Do I want to get the health insurance my employer subsidizes? Sure I do. The insurer makes that conditional on waiving my HIPPA rights. I guess they want to post my info on their web site (crap, they do!) and leave it where even the janitor can see it.
I'm also easy to impersonate.
Meanwhile, if she follows the law, my own wife has no ability to get the info. WTF?
My blood relatives should be able to get inheritable disease records. People who lived with me during the past year should be able to get contagious disease records. Anybody sharing finances with me (or recently, as with an ex-spouse) should be able to get billing records.
So HIPPA has pretty much made everything worse for me. I don't need more of the same.
First, the reason you might find offensive. It's more important (for our economy, for our gene pool, whatever) that we keep the highly skilled people alive. Given the choice between saving a brain surgeon and saving a homeless person, I want to save the brain surgeon. Not that money is the perfect way to judge value (lawyers!), but it's pretty close.
Second, this isn't just a matter of one person's wealth vs. another person's wealth. This is also a matter of one individual person choosing between alternate things to spend money on. A nice new car may be worth more than a toe joint replacement, but less than getting laser vision correction. Money is a way to cause individuals to decide their own priorities. If I choose to get the new car, than somebody else (who feels differently) can schedule time with the doctor. It's better for me to make this choice than to have some other person make it for me.
They are one and the same. One person's "need" is another person's "desire".
So then, based on YOUR idea of the distinction, you wish to ration things.
How about this powder keg: abortions (with/without any special condition you may imagine, and actually I don't wish to debate THAT topic)
Does somebody "need" pain medication for a... tooth filling? tooth extraction? stubbed toe? broken bone? torn ligament? amputation? cut finger?
Does somebody "need" a heart transplant? Does it matter who they are? (baby, pretty 17-year-old, mother of 7, father of 7 and sole source of income, 30-year-old with no living relatives or friends, 80-year-old with AIDS and cancer, etc.) Does it matter if the person belongs to a race that gets an abnormally high/low number of such operations?
See where this leads? You're making a personal value judgement when you try to define "need". I don't wish to give you the power to make that judgement for me. If you'd like me making that judgement for you... well you might not agree with the choice I make!
When technology enables new activities, that's an additional expense.
When technology makes existing activities cheaper, OTHER activities get more expensive. Remember that value is relative. Wikipedia's page on the Balassa-Samuelson_effect may interest you. It states the effect as: "The traded goods sector has a higher productivity growth than the non-traded goods sector, leading to higher relative non-traded goods' prices". That "productivity growth" is technology.
"absurdly productive": A small team of us write software. Once the software is written, we can sell an infinite number of copies. We don't have to keep working to produce more.
Bandaging someone effectively is easier now... by a small factor. Even if it is 10 times easier now, and even if that were all that nursing involved, nursing would still not come anywhere near the productivity gains of regular old industry -- never mind the information industry. Consider something like a paper mill, corn farm, or gravel plant.
The example is way overexaggerated, but in some ways I wouldn't be wrong in determining that I need an X-ray for my hangnail. If that's what I feel I need, and it isn't hurting you, what's your problem with it?
Normally it isn't so extreme. Maybe I overeat, and so I "need" stomach reduction surgery to keep myself from dying of obesity-related problems. (heart attack, suicide, etc.) Maybe my toe joint is all messed up, and so I "need" an artificial joint to make me feel better. Maybe I am nearsighted, and so I "need" vision correction surgery.
People like to use one email account for everything.
People hate to change their email account.
That's it. No malice needed, or even incompetence. It's just being lazy/efficient. Perhaps we should be thankful they aren't all using hotmail accounts.
The $millions are getting paid by doctors who do stuff related to childbirth.
Florida doctors often don't bother to get the insurance. They take advantage of the bankruptcy laws instead, buying a multi-million-dollar house. The house, no matter how expensive, is untouchable in Florida.
I once saw a great cartoon illustrating this. Two farmers were fighting over a cow. One was pulling on the front of the cow, and the other was pulling on the rear. The lawyer was milking the cow.
Basically, the legal profession is a parisitic drain on productivity.
A government system would run on the basis of how much care a community can afford for its citizens. It would be (is here in Europe) self correcting because voters wil force a government to make the right choice.
So, if the average citizen won't pay for good health care, then it shouldn't be available to me?
What you'd be doing is limiting good care to the rich. Bill Gates will still get fine care, at least for non-emergency stuff. The middle class will suffer a huge loss in quality while paying much more.
That "don't need immediately" is unjustified. Who are you to say that my treatment is unneeded? It sounds like you want to limit my care by some arbitrary idea of your own. No, this is making people wait for treatment they need.
What we're doing is slightly less awful. People decide their own need. Money is the push-back which prevents people from demanding infinite care.
Don't imagine that there is a lovely solution to this problem. That's fantasy.
Yes, we want a health care system which covers everyone who needs covering.
Pick a random person. Would you like them to be your doctor? No?
The supply of acceptable doctors is limited. Sorry. If we offer everyone all the care they need or claim to need, we won't be able to satisfy the demand. We can make people wait, causing many to die. We can hire McDonald's fry cooks to do surgery, causing many to die. We can have arbitrary quotas or a lottery, causing many to die.
First, the easy issue. Companies with competent accountents never have profit. Profit is taxed. Lots of effort goes into finding ways to be unprofitable as far as the law is concerned. It's essentially tax evasion.
Now the matter of technology...
You want that new medicine. In the 1940's, you couldn't have even asked for it because it didn't exist. Now you expect it as your right. That medicine costs money to produce and, far worse, costs money to develop and approve. Somebody has to pay. That'll be you, one way or another. (maybe via taxes, if things are all socialized)
You get paid OK. Well, the doctor wants to get paid too. You can serve an UNLIMITED number of doctors if you produce intellectual property, or a very large number if you run a machine in a factory. The doctor can serve a few people each day. The supply of medical work is thus limited. The demand is high though, because we all have medical troubles and hardly anybody is willing to go without treatment. Long ago, before all this technology, the factory worker wasn't so productive. The demand for his output was thus higher, making the doctor's work **relatively** less in demand than it is today.
...but really, is that an acceptable allocation of resources? The local system (UK) is so fucked up that patients have to travel to a foreign country to get treatment. The other system (France) may be fucked up as well, having excess treatment capacity.
Maybe the French send people the other way for other problems.:-)
Government does NOT allocate resources well at all.
First of all, you think a government-run system somehow wouldn't deny treatment? It would. This can happen directly, by delays, or by some quota-like system.
Life expectancy in the US is damn wonderful if you consider the crap we eat while sitting on our fat asses! We don't even drive without munching on some concoction of corn syrup, corn starch, partialy hydrogenated vegetable oil, and artificial flavor. (note: "drive" -- we don't walk) There's also that ugly issue of lifespan naturally varying by race; we're not Japanese or even all European.
That $100 medicine is a patent issue; Cuba ignores our patents while taking advantage of the inventions. I guess the issue would go away if we just stopped inventing these things, which is exactly what happens if nobody pays the $100 price tag. Not that I love the situation, but we're not talking about software here.
Where care is mandated or the patient can't shop for a good
price, government funding might make sense. You're not in a position to discuss
alternatives if you have a cracked skull and bleeding brain. Other than that
though...
Our problems do not come from a "failure" to socialize medicine. When I was
up in Canada, the news was that brain scanners were mostly going to places
with powerful politicians. Quebec got an unfair share. Money was
disappearing for political reasons. Over in the UK, people are being sent to
France for surgery because they'd die on the waiting lists if they didn't
go. Here in the USA we install brain scanners (lots of them too) where there
will be patients and we don't die on waiting lists for anything other than
an organ transplant -- and that only because we made it illegal to pay the
dead person's estate.
Our real problems are:
We invent new technology, expect to use it, and expect that costs won't
rise. Huh? We're expecting to get more for less. That only works for
computer hardware. (in a socialist medicine system, quotas and delaying
tactics are used to fight this problem)
The attitude is "I'll pay anything to save my dying children!". We then
act all offended that the hospital bill heads toward infinity. Since death
is common (100% of your children will die!) you can expect to pay until you
can pay no more or until we run out of technology to sell you. (as above,
socialist systems deny you this choice)
Simple economics is causing all service industries to be relatively more
expensive. The factory worker is now more productive because he has huge
machines. The high-tech worker is absurdly productive because he only
produces digital data which is trivial to replicate. The hospital worker,
like the college professor, is not getting such huge productivity increases.
Widgets and software can be sold cheaply while still paying the workers
well, but hospital services can not be made cheap while paying the workers
well. Because everything is relative, hospital costs skyrocket.
Over in India, patients have a very limited ability to sue for
malpractice and pain and suffering and... Medicine is cheap there. Over
here, some doctors must pay millions of dollars per year for malpractice
insurance. That means you pay. You also pay for unnessesary tests and other
procedures caused by a cover-your-ass mentality that has taken hold. This is
particulary true of caesarean births, which are dangerous and were once
rare. Before a jury, it looks good to have done more intervention.
Our health insurance is too good at insulating us from the costs of
various procedures. We don't shop around for a good deal. We then pay high
rates because the money ultimately comes from us. When I lacked insurance, I
was very careful to demand prices over the phone from multiple providers.
Now I just have my $20 co-pay, so why should I care? The price is the same
for me no matter where I go. I pick the fancy place on an expensive downtown
lot!
Some of these problems are not really solvable. Economics is what it is,
people like new technology, and nobody wants to see their little children
die. The lawyers have some mighty lobbiests, but a change would at least
be theoretically possible. The same goes for the co-pay insurance system,
which could be replaced by a sliding scale or percentage system. (example
insurance fix: the patient's payment must increase by at least 10 cents
for every dollar of the treatment cost up to "$200 for $2000", then by
1 cent per dollar thereafter)
Cuba is run by a fairly bad dude. He once even thought it nice to offer launch sites for Soviet missles.
Compare with Libya and Pakistan. We treated them the same way, until we got a wake-up call to go deal with the situation. Only then did we reevaluate the situation, decide it was stupid, and open up to them.
Cuba has had no such defining moment. If we suddenly needed Cuba for something (not likely), then we'd rather quickly let bygones be bygones.
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Do I want to get the health insurance my employer subsidizes? Sure I do. The insurer makes that conditional on waiving my HIPPA rights. I guess they want to post my info on their web site (crap, they do!) and leave it where even the janitor can see it.
I'm also easy to impersonate.
Meanwhile, if she follows the law, my own wife has no ability to get the info. WTF?
My blood relatives should be able to get inheritable disease records. People who lived with me during the past year should be able to get contagious disease records. Anybody sharing finances with me (or recently, as with an ex-spouse) should be able to get billing records.
So HIPPA has pretty much made everything worse for me. I don't need more of the same.
Two reasons.
First, the reason you might find offensive. It's more important (for our economy, for our gene pool, whatever) that we keep the highly skilled people alive. Given the choice between saving a brain surgeon and saving a homeless person, I want to save the brain surgeon. Not that money is the perfect way to judge value (lawyers!), but it's pretty close.
Second, this isn't just a matter of one person's wealth vs. another person's wealth. This is also a matter of one individual person choosing between alternate things to spend money on. A nice new car may be worth more than a toe joint replacement, but less than getting laser vision correction. Money is a way to cause individuals to decide their own priorities. If I choose to get the new car, than somebody else (who feels differently) can schedule time with the doctor. It's better for me to make this choice than to have some other person make it for me.
You keep trying to distinguish need from desire.
They are one and the same. One person's "need" is another person's "desire".
So then, based on YOUR idea of the distinction, you wish to ration things.
How about this powder keg: abortions (with/without any special condition you may imagine, and actually I don't wish to debate THAT topic)
Does somebody "need" pain medication for a... tooth filling? tooth extraction? stubbed toe? broken bone? torn ligament? amputation? cut finger?
Does somebody "need" a heart transplant? Does it matter who they are? (baby, pretty 17-year-old, mother of 7, father of 7 and sole source of income, 30-year-old with no living relatives or friends, 80-year-old with AIDS and cancer, etc.) Does it matter if the person belongs to a race that gets an abnormally high/low number of such operations?
See where this leads? You're making a personal value judgement when you try to define "need". I don't wish to give you the power to make that judgement for me. If you'd like me making that judgement for you... well you might not agree with the choice I make!
When technology enables new activities, that's an additional expense.
When technology makes existing activities cheaper, OTHER activities get more expensive. Remember that value is relative. Wikipedia's page on the Balassa-Samuelson_effect may interest you. It states the effect as: "The traded goods sector has a higher productivity growth than the non-traded goods sector, leading to higher relative non-traded goods' prices". That "productivity growth" is technology.
"absurdly productive": A small team of us write software. Once the software is written, we can sell an infinite number of copies. We don't have to keep working to produce more.
Bandaging someone effectively is easier now... by a small factor. Even if it is 10 times easier now, and even if that were all that nursing involved, nursing would still not come anywhere near the productivity gains of regular old industry -- never mind the information industry. Consider something like a paper mill, corn farm, or gravel plant.
It's been tried with mice and a number of other things.
You mean like the Russian dude?
The $millions are paid by doctors who do things related to childbirth. (obstetrician, neonatologist, etc.)
It depends on the part of the country of course, etc.
I've heard of values as crazy as 3 million. WTF indeed.
Not everybody can have the best surgeon. He's only one person! He can't do all that work. Somebody has to get the worst surgeon.
Got a better way to decide who gets the best surgeon and who gets the worst surgeon?
The example is way overexaggerated, but in some ways I wouldn't be wrong in determining that I need an X-ray for my hangnail. If that's what I feel I need, and it isn't hurting you, what's your problem with it?
Normally it isn't so extreme. Maybe I overeat, and so I "need" stomach reduction surgery to keep myself from dying of obesity-related problems. (heart attack, suicide, etc.) Maybe my toe joint is all messed up, and so I "need" an artificial joint to make me feel better. Maybe I am nearsighted, and so I "need" vision correction surgery.
So yeah, people do decide their own need.
This is a non-issue because classified info is not allowed on systems connected to the internet. RNC or whitehouse, it really doesn't matter.
People like to use one email account for everything.
People hate to change their email account.
That's it. No malice needed, or even incompetence. It's just being lazy/efficient. Perhaps we should be thankful they aren't all using hotmail accounts.
The $millions are getting paid by doctors who do stuff related to childbirth.
Florida doctors often don't bother to get the insurance. They take advantage of the bankruptcy laws instead, buying a multi-million-dollar house. The house, no matter how expensive, is untouchable in Florida.
Lawsuits are tools to help the lawyers.
I once saw a great cartoon illustrating this. Two farmers were fighting over a cow. One was pulling on the front of the cow, and the other was pulling on the rear. The lawyer was milking the cow.
Basically, the legal profession is a parisitic drain on productivity.
It varies by provence. Your provence probably has political power. Might you be in Quebec? I doubt you're in Alberta.
So, if the average citizen won't pay for good health care, then it shouldn't be available to me?
What you'd be doing is limiting good care to the rich. Bill Gates will still get fine care, at least for non-emergency stuff. The middle class will suffer a huge loss in quality while paying much more.
You may think this is fine.
That "don't need immediately" is unjustified. Who are you to say that my treatment is unneeded? It sounds like you want to limit my care by some arbitrary idea of your own. No, this is making people wait for treatment they need.
What we're doing is slightly less awful. People decide their own need. Money is the push-back which prevents people from demanding infinite care.
Don't imagine that there is a lovely solution to this problem. That's fantasy.
Here you go, slapping a stereotype on me and comparing that to a ficticious person who is wholly stereotype...
I'll presume you mean that this ficticious person gets bad care. Why should I not be abhorred to get bad care?
That's a lot of insults from what appears to be the same Anonymous Coward, but no rational argument.
Yeah, that's it. I'm just wacky. Maybe you'd like to suggest I'm evil too?
IMHO, once you spew like that, you've lost the argument and you damn well know it too.
Pick a random person. Would you like them to be your doctor? No?
The supply of acceptable doctors is limited. Sorry. If we offer everyone all the care they need or claim to need, we won't be able to satisfy the demand. We can make people wait, causing many to die. We can hire McDonald's fry cooks to do surgery, causing many to die. We can have arbitrary quotas or a lottery, causing many to die.
Hey, I want utopia too, but...
First, the easy issue. Companies with competent accountents never have profit. Profit is taxed. Lots of effort goes into finding ways to be unprofitable as far as the law is concerned. It's essentially tax evasion.
Now the matter of technology...
You want that new medicine. In the 1940's, you couldn't have even asked for it because it didn't exist. Now you expect it as your right. That medicine costs money to produce and, far worse, costs money to develop and approve. Somebody has to pay. That'll be you, one way or another. (maybe via taxes, if things are all socialized)
You get paid OK. Well, the doctor wants to get paid too. You can serve an UNLIMITED number of doctors if you produce intellectual property, or a very large number if you run a machine in a factory. The doctor can serve a few people each day. The supply of medical work is thus limited. The demand is high though, because we all have medical troubles and hardly anybody is willing to go without treatment. Long ago, before all this technology, the factory worker wasn't so productive. The demand for his output was thus higher, making the doctor's work **relatively** less in demand than it is today.
...but really, is that an acceptable allocation of resources? The local system (UK) is so fucked up that patients have to travel to a foreign country to get treatment. The other system (France) may be fucked up as well, having excess treatment capacity.
:-)
Maybe the French send people the other way for other problems.
Government does NOT allocate resources well at all.
First of all, you think a government-run system somehow wouldn't deny treatment? It would. This can happen directly, by delays, or by some quota-like system.
Life expectancy in the US is damn wonderful if you consider the crap we eat while sitting on our fat asses! We don't even drive without munching on some concoction of corn syrup, corn starch, partialy hydrogenated vegetable oil, and artificial flavor. (note: "drive" -- we don't walk) There's also that ugly issue of lifespan naturally varying by race; we're not Japanese or even all European.
That $100 medicine is a patent issue; Cuba ignores our patents while taking advantage of the inventions. I guess the issue would go away if we just stopped inventing these things, which is exactly what happens if nobody pays the $100 price tag. Not that I love the situation, but we're not talking about software here.
They's lose the option to avoid the waiting list if the USA were to change.
Our problems do not come from a "failure" to socialize medicine. When I was up in Canada, the news was that brain scanners were mostly going to places with powerful politicians. Quebec got an unfair share. Money was disappearing for political reasons. Over in the UK, people are being sent to France for surgery because they'd die on the waiting lists if they didn't go. Here in the USA we install brain scanners (lots of them too) where there will be patients and we don't die on waiting lists for anything other than an organ transplant -- and that only because we made it illegal to pay the dead person's estate.
Our real problems are:
Some of these problems are not really solvable. Economics is what it is, people like new technology, and nobody wants to see their little children die. The lawyers have some mighty lobbiests, but a change would at least be theoretically possible. The same goes for the co-pay insurance system, which could be replaced by a sliding scale or percentage system. (example insurance fix: the patient's payment must increase by at least 10 cents for every dollar of the treatment cost up to "$200 for $2000", then by 1 cent per dollar thereafter)
Cuba is run by a fairly bad dude. He once even thought it nice to offer launch sites for Soviet missles.
Compare with Libya and Pakistan. We treated them the same way, until we got a wake-up call to go deal with the situation. Only then did we reevaluate the situation, decide it was stupid, and open up to them.
Cuba has had no such defining moment. If we suddenly needed Cuba for something (not likely), then we'd rather quickly let bygones be bygones.