Goodbye to US HealthCare?

[Jim Nickerson]

Re: Goodbye to US HealthCare?

fascism is really a form of socialism, and this is what the present situation is about. A giant increase in government grabbing power and control over a huge part of the economy.

There is no constitutional authority for this.

And it is wrong because it is coercive.

But that debate is long over for most folks. They are fine with the government controlling 45% of the US economy today and maybe 55% after this facsist health care law passes.

What is disappointing is that on a site like iTulip, people do not recognize the over arching superiority of liberty and freedom when it comes to things like the ability to choose your own health care.

This is why theory is important. If you understand the theory of a free market, you realize that there are two ways to achieve something: by contract, with two parties both better off after the bargain than before, or by political means, with one party coerced and compelled unwillingly.

More and more decisions are done by political means and we are all poorer because of it. What applies in the FIRE economy also applies in the health care realm. A few people who are politically on top get very rich and the rest of us sink deeper.

First, I realize arguing with an ideologue is a waste of time, so, grapejelly, I am not arguing with you, but rather opining a different perspective for anyone wishing to read it.

As I understand it, right now there is a huge part of the economy that has grabbed power over most all of the population of the US, i.e. that is fee for service health care providers, hospitals, health insurance companies, drug and device companies. Being able to choose which insurance policy one buys does nothing to deal with the actual problem.

grapejelly, may be correct here. Denninger recently made the point that the government constitutionally can tax people, but has no authority to make individuals buy particular products or services (I think that is what he contended).

If my mother were dying in New York and I am in Fort Worth, then in a desire to be at her side, I could fly first or second class on perhaps four or five airlines, I could take a train in day coach or Pullman, I could take an express bus or one that wasn't, I could drive, I could hitchhike, I could run, I could walk. All sorts of choices would be available, but the last three would be inadequate solutions, and depending upon time the same is true in lesser degrees going backwards in the choices to flying. For the most adequate choice, I must have the financial ability to fly. So there are all sorts of choices possible, but they may not all be available. Now that is about as simplistic an example as I can come up with right now. In order to make what might be a suitable or good choice, I must have whatever amount of money the provider deems necessary. With no money, or even inadequate money, the poorer is the solution I seek.

If the simplicity of my example is quantified as one, then the complexity of the health care dilemma in this country is perhaps a 1000 or even a million on that scale. I absolutely am not smart enough and far, far from informed enough to know what is the solution, and there is no one else, yet, I've crossed on iTulip, or on other sites, who individually seems to have anything approaching the best answer, or in many cases even a better answer; more importantly most people opining solutions don't come close to comprehending the scope and complexity of the problems. Who does comprehend it? My guess is some outfit like Kaiser-Permamente or some group at Harvard who has had the funding and diligence to study the problem.

Recognizing that supposedly intelligent people can disagree on a lot of things, there should be some commonality in recognizing that the current system cannot continue.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

... there should be some commonality in recognizing that the current system cannot continue.

We agree on that much, Jim.

What some of us disagree on is whether there is any reasonable possibility that the current government can improve things, or just make them worse.

[lurker]

Re: Goodbye to US HealthCare?

What some of us disagree on is whether there is any reasonable possibility that the current government can improve things, or just make them worse.

Isnt' that tantamount to saying that Americans are less able to form a functioning government than practically every other major industrialized nation.

I suppose that's a form of exceptionalism :eek:

[cindykimlisa]

Re: Goodbye to US HealthCare?

I've ceased borrowing money. I no longer care what my credit rating is.

I will not voluntarilly contract with you or any other doctor for medical services for which I cannot pay. I purchase only what I can pay for, or drop dead.

Is that a fair deal in your view?

Sounds like a great philosophy Cow

But, not true.

There may come a time when the State is forced by law to make decisions for you and then somebody like me is going to have to pay for your broken plan!

Cindy

[Jim Nickerson]

Re: Goodbye to US HealthCare?

We agree on that much, Jim.

What some of us disagree on is whether there is any reasonable possibility that the current government can improve things, or just make them worse.

One can take take the position that there is no possible solution except continuation of the status quo until it (unchecked cost of health care) implodes, or assuming some possible extant intelligence in this country between the President, the national elected representatives and the voters, then even incipient wisdom strongly suggests a better solution should be sought. Now I am open as to who or what can provide some sort of an answer that works to solve the problem for the country except the government, and do not come back with any of this goddammed capitalistic, free-market economics bullshit.

There is no capitalism in the practice of health care by those who provide services. There is a bit in insurance companies' abilities to bargain with hospitals and providers, but there is nothing of which I am aware that is truly competitive with commercial insurance companies that skim 25-30%? away from paying for services. The insurance industry regarding health care involves too much denial, deception in the products it markets. Drug companies are said to have already made one bargain or another with government regarding what the government will or will not do to get the best possible prices.

If government cannot come up with improvement in the system, then it surely will not occur as an act of nature.

And, PC, you are a wild hare, in my opinion, with regard to what you see as the best answer for yourself. That is fine, but I don't think your personal answer has any national applicability.

[tree]

Re: Goodbye to US HealthCare?

If members of Congress had to procure their own health coverage in the individual policy market or had to pay cash for their own medical care, we would quickly have single payer health insurance and price controls.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

There may come a time when the State is forced by law to make decisions for you and then somebody like me is going to have to pay for your broken plan!

Netting it out, I'm less of a burden to my fellow citizens, not more.

In other words, any possible action or inaction I might take will for some plausible scenario be less than ideal.

One must choose by what is best on average for oneself and for society, not by rejecting all options that can in some situations be suboptimal.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

And, PC, you are a wild hare, in my opinion, with regard to what you see as the best answer for yourself. That is fine, but I don't think your personal answer has any national applicability.

Agreed. We might disagree on the reason this is so (I would say that the federal government is too corrupt to have a chance of applying such an answer; you might say that such an answer would be wrong for the nation) but I agree with your conclusion.

[Jim Nickerson]

Re: Goodbye to US HealthCare?

If members of Congress had to procure their own health coverage in the individual policy market or had to pay cash for their own medical care, we would quickly have single payer health insurance and price controls.

That brings to mind my thought that if men had to interrupt their lives with carrying a fetus around for nine months, there would be no issue of whether or not birth control measures were available including first trimester abortions.

tree, you are correct, the congress should have the same health care coverage as the average worker and non worker in the US has, though many are or will become millionaires before they might get seriously ill.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

Sounds like a great philosophy Cow

But, not true.

Or, in other words, the passage by the government of corrupt laws does not morally obligate me to perform harmful acts.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

If members of Congress had to procure their own health coverage in the individual policy market or had to pay cash for their own medical care, we would quickly have single payer health insurance and price controls.

Emotionally, I might agree with you out of spite -- the d*mn congress critters should be reduced to the sad state of medical care and funding therefore that the rest of us have.

Idealistially, I might agree with you in the Marxist sense that we should all receive from society according to our needs, without regard to class, power or wealth, including the high quality of health care and generous funding for such that Congressmen presumably receive.

Either way, I'd be wrong. Some will always have more than others of whatever is desirable. Efforts to completely remove inequalities of any such substantial kind can only serve to justify increased tyranny. Excessive inequalities are a symptom of a sick society, but proper remedies require as usual going beyond the symptom to a proper understanding of the cause and mechanisms.

[c1ue]

Re: Goodbye to US HealthCare?

you are not seeing that we have a 40% free market in health care already, and this is NOT a free market so how can you draw conclusions from it?

I must disagree - in the 3rd world there are plenty of examples of 100% free market health care systems.

And in every single case, the lot of the average person is much worse off than even the ugliest proto-communist state. Well, maybe not North Korea.

To say that the American system doesn't work well because it isn't completely a free market is a copout.

The loop works as follows: The present system doesn't work - it isn't fully free. A fully free system isn't possible because it is corrupt.

Therefore what? Unlike some other issues there is very much a problem.

I completely understand the desire to reduce the corrupted influence of at least parts of the federal government.

But it is ridiculous to lump all efforts as being unworthy due to this reason; if indeed the government is unreformable and irredeemable, the only alternatives are revolution or flight.

[Jim Nickerson]

Re: Goodbye to US HealthCare?

Agreed. We might disagree on the reason this is so (I would say that the federal government is too corrupt to have a chance of applying such an answer; you might say that such an answer would be wrong for the nation) but I agree with your conclusion.

Brings to mind my detached early opinion that the health care plan passed in the house was more good than bad, until someone put up Kucinich's explanation (somewhere earlier in this thread) as to why he voted against it (substantive versus political). Meanwhile my congresswoman, Kay Granger Rep., sent out a link to the 2000 page document in what I took as her "reason" for not supporting it. I surmised that perhaps the Republicans in this instance might have made the best decision, but in all likelihood for the wrong reasons (political versus substantive).

PC, you didn't offer up an alternative solution to solve the problem. Mine is the same as tree's: nationalize the whole system and control prices.

A couple of random thoughts, perhaps related or not. Almost 35 years ago I was out drinking and dining with some doctors, MD's and dentists, and wives and one physician got into to telling me why he had given up internal medicine (trained a Vanderbilt as I recall) after "practicing" it for two years and went back and did three more years to become trained in anesthesiology. The reason he said was that ~70% of the people he encountered he had no idea as to what was wrong with them, and that it was totally unfulfilling. Now such a conversation, I think, qualifies as "insider information," and I have noted long before that few of us really ever know much in the way of insider information, except occasionally from within our own bailiwicks.

Entitlement. How much ranting do I read here and elsewhere about the "evils" of entitlement? In my opinion, a highly relevant sense of "entitlement" exists in health care providers. They are generally smarter than average, worked hard to get the grades to get into professional schools (though I have noted a German professor from college telling me 25 years after I took German that cheating was much more common among those in premed than those in pre-dental), may or may not have worked as hard once in such schools because seldom do schools flunk out "cash cows," spend time doing residencies generally at reduced salaries (reduced from what would depend), and then expect society to remunerate their attainments based to some degree on the fact of attainment vs. what the quality level of practice might be. That is true, I believe, despite many schools being supported by tax revenues and federal grants--suggesting that we doctors did not entirely get educated at our own expense (certainly true in my case). Good doctors are due some higher level of earnings, but I have never been convinced that it should be the doctors who largely determine the level of such earnings.

Doctors are not necessarily paid on what they produce or the quality of their product. Generally who is to judge the outcome? Take the internist/anesthesiologist above, if even 50% of what he saw was undiagnosable by him, can one argue that he earned whatever he charged for encountering the patient (he never related to me that he didn't charge such patients; he might not have charged them, but I doubt it). Fees I believe are largely determined by providers based on the provider's perception of what his/her time is worth to him/her. There is not necessarily any relationship of what is charged vs. what is of value that may be received by whoever is paying a medical bill. Conceptually that might seemingly be more related to medical vs. surgical encounters. If you get an operation, there is no doubt but that you got an operation. In instances there can be doubt with regard to actual need of some operations or if perceived benefit from some operations is indeed the result of the operation vs. other explanations (thus the value of hard-to-come-by studies involving sham operations).



I have no idea as to the possible correctness of the above data, anybody wanting a reference to it, tell me and I'll come back with it.

Take radiologists above, there is no breakdown into those who are interventionists vs. those who may limit themselves to just obtaining and interpreting studies. The former probably should make a bit more. Consider you get a chest x-ray, the doctor gets to charge for it which is fair, sends a report to which ever doctor ordered it. Ordering doctor sits down with patient and discusses finding within his ability to do so--it seems to me there is some form of double charging within this mechanism. Same with pathologists report of patient's specimen, then another doctor discussing the implications with the patient.

An anecdote. Wife went to dermatologist with small leg lesion (her question was it an basal cell carcinoma or not). Dermatologist does new patient encounter, says he doesn't know what the lesion is, but can name a lot of "might be's." Excises it, pathologist can't be sure, but names two "might-be's." Dermatologist sees wife back and removes stitches, and discussed the "might-be's," and refers her to rheumatologist who develops his own list of "might-be's." To rule in or out all of the last possibilities, suggest wife might do more x-rays, chest, CT scan of chest. Wife got chest x-ray, negative. No CT. Lesion on leg healed, wife says "bad scar." I say not that bad. I'm too lazy to go get the costs of all this, but if anyone seriously interested, I might come back with it. IMO, the was not much positive benefit to costs.

Another anecdote. For reasons too long to explain, I had a very expensive abdominal CT angiogram done by two technicians on a new generation CT. Also had bilateral carotid artery doppler studies by a trained nurse technician. Doctor's office, a nurse, called a few days after the reports of these studies were, I assume, actually read by the doctor, and she said they were okay, and that I did not need to see the doctor back. I requested and received the reports, and I can tell you they were not normal, how abnormal compared to similar studies that might be "very abnormal," I have no idea. Other than confirming that I did not have an abdominal aortic aneurysm, of which there had been no hint from the clinical examination of my skinny belly, there was no benefit to me from receiving the studies, though surely in the hands of a serious doctor, something of benefit to me could have come from a return visit and discussion of the pertinence or lack of pertinence to some noted abnormal finding in the studies.

If under whatever payment scheme anyone is happy with his doctor and results, it is possible that the doctor is one of the country's finest and the results are related, just as well something to the contrary could be true, good result and a doctor that is mediocre at best vs. undesired outcome and in actuality a very good doctor--the deeper problem there is no way a layman actually knows on average of WTF is happening or why or what the services are actually worth.

[Ghent12]

Re: Goodbye to US HealthCare?

The over-arching superiority of liberty and freedom to choose your own health care so far has resulted in twice or more the annual cost per capita vs. anywhere in the world with poorer results.

The superiority has also resulted in 10% or more of the population uninsured.

The superiority of liberty and freedom also has enshrined a Medicare system in which costs are rising many multiple times the rate of revenue increases.

So, please enlighten me on the superiority. I am not seeing it.

If you think that we have a free market in health care now, what would you call the "optional" health care industry (i.e. cosmetic surgery)? Is that a super-free market?

[Orforded]

Re: Goodbye to US HealthCare?

I don't know what all the arguement is about. In 10 maybe 20 years China will be telling us what kind of health care system it will allow us to have.