The Bill is passed.....

**jeff** · 12-04-2009 04:30 PM

BB, it's too bad took that so negatively. I responded as neutrally as possible. I even said "be suspicious about statistics carefully selected to make a political point. From either side in the health care debate, of course." That's a lot more fair minded than you are.

I'm all in favor of early screening. I know several women who had early stage disease (including DCIS) detected and treated. But you're wrong - somebody who has DCIS and gets a lumpectomy is regarded as having "survived cancer" even if those lesions would never have developed. But as I said in my prior post - we just can't know in advance. To be very clear: DCIS should be treated as it is the best opportunity to treat the disease with highest survivability before it advances. It's not even stage 1 - that's the right time to treat it. But how the heck do you think that doesn't show up that way in the stats?

My point about screening is that it has its limits - for example, there's little value to doing mammography on a 30 year old woman because the breast tissue is too dense to get a good reading. Most cancers in young women are detected by other means (like palpable mass) It's also not just the radiation exposure, it's also the risks and complications from the biopsies that follow. Like I said, this is tough stuff and shouldn't be manipulated for political reasons - which is all this is about.

What's more important is looking at overall population morbidity and mortality, and the UK and US are roughly equivalent in those areas despite our paying roughly twice the %GDP as the UK. Or look at Japan, which has a higher incidence of stomach cancer, but nonethless they live much longer than Americans and at lower cost. Instead of using the UK, try comparing the US to one of the better systems rather than one that is about the worst in Europe. Then the differences in health care are really obvious. We lag on all the primary metrics of quality - life lifespan and infant mortality. All this is just an attempt to cherry pick a few numbers to try to make a political point.

And just how the heck to you expect the uninsured (or low income workers with lousy insurance) to get that screening? The extent to which it works now is due to to programs like Medicare and Medicaid - which are (gasp!) - the socialized medicine you're so afraid of. Otherwise, people without money don't get served (see Inq's last posts), don't get screened, don't get saved. They show up at ER in end stage disease when nothing can be done for them. That probably doesn't even show up in the stats because they never were medically followed to that time.

All this illustrates how science can be distorted by ideologues. You quote political hack Dick Morris (as if he's a medical authority!) with a reference from the Guardian. Right-wingers try to use the same information to suppress a public health system that left wingers try to use to increase the size of theirs. This is just a scare tactic from Republicans so they can produce 30-second attack ads and robocalls attacking Democrats in the next election. Imagine the hypocrisy for them to pretend to protect the public health options that they fought against.

Take a look at http://www.nytimes.com/2009/12/04/he...r=1&ref=health has a Democratic amendment that "on health benefits for women would, in effect, override new recommendations from a federal advisory panel that said routine mammograms should begin at age 50, rather than 40. Senator Barbara A. Mikulski, Democrat of Maryland, who proposed the coverage requirement as an amendment to sweeping health legislation, said it could save millions of lives. My amendment would eliminate one of the major barriers to care by getting rid of high co-payments and deductibles,” Ms. Mikulski said. “It does not tell women, ‘You will have a mammogram at 40.’ It says, ‘You will have access to that mammogram if you and your doctor decide it’s medically necessary or medically appropriate.’ "

So, despite the accusation that you're making (and the Republicans) that this is the precursor to Democrats sending people to die from cancer, it's the other way around and its Democrats preventing that from happening.

One place where Democrats are trying to save money over Republican objections is to reduce spending on Medicare Advantage, which is a Bush-era give away to private institutions that costs more than regular Medicare without providing any benefits.

**Phaeton** · 12-04-2009 04:53 PM

Originally Posted by Bayou Bum

Of course, you could let the women choose instead of some government bureaucrat trying to cut costs. Too bad liberals only believe in a woman's choice if she chooses to have an abortion

THIS is the problem with the healthcare debate. More != better care.

If I went into the doctor, and told him "It burns when in urinate, give me a damned MRI," I probably wouldn't, and shouldn't, get an MRI. The use of the MRI is reserved for people that actually need it, and honestly I may not need it. Then again, I'm 90% I could bully my doctor into it, because heaven forbid I have some weird condition that causes painful urination, I could sue for a lot of money.

Healthcare is weird in that the more supply of healthcare there is, the more people demand it, making the market function for most anything else I've heard of. I've anecdotally heard of multiple examples where adding doctors to a region increased healtchare costs. If consumers aren't watching out for price, doctors aren't, and neither are insurance companies who keeps price reasonable?

Part of the reason people don't get the cost of healthcare is that they are disconnected from the cost through insurance, and in a sense each doctor's visit is in a way subsidized, or failing that, something paid for as one would pay for a loan (over time, indirectly). I'm not saying women shouldn't get mammograms outside the demographic of risk, but they should pay the ENTIRE cost out of pocket.

The buck has to stop somewhere.

**lindajdunn** · 12-09-2009 08:11 AM

http://features.csmonitor.com/politi...public-option/

Under the healthcare public option plan being fashioned by Senate liberals and moderates, private nonprofit insurance plans would have to meet standards comparable to the options now offered federal employees.

**Inquartata** · 12-12-2009 03:57 PM

Catch-up time!

Originally Posted by jeff

Our first world cousins do not lack economists who have vetted their systems.

Which ones?

That dog doesn't hunt!

It does herd sheep very nicely, though.

The countries have economic figures as transparent as ours, so I reject rejection of their indicators.

I don't reject their data or their indicators, I just think that assuming they make for accurate comparisons with ours is asking for trouble...

the vast majority of medical care does not involve ungodly amounts per person - it's irrelevant.

The why are almost all of the examples and anecdotes being used by proponents of the present health care reform schemes of that nature? That is, people who have been ruined by enormous bills for medical care?

One shouldn't get to have it both ways. If they want to scare people into supporting their policies by citing exceptional cases, they should not be surprised that people begin to think that they are the norm.

In any event, my real purpose was merely to demonstrate that absolutes are few and far between, and that includes ones like "human life is always more important than resources"...

We did this already: some of those countries already are older than us and yet operate at less cost.

But see, I still don't accept that in fact they DO have lower costs merely because they say that they do.

Just to take one example, we do not know to what extent certain countries pay for their generous social welfare policies such as health care with reduced national productivity. National income accounting does not tell the whole story, even if it's perfectly transparent and completely accurate. That country X spends a lower percentage of its GDP on health care than country Y is only the tip of the iceberg. We talk about it a lot because it's the easiest part to see, but that doesn't mean that there's no more below the surface...

if it's too expensive for public, then it's surely too expensive for private

Why? The allocative mechanisms are different.

It's clear that systems that have 40-60 years of success are sustainable, notwithstanding hypothetical problems in the future.

I guess that's why we are all still citizens of the Roman Empire.

I'll tell you what's unsustainable: it's our fee-for-service system, which compensates providers for performing as many procedures as possible, and punished for cost effective care that actually improves outcomes.

Very likely.

However, this does not demonstrate that a government takeover of the industry is the best alternative. It doesn't even mean that reforming the system by government decrees and regulations is the best alternative...

And that is the false dichotomy being thrust upon us by Obama, Reid, Pelosi et al: "The present system is broken, and it's the present system or our plan."

The first sentence is a normative one, no?

Only in the sense that believing policies conforming to the precepts of a science such as economics are better than those arising from emoting, religious dogma or political marketing. In that sense, ALL preferences are normative. That I prefer medical care from an M.D. rather than from a naturopath or faith healer is also a normative choice. At the same time it's the more rational, evidence-based one.

The second, well - putting aside suggestions like free NASCAR, health care for everyone is very clearly in the "good for them" category.

Individually? Maybe. As a society generally? That's much less clear.

I'm sure whatever we do will be different from others. But it's foolish to not adapt working models from other countries.

Sure. I'm still not convinced that they are going to work for much longer.

The enormity of the change is also daunting, considering the well-known prevalence of human and institutional incompetence to be found in government. I had much rather see a series of small steps, which can be evaluated and adjusted or scrapped at relatively manageable cost should they prove problematic, than to risk the stability of such a large part of the economy on a single throw of the dice.

How does this apply to fire prevention? That's a public good, but we can't incarcerate a fire, can we? If we build a fire station in your neighborhood it's far too distant to protect me. I gain no benefit.

There are several benefits to you. For example, the property tax base is maintained at a higher level. Some portion of those taxes are spent on services by which you and others profit.

Keep in mind that "public good" does not necessarily mean "at a specific level". Eg its provision does not have to provide a benefit nationally, or statewide, or even city-wide. It doesn't even mean that it has to benefit all citizens. It merely has to have enough of a free-rider aspect to make its provision more efficient publicly than privately.

And human or bureaucratic failures do not make a public good into a nonpublic one. It's a matter of degree rather than of absolutes.

Strikes me as much the same as the "catching John Robie on 5th and 38th somehow protects somebody at Kingston Throop in Bedford Stuyvesant".

In what way?

The definitions of public good don't seem to describe a harm or even lack of benefit due to being so defined, and the "don't" doesn't seem to be universally adopted by economists... So, why do I care?

Sorry, maybe it's because it's been so long, but you lost me there.

Okay, but I'm still at the "so what".

You feel that the most efficient use of scarce resources is unimportant?

It does look like a great many people do want universal health care, and not NASCAR.

Why wouldn't they want it? Why wouldn't they want free bread and circuses?

Again, that people want something is not a sound guide to public policy. If they want something, they should be prepared to pay for it. I am not convinced that anything like a majority of the people in favor of this actually understand that they WILL be paying for it, much less how much.

Can they be frightened away from that by deceptive fear campaigns? Sure.

They have been won to it in part BY deceptive fear campaigns! How many times have we heard the President and his agents intone that "the status quo is unsustainable", and cite one horror story after another to convince people that change MUST happen, and now?

Originally Posted by jeff

Distracted by that silly thing called "real life", or just resolved to make better use of that finite resource called "time"?

A little of both.

A month or so back I started giving a ride to one of our young sabre fencers when I go to another club for practice. The second time he was late when I stopped by to pick him up, so I left without him. Later I had to explain the principle of scarcity to him, and how it applied to time, and how it was much more scarce and hence much more valuable to a 52-year-old than to him at 18...

**Inquartata** · 12-12-2009 03:58 PM

Faugh. "Character limit". If it's not one thing, it's another.

Originally Posted by Phaeton

We're haggling over what price, who pays, who sets the price, and if anyone has a say in what role he or she is going to play in the matter.

Fair enough. We economists do love simplifying assumptions.

I don't think anyone (including us liberals) are arguing that we shouldn't have some means of rationing care, as care is is a finite resource and should be rationed, what liberals are debating is how it should be rationed and in large part the market structure.

Yes. The problem, as I see it, is that they are arguing a failed view of the way economics works, simply because it comports better with the way they think that the world should work...and they keep arguing it no matter how many times the failure is made plain, because "this time it'll be different".

Originally Posted by Phaeton

I was hesitant to use rationing in my post (and perhaps should not have) because even though it is perfectly accurate (and perhaps the best word) to use in a denotative sense, the images of war-time rationing and soviet bread that are associated with "rationing" in the traditional governmental sense do not apply.

Unfortunate, but true.

Some people would have us think that we have a choice of keeping the system how it is or rationing care, but they present us with a false dichotomy. The choice is not whether or not to ration (because it's being rationed right now) but rather how to ration.

Always.

Originally Posted by jeff

Yes, somewhere between the extremes of "pay very little to save a life" and "pay enormous sums to extend the life of a mass murderer" there is a boundary that fits reality. BTW, I would use instead of the latter example "pay enormous sums to do things to terminal patients when it won't extend their lives or improve their quality of life" as that is a real situation.

I agree, but sometimes when faced with absolutism one must resort to ridiculous extremes.

Then there's the additional matter of choice. If one accepts the premise that "human life is always to be preserved whatever amount of resources must be expended to do it", then one must also accept, I think, that abortion cannot be tolerated, and that the DNR order is inherently immoral and also should be banned. Etc.

For those who believe that outcome is unacceptable, that proves that the free market cannot solve all our ills (pun is apt) because markets don't serve clients without money. If we do want to solve those problems, we must look beyond the free market.

Right. The problem, though, is that I don't think that there's any other efficient way TO solve such problems. The market is not perfect, but to paraphrase Churchill it's the worst system there is except for all the others...

More anon, it's fencing time again!

**Philistine** · 12-13-2009 09:49 AM