Health care reform.

[mike3]

Even if you don't like the current reform that was passed, we still should find some way to get decent health care to the poor.

Discuss.

[Brainster]

I, too, have been bummed out by the number of poor dying on the street.

[leonAzul]

Even if you don't like the current reform that was passed, we still should find some way to get decent health care to the poor.

Discuss.

The question is not as simple as you have presented it.

First, what is the basis for the assertion that we "should find some way to get decent health care to the poor?"

The answer to that would then influence the next question: "Is this something that our government ought to address, and at which level: municipal, state, or federal?"

Next would be: "What is the best way to resolve that problem, if we accept that this is, indeed, a problem that belongs within the domain of governance?"

I would argue that, although it is emotionally attractive, the notion that universal access to best health care is a politically enforceable right is wrong: What is enforceable is that when someone presents themselves as a health care professional and then recommends or prescribes actions in a demonstrable manner that is inconsistent with verifiable evidence-based practices, then fraud has been committed. IOW, from a legal POV, access to decent health care ought to be addressed by considering whether the criteria for a particular procedure or presciption are based on verifiable outcomes – or something else.

Let us stop there, and then continue…

[mike3]

The question is not as simple as you have presented it.

First, what is the basis for the assertion that we "should find some way to get decent health care to the poor?"


I'd say it'd have to do with the idea of minimizing human suffering/misery. Do you think it should be minimized, or not? Also, if we want to explore this more, how about discussing the question of why anyone should have health care. The idea, I'd think, is so they can live a less miserable life, or even any life at all (see, e.g. life-threatening diseases).


The answer to that would then influence the next question: "Is this something that our government ought to address, and at which level: municipal, state, or federal?"


So how does it influence the given question? From what I gave, it'd seem then we should ask: "does the government have/not have a responsibility to minimize human suffering/misery?"


Next would be: "What is the best way to resolve that problem, if we accept that this is, indeed, a problem that belongs within the domain of governance?"

I would argue that, although it is emotionally attractive, the notion that universal access to best health care is a politically enforceable right is wrong: What is enforceable is that when someone presents themselves as a health care professional and then recommends or prescribes actions in a demonstrable manner that is inconsistent with verifiable evidence-based practices, then fraud has been committed. IOW, from a legal POV, access to decent health care ought to be addressed by considering whether the criteria for a particular procedure or presciption are based on verifiable outcomes -- or something else.

Let us stop there, and then continue…

And this is the rub. First off, why do we need to talk about it in terms of being a "right"? If something is a good thing to do, how does that equate to it being a "right"? This whole talk of it as a "right" or not seems to make it too simple -- e.g. if you don't believe it's a "right", then you don't believe we should have it, which is not the case. Not everything we have or even should have are formal "rights".

And if you suggest it should be done without using government, what would you propose to use?

[leonAzul]

If something is a good thing to do

Which is precisely the point of the first question.

I'm not saying that I disagree with your conclusion that it is a Good Thing to Do™, but rather that it is axiomatic that it is a Good Thing to Do™, and, based upon those arguments that support such axioms, why government is the proper institution for accomplishing the goals that such axioms demand.

[leonAzul]

First off, why do we need to talk about it in terms of being a "right"?

Because you have presented it as an entitlement. Please clarify why a person is entitled to health care. If not from a natural right, then from what POV? The only POV that makes sense to me, IMHO, is that physicians are sincerely committed to best health practices. I recognize that there are pragmatic, emotional, and economic arguments, as well.

I have assumed no more than that health care needs to be determined based on verifiable outcome.

If the law is to be the instrument of justice, then those who present themselves as providers of access to health care [ie, HMOs and Insurers] and yet fail to base their disbursement decisions on best health care practices, the so-called providers are guilty of fraud, which is well covered by current law.

[The Painter]

The idea, I'd think, is so they can live a less miserable life, or even any life at all (see, e.g. life-threatening diseases).

What is it that makes them miserable? Their health or their poverty? Instead of health care, why don't you just give them money?

[ponderingturtle]

The question is not as simple as you have presented it.

First, what is the basis for the assertion that we "should find some way to get decent health care to the poor?"

And "Why do we bother with paying for the health care of a bunch of old parasites who don't contribute to society?" Of course that would be political suicide in Florida, hence why republicans fight so hard against cuts in medicare spending.

I would argue that, although it is emotionally attractive, the notion that universal access to best health care is a politically enforceable right is wrong:

Yes we need to stop viewing our selves as a major nation and embrace our third world status.

[leonAzul]

The question is not as simple as you have presented it.

First, what is the basis for the assertion that we "should find some way to get decent health care to the poor?"

And "Why do we bother with paying for the health care of a bunch of old parasites who don't contribute to society?" Of course that would be political suicide in Florida, hence why republicans fight so hard against cuts in medicare spending.

I would argue that, although it is emotionally attractive, the notion that universal access to best health care is a politically enforceable right is wrong:

Yes we need to stop viewing our selves as a major nation and embrace our third world status.

Quite the contrary: We do good not because we are compelled to do so, but rather because we desire to.

[leonAzul]

And "Why do we bother with paying for the health care of a bunch of old parasites who don't contribute to society"

It would seem you are pondering wrong.

Perhaps you need to more critically examine the actuarial as well as the cultural evidence.

You stopped at the colon: Perhaps there was something of significance that followed ;)

[ponderingturtle]

Quite the contrary: We do good not because we are compelled to do so, but rather because we desire to.

Facts seem to not back this up. Or is it better to let people die so that the few that get saved is actual a good act?

[Rolfe]

To my mind, it's more about whether, and if so how, to spread the cost of healthcare.

Healthcare has to be paid for - the fairies don't deliver it in the night. Some people have medical needs that so far outstrip their financial resources that they could never hope to pay for the treatment they need. Others are blessed with good health and scarcely need to spend a dime before they have their sudden, fatal heart attack or accident. And you can't determine before the fact which category most young people are going to fall into.

So, are you going to insist that everyone pays their own way, in full? In that case, many people will not get the treatment they need, and medical professionals' skills will be wasted. Or are you going to leave any cost-spreading arrangements entirely private, with coverage dependent on how prudent an individual has been, and how generous an insurance company happens to be feeling? Or are you going to impose some compulsory cost-spreading by way of tax funding?

This last changes the payment principle from pay according to perceived risk, which again will leave some people unable to participate at all if their risk is assessed to be too great, to pay according to your means. This allows the system to be appropriately funded so that everyone can be covered, even those with the most expensive needs, but at the cost of the well-off contributing disproportionately more than they would in a risk-based system.

Cue howls of "communism", and "taking away my freedoms", and that rather than everyone pay a fairly modest tax into the universal pool, these irresponsible scroungers who can't afford the tretment they need should be left to realise how imprudent they've been and teach the rest responsibility.

No other country generates these howls at the concept of universal healthcare, but it seems to be de rigeur in America. No, I don't know how you deal with it either.

Rolfe.

[DDWW]

Federal grants/loans for promising students to attend medical schools (Doctors, nurses, technicians, etc.). Graduates then commit to serving 5 years at hospitals and/or clinics that will treat the poor for little or no costs. I am assuming the hospital/clinic is making money from other patients and services so that they can make a “livable wage”. After 5 years they can stay or go into private practice. If they leave before 5 years they must re-pay the loan with a substantial penalty. Grant is forgiven after five years of service.

Sort of like going into the Military and getting training in exchange for set number of years of service.


DDWW

[mike3]

Quite the contrary: We do good not because we are compelled to do so, but rather because we desire to.

If we "desired" to do good then if we don't like government we'd set up our own non-gov system to get that health care to the poor.

[mike3]

What is it that makes them miserable? Their health or their poverty? Instead of health care, why don't you just give them money?

In this case, I'm talking about diseases. Why not just give them money? Because for one, you don't need to do that to get them the health care, you can just pay for it for them.

[mike3]

Because you have presented it as an entitlement. Please clarify why a person is entitled to health care. If not from a natural right, then from what POV? The only POV that makes sense to me, IMHO, is that physicians are sincerely committed to best health practices. I recognize that there are pragmatic, emotional, and economic arguments, as well.

The argument is that health care is an important need, since anyone can get sick. It is not as necessary as food and water, but I'd say it's still pretty important because of that. Why should they have it? Well, what do we want here: do we want our people to suffer, even if we had the ability to do something about it, or not? If the former, then the USA is most certainly not the best country on Earth. If the latter, what do we want?

[JoeTheJuggler]

I think we've actually got a decent safety net for the really poor in place. It's the working class (the not-quite-up-to middle class) that have the most difficult time getting healthcare (and the lower-income self-employed).

I do think we as a nation ought have a system at least on part with the rest of the developed world, though.

Similarly, I think we ought improve our education system--not out of any political theory (as in a "right" to a higher education), but because as a nation we're lagging behind in that area too.

[Schrodinger's Cat]

How about decent health care for the not poor who have paid thousands upon thousands of dollars faithfully to top notch insurance plans for over a decade, and then, when they actually come down with a serious health condition, are denied treatment as "not medically necessary."

I'm a financial counselor at one of the top cancer hospitals in the world with some of the best oncologists in the world. I constantly have insurance companies denying treatment for patients these doctors say are both effective and necessary. And no these are not just cases where patients have very slim chances of survival even with treatment.

One of the things that bothers me most about the health care debate is that it focuses on the uninsured and the poor. And I care about them too, don't get me wrong. But what should be more frightening to people is that you can spend $600 a month for ten years for a health plan only to be denied when you actually, really need it.

You don't have to be poor to get screwed. You can be a perfectly stable middle to upper middle class person who got health insurance, and top ranked health insurance, only to find out they won't pay for your or your family member's treatment, which can be hundreds of thousands of dollars. Then all of a sudden, you aren't middle class anymore. It's even worse if you're the main breadwinner and become too sick to work and then have to go on disability. I've seen upper middle class people with top of the line health insurance made destitute by health issues and the associated health care costs. We're a non profit hospital so we do offer some financial assitance, we write off what we can, but we have so many patients and we simply cannot help everyone. Even if we write off or give a discount on some services, the costs are just so high that even that doesn't always help much. 20% off a half million dollar transplant is still a heck of a lot of money. And that doesn't include your follow up care.

[Rolfe]

This is what I don't understand, about the universal healthcare debate. We hear Americans opposed to UHC going on about rationing, and bureaucrats standing between the patient and the doctor, and we scratch our heads and reckon that in America everyone with good insurance must get absolutely everything, no questions asked. In particular, they must get very expensive treatments that might only keep them alive a few weeks more - because that's just about all that's "rationed" in the NHS for example. (And there are no bureaucrats standing between us and our doctors - the doctor himself approves the treatment when he decides it's necessary.)

We hear people with insurance saying that universal healthcare would be poorer service for them, because America has the best healthcare system in the world if you have the means to pay for it. So we believe the problems only affect the poor and the uninsured.

Then we hear stories like the above. I don't entirely understand. Surely some people are getting the transplants and so on? What sort of definition of "medically necessary" are these bureaucrats using anyway?

Rolfe.

[The Painter]

In this case, I'm talking about diseases. Why not just give them money? Because for one, you don't need to do that to get them the health care, you can just pay for it for them.

Why do you have to pay for it? Just give them the money and they can pay for it themselves.

[rwguinn]

oops... (http://www.cnbc.com/id/37451253)

Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb health care costs, a trend that could erode the principles of the popular state-funded system.

[ponderingturtle]

I think we've actually got a decent safety net for the really poor in place. It's the working class (the not-quite-up-to middle class) that have the most difficult time getting healthcare (and the lower-income self-employed).

Once they get onto medicaid sure. But I wonder how many people die because say they can not afford the medication they need while waiting to get on the medicaid rolls.

I am not sure that the thousands who die every year from lack of insurance do not have a good percentage that fit into the category of poor.

[ponderingturtle]

oops... (http://www.cnbc.com/id/37451253)

Yes many nations need to cull their elderly, so what?

Of course we have a single payer system in the US for exactly that group, damn socialism.

[thaiboxerken]

This is what I don't understand, about the universal healthcare debate. We hear Americans opposed to UHC going on about rationing, and bureaucrats standing between the patient and the doctor, and we scratch our heads ...

That's because those who make this argument are only opposed to the government doing the rationing and providing bureaucrats. If it's an insurance company doing it, that's ok. It's based on the false notion that the free market provides the best of everything.

[Rolfe]

I'd like to say that makes perfect sense, but.... :nope:

Rolfe.

[funk de fino]

People who oppose health care for all, are a lower class of human being. The system as it was in the US, was an abomination.

[thaiboxerken]

It still is. They should've just made it Medicare for all.

[funk de fino]

It still is. They should've just made it Medicare for all.

I wouldnt disagree there but more people will be covered and hopefully less people will die due to not having that care. So less of an abomination.

[Beerina]

"Coming up with a way for 'the poor' to be covered" is not the same as "reform". "Reform" suggests busted, yet we have the most rapidly advancing medical science in the world. I submit this is not busted, and that anything which slows this down is.

If we agree with funk de fino, that maximizing the number of lives saved is the yardstick for abominationesquity of things, of course.


After all, you can't provide it for free if it doesn't exist.



So pardon if some of us want to keep an eye on those who want to help "the poor", and use it as an argument for something...else.



Since we're all "agreeing", can we agree that helping "the poor" does not imply command-and-control mechanisms are justified?

[funk de fino]

Slow down. Yes, what ever you say.

[ponderingturtle]

"Coming up with a way for 'the poor' to be covered" is not the same as "reform". "Reform" suggests busted, yet we have the most rapidly advancing medical science in the world. I submit this is not busted, and that anything which slows this down is.

So we should view their deaths as the grease that oils the machine that is our health care system. I mean look at how good we are at developing many different kinds of erection pills. We're Number 1!

We are also great at developing more expensive and less effective medical treatments and getting people to choose them. Shear genius that is.

[Shalamar]

Hmm.. How much money are the insurance companies putting into medical research?

[Arrow]

I saw this article this morning and thought it was troubling. Here is part of what was said:

http://www.investors.com/NewsAndAnalysis/Article/536549/201006071833/The-Doctor-Will-See-You-Later.aspx


"Health Care: The British government has decided that it needs to cut millions of operations because the public system cannot afford them. This is coming soon to a hospital or doctor's office near you.

According to the Daily Mail, Britain's National Health Service is "preparing to cut millions of operations" so that it can save $29 billion by 2014. Procedures that will be "decommissioned," if we may borrow a particularly descriptive term used by one doctor, include hip replacements for obese patients, some operations for hernias and gallstones, and treatments for varicose veins, ear and nose problems, and cataract surgery.

Thus is the future of all socialized medicine. Bureaucratic rationing of treatment is inevitable. No system can forever meet the demand of "free" care. Jeff Taylor of the Economic Voice clarified the problem when he wrote last week that "the U.K. is broke."

[ponderingturtle]

Thus is the future of all socialized medicine. Bureaucratic rationing of treatment is inevitable. No system can forever meet the demand of "free" care. Jeff Taylor of the Economic Voice clarified the problem when he wrote last week that "the U.K. is broke."

So why is having private bureaucratic rationing so much better? You get people denied transplant because they didn't have enough insurance in the US. Talk about rationing.

[thaiboxerken]

Thus is the future of all socialized medicine. Bureaucratic rationing of treatment is inevitable.

The FUTURE of socialized medicine, but it is the present state of privatized health care.