89 replies to this topic

[sUper GeNius]

Once the HMOs and other similar organizations started to command a very large share of the population they started telling doctors and hospitals they were only going to start paying 80 cents on the dollar, and they better take it or leave it. Of course hospitals just raised their premiums by 25% to compensate, and thus the upward spiral in health costs began. All this works exactly like socialized medicine already, and it's entirely the fault of most people and employers for buying into this ponzi scheme to being with. It took the negotiation point away from the people actually involved. The doctor and the patient.

The upward spiral is from lack of free market forces. I'll let the doctors on these forums chime in here, but I believe HMO's attempted to ration care by giving primary doctors incentives to treat patients in-house and not refer them to specialists.

Years ago I had no insurance, was between jobs, but I needed an eye exam. I called a opthamologist's office, (he actually answered the phone!) and I asked him how much he charged for an eye exam. had to know, since I had no insurance, I was shopping around. He said, "Hmm, I don't know, whatever the insurance pays, I guess."

Another time I got an appointment with an dermatologist. I had excellent health insurance at the time, traditional fee-for-service. That dermatologist treated me like I was a king! Spent a bunch of time with me. A year later I switched to an HMO, the guy went from jekyll to Hyde, in and out.

The big problem with healthcare today is not the number of uninsured. The uninsured problem is easily fixed by throwing money at the problem, (increase a tax.) The real problem is containing costs, the amount of healthcare people use and the rate of increase in the costs of that care. Healthcare services are not subject to economic forces. We don't shop around, check prices, decide for ourselves how much healthcare we can afford and what we're willing to pay for that care. That's the big problem. Consumers expect as much healthcare as is available for any condition. That's different than any other product or service we consume. I don't wash my car and have it detailed every time it get's dirty. If I did I'd be washing it three times a week at the carwash. I decide how much of a dirty car I can live with.

I like my Starbucks idea that I presented a while back. Individuals need to get some skin in the game. They could be forced to save from birth, with the gubberment matching. The gubberment or some other entity, (could be private) would provide insurance that involved co-pays or some other cost sharing arrangement. Now the consumer has some skin in the game and healthcare services would be subject to market forces. It's either this, (or something like it,) or it's outright rationing.

I always thought the US was different from the Euro-collectives, (nations.) I thought America required different solutions because we are a rather unique nation, with an unusual history and emphasis on individual rights. We required "American" solutions. Some of the libbies admire the European solutions, despise our way of doing things. Not me. I'm proud of our heritage and accept the fact that we're different, (and proud of many of those differences,) and accept the fact that we require different solutions. I don't have euro-envy. However, alot of the Libbies in power do in fact have extreme euro-envy, and they'd like to take advantage of the current desperate situation to force us in that direction. If we don't resist, in 20 years we'll all be living in little "flats," getting retirement at age 50, 12% unemployment will be the norm, with car-bonfires ever summer. Oh, and no guns. The gubberment will promise to take care of you for everything, for life, no worries. They'll even let you take home a little of your paycheck too! And you'll be grateful!

Edited by FuLL meMbeR, 12 February 2009 - 02:26 PM.

[nowayout]

I always thought the US was different from the Euro-collectives, (nations.) I thought America required different solutions because we are a rather unique nation, with an unusual history and emphasis on individual rights. We required "American" solutions. Some of the libbies admire the European solutions, despise our way of doing things. Not me. I'm proud of our heritage and accept the fact that we're different, (and proud of many of those differences,) and accept the fact that we require different solutions. I don't have euro-envy. However, alot of the Libbies in power do in fact have extreme euro-envy, and they'd like to take advantage of the current desperate situation to force us in that direction. If we don't resist, in 20 years we'll all be living in little "flats," getting retirement at age 50, 12% unemployment will be the norm, with car-bonfires ever summer. Oh, and no guns. The gubberment will promise to take care of you for everything, for life, no worries. They'll even let you take home a little of your paycheck too! And you'll be grateful!

What utter nonsense! Have you ever bothered to travel beyond whatever ignorant little rock you crawled out from under?

Edited by andre, 12 February 2009 - 02:33 PM.

[advancedatheist]

All other things being equal, I'd rather receive more healthcare than less. On the other hand, I wouldn't mind getting something for "free" (of course, these is no free lunch.) I pay over $7,000 a year in premiums, and it keeps going up.

The empirical evidence shows that a lot of the "healthcare" we consume doesn't do much good. Refer to Robin Hanson's paper, "Fear of Death and Muddled Thinking – It Is So Much Worse Than You Think":

http://hanson.gmu.edu/feardie.pdf

Specifically Robin's interpretation of the RAND Health Insurance Experiment back in the 1970's:

In the late 1970s, most of 5816 non-elderly adults6 from six U.S. cities were randomly
assigned for three to five years to one of two situations. Either they had free health care, or
they had to pay a substantial fraction (ranging from 25 to 95 percent) of their health care
costs. People with free health care had more doctor and hospital visits, and those with free
care spent about 75% more than those who paid nearly full price. While this sample was
too small to see effects on death rates, the plan was to look at a general health index based
on over twenty health indicators (Newhouse & Group, 1993).

What did they find? The bottom line: no significant difference in general health was seen
between those with more health care and those with less. And since this was a randomized,
but not blind, clinical trial, this no-effect result includes any health benefits that people get
from feeling that they are being cared more for via free care. This suggests that free care
would look even worse without such placebo effects.

Breaking the data down by four subgroups, the closest result the RAND experiment
found to being significant was that free medicine made initially-well poor people sicker (6%
significant). Breaking the data eighty ways by health indicators, the RAND experiment
found the following 5% significant results.7 On the positive side, free health care produced
better vision from free eyeglasses, fewer decayed and more filled teeth in kids from free dental
care, and lower blood pressure from regularly testing for this condition.8 On the negative
side, free care also induced more restricted-activity days, when people could not follow their
normal routines. And in the sickest quarter of patients, free care made their acne and hearing
worse.

Thus while there may be health benefits from wearing eyeglasses, filling decayed teeth,
and regularly checking blood pressure, the RAND experiment found no net health benefit
from all the other health care that having free care induced people to get. While some
subgroups may have benefited, either those groups were very small, or other subgroups
suffered harms of a similar size.

The RAND experiment and all the other correlations-in-the-world studies only speak
directly to the health effects of “marginal” medical care, i.e., the care that the studies saw
some people get and other people not get. But the RAND experiment does give us some
clues about the health effects of common care, the care that everyone in that experiment
got. Common care (the first two-thirds of spending for those with free care) and marginal
care (the last third of spending for those with free care) had the same fraction of “inappropriate”
hospital admissions and care-days, as judged by doctors reviewing cases, and also
the same fraction of major and catastrophic disease presentations, relative to moderate and
asymptomatic disease manifestations.

Thus it is clearly not the case that marginal care contains mostly treatments that doctors
know to be less useful and more frivolous, while the serious situations where doctors know
medicine is very valuable are usually in common care. In fact, doctors do not seem to see a
difference between common and marginal care. So, if common care is much more useful on
average than the useless-on-average marginal care, it must be because each patient somehow
knows something that doctors cannot see about when he really needs to see a doctor. Now
how likely is that?

[sUper GeNius]

I always thought the US was different from the Euro-collectives, (nations.) I thought America required different solutions because we are a rather unique nation, with an unusual history and emphasis on individual rights. We required "American" solutions. Some of the libbies admire the European solutions, despise our way of doing things. Not me. I'm proud of our heritage and accept the fact that we're different, (and proud of many of those differences,) and accept the fact that we require different solutions. I don't have euro-envy. However, alot of the Libbies in power do in fact have extreme euro-envy, and they'd like to take advantage of the current desperate situation to force us in that direction. If we don't resist, in 20 years we'll all be living in little "flats," getting retirement at age 50, 12% unemployment will be the norm, with car-bonfires ever summer. Oh, and no guns. The gubberment will promise to take care of you for everything, for life, no worries. They'll even let you take home a little of your paycheck too! And you'll be grateful!

What utter nonsense! Have you ever bothered to travel beyond whatever ignorant little rock you crawled out from under?

I travel over 30 weeks a year, mostly Europe, and because of my business, I am all too aware of the differences. I would never expect a former citizen of one of the Euro-collectives to understand.

[Mind]

Reason opines on the potential new health care regulation in the U.S.

I don't think I need to comment on the intent, beyond noting that it is unusually honest. This approach has been underway in Europe for some time now: see for example, the "fair innings" philosophy.

The fair innings argument (FIA) is frequently put forward as a justification for denying elderly patients treatment when they are in competition with younger patients and resources are scarce.

...

The whole debate has to be put in context, however. This is related to the operation of the universal health care system in the UK, a system that has long been in the doleful steady state of all such socialist, centralized systems: waste, terrible services, and - most importantly - rationing. Every taxpayer involuntarily funding this behemoth feels that they own a piece of it, and everyone has that tug on their human nature urging them to make sure that no-one gets more than they do. It's ugly, and it's why socialism fails. Along the way to failure, however, it produces dangerous ideas, such as "human beings have a fixed length of life, after which they should be cut off and left to die."

[sUper GeNius]

Reason opines on the potential new health care regulation in the U.S.

I don't think I need to comment on the intent, beyond noting that it is unusually honest. This approach has been underway in Europe for some time now: see for example, the "fair innings" philosophy.

The fair innings argument (FIA) is frequently put forward as a justification for denying elderly patients treatment when they are in competition with younger patients and resources are scarce.

...

The whole debate has to be put in context, however. This is related to the operation of the universal health care system in the UK, a system that has long been in the doleful steady state of all such socialist, centralized systems: waste, terrible services, and - most importantly - rationing. Every taxpayer involuntarily funding this behemoth feels that they own a piece of it, and everyone has that tug on their human nature urging them to make sure that no-one gets more than they do. It's ugly, and it's why socialism fails. Along the way to failure, however, it produces dangerous ideas, such as "human beings have a fixed length of life, after which they should be cut off and left to die."

Very interesting.

[sUper GeNius]

Here's an interesting interview with Uncle Chester the... well, you know which Chester I mean. There's a blurb about healthcare and the end.

http://www.cnn.com/2...anda/index.html


I wonder what brand of cigar he's smoking these days?

Edited by FuLL meMbeR, 17 February 2009 - 02:35 AM.

[Mind]

More calls for rationing

Reading this made me ill.

Bullet points:
1. Disabled should die, non or less disabled live.
2. Elderly people should die, teenagers should live.
3. Advanced or rare cancer patients that require expensive treatment should die, "cheaper" cases live.

Singer omits the main difference between current rationing and the proposed rationing. One is done by the individual the other is done by a bureaucrat/politician.

President Obama has spoken about his mother, who died from ovarian cancer in 1995. The president said that in the last weeks of her life, his mother “was spending too much time worrying about whether her health insurance would cover her bills” — an experience, the president went on to say, that his mother shared with millions of other Americans.

If she were alive under single-payer rationed care she wouldn't have to worry about bills, she would be dead.

It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Americans by far have the worst health habits of industrialized nations. They eat crap, are stressed out, don't sleep, don't exercise. I am not sure how a single-payer system is going to magically clear this up. Obama and others pushing for nationlized health care keep confounding (perhaps intentionally) health care (taking care of your health, lifestyle, nutrition) with medical care (treatments, surgeries, drugs, etc). The U.S. has very advanced (and sometimes expensive) medical care.

[forever freedom]

More calls for rationing

Reading this made me ill.

Bullet points:
1. Disabled should die, non or less disabled live.
2. Elderly people should die, teenagers should live.
3. Advanced or rare cancer patients that require expensive treatment should die, "cheaper" cases live.

Singer omits the main difference between current rationing and the proposed rationing. One is done by the individual the other is done by a bureaucrat/politician.



If she were alive under single-payer rationed care she wouldn't have to worry about bills, she would be dead.



Americans by far have the worst health habits of industrialized nations. They eat crap, are stressed out, don't sleep, don't exercise. I am not sure how a single-payer system is going to magically clear this up. Obama and others pushing for nationlized health care keep confounding (perhaps intentionally) health care (taking care of your health, lifestyle, nutrition) with medical care (treatments, surgeries, drugs, etc). The U.S. has very advanced (and sometimes expensive) medical care.

Well one thing is for sure, the US public healthcare system has to go through a deep reform or it will get in real trouble in the next decades. Too much spending + many many more older people in the future will be big trouble. The US gov should out efforts into privatizing as much of the health care industry as possible.

[niner]

More calls for rationing

Reading this made me ill.

Bullet points:
1. Disabled should die, non or less disabled live.
2. Elderly people should die, teenagers should live.
3. Advanced or rare cancer patients that require expensive treatment should die, "cheaper" cases live.

Mind, did you and I read the same article? Those bullet points didn't say that. They were asking us to think about the problem. This is what they said:

Public health insurance should pay up to $_______ for a treatment that would extend a patient's life by one year.
Saving the life of one teenager is equivalent to saving the lives of ____ 85 year olds.
____ years of a disabled life is worth _____ years of a non-disabled life.

This is a fill in the blanks problem. Your answers would apparently be infinity, one, one, one. The first answer is not possible, but any number greater than zero is taking money from one person, "by force", and using it for the benefit of another. I thought that as a Libertarian, you would be opposed to that. Equating the life of a teenager to the life of an 85 year old strikes me as unfair and non-utilitarian, though effective life extension technology would change this equation. Finally, it seems crazy to spend a huge amount of money to "save" a person when that means they will be left as a vegetable. Should we allocate the same resources to that problem as to one that would leave them hale and hearty? It will mean that we will have less to spend on the latter treatments.

People should read the article. It points out that we already ration health care. It points out that we have to ration health care. We can't spend more money than we have. The only thing that should be at question is what is most fair and leads to the best outcomes for the most people. Finally, this being America, the rich will always be able to buy whatever health care they can afford, so there's really no need to be alarmist on that count.

[Mind]

I realize I hastily reduced the bullet points. It just hits me the wrong way. I have a strong negative reaction to it. I can't believe we are debating putting the control of people's lives in the hands of bureaucrats and politicians. Fighting for your own life with your own resources and the resources of your friends, family, and community, is a whole different ballgame than giving away all that power to the government - something Singer completely glosses over (perhaps intentionally). Any student of human history should recoil at the prospect of putting the lives of so many people in the hands of so few.

Humans are not ants. We shouldn't be sacrificing the workers (me, you, disabled, elderly) for the queen (Obama, other leaders, and favored groups). We should be working on solutions to save every life possible, not casting some aside like so much worthless trash.

[niner]

I realize I hastily reduced the bullet points. It just hits me the wrong way. I have a strong negative reaction to it. I can't believe we are debating putting the control of people's lives in the hands of bureaucrats and politicians. Fighting for your own life with your own resources and the resources of your friends, family, and community, is a whole different ballgame than giving away all that power to the government - something Singer completely glosses over (perhaps intentionally). Any student of human history should recoil at the prospect of putting the lives of so many people in the hands of so few.

Humans are not ants. We shouldn't be sacrificing the workers (me, you, disabled, elderly) for the queen (Obama, other leaders, and favored groups). We should be working on solutions to save every life possible, not casting some aside like so much worthless trash.

Your reaction to the idea of rationing is the same as most people's. No one likes the idea, and that's why it's being used as a way of scaring us into opposing the reforms that are desperately needed. Our lives are at present in the hands of insurance company bean counters; that situation arose without debate. Worse, if we are sick and we lose our job, we can't even get insurance. So again, our lives are in the hands of the bean counters. No one is talking about sacrificing the workers here, and the queens aren't our political leaders or favored groups, unless by "favored groups" you mean insurance executives and small groups of doctors running excessive care mills. (i.e., doctors who own expensive facilities like MRIs, and steer their patients into using them more than is needed.)

Health care in America is an industry, and an extremely lucrative one at that. We simply can't spend infinite money that we don't have. Try this thought experiment: A 95 year old man is bedridden and in pain. He's at the brink of death. He is also flat broke, so his care is on the taxpayer's dime. With a heroic and very expensive intervention, we could forestall his death (and prolong his pain) by one month. Assuming he or his family want to do this, how much taxpayer money should we devote to this procedure? A trillion dollars? A billion? A million? In deciding the answer, bear in mind that we are deducting that sum from the budget, because we can't have a deficit. Thus, whatever his care costs is being deducted from care that other people need. If we spend too much on him, someone else dies. Maybe a lot of people die. Maybe a lot of kids can't get needed preventive care.

We have always rationed care, and we will have to do it for the foreseeable future. Anything else requires magical thinking.

[DJS]

I didn't have the motivation to type it out, but my thoughts are very much in line with Niners.

Rationing is already a way of life, and a rational principle when it comes to public policy. Regardless of what we hope the future will bring, as of right now it doesn't make sense to spend hundreds of thousands of tax payer dollars on a terminally ill 85 year old.

I'm fairly skeptical that the current push for health care reform will amount to being 'the answer' but I do view all of the hubbub over 'rationing' as fearmongering.

[alexd]

A while ago when the internet was limited to a few thousand scientists Ray Kurzweill predicted that in 15 or so years the internet would connect a large number of people in the world. People thought he was nuts. Yet when asked he simply projected the growth based on the accelerating rate of change. This is a variation on compound interest. I heard yesterday at he rate the USA is going healthcare will double in 7 years. Whether this number is spot on is not too important. If the number is 7 years, 10 years or 15 years it is easy to see that that going from about 15% of GDP to pay for healthcare to 30% of gdp in unworkable. Of course further extrapolation gets even crazier.

There might be great advances in healthcare but we have to work with the situation as it is now.

As a measure of how good a healthcare system is working let us look at the average age of death in a given country to establish how well things are working. There are always outliers, they person who lives to 110 or the accident that kills a 3 month old baby etc. Let us just accept that those variables are likley to be universal. if America which used to be #1 in mortality/healthcare is now 37th it might be fare to say that the trend is getting worse.

If France and Japan can provide healthcare to all their people at about half what we pay for per head, and their life expectancy is higher then I think they have a better system. If we paid more and lived longer then we would be better.

A drug that works well for me and prescribed by my Dr. is refused by my insurance company because it is off label. The criteria has nothing to do with whether it works or not. The drug costs about 435 dollars a month here in the USA. If I get it in Canada it is 54 dollars. The company that makes it , Cephalon paid 200 million dollars to four generic companies to not make the drug for a number of years. They then raised the price of the drug 48%. They are being sued by the government for anti competitive action. The generic companies will make the drug starting in 2012. That should be around when the case goes to court. IT will be rendered moot since the drug will be available. Meanwhile the drug company will have increased its sales by about 4 billion dollars during the duration. It is obvious our health care situation has some problems.

One aspect of the problem is that health care is a for profit industry. They can afford such extensive lobbying and support of politicians that change is impeded. why should healthcare be for profit? The healthcare industry does not want a single payer system because it would offer more for every dollar spent. they simply do not want to compete with a healthcare industry that would force them to lower profits and increase efficencies in order to be competitive. So we need to have campaign reform where politicians campaigns are paid for by the voters. We need to stop recognizing companies as if they were individauls and deny them so called free speech. the ability to spend millions of dollars to push a pov of view is not given to most individuals unless they are extremly wealthy. There internet is starting to change things but it is still problamatic. the best ideas do not neccesarily get widly presented, rather it is those ideas with the most funds behind them get presented.

Another example is that it has been recently calculated that solar power will reach grid parity in 2015. If that is true we should be working our butts off to produce power that way and to be able to utilize it in our cars, and homes. Then we could begin to stop using fossil fuels for power, avoid much of the hydrocarbon pollution , and stop sending so much money overseas. Yet we hear "Drill baby drill" which is the oil companies mantra. Who pays for that slogan? Right now those who benefit most are doing all they can do stop or delay change for their own financial benefit. Not the benefit of the US or the world as a whole. Their job is to delay the synchronicity (if possible). Of course what and when a synchronicity occours is another speculation.

My two cents.

[rwac]

If the number is 7 years, 10 years or 15 years it is easy to see that that going from about 15% of GDP to pay for healthcare to 30% of gdp in unworkable. Of course further extrapolation gets even crazier.
The growth is in absolute cost, not percentage.


if America which used to be #1 in mortality/healthcare is now 37th it might be fare to say that the trend is getting worse.
American life expectancy is bad due to a bad diet.
Healthcare wise, Americans try the hardest.
Low birth weight infants are not counted against the "live birth" statistics for many countries reporting low infant mortality rates.

They are being sued by the government for anti competitive action.
As they should be. This is not a fundamental flaw in the system.

One aspect of the problem is that health care is a for profit industry.
Well, doctors need to see some sort of returns on their investment of time and money.
So do people who design and produce medical equipment.
As do people who build and run hospitals.
Without a profit motive, there's no incentive to improve the process.
MRI in Canada ? Wait a month.
MRI in the US ? Tomorrow.

[Mind]

As a measure of how good a healthcare system is working let us look at the average age of death in a given country to establish how well things are working. There are always outliers, they person who lives to 110 or the accident that kills a 3 month old baby etc. Let us just accept that those variables are likley to be universal. if America which used to be #1 in mortality/healthcare is now 37th it might be fare to say that the trend is getting worse.

If France and Japan can provide healthcare to all their people at about half what we pay for per head, and their life expectancy is higher then I think they have a better system. If we paid more and lived longer then we would be better.

Again confusing healthcare with medical care. The american lifestyle (the care they take of their health) leads to early death and higher mortality. Put an obese diabetic american in the french or japanese medical system and they are still obese and diabetic. Unless they change their lifestyle they are still going to die an early death. Europeans and Japanese are much healthier and have lower mortality because of lifestyle, nutrition, exercise.

[Mind]

This is a variation on compound interest. I heard yesterday at he rate the USA is going healthcare will double in 7 years. Whether this number is spot on is not too important. If the number is 7 years, 10 years or 15 years it is easy to see that that going from about 15% of GDP to pay for healthcare to 30% of gdp in unworkable. Of course further extrapolation gets even crazier.

There is ample evidence to expect that a government run system in the U.S. would be even more expensive and more in-efficient. Nearly everything the U.S. government touches becomes a bloated ineffective politically manipulated bureaucracy. I prefer that the healthcare system not suffer the same fate.

According to Medicare's Midlife Crisis "In 1965, actuaries in the Department of Health, Education, and Welfare projected that the hospitalization part of Medicare would cost $9 billion by 1990. The program actually cost $66 billion in 1990."

Even if we don't assume government cost over-runs that extreme, it always happens (Iraq war anyone? Social Security anyone?) it is still very likely to cost multiples of the 1.5 TRILLION figure touted by the CBO. How to avoid this? Extreme rationing. More than Singer can even imagine.

[niner]

One aspect of the problem is that health care is a for profit industry.

Well, doctors need to see some sort of returns on their investment of time and money.
So do people who design and produce medical equipment.
As do people who build and run hospitals.
Without a profit motive, there's no incentive to improve the process.

Health care could be non profit while still paying doctors handsomely. A lot of people get into medicine because they want to help people, (or they want to be respected, or treated like a god..) not just to get rich. We could still provide incentives for research without an ROI that is wildly higher than other high tech fields.

MRI in Canada ? Wait a month.
MRI in the US ? Tomorrow.

There could be a happy medium between "wait a month" and overuse of expensive diagnostics by doctors who have a financial stake in the operation of those diagnostics. If there is no wait at all for highly expensive instruments even in non-emergency situations, we are not making the best use of our money. Obviously, when you present at the ER with stroke symptoms, you need imaging immediately. If you have a sore knee, it isn't going to kill you to wait a few days. A month is imho excessive, but there's little danger of that happening here.

[Mind]

Rationing is already a way of life, and a rational principle when it comes to public policy. Regardless of what we hope the future will bring, as of right now it doesn't make sense to spend hundreds of thousands of tax payer dollars on a terminally ill 85 year old.

Many terminally ill patients already freely choose to "take their leave" based on quality of life issues. The difference in the future is that Obama's health bureaucrats will force them to die. The decision will not be theirs. Sickening.

What about the people who can pay for it out of their own pocket? It is a necessity in single payer systems to make private medical care illegal. Otherwise that is where all the best doctors, medications, surgeries, technology will reside.

[niner]

Many terminally ill patients already freely choose to "take their leave" based on quality of life issues. The difference in the future is that Obama's health bureaucrats will force them to die. The decision will not be theirs. Sickening.

This is still magical thinking. We ration now, and until we have infinite resources, we will always have to make triage decisions as to how to deploy resources. I can understand that the concept of rationing is sickening, but that's an emotional response, not a rational one. Is the way we ration today not sickening?

What about the people who can pay for it out of their own pocket? It is a necessity in single payer systems to make private medical care illegal. Otherwise that is where all the best doctors, medications, surgeries, technology will reside.

I don't see this ever happening in America. It's not even remotely on the table.

[Mind]

I personally know and befriended a fellow who is quadriplegic. He needs daily care in order to sleep, wash, move around town. He is a person who values and enjoys his life and makes the best of a bad situation, despite his disability. He once told me he would not be living without state support. Under Singer and Obama's plans he will considered expendable, or at least worth less than the person standing next to him.

I don't want to play authoritarian pragmatics with individual human lives. It is giving up. It is the wrong frame of mind. We should be striving to remove the need for rationing, not resigning to failure. We should be striving to save as many lives as possible.

[Mind]

This is still magical thinking. We ration now, and until we have infinite resources, we will always have to make triage decisions as to how to deploy resources. I can understand that the concept of rationing is sickening, but that's an emotional response, not a rational one. Is the way we ration today not sickening?


I don't see this ever happening in America. It's not even remotely on the table.

Of course it is not on the table, it is in the backroom discussions. Every other single-payer system in the world has at least some major limitations on private medical care, if not being illegal. I am not sure what magical pixie dust is going to make the U.S. any different.

I wasn't born yesterday.

[niner]

I personally know and befriended a fellow who is quadriplegic. He needs daily care in order to sleep, wash, move around town. He is a person who values and enjoys his life and makes the best of a bad situation, despite his disability. He once told me he would not be living without state support. Under Singer and Obama's plans he will considered expendable, or at least worth less than the person standing next to him.

No. This is simply not true. There is nothing in Obama's plan that would lead to this outcome. Singer isn't saying this either.

I don't want to play authoritarian pragmatics with individual human lives. It is giving up. It is the wrong frame of mind. We should be striving to remove the need for rationing, not resigning to failure. We should be striving to save as many lives as possible.

Until we have infinite resources, the way we save as many lives as possible is by using our limited resources most effectively. If you're willing to pay for the fourth liver transplant for an 85 year old alcoholic who won't stop drinking, then some kids will go without care they need.

[eternaltraveler]

I do view all of the hubbub over 'rationing' as fearmongering.

I support all fear mongering on this issue

the present plan seems to be to pass "something" whatever it is, as quickly as possible and without giving anyone a chance to read it. A little healthy fear mongering is needed to slow the process down.

None of us have any idea what we are debating because non of us has any idea what the hell they are trying to pass. They don't have any idea either.

The US is also broke. We need to look at all new legislation from that perspective (ie any increase in expenditure is completely unsustainable because the current level is completely unsustainable).

Eh. Maybe like alcoholics the US needs to hit bottom first.

[Mind]

Another thing I have forgotten to highlight (because admittedly for me it is an emotional issue - and something that should be emotional IMHO), is that there is a difference between the rationing we are talking about here. Just saying that we ration all the time is ignoring one major glaring issue - the WE part. We all ration things every day of our life. Businesses make rationing decisions all the time - including insurance companies. The difference is that these decisions are made voluntarily. I would rather have an insurance company make a rationing (pricing) decision over my medical care any day. It is much superior to handing this life and death decision over to the government. At least I have a choice of what insurance company to go with. At least currently, if I don't like what my insurance company does, I can sue them, seek other options, pay for it out of pocket, go to another country, whatever. When you put the rationing decision in the hands of a government then you taking all other options out of the picture (as mentioned earlier, this is always the case in single-payer systems). You put the lethal force/compulsory action of government behind the decision over which people live and which people die. Very dangerous.

[Futurist1000]

How will we even know that this new system is working?

They can easily reduce the "number" of uninsured. A lot of people who are uninsured could afford it, but don't get it. We could just force them to buy insurance. Another percentage could enroll in a government program but don't. Up to a third of the 47 million uninsured may be illegal aliens. Of course I'm sure in the future they will just conveniently leave these people out of the counting. Magically the number of uninsured will be reduced by essentially just adjusting statistics. Then the democrats can pat themselves on the back for doing a good job.

When the government has more control over healthcare they will just have more reason to cook the books and make the healthcare figures look good. Like they can claim a low overhead with medicare because they just offload the administrative work/expense to hospitals and doctors. There will be more lot of incentive to make figures look better when the government has more control.

How the hell will you tell if it is working when there is no stable metric?

I'm not confident in putting people who have an IQ like 1 standard deviation below most of the people in this thread in charge of our healthcare.

Edited by Futurist1000, 22 July 2009 - 10:29 PM.

[alexd]

Rwac If the difference in mortality is totally a question of lifestyle than why do Canadians who do have a one payer public system live longer? Their culture is not that far off ours in lifestyle and eating habits? ne reason is that people are not as inclined to put off medical care as when a potentailly daunting bill (in some cases co pays is looming overhead.

I do agree with you that Americans make some awful choices in lifestyle that result in certain preventable maladies, but that is not the only factor.

To the guy who thinks that the system is working because Cephalon is getting sued. You missed the point. They are gaming the system. When they get to courts the point will be moot meaning the case will be dropped because the generics would then have just started competing. There is talk but only talk that justice will have this type of activity declared a criminal offense but it is not that way now. No they will have spent 200 million dollars to buy 6 years of non competitive revenue and made up for the 200 million and more via the immediate raising of the price 48% as soon as their was no longer a possibility of competition.

Health care and oil make up 5% of the SP 500 but they make more than the remaining companies combined. They have incredible financial clout. Please don't forget that our current manner of electing congresspeople gives us the best politicians money can buy. They have to raise 20k+ a day for their next election. As long as it is that way, they will have a lot of debt to vested interests who can carry some of that load for them, rather than good representation. This is a major problem for us. Term limits are an incomplete answer, since we have a revolving door of political typess working for companies that used to lobby them.

It is not about Democrat or Republican it is that all too often our representatives are influenced by those who have the wherewithal to have them in their debt. Hopefully the internet will help mobilize indivuals to influence the politicians in groups becasue in the end it comes down to votes. Of course we really need a better method of tallying votes. Thats another issue but off topic.

[niner]

How will we even know that this new system is working?

The number of people who are inadequately covered would be one metric. Overall expenditures would be another.

They can easily reduce the "number" of uninsured. A lot of people who are uninsured could afford it, but don't get it. We could just force them to buy insurance. Another percentage could enroll in a government program but don't. Up to a third of the 47 million uninsured may be illegal aliens. Of course I'm sure in the future they will just conveniently leave these people out of the counting. Magically the number of uninsured will be reduced by essentially just adjusting statistics.

I agree that some of the "uninsured" are not really a problem, but I am very worried that my family's lives hangs from the thin thread of a job; a job that in this day and age can not be counted on to stick around forever. Lose that, and there are "pre-existing conditions" to be dealt with. Maybe I'm sufficiently wealthy and savvy to deal with it, but how many people are not? This situation is not acceptable.

Then the democrats can pat themselves on the back for doing a good job.

Does this have to be a partisan issue?

When the government has more control over healthcare they will just have more reason to cook the books and make the healthcare figures look good. Like they can claim a low overhead with medicare because they just offload the administrative work/expense to hospitals and doctors. There will be more lot of incentive to make figures look better when the government has more control.

Does the government really lie to make Medicare overhead look low? It's already lower than for-profit insurance companies; why do they need to lie, and what is the evidence this is happening?

I'm not confident in putting people who have an IQ like 1 standard deviation below most of the people in this thread in charge of our healthcare.

That's a pretty harsh accusation; what's the basis for it?

[rwac]

Also, the racial makeup of the US is different from Canada.

Yes, the system has problems. That does not mean we should put the government in charge.
Just remember, once you go to govt health care, there's no going back.
Even if people are unsatisfied.

[Futurist1000]

The number of people who are inadequately covered would be one metric. Overall expenditures would be another.

Inadequate healthcare is such an amorphous term. Especially when you can still get healthcare even if you are uninsured. Some people choose to go without insurance and they just pay things out of pocket. Just because they are uninsured doesn't necessarily mean they don't get healthcare. There are so many externalities to expenditures that it may be hard to know if you are actually reducing costs too. Like if you put price controls on drugs or medical equipment, then fewer get made in the future. Or if you put salary controls on doctors they make less money and fewer people might become doctors in the future. It is extremely difficult to quantify many of these things.

Does this have to be a partisan issue?

It's not meant to be overly partisan and sorry if it came across as that. The democrats are mainly in power and there the ones pushing this reform.

Does the government really lie to make Medicare overhead look low? It's already lower than for-profit insurance companies; why do they need to lie, and what is the evidence this is happening?

That's a pretty harsh accusation; what's the basis for it?

It's not that they lie necessarily. They just don't report what they don't need to. Your taking figures at face value niner without thinking as to whether they are comparable or not. Comparing the % overhead between medicare and private insurance may be like an apples to oranges comparison. Medicare covers the elderly and they cost more than people who are covered with private insurance. So the fact that there is only a 3% overhead may be due to the fact that administrative costs are a smaller percentage overall if you have more care. Technically medicare has higher administrative cost per patient than private insurance, but it shows up as being a smaller percentage overall since they get more care. You can't really compare the two since they are not equivalent. You could argue that medicare patients get more care for the amount of administrative costs that they pay. However, I'm not sure if we know that administrative costs increase linearly with amount of care received. That's the thing about statistics, it's so hard to make comparisons.

Also there are a bunch of other stuff that may not be taken into account. I'm not sure if it is even possible to compare, medicare vs. private insurance at all. It's just apples to oranges and there is no way you can really account for all the externalities. This of course goes for private companies too. I'm agonstic as to whether medicare has less overhead, but I think you take these figures at face value too much. These are a few potential costs not taken into account in medicare.

* Medicare has its own billing department. It's called the IRS.
* Medicare's negotiation with drug companies occurs between lobbyists and Congressmen, and are not done internally. An insurance company has to pay for their own billing.
* Medicare has more fraud due to a less aggressive pursuit of phoney claims (the flipside of insurance companies, which may be too aggressive about avoiding payment).
* Medicare represents a tax on employment, which is a cost externalized on society, which doesn't show up on its own budget.

A lot of times, if something looks too good to be true (3% overhead vs. 12%), it probably is. My guess is if medicare does have an advantage, it is much less than it actually appears. I think if we switched to a "medicare for all" the savings would be not as much as some people claim.

Edited by Futurist1000, 23 July 2009 - 03:34 AM.