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What US Health Care Needs
Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. "Half a century ago, medicine was neither costly nor effective. Since then, however, science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we're struggling. There is no industry in the world with 13,600 different service lines to deliver. ... And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem — far and away — is the soaring and seemingly unstoppable cost of health care. ... Like politics, all medicine is local. Medicine requires the successful function of systems — of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively. ... This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do."
If I want to give my patients the best care possible ... This will take science. It will take art. It will take innovation. It will take ambition.
...it will also take the AMA not artificially restricting the number of new doctors. More than half of ostensibly qualified applicants every year are turned away. In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty. The fewer doctors we have, the more each doctor is paid. The AMA carefully guards doctor salaries. This practice can be seen over and over (and resistance to influx of doctors willing to work for cheap) in country after country (the film Salud covers this well).
/. has a typical signal-to-noise comment ratio... for those who want to doubt my claims above, calling them propaganda, etc, they are backed up by reputable sources. Paul Farmer, for instance, has written extensively about Cuba [and also happens to be the UN Envoy to Haiti and runs Harvard's School of Social Medicine at their Medical School, so he tends to be considered a reputable source] and almost never has a bad thing to say about their healthcare attitudes or outcomes. The list goes on.)
Furthermore, we need to eliminate the debt load for student doctors. You can't expect doctors to work for lower salaries (as I propose above) when they are graduating with hundred of thousands in debt. Basically we need way more medical schools (or slots in existing schools) and we need to lower their cost in exchange for a willingness to work for less money. This has the benefit of more doctors and lower cost, as well as shifting the pool of applicants to those who want to be DOCTORS and not just those who want to make MONEY or play GOLF all the time (and so on).
Cuba is a perfect example of this. They have better or equivalent health outcomes to the United States, yet they spend a fraction (read: less than 1/20th) as much per person on healthcare. They achieve these same outcomes using finnicky x-ray machines from the 1980s and out of date textbooks. They do this by having the greatest doctor-to-patient ratio of any nation, and by focusing on preventative medicine. But that's evil socialism. Insert dramatic music here. At any given time more than a third of Cuban doctors are voluntarily serving abroad (often in Africa) doing global health work. More than a third. What percentage of American doctors voluntarily serve in Africa? And they have a 98% retention rate, so any claim that this service is to "escape Cuba" is pretty well dispelled. (and just to go on the offensive for a sec, since I don't generally reply to those who reply to me, unless they actually make good points, since as you know
I am Jack's complete lack of surprise.
Is there a link, or are we just supposed to read the blurb.
Oh hell, this is slashdot, no one reads the article anyway. Never mind. Carry on.
One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem -- far and away -- is the soaring and seemingly unstoppable cost of health care.
I'll admit that my concept of our spending is probably skewed by intentionally misleading infographics and such, but this doesn't seem to jive with anything I've ever seen. Can someone explain how this is true, or point to something that does?
Oh - dang it - that's NOT the right address.
Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.
I'm not saying this is the entire problem, but it's a huge part of it. If you don't see the costs of your health care, you won't wisely use it. It's the same problem plaguing college tuition costs. "Oh, it's free money - either I'm getting a loan (free money!) or someone else is paying for it!". Yeah, until schools notice this and start charging $25k a year to attend because nobody cares - it's "free money".
My solution is a high deductible plan. If you can't afford it, the government picks it up for you. You pay the first $5k of your health costs out of pocket, the HDHP kicks in afterwords. If you're too poor for that, then they have government clinics for you.
HERE it is...
http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.html#ixzz0rEyC8iDU
1. Put old system into barrels marked "nuclear waste".
2. Throw barrels off cliff.
3. Pick working system like that from Australia or Canada.
4. Copy it.
5. Don't let the rebulocrats change anything.
6. Profit.
I'm serious, even if you choose to keep private health your premiums will go down as they now have to compete with the lowest cost alternative (public health), which is net profit for you. Another boon will be increased service from private health funds as public health sets the minimum standard for care.
Calling someone a "hater" only means you can not rationally rebut their argument.
This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do...
This is just lovely. Go on, start innovating, spend lots of money. By no means must you look at other countries to find out why your healthcare expenditure is so high, you can look forward to your "not invented here" syndrome to keep costing you a fortune.
Who is to say where the cut-off line should be?
You could put that line almost anywhere without being unreasonable. I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?
It seems the AMA decided that the lower 50% are unfit. OK. Well, would you want one of those doctors instead of one in the top 50%? The top 50% is dangerous enough.
Half a century ago, medicine was neither costly nor effective. [...] Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive.
This is the problem in a nutshell. The notion that leads people to call for universal health care is intuitively moral: that every human being deserves the best medical care possible, even if they can't pay for it. It seems cruel to deny that. But medical care is some of the most expensive labor in the world. And justly so: pharmaceutical patent abuse aside, doctors and nurses deserve to be paid a bundle for how long they have to study to get certified and for what a general pain in the ass their job is. So to say that every human being should be provided with ample attention from doctors, at the government's expense if necessary, is akin to campaigning for a universal supply of platinum bars.
I get that the speaker isn't necessarily speaking as though socialized medicine is the only answer, but he seems to implicitly acknowledge that the government is the only one who will pay doctors to care for poor people. Even if you don't oppose such a thing on political grounds, the money just plain isn't there. I can't really suggest a solution except to keep science and technology marching along and hope that medicine eventually starts getting cheaper when the remedies we invent finally start outpacing the diseases we discover.
"This algorithm runs in constant time. Come on, 2,147,483,648 is a constant..."
The Movie "The Blob" Supports the Case Against Government Healthcare
Okay, this isn't exactly the most serious piece I've ever written, but I think it's interesting and may make a good point. This past Spring, I was sifting through Comcast OnDemand, and found two versions of the movie "The Blob"- the original 1958 version, and the 1988 remake. The 1958 version is an old favorite of mine, so I decided to check out the 1988 version for comparitive purposes. I didn't get very far into the movie- I thought it was awful compared to the original -but I did get far enough into it to notice one crucial difference between the remake and the original.
In both movies, an old man in the woods is attacked by the Blob, which sticks to his arm, and is then taken to get help by teenagers that find him. In the orignal film, they bring him to the town doctor, who is about to leave town on business. The doctor immediately forgets his previous plans and brings the old man into his office for treatment. The doctor sifts through books, and calls friends to attempt to diagnose the problem with the man's arm. He is clearly dedicated to helping the old man and the idea of payment is never even mentioned.
In the remake, the teenagers bring the old man to the town hospital, but when they rush him to the front desk, they are greeted by an indifferent secretary who simply asks if the man has health insurance. The two teenagers become very upset and irritated at this point. The old man is eventually led into a room, and apparently forgotten. The doctor is uncaringly sitting at his desk doing paperwork.
If each movie can be considered a reflection of the time it was produced in, a case may be made against government interference in healthcare. In the 1958 version, the doctor is apparently providing healthcare because he feels that it is his duty to do so, not because he is looking to make lots of money. In the 1988 version, the hospital is clearly only giving healthcare to make money, and it does not deem human well-being important. If one remembers Ron Paul's discussion on healthcare in "The Revolution: A Manifesto," this difference makes perfect sense. Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it. He then goes on to say that this benevolence ended when the government increased regulation on the healthcare industry (in the sixties), making free healthcare too expensive to give.
So there you have it- the same story, with two different scenes (which doesn't really matter to the story, because the Blob does what it does best in both cases). Now, I don't really like it when people make art into things that it's not. But I really do think that each movie is accurately reflecting its own time period, and I think that government interference may be resonating even through the movies we watch. Really though, I just wrote this article for a little fun. Beware of the Blob! [And government :)]
...the US Health System just needs more people who stand to make a significant short-term profit from all citizens who are healthy and treated promptly.
1. Uniform billing codes and realtime price-lists so that we know we're not getting ripped off. California's chargemaster publication requirement is a step in the right direction, but it needs to be updated more quickly, and rural hospital exemptions are BS. If you can run a hospital, you can update your billing DB no matter where you are.
2. No anti-trust exemptions. This is so fundamental it's mindblowing.
3. Nationwide competition.
4. No more buyer's clubs. If the doctor and/or hospital is *licensed* then the insurance must pay out. You get to keep your doctor no matter what. Any company that wants to keep having a buyer's club can do that; but you can't be compelled to purchase into a club, only real insurance.
5. Real insurance means you can't lose your life savings due to a percentage payment or a cutoff. After all, you can't actually insure health. Only genes and behavior can do that. When we talk about health insurance, we're really talking about medical bankruptcy insurance, and the current system fails to do that. In order to be considered a real insurance plan, you have to prevent medical bankruptcy. That means, for example, you can lose no more than 10% of your net worth or income in any calendar year. That way, you could be severly ill for 5 years, on chemo, and emerge with roughly 60% of your life savings intact instead of nothing.
6. Stop torturing doctors. No, really. Many people won't even consider med school because it's torture. Maybe we need to put some doctors through boot camp. Maybe it's important for brain surgeons; but I can't imagine this system is really doing much to increase the number of competent family doctors.
7. Malpractice/tort reform. Duh! If a doctor is so incompetent that we're better off taking him out of the profession then let's do that. Requiring all the other doctors to pay out as if they're that bad is insane. Multimillion $ payouts won't bring back your relative. License revokation, however, will prevent it from happening to somebody else. Note, this is tricky since it's possible for competent people to make mistakes. You actually need to make sure that the number of mistakes is statisticly significant. Otherwise, nobody will want to risk becoming a doctor (see point 6). Statistics is a bizarre thing. There's actually an expected number of botched operations; but the odds of a single doctor botching 10 operations in a row are probably low enough so you can safely conclude that doc needs to lose his license.
8. Everybody self-pays and submits claims. That's right. You run healthcare like a normal business. I know it's hard to believe, but it really is just like buying a loaf of bread. Fire the beurocrats. No biggy. They'll get free health care while they look for a real job.
9. No paper work until the patient is well. No signing anything under diress.
10. You can put a pharmacy in the hospital. Quit making sick people drive to get meds.
Some quotes from the AMA themselves:
"Not a single allopathic medical school opened its doors during the 1980s and 1990s
I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?
How about 98% rejection rate? From the AMA article above: "Many private medical schools have 5,000 or more applicants for a class of 100 students."
Again, I hope it comes across, I know something about this issue. I said "ostensibly qualified" and "more than half" in my OP because I didn't want to get into a big debate about the exact percentage of people who apply and are grossly underqualified and rejected versus the legit applicants who are rejected, but basically the former is not happening, since you need to take the MCATs (not easy) and complete the equivalent of a degree in Molecular Biology simply to even apply to med-school (and currently to be competitive you need hundreds of hours of volunteer work, professional medical experience such as EMT work, and even then it is often a crapshoot, I know many qualified applicants who have been rejected more than one year in a row).
I am Jack's complete lack of surprise.
You're right that the money isn't there, but we can still promise the care. We don't have the stomach for death committees or official rationing. We will refuse to accept the problem.
Of course, the waiting lists will grow as required to ration out the supply. Everybody gets healthcare, except the people who die while waiting for treatment.
Maybe you can bribe your way to the front of the list, make friends with a senator, or claim to be part of some disadvantaged group that needs special treatment. The blackmarket possibilities are endless.
For most of human history our ability to care for the sick has been limited by knowledge. It was relatively easy to do everything we knew how to do. So we have this idea that we need to do everything possible to help people. The trouble is our medical knowledge has rapidly outpaced our ability to pay for it. We argue a lot about how to give everyone the best medical care, but that just isn't possible. What we need to do is decide how much of our wealth we want to spend on medical care and then worry about spending it well.
science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures.
It's too bad that Western medicine doesn't have a comprehensive guiding philosophy. Imagine if they taught principles like these in M.D. schools:
Western medicine plays whac-a-mole with the body's symptoms - a pill for high blood pressure, a pill for acid reflux, a pill for high cholesterol, ad infinitum - while health practitioners guided by superior philosophies (there are many) try to distill down to the fundamental reasons for a given body's dysfunction.
The brand of medicine represented by this commencement address is defective because medical education was hijacked by the Carnegie Foundation (who represented the drug trusts). My favorite articles on this bit of history are 100 Years of Medical Robbery and the followup, Real Medical Freedom. "How The Cost-Plus System Evolved" (pt 1, pt 2, pt 3) is also well-written.
US Healthcare needs guiding principles: nothing more, nothing less.
/.tivism? Slashtivism? This is the first time I've seen the editors directly come out on the side of a political issue in the form an article on the main page.
I once took an excursion to Reddit, and later HN. Unlimited up/down voting sucks when dealing with a hive-mind.
Yup, cutting defense solves everything. Right up to the point where you start wishing you really could defend yourself.
If you think that a world war will never happen again you are fooling yourself. Do you really think the Chinese would hesitate for a moment if the American military vanished over night?
It is also one of the few federal expenses that the Constitution actually even permits.
war spending != defense spending.
There aren't many nuclear submarines deployed in Afghanistan.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Cuba has a dog and pony show.
I already warned you in my original post not to trot this shit out, because I'm not some idiot who happens to have seen a Michael Moore film and now thinks Cuba is a utopia. Instead I'll choose to believe the guy who runs Harvard Medical School's Social Medicine program (see: end of my original post), Jim Kim MD (former Prof of Medicine and Chair of Global Health for Harvard Medical School, now president of Dartmouth), and the World Health Organization, amongst many other credible sources.
Because I am busy and you make no effort to substantiate your claims, I'm just going to paste a chunk from Tracy Kidder's (Pulitzer Prize winner) biography of Dr Farmer, where Farmer talks to Kidder about dispelling myths about Cuba (and then after that some of Farmer's own writings)...
"For me to admire Cuban medicine is a given," Farmer said. It was a poor country, and made that way at least in part by the United States' long embargo, yet when the Soviet Union had dissolved and Cuba had lost both its patron and most of its foreign trade, the regime had listened to the warnings of its epidemiologists and had actually increased expenditures on public health. By American standards Cuban doctors lacked equipment, and even by Cuban standards they were poorly paid, but they were generally well-trained, and Cuba had more of them per capita than any other country in the world-more than twice as many as the United States. Everyone, it appeared, had access to their services, and to procedures like open heart surgery. Indeed, according to a study by WHO, Cuba had the world's most equitably distributed medicine. Moreover, Cuba seemed to have mostly abandoned its campaign to change the world by exporting troops. Now they were sending doctors instead, to dozens of poor countries. About five hundred Cuban doctors worked gratis in Haiti now-not very effectively, because they lacked equipment, but even as a gesture it meant a lot to Farmer.
One time he got in an argument about Cuba with some friends of his, fellow Harvard professors, who said that the Scandinavian countries offered the best examples of how to provide both excellent public health and political freedom. Farmer said they were talking about managing wealth. He was talking about managing poverty. Haiti was a bad example of how to do that. Cuba was a good one.
He had studied the world's ideologies. The Marxist analysis, which liberation theology borrowed, seemed to him undeniably accurate. How could anyone say that no war among socioeconomic classes existed, or that suffering wasn't a "social creation," especially now, when humanity had developed a grand array of tools to alleviate suffering. And he was more interested in denouncing the faults of the capitalist world than in cataloging the failures of socialism. "We should all be criticizing the excesses of the powerful, if we can demonstrate so readily that these excesses hurt the poor and vulnerable." But years ago he'd concluded that Marxism wouldn't answer the questions posed by the suffering he encountered in Haiti. And he had quarrels with the Marxists he'd read: "What I don't like about Marxist literature is what I don't like about academic pursuits-and isn't that what Marxism is, now? In general, the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy. I can't stand the orthodoxy, and I'll bet that's one reason that science did not flourish in the former Soviet Union."
He distrusted all ideologies, including his own, at least a little. "It's an ology, after all," he had written to me about liberation theology. "And all ologies fail us at some point. At a point, I suspect, not very far from where the Haitian poor live out their dangerous lives." 'Where might it fail? He told me, "If one pushes this ology to its logical conclusion, then God is to be found in the struggle against injustice. But if the odds are so p
I am Jack's complete lack of surprise.
Insurance companies, hospitals, and even individual doctors are profit driven.
While it is certainly no crime to make a dollar, that dollar shouldn't be THE_MOTIVATING_FACTOR in health care.
If/when every doctor, every hospital, and every insurance agent actively seeks to provide the best REASONABLE care possible, at the lowest REASONABLE cost possible, then we will have gone a long way toward solving our health care problems. Ambulance chasing lawyers need to be reigned in as well. An accident in which a person's neck is broken should involve some pretty big money - but the sum of money involved shouldn't guarantee that the victim can live on Easy Street with all his freinds and relatives for the rest of their lives, either. Worst of all - those ambulance chasers pocket half the settlement anyway, so the victim is screwed in the end, no matter what!
And, insurance fraud needs to be punished much more seriously than it is today. Any moron who defrauds an insurance company should get automatic prison time, the sentence to be determined by the amount of the fraud. 1 year for each ten thousand dollars sounds about right to me, sentences to include any and all executives of any companies involved.
In short, let's clean up our act, and stop looking at health care as a cash cow. Start looking at health care as an obligation to take care of each other. And, ourselves, of course.
"Windows is like the faint smell of piss in a subway: it's there, and there's nothing you can do about it." - Charlie Br
Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.
So what is the cost of a human life?
Shai Schticks:"You don't make peace with friends, you make peace with enemies"
For just about everything else in life, insurance is just that: Ensuring that in the event something happens, you are covered. It is a risk transfer for certain situations. For example I carry insurance on my house. In the event it burned down, or everything was stolen or the like, I could not afford to replace it all. My cash reserves are insufficient and, indeed, I have to have a mortgage to own the place. So, in an emergency, the insurance company will cover my loss. However, it is only in an emergency. They do not cover regular maintenance and upkeep of the house. Even in terms of qualifying emergencies, like theft, there's a $500 deductible. So if someone breaks in and steals a couple speakers, I'm paying for that myself, but if they steal everything the insurance company will pay.
It is all about transferring risk. I take care of the high risk, low cost stuff, they assume the low risk, high cost stuff. It is a certainty I'll have to repair things, the risk of something breaking down is as high as it can be, more or less. But the cost is low, I can afford it. The risk of my place burning down is quite low, but the cost is high, too high, so I transfer that risk. Doesn't cost a lot, since it is low risk. Likewise, my insurance company does the same thing. They cover individual incidents. However for large things, like disasters, they have their own reinsurer. That company only deals with extremely rare stuff, the risk of it happening is minimal, but the costs are astronomical.
But for health insurance, that's all turned around. It covers EVERYTHING. I pay, at most, $10 for anything. Insurance pays the rest. Doctors visits, tests, hospital, etc. I only bear the cost if it is extremely cheap, like a generic drug. Otherwise they pick it up. However they also pick up high cost stuff. If I have a major accident and require intensive care, they pick all that up. They are liable for ALL risks to my health.
Is it then any wonder that it costs more per month than my home insurance does per year?
I really thing a medical savings account kind of plan is the right idea. You save money to pay for normal things. In the event of something catastrophic, no problem, your insurance is there to pay any and all costs.
However finding that is hard. They started offering one at work... And it wasn't worth it. My premiums stayed the same, my employer had to put in just as much money, and my personal financial risk increases. How he hell is that useful? It should cost my employer much less, but it doesn't.
Your suggestions tells poor people who happen to have a handicap or chronic condition to get stuffed.
You sir fail at humanity. Congrats, you can now enroll in US politics.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
OP here. Infant mortality rates? Yeah, there are two ways to measure them. Yeah, Cuba uses a marginally different one that makes their stat slightly better. And they "cheat" by having widely available abortions. When it comes to their life expectancy do they "cheat" by reanimating their dead? Because we also have life expectancy on parity with them, despite the fact that they have a per capita income of something like 1/5 of ours (off the top of my head) and according to you "dog and pony show" medical care that amounts to utter neglect. So why do they live as long as us?
Regarding your source:
1: good job linking a right wing thinktank. Funded by philip morris and headed by a former coordinator of Bush campaign? I'm SHOCKED that they don't like Michael Moore's film, haha.
2: i win a prize for calling it... you're a disgruntled Moore hater. Well, so what. Get over it, and start contesting some of the legitimate non-fiction academic literature on Cuba instead of stuff that plays alongside action movies in theaters across the US.
Even poor people in the US have access to multimillion dollar equipment and highly trained doctors, expensive medications, etc... Do you really think a little shithole poor country like Cuba has better healthcare?
Tiger Woods is a billionaire. So I'm sure he wear condoms all the time he's banging cocktail waitresses, right? That's about the same sort of stretch in logic you use above.
SOME poor people have access to multimillion dollar equipment in the US. And for every one of them, there are 20 persons who have health insurance, get cancer, and are dropped by their insurance company or denied coverage (because a commission is paid to reps every time they find a way to deny coverage, and those who don't are fired). The vast majority of American poor are victims of structural violence, are highly marginalized, and have essentially no access to first world medical care.
Yeah, and the movie Birth of a Nation supports the case for the KKK, while the movie Terminator 2 supports the case against improving computer technology. Lets all base our political decisions on this.
"I don't care about the Constitution!" --Bill O'Reilly, November 17, 2009
Dr. Gawande suggests the "13,600 different service lines [doctors] deliver" is an issue in health care costs. I put forth these comments:
* How many services are listed in the manual which guides the number of hours an auto mechanic is allowed to charge for a repair, e.g., replace spark plugs: 0.75 hours. How many items are in this book?
* How many different services does a software engineer deliver over a year's time?
I suggest the problem is related to control over charges. Car mechanics have a job with similar complexity to what doctors face. Software engineers often face a problem much more complex. (How many "surgeries" require several weeks to solve a single-line bug?)
The control of health care "service" in the US is in the hands of the AMA and the bureaucracies created around hospitals and other facilities. If they were willing to reduce their profit margins (assuming we can eliminate the defaults they see because of uninsured/under-insured patients), we could see significant reductions in general health-care costs.
This is just a thought...
-Todd
Omne ignotum pro magnifico.
Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it.
Was this before or after they stopped exchanging chickens?
"I don't care about the Constitution!" --Bill O'Reilly, November 17, 2009
Um...hate to burst your bubble there but fact is that all the other G7 countries(which all have public health care btw) spend about HALF(in terms of % of GDP) of what the US does in healthcare and yet people in those countries live longer(there are lifestyle factors involved, but they aren't the only ones).
I have yet to hear a single empirically sound argument against public health care. No amount of ideology can contradict two very basic, and very important, statistics: percentage of GDP spent on health care and life expectancy. If the government was really driving up the cost of health care then you would expect to see the former be much higher than the US, but in fact it is the opposite. Also, if the health care was really as bad as a lot of people on the right make it out to be, you would see average life expectancy to be lower than that of the United States but it is in fact higher.
Monstar L
2) Effective heath care
3) Obscene corporate profits from health care
As long as corporations control our government, number 3 is not optional.
We don't see the world as it is, we see it as we are.
-- Anais Nin
So if you eat too much/drink occasionally/smoke/use a cellphone in SF or any number of other things that are bad for your health you don't get cover? So I decide to go bungee jumping and you spend ten years eating burgers 3 times a day. I don't deserve medical cover if something happens, but you do?
I have a friend who is a podiatrist. He has patients who have ignored their conditions, to the extent that the necrotizing faciitis they have has eaten a hole clean through the centre of their foot (you could see 3 metatarsals). This patient is an idiot for not going to the doctor earlier when something could have been done, do they get care? What about people who don't get the vaccines or smear tests or prostate exams they are supposed to. All conscious decisions, all of them idiotic. Should they too be denied care? I'd bet that the people that make those kinds of idiotic decisions cost an order of magnitude more than the people who get hurt doing extreme sports that you seem to have a problem with. Or is it just that you don't like other people having fun whilst you're in your sterile bubble of healthiness?
ACing this since you posted as AC above (where I replied as AC and refuted your infant mortality claim).
First, if you have any background in health you know the different between determinants and indicators. You can cherry pick whatever indicators you think will militate best in your favor. And when they don't militate the way you'd like (say: infant mortality) you will claim they are "cheating" by offering abortions or by using a marginally different method.
Allow us to get into the technicals of the method they use. Using your OWN LINK's info, the US method includes less than 1.3% extra babies, of whom 50% may die (less than this but we'll round up. So instead of 6.0 per 1000 for Cuba and 7.2 for the US The US actually has (.5*1.3%) better stats. So 7.1532 instead of 7.2. Wow, who cares. Furthermore, even if we ignore all of this and say that US IS BEST EVER for infant mortality, Cuba still trumps several other "first world" countries that have way more GDP/PPP and use the SAME method of measurement as Cuba. So their indicator holds.
Furthermore, this is ONE indicator. Life expectancy is another important indicator, and one you can't explain your way out of so easily, especially if Cuba has such a horrible medical system the fact that they live approximately (but not quite) as long as Estadounidenses again speaks to their health outcomes. Or their abilities at reanimating their dead.
You cherry pick breast cancer survival, which is a pretty random and focused statistic. I don't think you want to get into the "focused indicator game" with me to prove which country has better health outcomes. How many people does breast cancer kill in the US? Instead of arguing if Cuba wins or loses here, I'll just let you have it. Now how may people do GUNSHOTS kill here? How many in Cuba? Drug overdoses? Car crashes? You will lose the focused indicator game. Most resident doctors in Havana's hospitals have never seen a gunshot wound. Or a drug overdose.
And when we dig deeper into indicators, and I mean overall indicators, not narrower ones that are likely to show more bias, things get interesting. US life expectancy is one thing, but the distribution of life expectancy tells us a whole lot more. Which is to say that black men who live in Harlem have a shorter life span than the average Bangladeshi. So yea, if your last name is Buffet or Rockafeller you're gonna live maybe even 10 years longer than the average Cuban (if you're really lucky), but for the million of marginalized minorities in the United States, you'll probably live 10 years less. See: Hans Rosling's work.
Lastly you are either an idiot (i don't think so) or disingenuous to characterize experts who literally write WORLD HEALTH policy as "enchanted foreigners." If you or I went to Cuba and came back with a glowing review, we might fairly be viewed as "enchanted." When the world's foremost health equity experts have glowing reviews it is ignorant and dismissive to call them "enchanted." I cited people who run the top medical schools in the world. You cited a Philip Morris funded web site. Game, set, match.
In US 50 years ago a family of 4 could have actual health insurance (covering of up to $50,000 of expenses, which was enough for everything) for a year for $25 dollars (payment for an entire year!) with a $500 deductible.
Basic problem is the government giving out public funding for any sort of endeavor. This leads to very rapid price increases. Before Nixon, a day in a hospital could cost $100, today it could cost up to 100 times that much. Obviously this has nothing to do with inflation. Costs to treat cancer could go as high as up to 20,000 dollars before then, now it could easily reach between 500,000 to a cool million.
Another ranting Rand-ite with no actual understanding of the problem.
Look, idiot, 50 years ago, virtually every hospital was run on a not-for-profit basis. Because there were no shareholders to have to provide quarter-over-quarter profits to - and essentially no MBAs to pander to them - nearly every dollar spent on hospitalization went to actual medical care. Likewise, medical insurance was MUCH less paperwork-intensive, which meant that overhead costs for medical billing were a whole lot lower than they are today. And finally (and utterly crucially), medical technology was barely getting started in 1960: no MRIs, no monoclonal antibodies, no gamma knives, no transplants. In fact, the only real high-tech devices were "iron lungs", developed to keep polio victims alive. If you got cancer then, surgery and whole-body radiation were pretty much the only options. Cisplatin-based chemotherapy didn't become commonplace until the 70's. So, no high-tech drugs and devices meant that treatment costs were quite modest by today's standards - and so were survival rates. It's a pretty straightforward tradeoff.
Free-market fanatics like you want to make government spending the culprit for all financial ills, because that makes understanding the world so much simpler for you. The problem is that your underlying assumptions are simply wrong, so your worldview is full of shit. The fact is that medical costs are out of control in this country not because of Medicare/Medicaid spending, but because of proliferating treatment costs and the rise of the for-profit medical insurance economy (whose overhead costs run ~30% - as opposed to Medicare/Medicaid, whose overhead is ~1.5%).
Oh, and Medicare/Medicaid wouldn't be facing the deficit problem that's looming, if Congress had had the sack to increase Medicare premiums and payroll taxes by a relatively tiny percent 25 years ago, when the impending problem first became apparent. Or, to put it in terms your tiny mind will reject: the problem isn't government spending, it's the government's cowardly unwillingness to raise taxes to levels sufficient to fund its spending mandates that's the problem.
I'm not surprised I have to explain this to you, because you're obviously too blinded by your free-market dogma to grasp the actual causes of the medical economic bubble we're experiencing in this country.
Check out my novel.
You take that money and put it in that lock box Al Gore was going on about in 2000, so that Republican raiders can't get their grubbies on it.
I doubt that will help much since you have given Democrats the key to that very box. And they are very, very hungry to make use of the contents as they have shown over the last year - even moreso than the last batch of Republicans.
Your "public option" fan fic was amusing, though once you see in real life what happens when you let people take as much as they can for free it of course goes all to hell.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
Now. They US is spending all that money on health insurance and payments now.
Did you read my post?
Besides, the problems related to the socialist dream that Greece was are not only contained to Greece.
The public health insurance works when there is money for it, however look at UK, if you think Greece has problems, you just may be surprised to find out that UK has bigger problems with debt it cannot repay.
In fact everything I said relates to all governments that meddle with economy, not only the US. UK also has a government that kills competition and creates giant monopolies, and those giant monopolies move their production capacity out of UK, while UK is in wars and paying for all of the entitlements and their debt obligations are growing and with the falling production capacity this debt also cannot be repaid.
All government programs works to a point, at which they stop working because government is again, a machine that creates inflation, has politicians that want to stay in power by any means necessary, which include borrowing/printing money/taxing more. This works in a short term, and I consider anything under 50 years to be a short term.
You can't handle the truth.
The US medical culture is often about "doing everything possible" (more often when you are both white and non-poor), and our infant mortality stat is measured differently, but this difference is marginal at best.
The difference is basically as he said, we try to save babies that are below 1KG in weight, and half of those die, and we count that. Other countries don't. BUT! The total number of births below 1.5KG is only 1.3% so this does not significantly affect the stat. The number I am citing is from his OWN LINK where he is arguing this point elsewhere in the thread.
I don't think the post above needs to be modded troll, but it's important for people to understand the difference in infant mortality measurement is marginal, and the US is the outlier in how we record these deaths.
What this country needs is a good $5 plasma weapon.
Thank you for essentially proving my point, instead of combatting my argument with empirical evidence on the efficacy of privately run healthcare you just responded with a lot of ideology with no statistics to back you up. Guess what, the problems in Greece is NOT the fault of healthcare, it stems from the government giving lavish gifts to it's own employees with 0 oversight all while trying to hide what they were doing. That happens elsewhere, including the US, all the time(both Repubs and democrats do it).
To add further empirical fuel to my argument, look at which economies in the G7 are recovering the fastest, Japan, Canada, and Australia. What do those three have in common that other countries do not? They all have public healthcare systems WITHOUT a lot of the other bullshit that comes attached with hiring and firing workers that the Europeans have. Despite their surging currencies(the loonie, ozzie dollar and yen are all really strong right now) it is STILL cheaper to hire workers(esp. for small businesses) in these countries than it is in the US. The healthcare system in the US is hurting international competitiveness and thus costing a massive # of jobs.
If you want to refute me please actually use real, verifiable evidence and don't repeat your last rebuttal where you think you win an argument just by using the word "socialism".
Monstar L
ACing because I don't need ego-stroke or karma for reposting, but since you want the cite:
Erwin Ackerknecht's A short history of medicine, page 224. This is on Google Books if you doubt me. Quote:
"There were no less than four-hundred medical schools in the US in the nineteenth century. [skipping less than a sentence] ... and it was not until 1930 that the number had been reduced to seventy-six well-qualified institutions."
Incidentally I agree with the rest of your post, and many of the 400 were certainly diploma mills or quackeries. My point is that we have expanded as a nation, aged as a population, and reduced the number and proportion of doctors we create. Bad idea if your foremost goal is public health.
Yeah, government clinics for the poor, and they just happen to have the worsed equipment and the place where the big pharmacuticals do their testing.
You know, most of the developed world has sorted this out a long time ago. It is called socialism. Embrace it or die.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
This is completely true. I don't know why people on the left keep trying to wheel out this "don't you care about Old Mama Poor not being able to afford her drugs?" shthick; the economic arguments for having publically owned healthcare are stong enough on their own.
For example, if a pharma company invents a new drug in the US, and goes to the insurers and says "I've got this new drug, it's awesome, it costs $100,000 if you don't buy it, your competitors will and everyone worried about getting cancer will flee to them", then what happens is the pharmas get to dictate prices.
In the UK, the NHS goes "Oh, that's too bad, we're only paying $20,000 for it". The pharma company HAS TO SELL to the NHS and it's 65 milllion customers so it will accept this much fairer price.
Of course, it is in the NHS's interest to keep GlaxoSmithKline profitable and inventing drugs, so it won't say it's only paying $10 or whatever, but it means the balance of power is tipped back towards the people and not the megacorps.
This article doesn't explain why health care in the US is five times more expensive than in most countries in Europe. I live in Amsterdam, I am single, I pay $120 a month, full coverage, no co-payment, no dentist.
no, I don't have a sig
A big part of efficient health care is to keep people out of hospitals. Prevent, inform and make basic health care easy, accessible and inexpensive. If this patient you're talking about had the option of going to a local doctor for a basic diagnosis and medicine for free (or a couple of dollars), I guess he would have done it. If his only option was going to a hospital where the doctor would give him unnecessary treatments and squeeze every dollar out of him while losing his insurane for the rest of his life, a first sign of a disease would mean as much as a personal bankruptcy for him. It's no wonder people are going to try to live with easy-to-cure diseases until it's too late and expensive treatment is necessary. You say he's an idiot, but actually he just decided that getting rid of a small inconvenience wasn't worth a personal bankruptcy.
Besides, the whole financial incentives system is broken. If a 400lb patient comes to the cardiologist, what is the financial incentive to just assign the patient a lifestyle coach, which is the only long term cure for his/her problems?
Less endemic morbid obesity.
Finally had enough. Come see us over at https://soylentnews.org/
it is simply because they are paying a large amount on a smaller number of people. The ratio of administrative (records, tracking and such) makes up a larger percentage of the cost of managing a healthy patient than an unhealthy one. Think of it this way, if I go to the doctor four times a year for a check up and at most one real event the costs to track me will take a higher percentage of my overall health care dollars compared to Joe, the 70 year old who ends up in the hospital for a twelve thousand dollar visit.
So if my health care costs for four visits were $600 I am quite sure the admin of tracking that is amazing higher in percentage than tracking Joe who racks up twelve thousand in one shot.
Sure Medicare will work, if you force young healthy people who don't need such coverage to pay for it. I am sure they are going to love it. They will get what they deserve in the end, electing people to give them stuff sounds good because they themselves never expect to pay for it. Any workable Medicare system will require ALL people pay where opt out penalties are higher than staying in.
The "Health Care bill" was designed to drive privates out by forcing them to insure those who wanted it and letting people who didn't want to chip in to pay a penalty to the government. As in, put all the onus on one side. Funny how the solutions when offered by the government as sole provider don't follow the same rules.
* Winners compare their achievements to their goals, losers compare theirs to that of others.
Do you really think the Chinese would hesitate for a moment if the American military vanished over night?
It is also one of the few federal expenses that the Constitution actually even permits.
Okay, where in the Constitution did you see anything allowing the funding of a permanent national military? I recall seeing that militias can be raised, but control must remain with individual states, and that clause about a limit of two years of funding for any money appropriated to raising and supporting an army.
Seriously, the Constitution is about as anti-superpower as you can get. Remember it was written by a bunch of people who didn't trust their government. Perhaps our military is a good example of how much governments have changed since 1776, as now people feel government exists only to defend and serve the people.
Healthcare in the US isn't close to 5 times as expensive if you are going to base that on your personal healthcare.
I pay $150 a month, full coverage, $20 copay for most issues, $50 copay for a specialist (x-rays, lab work, etc), full dental coverage (oddly enough x-rays included), $10 prescriptions delivered to my house (no waiting at a drugstore), $300 hospital stay (up to 30 days). This is on COBRA. When I was employed, it was around $55 a month.
Private insurance for someone my age and etc is less than $200 a month (your service level may vary, thats why you shop around and have competition for private insurance).
Of course, the article doesn't address your blatent lie because it isn't about the differences between US and European healthcare, but rather about why quality care is not uniform (the article is inaccurate, the problem is that many doctors are not good doctors and like any profession, the better doctors tend to charge more while actually helping their patients more effectively).
Two of them have vast national resources, and the other has stagnated for decades, I'm not sure of the relevance. The UK has a 'flexible' labour market and it's not done an awful lot of good.
Bingo. Got it in one.
I work in the public health system in Australia, and it is going down the tubes. So much public money is being spent keeping people alive for decades because of self-inflicted illnesses. Type 2 diabetes is the next "epidemic" we're told to expect but it is almost always a direct consequence of known lifestyle choices.
"Bariatrics" is now a specialty. We spend thousands on super-size wheelchairs for fat bastards but aren't allowed to say they are fat bastards. We will modify their houses for them free of charge, as if morbid obesity was a sudden injury like a spinal injury.
We hand out, install, service and support dialysis machines for renal patients who are the "victims" of their own stupid choices. Some genuine cases of kidney disease, yes, but a lot of lifestyle stuff.
I love working in public health. Being able to make sick people well again is great, but we are being dragged down the toilet by people who don't give a rat's arse about their own health and just seem to revel in making the rest of us wallow in their shit.
PS love the name. Cool album.
When they came for the communists, I said "He's next door. Take him away. Goddam commies."
How about corporate officials making no more than 40 times the pay of the lowest-paid health worker?
We have many, many patients that just ignore stuff until it's to big to ignore and then require intensive hospitalisation, surgery, rehab and care. And we have a fully funded public health system. The idiots are going to send us broke.
We have the 400 lb patients here, too - who is going to force them to use a lifestyle coach? What's their incentive when an entire cardiac team will run around after them at no cost to them; when hospitals will buy super-size wheel chairs to ferry them around; when rehab will get free modifications on their house so they can use their own toilet again. They do everything short of buying them a muumuu.
We have basic health care that is free and accessible. We have the most educated and health literate people in history and still they fuck up the most basic of choices, over and over again. Can you really educate the stupid out of people?
When they came for the communists, I said "He's next door. Take him away. Goddam commies."
If it wasn't costly, why was there such public support for the introduction of the NHS in post WW2 Britain?
If it wasn't effective, why did they want it?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
There were plenty of nuclear submarines deployed for the invasion of Iraq - they were one of the central platforms for cruise missile launches.
How do you answer the point that many other developed countries have much more government involvement in healthcare, and yet pay less for better healthcare?
In France, for example, public healthcare is available to all, but they pay only only 3/5 as much as the US as a proportion of GDP and are considered to have the best healthcare system in the world by the WHO.
The British NHS, which at the time of the WHO's report cost only half as much as the French system in terms of GDP, was placed 18th; a fair few countries behind France, but still 19 places ahead of the US. To reiterate: the NHS, which is entirely Government funded, costs only just over a quarter of the US system and yet has better results.
Developed countries with socialized or partly socialized healthcare systems topped the list, while the US, coming far closer to your vision of non-Governmental healthcare, was beaten by powerhouses like Costa Rica, Columbia, Morocco, and the UAE.
You called me an idiot, while you are staring right into the problems face and being totally blind about it.
You think he's wrong despite what he says. I suspect strongly that you haven't even read it deeply.
Once the government guarantees that it will pay, the incentives to keep prices at what the market can bear disappear.
If that is true, then why is health care so much cheaper everywhere else in the world - where the government really does guarantee to pay?
Government provides a gigantic moral hazard, you are looking at it and completely not seeing it.
What an awesome argument! Way to go brains! Did it ever occur to you that what you think you can "see" is just the play of neurones? It's not actually real.
If the government is such a huge moral hazard, then perhaps you should go live some place without a government - say like Somalia. No government there. Just pure economics. Paradise!
You buy civilisation with taxes,and that must be administered by government. Far from being a moral hazard, the collective spending and government administration is the basis of a functioning economy. It really is a question of what qualifies as efficient and worthwhile.
If private industry cannot do better than a government institution, then why prop up an inefficient private solution? That is precisely why we have public fire fighters.
Or is that a big moral hazard as well??
No wonder you immediately start with an ad-hominem, you have no intelligence to do otherwise.
Psychologists call that projection
Like all pain, suffering is a signal that something isn't right
The problem is that medicine is seen worldwide as a business, as in other businesses where the only objective is to maximize its profit. And that's not counting the medical courses are usually so expensive that only rich kids can have them, attracting people who are only interested in money rather than save lives. Medicine can not be seen as a mere ... business.
Religion: The greatest weapon of mass destruction of all time
I suppose to the many in the slashdot community it may seem that way. It sure seems to me that the whole premise here presupposes that complete and total health care is a right.
Last time I read the constitution, it wasn't.
To put this "Health Care" crisis in perspective, Americans spend about three times as much on transportation as they do heath care.
Of course we would wouldn't want facts to get in the way of our political agenda.
Let the flaming commence.
Your plan sounds excellent - where do you live, who's your provider? Oh, and what % does your employer kick in?
These are real questions, since I employ people in NYC, and have just been going over health plans to figure out how to reduce the cost.
The US spends more than most of the rest of the world combined, including China. What will China do if the US cuts 10% off his military budget? Absolutely nothing.
Since when was Afghnistan part of Iraq, moron?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
..and what will 10% solve, exactly?
We are talking about $100 trillion dollars in projected unfunded liability for social security and medicare. Its 100% of the economic output of the entire nation for a decade, and its only that low assuming we dont let any more people onto these plans.
That extra 10% in military spending could come in handy once our entire system collapses under its own weight. We can't just be on par militarily when it happens.. we need to be way ahead.
"His name was James Damore."
The article is interesting in stressing the need for a more systematic approach to medicine in the hope of providing both better care and lower costs. That will improve things but it does not solve the fundamental problem.
The fundamental problem is the inherent improper design of biological systems which results in aging. As organisms age components fail and need treatment, repair or replacement. As the fraction of the population which requires these therapies increases costs will increase. Period. There are only two ways to solve this. Agree that because the biological systems are failing and will eventually lead to death we should reduce the level of care provided to these failing systems. Or redesign the systems so that they are more resistant to aging -- i.e. eliminate aging. If one eliminates aging one eliminates a significant fraction of the anticipated increases in the costs of health care.
Now as is usually the case the devil is in the details. What causes aging? Largely the inherently poor design of the system, e.g. energy production methods (the electron transport chain in the mitochondria) which produces free radicals which in turn damage the DNA producing point mutations and/or DNA double strand breaks the repair of which cumulatively corrupts the genetic program of each and every cell in the body until one ends up with either cancer or "aging" [1]. From a programmer's perspective each and every program in the trillions of cells in an adult human's body is becoming corrupted and will eventually fail. We have replacement capacity for some of those programs through our stem cells but those programs become corrupted as well. Until we have the ability to replace or repair the declining genetic programs we will not solve the increasing costs of health care.
Note that one can replace the programs in bulk (organ transplants) and there is an X prize pending for growing replacement organs from ones own stem cells. There are also a number of companies, e.g. Regenexx, BioHeart, etc. working on legitimate autologous stem cell therapies. There are also companies like 23andMe, Navigenics, etc. making personalized medicine available to the masses (so one can known what ones own genetic weaknesses are). And eventually if molecular nanotechnology develops quickly enough and we get real nanorobots like "chromallocytes" the repair of the cumulative DNA damage in each and every cell may become feasible (at low cost without the need for an operating room and a team of surgeons to perform a large organ replacement proceedure).
But until one starts seeing more people point out that the lack of clothes on the emperor (that the real problem is gradual genome corruption and "aging") and the need for a real "industry" to deal with it *and* the political problem that if you solve aging (so people live indefinitely [2]) then one is also going to have to touch the "third rail" of politics (social security entitlements) if one is going to avoid bankrupting nations [3] then speeches such as the one cited will miss the critical issues.
1. This isn't the only way the system is mis-designed. One could argue that the use of free radicals and inflammation by the immune system is questionable. On the one hand it may help to fight bacteria or viruses when one is wounded or otherwise exposed to them but at the same time the same processes probably contribute to heart disease. But heart disease can largely be dealt with through proper diet and exercise, and if necessary relatively inexpensive drugs, the same cannot be said for cancer and aging.
2. Indefinite lifespans are not "immortal" lifespans. Fatal accidents still have a non-zero probability.
3. All of the news debates about medical care costs, national debt, etc. (largely promoted by right wing politicians, new "Tea parties", etc. IMO) *all* ignore the probability that these perspectives largely disappear in light of molecular nanotechnology. People largely don't need Medicare if their genomes were better engineered to last indefinit
Well this patient was in the UK. All he had to do was go to his GP or walk into a 'walk in' centre. No cost at all. Plus the likelihood (I don't know for sure) is that the patient had diabetes, and so should have been well aware of the increased risk of those sort of conditions. I can understand that if he was in some backward state where getting vital, preventative healthcare can bankrupt you he might feel forced to wait, but this was not the case.
I'm in the UK, so women get a letter through about smear tests at some point in their mid 20s.
Anyway my point is that the OP is arguing that people should be denied healthcare for problems caused by voluntary choices. I was simply pointing out that it's a bit unfair to categorise one set of voluntary choices as idiotic, and hence not deserving of medical care, and not another.
that those who oppose the idiocy of libertarianism are not "lovers of big government" as you say? why, why would we love big government? who would anyone? what is the motivation?
"oh, i am a sworn protector of bloated government bureaucracy, it is my burning passion" pffft
NO ONE loves big government. but we oppose libertarianism BECAUSE BE UNDERSTAND IT BETTER THAN LIBERTARIANS: it is clearly a road to hell
if you say "how could you understand libertarianism better than libertarians", well: do you understnad communism? do you have to be a communist to understand or oppose communism?
no: clearly communism is stupid, as it destroys society by removing any impulse to actually try and work. LIKEWISE, libertarianism removes the impulse to have any public good. libertarianism is simply social darwinism: humanity as craven selfish competing indivuduals with no rules, nothing to punish them for bad behavior, without the slightest concern for anyone else. a society of sociopaths
libertarianism is the mirror image of communism: the fanatical triumph of selfishness over altruism. much like communism is the fanatical triumph of altruism over selfishness. the truth is BOTH communism and libertarianism are dangerous destructive follies at either end of a spectrum. the ONLY true way to run a society is a MIX: socialism with capitalist engines, or capitalism with socialist safety nets
the MODERATE path is the only path that makes sense, because humans are a paradoxical mix of the selfish and the altruistic, and any ideology that addresses only one side of human nature fails to rule human beings, by not adequately reflecting who and what they are
we need GOVERNMENT, period. not BIG government. we're not idiots, we don't defend government blindly: government has problems, we need to FIX it. its an ongoing maintenance function that never ends
but libertarians want to THROW GOVERNMENT AWAY, to destroy it down to a cauterized ineffective nub. which is incredibly stupid. libertarians want this country to be like haiti or somalia, where there are a few ultrarich, legions of poor, abuses on every street corner, and the power vacuum of no government filled by mafias and corporations. libertarians may not actually say this is what they want, but this is the end result of their philosophy, whether they realize it or not
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
SCENE: dead of night, full moon, desolate plain near kandahar
a group of mujahideen slowly creep through the brush towards an american outpost, one takes aim at a sentry
just then, the ground starts to shake, the mujahideen lower their arms and look at each other helplessly. suddenly, a periscope pokes out of the dirt behind the mujahideen, and then the top of an entire submarine
"mustapha, the infidels are using sand submarines!"
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The big point entirely missed is that some aspects of US medical care are so broken that even Cuba can do things better than the US on average.
There are of course dozens of countries that do it better than Cuba, and some systems in the USA (Veteran's Hospitals etc) that are also better than Cuba.
Where do you get this from? Obesity seems to be on the increase - not normally an indicator of "healthier natural diets": http://www.cdc.gov/obesity/data/trends.html#State
To give an example of how insane the AMA/AAMC is I give myself as an example. I didn't do well in college(We're talking B-/C+ GPA) when I was younger but I got bit by the medicine bug in my early to mid 30's and went back to do a premed program as a post bacc. It was surprising how much I had grown up and changed and I did extremely well. Taking the standard premed coursework I had a GPA on that in excess of 3.9 and even got a balanced 33 on my MCAT. Anybody want to guess what I was judged on? Yup, that classwork that was on the order of 15 years old and not the stuff I had just taken. (You'd think someone like me would be a great to have in medical school since I was doing this on my own and not to please a parent and shown how much I wanted to do this. Instead I was judged on things that didn't reflect me at the time of application and was insulted behind my back which is really a dick move.)
Did you know 80 to 90% of the moderators on slashdot wouldn't recognize a troll even if one dragged them under a bridge.
Free-market fanatics like you want to make government spending the culprit for all financial ills, because that makes understanding the world so much simpler for you.
It's a feature not a bug. Free markets don't only make things simpler for "Randites", they make things simpler for everyone who uses them. Complexity reduction is a legitimate benefit that in itself usually reduces the cost of goods and services in a sector that uses markets.
And finally (and utterly crucially), medical technology was barely getting started in 1960: no MRIs, no monoclonal antibodies, no gamma knives, no transplants.
And we all know that better technology has to cost more, right? The problem with this assertion is that it doesn't follow. Just because we use more advanced processes and technologies now, doesn't mean that health care has to cost more.
The fact is that medical costs are out of control in this country not because of Medicare/Medicaid spending, but because of proliferating treatment costs and the rise of the for-profit medical insurance economy (whose overhead costs run ~30% - as opposed to Medicare/Medicaid, whose overhead is ~1.5%).
Overhead is not the sole measure of effectiveness of a medical program. We also have to consider such things as fraud prevention, cost reduction, medical liability, and government power. Medicare doesn't do much of anything to prevent fraud. It doesn't need to. A congressperson has a far greater chance of losing their job due to Medicare denying someone care than they do to rampant fraud (in fact, the latter might help them get reelected). Neither is Medicare liable, if a patient suffers harm as the result of a Medicare policy. Insurance companies don't have that protection and they need to care about fraud. Hence, their overhead is higher naturally.
My view is that the real problems are that too many of these policies (government and insurance) encourage voracious consumption of health care services, that too many insurance policies are linked to employment (and hence, there's far less competition in the insurance industry than there should be), malpractice liability and medical professional training regulations need to be reformed, rules have been set up so that insurance company can profit by reneging on their contracts. Yes, some of this is probably due to the contrivance of insurance companies, but there is a huge nest of contributing factors that all raise the cost of health care tremendously.
These factors in turn drive the increases in medical treatment costs. Encouraging much higher demand means higher prices which in turn encourages higher costs among suppliers in a moderately competitive market.
Oh, and Medicare/Medicaid wouldn't be facing the deficit problem that's looming, if Congress had had the sack to increase Medicare premiums and payroll taxes by a relatively tiny percent 25 years ago, when the impending problem first became apparent. Or, to put it in terms your tiny mind will reject: the problem isn't government spending, it's the government's cowardly unwillingness to raise taxes to levels sufficient to fund its spending mandates that's the problem.
What's considered a "spending mandate" is subjective. My view is that most services, including entitlements such as health care, are not mandates of a government, but electives that it chooses to do. Legally, if the US government (via Congress) decides to pile a few trillion dollars worth of stuff in a huge pile and burn it, then that is as much a spending mandate as national security or the health care of doe-eyed constituents.
When we get to government spending, it's worth noting here that the US government has only a few years in its entire history when spending was nearly equal to tax revenue. Most times, spending is considerably higher. If taxes were raised, why wouldn't this continue? In ot
that the us healthcare system is extremely broken and needs an overhaul is plainly and painfully obvious to anyone with half a brain
there does however seem to be a large inflamed population of completely propagandized idiots that oppose the overhaul, but so what? there's also a bunch of morons who support creationism who think evolution is controversial too, and that simply teaching evolution is "activism"
i guess simple common sense is "activism" to a moron
but really, when it comes to the healthcare system in the usa, there's no controversy: its horribly broken, and it needs to resemble the way it is in other, saner countries in the world
and that is a simple obvious fact unless you are a hysterical propagandized twit
heck, there are desperately poor countries with saner healthcare policies than the usa:
http://www.nytimes.com/2010/06/15/health/policy/15rwanda.html
you really wonder exactly what the hell motivates people to oppose universal healthcare. you look at the idea of it, your mind examines all of the pros and cons of universal healthcare, compare it to the current system the usa has, or some libertarian social darwinistic fantasy of people unable to treat broken arms because they don't have $100,000 in their bank account, and it is such a NO BRAINER OBVIOUSLY SUPERIOR APPROACH TO THE PROBLEM OF HEALTHCARE
you really have to wonder exactly what motivates those to oppose a system of care which is in their own selfish interest to accept! do these people believe they are immortal? that they are immune to a sudden accident they can't afford? or that if you can't afford insurance, or are too stupid to realize you need to buy it, that the rest of us can just go "well sucks to be you" and watch you die on the street? is that it?: do you have to be a sociopath not to accept universal healthcare?
what exactly are these morons who oppose universal healthcare thinking?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
After thinking about things for a bit, here's a simple statement of the health care "problem" - from a bias of being familiar only with the US system. I've also got a proposal that could address many of the issues while meeting most of the goals of a health care system.
As introduction, the marks of a "good" system might be: treatment at any given level is available to all independent of individual wealth (equality of care), there is enough care at a given quality to support the needs at that level (availability of service), there is an emphasis on preventive care, and cost to individuals is proportional to amount of service utilized (fairness of cost). These are pretty much the main arguments of the day - people want to get (good) care for everyone but it is not economically or socially responsible to have everyone pay the same amount personally to get massively different benefit.
My solution would be along the lines of requiring everyone to pay some baseline amount for insurance. This would be a small amount so everyone could afford it. Note that I would not exempt anyone from this small payment. But: If individuals go in for at least the basic regular checkups and basic preventive care, they would receive rebates that would offset this minimal fee. However, if you need more service than that, you must pay increasing amounts depending on the level of service needed.
So this is something like the Taguchi loss function - if society as a whole has zero health care that's a big loss so should have a cost (the "minimum fee"). But if people have basic care to prevent communicable disease, basic checkups, etc. the total cost to society is lower - this is why rebates are offered. But then there are major illnesses and the like, which increase cost to society - so those should carry larger costs.
Admittedly there are details that are probably important, but the major idea is sound - it encourages both minimal levels of treatment and preventive care but also (fairly) puts higher costs on those who need greater amount of care. This "greater cost" should probably be on some kind of relative scale; chronic illnesses with treatments should have not have debilitating payments (think of future value of work). Probably something like cost is inversely proportional to amount of time remaining to the average lifespan or something. Or so that "chronic" treatments are just a small amount per month, but a major illness at age 68 would cost more than the same illness at age 28 or 38. The costs should really be structured to reflect the cost/benefit to society rather than simply spreading high costs for a few to a small amount of people (in other words, avoid the "car payment" situation where yes, the monthly payments are lower but the total cost is higher. This is the sad economic effect of the current health care system; individual payments may be lower but the total cost to society is higher.)
To summarize:
1. Minimum fee required by all.
2. Rebates for routine checkups and basic preventive care that would fully offset the minimum fee.
3. Additional fees for any additional treatment beyond preventive/basic care ("basic" here things like non-STD communicable diseases or non-lifestyle-related injuries) to discourage unnecessary treatment and overly-risky behavior (e.g., X-games participants would pay for injuries or take out additional "occupational/hobby injury" insurance) but structured in a way to not financially crush people who need it.
4. Provide some mechanism to reduce facility costs - property tax breaks or something. After all, we provide public libraries but not public clinics?
5. Reduction in certification requirements for basic health services to increase the available health care providers to help with supply side. Things like nurse practitioners are a step in the right direction.
I'm sure there are other minutiae, but this framework should address many of the personal-cost-side issues related to health care.
"There are a dozen opinions on a matter until you know the truth. Then there is only one." - CS Lewis (paraprhase)
The original article is the commencement speech at Stanford’s School of Medicine. It gives a bird's eye philosophical perspective on the state of the medical profession. As such, I like it.
What I don't like are the people here trying to derive a political message from it. Health care in the US is so much less cost-efficient than the other industrialized countries, countries that have equivalent or better health care and that face the same challenges. This discussion sounds like looking for excuses not to fix the broken health care system.
"Why The Face" is this on Slashdot?
In those countries, every study I have seen indicates that the prognosis for those diagnosed with serious illness is worse than for someone diagnosed with the same illness in the U.S..
The truth is that all men having power ought to be mistrusted. James Madison
The ONLY reason healthcare costs are spiraling out of control is because we have now had more than 100 years of practicing fascism in the field.
Read this before modding me troll.
they profit from the taking of organs, be damned about the ethics or the consequences
the reason that there is no legal market for human organs is the the fact that the poor will sell their kidneys. there is a belief in human dignity, i don't know if you share it, and anyone ethical does not believe that poverty should be a gateway to permanent degradation of health, of loss of dignity. being poor does not mean you have no human dignity
of course, people will still sell their kidneys, on the black market. there's nothing that can be done if someone is hell bent on ignoring their human dignity
but that doesn't mean that anyone with ethics is going to accept the fact that some people have no dignity, and that some businessmen recognize no human dignity. accepting these thoughts is a gateway to a hell of social darwinism, where human life and human dignity has no value
you may have no problem with that, but i do, and plenty others with a belief in human dignity do as well. so, stay in the shadows with your black market with your fellow sociopaths, and understand that just because you convinced someone to degrade their dignity, and you yourself recognize no dignity, does not mean that human dignity does not exist, and that it is not important for most of us
take solace in the fact that you should do well in business, where sociopathology is rewarded
as if doing well in business is the ultimate determinant of what is right and wrong. as so many callous ayn rand fools currently believe in this world, unfortunately
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
wrong answer, try again!
Infant mortality rates: the US ranks an embarassing 33rd according to the UN, 46th according to the CIA
US also ranks pretty shittily in heart attack rates too
Do I really need to go on pointing out what a farce the supposed "superior" US healthcare system is?
Monstar L
YES.
We, a small Canadian company, let our US division deplete from attrition because we could not afford the ridiculous insurance premiums. Our intent was to increase the number of jobs there because there was less travel involved the wages were perhaps slightly less, and we thought perhaps Americans would like to deal with Americans (stupid Canadian cultural sensitivity). The number one reason people left us was because someone was offering a slightly better health care package, and ours was actually pretty good. After the last round of interviews where the first question we were inevitably asked was "... health insurance" the higher ups finally got pissed off and stopped trying to hire there.
Instead we hired another 6-10 people in Canada and we travel to the US when necessary.
The billing system is like dishonest car sales / repair.
With no or way off listed prices + lots of hidden fees / junk fees that few people know what they even are for.
lot's of 3rd party billing that goes to 1st and 2st party and if someone messes up they bill you even if some other party payed / covered that under a different fee.
over and double billing when fixing a car you don't get to bill the full labor cost of replaing 2 parts that are right next to each other when both need to be repaced at the same time.
Billing for stuff that happened mouths ago that was no billed at first but came form a 4rd party that took that long to work thought party's 1,2,3.
AND WHY IS THIS CARP TIED TO YOUR JOB????????????
I have yet to hear a single empirically sound argument against public health care.
According to the WHO, when it comes to "level of responsiveness" (i.e. patient satisfaction and how quickly and efficiently the system works), the US beats all other countries.
percentage of GDP spent on health care and life expectancy.
The US has a lower life expectancy because the US has a higher proportion of people who are fat and live an unhealthy lifestyle.
That chart shows how people spend money with their own personal spending. It doesn't mention how much money is spent by governments, businesses, and insurers on health care. Medicaid and Medicare run at about a sixth of our federal budget, IIRC. You shouldn't use personal spending alone to gauge the impact that health spending is having on the economy.
Libertarians somehow believe that private businesses should be stronger than governments but weaker than individuals.
Also worth noting that Britain and Canada and Japan all must have their own certain percentage of stupid people who do dumb things, and yet I believe they all treat those people under their policies as well, yet they still spend much less on their healthcare.
Libertarians somehow believe that private businesses should be stronger than governments but weaker than individuals.
because we DO need more regulation. the 2008 market crash proves this: the fruits of years of deregulation in the financial world resulted in that (this is where you chirp in with your insane alternative reality explanation of why and how regulations resulted in the 2008 crash)
if you don't understand why healthcare needs regulation, you're truly insane
and enough with the commingling of government and corporations in your mind. if you reduce government, corporations take over in the power vacuum, commit every injustice you see a corporation corrupted government do, AND THEN SOME MORE INJUSTICES. what you do is you REDUCE the corrrupting influence of corporations in government. you certainly don't destroy the only thing you have protecting you from the abuse of corporations!
FIX government don't DESTORY it, libertarian morons
if your roof is infected with termites, is the solution to remove the roof from your house? no, the solution is to get rid of the termites! corporations are your enemy, NOT the government. without understanding this obvious fact, there is no understanding possible with you at all, because you are clearly insane if you believe your government, the only agent you have in the fight against corporations, is the enemy instead. INSANE
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Or is it just that you don't like other people having fun whilst you're in your sterile bubble of healthiness?
It seems to be the case with a lot of people these days. If they don't get (or want) to do something, then nobody else gets to do it too.
Part of it stems from human condition being social creatures, the other part from jealousy.
"If a nation expects to be ignorant and free in a state of civilization, it expects what never was and never will be."
The productive people (those who can afford health insurance) are rightly concerned about facing this choice. Right now, they get the good doctor.
To be blunt and mighty cold, it is not economicly sensible to waste good doctors on the unproductive people. The care standards of a century ago would be sensible; they'd get no worse than my great grandparents had.
We simply can't provide everybody with the very best, in healthcare or anything else. (think "housing" or "food" if you like) Allowing a lottery to decide who gets the best care is worse than allowing money to decide who gets the best care.
Imagine if we handed out mansions by lottery, perhaps with a waiting list. Shelter is a human right, and everybody deserves the best! Just as in healthcare, the country would go broke trying and/or the waiting list would grow as required to ensure that most people die on the waiting list.
Right now, better health care is a mighty big incentive to work harder. People seek jobs that provide insurance and/or jobs that pay enough to make insurance affordable. People are lazy and selfish; they won't work simply for the common good.
Okay, I'll bite.
A friend with breast cancer recently flew from Canada to the Bahamas with a stopover in California where she was scheduled for a PET scan. The scan revealed a pleural effusion, fluid between the lung sac and chest wall. Her oncologist stated she should not fly again until the fluid was drained. The procedure, a thoracentesis or pleural tap is simple, ordinarily performed in the physician's examining room. My friend has excellent private health insurance and the insurer immediately assigned a case number to the incident. So far so good.
No physician would see us. The universal response was "we don't take walk-ins."
We decided to try face-to-face communication, and visited a large pulmonary practice. "We don't accept walk-ins" the receptionist explained. I replied, "I completely understand. I was a First Responder for 18 years, and every time I left a warm bed at 2 a.m. to help a stranger I knew I was putting my personal assets on the line. I always delivered the department lecture on liability. So I totally get it. Do you mind if we rest a few minutes before returning to the car?"
A few minutes later we were told that Dr. H. would see us. Said he has performed pleural taps countless times in his office. He would charge $100, or for a Canadian visitor would even do it for free, but no longer keeps the necessary tray on hand. Everything is now done in the hospital, where the procedure with tests and overnight stay will cost $30,000 - $40,000.
I telephoned the imaging center where the PET scan had been performed the previous day to ask if their invasive radiologist would perform a thoracentesis; my friend was an established patient there, not a "walk-in." He demurred but stated the condition was life-threatening and advised an immediate trip to ER.
Her PET was loaded on my laptop and we breezed through triage in two minutes flat. However, the thoracentesis was delayed by a mass casualty incident and she was given a room for the night. Hospital wanted to perform a PET scan even though we had the CD and written report from the previous day; finally common sense prevailed.
The following day she was brought to an examining room where a very young physician, still in his bicycle clothes and helmet, entered and introduced himself, drained 1.5 liters of fluid, applied a bandaid, and bade us farewell. A fifteen minute procedure.
Cost in any ER in Canada: $75. Cost in California: we're guessing $20,000. The hospital can sort it out with the insurers and we'll pick up the co-pay.
The experience has forever changed my view on the reasons for runaway health care costs in the U.S.A.
While it's too bad there aren't more medical schools in the U.S., fortunately there are other countries that are eager to set up medical schools, and ones set up to serve the overflow from the U.S. can be found dotted throughout the Caribbean and now Central American as well. Yes, people criticize them as being for people who couldn't get into an American school, and to some extent that's true, but there are some gems down there, like Ross University in Dominica or St. George's University in Grenada. In any event, graduates of foreign medical schools who want to practice in the U.S. must pass the U.S. Medical Licensing Exams, so it's not like it's a route through which dummies can become doctors.
For those who don't mind going further afield, Soochow University in China has an affordable English-language MD program. I'm sure there are many others.
Space game using normal deck of cards: http://BattleCards.org
No, in fact, it's not.
The bottom 50% of the population accounts for something in the order 3% of the health costs, while the top 5% account for about 49% (US government data). The bulk of people who are partaking of this "buffet" don't really cost a lot to cover; the seriously sick few are vastly more expensive. Imposing the high-deductible nonsense has the most effect on that 50% of the population who uses 3% of the healthcare. Yeah, that's gonna help a lot.
The other thing you are missing (and other people who make your argument) is that the incidence and cost of expensive health episodes is reduced by preventive care. Allowing people to go to the doctor today for cheap means that more potentially serious health conditions are detected early and managed for less cost. This is why detractors' typical analogies to car insurance are misguided: a car insurer that paid for your gas would be making it more likely that you'd have an accident (by incentivizing you to drive more). A health insurer that pays for your routine visits is making it less likely that you'll have a major health episode.
Are you adequate?
Another solution that seems to be coming due to need is the use of Physician Assistants in place of doctors. PA's have to be overseen by doctors but you can arguably have good health care for many people by combining many PA's under one doctor to see numerous patients. In many rural areas, this is becoming the norm and is good financially when dealing with everyday ailments.
Software and hardware engineers don't go around making excuses for the high cost of computers. They just lower them. The cost of computers has been reduced from $600,000 to $600 and the speed has been increased by 16 Million Times since 1950. On top of that, that's funny money. If you look at it in terms of real money, the cost of a computer has dropped from 20,000 ounces of gold to about 0.5 ounces.
When technology gets better, the cost of services should come down. The problem with health care is that the government has so much involvement with it. Instead of health care prices dropping, like they should be, for standard procedures they are rising. If you look at plastic surgery and lasik, two non government subsidized procedures, you'll see that they've come down dramatically in price just in the last 10 years.
Get rid of the HMO, Medicare, Medicaid, government regulations on what insurance companies must sell, The Prescription Drug Program. the AMA, licensure laws which politicize who may or may not be a doctor and do little to ensure quality of care. These are all government imposed monopolies or oligopolies Get the government out of education so that it doesn't cost half a working career salary just to get a medical degree.
I'm not going to deny the need for a military force, but let's follow through with your thought. China wouldn't hesitate to do what? Let's go ahead and look at just what our fears are, then compare those things to the Constitutional rationale for the military.
Because if you're gonna say, "they wouldn't hesitate to invade Taiwan," then you're going to have to do a lot of research to determine when Taiwan became the 51st state or find a good reason why we should have a treaty with them such that Taiwanese interests are strong enough that American people should be willing to die.
If you're going to say, "they wouldn't hesitate to invade the west coast of America," then I'll agree we do need a military for that contingency, but that it's not going to cost a whole lot to keep a force around that is more than capable of handling that job.
I think a good defense budget would need to cover a preposterous Canada+Mexico axis alliance, and then maybe sanity-check it against France's budget.
"Believe me!" -- Donald Trump
12 To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
13 To provide and maintain a Navy;
A few lines later it has ...
16 To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;
Seems pretty clear that in addition to the milita there is to be an Army and a Navy. The states do get a say in the militia, but only according to the orders of Congress.
Only funding them every two years just means that they have to have a budget audit on a regular basis to see if more or less is needed, not that they only get funding for two years at a time then are dismissed.
"There is no industry in the world with 13,600 different service lines to deliver"
I don't just call BS. I propose that we consider IT as an example. How many 'different service lines' are there in just Windows server management? If by 'service lines' you mean 'functional tasks', well I still think 13,600 is an awful lot.
Consider Orthopedics. Is setting a left femur a seperate line of service from setting a right femur? How about setting an ulnar? Tibia? I suspect the number of 'service lines' in Orthopedics could be as many as a hundred, if you're creative.
As a general practitioner? Is the 'service line' of diagnosis of a common cold significantly different and worthy of differentiation from diagnosing, say, influenza? Bronchitis or pneumonia? Different findings, but very similar effort and knowledge. In fact, differential diagnosis relies on this step-by-step process, of which many steps are common.
The whole concept that medicine in the U.S. is more expensive than it need be because of the complexity of so many 'service lines' ignores the reality that, for the industrialized world, diagnoses are largely identical. Most of these nations find and treat the same illnesses, though perhaps in different proportions or severities.
All this time I thought American healthcare was expensive because we were obese, sedentary, and dependent on drugs. Now I find out we just know too much.
No, that's BS. We pay more for our healthcare first because it is unnecessarily complex - doctors perform tests intended to protect them from lawsuits far too often. And patients demand treatments and medications that are either marginally effective or just more expensive than necessary.
I lowered my overall cholsterol level from 238 to 197 in a year by diet modification alone. I am 56, and take no prescribed drugs. Oh, wait, I'm using my asthma meds PRN to deal with an allergic reaction, first time in 3 years. I could be taking arthritis drugs, any of several meds for asthma prevention (I have attacks every few years), meds for sinusitis/allergic rhinitis, etc. I exercise, so my blood pressure is not an issue, and I haven't have the expensive cardiac work done to see if my heart has anything previously undetected going wrong. And I could still keel over from a heart attack despite all the diangostics available. You cannot tell everything after all.
Admittedly, my wife has not been so fortunate. Four years ago, total knee replacement. Who knew a new knee joint costs $20,000? How much of that for insurance for the manufacturer? How much for R&D? How much R&D to avoid lawsuits? Three years ago, microfracture surgery on the other knee (auto accident 25 yrs ago made both pretty mangled) which has been completely successful. Less expensive than a replacement. Last year, removed a cancerous kidney. Not cheap. Found that 'accidentally' when diagnosing what was thought to be a gall bladder problem, pain in the abdmominal area usually associated with gallstones. Lucky. Expensive. Follow-up has been almost 50% of the cost of the surgery, but we're fairly confident there is no other cancer. So my wife has cost $86,000 is healthcare the past four years. I look this up. That's more than I've cost my entire life. I've spend 9 days in the hospital my entire life outside of the nursery after birth, and most of that was simple overnight+ for a viral thing and two surgeries - appendectomy in 1959 and cyst removal in 1966. I'm relatively cheap, including the fractured fibula in 1979.
I'm a little disappointed at the costs associated with ER visits, but here in AZ we have so many people without insurance and private physicians can't get reimbursed for charity care like hospitals do (yes, they do), so people are driven to the ER. It could be more cost-effective for the indigent and uninsured to get subsidies and stay out of the ER.
Let's not get into the illegal aliens that crowd the ER. They need care, and we must care for them. Then we need to send them w
deleting the extra space after periods so i can stay relevant, yeah.
You limited it to Afghanistan, not me and not anyone else in the thread - and you were wrong to do so since the topic is about war spending, not Afghanistan singularly. Nuclear submarines can most certainly be offensive and part of a war spending budget, especially when they are used in the support of an invasion.
Also, nice to see you were very quick to jump to the insults, quite immature.
Those countries implement cost controls of the entire health-care and educational industries that simply are not going to happen in the USA. If we could reduce salaries of professionals by 3/4 or even 99/100 we would get the same results (even better since doing less means less waste and error!), but good luck taking all that cash away without having your hand bitten off.
And those people end up paying more in the long run? I don't have a problem with that. Unless of course you ask me to foot the bill for their lack of maintenance.
...which is the point. Providing a reasonable standard of health care to all individuals in a society provides huge benefits to the functioning, productivity, and quality of life of the society as a whole, and as a society we're going to face significant costs for 'lack of maintenance' or 'bad luck' or any other given issue that leads to serious health difficulties for an individual who lacks the means to pay. The assumption that we can reduce the costs to society as a whole by letting individuals get substandard care is false even from a purely economic perspective, backed up by a great deal of epidemiological and social science research.
So, ideally, we need a rational healthcare system which decouples healthcare decisions from monetary incentives and relies on healthcare providers to make reasonable decisions about treatment that maximize the overall benefit to society.
This was effectively SOP for the health care industry in the USA until relatively recently. I have half a dozen MDs in my family near/past retirement age, and they have stated that the expectation in the field of medicine was that between 10% and 30% of patients would simply be unable to pay for treatment, and that providing a reasonable standard of treatment for them regardless was simply the cost of doing business.
Coming out of medical school today with hundreds of thousands of dollars in debt and with the range/cost of treatments skyrocketing, medical students today don't have this option. This has also contributed to a legion of other perverse economic incentives, such as clinics which make money from the tests they recommend, and the transitive nature of health care coverage has given insurance companies solid financial reasons to deny coverage to the greatest degree possible, so the greatest amount of the cost is distributed elsewhere. The prime motivator for the increase in health care costs isn't the cost of the treatments available, it's coupling treatment decisions with monetary incentives that are inherent in the structure of our current system.
Health care can best be envisioned as a public utility. It's in our own interest to structure it in a way that provides the best quality of care available at a price we can pay.
So, SOMEONE has to determine which treatments are actually beneficial and cost-effective for patients. The best group to do this is medical professionals who get a steady paycheck and are judged on the quality of the health outcomes of their patients.
This means SOMEONE has to provide the steady paycheck, as well as provide metrics on the quality of work done, enforce professional standards, and generally keep a lid on things. Any structure capable of doing that society-wide is going to end up being functionally equivalent to a government. Attempting to do it on a smaller scale leads to massive structural inefficiencies as other health-care entities that are running for profit do their best to chuck 'unprofitable' patients/treatments out of their coverage areas and 'cherry-pick' profitable individuals.
Any plan that significantly disagrees with these core ideas is likely to be based on political posturing or willful ignorance... which is precisely the problem we're running into.
"We have to go forth and crush every world view that doesn't believe in tolerance and free speech." - David Brin
So, if a person is involved in an accident and needs $100,000 of critical care or they'll die, however with the care they are likely to nearly fully recover and live a high quality life for many decades, we spend the money. It is worth it.
Suppose the person is a criminal. Their mere existance is a loss to society. (they sell cocaine, or they are a mafia enforcer, or they rob people at gunpoint, or they rape little boys...)
Suppose the person is very useful. They are expected to provide millions of dollars of value to society. We could spend much more to ensure they get a better outcome. The bare minimum $100,000 isn't appropriate; we could spend $millions on the valuable person.
Well, I am back, had to go pick up some silverware we bought at an auction.
Your entire point is orthogonal to mine. I am talking how government intervention into private health insurance and creation of CHIP during Nixon administration pushed the prices up. You are talking about countries where it is ILLEGAL to run private medical centers in the first place.
In US there is a combination of private hospitals, private pharma corporations, private clinics and at the same time government provides guarantees to cover the costs of certain layers of population. This drives the costs up because they can be set at any arbitrary level and the government still pays.
You are talking about Canada or France, where there is basically no private health insurance and no private medical centers, it is all heavily regulated. This circus will last longer than what US had since Nixon, as long as the economy allows it, but the quality of these services correspond to their perceived costs. I am a Canadian who uses medical treatment in Buffalo, New York and in Germany at this point, so I can compare.
So if the US decided to completely control prices on medical procedures while providing public health insurance, then you could have a system that resembled that of Canada or France or partly of Germany (in Germany private and public coexist, depends on the income level.)
However, my point is as always that anything government gets into that relates to economics, to equalizing outcomes for people, the government will turn into giant pyramid schemes, which will eventually collapse. On the other hand, if the government seriously controls the prices, like what is happening in France, Germany, Canada, then there will be shortages of qualified medical professionals created over time, as they will move to places where there are no price controls. This does not happen overnight of-course, I expect this to be a long term thing, however it is readily obvious in Canada, where there are serious shortages of qualified doctors, who simply move to US to run their businesses.
In either case, those governments that create monopolies, eventually destroy the small/medium sized businesses, and then when monopolies move out of the countries for production, the trade imbalances increase, the governments of these countries end up borrowing more than they can afford to pay back, while printing currency into inflation and probably eventually into hyper inflation. I am only interested in long term prospects for such economies, as they look bleak, while providing clear direction of where the money can be made and how to make them best.
You can't handle the truth.
Canadian citizen here: Part of the speed of Canada's recovery comes from the fact it wasn't caught up in the banking/mortgage problems that affected many countries. That's because our banks are much more heavily regulated. Don't know enough about health care to comment.
The answer is obvious. France, Canada, Germany have not only provided publicly funded health insurance, they are also heavily regulating prices on medical procedures and probably on drugs, on hospital stays, etc. The kinds of procedures that can be done are also heavily regulated, probably to the detriment of certain people, but this is not important to my general point.
I see that people have neglected to note, that US had a very competitive health insurance system before Nixon appeared and killed off the competition by getting the government into the insurance game, which allowed the practitioners to raise the prices much above the levels that markets could or would bear otherwise. Based on the moderation done to this thread, I see that most people here do not understand that point.
It was possible for a family of 4 to pay 25 dollars a year for insurance, that covered all their costs for any single event with a 500 dollar deductible, and at the time 50,000 dollars was more than enough to cover almost 3 near or completely lethal problems in a year, the most expensive treatments did not go above 20,000 dollars.
The countries that run very socialized health insurance and also enforce price controls, like Canada, France, UK, will have a more stable health insurance/treatment systems until their general economy becomes too battered, at which point they will have to remove various procedures, they will have to try and reduce prices through reducing salaries. This is going to happen soon, as these countries have ran into debts that they cannot repay and their banks have given out loans to governments and companies, who cannot repay these money. These will lead either to defaults of governments/companies (not perfect, but better than the alternative), or it will lead to increased levels of inflation (more likely scenario), because governments try to solve their problems in about the same ways: print/borrow/give out tons of cash.
In a short term (a few decades), socialized systems would work, in the long term, these systems would kill their small/medium sized businesses, would create monopolies that would eventually move production into cheaper production areas and then they would suffer trade imbalances that would cause economic destruction to levels, at which entitlements can no longer be provided. Honest governments do not exist, so they will all print more and more money, which is why commodity prices are going up and will continue to do so, until the debasement of currencies will stop due to their complete destruction or some other terrible event, like taking over governments by dictators and/or military personnel/wars. Eventually the economies will rebalance, people will again forget or just not understand what happened and the whole thing will start again.
There is no such thing as free lunch. Nobody wants to work for free. There are prices markets can bear, then there are prices that are set due to government intervention, that markets cannot bear and then economy starts moving production into places, where prices are more in tune with the market requirements. This eventually causes economic implosion for those, who are left without production capacity but with excess of printed money. The economic powers then shift and change places for long time until the story repeats.
You can't handle the truth.
Get government out of economy, take government's ability to screw with market prices out of the equation
Take a step back and listen to your world view and the private insurers' argument for a second.
1. The government is horribly inefficient, and always will be.
2. The private sector is intrinsically efficient due to profit motive and competition.
3. Private insurance can't compete against the government.
Private insurance can't compete on cost and service against the organization that's bloated and can't find it's own ass with both hands and an electronic ass finding machine? If that's the case, how the fuck can private insurance even exist?
AFAIC all government behavior that touches economy leads to pyramid scheme being created.
Luckily for the rest of us, that's simply not true.
Women don't need them unless they fuck guys with warts.
Suggestion: don't fuck guys with warts
However, my point is as always that anything government gets into that relates to economics, to equalizing outcomes for people, the government will turn into giant pyramid schemes, which will eventually collapse.
I didn't realize that the CDOs and Enron were government schemes. The fact of the matter is that throughout history you can trace every economic collapse to one thing, lack of regulation. Oh sure, it sounds nice, but it doesn't work in practice. Just like command economies, anarchy, and laissez-faire economics. You like to do these simplistic one variable thought experiment because when presented with actual economic data, the argument falls apart. The world simply doesn't work they you think it does.
1. The government is horribly inefficient, and always will be.
- correct.
2. The private sector is intrinsically efficient due to profit motive and competition.
- only if there are no external forces, like government messing with the outcomes.
3. Private insurance can't compete against the government.
- I never said that.
----
Private insurance can't compete on cost and service against the organization that's bloated and can't find it's own ass with both hands and an electronic ass finding machine? If that's the case, how the fuck can private insurance even exist?
- I never said that.
I don't understand who you are replying to, must be some other commentator.
I said exactly the opposite: the private insurance could provide health insurance for 25 dollars a year to a family of 4 people, they would cover up to 50,000 dollars in claims in a year while only requiring $500 deductible.
This means that the insurance still found it profitable to do business in those conditions. People had to pay out of pocket for the first $500 worth of treatment, and before Nixon and before government got into health insurance, the prices for medical treatment that was not critical never exceeded 500. A stay in hospital could cost up to 110 dollars per day.
So you are putting weird words in my mouth that I never said. In fact, once government got into the insurance business, the medical professionals as well as drug manufacturers started raising prices to levels that are much higher than what the markets could really bear and they could do so knowing that government would foot the bill. Government created moral hazard of health insurance, of government funded medical procedures, of government paid medications.
--
It is true, that everything that relates to money and that government touches becomes a pyramid, whether you see it or acknowledge it or not is irrelevant. Social security became a pyramid, CHIP and medicare and veteran care etc. made the entire medical insurance/treatment fields into pyramids, the fiat money itself is a pyramid scheme, which is apparent and obvious to people who understand what inflation is, how government prints money and borrows money that it never intends to pay back.
I don't need you to acknowledge anything in my post, I don't need 'karma' provided by the moderators, I have gotten plenty over the last 10 years on /. I just want to leave these posts here for a record of different opinions, based on the comments, on replies, on moderation, it is all very telling.
You can't handle the truth.
You'd be subjecting productive people to the standard of care that we can afford to give everybody, but the productive people deserve better.
Productive: that guy running SpaceX
Unproductive: car thief
while Enron was a scandal, it was nothing special, a company failed because it was fraudulent in its accounting practices, I don't see a problem with this, do you? Companies that do that should fail. Governments on the other hand, decided that they will from now on bail out failing companies, even if the failures are due to fraud - that is a problem.
However you are also missing the fact that Enron had a government granted monopoly on providing power in their geographic areas.
Government set various price controls, trying to remove price fluctuations, which are an important free market tool.
Government prevented construction of new power generating plants.
Then at some point, government lifted price restriction in 2 geographic areas, why? This is an interesting question in itself, but this is just the fact that matters here. So in 2 areas prices are not set, while they are everywhere else - an imbalance is created, prices skyrocket and what is also interesting, is that Californian government enters long term contracts on energy at those very high prices. The entire thing stinks of government collusion and corruption.
So while YOU do not realize that Enron was a government caused problem, some other people in fact do realize it.
When you talk about CDOs, I assume you are talking about the collapse of the housing bubble, do I understand you correctly that you do not realize that this is an entirely government caused issue?
Really, you don't realize it? Then why are you replying to me?
You have government running insurance schemes through Fannie Mae and Freddie Mac, you have government creating incentives for consumers to live on debt, you have government doling out free money to banks, you have government destroying small business while creating gigantic monopolies who move production out of the country because their size makes it profitable, you have artificially set insurance rates by the Fed and you don't realize what this bubble was caused by, just like the dot-com bubble before it? Just like the t-bills and bonds bubble that is going to burst soon and take down the US dollar with it?
Sorry dude, I can't help you.
You can't handle the truth.
There is no recovery, I am the original poster, I am also a Canadian citizen but I haven't lived in Canada for the past 7 months or so.
What you think is a recovery is just a delay. Canada does regulate the banks much closer than many other countries, including the US, so Canadian banks mostly didn't get into the SIVs that were based on bad loans. However Canada loans money to other nations and some of those are going to default, Canada also is losing its manufacturing, while of-course becoming more dependent on selling raw materials mostly to US. When US dollar goes down, once the t-bills/bonds bubble bursts and US prints USD into hyper-inflation, Canada will suffer plenty and will continue to suffer until it finds new consumers for Canadian raw resources, this is probably going to be China, but I expect that before this US administration is done with their first term we will see a massive economic collapse, even worse than the one that burst the housing bubble and something that will probably destroy the value of USD and will severely undermine Canadian economy at least for a while.
Being with these very close ties to US is both a blessing and a curse.
You can't handle the truth.
Having people choose insurance unrelated to their employer obviously solves that issue, as would paying out of pocket.
Either way though, without or without the stupid employer-provided plans, people are encouraged to work harder. When personal desires like healthcare are provided for free, people give in to their lazyness more.
Did you even bother to read the text you quoted? How about we provide the "unproductive" people with crappy third-rate care?
I don't see how to do that, with or without ignoring the political impossibility.
We license doctors. This means yes/no. It's a boolean value. All doctors within a specialty are considered equal to each other. They are interchangable.
We don't assign ratings. I can't imagine actually having some system where your healthcare plan specifies a maximum doctor rating for you to use. There would be outrage.
You talk about what "would" happen with socialized systems and the problems that "would" occur, almost as if the idea of public healthcare were some sort of daydream. But the results that I and other commenters mentioned above aren't the result of a few years of misguided experimentation. The NHS, for example, is about as old as the US employer-dominated health insurance system, so a claim that the lead that socialized systems currently enjoy is just because they are immature and will run into problems in the future needs a lot more to back it up than you have provided.
You also ignore the fact that free-market health care is not, itself, immune from the economic problems that you claim will make socialized healthcare unworkable. As you point out "there is not such thing as [a] free lunch" - but this applies to private enterprise as much as to government-run schemes. In times of economic difficulty individuals, as well as countries, have to cut back on their spending - and this can be much more dramatic since they do not have the creditworthiness that allows governments to use borrowing to mitigate the shock of the transition. I think it's telling that in the current economic crisis the NHS is having its funding cut by about 5%. This will certainly have some negative consequences, but healthcare will still be available to everyone who needs it. Meanwhile, over in the USA, where the system is much closer to your capitalist ideal, half of the population is either uninsured or underinsured, and the credit crisis has meant that with insurance have reduced their uptake of nonacute or preventative care by up to 29% (source). So it would appear that even in times of economic difficulty socialized health care is able to weather the storm better, and the individual approach lags even further behind.
In US there is no more capitalism in the health care system than there is in France. France decided to set prices and to provide public health insurance while US decided to allow government to enter the health insurance business (bad) while not controlling the prices.
Right now the US is as far away from my idea of a working Free Market as France.
You can't handle the truth.
Yeah, it doesn't make sense to think of "health care" as limited only to things which the patient had no control over. The first obvious problem (which you bring up) is, how much control do you need to have? Obviously a whole lot of health problems can theoretically be prevented by some kind of behavior, but where do you draw the line? If I smoke my whole life and get lung cancer at 80 years old, is it my own fault? What if I just smoked for a few years? What if I smoked a single cigarette once? What if I worked in a coal mine? What if I lived in a city with bad air pollution? At what point does it cease to be "my own fault"?
But aside from that, there's another problem: There's a reason why we provide health care to people who can't afford it. I don't just mean, "because we're nice" or "because they deserve care". There's a real, practical, economic reason to provide health care to people. A healthy worker adds productivity to our economy, whereas an unhealthy worker (who can't work) is a drain on our economy. Even if we don't provide health care to that unhealthy worker, he won't be adding to the GDP, and his friends and family will spend their money to help him get medical treatment. Even if we let people die in the streets, it will cost us some amount of money to dispose of the body and deal with the diseases that sick people spread.
This is what people really need to understand: If you have an efficient and well designed healthcare system, it is entirely possible to spend $X on public health care and see it result in $Y in increased production, resulting in $Z of increased tax revenue, such that $Z > $X.
Healthcare isn't necessarily charity or rewarding irresponsible people. It could be a simple win-win situation.
Regarding the parent post moderation: Just because you don't like a point of view, it does not make that point of view a Flamebait, simply because you can't hold you flames to yourself :)
You can't handle the truth.
Maybe it's just me, but perhaps if doctors began acting professionally, there might be some kind of improvement.
Where I work, there's frequent interaction with doctors. I'm tired of watching my co-workers get torn new assholes by doctors every other day. It's gotten to the point where I'm not sure I can trust any doctor here in down anymore given the threats they've dished out. There was even a case where they flat-out violated HIPAA to get a co-worker fired.
There's a good lesson to learn from doctors. Don't talk to your doctor when contracts are up for negotiation or you'll get fired!
It's not right. It's simply not right to say that doctors are the problem, but we need medical professionals, not abusive prima donnas who lose their shit every five minutes. Why do mistakes happen? Because no one wants to get their head torn off and possibly fired for telling a doctor he's wrong.
At least there's a telephone wire between us and the doctors. What about the nurses who have to be hospitalized after being violently assaulted by doctors? Excuse me, but I think if I were to go crazy and start beating one of my co-workers, I'd be in jail. Apparently if you're a doctor, it's your right to free speech.
I'm not making any of this up, which is why I'm not posting as anonymous. Someone needs to say something. Thank you.
Join the Slashcott! Stay away entirely Feb 10 thru Feb 17! Close all tabs to prevent autorefresh!
"Just put some 'tussin on it!" - Chris Rock
Harrison's Postulate - "For every action there is an equal and opposite criticism"
France, Canada, Germany have not only provided publicly funded health insurance, they are also heavily regulating prices on medical procedures and probably on drugs, on hospital stays, etc. The kinds of procedures that can be done are also heavily regulated, probably to the detriment of certain people, but this is not important to my general point.
So, the government, which is paying for services, has also said how much it's willing to pay for those services. That sounds awfully market-like to me, what with the customer stating explicitly the value of demand.
Individual healthcare is an implicitly unfair market, because there is no price that I would not pay to live one day longer. The provider can ask any price at all and he will find consumers. Nor will a healthcare provider increase demand by lowering prices. Regardless of how inexpensive chemotherapy is, I will not buy it if I don't have cancer. A true market for medical services can exist only at the public level where the demand for particular treatments becomes predictable.
Here are some related ideas. Herbert Shelton advocated whole foods, fasting, and sunbathing, and was attacked by the medical community for it almost a century ago. His bio:
http://www.soilandhealth.org/02/0201hyglibcat/020127shelton.III/020127.toc.htm
And writings:
http://www.soilandhealth.org/02/0201hyglibcat/020127shelton.III/020127.toc.htm
More recent advocates of similar things:
Whole foods (and some fasting):
http://www.drfuhrman.com/
Whole foods (but maybe too whole grain heavy):
http://www.drweil.com/
Sunlight (as in curing vitamin D3 deficiency):
http://www.vitamindcouncil.org/treatment.shtml
An approach towards promoting moderate exercise and good eating by promoting physical infrastructure in our communities:
http://www.bluezones.com/makeover-about
Psychological health, to combat depression and promote healthy transformation:
http://books.google.com/books?id=bCuC2H-6k_8C
http://books.google.com/books?id=RKZreNYKNHQC
Economic health:
http://en.wikipedia.org/wiki/Jobless_recovery#Four_long-term_heterodox_alternatives
The big problem is simply that real cures (or preventatives) are inexpensive (sunlight, fasting, whole foods) for most expensive diseases of industrialized countries like cancer, hearth disease, and diabetes. The big profits are just in life long treatments, so no one pushes everyone to eat right, exercise, build community infrastructure, etc. And the medical insurance system is not set up to pay for people to live in healthy places, eat well (perhaps with a personal chef buying organic foods), have a better economic system with less stress for most people, etc.
Related recent discussion I was involved in on Slashdot:
http://slashdot.org/comments.pl?sid=1691318&cid=32642764
There are solutions. The biggest problem is, as you imply, social, not technical.
With that said, modern medicine and better sanitation and infrastructure as we now enjoy can treat or prevent a lot of things that were big issues in the past (accidents, infectious diseases). So, there have been improvements. But going forward, we really need to go back to the basics again.
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
"This leads to people avoiding preventive care, which drives up costs in the long run."
No, you are wrong. As it turns out, preventative care - on average - does not lower cost. So says the NEJM "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."
http://content.nejm.org/cgi/content/full/358/7/661
46 & 2
Your entire point is orthogonal to mine.
No. His argument (and evidence to support it) directly contradicts your argument.
I am talking how government intervention into private health insurance and creation of CHIP during Nixon administration pushed the prices up.
No, you said "Any time a government is involved in giving out money, the costs for any services/products go up". antifoidulus proved that this is utterly incorrect.
You are talking about countries where it is ILLEGAL to run private medical centers in the first place.
Wrong, wrong, wrong. In Canada, I visit a private medical practice. Everybody else does too. The doctors are private corporations, just like in the US. The doctors here bill the government for services rendered, and yet health care costs are 1/2 of those in the US, where doctors bill either the patient or a private insurance company.
Please just admit you're wrong, rather than blather on demonstrating how little you know about other places.
Most of all is people who don't oversimplify things by anthromorphicizing everything. The health care system isn't a person, it doesn't want or need anything. The people who make it up, on the other hand, are a very diverse group who have diverse and often conflicting needs and desires. If I'm a patient, cheaper healthcare is probably much more important to me than if I'm a doctor. We need to start taking into account the reality that there's no reform that isn't going to make some better off and others worse off.
You don't understand. These countries (I live in the Netherlands, which has the same sort of system) have some history in getting their health care right. Negotiating how much various procedures should cost, how much the patient should pay, this is just business as usual: it happens every year.
Inflation as the only tool for a government to regulate it's health care costs feels a bit simplistic. In fact, it's a ridiculous idea, given the abundance of other options our government seems to have. I can only think that your misguided view is the result of coming from the hard & cold background of a runaway-free-market health care system, where there is actually NO options to get things right (it's a free market, right?) -- so the only thing you can think of is even worse than that.
Also, you forgot an important aspect. In our system, there's more money available for prevention, simply because that will keep general health care costs lower. There's hardly a place where prevention will fit in a true market driven system. (Yeah, your insurance company could have prevention programs, but an insurance company without these expensive programs would be cheaper, right? Exit prevention.)
my other sig is a 500 page novel
I am a Canadian citizen, lived there for 15 years, for the past 7-8 months I live in Germany. While in Canada I used to go to Buffalo Medical Group in NY state to see professional doctors that would otherwise take me months and months to wait for in Canada, Ontario, Toronto. In Germany I find the prices to be much lower than in US though and quality much higher than that of Canada.
I said this:
"Any time a government is involved in giving out money, the costs for any services/products go up".
and it is true. In Canada, France, Germany and some other places though the prices are set by government so that IS what I mean when I say that the medical system is ran by government, not only the insurance.
So if the prices are set at some level and are not allowed to go up, then of-course, it is not going to be the price that goes up, the quality of service will suffer for a different reason. In case of Canada that reason is that Canada cannot compete on doctors' salaries, so in Canada there is a doctor shortage, they study and move to US.
There is always a trade-off. The government can provide 'free money' and create moral hazard and cause the prices to skyrocket, but it can also try and control the prices, in which case the country will have shortages. In Canada the shortages of doctors are directly linked to the government setting prices.
I am not incorrect in my statement, but I am not specifying the other part of it - whether government installs price controls.
The ONLY reason for Canadian/German/French/UK prices to be at their current levels is of-course government setting them, which is another way to screw with the market and to cause different types of imbalances.
You can't handle the truth.
So, the government, which is paying for services, has also said how much it's willing to pay for those services. That sounds awfully market-like to me, what with the customer stating explicitly the value of demand.
- sure, until you realize that for example in Canada you cannot have an alternative, you cannot opt-out of paying taxes and use private insurance, so there is NO price that is set by real market. There is a mandate, and mandate has noting to do with market.
Mandate creates different types of imbalances, again in case of Canada this means shortage of doctors, many of who live and start businesses elsewhere, especially in US.
Individual healthcare is an implicitly unfair market, because there is no price that I would not pay to live one day longer. The provider can ask any price at all and he will find consumers. Nor will a healthcare provider increase demand by lowering prices. Regardless of how inexpensive chemotherapy is, I will not buy it if I don't have cancer. A true market for medical services can exist only at the public level where the demand for particular treatments becomes predictable.
- this is why you buy insurance, which is not for everyday activities but for critical events.
This is why in US it used to be possible to pay 25 dollars a year for a family of 4 to get 50,000 dollars worth of coverage in a year with a 500 dollar deductible. Most problems would cost much less than 500 dollars, a day in a hospital cost around 100 dollars. This was before Nixon decided that government now will start paying for various procedures to various layers of population all while NOT controlling what the prices are.
You can't handle the truth.
I was born in the USSR, lived in Ukraine after the country fell apart, spent a year in Israel, 15 years in Canada and am living in Germany since October of last year. I spent enough time in USSR, which had a 'free' system and in Canada, which has a socialized system. I went to Buffalo to actually see professional doctors because in Canada I would wait for months to see them due to doctor shortages, since only public insurance is allowed and prices for medical care are fixed, which creates shortage of doctors, given that USA is right across the border.
So that's my background, now to your comment.
Inflation as the only tool for a government to regulate it's health care costs feels a bit simplistic. In fact, it's a ridiculous idea, given the abundance of other options our government seems to have.
- please show me where I said anything about using inflation to control prices, this is something you misunderstood from somewhere.
Also, you forgot an important aspect. In our system, there's more money available for prevention, simply because that will keep general health care costs lower.
- just like in Canada, you keep the costs lower by fixing prices, maybe one thing that you have to your advantage, is that you are surrounded by similarly ran countries and US is not there to take your doctors, who I am sure would prefer to get better pay than what your fixed prices allow. So this is a system that colluded on prices across nations, that's an interesting experiment.
There's hardly a place where prevention will fit in a true market driven system. (Yeah, your insurance company could have prevention programs, but an insurance company without these expensive programs would be cheaper, right? Exit prevention.)
- in US it used to be possible to have very cheap insurance for a family, between 15-25 dollars a year depending on family size. The deductibles were around 500 dollars, this is related to the price you pay for insurance premiums and coverage was about 50,000 dollars, which again, before Nixon destroyed the Free Market health insurance system and caused prices to skyrocket was more than enough for any critical problem, in fact it was 2.5 times more than any most expensive run-away problem you could have at that time.
I expect European countries to show about the same level of economic problems as US will show because the governments like in US and Europe have created an environment, that prefers and creates monopolies, who now are shifting all production capacity to much cheaper places, like China etc. This will cause imbalances in trade to increase, this will cause the debt of these countries to grow, who will increasingly borrow money they cannot repay due to the worsening trade imbalances. This will cause collapse of USD and probably of Euro eventually. This sort of socialism will fail eventually in the market that provides cheaper abundant work force, just like the fake capitalism of US will fail, because it is not based on Free Market principles.
You can't handle the truth.
In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty.
You're referring to the big medical education reforms that occurred in the early part of the 20th century. Most of those pre-reform "medical schools" did little more than help their students cram for state medical exams. What put them out of business was not some arbitrary AMA quota, but the fact that getting actual clinical experience became a mandatory part of medical education.
In any case, the "shortage" your conspiracy theory posits (sounds like something Glen Beck would talk about) would have been well in place by 1950. And in 1950, medical care was still relatively cheap. It's only since then that prices have gone through the roof.
Finally, you're assuming that greedy doctors account for most of medical costs. Wrong. It's mostly drug costs, device costs, hospital costs (and I think you'll find that few hospital employees make a lot of money), etc.
I can't get insurance, and I need a hearing aid. I needed to get examined by an MD, who also dealt with the wax buildup in my ears. Cost: $200. Next I have to see an audiologist and get a hearing test, which will cost another $100-200. Finally the hearing aid itself will cost at least $1500. Sorry, no greed here, just an excess of expensive technology.
Don't allow the drug companies to own the FDA.
Break the drug companies hand-in-glove relationship with health insurance providers.
Fix the FDA so drug companies can only market actual cures, not yet more temporary symptom suppressants.
Review and fix all drug companies and health service providers pricing to be in line with all other countries.
You think US can afford any entitlement programs at all, or the wars it is running, or the bank bailouts, or anything at all at this moment, when its production capacity is shrinking and jobs are disappearing while the debt is growing and the government is printing the dollar into oblivion? What do I have to prove? Soon enough there will be no USD to speak of, how will anything be paid? I know, with printed paper. Good luck with that theory.
You can't handle the truth.
My ex-employer is self-insured (They use a billing specialist, medical uses get sent to the billing specialist, who gets paid a flat rate per employee plus actual billings, however I do not know what this rate is). I live in the southern US.
Your best method of reducing your health plan costs is to have an enormous install base (>100,000 employees) and get providers to kick in for health initiatives (fill out personal information such as work out history, get a $25 credit, join the company gym and attend a certain number of fitness classes, get the gym membership for free, sign a no smoking pledge, get a credit type deal). Unhealthy employees pay considerably more, however health care is an opt-in (all employees are eligible, but if you do not want the company plan you are not required to receive it...generally the only people who choose not to get it are those who have other plans through spouses).
"We can choose what companies we want to do business with."
you are a clueless naive moron. ever hear of a MONOPOLY you idiot? what is the only entity that keeps corporations from becoming monopolies?
i'll give you a hint retard: it starts with "g" and ends in "overnment"
seriously you free market fundamentalists are FUCKING MORONS. you would be hilarious if there weren't so many of you clueless assholes hellbent on destroying this great country with your STUPID INSANE NONSENSE
your ideology is a form of naive gullible wish fulfillment fantasy that is ignorant of history and common fucking sense. seriously
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The article you linked did not give the overall prognosis for someone diagnosed with cancer in various countries, but it listed that "the U.S., Japan, and France recorded the highest survival rates among 31 nations for four types of cancer." Therefore it comes closer to supporting my argument than it does yours. BTW it also shows one of the problems with comparing the U.S. as a whole to other nations. Individual states (which are more closely comparable to most other nations in terms of population) vary widely in health care delivery.
As others have pointed out, one of the reasons that the U.S. ranks so low in infant mortality rates is the way that the U.S. counts such deaths. Another factor is the much greater ethnic and cultural diversity in the U.S. versus other nations.
The truth is that all men having power ought to be mistrusted. James Madison
"I don't deserve medical cover if something happens, but you do?"
Did I say that? No. Explain how I'm responsible to pay for someone who consciously decides to go do something dangerous. I don't care if they do something stupid, but when I have to pay the price for people who behave in in that manner --- the people who decide they're going to live dangerously at my expense --- that's when I have a problem with the system.
Also, "medical cover" is not what we're talking about. "Health Care" does NOT mean "Medical Cover" as you (and much of the political propaganda) suggest. A broken bone is not detrimental to someone's health.
"Should they too be denied care?"
Again, no, that's not what I said. But I should be allowed to not have to pay for it. It's because of these people why "health care" is so expensive. From what I understand, you don't understand my argument. I'd suggest researching what "health care" means, instead of going by what you hear from the political propaganda.
I do not know much about Japan's or Australia's banks, but Canada has very well regulated banks, and that is the primary reason why they never really 'crashed' like other countries did. Canada's banks are essentially regulated like the USA's used to be, before Reagan and subsequent presidents stripped regulation away and stopped aggressively enforcing the remaining regulation.
What happened here guys? Prior to the health care reform bill passing, I could have sworn that slashdot was the favorite forum for Fox News consumers. Todays thread actually seems moderated in favor of public health care! (Which I support).
I suppose since Fox stopped talking about health care 24/7 that the sheep have lost interest in the subject?
I live in a country where we have a publicly funded health care system. There are no death panels. When I get asked about pre-existing health problems it's for a doctor to better treat me. Not to deny treatment or insurance payout.
When I get asked about race, nationality, it's to better cater to your cultural needs. You won't be tested for your wealth.
Treatment here is based on need and need alone. Not on ability to pay / socio-economic caste.
Of course there are limited resources and distribution issue, and somehow inequality still emerges (Inevitably, a capatilist demorcracy does not suffer the under class it creates) and you will go on a waiting list if you have non-urgent surgery. But thankfully this is assesed on medical need first and foremost, not on whether you're worthwhile saving.
The providers of medical care in America are blessed with an oversupply of diagonese and treatments compared to 1910 when doctors could do little but give you snake oil and suggest bed rest. Of course, to make more and more money they have invent new ways to provide more service and treat more agressively. In litigious America better for Doctors to over diagonose and over prescribe, with to a false dubios positive being better than a lawsuit spawning false negative.
In turn the insurance companies need to make more and more profit, charging it's customer base more and paying out less. A route to record profit is denying treatment at every excuse.
Who gets the squeeze here? It's the very people who the healthcare system was intended to treat.
I recall reading that the actual all up cost of hospital bed for a night in the US is as much as six times that of other countries.
When you shine a light on America's health system from the point of view of any other developed nations health system it looks very very bad.
But here's the death blow to private health care model: We still have private health care insurance and private practices and private hospitals in my country.
Yep it co-exists nicely with a publicly funded baseline system.
The old quote is that with tax you buy civilisation. I've often said tax is kind of enforced insurance on civilisation. It spreads the cost of maintaining civilisation accross the population, like an insurance policy spreads bankrupting life saving surgery of one individual accross all policy holders.
The only way to fix healthcare in America is a gradually introduced public healthcare system at least for urgent & emergency care, with elective and first instance care through insurance and private practice.
After logging in slashdot still does not take you back to the page you were on. It's been that way for 20 years.
You obviously have done about 0 research on this topic, in places like Japan and the UK, both of whom have government health insurance programs, have thriving private health insurance systems and even private hospitals as well, it's not illegal to operate these as you claim. Meanwhile healthcare in both of these countries is a hell of a lot cheaper than in the US. There are also no insurance execs with armadas of yachts and private jets, maybe there is a connection between those two facts.
While you ate correct in saying that when government gets involved in competitive industries the result is usually bad but the problem is that the health insurance execs in the us have colluded to make health insurance insanely uncompetitive They dint actually even have to render the service you paid them for. If some exec decides he wants a new yacht more than he wants to actually provide health care then he can just order more claims to be rejected. No other industry is allowed to do that. How long do you think an airline would stay in business if, after you had bought your ticket they told you that you didn't make a compelling enough case for why you need to fly today so they are not letting you on the plane and not giving you a refund or any other remuneration? And yet this is essentially what health insurance companies do on a daily basis and get away with it. Furthermore in pretty much every other industry changing providers is quite easy, didn't like the meal you had at the restaurant? Don't go there again. However changing health insurance providers is next to impossible(and the execs know that). Doubly so if you have a "pre existing" condition. Contrast this with places where there is a government option, if health insurance cos tried to pull the kind of stunts they do in the us they would be out of business in a flash because their customers actually have a choice.
again you have failed to offer any sound empirical evidence that government run health insurance is more expensive or less effective than private insurance.
Monstar L
Sure the OB will tell you what they charge, and maybe some of the other docs involved. The hospital has no interest in doing so. The best I could do last time my wife and I had a baby (less then 2 years ago) was people with insurance usually pay in this range.
I asked the genuine midwives (non-hospital) and got answers. Last I checked, it was about $2500 to $3500 for the very best. That gets you a midwife with 20 to 25 years of experience, an assistant/substitute midwife with about 7 years of experience, and a helper to fetch things and clean messes. Such a team is capable of handling twins and breach births. Cheaper alternatives are probably available.
That covers everything: prenatal visits (you at their place), practice visit (so they can find your home), false alarms, a birth that could be lengthy, baby registration, and a couple post-birth visits.
Best of all, you're not treated like an item on an assembly line. You get to be informed and you have no trouble being in control. Nobody has a financial incentive to perform extra procedures that could hurt the baby or the mother. Nobody is eager and willing to force the birth (induction/episiotomy/caesarean) in order to get home early. Nobody will use scare tactics to control you. The germs are the ones your body faces everyday at home and would be bringing to a hospital if you went; there won't be any extra-special exotic germs that your immune system hasn't seen before. There aren't any cables or tubes attached to discourage you from moving about while increasing the risk of infection. Things don't go BEEP all night long, unless your home is normally like that. You get the food you like, unlimited visitors, your own comfy bed, and control over the thermostat. You can turn off the lights. You can birth in the best position (usually squatting or crawling) rather than the position that fits standard hospital equipment and doctor expediance.
I already replied explaining that if a government sets prices and not the medical establishment itself, then there is no difference, it is still not a private business.
Government sets the prices on medical procedures in UK, Canada, Japan, France etc., so your first comment about 0 research is stupid. I lived in USSR, then Israel, then in Canada for 15 years, used the US medical system by paying out of pocket while living in Canada due to doctor shortage and having to wait for months to see a specialist, currently in Germany, where I have good relationships with a few doctors who work here, in France and UK. Never been to Japan, but I know they also control the prices there. Once the government sets the prices it does not really matter whether the establishment is officially private or public.
So this explains while care is 'cheaper' in these places, simply because it cannot be more expensive by law. In US the government got into insurance but the prices are not controlled by the government, thus this this market imbalance allows the prices to skyrocket, and they do that since the government made it clear, it will foot the bill.
However before the government did this, the health insurance in US was actually cheaper, more effective than in UK, Japan, Canada or France... It was possible for an insurance company to provide insurance to a family of 4 for $25 a year, covering up to $50,000 with a $500 deductible and this was enough to cover 2.5 times the maximum possible cost of the most expensive treatment for cancer, that could run up to an incredible $20,000. The government meddled with this by Nixon doing what he did and prices skyrocketed.
This is empirical evidence here, it's real.
You can't handle the truth.
I think broken bones are pretty detrimental to peoples health. If I remember correctly they can leak bone marrow or blood which is pretty bad for you. Also the ends tend to be sharp. Not to mention it's quite painful. Pain has a pretty significant effect on people's ability to carry out their lives
I stand by my original assertion, what you said is that someone who has made a conscious decision to perform an action does not deserve health care/medical cover or whatever you want to call it. My question (which you have not tackled) is what you define as a conscious decision. As I said originally, is eating badly enough to mean you don't get cover. So where do you draw the line?
Oh and a final comment: The political propaganda is of little interest to me, because I am one of those citizens of a first world country that has free and universal health care. And despite covering people who make 'conscious' decisions to partake in dangerous activities, the drug users, the unemployed and all the other people that you obviously don't want using your money costs less than half what your health care costs. You could even spend a bit more and get private insurance and guarantee you see every doctor and specialist you want in next to no time. But it's ok, you keep blaming skydivers for your ludicrous healthcare costs.
The classic slashdot assumption that everyone is in the US. If they hadn't had the treatment because it was something they couldn't afford, I wouldn't be calling them idiots, I'd be calling the people who support such a system idiots.
I think you're entertaining a little bit of hyperbole there with your $100 trillion number.
As to 10%, that's about $63 billion a year, which is a good start (Click).
"the sort of regulation that allows a health insurance company to make an obscene profit by closing out competition"
regulations didn't do this. GREED did this. how the FUCK do you blame lack of adequate regulations instead of SIMPLE HUMAN GREED?
what we have now, case #1: shoddy poor quality regulations -> obscene profits, closing out competition
what you want, case #2: less government, less regulations, less enforcement -> MORE obscene profits, monopolization, MORE corruption of remaining cauterized rump of a tiny government
what should happen, case #3: MORE regulations, of HIGHER quality -> SMALLER corporate profiteering on people seeking healthcare, MORE competition
WITHOUT regulations, companies naturally gravitate towards oligopoly. monopoly. i DO hope you see this simple obvious truth, right?
say a bank was robbed because the doors were left open. a sane person would make sure a policy was put in place to make sure the doors are locked every night, and go after the thieves (aka: introduce more, higher quality regulations, and go after the REAL PERPETRATORS). but a libertarian/ free market fundamentalist/ tea party moron meanwhile would say:
1. forget about the thieves ...morons)
2. the problem is the bank's regulations! (you mean LACK OF regulations/ SHODDY POOR QUALITY regulations!)
3. finally, the solution is: completely remove the doors from the bank! (less government! yay!
"maybe the answer is to have a small government"
then the power vacuum is filled by corporations. and they kick around the tiny government even more. do you know how corruption works?
"how many government employees do you actually really need?"
as many as it takes to adequately police the corporations. not more. not less. how many were needed to police bp before they let their oil well blow out? a hell of a lot more than they had before late april, that's for sure
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
"You think that free market principles and the idea of individual liberty..."
i stopped reading right there
yes: if you COMPLETELY CHANGE THE FUCKING SUBJECT MATTER then you can make me look like a total asshole by applying my observations to COMPLETELY FUCKING UNRELATED SUBJECT MATTER
i believe i was talking about regulating CORPORATIONS, no?
can you tell the difference between a CORPORATION and an INDIVIDUAL?
do you understand my observations are about CORPORATIONS?
do you agree with my observations about CORPORATIONS?
do you believe that CORPORATIONS deserve the same protections as an INDIVIDUAL?
no?
then apologize for going off on me like a spastic retard who can't keep track of the fucking subject matter, you histrionic twit
there is more than the threat of GOVERNMENTS to individual liberty. there is also the threat of CORPORATIONS to individual liberty. therefore in the name of individual liberty, support government regulation of CORPORATIONS
understand now you panicky fuckwit?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Who is responsible for health care? At one time a doctor had a "consulting room". A physician doesn't give diagnoses on stone tablets as delivered from burning bushes and many physicians have their own quirks and favorite treatments. A patient should not be averse to challenging what he is told. The old bit about getting a second opionion should always be considered.
One huge failing of the U.S. health care industry has been the systematic of legislating away a patient's ability to treat himself. In the 70's; if you had conjunctivitis (pink eye) you went to the drug counter and purchased opthalmic grade silver nitrate solution and used the eye drops. Today you pay $175 to a physician after a several hour wait to write a prescription for opthalmic ointment that you pay $80 for and is simply opthalmic grade silver nitrate ointment. A patient is, today, considered too stupid to treat common maladies.
One solution would be to disconnect the health insurance industry from the health care industry. As long as "for profit" massive corporate hostpital chains are owned by "for profit" health insurance companies it is only in their interest to keep costs spiraling upward. This certainly seems to call for a Teddy Roosevelt mentality to correct. How about legislation to consider the collusion on costs between insurance and corporate providers to be a SEC conflict of interest violation?
Another solution is to remove some of the monopolistic controls of pharmaceutical grade drugs. i.e. Amoxillin at my local pharmacy costs $125 for 20 500mg tablets. I can purchase veterinary grade Amoxillin over the counter at the Ranch and Home store at a cost of $12.95 for 100 500mg tablets. The real kicker is the tablets are identical in marking and the coding on the packaging shows they are made by the same company from the same factory.
There has been a systematic mindset propagated since the inception of organizations like the AMA that all treatments HAVE to come from a licensed physician. And we have draconian legislation to force such dependence on physicians which is often not called for and crowds emergency rooms with routine cases.
I still laugh at the Obama "Health Care" bill that does nothing to address health care but seems to be a legally mandated sinecure to heal insurance companies.
NRRPT/RCT
i am glad you have a fucking bug up your ass about individual rights
but why don't you fucking apologize to me for complete misrepresenting my words, asshole
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
While I agree with the thesis you propose, your argument that the only feasible rating system would need to be "functionally equivalent to a government" seems flawed. Further, some sort official rating system on medical efficacy does not on it's own mandate insurance coverage, unless you were envisioning a single-payer system (which itself has flaws with dealing with innovation and varying desires of coverage). Moreover, you admit with political posturing or willful ignorance this won't work, but this is the current reality of our government.
While it's great to dream about health-care reform from the provider side, the change really needs to happen on the insurance side. I agree, as you eluded, that mandated minimum coverage for all would help lower provider costs. Implementing such a system, however, is still up for debate.
In contast, to lower insurers costs, one would need to define a minimum set of preemptive care, so that patients can easily float from one policy to another, without insurers having to worry about their previous lack of coverage. The most sensible way I can think of to do both would be provide vouchers that only work with mutual insurers. As the money would be pre-alloted for you, you wouldn't need to pay as high of a fee (like choosing to pay your car insurance all at once, instead of throughout the year) or be limited by your employers coverage options. Further, since your voucher will be with a mutual insurer, you'll potentially receive dividend pay back at the end of the year by choosing the most efficient plan for you. This would create a self regulating public, and provide insurance companies as well as patients incentives to access efficacy of care. On the flip side one would need to provide a finical penalty for not going to your preventative appointments (much like one would have a penalty for not changing the oil on a car under lease) in order to allow the public to easily upgrade or downgrade their level of coverage.