Stossel Solves the Health Crisis with Capitalism

[Toke]

I heard from some people on a distilery tour that the haggish were served with a small botle of wisky to dull the taste. Strange, my faroese ancestry have given me a good taste in lamb inards, and dried meat. Dried only slightly faster than rotting.

The idea of educating poor children to avoid illiterate adults later, and do the same for healthcare, makes perfect sense to me.
I am afraid it is in conflict with some basic US conservative ideas.

The conflict might be in the individuals rights/responsibilities versus the interests of society.

The socialist CT in me is tempted to see it as a scam/false flag opperation for the elite to maintain their hold on power by having a population that is uneducated and too worried about their next meal/mortage/medical bill to pay attention to how society is run.


Now, everyone let us attend to the vagina of Hokulele.
Her answer is post 18.

[Rolfe]

Originally Posted by Toke

Now, everyone let us attend to the vagina of Hokulele.
Her answer is post 18.

Maybe the first time a TLA finallist post has been in AAH???

I just follwed that thread back to the beginning. Then back to where that came from. Then back to the thread THAT OP came from.

I think my brain just crawled out of my ears.

[Toke]

Yes, Yrreg is amacing

[aerosolben]

Originally Posted by themusicteacher

No, they think that they should get their money back to spend it where they wish.

Sorry to snip a bit, but we're starting to drift off topic. I'm not arguing for vouchers, I just don't think it matches the scenario I'm envisioning. If they wanted only the very poor to get vouchers, and everyone else to pay out of pocket to send their children to school, that would be the same. I do see your generally point about it indirectly dismantling the public service.

[aerosolben]

Originally Posted by Rolfe

I'm quite shocked by all the knee-jerk declarations that "socialism" is the way to hell in a handbasket. We wouldn't mind a bit more of it here.

...

I hope Obama has the sense he appears to have been born with.

Rolfe.

An impassioned point, but one that won't fly here, I'm afraid. That's the sort of talk that inflames right-wing radio hosts and sends politicians in red states scrambling into foxholes.

I have no strategy for you on selling Americans "socialism" or "sacrifice for the greater good" or anything like that. But I don't think you need to for UHC - it can work on strictly pragmatic grounds.

[Rolfe]

Oh sure, universal healthcare is arguable on totally pramatic grounds. I was just pointing out that far more radical "socialism", such as taking people's land against their will, was already SOP in America.

The problem seems to be that although the pragmatic arguments are unassailable, the ideological arguments are used to damn the idea. In spite of the fact that, as I said, far more radical socialism is already accepted in other areas. Like someone else said, it would work very well in practice, but we feel it doesn't work in theory.

How do you cope with people who characterise universal healthcare as "these commies want to take my money and use it to get medical treatment for someone else's child, when I need it to get medical treatment for my child!"

That "isn't even wrong", but it's the sort of mindset that keeps coming up.

Rolfe.

[oggiesnr]

Originally Posted by Rolfe

How do you cope with people who characterise universal healthcare as "these commies want to take my money and use it to get medical treatment for someone else's child, when I need it to get medical treatment for my child!"

...and don't seem to understand that they will get medical treatment for their child because the healthcare is universal and that includes them!

Steve

[Rolfe]

They seem to be convinced that "socialised medicine" is so substandard that they wouldn't want it. Look at the guy who was saying how much poorer someone on a low income would be, because his taxes would go up to pay for the "socialised medicine" (why?) and he'd still have to find money for insurance because the "socialised medicine" would be such limited coverage.

I suppose if and when the USA gets a universal healthcare system, it will be how the USA devises it. But nobody else has such a system that is so limited in coverage that people are obliged to supplement it, or not so far as I know. Here, people with serious health problems find it's the NHS that provides the level of care they need. The leader of the Conservative party, a very rich guy indeed, used the NHS for his seriously ill child, because that was where the expertise and facilities are. Private medicine is more for convenience and better accommodation and not having to rub shoulders with the Great Unwashed.

I'm thinking maybe that's why the publicly-funded healthcare in the USA is getting such a bad press. If it's only used by people with no influence, then where's the incentive to provide a good level of serivce? However, if your movers and shakers, your politicians and businessmen, even just the bulk of the middle-classes who are voters and opinion-formers, use it, you immediately et the pressure to raise the game and deliver state-o-the-art.

You should try it. It works pretty well.

Rolfe.

[Rolfe]

See what I mean? There's stuff like this all over the forum.

Originally Posted by Ducky

I am going to switch hospitals/oncologists for many reasons, not the least of which is being threatened with lawsuits over what I owe for insurance companies not paying for over the past 5 years. [....]

It's good I got a raise this year but things are still tight and I still have mountains of debt from the original surgery when I didn't have insurance and for the times my switching jobs and insurance didn't cover MRI's and radiation etc.

It's inhuman. It's batst insane. It's bad enough having the disease Ducky has, that's more than any human being should have to put up with it. To have to worry about paying for necessary treatment as well is just too much.

Why does your society put up with it?

Rolfe.

[themusicteacher]

Originally Posted by Rolfe

See what I mean? There's stuff like this all over the forum.




It's inhuman. It's batst insane. It's bad enough having the disease Ducky has, that's more than any human being should have to put up with it. To have to worry about paying for necessary treatment as well is just too much.

Why does your society put up with it?

Rolfe.

Because Americans are some of the most dogmatic, unreasonable people you'll ever meet. It doesn't matter is something is logical or reasonable, the idiology is what is important. It's more important to be right on a hypothetical level than it is to do right on a real level. This is where we get Glenn "I just love my country so much (sob, sob, sniffle, golly-gosh, gee whiz)" Beck. No critical analysis of an issue is necessary. Just label something "socialist/communist/fascist," show some Nazi's marching along and kill the debate dead in it's tracks. It also helps to present a few well-placed anecdotes from people who say, "Canada's health care system is awful!"

[DaN K. StAnLeY]

Just wanted to drop in and let everyone know I have completely dropped my HC and am going balls out with my own business. I'm going to look into getting my own insurance and see how tough/expensive it really is. So far I've found a PPO that is only $42 dollars a month and even one as low as $26 dollars a month. I'm going to try and apply for those, and if that doesn't work I've made an appointment with CareLink so I'll at least have something to cover me until I get private coverage. So far, so good.

[DaN K. StAnLeY]

Everyone cross your fingers so I don't come down with scabbies soon.

[Rolfe]

Originally Posted by DaN K. StAnLeY

Everyone cross your fingers so I don't come down with scabbies soon.

Hey, good luck with the new venture! Good for you.

Remember the lessons we've learned from this thread.

• Don't put off getting coverage one minute longer than need be. Higher priority than eating if necessary. You just don't know what might happen.
• Go for a high upper limit on the policy, even if it means a large excess (co-pay, is that what you call it?), because it's the big-ticket items that really screw you over.
• Avoid "temporary" policies that won't cover you after a certain date even if you've contracted the illness while the policy was in force.

And good luck again!

Rolfe.

[ponderingturtle]

Originally Posted by Rolfe

Thanks to Aerosolben for your kind words. Honestly, the more I hear about the US healthcare system the more shocked I get. Every time some forum member says something about not having the money to see a doctor or fill a prescription I get a physical shock.

The weirdest part of it all is the cognitive dissonance. So many Americans really honestly believe they have the best, the most superior system in the world. They don't believe you can have a heart-lung transplant or stuff like that on the NHS, whereas of course you can.

I don't get this either. It seems my coworkers are totaly convinced that the care is almost non existant in other countries.

[Rolfe]

It's weird how often I've posted the link to Abigail Hall's heart transplant in these threads, and I have not had a single American poster engage with the issue. This is in well over a year (I first posted it when I read it in the dead-tree paper the day it was published).

Abigail was born with a serious heart defect. She needed a transplant, but the main difficulty was keeping her alive until a suitable donor could be found. She was airlifted in the NHS air ambulance for a transplant, but the donor organ turned out to be unsuitable. She was deteriorating, and the doctors decided to try her on a type of artificial heart developed in Germany which had never before been used successfully on someone with her condition. This was successful enough that it kept her alive until a matching donor was found, at which point she was airlifted to the heart transplant centre, and the operation was successful.

Jerome da Gnome's only comment was that looking at the photo with the article, he didn't think the mother had good dental care.

Dan remarked that the first artificial heart was developed in the USA anyway.

Nobody answered my questions.

1. What more could possibly have been done for Abigail if she'd been an American child? (We're constantly being told how inferior and basic the care we get is, so come on, tell us, what did she miss out on?)
2. If she's been an American child, would she have been guaranteed to get that standard of care, no matter who her parents were?

I still don't have any answers on those questions.

I was struck in that story by the sheer persistence of the medical team. It must have looked as if it was a lost cause, but rather than just bow to the apparently inevitable, they pulled out all the stops and tried an experimental procedure, and hey, it paid off. Now maybe a US team would have done that too. But I hear so many stories about US insurers refusing to pay for procedures because they don't reckon much on the chances of success, that I do wonder.

I was also struck by how much it all must have cost. Abigail's parents were middle-class professionals, the sort of family who would usually have decent insurance cover in the USA, but it still must be a terrible worry. At least all they had to worry about was whether or not their little girl was going to recover. Nobody was trying to put a price on her life. And if her parents had been penniless, she'd have got exactly the same.

I also noticed that the experimental artificial heart that was used was developed in Germany, another country with a universal healthcare system. Medical research goes on. Some government funded, some charity-funded and some funded by drug companies. Just the same as in the USA.

Since I posted about that story, two forum members have told of their own personal experience with similar cases - one even was the patient, many years ago. It goes on all the time. This one only made the paper because of the pioneering technique, not because the standard of care was anything out of the ordinary.

Read also the biography of Sam Galbraith. He was a top brain surgeon, with turned to politics in the later part of his life. He had a heart-lung transplant nearly 20 years ago, and he's still alive. As I said, he was a brain surgeon, and later he was a Member of Parliament. But he got the transplant and the aftercare and so on on the NHS, just the same as anybody else. Because like everybody else, he's entitled to NHS care, and the NHS is the best place to receive such care because that is where the expertise is.

Of course people bitch and moan about the NHS. Nothing that size is ever going to be perfect, or ever going to reach a stage where you can't improve it. And when people are let down because they didn't receive what they were entitled to, they get annoyed, and vocal. But that doesn't mean they'd rather have the sort of healthcare system that exists in the USA. Most of them would rather gnaw off their own arm.

I told earlier about an American friend who was struggling under a heavy burden of chronic illness, but was so happy and grateful to be American because she knew she wouldn't be getting the top-class treatment she was getting if she lived anywhere else. I didn't have the heart to tell her that in Britain she's have got it, and not had to worry for a second where the money was coming from.

You guys need to get out more.

Rolfe.

[ponderingturtle]

Originally Posted by Rolfe

Oh sure, universal healthcare is arguable on totally pramatic grounds. I was just pointing out that far more radical "socialism", such as taking people's land against their will, was already SOP in America.
.

Hell in america we will take your land and give it to someone who will create a higher tax base.

[Rolfe]

Originally Posted by themusicteacher

It also helps to present a few well-placed anecdotes from people who say, "Canada's health care system is awful!"

Funny you should say that. Yesterday a student showed up here for a week's work experience. She happens to be Canadian. I asked her about their healthcare system.

She launched into an impassioned defence of the system, said it was more or less the cat's pyjamas, and that although waiting lists were sometimes a problem, if you were a clinically urgent case you would be bounced to the top immediately.

She said, although her Canadian entitlement card would get her treatment in the USA if she needed it while she was there, she would be back in Canada as fast as she could the minute she needed any healthcare. Because the US system was so incredibly expensive and unreliable.

She also said, you asked me why I chose to study in a foreign country. Well, I did, and here I am. I'm not in the USA. No way would I choose to live in a country without a universal healthcare system, even temporarily.

OK, just one random Canuck who happened to cross my path. But there you go.

Rolfe.

[Rolfe]

I'm not searching the thread for the post to reference, but this is an update on the glucose meter thingy.

We had a poster who had a prescription for a glucose meter, and he told us the pharmacist gave him a choice of meters starting about $20, with the most expensive at $80. If he'd been paying for it himself, he said he'd have picked the one at $40, but because the insurance company was paying he just went for the $80 model. He also said that the strips were stuck on about $1 a pop, but should cost much less given what they were.

He blamed all of this on the insured patients having no sense of value for money, thus there was no commercial incentive to cut prices. This was used as an argument against univeral healthcare, on the grounds that if everyone was getting it for free, nobody would have any incentive to shop for good value.

Of course this is nonsense per se. If patients can do that in the USA, it's the fault of the insurance companies for not mandating that the doctor specify the most cost-effective item. Far from being a problem in universal systems, it just doesn't arise, because the universal healthcare system makes damn sure the doctors prescribe the cheapest option that will satisfy the patient's needs. It's funny how we keep being shown faults in the existing US system, and being told that these are reasons for not having a universal healthcare system - when these faults are demonstrably not present in existing universal systems. Project much?

Anyway, the glucose meters. I'm a bit hazy about why they're so easy to buy in Britain. If you're diabetic here, you get given one that suits you, and you get given the strips, I think 4 per day. Nevertheless the strips are on sale at any pharmacy (it's likely some diabetics want to buy more to supplement their ration), and so are the meters. Of course vets and owners of diabetic animals also buy them, but their sale isn't confined to veterinary outlets.

I'm a vet, and we need one of these things. Don't know why I didn't get it ages ago. I'm going shopping.

I check online. The price varies a bit but it's not hard to find good offers. In the end I bought one on eBay.co.uk for £5.49. That's just over $8 at current exchange rates. For an absolutely state-of-the-art machine that takes only 3 seconds to give a reading. (And it came with 10 strips free as well.)

So now I want a supply of strips to use with it. The normal pack size is 50, and again there are varying prices to be found, with bargains easy to come by. Again, eBay.co.uk comes out cheapest. £7.89 per pack. That's less than 16p each, or about 23 cents. (I admit that postage and packing adds to that a bit, but it's still under 17p or about 25 cents a strip.)

This is the availability for purchase by anyone, in a country with a universal healthcare system. (If I hadn't gone with eBay I'd have paid a little bit more, but there were still actual pharmacy prices not far off that.) I can flat guarantee that whatever you can get these things for on eBay, the NHS is paying less. The purchasing clout that comes with buying for the entire population gets you a pretty sweet discount.

So, in the wonderful world of free-market America, patients are paying $80 for a meter and $1 each for a strip. In the awful commie world of universal healthcare the free market price is $8 for the meter and $0.23 per strip. The central purchasing system which buys for most patients is probably paying even less.

And this is an argument for not having universal healthcare, because it would remove the price competition that brings prices down?



Rolfe.

[DaN K. StAnLeY]

Just wanted to hit this topic again because it looks like things might be changing here in the US. I heard recently that we may be getting some sort of public HC soon and joining the rest of you "godless socialists" in having inefficient medicine. My views on the subject have changed dramatically since i engaged in this discussion with Rolfe (and others). I still believe that the free-market is an awesome thing, but commenting here and having it out with some of you has helped me realize that one ideology may not be the best solution for every problem. Some of the points made in here have also prompted my dad (George Bush/ Free-Market Fan Club President)to start doing more open minded research on the subject. I still don't have health coverage, but it's just because I haven't really been looking. If we do get public coverage i must admit, it would make things easier for me and my business.

Anywho, just checking in. Hello to everyone and I hope you are all happy and healthy.

P.S. Did anyone hear Glen Beck screaming about UHC the other day? Pretty funny stuff

STANLEY OUT!!

[Rolfe]

Originally Posted by DaN K. StAnLeY

Just wanted to hit this topic again because it looks like things might be changing here in the US. I heard recently that we may be getting some sort of public HC soon and joining the rest of you "godless socialists" in having inefficient medicine.

Hey, who are you calling godless? I won't be called a woo by Thaiboxerken only to have you call me godless!

Originally Posted by DaN K. StAnLeY

My views on the subject have changed dramatically since i engaged in this discussion with Rolfe (and others). I still believe that the free-market is an awesome thing, but commenting here and having it out with some of you has helped me realize that one ideology may not be the best solution for every problem.

Well, the funny thing is, you see, that we think we have a free market here as well. Thoroughly capitalist economy. We just use taxation (which you have too) to pay for one more thing than you do! The money still goes around just the same, and the doctors still have their Mercedes and their yachts.

Originally Posted by DaN K. StAnLeY

Some of the points made in here have also prompted my dad (George Bush/ Free-Market Fan Club President)to start doing more open minded research on the subject. I still don't have health coverage, but it's just because I haven't really been looking. If we do get public coverage i must admit, it would make things easier for me and my business.

Seriously, Dan, Obama may be awesome, but even he is not going to deliver universal healthcare to the USA on a platter in ten minutes. It's a huge job and the transition ain't gonna be easy. In the meantime, people will still get sick.

Even young healthy people like you get sick or get hurt sometimes.

Remember the woman at the start of the Stossel film. She gave up her job, with healthcare coverage, to strike out on her own in business. She was more prudent than you're being, but she still ran into trouble. She got sick with a chronic illness during the period when she didn't have appropriate health insurance. It completely ruined her life. The last we saw of her was a woman not going for her follow-up appointments because she was afraid of being told she needed more treatment that would cost money she didn't have.

You are risking the same, only worse (she at least had insurance cover for her initial course of treatment). For goodness sake take some advice and get something sorted out.

(And I say again, this is just one more freedom that we benighted communists have that is denied to the citizens of the great US of A. The freedom to give up our job to do something else, without losing our healthcare coverage.)

Originally Posted by DaN K. StAnLeY

Anywho, just checking in. Hello to everyone and I hope you are all happy and healthy.

P.S. Did anyone hear Glen Beck screaming about UHC the other day? Pretty funny stuff

STANLEY OUT!!

1. Indeed, both, excellently so. (I've just ordered a new car, a peach of a model, which I certainly wouldn't have splashed out on if I had to worry about saving for a possible big-ticket healthcare need in the future.)

2. No. Linky?

3. DON'T WALK AWAY WHEN I'M TALKING TO YOU....!

Rolfe.

[Tsukasa Buddha]

I was actually watching Beck today and he had a libertarian circle jerk with Stossel and Penn Jillette.

Apparently, insurance is itself a bad thing. "If people had food insurance, they would always go gourmet."

... So they want people to pay out of pocket for everything because that would make them consider the value of each test and treatment and be "good" consumers?

[Patrick_R]

Rolfe are we supposed to be turned by anecdotal evidence all by itself? Lots of people will, don't get me wrong, but I don't think any self respecting critical thinker should.

[Patrick_R]

Originally Posted by Tsukasa Buddha

I was actually watching Beck today and he had a libertarian circle jerk with Stossel and Penn Jillette.

Apparently, insurance is itself a bad thing. "If people had food insurance, they would always go gourmet."

... So they want people to pay out of pocket for everything because that would make them consider the value of each test and treatment and be "good" consumers?

You don't get the point. The point is we have a 3rd party payer system. You don't shop for the best priced medical care with the best service. We don't care what it costs. The doctor knows this and he will offer us treatments that we don't actually need, he doesn't care, someone else is paying the bill.

Health insurance, just like universal insurance, will drive up the cost because of this serious flaw.

What they are recommending is something called a health savings account. It is a high deductible insurance policy with a tax free savings account that grows interest over time to help pay medical bills if you need it. This encourages us to price shop and it encourages Doctors to compete on price.

Already we see plastic surgery and animal care competing on price and the prices are not rising anywhere as fast as other forms of human healthcare.

[Patrick_R]

and yes if we had no insurance at all, we'd not only pay out of pocket, but medical bills would be low and we'd have higher income....medical insurance is an untaxable cash benefit. If we didn't get it the company would pay us cash - they don't care how we get the money. It would, of course, be more fair if government didn't tax income and didn't tax sales either... but thats another story.

[David Wong]

The Glenn Beck comment on the subject:

YouTube Video This video is not hosted by the JREF. The JREF can not be held responsible for the suitability or legality of this material. By clicking the link below you agree to view content from an external website.

I AGREE

About as well-reasoned a defense of the American system as anything in this thread. A couple of incorrect examples, and then incoherently shrieked insults.

[oggiesnr]

Originally Posted by Patrick_R

and yes if we had no insurance at all, we'd not only pay out of pocket, but medical bills would be low and we'd have higher income....medical insurance is an untaxable cash benefit. If we didn't get it the company would pay us cash - they don't care how we get the money. It would, of course, be more fair if government didn't tax income and didn't tax sales either... but thats another story.

History proves this wrong. What happens is that people don't get medical care and die younger than they do now.

Suggest you go back and read the whole of this thread and the equally long from earlier this year about socialised medicine.

Steve

[Rolfe]

Have you actually read the thread, Patrick? I would recommend it.

Anecdotes of course have limited value. However, they do serve as examples. The number of "examples" of people being left without healthcare in the USA not because of one-off blunders, but because of obvious deficiencies in the system, is really quite striking. Some of the US anecdotes in this thread describe situations which simply would not happen in a universal system.

I would suggest you check your prejudices in at the door and actually read the thread.

Rolfe.

[Rolfe]

Originally Posted by Patrick_R

and yes if we had no insurance at all, we'd not only pay out of pocket, but medical bills would be low and we'd have higher income.....

Uh, not exactly.

If you had no insurance at all and every medical need was paid out of pocket, expenditure on healthcare would drop like a stone, certainly. But not because brain surgery or a quadruple bypass suddenly becomes as affordable as a Big Mac, but because very few people would actually have these procedures.

Some things are inherently expensive. Major medical and surgical interventions are in that category. The irreducible costs are such as to make even the rock-bottom price completely unaffordable to citizens on relatively low incomes. Nobody sells their product at less than it costs them to provide it - or not for long anyway. And nobody invests ten years of their lives and runs up student debt to the tune of tens of thousands of dollars to earn the sort of wage you can get flipping burgers either.

If you had no insurance, so many people would be priced out of the market that a sizeable chunk of the healthcare industry would simply pack its bags and go away to do something else. And bright, morivated school leavers who might have considered a career in medicine will become bankers instead. Drug companies producing expensive cancer drugs and so on would also take a major hit, as their US sales would go through the floor.

If you had no insurance, you'd have a higher disposable income, sure. And if you never suffer a serious illness you'll have more money. However, if you do suffer a serious illness you'll be bankrupt. Or dead. Probably both, actually, in that order. But think about it a bit longer. Would you really have that higher disposable income? Theoretically, yes. But instead of putting away a bit every month into your insurance plan, knowing (or maybe hoping, I don't like the sound of some of those insurance industry practices) that if you get seriously ill you can draw on that plan for far more money than you ever put into it, you have to think about making provision for paying the entire cost if that happens.

So really, if you had no insurance, and you wanted to be able to pay for major surgery if you happened to need it, you'd probably have to put every penny you can spare into savings. So much for having more money to spend. And too bad for those producing the goods you might have bought otherwise. (Yes, banking is beginning to sound like a really good career choice here....)

While I certainly don't disagree that some sectors of the US healthcare industry are bloated and overcharging, your premise that all essential healthcare can become practically affordable to ordinary citizens is simply nonsense.

Rolfe.

[Rolfe]

Short answer. Effective medical care is expensive. When an expensive need and a low-ish income come together, there are only two options.

• Other people pay for the patient's treatment.
• The patient does not get the treatment.

If the second one is the way you want to go, hell mend you. If you feel you'd rather live in a world where the first option is the popular choice, we're now only talking about the mechanics.

Rolfe.

[Blue Mountain]

Patrick_R, last year's major thread on this topic is here: This is the Government that You Want to Run Health-care? Please take some time to go through it and look at some of the links and studies pointed to from there.

[Rolfe]

Thank you Blue Mountain, that was what I was looking for.

That thread, Patrick, and the previous 780 posts in this one.

And read it carefully, and follow up the important links. Most of us posting here have already done all that, and we're not that keen on starting again from scratch just because you can't be bothered to get up to speed.

Rolfe.

[Cayvmann]

Originally Posted by Rolfe

Oh sure, universal healthcare is arguable on totally pramatic grounds. I was just pointing out that far more radical "socialism", such as taking people's land against their will, was already SOP in America.

The problem seems to be that although the pragmatic arguments are unassailable, the ideological arguments are used to damn the idea. In spite of the fact that, as I said, far more radical socialism is already accepted in other areas. Like someone else said, it would work very well in practice, but we feel it doesn't work in theory.

How do you cope with people who characterise universal healthcare as "these commies want to take my money and use it to get medical treatment for someone else's child, when I need it to get medical treatment for my child!"

That "isn't even wrong", but it's the sort of mindset that keeps coming up.

Rolfe.

It's a matter of who the "socialism" benefits, isn't it? Yay, big business, boo lowly worker who is actually the reason the big business is big ( fascism ). It's really not socialism, if everyone doesn't own everything.

Supporting the 'general welfare' is not in any sense socialism, it's just good for the country and good long range thinking. Glad the founding fathers put it in writing. Those dirty communists ;-)

[ponderingturtle]

Originally Posted by Rolfe

Seriously, Dan, Obama may be awesome, but even he is not going to deliver universal healthcare to the USA on a platter in ten minutes. It's a huge job and the transition ain't gonna be easy. In the meantime, people will still get sick.

There was another point that if we do mannage to reduce costs to a sensible level, we might have issues with all the managerial staff that gets cut.

[jimbob]

Looking through the thread I hadn't seen this covered fully:

Originally Posted by Ivor the Engineer

Originally Posted by Tim Moen

I agree with you. I don't recognize the validity of corporations to exist. You can't create a limited liability entity that allows individuals to absolve themselves of accountability. This is no different than creating an imaginary friend to take the blame when things go wrong.... no good can come of this. I wouldn't consider it private healthcare if corporations were involved.

I think in a free market I would pay more to see physicians who had the highest cure rates. Physicians should be able to maximize their profits, this would drive the incentive to cure higher and higher.

This is la la land thinking. Modern healthcare (and every other technology) requires more knowledge, ability and technology than any one physician (or engineer or scientist) could possess.

My back of envelope calculations from a previous thread:

Look at the cost of supporting infrastructure...

Originally Posted by jimbob

Bump for Jerome...

Originally Posted by jimbob

The details please.

Will a general hospital in a large prosperous city magically be built on land that is cheap? If not how will the capital cost of a general hospital be reduced?

Will a 5-hour surgery not require a surgeon, anaesthetist, and supporting nurses? Will surgery currently requiring 5-hours in theatre, suddenly need less time?

Will the surgeon and anaesthetist spend a greatrer proportion of their working time in theatre? (Actually my rough calculation, completely unrealistically assumed that they spent 100% of their time in theatre). If this time is to be maximised by the free-market, how?

Aside: Does anyone have any figures for what proportion of a general surgeon's work is actually in theatre?

Will the general surgeon, and anaesthetist accept lower wages, when their skills are still in demand?

Will the capital cost of the theatre be reduced? If so, how? Will it be depreciated over a longer time?

Why would the cost of medical equipment be reduced?

I have already asked these questions, or simlar ones, and your answers seem to say that you accept my calculations but in later posts deny their validity, why:

Quote:

Originally Posted by JEROME DA GNOME
Quote:

Quote:

Originally Posted by jimbob
Any specific examples?

The current problems in the American health-care system.

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In a deregulated market, will economies of scale suddenly vanish?

Nope.

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Will the capital cost and depreciation of medical equipmens suddenly reduse?

Nope.

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Will medical treatment and diagnosis suddenly not need highly qualified workers? Will highly qualified workers, in a field where there is demand for their services suddenly not command high wages?

Nope and nope.

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Will large hospitals not be needed, or will the capital cost of the hospital also not need to be covered? Will the land value of new hospitals vanish.

Nope and nope.

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Without regulation, how do you protect against cartels?

Why should I protect against cartels?

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Where are the costs going to be reduced. With specific examples (other than the free market pixie).

ETA: Here are my detailed calculations, hidden for brevity,

Please tell me which parts are not estimating the lowest plausible cost:

But they wouldn't make any money in selling inherently expensive treatment at below cost.

According to this the median net worth of a renting household was $4k in 2004 (if I am reading the data correctly)

How could a household with a net worth of that actually pay any more than $4k for anything? Especially as they are likely to be poor credit risks, so borrowiong the money would be difficult.

Can we get the coronary healthcare cost below $4k?

5-hour bypass surgery: General surgeon with less than 1-year experience, $170k, Anaesthetist , less than 1-year experience, median salary $145k.

Both work 60 hour weeks for 50 weeks a year. This means that their combined equivalent hourly rate is $105/hour.

Now they are not performing surgery all of that time, so the actual money that the they are paid as an hourly rate whilst in theatre has to be higher.

As well as the two highly-skilled doctors, you need support staff, (in one photo, the team seemed to be four people), so that makes two other wages that need paying directly during the surgery.

You also need to pay for the use of the theatre, and expensive equipment, say $3million, depreciated over 5-years, when the equipment is in yse 52 weeks per year, gives a theatre cost of $11.5k/week. Now the theatre can't be in use all this time, there has to be preparation, so (generously) we could also assume a 60-hour week for the theatre, which gives $190/hour just for the theatre. Actually it will cost a lot more than this, but I am making a conservative point.

So far just taking the cost of the theatre depreciation and the salaries of the surgeon and anaesthetist, both at the bottom of their respective pay scales, and both working 60-hr weeks in theatre, we get to $295/hour, or $14745 for the five-hour surgery.

You could probably double this for more realistic utilisation rates.

You now need to add in the cost of the other two team members, and of the provision of facilities, and of the proportion of the hospital capital cost that is being depreciated (say over 30 years), and the cost of the bed and accomodation over (three days) stay inhospital.

It soon costs more than the $4k that these people have.


Rolfe works in a free-market system providing medical care to animals, so I will ask him this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

And as to this argument:

Originally Posted by Darat

Originally Posted by ponderingturtle

It is because americians are signularly incompetent at managing systems.

...snip...

Well I used to say that was obviously absolute codswallop given the size and success of USA corporations but....

I know US anti UHC proponents have actually argued this...

To which I reply "British Railways...." We have a fine ability to cock up major projects, but the NHS still works far better than the US system.

[jimbob]

Originally Posted by Toke

Yes I know that one, and it leads to/requires the incompetent goverment belief.

I am just wondering if there are any objective measure of goverment/public administration competence.

I don't know, but Italy has a betterinfant mortality rate than the US accorging to google...

It isn't usualy considered an exemplar of efficient and uncorrupt government....

[jimbob]

Originally Posted by Rolfe

Mark Corrigan tells us a personal story not entirely dissimilar to Abigail's. I haven't ever had an answer about whether there's any possible care Abigail might have received if she'd been a US citizen instead of a little Scottish girl. Or whether Abigail would have been guaranteed to receive that care if her parents had been American, even if they'd been on a low income or unemployed.




Dan, would you explain the mechanisms through which this outcome could have been achieved in the US?




My God, I might be going to say something I'd regret here. Not much difference????? This is a staggering 28% higher infant mortality in the USA. I honestly had no idea. Given that there is inevitably an irreducible number of neonatal deaths that no amount of care can save, this is absolutely appalling.

One extra death for every 730 live births.

Sorry, I have to go away and calm down for a bit.

Rolfe.

Then there is the analysis that about a quarter of the differfence in adult life expectance can be attributed to firearms, which is a lot butstill leaves 75% unaccounted for...

Originally Posted by jimbob

Originally Posted by JEROME DA GNOME

Originally Posted by jimbob

I have found one estimation, in what seems like an appropriate journal.

Thank for for your research.

"The United States thus suffers from a life expectancy gap of 1.7 years."

Now add 1.7 years to your previous stats and tell me were we are.



Keep in mind that this is only one factor to be considered.

"These deaths account for 26.86 percent of the U.S. males' excess mortality when compared to peer nations, and 8.7 percent of the racial gap between black and white males in the United States."

So, yes Jerome, it is significant, but only explains about a quarter of the difference between the US and the other thirty-four other richest countries.


In fact I am surprised at the magnitude of the effect, but it still leaves 74% unexplained by gun-deaths.

[MysteryMammal]

Originally Posted by DaN K. StAnLeY

Sure they are different. I don't think they are tottally irrelevant just because you say so. There are plenty of other government run organizations here that perform poorly, would you like a list?

I will point out how 20/20man's analogy of "Food Insurance" is faulty for you:

He said something to the effect of "With food insurance, I'll get steak. Heck, I'll just get everything."

Wrong, unless "food insurance" is going to run in a completely different way than health insurance. With health insurance you don't get to say "Doc, my knee hurts, I want a CT, MRI, PET and throw in some additional, old fashioned X-rays for good measure." Well, you can... if you don't mind footing the bill. Your health insurance company will refuse to pay for certain things they deem unneeded. This becomes even more evident when you go to fill an Rx. With "food insurance" you may wind up going to the grocery store more often, but you'll be returning home with a bottle of Boone's Farm and that horrible 70/30 ground beef, not a $300 bottle of whatever wine and filet mignon.

Also, I'd like to point out the whole "competition drives the drug innovations" point that amounted to "ZOMG! Look at all the drugs on the market!" Yes, that's a metric crap-ton of drugs on the market. Look at buproprion. Or should I say Wellbutrin? Or Zyban? Should I add an XL to the name? SR? XR? Also, look at the amount of medications on the market that are really just a combination of two existing medications. I'm a big fan of Co-Tylenol myself. All the painkilling benefits of codeine with an OTC that has never relieved any pain I've had. But if I ever break my arm again and have a fever at the same time, that Tylenol in there might be of some actual use.

Face it, 20/20boy solved nothing, threw out some stupid arguments, but may have made some valid points somewhere along the line... I just couldn't find them because I was too busy dwelling on stupid analogies like "Food Insurance."

[Rolfe]

Well, insurance is all about spreading risk. It's appropriate when we know some people will be left with big liabilities but others (probably most people) won't. Like house fires or burglaries or even bad car smashes.

So we make a deal. We'll all pay in a share of the likely total cost for the group, plus admin, and then that pot of money will be used to pay the liabilities of the minority who strike it unlucky. It works, because even those who pay in and get nothing back, like the security of knowing that if they did turn out to be the unlucky ones, they wouldn't have to worry.

So how does that work with this hypothetical food insurance? Everybody needs to eat. There's no asymmetry of risk. There will be no happy, lucky contributors who won't need to claim any benefits - the first, most essential component of any insurance scheme. Why pay into a common pot, plus admin, when everybody's needs are going to be about the same anyway? Might as well save the admin and just pay your way.

But supposing Stossel's daft plan did get implemented? All contributors are entitled to go to the supermarket and stock up on whatever luxury items take their fancy. The total cost, plus admin, still has to be covered by the premiums. Everyone would simply be paying through the nose for it - indeed, because that pesky admin won't go away, paying more than if they'd just coughed up at the till in the first place.

This is so damn obvious from the get-go, it's both why no such plan would ever be mooted, and why nobody would join it if it was. They'd take one look at the premiums and politely decline.

And if the scheme ever did get going, in some bizarre parallel universe, would the grocers immediately rub their hands and put up their prices? Might not be so easy. If Tesco does that, Sainsbury's is on to a good thing by keeping prices reasonable. Unless the "insurance company" was stupid enough not to mandate the use of the cheaper store. Even if prices did go up, all that would happen is that the premiums would rise in proportion.

It's completely insane. As an analogy it doesn't even get off the ground. Food, where everyone has similar and predictable needs, simply isn't suited to such an insurance system. As anyone with two neurones to rub together should surely see. And you can call it "universal food service" instead of insurance and it's exactly the same. It isn't even a starter without asymmetry of risk, and whatever you do, the premiums must cover the outgoings plus the admin, and you have to administer the scheme to stay in budget.

I'm quite disturbed by the number of people who are prepared to parrot this nonsense uncritically, without even noticing the falseness of the analogy. I can't decide if Stossel and his like, the people disseminating it who should have thought it through, are just idealogues and too stupid to notice, or manipulative and agenda-driven, and just hoping that most of the audience won't notice.

Rolfe.

[Chaos]

Originally Posted by Rolfe

Well, insurance is all about spreading risk.

Indeed. If that Stossel moron doesn´t even understand that, well... that doesn´t really make him any dumber than other "free market" folks I could name.

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And if the scheme ever did get going, in some bizarre parallel universe, would the grocers immediately rub their hands and put up their prices? Might not be so easy. If Tesco does that, Sainsbury's is on to a good thing by keeping prices reasonable. Unless the "insurance company" was stupid enough not to mandate the use of the cheaper store. Even if prices did go up, all that would happen is that the premiums would rise in proportion.

Actually, in that scenario Tesco is going to offer something somewhat fancier for a ridiculously inflated price. Since price is no longer a disincentive for getting something, insured folks will flock to its stores.

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It's completely insane. As an analogy it doesn't even get off the ground. Food, where everyone has similar and predictable needs, simply isn't suited to such an insurance system. As anyone with two neurones to rub together should surely see.

I think you nailed it here. "Anyone with two neurones to rub together", indeed. Those without them come to different, entirely predictable conclusions.

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I'm quite disturbed by the number of people who are prepared to parrot this nonsense uncritically, without even noticing the falseness of the analogy. I can't decide if Stossel and his like, the people disseminating it who should have thought it through, are just idealogues and too stupid to notice, or manipulative and agenda-driven, and just hoping that most of the audience won't notice.

Rolfe.

Makes you wonder, doesn´t it? We´ve noticed in other threads that libertarians seem to assume they´re the ones on top in the hellholes their ideology will create if implemented. Maybe Stossel pictures himself as the one pocketing the profit his food insurance makes?

[YoPopa]

Originally Posted by Rolfe

But supposing Stossel's daft plan did get implemented? .....
snip......
It's completely insane. As an analogy it doesn't even get off the ground. Food, where everyone has similar and predictable needs, simply isn't suited to such an insurance system.

You've missed the point entirely Rolfe. Stossel's point was that food insurance would be a daft plan. Finding the flaws is what he wants you to do. You succeeded in finding the flaws, good for you.

As an analogy it does work quite well. There are a great many things about health care which are predictable. In my case these include the fact that I get a check-up once per year. I also take three prescription medicines currently and expect that in a few more years that will increase by one or two based on my family history.

Does it really make good economic sense for me to pay an insurance company so that the insurance company can pay those expenses which I know for a fact are going to occur? Or can I cut out the middleman and shop around for the best value buying direct from the provider with the best price/service/quality? The insurance company, whether it is public or private is an expensive middle man for these predictable costs.

There is significant risk in some aspects of health care and Stossel acknowledges that fact. This is a good reason for carrying catastrophic health insurance for those risks and Stossel knows it.

"Bad car smashes" are a good analogy to catastrophic health problems. Oil changes are not.