at least there will be an actual test.
As you've repeatedly pointed out, the government can and likely will run the public option at a loss. When a government or business operates at a loss, that means it is destroying value: it is taking resources from their socially optimal allocations and misallocating them to the loss-making activity. That's popular for the people being buoyed by the loss-making activity, but from an objective perspective, it is by definition a bad deal for society.

What's more, you have a highlys static notion of "best." If the public option is a better deal for consumers in 2009, causing the collapse of all the private insurers, then the public option will be the ideal form of health coverage for the rest of time? Don't institutions sometimes lose their way and become less efficient than they were previously?

In addition, I believe you've made clear that the public option will not have any point-of-service costs (or at least severely reduced ones), and will instead be financed by taxes on the "rich." Regardless of whether I'm rich or poor, the price for the public option has already been paid. It would have to be as bad as a public school for me to even consider paying again for a private option. There are a lot of people who send their kids to public school, but I doubt most of them would continue to do so if the government offered them a voucher and told them they could choose public or private.

Finally, health insurance is a scenario characterized by information asymmetry. The most glaring example is that people know their own health, and their own health decisions, better than the insurer does. They can estimate their future medical needs better than the insurer, and you propose to order the insurer not to take into account even the limited information he already has (i.e., pre-existing conditions). The effect will be predictable: no matter how terrible the public option is, the private insurer will inevitably go broke as the healthy people choose the already-paid-for public option and the sick people choose to top up. Some arguments about UHC deserve serious thought; this one definitely does not.

Generation ABXY

08-06-2009, 08:45 AM

In addition, I believe you've made clear that the public option will not have any point-of-service costs (or at least severely reduced ones), and will instead be financed by taxes on the "rich." Regardless of whether I'm rich or poor, the price for the public option has already been paid. It would have to be as bad as a public school for me to even consider paying again for a private option. There are a lot of people who send their kids to public school, but I doubt most of them would continue to do so if the government offered them a voucher and told them they could choose public or private.

Oh, good. You've addressed that probably much more eloquently than I would have.

As for coverage for pre-existing medical conditions, I'm sure there's a middle ground. Maybe if enough insurance companies deny you coverage under one of those if-we-accept-you-you're-covered-no-questions-asked plans, you become eligible under Medicaid.

Johan

08-06-2009, 09:01 AM

It would have to be as bad as a public school for me to even consider paying again for a private option.

Dear me...it'll never be that bad, will it? Not only will we all be dead, but we'll all be stupid, as well! :D

Ink Asylum

08-06-2009, 09:50 AM

Those are personal insults? Okay, I'll try to rein it in. I hardly intended to imply that your relative good health is something to be ashamed of.

You shouldn't assume anything about my health and using that to imply that I have a lesser understanding or appreciation of the issues at hand. I also have an immediate family and friends whose health is of great concern to me, and that have needed large amounts of care, but I don't want to bring them into this discussion. I'd like to avoid making anyone's personal health care/insurance part of the issue as much as I can.

This is inevitable regardless of the system we use, isn't it? Every government agency employs fraud investigators. Every government agency imposes limits for eligibility and enforces those limits. Obviously enforcement almost always comes into play when the agency is asked for a disbursement. Regardless of the system, there will be a bureaucrat whose sole job is to figure out how to screw you.

Call me naive, but I believe you're more likely to have the people making those decisions in the government genuinely concerned with providing me health care than in a private company. If my choice is to give one of them my money in return for a promise to help me when I need it most I'll choose the government. I know not everyone feels that way, and we can go back and forth for days with anecdotal evidence about promises broken by government or private business. I may get screwed either way, but I believe my odds are better with the government.

And before it gets brought up again, I also don't believe this alone makes me a Communist. As I've said numerous times, I am more than happy to take my chances with private business when it comes to wants, not needs. I believe that I have much greater power in a transaction when my life isn't on the line, and that increased power helps keep companies more honest and competitive, which produces better products.

Surely we've got to have some level of restriction on people's ability to move from one tier to another upon diagnosis of a major illness. I believe you've said before that you're not demanding perfectly equal medical care, and that it's okay for people to purchase gold-plated or top-up insurance. We can't have people doing that the day they get diagnosed, or the whole concept of "insurance" becomes even more meaningless than it is already. If there are outright violations of contract, there are ways to impose greater penalties and step up enforcement. If the contracts are vaguely worded, then we can tighten up language.

You're absolutely right. People shouldn't have equal access to the top levels of coverage regardless of health status, but there should be a minimum level that does allow equal access. I've used the word minimum alot when I talk about what people should be guaranteed, but never maximum. This minimum level is debatable, but it should be close to the goal we both share, basic routine and catastrophic care. Once that's covered, and people largely don't have to worry about choosing between their money or their lives, the rest is up for grabs.

You don't have to convince me that one's health is uncorrelated with one's moral worth as a human being. But you seem to want to wave away the disadvantages of being sickly. Let's face that this isn't going to happen: people who are born ugly have to spend money on hookers, and people who are born sick have to spend money on medicine.

There are going to be disadvantages, but I believe one of the jobs of government is to at least try to mitigate some of them. We mandate that companies have to spend extra money to provide handicap access. We provide access to social security earlier for people who suffer debilitating injuries. Will we ever completely eliminate such disadvantages? Probably not, but that shouldn't stop us from taking the steps we can afford to.

Again, your argument is much broader than you realize. I didn't deserve to be born sick, but John didn't deserve to be born stupid, either. Why should he suffer poverty and mockery for God's injustice? Why should we permit people who are born smart to have so much more respect, wealth, and success than the stupid? It's no more just than the disparity between sick and healthy, yet we celebrate it when the smart are unjustly rewarded and the stupid unjustly suffer.

You're demanding equality of outcome, or at least equality of outcome as close as we can practically achieve. Really, the most effective way to do that is to round up all the healthy people and irradiate them until they're as sick as I am.

Again, I am not advocating a complete equalization of all wealth, respect, and success. THAT would be Communism. I want us to work towards a minimum level of security and stability that people can build upon themselves. Some people will naturally build higher than others, that's fine. I'm not looking to equalize outcome, but equalize the starting foundation as best we can.

As you've repeatedly pointed out, the government can and likely will run the public option at a loss. When a government or business operates at a loss, that means it is destroying value: it is taking resources from their socially optimal allocations and misallocating them to the loss-making activity. That's popular for the people being buoyed by the loss-making activity, but from an objective perspective, it is by definition a bad deal for society.

This a fair point, and it's one of the biggest problems with a public option for anything, be it police, an army, etc. What makes it worthwhil is if what we're dealing with is a public good. If you believe, as I do, that basic routine and catastrophic care regardless of ability to pay is as much a public good as police, fire department, etc, then you accept the chance of running it at a loss, and support it by taking resources from elsewhere, since that is preferable to not having it at all.

What's more, you have a highlys static notion of "best." If the public option is a better deal for consumers in 2009, causing the collapse of all the private insurers, then the public option will be the ideal form of health coverage for the rest of time? Don't institutions sometimes lose their way and become less efficient than they were previously?

Of course, and I believe that's already happened with our private insurance industry. When you have an institution, either private or public, that's lost its way but it's one people and society needs instead of one they can easily abandon, you have three options. You can heavily regulate and reform the existing institution, you can create a competing version which will force the existing one to regulate itself better, or you can completely eliminate and replace it.

Maybe we can fix the system just by reforming the existing insurance and health care industry. I don't think that we can do that enough to accomplish the goal of minimum basic routine and catastrophic care for all, regardless of ability to pay, without some kind of public option.

If the public option becomes such a sweet deal that it eliminates private insurance then becomes as inefficient and corrupt as our current private system, albeit in different ways, then we'll have to deal with it like we currently have to deal with the private industry. But that's still an if, and it's also possible that won't happen. What determines that is how the public option is constructed.

You make some great points in the last couple paragraphs but I think my wall of text has gotten long enough for now.

Ink Asylum

08-06-2009, 09:57 AM

As for coverage for pre-existing medical conditions, I'm sure there's a middle ground. Maybe if enough insurance companies deny you coverage under one of those if-we-accept-you-you're-covered-no-questions-asked plans, you become eligible under Medicaid.

That's not a bad idea, but that'll increase the costs of Medicaid by a lot, which means more debt or taxes which will be spread around to the rest of the people just as if the insurance company did pay for those conditions and just jacked up everyone's premiums so they can maintain the same level of profit, which is something you seem to want to avoid.

You seem to be more conservative than either me or Ox when it comes to what your final goal is. I'd be curious to hear how you define it.

Generation ABXY

08-06-2009, 11:29 AM

That's not a bad idea, but that'll increase the costs of Medicaid by a lot, which means more debt or taxes which will be spread around to the rest of the people just as if the insurance company did pay for those conditions and just jacked up everyone's premiums so they can maintain the same level of profit, which is something you seem to want to avoid.

But it likely wouldn't jack up the cost the same amount as an all-encompassing plan.

You seem to be more conservative than either me or Ox when it comes to what your final goal is. I'd be curious to hear how you define it.

I want the same thing as you do: choice. Just as you say you want the choice to put your money into a public option, I want the choice not to. Unfortunately, you're also telling me we need to socialize the cost, meaning you get to make my choice for me. Hell, if I still decide to exercise my freedom even after this is implemented, I could still potentially get hit up to three times: my regular taxes, a penalty for not having insurance (or at least a plan they approve of) and whatever extra taxes they're considering (soda, cigarettes, etc.).

I think the current system can be fixed, and I think it would prove more beneficial to fix than trying to implement an all new system which even advocates are admitting also has problems we'll have to address.

Ink Asylum

08-06-2009, 11:40 AM

But it likely wouldn't jack up the cost the same amount as an all-encompassing plan.

Why do you say that? If the treatment costs the same it'll jack up costs the same amount whether the tab is picked up by a private insurer or by Medicaid. It'll also jack up costs if no one picks up the tab and the person gets the procedure anyway, goes into debt and eventually can't pay.

The only way the cost of a treatment for someone who can't pay doesn't get absorbed into the system and distributed to others is if the person doesn't get the treatment at all.

Of course, if you're saying the refused treatment will be cheaper under Medicaid than it is under private insurance you're yielding a huge point to government insurance.

I want the same thing as you do: choice. Just as you say you want the choice to put your money into a public option, I want the choice not to. Unfortunately, you're also telling me we need to socialize the cost, meaning you get to make my choice for me. Hell, if I still decide to exercise my freedom even after this is implemented, I could still potentially get hit up to three times: my regular taxes, a penalty for not having insurance (or at least a plan they approve of) and whatever extra taxes they're considering (soda, cigarettes, etc.).

I don't just want choice, I want everyone to have access to a minimum level of basic and catastrophic coverage, regardless of ability to pay. Do you want that, too?

Generation ABXY

08-06-2009, 11:59 AM

I don't just want choice, I want everyone to have access to a minimum level of basic and catastrophic coverage, regardless of ability to pay. Do you want that, too?

I was referring to an earlier, when you made it clear (at least from my perspective) that you'd prefer single-payer instead of fixing the existing system or even providing tax credit for insurance. The latter would address the same problems, but you said you didn't want to see your money going into some executive's pocket. If I, on the other hand, don't want to see my own going into the pocket of some politician with no say in the matter, which of us gets listened to?

As to whether I want to see everyone covered...I have my limits.

Ink Asylum

08-06-2009, 12:05 PM

Esquilax1138

08-06-2009, 12:18 PM

Give it up Comrade Ink, and just come on up to Canada. Flee your corporate oppressors and come bask in the light of our socialist paradise.

We even have running water now!

Ink Asylum

08-06-2009, 12:21 PM

Sorry. I can't stand the cold weather. :) I'm as far north as I'll ever get. Even Buffalo terrifies me, and that's in the same state!

Kelegacy

08-06-2009, 12:34 PM

I seriously hope some sort of reform is passed. Something worthwhile. As an employee in the healthcare industry, I see the worst of the industry every day. I work in billing so I handle preexisting denials, non-coverage of needed services, patients refusing care because services cost too much or insurance won't cover it, skyrocketing prices, insurance companies that trip us up every step of the way just to make it harder for us to get a claim paid (denying for the most ridiculous reasons, making us have to appeal all the damn time).

Now with a child under my plan, I bring home much less than I normally would. It's expensive to insure your family, but you need to do it. We're handicapped by the for-profit healthcare industry. It doesn't make sense--they profit off our sick and dying. I don't think healthcare in America should ever be about that. And I'd be fine with higher taxes if it meant I was fully insured--I already pay for the poor, elderly, and other people to get healthcare, I'd like to be able to get it myself to be honest.

I haven't been able to follow the thread but have there been many non-Americans posting here? I'm curious if the scare tactics by the opposition, about socialized medicine being terrible and riddled with long waits, etc, is true...directly from the people that have experienced it.

And yes I've seen Sicko but want more personal feedback.

08-06-2009, 12:37 PM

You shouldn't assume anything about my health and using that to imply that I have a lesser understanding or appreciation of the issues at hand.
You misunderstand my point. You claimed that people don't make the right choices about how much medical care is worth to them. Regardless of your personal experiences, you can only say whether paying for medicine is worth it to you. I value my life and money differently than you do yours, and you cannot comment on the wisdom of my choices without arrogating to yourself an unwarranted level of authority. Any group method of paying for medicine - including both private insurance and the public option - necessarily involves letting other people have a say in whether your medical decisions are worth paying for. We are compromising a lot of autonomy, and as someone who believes in personal autonomy, I would think this would disquiet you.

Call me naive, but I believe you're more likely to have the people making those decisions in the government genuinely concerned with providing me health care than in a private company.
I shan't call you naive. But I find it interesting how much trust you put in the goodwill of government employees in certain circumstances. I don't think you had much trust in the good intentions of the previous Administration, Officer Crowley, the Haditha defendants, or others. The converse accusation could be made against me, I suppose.

You're absolutely right. People shouldn't have equal access to the top levels of coverage regardless of health status, but there should be a minimum level that does allow equal access.
Do you see the problem with this? 'Minimum' or 'routine' coverage is undefined. Being confined to a bed for a year while you wait for a hip replacement isn't exactly an acceptable option. You seem to believe there's a category of medicine that's neither routine nor catastrophic, but I'm not sure that's the case.

There are going to be disadvantages, but Will we ever completely eliminate such disadvantages? Probably not, but that shouldn't stop us from taking the steps we can afford to.
If we can we afford it? It's a lot more expensive than the ADA. There's every reason to believe we can't remotely afford Medicare as it already stands, much less expanding government healthcare to everyone.

I'm not looking to equalize outcome, but equalize the starting foundation as best we can.
I'm very skeptical of this. Almost all discrepancies in healthcare result in differences in survival and quality of life. Are you going to tolerate my cutting the line for a hip repklacemewnt because I'm
rich?

Generation ABXY

08-06-2009, 01:14 PM

What kind of limits?

For those people you don't feel should be covered regardless of ability to pay, would you support somehow preventing them from using the emergency room or going into debt they won't pay off to get their treatment? If you don't you're going to end up with their costs spread around taxpayers and insurance consumers anyway.

Well, for one example, I wouldn't want to cover illegal immigrants. In that case, I think providing them the same benefits as someone who breaks the law provides no real incentive to change. It's the same problem we face with a number of social programs: Why should you better yourself, if you're already provided everything you need.

Right now, we're willing to accept certain losses for those less fortunate, if we cover even those who are fortunate, the costs will increase dramatically. And, if you're going to have to take more from me just to provide something I can get on my own, I'd much rather keep it and have some say in the matter.

Fortunately for us, there aren't just two solutions (broken public option and broken private option) to the problem we face. People in here have repeatedly discussed ways in which to improve not only health insurance, but also health care in general.

Generation ABXY

08-06-2009, 01:21 PM

Now with a child under my plan, I bring home much less than I normally would. It's expensive to insure your family, but you need to do it. We're handicapped by the for-profit healthcare industry. It doesn't make sense--they profit off our sick and dying. I don't think healthcare in America should ever be about that. And I'd be fine with higher taxes if it meant I was fully insured--I already pay for the poor, elderly, and other people to get healthcare, I'd like to be able to get it myself to be honest.

Unfortunately, somewhere along the line, the healthcare industry is always going to be "for profit". Whether it is the doctor who treats you directly or the people who make the medicine he uses, someone will be making money off of the fact that you got sick, and that will be just as true in a public plan (only now you've swapped out an insurance executive for a politician or some other government advisor).

Hell, I'd be willing to bet that insurance companies being willing to deny some medicine has probably lead to at least a slight decrease in some prices, or some generic versions of the drug. You offer to cover this stuff regardless of the cost, and I think we'll see a fair of bit of inflation in that market...

Johan

08-06-2009, 02:09 PM

Well, for one example, I wouldn't want to cover illegal immigrants.

Emergency rooms already provide free care, for illegals and others, by law. I love unfunded federal mandates so much.

Also, criminals get free (arguable on quality, however) care.

Ink Asylum

08-06-2009, 02:25 PM

Any group method of paying for medicine - including both private insurance and the public option - necessarily involves letting other people have a say in whether your medical decisions are worth paying for. We are compromising a lot of autonomy, and as someone who believes in personal autonomy, I would think this would disquiet you.

We already compromise a lot of personal autonomy in our current private insurance system. The only way we retain complete autonomy is by paying for absolutely everything out of pocket, which is a huge gamble for most people. So most people agree to give up some autonomy over their health care decisions to gain security in case the worst happens, just like we give up some autonomy to the police in order to gain security from criminals. Where we draw the line between autonomy and security is what's up for debate.

I shan't call you naive. But I find it interesting how much trust you put in the goodwill of government employees in certain circumstances. I don't think you had much trust in the good intentions of the previous Administration, Officer Crowley, the Haditha defendants, or others. The converse accusation could be made against me, I suppose.

You know, with regards to the last Administration, I'll gladly say that although I didn't trust them they didn't do nearly as much damage in the executive branch of the government as they could have to a private company they were running in a similar manner. The US survived Bush, and as big a mess as they left behind I believe we will recover, undo their damage, and become stronger. Things would have to get pretty bad for any small group of ne'er-do-wells to destroy America from within the government, despite the hue and cry from extreme partisans on both sides. Even modern democracy moves slowly and resists radical change. It's how countries survive for as long as they do.

Contrast that with private companies, which rise and fall very quickly. The executives of a company can make very quick changes, and wield much more power to change internal policy than a President that has to deal with a Congress nearly or more than half full of his opponents, a Supreme Court that can't be fired, and regular elections every two years that have the potential to greatly limit his power should he lose control of Congress.

So yes, while in the short term I may get upset about what the current President is doing, I have faith that in the long run things will work out.

I don't recall weighing in on either the Crowley or Haditha incidents, so I'd appreciate not having my position on them assumed merely because I identify as Progressive. Even if the worst is true of Crowley and the Haditha soldiers, I don't see what that proves. The Crowley case has been addressed significantly and any potential wrongs corrected. The Haditha incident was discovered and is now being investigated, and any wrongs will be punished. Both are examples of the system policing itself for inevitable wrongdoings. If these kinds of situations were the norm instead of exceptions I might be more worried about the direction of our government, but they aren't.

If I didn't have goodwill and faith in our government to do the right thing most of the time, or in the ability of the US populace to correct the course of the nation when it steers too far to the right or left, why would I want to live here? And I do want to live here, joking about fleeing to Canada aside.

Do you see the problem with this? 'Minimum' or 'routine' coverage is undefined. Being confined to a bed for a year while you wait for a hip replacement isn't exactly an acceptable option. You seem to believe there's a category of medicine that's neither routine nor catastrophic, but I'm not sure that's the case.

I don't want to get bogged down into brass tacks, but there's plenty left over that people would be willing to pay for coverage of. More frequent visits to the GP, more effective and newer drugs, longer and more comfortable hospital accomodations, all kinds of elective surgeries and treatments, new experimental procedures, the absolute best doctors, on and on. The medical industry is huge, it is much much more than routine care and life-saving procedures, even if you include treatment for horribly disabling things like hip-replacement.

If we can we afford it? It's a lot more expensive than the ADA. There's every reason to believe we can't remotely afford Medicare as it already stands, much less expanding government healthcare to everyone.

I believe we can afford it more than we can afford the status quo.

I'm very skeptical of this. Almost all discrepancies in healthcare result in differences in survival and quality of life. Are you going to tolerate my cutting the line for a hip replacemewnt because I'm rich?

Considering that there are very few rich people compared to poor people, I don't see that it would be too much trouble to allow that. I don't think it would cripple the system.

Generation ABXY

08-06-2009, 02:27 PM

Emergency rooms already provide free care, for illegals and others, by law. I love unfunded federal mandates so much.

Also, criminals get free (arguable on quality, however) care.

That may be, but that's just an example of who I wouldn't want to cover.

Ink Asylum

08-06-2009, 02:31 PM

Well, for one example, I wouldn't want to cover illegal immigrants. In that case, I think providing them the same benefits as someone who breaks the law provides no real incentive to change. It's the same problem we face with a number of social programs: Why should you better yourself, if you're already provided everything you need.

Because most people want more out of their life than just surviving and barely getting by. The trick with any social program is providing enough to avoid unnecessary suffering but not too much that the average person is going to be content living off the system.

08-06-2009, 02:50 PM

You know, with regards to the last Administration, I'll gladly say that although I didn't trust them they didn't do nearly as much damage in the executive branch of the government as they could have to a private company they were running in a similar manner.
But not for lack of trying. If Dick Cheney had been your government insurance adjuster, wouldn't he have denied you coverage just for the joy of watching you suffer? You don't just have faith that governments are better at correcting rogue employees, you have faith that government employees are better people... Except when you're not.

I don't recall weighing in on either the Crowley or Haditha incidents, so I'd appreciate not having my position on them assumed merely because I identify as Progressive.
I didn't assume your position based on you calling yourself a Progressive. I assumed your position because you're a Communist. ;)

I don't want to get bogged down into brass tacks, but there's plenty left over that people would be willing to pay for coverage of. More frequent visits to the GP, more effective and newer drugs, longer and more comfortable hospital accomodations, all kinds of elective surgeries and treatments, new experimental procedures, the absolute best doctors, on and on.
You're going to force people to deal with incompetent doctors, obsolete treatments, and ineffective drugs? This UHC thing isn't really looking very attractive anymore. What's the point?

Considering that there are very few rich people compared to poor people, I don't see that it would be too much trouble to allow that. I don't think it would cripple the system.
Say a hip replacement costs between $20,000 and $30,000. Lots of people can raise that kind of money if they need to.

Generation ABXY

08-06-2009, 02:53 PM

You know, with regards to the last Administration, I'll gladly say that although I didn't trust them they didn't do nearly as much damage in the executive branch of the government as they could have to a private company they were running in a similar manner. The US survived Bush, and as big a mess as they left behind I believe we will recover, undo their damage, and become stronger. Things would have to get pretty bad for any small group of ne'er-do-wells to destroy America from within the government, despite the hue and cry from extreme partisans on both sides. Even modern democracy moves slowly and resists radical change. It's how countries survive for as long as they do.

Time heals all wounds...now there's a new perspective on the Bush Administration. :D

Sure, the U.S. survived this time. But I'd wager the families of all those dead in Iraq and Afghanistan – whether they were soldiers, civilians or enemy combatants – probably feel a bit different the ability to recover from a bad American president and his tiny band of ne'er-do-wells. Sometimes all it takes is one bad decision, Ink. Maybe next time it'll hit a bit closer to home.

Ink Asylum

08-06-2009, 03:13 PM

But not for lack of trying. If Dick Cheney had been your government insurance adjuster, wouldn't he have denied you coverage just for the joy of watching you suffer? You don't just have faith that governments are better at correcting rogue employees, you have faith that government employees are better people... Except when you're not.

The incoming administration doesn't flush out every worker employed by the government all the way down to pencil pushers and beat cops every time a new one comes into office. Yes, I believe that you are more likely to find people concerned with actually advancing public health and watching out for the little guy working in the government than working in the private insurance industry, even when Republicans are in control.

You're going to force people to deal with incompetent doctors, obsolete treatments, and ineffective drugs? This UHC thing isn't really looking very attractive anymore. What's the point?

There is a broad spectrum between the absolute best and the utter worst. It's not either or.

Say a hip replacement costs between $20,000 and $30,000. Lots of people can raise that kind of money if they need to.

That still doesn't mean it'll break the system. What do you think line jumpers like that will do?

Ink Asylum

08-06-2009, 03:19 PM

Time heals all wounds...now there's a new perspective on the Bush Administration. :D

Sure, the U.S. survived this time. But I'd wager the families of all those dead in Iraq and Afghanistan – whether they were soldiers, civilians or enemy combatants – probably feel a bit different the ability to recover from a bad American president and his tiny band of ne'er-do-wells. Sometimes all it takes is one bad decision, Ink. Maybe next time it'll hit a bit closer to home.

Thanks for trying to make things personal, despite all I've done to avoid that in a discussion of a topic that can too easily devolve into such attacks. You know nothing about how I have or have not been affected by the Bush Administration's decisions, and I have no need to defend myself to you if this is how you feel like steering things.

Esquilax1138

08-06-2009, 04:01 PM

I haven't been able to follow the thread but have there been many non-Americans posting here? I'm curious if the scare tactics by the opposition, about socialized medicine being terrible and riddled with long waits, etc, is true...directly from the people that have experienced it.

And yes I've seen Sicko but want more personal feedback.

Ok I'll do a brief rundown of the major times me and my family has needed health care in BC, Canada. Now other provinces might be different, since it's run by the provinces with help from the federal Govt. but I can take my health care card and get treatment all across Canada.

I had broken leg, so a trip to ER, X-rays, cast and out the door in about 2 hours, out of pocket expense was nothing.

I came down with a serious respiratory infection, went to the ER and since I was really sick they took me in right away, ended up 8 days in a private room on round the clock IV antibiotics, walked out and the only out of pocket was the bill for the TV rental, about $21.00.

Mom has had cancer twice, both times waited less than a week to go in for surgery, week of hospital stay and 9 weeks radiation after that, with twice a year follow ups with the specialist since then, no out of pocket cost.

Mom recently needed to go on insulin, from the family doc to the visit to the Diabetic Day Care center in the hospital was 3 days, walked out with enough free stuff to last until can see the specialist (5 weeks) and from then will get regular appointments, with almost free insulin and testing stuff.

When the politications here start talking about messing around with our health care system, or even worse, moving to a more US based one we raise hell and they don't last long in office. Only thing that gets us more worked up than talking about messing with our health care is a hockey riot.

I have I ever had anything at all to do with anyone from the Govt. trying to refuse treatment, just see the doc, or the ER, and they take care of you, no Govt. officials are running around the wards telling people they don't deserve treatment. Old people are not stacked up in boxcars waiting to die, the streets are not filled with corpses.

Generation ABXY

08-06-2009, 04:20 PM

Thanks for trying to make things personal, despite all I've done to avoid that in a discussion of a topic that can too easily devolve into such attacks. You know nothing about how I have or have not been affected by the Bush Administration's decisions, and I have no need to defend myself to you if this is how you feel like steering things.

How did I make things personal? If you're talking about the closer to home thing, I meant maybe next time we get a bad president, the thousands dead will be our own civilians. Mind you, that could already happen, but I'd rather not give them another avenue.

Johan

08-06-2009, 04:34 PM

So yes, while in the short term I may get upset about what the current President is doing, I have faith that in the long run things will work out.

Every single current poll says that the majority of Americans do not share your "faith" (a horrible pillar of support for a person to build trust upon for a politician) as regards Obama's plans for health care.

I look forward to the implosion of the Democratic Party at the mid-term elections. It'll start, however, with the governor's race in Virginia this fall. American politics is so entertainingly cyclical. The cycles seem to be speeding up, too...much to my amusement.

Esquilax1138

08-06-2009, 05:26 PM

American politics is so entertainingly cyclical. The cycles seem to be speeding up, too...much to my amusement.

Kind of like watching a machine go out of balance, first it wobbles, then picks up speed and starts to swing back and forth until it finally topples over.

Yes, it sure should be entertaining to watch, from the outside. *grabs a giant bucket of popcorn*

Ink Asylum

08-07-2009, 07:36 AM

How did I make things personal? If you're talking about the closer to home thing, I meant maybe next time we get a bad president, the thousands dead will be our own civilians. Mind you, that could already happen, but I'd rather not give them another avenue.

I read your "closer to home" comment wrong, then, as you implying I wouldn't have that opinion if someone I cared about were killed. I apologize for getting unnecessarily upset.

Generation ABXY

08-07-2009, 08:59 AM

Sorry for not making it clearer; the language probably was a little too ambiguous for its own good.

BlackPete

08-07-2009, 09:42 AM

Things got a little emotional at CNN: (http://www.talkingpointsmemo.com/livewire/2009/08/cnn-anchor-rips-into-health-care-ceo-whos-funding-anti-reform-effort.php)

Sanchez started simply, asking Scott, the founder of Conservatives for Patients' Rights, if he takes credit for the recent disruptions at health care reform events. Scott responded, "It'd be nice to, right?" before saying he thought everyone should go to meetings, but "oughta be nicer about it."

Then Sanchez started in on him, describing the charges and fines against Scott's company, the Columbia Hospital Corporation.

"Some would argue, and it would be hard to say they're wrong, that you would be the poster child for everything that's wrong with the greed that has hurt our current health care system," Sanchez said.

Don't hold back, tell us what you really think, Sanchez!

Johan

08-07-2009, 11:12 AM

Health care...the Democratic Party's albatross. (http://online.wsj.com/article/SB10001424052970204908604574334623330098540.html)

In his first five months in office, Mr. Obama had racked up big wins—the stimulus, children’s health insurance, House approval of cap-and-trade. But he stayed too long at the hot table. All the Democrats in Washington did. They overinterpreted the meaning of the 2008 election, and didn’t fully take into account how the great recession changed the national mood and atmosphere.

And so the shock on the faces of Congressmen who’ve faced the grillings back home. And really, their shock is the first thing you see in the videos. They had no idea how people were feeling. Their 2008 win left them thinking an election that had been shaped by anti-Bush, anti-Republican, and pro-change feeling was really a mandate without context; they thought that in the middle of a historic recession featuring horrific deficits, they could assume support for the invention of a huge new entitlement carrying huge new costs.

They be fucking up royally, yo! :D

What the town-hall meetings represent is a feeling of rebellion, an uprising against change they do not believe in. And the Democratic response has been stunningly crude and aggressive. It has been to attack. Nancy Pelosi, the speaker of the United States House of Representatives, accused the people at the meetings of “carrying swastikas and symbols like that.” (Apparently one protester held a hand-lettered sign with a “no” slash over a swastika.) But they are not Nazis, they’re Americans. Some of them looked like they’d actually spent some time fighting Nazis.

ShivaX

08-07-2009, 12:22 PM

Heres your "Grassroots":

http://www.colbertnation.com/the-colbert-report-videos/240728/august-04-2009/the-word---hippie-replacement

Johan

08-07-2009, 01:50 PM

Here's your big brother's catch-22! (http://www.foxnews.com/politics/2009/08/07/white-house-collect-fishy-info-health-reform-illegal-critics-say/)

"The White House is in bit of a conundrum because of this privacy statute that prohibits the White House from collecting data and storing it on people who disagree with it," Judge Andrew Napolitano, a FOX News analyst, said Friday.

"There's also a statute that requires the White House to retain all communications that it receives. It can't try to rewrite history by pretending it didn't receive anything," he said.

"If the White House deletes anything, it violates one statute. If the White House collects data on the free speech, it violates another statute."

Generation ABXY

08-07-2009, 02:15 PM

For what it's worth, Charles Krauthammer has weighed in on health care reform (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html?nav=rss_opinion/columns).

Kelegacy

08-07-2009, 02:33 PM

I just found out today my son is going to cost me an extra $2600+ per year for health coverage--just to be covered, doesn't count deductibles and copays and coinsurances (not much compared to many other plans, but it still stings a bit). I've got to start penny pinching some more. I'd yearn for a public plan if I paid in less than what it costs to cover my family now. Even if it cost the same, I'd probably get better coverage and have little to fear from preexiting conditions and other denial dances the insurance companies use.

Johan

08-07-2009, 03:05 PM

For what it's worth, Charles Krauthammer has weighed in on health care reform (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html?nav=rss_opinion/columns).

His two principle suggestions (tort reform and separating insurance from employment) are both terrific ideas that would work, but neither has a chance in hell of happening with the levers of power in Washington all under Democratic control.

Esquilax1138

08-07-2009, 07:45 PM

His two principle suggestions (tort reform and separating insurance from employment) are both terrific ideas that would work, but neither has a chance in hell of happening with the levers of power in Washington all under Democratic control.

Just honestly curious, why didn't Bush do those things just 6-8 years ago when the Republicans had the house, senate and white house then?

My guess is both sides have the cock of the health care industries up their ass. The cynical part of me says no reform is coming from either party, ever.

Generation ABXY

08-07-2009, 08:03 PM

You certainly have a point, Esquilax1138. A lot of problems haven't been fixed because these politicians, no matter what side of the aisle they fall on, are too busy trying to hang on to their jobs; I honestly believe we would see a lot more meaningful legislation if they had term limits as well.

In regards to Bush, even though he never accomplished anything when Republicans were in control, there were some belated attempts at health care reform (you may have heard of the Affordable Choice Initiative). However, as it stands, the Democrats are the ones currently pushing for it. And if this is really about the people and not just some power grab, I think all options should be on the table, if only to see if some sort of compromise can be reached.

08-07-2009, 08:36 PM

Just honestly curious, why didn't Bush do those things just 6-8 years ago when the Republicans had the house, senate and white house then?
He certainly attempted tort reform. However, Bush never had more than 55 Republicans in the Senate, and several of those are wishy-washy. Without 60 votes to break a filibuster, it is very difficult to achieve a major reform that the opposition party strongly opposes. Thus, the eventual law (http://en.wikipedia.org/wiki/Class_Action_Fairness_Act_of_2005) lacked most of the changes which Republicans have argued would be necessary to improve American healthcare.

Or you could just ignore the fact that Americans disagree about how best to reform healthcare and instead posit a shadowy group of malevolent ne'er-do-wells manipulating the levers of power. That works too.

Johan

08-07-2009, 09:03 PM

Just honestly curious, why didn't Bush do those things just 6-8 years ago when the Republicans had the house, senate and white house then?

Our system was set up to encourage paralysis. The Republican Party is no better, or worse, than the Democratic Party. I just happen to agree with more, though not all by any stretch, of what the Republicans advocate. Neither party represents my interests well, however. I would love a third option, but there isn't a truly legitimate one.

Ink Asylum

08-08-2009, 06:46 AM

Oh boy. Sarah Palin is weighing in on health care reform. On Facebook, no less! (http://www.facebook.com/note.php?note_id=113851103434) Let's see what she has to say.

As more Americans delve into the disturbing details of the nationalized health care plan that the current administration is rushing through Congress, our collective jaw is dropping, and we’re saying not just no, but hell no!

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion.

Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.

We must step up and engage in this most crucial debate. Nationalizing our health care system is a point of no return for government interference in the lives of its citizens. If we go down this path, there will be no turning back. Ronald Reagan once wrote, “Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth.” Let’s stop and think and make our voices heard before it’s too late.

- Sarah Palin

Emphasis mine. Besides the fact that Obama is proposing nothing of the sort, it's such over the top scaremongering as to be disgraceful. Wasn't she just condemning the press when she quit her job for "making things up"?

The blogger Publius makes a great point about this "death panel" nonsense. (http://obsidianwings.blogs.com/obsidian_wings/2009/08/its-evil-alright.html)

Palin is sort of right on one point -- there are people who weigh whether children like Trig are worthy of insurance. They're called insurance companies, and they have decided that these children are not in fact worthy of coverage. That's because Down Syndrome is a "pre-existing condition."

Georgetown Univ., Center for Children and Families:

Margaret Demko, the mother of three-year-old Emily, testified before the Ohio Finance Committee on February 27, 2008, on how waiting for health care coverage has impacted Emily and her future.

Emily was born with Down Syndrome. After receiving Emily's diagnosis, the family decided that it was important for Margaret to stay home in order to best meet the needs of their child. They explored numerous options after losing their employer-sponsored coverage, but due to Emily's pre-existing condition, the Demkos were denied private coverage. Luckily, they qualified for Medicaid. However, by their 6-month reauthorization meeting, the monthly family income was $135 over the allowable limits.

The medical bills, in excess of $3,500 a month, were devastating, forcing the family to make difficult decisions regarding therapy. Emily's medical condition requires orthotic shoe inserts, physical therapy, and corrective eye treatments, as well as hearing and blood tests. The Demkos cannot afford to incur all the expenses at once.

So the scary government health care would have covered a Down Syndrome baby that private insurance refused, but the child's family was too poor to qualify, and Sarah Palin is ginning up lies about a public health care option which probably would have helped where private insurance failed.