Health Care Reform in the US

[Inquartata]

Originally Posted by jeff

Apparently you're wrong http://www.straightdope.com/columns/...e-floes-to-die

The infamous Wiki reply!

http://en.wikipedia.org/wiki/Inuit

A different source:

http://www.crystalinks.com/inuit.html

That one says that elders sometimes "chose or were convinced to choose" suicide in extreme times.

Interestingly, my Googling brought up a large number of sites alleging that Canadian Inuit populations currently suffer from very high suicide rates. I wonder whether this is the result of their status and treatment in white society, or whether it might have historical and cultural roots?

Ah, well. Don't let me sidetrack the main debate. I take your point...


But PS, how well do these high suicide statistics speak for Canada's vaunted universal health care system?

[Inquartata]

Originally Posted by jeff

You do recall we live in a republic, not a direct democracy, right? We already had the vote, and the candidate who wanted to put in universal healthcare was elected.

Wait...so you are arguing that whatever an elected official does, we must have wanted or we wouldn't have voted him into office? The worst sorts of pork-barrel spending, his efforts to secure pay raises for himself, whatever it may be, we shouldn't complain because by electing him we gave tacit approval for it?

So I guess we all wanted torture and wire-tapping because we elected Bush twice? We wanted the Vietnam War when we voted for Kennedy and Johnson? ( I use the term "we" historically in that case. )

I mean, I see what you're saying, but still, I look askance at the idea that when an elected official votes for something it's the same as the public "wanting" that thing.

It doesn't work just fine, as has been observed by parties on every side of the political spectrum (the disagreement is what to do about it, not that we have a working 'just fine" system.)

So, all the millions of people who go to their practitioners every day and have it paid for by their insurers---that's a sign that the system doesn't work?

I think that you have an excessive idea of what "broken" means, my friend! Just because X works less efficiently than Y doesn't mean that X doesn't work at all, or even that it doesn't work satisfactorily! Just because a Yugo isn't a Lexus or even a Camry doesn't mean that it won't get you wherever you need to go...

We have the "pay MUCH more than comparable 1st world countries while still having far worse health" for starters.

Maybe yes, maybe no. Before we can make that determination, we have to know how they calculate GDP, what sort of things are excluded and how others are treated, etc. National accountancy is not a consistent science.

Even if it were, and we were guaranteed that, say, 8% of per capita GDP for France was exactly the same as 8% of per capita GDP for the US, there is still the time dimension I mentioned yesterday. If in 20 years France is expending 12% on health care due to demographic trends and the US is only paying 8%, will that then mean that the US system is better than the French system? Will everyone reverse their positions on the comparative worth of the two systems? I am dubious...

What it does prove is that there are extremely expensive parts of healthcare that have nothing to do with government "interference", and could be eliminated by changes in procedures.

Again, do you think that the makers of these devices are free from government regulation and reporting requirements and testing and marketing standards and all of the practices which impose costs upon them? If not, I do not see why you think that the prices of the goods they produce are somehow independent of the costs of producing them...

The government does not mandate the use of it, it's entirely discretionary.

This does not establish that the expensive nature of those items "have nothing to do with government interference", though. It establishes something, I'm not sure what, but surely not that government regulation does not raise the cost of health care...

And now I'm off to fencing. Anon.

[jeff]

Originally Posted by Inquartata

Sir, have you tried the Soylent Green? The chef says it's fresh today.

And Welcome to the Monkey House, and the "ethical suicide parlors."! Or Blade Runner. Odd how SF often has dystopias where the old get offed. Not the part of SF I particularly enjoy.

[jeff]

Originally Posted by Inquartata

Ah, well. Don't let me sidetrack the main debate. I take your point...

So many tangents, so little time

Originally Posted by Inquartata

But PS, how well do these high suicide statistics speak for Canada's vaunted universal health care system?

I dunno. Don't we have the same thing for Inuit in USA? Not to mention high alcoholism and early deaths among native Americans on both sides of the border. Seems like a really tough problem to solve.

[jeff]

Originally Posted by Inquartata

Wait...so you are arguing that whatever an elected official does, we must have wanted or we wouldn't have voted him into office? The worst sorts of pork-barrel spending, his efforts to secure pay raises for himself, whatever it may be, we shouldn't complain because by electing him we gave tacit approval for it?

So I guess we all wanted torture and wire-tapping because we elected Bush twice? We wanted the Vietnam War when we voted for Kennedy and Johnson? ( I use the term "we" historically in that case. )

I mean, I see what you're saying, but still, I look askance at the idea that when an elected official votes for something it's the same as the public "wanting" that thing.

I'm saying that when an elected official does something that was an explicitly expressed and major part of his campaign, then it indeed does reflect the people's will. That's a different proposition from the way you state it "whatever an elected official does". Though frankly, that's what the prior administration did do when it claimed a mandate for domestic and foreign policies. Bush and Cheney were explicit about that, eg: voting for them was the mandate to remake or end Social Security as they attempted in their first years.

I think we're on the same track - there's the possibility of unjustified overreach. But in this case Obama campaigned with emphasis on this very issue. It's hard to say that it's not a representation of the People's will.

Originally Posted by Inquartata

So, all the millions of people who go to their practitioners every day and have it paid for by their insurers---that's a sign that the system doesn't work?

I think that you have an excessive idea of what "broken" means, my friend! Just because X works less efficiently than Y doesn't mean that X doesn't work at all, or even that it doesn't work satisfactorily! Just because a Yugo isn't a Lexus or even a Camry doesn't mean that it won't get you wherever you need to go...

Whence cometh this "broken"? You said "I think it works just fine". I said it does not "work just fine". You respond to a claim I did not make! Lets go off on and see which pols (or anyone else) think that health care works just fine.

Hey! You didn't respond to a point I did make, about the mistaken claim that "baseline assumption that universal health care" involves the indefinite repeal of the laws of supply and demand. Were that the case then those countries would be expending vastly more on health care, but they don't. Therefore that line of reasoning is incorrect. QED.

Originally Posted by Inquartata

Maybe yes, maybe no. Before we can make that determination, we have to know how they calculate GDP, what sort of things are excluded and how others are treated, etc. National accountancy is not a consistent science.

Even if it were, and we were guaranteed that, say, 8% of per capita GDP for France was exactly the same as 8% of per capita GDP for the US, there is still the time dimension I mentioned yesterday. If in 20 years France is expending 12% on health care due to demographic trends and the US is only paying 8%, will that then mean that the US system is better than the French system? Will everyone reverse their positions on the comparative worth of the two systems? I am dubious...

This is quite a new tack - to say that GDP figures for different countries are not comparable. Such comparisons appear all the time in economic papers and the press. For years we've accepted such comparisons as parts of our debates. If we're going to depart from such well-established practice, then I'm going to have to ask you to provide some justification rather than just say "well we can't compare the costs after all".

That said - if in 20 years we're paying less and living longer and better, then I sure as heck will reverse my position on the relative merits of the two systems. As said by John Maynard Keynes: “When the facts change, I change my mind – what do you do, sir?” And I'd be delighted to have the opportunity.

In the meantime, countries like Japan, Germany, Italy and Scandinavian states already have older populations and are facing our future demographic challenge today. Why then do they still spend less on health care than we do despite being disadvantaged in that way. Clearly there is something systematic in their approach that is less expensive despite older populations.

Originally Posted by Inquartata

Again, do you think that the makers of these devices are free from government regulation and reporting requirements and testing and marketing standards and all of the practices which impose costs upon them? If not, I do not see why you think that the prices of the goods they produce are somehow independent of the costs of producing them...

Let's go back to your Yugo and Lexus. Both are subject to the same regulations. One costs much more than the other. The same applies here. One surgical device is very expensive, the other is not. If you wish to claim that a Lexus is more expensive than a Yugo because of government regulation feel free to provide evidence to support that.

I'm sorry, but this is just a red herring. The devices in question are more or less expensive due to the intellectual property to create them and the cost to manufacture them, not because the government makes it so. And the reason for their costs isn't the question, but rather the wasteful use of expensive equipment when less expensive would have done the same job.

Originally Posted by Inquartata

This does not establish that the expensive nature of those items "have nothing to do with government interference", though. It establishes something, I'm not sure what, but surely not that government regulation does not raise the cost of health care...

And now I'm off to fencing. Anon.

I answered that in the previous section. If government regulation raises the cost of health care it does not do so in this instance, which is purely an example of voluntary selection by practitioners to use extremely expensive equipment.

I fenced this morning. Boy oh boy, is sabre different now than the Old Days.

[Sins of the Fleche]

I read in the newspaper (before anyone asks, the Raleigh News & Observer) today that Obama has suggested making cuts to Medicare and Medicaid as part of an effort to trim cost from the healthcare reform bill and ease its passage.

Now, this seems to me to be a counter-intuitive move. The government, in an effort to provide coverage to the uninsured, is going to slash the budgets of the already ailing Medicare and Medicaid programs, leaving those with them with an increasingly worthless plan.

Also, I've worked in outpatient clinics and a hosptial ER. Don't try to tell me that Medicare and Medicaid cover all, or even most, medical procedures or visits, or that they "can take the hit." They don't, and oftentimes, the unpaid portions of the bill are passed on to the patient or the hospital/physician has to simply forgive the debt.

Thoughts?

[I_luv_saber]

Originally Posted by Inquartata

There are supports groups for diseases which are called rare by medical science. You'll have to do better than that.

If you can't find numbers showing how many claims are filed in a year, how do you expect me to find numbers showing how many are denied unjustly?

Aside from indirect evidence, I'm sure there's nothing else to provide...

I didn't say "majority", did I? I said a large enough proportion of the total number of claims. Unless it is possible to identify a pattern of some sort, in which case it might be a large enough proportion of certain types of claims.

So again, if, say, identity theft or mail fraud (or what have you) happens to an extremely small proportion of those who use the US Postal Service, does that mean we don't put laws in place making it illegal? I don't see why you are applying this logic to this and not everything else...

I'll say it again: given the doubtless enormous number of claims for health insurance use each year---and I am not sure how to find that number, if it's even tracked---

So, I am to find numbers showing how many claims are unjustly denied, but you can't find find numbers showing this enormous number of claims?

...even a few thousand annual instances of abuse or shady behavior by insurers is probably not sufficient to demonstrate a pattern or a deliberate policy of denial/delay intended to escape paying large claims.

Then we have a fundamental difference opinion on what a society should be.

IMNSHO, any society that lets despicable acts happen to thousands of it's people because it's not considered a big enough problem, is a barbaric one. There are many things in our society that are relatively rare, but we still have laws protecting people from those situations.

You haven't done that, either, though.

For you, I doubt that, even if I could pull numbers from a government organization that tracked the numbers of claims filed and claims denied, you would be convinced.

IMO it has to be a significant problem in comparison to the entire market, or the costs of additional regulation will far outweigh the benefits.

However, as has been pointed out many times before, we don't live in a completely cost/benefit world. Humanity, compassion, and justice all come into play as well, thankfully. As pointed out, if we were a complete cost/benefit society, we would be ridding ourselves of all those who have become less than efficient. We would breed in a way to maximize human efficiency and let die those who are disabled to the point where their contribution to society is outweighed by their cost.

No, thankfully, we don't live in that society, nor would I want to, thank you.

You were saying that the sorts of abuses against which you are railing ought not to be "legal". If they are prosecuted, as they are, clearly they are not "legal". I was pointing this out, so that you don't go on thinking that somehow HMOs are getting away with illegal practices. That is not a reason for "more laws" or more regulatory resources to be thrown at the problem.

Some of the practices ARE legal, firstly.

As far as getting away with illegal acts, see below...

Now, you can argue that some of their practices are immoral and OUGHT to be illegal. But I don't see how you can allege that anyone is being allowed to "get away" with currently illegal acts when in fact there are numerous prosecutions and settlements attending them.

I AM arguing that most of it ought to be illegal.

I DO call their sometimes blatant breach of contract illegal (as well as some of the other discriminatory practices), and many times they do get away with it. This is because 1) The amazingly strong lobbying power, 2) Their legal power, and most importantly 3) The settlement tactic.

Me, I see waiting someone out in court and giving them a lowball settlement 3-4 times less than they should have paid "getting away with it", but hey call me crazy.

The choices are not limited to the extremes of "legalize it" or "devote huge amounts of new resources to investigating and prosecuting it". It's not the runaway problem which the media leads us to believe it is.

You may not think it is, but that does not make it so. Do you have any proof of this assertion?

As far as my opinion on it, I can assure you it does not come from the media. Truthfully, I've never seen anything in the media damning insurance companies for the things I damn them for, but I don't watch TV much.

My opinion is formed from my personal experiences with insurance companies as well as the multiple experiences of others I've found who have gone through the same problem. I've found that I'm not the only one, and what's more, that it's happening to enough people to be a problem.

You seem to be arguing that it is not because the abuses are matters of policy and are so numerous that more resources need to be devoted to stopping them. Can we agree on this much at least, and that "abuses should be legalized!" is a red herring?

If I change it to "abuses should be allowed to happen since the cost will outweigh the benefit" will you feel better?

Hey, I can't help it if your standpoint sounds really bad when put in simple context!

I see no calls in Congress or the White House for "more regulation". I see call for reforming the system. What are you seeing?

As I said, most system reform I have seen I am against (at this point). I am in favor of slight reformation through additional regulation and control.

Not but that I think "more regulation" is seldom the answer to anything, either.

Regulation has it's place and it's uses. I more than agree that excess regulation is not good. I don't agree that no regulation IS good. Extremism is so passe!

"A million here, a million there, pretty soon we're talking about real money".

Everyone wants to take "a small step" in their particular pet area. Name me an industry or practice in which someone doesn't think that expanding regulation is a great idea. Now add them all up.

I never denied that. I simply said it's quite a bit of a stretch to call some additional regulation 'total system reform', which it is.

So what I hear you saying is that you are pulling for Mr. Obama's reforms to succeed. ( Forbidden fifth emoticon here---I leave it to you to imagine which one. )

....

So, if your neighbor slips on your icy sidewalk ( yes, I know, but bear with me, this is a common example ) and sues you, you should have to pay right away, before you even have your day in court?

With an insurance company, I have signed a contract. I'll pay you monthly while I'm healthy if you'll pay for my bills when I get sick (simplified, but about right, no?). When I get sick, the insurance company decides that (here's a common one) I must have had a preexisting condition that I did not disclose. Now, since they have NOT held to their contract, I now have no way of paying my bills, nor any way of getting money TO pay the bills (I'm sick, remember?).

Your example is happenstance, and a poor analogy, IMO. I will NOT bear with you!

This would be a complete remodeling of our system of civil justice, and it could not long be limited to insurers, given the way precedents advance the law, I don't think. Would that be a good thing?

As noted, the difference in this case is that the insurer has an extremely unfair advantage not present in most situations.

And if you should slip on Warren Buffet's icy sidewalk, so would he. That is not a good reason to change the way the civil law works, IMO. People ( and businesses ) have disproportionate powers and advantages in court proceedings, but changing the basic rules on the basis of who you are and whom you face is not the answer, IMO. This would no longer be equality before the law, it would be favoring whichever side seemed to be the "underdog"...

Even if we don't change the law to pay out first, there must be some regulation in place to prevent insurance companies from employing these siege tactics. Perhaps stiff fines, leading up to the revocation of their license to insure? I'm open to ideas other than my own... but to say the system is working the way it is now is ludicrous! It's happened to far too many people to be considered "rare" in my mind.

Really? Even if you break your back?

So we should bypass the courts, make the auto insurer---or maybe the guy who hit you---pay you enormous sums up front and then, AFTER a court rules that you were negligent, try to get the money back from you?

(if you break your back then it suddenly becomes a... health issue! But I'll bite anyway...)

If I have signed a contract stating that insurance is to pay me when something goes wrong, why is the status quo that it is okay to NOT pay me and assume I am guilty of negligence with no proof? Is it so much to ask that they must submit at least SOME proof of negligence or of fraud before denying a claim?

No, it's still being argued. It is not a settled point, to be used as a ground assumption for further advancing a position!

I can argue the moon is made of cheese, it does not make the point that the moon is not made of cheese invalid!

Plenty of proof has been put forth that regulation (to an extent) works. It's your turn to disprove that.

Personally I side with Milton Friedman: everything presently accomplished by regulation could be accomplished by the private marketplace, under the proper framework of laws. ( Well, except for larger payrolls and budgets for regulatory agencies and law firms, that is. )

For example?

[erik_blank]

Originally Posted by Inquartata

Personally I side with Milton Friedman: everything presently accomplished by regulation could be accomplished by the private marketplace, under the proper framework of laws. ( Well, except for larger payrolls and budgets for regulatory agencies and law firms, that is. )

I'm confused... What is his definition of laws and regulations? Are they not one and the same? It seems like Mr. Friedman is trying to suggest that instead of a set of laws that regulate business that we should have a set of laws to regulate business...

[DonnaP]

Got a kick out of the Headlines in my local paper yesterday.....

"It pays to run a hospital" "Hospital CEO's in region paid handsomely"

Local CEO salaries of "non-for profit" hosptials in the region......

Low - Paul Moss, Milford Hospital, $436,656
High - Robert Trefry, Bridgeport Hospital, $2,543,047

Average in local hospitals: $1.1 million for CEO's, and actually more for most CFO's.

The average local hospital in my area is spending >$5 million dollars on salaries for the top 10 paid employees. Not bad for "non-for profit" businesses.....

[Inquartata]

Carrying on from yesterday. ( I feel like Sisyphus again. )

Originally Posted by jeff

Irrelevant - that's not what makes them expensive.

I have to disagree. A manufacturer faces many costs of production. The higher these costs, the higher, given the constraint of elasticity, the price they will charge for their product. Manifestly, regulation adds to these costs for the manufacturer. Hence, within the constraints of elasticity, it MUST add to the price of the good produced.

Yes, there are other contributors to cost. Yes, there are things such as patent protection which can offset to an extent certain contributors to cost, by conferring a sort of monopoly condition in a given market. But no, these do not make obvious additions to cost "irrelevant", by any means!

They are protected by patent and there's a small market, so the manufacturers charge whatever they want.

They can?

So, these manufacturers merely "want" to charge a price of X, rather than X plus, say, another $1000? Or another $10,000? Or another $1 billion? They are forgoing additional revenue which they could have simply by "wanting" to charge even more out of philanthropical feelings?

I don't think this is really what you meant to say, is it?

Not even outright protected monopolists can "charge whatever they want". Even they have cost and revenue curves which constrain the quantity they will supply and the price they will charge. At some point charging more will reduce their profit, not increase it---elasticity again. And the makers of these devices are not even outright monopolists...

Practitioners who are not cost sensitive

1) There is no such thing.

2) If there were, you realize that the likely result of extending health care coverage by the government would be to make this sort of thing worse, not better? I mean, government is the ultimate deep-pockets eventual payer. Just look at Medicare. How could extending that model to the entire marketplace actually reverse the effect you are saying exists?

That sounds very SciFi. Or syfy, as the nitwits on the cable TV station renamed it.

"A dimension of mind..."

I wondered what had become of the Sci-Fi Channel. So it's gone Gen Y textish? Sigh...

I mostly agree with the last sentence,

And Medicare has if anything even more problems than Social Security. Only going to get worse as the population both ages and lives longer, too.

I don't know if they worry more than we do, and would want evidence of that before I accepted the conjecture

I keep reading that Europe's demographics of aging are even more serious than ours, but I never think to bookmark the articles...

But

http://www.csmonitor.com/2004/0520/p06s01-woeu.html

http://www.china-europe-usa.com/leve.../hum/011_7.htm

http://www.thefirstpost.co.uk/50329,...ation-global-w

And if you think about the fact that in many European countries a higher tax burden is necessary to pay for not only health care but other social welfare programs such as pensions, the shrinking taxpaying workforces vis a vis the populations of aging retirees they must support cannot but exacerbate problems in them in way that we do not face. ( At least not yet; Mr. Obama may yet get us there. )

Here's something I came across while looking for confirmation of more serious demographic problems in Europe. It doesn't speak to that issue, but it has a few things to say about European health care systems---by Europeans:

http://news.yahoo.com/s/ap/20090704/...health_lessons

Our healthcare system disproportionately spends money on last 6 months of life is further cost disadvantaged. We have the technology, pay for it, and spend it even when it doesn't particularly add to longevity or quality of life.

So it's better to do what by implication they do elsewhere: DON'T spend as much on end-of-life care, but simply let more of the elderly die? Not quite as cruelly as the ice-floe option, perhaps, but still...

http://jnci.oxfordjournals.org/cgi/c...ull/93/19/1444

And I came across something that indicated that many more cancers go undiagnosed and untreated than in the US, despite the British universal free health care system and its oft-trumpeted superior results by other yardsticks. So maybe it's not just end-of-life care that's falling by the spending wayside.

I do not mean alleged at all. I reiterate that this has been acknowledged by HMO executives and revealed in the press.

Weeeell...still sounds awfully like "alleged" to me...

Does WHO is alleging a thing change it from allegation to demonstrated truth? I mean, you can say "acknowledged" instead if you like that word better, but it's still someone just saying that something is so, is it not?

When executives make such statements in public, and in fact when there are cases that have been proven in court, it's "facts".

Well, I would feel much more comfortable with that if I could read, say, a court finding saying it, or an independent study saying it, as opposed to hearsay that they have said it...

Not that I am trying to give you more homework or anything.

prove that tangent!

I would have go go a-searching, but I think that your original framing of this claim was that the economic interests of buyers and sellers are always aligned, no? Something like that?

It's not an assumption - it's an assertion.

If it's an assertion that we are expected to accept as the basis for the next step of an argument, it has become an assumption. These are often signaled by statements like "X is clearly so, now let's move on to Y".

I further assert that I've already provided more than adequate substantiation for it! I won't play "debate by demanding evidence that has been provided repeatedly over the last 5 years"

See? Another assumption.

Seriously, though---you actually expect me to remember these things? As it is, I have to keep three windows open on this thread alone: one for the reply, one to read the whole text of the post to which I am replying, and one in which to go searching from previous posts referenced in the post to which I am replying! And you think I can remember citations in other threads from before?! Much less whether I accepted them as probative?! Waugh!

This is probably why when someone writes a scientific paper they always include references, every time, rather than saying "this was referenced in a paper I did back in 1966, go back to that paper if you need to look it up, otherwise just accept that it's so"! ( Surely I have exceeded my allowance of emoticons by now. )

Eh? That doesn't follow at all. The insurance coverage specifically is for getting covered services, which the HMO then drags their feet on actually approving and paying.

Yes. But it's still not the same as paying the actual provider for the actual service. If I go to a doctor and pay out of pocket, THAT is paying for the service and the service has been "rationed" by price alone. The service about which you are talking is insurance. We can talk about the rationing of health insurance, if you like, but it's not the same thing as the rationing of health care. Two different markets.

Damn it all, over the frigging character limit, too! Grrrrr....

[Inquartata]

Part effing two:

Insurance is always about paying for services you may not need so that you get the service if you're unlucky enough to subsequently need it.

Just so. That's the insurance market, though, not the market for the underlying service...can't talk about the rationing of one in terms of the other.

The insurance premiums are priced to cover expected claims for services (plus overheads and profits), with the expectation that a number of claims will be denied even when they are medically justified and are covered services according to the terms and conditions of the insurance.

A-HA! Assumption!

It is a part of the business model of these firms to (essentially) refuse contracted-for services, knowing that they can mostly get away with it.

And your evidence for this is....?

NB "So and so admitted it" or "A NY Times investigative reporter said it is" is not really evidence, of themselves. Both want corroborating documentation.

And again, I am not disputing that things go on, I'm just dubious that it's a "business model".

I've lost the number of back and forth replies.

See what I mean about remembering stuff? You need to keep three windows open, minimum!

Did we just agree to something?

Oh, damn you, sir! Now I have to go looking to see what that was all about! Off to Window #3...

Oh, here it was: "Teddy Roosevelt signed the law that created the FDA in 1906. What regulations did you think applied before that?[/i] You may emphasize "applied" if you wish."

That's what I already answered: Which regulation existed, eg applied, before that.

I know, you think that they were ineffectual. Maybe so, maybe so. Still, they both existed and applied...

(BTW, did you ever notice that the Brits drop the "to" in sentences like the preceding one?)

No. What, you mean like "agree something"?

I believe I cited them in this thread. Or maybe in the Korean thread. In any case, I've posted this in the last month or so.

Aaaaiiieeeee!

What this historic moment signifies is that in this example price becomes the dominant factor only for products that are safe - a result provided only by government regulation.

Ah, ah, ah! The corollary doesn't follow! Specifically, the "only" part.

I strongly suspect that in fact safe products were to be found before government regulation---indeed, perhaps even before government---and besides, there are many reasons why a consumer might believe products to be safe, other than the existence of regulation...

People have to eat - yet when it was revealed that their foods were tainted, they stopped consuming as much. The market in meat suffered.

Ah, but these are not the same things. Assuming that your numbers are correct, and that they were correctly interpreted, they would merely prove the operation of the substitution effect. That is to say, they show the economic commonplace that people will sometimes, for one reason or another ( price increases are the usual one ) switch from one good to a substitute. Instead of coffee, they will drink tea. Instead of driving, they will take the bus. Etc. In this case all that is demonstrated is that people may have switched to other foods, not that they "stopped consuming as much"...

The example with stock markets is much stronger: regulation made it possible for the market to grow and be effective on dramatically larger scales than ever before. Regulation fosters the engine of capital formation. Funny, aint it?

I am still not convinced by this model of stock-market-as-con-game. That's just not how markets develop. Though there will always be fools to be defrauded, there are never whole markets of them. "You can fool some of the people all of the time, or all of the people some of the time, but you cannot fool all of the people all of the time". Your model would have amounted to fooling all of the people all of the time...

And, before there's healthcare rationing, look at the effects of smiley rationing!

It's an outrage, I tell you!

[Inquartata]

Originally Posted by jeff

It may be exhausting, but I don't know if it's exhaustive.... I'm troubled by limited regulatory oversight for issues that are discovered after a drug has been on the market and then found to have lethal side effects (eg: the Vioxx situation), or for off-brand use and combinations of otherwise approved drugs - Fen-phen being an example. The wikipedia article is interesting http://en.wikipedia.org/wiki/Fen-phen

So, there's room for improvement, both in speed and cost of approval, and in prevention of lethal drugs.

This touches on something else I just read, about the regulation of the financial markets; but alas, "the library will be closing in five minutes", and they are blinking the lights on and off...

[thereom4]

Originally Posted by Inquartata

Part effing two:

Ha! ha! This is funny. For real. I don't know why, it just made me laugh.

I would offer you a hug, but I'm afraid that you're going to ask me to provide you with evidence on why I think you need a hug.

Well I'll ask anyway. You need a hug Inq?

[jessicasimpson]

[quote=DonnaP;811845]Got a kick out of the Headlines in my local paper yesterday.....

"It pays to run a hospital" "Hospital CEO's in region paid handsomely"


Average in local hospitals: $1.1 million for CEO's, and actually more for most CFO's. [quote]

Wow, that is alot more than the Ceo's for health insurace companies! (Heavy Sarcasm)

[dcmdale]

Sorry about the delay in replying. The capitalist pigs that pay me sometimes demand my time.

In as much as my original comments were not intended to advocate a completely free market solution, but rather to point out how a free market, capitalistic economy might lead to conclusions that both of us would reject as immoral (imagine us agreeing on that!), I am hesitant to go into a full fledged defense of my characterizations of how capitalism pushes society. However, here are some comments.

Originally Posted by jeff

Indeed, and not just capitalism. I supposed we could decide to emulate the Inuit and throw elderly people onto an ice floe when they are no longer able to support themselves. We don't behave that way, even though a purely economic process might suggest that. Heaven forbid.

Yes. As you know from previous conversations, I would absolutely reject that capitalist theory drives morality. I have respect for capitalism as an economic tool, not as an inherent good.

Originally Posted by jeff

Where the analysis really breaks down on is that health care expenses (and associated research) sharply escalate for the old and ill. If you looked at the distribution of costs (at least in the US), it is sharply skewed to elder care, in particular end-of-life care, typically for the last 6 months to a year of people's lives. That's where the bucks go in general - to individuals who have no future economic contribution because they are dying, and to research into late-life/end-of-life ailments.

Absolutely true that many people go "all in" with respect to their final illness. That is particularly true where there is insurance involved and, therefore, "free money." Because capitalism sees "efficiency" in purely monetary terms, "free" anything distorts that analysis. (What is the environmental cost of free-use-of-air, for example). My wife's 88-year-old grandmother got talked into a quad-bypass for $100K+, mainly because it was entirely covered.

From a purely economic standpoint, I would argue that the amount spent on the last illnesses of the elderly is more of a deferred compensation. It is encouragement for people to work hard today to provide for anticipated needs post-retirement. And a benefit that society can give when the economy is doing well, but can go away as the economy sours. (So says the guy whose vested retirement medical benefits evaporated into the ether of the bankruptcy courts last week).

This all-in feature, of course, complicates all comparisons between systems. We could really improve our metrics compared to other countries if we adopted a more brutal approach to last illnesses: "Ms. Jones. We got back your test results. I'm afraid that the news isn't--BLAM!--good." So long as people are allowed to put massive amounts of money into their last illness and they have (either through savings or insurance) massive amounts to throw at it, our metrics aren't going to look good by comparison. Government sponsored systems don't go as far as shooting everybody with cancer, but they towards "making intelligent decisions in the use of public funds." My wife, for instance, was diagnosed with osteosarcoma several years ago and we had the opportunity to compare Canadian and U.S. systems. The Canadian standard of care guidelines offered "wide margin amputation"--in this case, above the knee. The U.S. HMO allowed, and of course ended up paying for, a more expensive leg-saving procedure. Those kinds of differences are hard to quantify in comparison studies. [She has been cancer-free for several years now.]

Originally Posted by jeff

If we actually based expenditures on future economic value of the individuals involved, we would spend more money on pre-natal and early childhood care. But we don't, and we lag other first world nations. That's why our infant mortality figures are so sadly worse than others.

Not necessarily. Have you run the net present value numbers on babies? Even against a fairly conservative 3% opportunity cost of funds, kids born into lower middle class (and lower) families are a net liability from a purely economic standpoint. And, babies are far more likely to be insured if they have a positive anticipated NPV. (I have actually heard these arguments used in the abortion debate: by preferentially aborting poor babies whose net present value is underwater, you benefit society. You might guess where I stand on that.)

Originally Posted by jeff

I've addressed part of this above. Bear in mind also that much medical research is already taxpayer funded. I read medical journals sometimes and the "Funded by NIH Grant xxxxxx" pops up a great deal. Certainly there's a great deal of private medical research, but we're not unique in that. There are non-US med and pharma companies.

Of course there is public money going into research as well as non-U.S. money. NIH contributed $21B last year. That is a lot of money; however, it amounts to about 2% of its overall health expenditures. I don’t work in the health care industry, but my company reinvests 17% in R&D, which is more of what I expect in a competitive market.

Originally Posted by jeff

I disagree with the premise that inherently capitalism pushes towards efficiency. Sometimes yes, sometimes no. So-called "socialist medicine" costs less while scoring better on quality metrics (Germany, France, Scandinavia for examples). Or do about the same as us, while costing very much less (UK).
…
We must take into account the economic impact, but I think we should benchmark against "best of breed" nations in health care and try to figure out how to gain as good efficiency and quality as they do. It should not be a foregone conclusion that universal insurance costs more when there is proof-by-existence out there in the world to refute that.

How to lie with statistics is alive and well in this debate. On both sides. Benchmarking is interesting, but not dispositive. 45% of the U.S. health care spending ($1 Trillion of the $2.4T) already comes from public sources (Medicare, Medicaid, and similar programs).

Comparing public vs. private effectiveness in the United States, Medicaid pays an average of $7.900/year per enrollee vs. $8300 for the general public. I suspect that if the poor were getting 95% of the quality of care through public services that the general public was getting through private sources, we wouldn’t be talking here.

Originally Posted by jeff

A recent NYT magazine article described the city with the most expensive health care in the US. A Texas locale (hence, protected by state laws on medmal), with the same distribution of ages and immigrants demographics as other Texas places with far lower costs, yet exorbitantly expensive. Why? Because they have for profit institutions, including physician-owned ones, who know that the more tests and procedures they prescribe, the more money they make.

Rather than hypothesize fruitlessly, I request we take a careful read of this Economist article: http://www.economist.com/opinion/dis...ry_id=13900898

….

All the more reason for (cough) regulation, eh? It's not as if the lay population enjoys parity of information to detect such frauds.

….

And, don't forget that a great deal of the fabrication is due to profit motives of private sector fudging. Look at the recent scandals with Medtronic, or older ones involving Vioxx. Let's not make this a private vs. public sector argument. Suppression of bad results in order to let a product out the door is a very serious problem - and that's purely a "capitalist" issue.

My thoughts about the difference between market regulation and criminal regulation was expressed in a previous post. I emphatically believe that crime is crime: a rich person stealing money shouldn’t be treated any better than any other thief. In jurisdictions with felony murder statutes, I would fully advocate that “white collar” fraud resulting in death should be treated the same as a bank robbery resulting in death.

Originally Posted by jeff

Incorrect as written. The dying individual has a strong interest, but it's not an economic one.

Meh. From an economic standpoint, the strong intrinsic interest in retaining one’s life is measurable by one’s willingness to invest large sums of available money in retaining it (however briefly).

Originally Posted by jeff

And, since we cost a lot more than other countries that also have guild systems, this clearly is not the reason.

Not so clearly. Guild-hostile philosophy underlies a lot of public heath system thinking. It is certainly not original to me. The fact that governments can more easily thumb their nose at the guild could well be the key competitive advantage of some of these systems. Government can do things like send public heath nurses out into barrios and migrant farm camps that private health care couldn’t do (even if it had an incentive to do).

I'm rambling, but I need to get this out.

[jeff]

Originally Posted by Inquartata

I have to disagree.(snip))!

It's irrelevant because we are comparing two items that have the same regulatory burden, yet one is much more expensive than the other. The difference between these is not the cost of regulation., and the point I raised was an optional and often unnecessary cost that has nothing to do with government. Unless you want to say that a cautery tip is $30 and a disposal harmonic scalpel tip is $300-500 because of government regulation (or that a Lexus costs more than a Yugo because of regulation) - and if so, I wanna see the proof! Other than that it's a common burden in both cases and can be factored out.

And the real reason it's irrelevant (it's my gosh-darned example about the harmonic scalpel after all) is because its about government individuals creating unnecessary cost. That's all it was about.

Originally Posted by Inquartata

They can?

Of course they can.

But if they price too high they will make fewer sales, and if they price too low they leave money on the table. I said they "charge whatever they want" - not that they sell all their inventory at whatever price they pick. What the "want" is to (usually) maximize revenue in the available market. Sometimes they want to dump old inventory, or have a loss leader to bring in other business, or it's the end of the quarter, or...
I'm not implying that people can charge whatever they want without consequences in the faces of market conditions and the law of supply and demand.

Originally Posted by Inquartata

So, these manufacturers merely "want" to charge a price of X, rather than X plus, say, another $1000? Or another $10,000? Or another $1 billion? They are forgoing additional revenue which they could have simply by "wanting" to charge even more out of philanthropical feelings?

I don't think this is really what you meant to say, is it?

No it isn't! I am saying that expensive products cost more than inexpensive ones because of prices set by the manufacturer, relative to market conditions and the need to cover manufacturing, marketing, R&D, and sale costs while provide a margin, and with the observation that commodity items have smaller margins and more competition than specialized items with more "unique value proposition" components.

Originally Posted by Inquartata

Not even outright protected monopolists can (snip).

Of course. I never claimed otherwise.

Originally Posted by Inquartata

1) There is no such thing.

Of course there are practitioners who are not cost sensitive. You see it all the time, with people ordering lots of tests that may not be needed (or are needed only as "defensive medicine" to fend off lawsuit), or use expensive on-patent drugs when a generic at a fraction of the price would do as well, or use really, really expensive devices when there's one just as good for most cases at 1/10th the cost. Like in the example we've been wrassling with.

If it doesn't come out of the practitioners pocket, he or she may really not care at all. Or - like that Texan town - the doc owns a part of the company that provides the Lexus and is eager to drive business to himself.

Originally Posted by Inquartata

2)you realize that the likely result of extending health care coverage by the government would(snip)

Tie compensation to "productivity" and expense in either private or public sector and cost sensitivity comes back into the picture. This is another orthogonal (I really like that word) situation.

Originally Posted by Inquartata

And Medicare has if anything even more problems than Social Security. Only going to get worse as the population both ages and lives longer, too.

All the more reason to address the issue head on rather than hope the Invisible Hand solves it. Or Learned Hand, for that matter.

Originally Posted by Inquartata

I keep reading that Europe's demographics of aging are(snip)

If France is older and has these inefficencies, then why aren't they already more expensive than us? We should be so lucky as to be in such a tough situation. My god, they're talking about imposing a 1 Euro co-pay! Holy cow!

If we're younger than the Europeans now going forward, and have more workers to support older people, that hardly invalidates their experience with healthcare with lower %GDP costs than ours.

Originally Posted by Inquartata

(snip)Here's something I came across while looking for confirmation of more serious demographic problems in Europe. It doesn't speak to that issue, but it has a few things to say about European health care systems---by Europeans:

http://news.yahoo.com/s/ap/20090704/...health_lessons

So, they're not perfect. But note: "According to the Organization for Economic Co-operation and Development, the U.S. spent $7,290 per person in 2007, while Britain spent $2,992 and France spent $3,601." We outspend them 2 to 1, but overall mortality in our country is about the same as UK and far worse than France. Maybe they should spend a little more, but their results are still as good as or better than ours.

Originally Posted by Inquartata

So it's better to do what by implication they do elsewhere: DON'T spend as much on end-of-life care, but simply let more of the elderly die? Not quite as cruelly as the ice-floe option, perhaps, but still...

http://jnci.oxfordjournals.org/cgi/c...ull/93/19/1444
.

Gosh, "McLaughlin’s Canadian comparison shows closely similar incidence rates for various cancers among Canada, the United States, England, Wales, and Denmark, along with a number of other Western European countries." (despite them smoking more!) What are you saying the article says?

Originally Posted by Inquartata

Weeeell...still sounds awfully like "alleged" to me...

Does WHO is alleging a thing change it from allegation to demonstrated truth? I mean, you can say "acknowledged" instead if you like that word better, but it's still someone just saying that something is so, is it not?

Several of us have put up on f.net quotes and links to articles where people said that they themselves did it. That's not allegation, that's confession!

Originally Posted by Inquartata

Well, I would feel much more comfortable with that if I could read, say, a court finding saying it, or an independent study saying it, as opposed to hearsay that they have said it...

Not that I am trying to give you more homework or anything.

For sure, I'm not even going to catch up on these posts tonight!

Originally Posted by Inquartata

I would have go go a-searching, but I think that your original framing of this claim was that the economic interests of buyers and sellers are always aligned, no? Something like that?

I don't think so, because a healthcare person and patient are only partially buyer and seller. But let's see if we get motivated enough to look it up later on.

Originally Posted by Inquartata

If it's an assertion that we are expected to accept as the basis for the next step of an argument, it has become an assumption. These are often signaled by statements like "X is clearly so, now let's move on to Y".


See? Another assumption.

Seriously, though---you actually expect me to remember these things? As it is(snip)

I'm afraid that's a limitation of the medium we're working in. Believe me, it's frustrating to be asked to provide evidence you have already provided. I sure don't keep notes of where I've put up a particular piece of evidence, and it's a lot of work to go searching. But just trust me - I've actually put up and seen such evidence. You know you can trust me!

Originally Posted by Inquartata

Yes. But it's still not the same as paying the actual provider for the actual service. If I go to a doctor and pay out of pocket, THAT is paying for the service and the service has been "rationed" by price alone. The service about which you are talking is insurance. We can talk about the rationing of health insurance, if you like, but it's not the same thing as the rationing of health care. Two different markets..

hm, a distinction without a difference, I'm afraid. I take it as a technical distinction, but don't think it's germane to the actual issues. Somebody contracts via their HMO to get health care, and the HMO rations it - and they can't afford to get it on their own.

Anyhow I have to stop now - time to go fence! and I'm over the frigging character limit, too!

[jeff]

catching up....

Originally Posted by Inquartata

Part effing two:

funny!

Originally Posted by Inquartata

Just so. That's the insurance market, though, not the market for the underlying service...can't talk about the rationing of one in terms of the other.

But if the insurer is the one way to get the underlying service, it's the very same thing for those who are affected.

Originally Posted by Inquartata

A-HA! Assumption!

M'lud, I refer you to artifacts entered into evidence and found via the Search button. Hm. Not as easy as that...

Originally Posted by Inquartata

And your evidence for this is....?

NB "So and so admitted it" or "A NY Times investigative reporter said it is" is not really evidence, of themselves. Both want corroborating documentation.

And again, I am not disputing that things go on, I'm just dubious that it's a "business model".

Depends on your definition of "business model", I suppose. Evidence has been presented on this very forum that individuals were bonused for doing that. Sounds like part of the business model to me. "admitted it" is evidence in court, so it should be more than sufficient here.

Tell ya what - let's accept this conditionally for the sake of argument. If it's all been a fever dream and nobody every provided such evidence and it doesn't exist, just pencil it out.

Originally Posted by Inquartata

See what I mean about remembering stuff? You need to keep three windows open, minimum!

The PITA is going back to posts from days, weeks, and months ago...

Originally Posted by Inquartata

Oh, damn you, sir! Now I have to go looking to see what that was all about! Off to Window #3...

Oh, here it was: "Teddy Roosevelt signed the law that created the FDA in 1906. What regulations did you think applied before that?[/i] You may emphasize "applied" if you wish."

That's what I already answered: Which regulation existed, eg applied, before that.

I know, you think that they were ineffectual. Maybe so, maybe so. Still, they both existed and applied...

Okay, fine - but I'm not awfully interested in ineffectual, and I'm not convinced that they covered the topics we've been discussing.

Originally Posted by Inquartata

No. What, you mean like "agree something"?

Yes, exactly. Use the goddam pronoun, I say.

Originally Posted by Inquartata

Aaaaiiieeeee!

Told ya it was a PITA!

Originally Posted by Inquartata

Ah, ah, ah! The corollary doesn't follow! Specifically, the "only" part.

Which "only" do you mean, the 1st or 2nd one in that paragraph?

Originally Posted by Inquartata

I strongly suspect that in fact safe products were to be found before government regulation---indeed, perhaps even before government---and besides, there are many reasons why a consumer might believe products to be safe, other than the existence of regulation...

Indeed, and before Sinclair published his book, people believed their meat was safe. Before antics on Wall St were exposed prior to post-Great Crash regulation, many people believed it was safe too. Best to make the reality conform to the naive belief.

Originally Posted by Inquartata

Ah, but these are not the same things. Assuming that your numbers are correct, and that they were correctly interpreted, they would merely prove the operation of the substitution effect. That is to say, they show the economic commonplace that people will sometimes, for one reason or another ( price increases are the usual one ) switch from one good to a substitute. Instead of coffee, they will drink tea. Instead of driving, they will take the bus. Etc. In this case all that is demonstrated is that people may have switched to other foods, not that they "stopped consuming as much"...

Read the cited accounts from the period: meat consumption was indeed down post revelation of the industry practices.

Originally Posted by Inquartata

I am still not convinced by this model of stock-market-as-con-game. That's just not how markets develop. Though there will always be fools to be defrauded, there are never whole markets of them. "You can fool some of the people all of the time, or all of the people some of the time, but you cannot fool all of the people all of the time". Your model would have amounted to fooling all of the people all of the time...

What do I know - I only worked in banking and brokerage 20 years, eh?

No, not everybody got fooled, but you don't need to fool everybody in order to game a market with insider trading, front-running, pump and dump, or sale of shares in non-existant companies or ones with fraudulent representation of financials. It is not a wild leftist statement to say that regulation to curtail such abuses was central to making the stock market the 'engine of capitalism'. That's the basis of "bringing Wall Street to Main Street" that once upon a time was the credo of Merrill Lynch. (RIP)

Originally Posted by Inquartata

It's an outrage, I tell you!

a curtailment of our rights to freedom of expression!

[jeff]

Originally Posted by dcmdale

Sorry about the delay in replying. The capitalist pigs that pay me sometimes demand my time.

They simply do not have the right priorities!

Originally Posted by dcmdale

In as much as my original comments were not intended to advocate a completely free market solution, but rather to point out how a free market, capitalistic economy might lead to conclusions that both of us would reject as immoral (imagine us agreeing on that!), I am hesitant to go into a full fledged defense of my characterizations of how capitalism pushes society. However, here are some comments.

Yes. As you know from previous conversations, I would absolutely reject that capitalist theory drives morality. I have respect for capitalism as an economic tool, not as an inherent good.

Looks like we agree on this, at least.

Originally Posted by dcmdale

Absolutely true that many people go "all in" with respect to their final illness. That is particularly true where there is insurance involved and, therefore, "free money." Because capitalism sees "efficiency" in purely monetary terms, "free" anything distorts that analysis. (What is the environmental cost of free-use-of-air, for example). My wife's 88-year-old grandmother got talked into a quad-bypass for $100K+, mainly because it was entirely covered.

From a purely economic standpoint, I would argue that the amount spent on the last illnesses of the elderly is more of a deferred compensation. It is encouragement for people to work hard today to provide for anticipated needs post-retirement. And a benefit that society can give when the economy is doing well, but can go away as the economy sours. (So says the guy whose vested retirement medical benefits evaporated into the ether of the bankruptcy courts last week).

This all-in feature, of course, complicates all comparisons between systems. We could really improve our metrics compared to other countries if we adopted a more brutal approach to last illnesses: "Ms. Jones. We got back your test results. I'm afraid that the news isn't--BLAM!--good." So long as people are allowed to put massive amounts of money into their last illness and they have (either through savings or insurance) massive amounts to throw at it, our metrics aren't going to look good by comparison. Government sponsored systems don't go as far as shooting everybody with cancer, but they towards "making intelligent decisions in the use of public funds." My wife, for instance, was diagnosed with osteosarcoma several years ago and we had the opportunity to compare Canadian and U.S. systems. The Canadian standard of care guidelines offered "wide margin amputation"--in this case, above the knee. The U.S. HMO allowed, and of course ended up paying for, a more expensive leg-saving procedure. Those kinds of differences are hard to quantify in comparison studies. [She has been cancer-free for several years now.]

First let me say that I'm very happy to hear that your wife has been cancer-free for these years, and express my hope and wish that it continues that way.

I hear more stories about amputation that are related to diabetes, where there are definitely important health and life quality benefits in trying to preserve as much of the leg as possible (in particular avoiding above-the-knee amputation). For cancer the practice of going above the knee might be based on the desire to ensure clear margins more than the financial aspect. That happens when treating breast cancer where there's a conflict in goals between breast-conserving surgery and getting more margin. There's a controversy there that is unrelated to cost.

With grandma, besides the $100K+, what concerns me as an ethical question is whether that really improved her quality of life and merited the risk. In other words, was she a good candidate for the procedure for medical reasons? Not just because the cardiologist could net a nice pay day out of it.

The expression "wallet biopsy" is usually defined as in http://www.wordspy.com/words/walletbiopsy.asp but is also used in the context of "this person has money or insurance, so let's offer them something profitable and expensive.". I'm not saying this is necessarily the case with your grandmother-in-law, but it's a factor.

Originally Posted by dcmdale

Not necessarily. Have you run the net present value numbers on babies? Even against a fairly conservative 3% opportunity cost of funds, kids born into lower middle class (and lower) families are a net liability from a purely economic standpoint. And, babies are far more likely to be insured if they have a positive anticipated NPV. (I have actually heard these arguments used in the abortion debate: by preferentially aborting poor babies whose net present value is underwater, you benefit society. You might guess where I stand on that.)

Nope, I've never calculated NPV on kids. Wow, the idea never occurred to me. We probably stand on the same side on the idea of society deciding to abort kids because Mom is poor. I think that the idea of choosing who lives and dies on the basis of their economic contribution to society is (too use a non-technical term) icky.

Originally Posted by dcmdale

Of course there is public money going into research as well as non-U.S. money. NIH contributed $21B last year. That is a lot of money; however, it amounts to about 2% of its overall health expenditures. I don’t work in the health care industry, but my company reinvests 17% in R&D, which is more of what I expect in a competitive market.

How to lie with statistics is alive and well in this debate. On both sides. Benchmarking is interesting, but not dispositive. 45% of the U.S. health care spending ($1 Trillion of the $2.4T) already comes from public sources (Medicare, Medicaid, and similar programs).

Comparing public vs. private effectiveness in the United States, Medicaid pays an average of $7.900/year per enrollee vs. $8300 for the general public. I suspect that if the poor were getting 95% of the quality of care through public services that the general public was getting through private sources, we wouldn’t be talking here.

Probably not.

Originally Posted by dcmdale

My thoughts about the difference between market regulation and criminal regulation was expressed in a previous post. I emphatically believe that crime is crime: a rich person stealing money shouldn’t be treated any better than any other thief. In jurisdictions with felony murder statutes, I would fully advocate that “white collar” fraud resulting in death should be treated the same as a bank robbery resulting in death.

I could not disagree with that.

Originally Posted by dcmdale

Meh. From an economic standpoint, the strong intrinsic interest in retaining one’s life is measurable by one’s willingness to invest large sums of available money in retaining it (however briefly).

Meh to you too! We're using "economic" very differently. I'm talking about policies and decisions to foster wealth, not how much of wealth you're willing to spend in order to have them. We can disagree on this minor point.

Originally Posted by dcmdale

Not so clearly. Guild-hostile philosophy underlies a lot of public heath system thinking. It is certainly not original to me. The fact that governments can more easily thumb their nose at the guild could well be the key competitive advantage of some of these systems. Government can do things like send public heath nurses out into barrios and migrant farm camps that private health care couldn’t do (even if it had an incentive to do).

In the private system people go to inner cities and other underserved areas, and the military, in order to retire their medical school debt. Similar results through different pathways in both private and public sector approaches.

Who the government cannot thumb their nose at is the powerful industries (insurance, pharma) - everybody else is open season...

Originally Posted by dcmdale

I'm rambling, but I need to get this out.

Why ever else would any of us waste time here?

[dcmdale]

Originally Posted by jeff

I hear more stories about amputation that are related to diabetes, where there are definitely important health and life quality benefits in trying to preserve as much of the leg as possible (in particular avoiding above-the-knee amputation). For cancer the practice of going above the knee might be based on the desire to ensure clear margins more than the financial aspect. That happens when treating breast cancer where there's a conflict in goals between breast-conserving surgery and getting more margin. There's a controversy there that is unrelated to cost.

All true. But where a legitimate medical position coincides with financial benefit to the decision maker, it can be more challenging to disintertwingle for the purposes of comparison. My wife was offered both options in the U.S.

Originally Posted by jeff

With grandma, besides the $100K+, what concerns me as an ethical question is whether that really improved her quality of life and merited the risk. In other words, was she a good candidate for the procedure for medical reasons? Not just because the cardiologist could net a nice pay day out of it.

The expression "wallet biopsy" is usually defined as in http://www.wordspy.com/words/walletbiopsy.asp but is also used in the context of "this person has money or insurance, so let's offer them something profitable and expensive.". I'm not saying this is necessarily the case with your grandmother-in-law, but it's a factor.

As I hinted, the main beneficiaries were in the medical community. Now, I am sure that their was a vague possibility that the surgery "could have let her live to 100" (even with her diabetes and Parkinson's), but a big payday clearly figured into the equation.

This is my point about "free money." There is no way that she would have had the procedure if it had come out of her pocket, but between medicare and private insurance...

Originally Posted by jeff

In the private system people go to inner cities and other underserved areas, and the military, in order to retire their medical school debt. Similar results through different pathways in both private and public sector approaches.

Similar results, but different magnitude. Direct side-by-side comparisons are challenging though for all the same reasons discussed above.

[Inquartata]

Originally Posted by jeff

Don't we have the same thing for Inuit in USA?

I...don't know. I was just struck by the number of articles about the high suicide rates amongst Canadian Inuits that had floated to the top of that Google search page.

Not to mention high alcoholism and early deaths among native Americans on both sides of the border. Seems like a really tough problem to solve.

Yes, but that IMO is not a consequence of access to health care, because I believe that Native Americans already have universal care. ( I may be wrong. )

I think it's more to do with the nature of reservation life in general---unemployment, poverty, boredom, lack of opportunity---and maybe with an unfortunate genetic susceptibility to alcohol...

Originally Posted by jeff

I'm saying that when an elected official does something that was an explicitly expressed and major part of his campaign, then it indeed does reflect the people's will.

So...when the polls indicate that the people have subsequently changed their minds about such a policy---as they appear to be doing on Obama's health care plan, coincidentally ---does that make the policy illegitimate? Or is the people's "will" locked as of the moment of the election?

And should support for health care "reform" drop below 50%, will it no longer be a "basic right"? Can we then oppose it without being uncaring inhuman barstids?

You respond to a claim I did not make!

You said that "we do not have a working ( just fine ) system", I believe. No?

"Not working"="broken", no?

Gah! This library is so frustrating. Stupid wireless connection keeps locking up for minutes at a time. So I sit doing nothing waiting for pages to load. I'll never catch up at this rate!

Oh, well, it's time to head to practice anyway...