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Clinton, Obama, Insurance
By PAUL KRUGMAN
The difference between the health care plans of Hillary
Clinton and Barack Obama could well be the difference
between achieving universal health coverage and falling far short.

http://www.nytimes.com/2008/02/04/opinion/04krugman.html?th&emc=th

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But...but...but.... I'm FOR Universal Healthcare.
I don't think I've ever been so torn in a political primary election.
Usually I know which candidate I want. This time, I want them both.

AM
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$124B....I love how he doesn't tell us where that money will come from. New taxes? Or just load it into the deficit? They spend all their time talking about how to cover the most people, and completely ignore the other side of the equation (i.e. the bill). Americans seem to have no idea how to manage debt (personal or governmental).

Assuming it is distributed evenly among the population, a family of four will see an increase of $2000 to their tax bill to pay for Clinton's plan.

Obviously that is a rough estimate. If it's levied as a percentage increase, then it will scale by income. It would be nice if someone like that MIT guy did an analysis of this side of the equation.

I can't afford another $2K in taxes (including MIL, I have four people under my roof).

1poorguy
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Hillary Clinton's plan bothers me though. I am not a fan of her saying wages should be garnished if someone is not willing to pay on their own.

http://www.time.com/time/politics/article/0,8599,1709472,00.html

While I think everyone should have health insurance, I am not too keen on forcing someone into a system, which I feel garnishing wages does.

While I love the idea of universal health care, I still don't see how it works in the U.S.. There are so many hurdles....especially from the health care field.

Charlie
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I am not too keen on forcing someone into a system, which I feel garnishing wages does.

You're against Social Security?

How about roads, are you against those too?

Goofy
(not particularly happy about being "forced" into a war in Iraq, either.)
 
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Once again, I feel I am missing something vital in a political discussion. If we want universal health care, why are we coming at it from a band-aide point of view?

First, we need to figure out the costs of health care. We need to ignore the drug company lobbies and figure out cost of drugs. There is NO/NONE/NADA need for reps to be wineing and dinning thousands of doctors every month, there is no need for massive advertising campaigns to make clocks/pens/pads/t-shirts/letter openers/desk junk/etc. There is no need for the over the top spending in Washington by the companies.

ALL of that money is what we are paying for. Don't be fooled, it is not the cost of research/cost of failed trals/etc. It is the frikken BILLIONS of DOLLARS spent on marketing. There are much better ways to educate docs.

Next we need to figure out the whole liability system. First we need to figure out how to make/create/train docs to be as accident free as possible. (I hear frightening number of stories about docs that are careless/neglectiful/uncaring...and those kinda docs should be weened from teh system.) Secondly we need to revise the ability for lawsuit...accidents happen and sorry sometimes the stats don't fall in your favor. (Take away the costs that plantif's attornies can take off the top and you eliminate a bunch of this.)

Lastly we need to develop a real preventative health system. People and healthcare staff need to be taught how to STAY healthy and how to avoid chronic issues. The healthcare system should not be the failsafe, it should be the last resort. Living healthy should become a cutltural issue.

That is how we fix healthcare. Then you bring the prices down to the range that people 'could' afford it out of pocket. Then you eliminate the need for outragous health insurance costs.

Once again I feel we are not addressing the causes, just the effects.
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I can't afford another $2K in taxes (including MIL, I have four people under my roof).

1poorguy

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Can you afford more than two million in medical expenses if one of your kids gets cancer?

AM
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While I love the idea of universal health care, I still don't see how it works in the U.S.. There are so many hurdles....especially from the health care field.

Charlie

------------------


Hurdles exist to be jumped.

AM
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While I love the idea of universal health care, I still don't see how it works in the U.S.. There are so many hurdles....especially from the health care field.

This is what concerns me as well.

Does anyone know how other country's systems evolved into Universal Health Care? Particulary how the British system evolved? We tend to follow in their footsteps with some separation of years. The number of years we lag isn't steady, but we tend to repeat their history. Yes, I'm aware this is a totally simplistic position, but it has validity just the same.

Rebecca
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No Goofy....

I am fine with those. Then again my wages are not being garnished for them.

Charlie
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AM,


So how do we over come them?

Charlie
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I am fine with those. Then again my wages are not being garnished for them.

REally? You don't pay FICA? How do you manage that?

For me, FICA is by far the largest "garnishment" from my wages.


David
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AM,


So how do we over come them?

Charlie
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Charlie, I've explained this so many times that I'm tired.
We just do it. It's simple. There are, as far as I can see, only two things stopping us:

1. The vast amounts of money given to members of congress (and hopeful members of congress) by the insurance and drug companies.

2. Our own stupidity in thinking the word "Socialism" every time someone mentions something that might actually help others that are worse off than we are. (Yet, as someone very astutely - and recently - pointed out, the Military is a huge Socialist organization. And no one seems to have a problem with that.)

You just do it.
Many things are made into law.
They got made into law because somebody did it.
You just do it.
You just do it.
You just do it.

Yes we can!
Yes we can!
Yes we can!

Other nations have done it.
We can do it.
Last night CNN did a special on "Broken Government" that discussed our sorry health care system. In France, if a mother has a child that needs cancer treatment, the child gets the treatment -- and the mother gets no bill at all. Ever.

Are we saying that France -- those horrible cheese-eating, freedom-fries hating, awful people who don't love Bush -- can do this, but we can't?

The United States simply cannot do something most first-world countries have been able to do? Who woulda thunk it? I never realized we were such candy-butts.

Yes, we can!
Yes, we can!
Yes, we can!
(To steal a very good slogan.)

AM
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Once again I feel we are not addressing the causes, just the effects.

I agree.

I related previously the anecdote of a hospital billing process of which I have first-hand knowledge. To recap, the bill was for $34000 (1 night in the hospital, plus the actual procedure that was done). When the insurance company got it they invoked a "contractual discount" and the bill dropped to about $3K (as I recall), they paid their percentage of that leaving the patient with a ~$500 bill. So were did that $34K come from, and how (if that was a reasonable billing) could they possibly accept 1/10th that amount later? Had there been no insurance would the $34K have been billed? Would they expect payment from the average working family? This to me seems to be a huge disconnect. Why bill $34K if you know you're only getting 1/10th that? Why not just bill that much (in which case most folks could afford it if they had to)?

I would add this to your list of things that need to be addressed.

1poorguy
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Yes, we can!
Yes, we can!
Yes, we can!


No we can't!
No we can't!
No we can't!

Gee...this is fun...don't need any facts or figures to back up anything. Just say it and it's so!

1poorguy

(Actually, "yes", we can...BUT...I will never come on board until someone can explain coherently and reasonably how to pay for it, and how adding $124B to our already-bloated budget is not going to push us into insolvency.)
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1. The vast amounts of money given to members of congress (and hopeful members of congress) by the insurance and drug companies.
------
Are we saying that France -- those horrible cheese-eating, freedom-fries hating, awful people who don't love Bush -- can do this, but we can't?
AM


Your 1. is the main roadblock and it's the reason why IMO the US can't do what France does.

Naturally Krugman doesn't mention the fact that Hillary has been bought out by big pharma & insurance. For that reason she, particularly, can't deliver an affordable system. I don't blame her for this (although Krugman's omissions and one-sidedness border on dishonesty). It's the American political way to accept campaign contributions and deliver a return of taxpayer dollar benefits at a rate of 10+ to one.

For health care the US spends at roughly twice the rate of France and other so-called developed nations. And the US health care is considerably inferior. The system needs reform desperately. The only way that's going to happen is through campaign reform in a way that will return the US from a country governed by special interests to a democracy.
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Can you afford more than two million in medical expenses if one of your kids gets cancer?

No. But my inability to afford that is completely irrelevant to my inability to afford the other. I can't afford either. Give me something else.

1poorguy
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(Actually, "yes", we can...BUT...I will never come on board until someone can explain coherently and reasonably how to pay for it, and how adding $124B to our already-bloated budget is not going to push us into insolvency.)

-------------------


If you continue to be this stupid I'm going to p-box you.
You pay for it through taxes, of course. That's how we pay for everything in this country.

You haven't answered the question I asked you earlier.
Can you afford two million to pay for treatments if your child gets cancer?

On last night's CNN program there was a very good example of what can happen to YOU. A couple with premature babies needed much care for one of those babies. She needed open-heart surgery (among other treatments). This couple owned more than one home and they also owned a business. They lived much better than I do. AND they had excellent healthcare insurance. So they thought. Well, it was excellent by United States standards.

The baby needed to go to another state for immediate treatment, and the couple were told that a plane was standing by and ready to fly them there. But first, they would have to pay $30,000. No $30,000 and the plane would not take off. Presumably, the baby would just sit there on the tarmac and die. So the couple scrambled from pillar to post in order to get together the money required for the flight.

The baby got treatment. Up to and including the two million dollar lifetime cap the insurance company set. Then they had to pay out of pocket. Such are the expenses that happen in this country when someone gets really sick. They lost their business. They lost their second home. They lost nearly everything. And ultimately the baby died.

We are 300 million + people in this country. To pay for that $30,000 flight for a pair of frantic parents would have cost each one of us less than a penny. Would you have denied that couple a penny to save their baby?

That's what you do when you whine about taxes for healthcare for everyone.

AM
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1poorguy says

I can't afford another $2K in taxes (including MIL, I have four people under my roof).

Can you afford $2K for medical care?
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Then you eliminate the need for outragous health insurance costs.

You forgot one last step.

You make insurance into co-ops and not public companies with IPO's and stockholders.

The way co-ops work, is that profits that aren't needed to keep the company going are paid back to the people who paid in according to the share that they paid in, and not paid out as dividends to shareholders.

(I LOVE my power co-op. Every year or two they give us a credit on the monthly bill based on the money they pay back to us, the owners. And I know some of my friends have insurance with a company that does exactly the same.)
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No Goofy....

I am fine with those. Then again my wages are not being garnished for them.


What are you talking about, of course they are. You pay taxes, those pay for roads. You pay FICA, that pays for Social Security. You think those things just helicopter in from the sky?

I can't afford another $2K in taxes (including MIL, I have four people under my roof).

Ah, but wait. How much do you think you are paying right now for health insurance for those four people? I can almost guarantee you it is more than $500 per person, per year. (Particularly since that expense is mostly pre-tax.)

For most people, the one-payor system will be a replacement, not an addition. Savings come from the dramatic drop in administrative costs and other things which the private market has. Indeed, for some people it will likely be cheaper, not more expensive. Surely you don't think you are going to keep the same level of coverage (and cost) while another, more comprehensive (and paid for a different way) comes about, do you?

Naturally Krugman doesn't mention the fact that Hillary has been bought out by big pharma & insurance. For that reason she, particularly, can't deliver an affordable system. I don't blame her for this (although Krugman's omissions and one-sidedness border on dishonesty). It's the American political way to accept campaign contributions and deliver a return of taxpayer dollar benefits at a rate of 10+ to one.

Terribly over-cynical. In the 1960's Big Tobacco made gigantic contributions, too, and yet the Surgeon General made his recommendations, and (admittedly) incrementally the tone of the discussion changed, legislation passed (locally at first), and now you can hardly find a trace of what those Big Tobacco payments bought. Remember seat belts, catalytic converters, and CAFE standards? Detroit has been fighting those for years, and the bar keeps moving. Faster at times, slower at others (like the last 7 years) but they do keep moving, payments or not. Remember smokestacks, air pollution, industrial waste? Contributions to Congresspeople a plenty, and yet we have regulation and legislation dealing with it.

Is it an impediment? Sure. Does it consign us to a society wherein we have no voice? Obviously not. Buck up; things aren't really so bad as you portray.

No. But my inability to afford that is completely irrelevant to my inability to afford the other. I can't afford either. Give me something else.

Sometimes you don't get a choice. I'd like to have my fairy godmother come down and give me 3 wishes, but that ain't gonna happen either. So hold your nose and pick what's best out of the less-the-perfect barrel. Good advice for many things in life, methinks.
 
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Ah, but wait. How much do you think you are paying right now for health insurance for those four people? I can almost guarantee you it is more than $500 per person, per year. (Particularly since that expense is mostly pre-tax.)

Excellent question. I have no answer at this time. I'll have to check my pay stubs and get back to you (like most folks, mine is through my employer...I have some withheld every pay check).

For most people, the one-payor system will be a replacement, not an addition.

Valid point. It would be interesting to see a realistic breakdown of this, rather than cheerleading and sob-stories.

Savings come from the dramatic drop in administrative costs and other things which the private market has.

That would be great, if true. I have yet to experience the feds getting involved in anything and have it result in less administration and bureaucracy. Usually they add more layers.

So hold your nose and pick what's best out of the less-the-perfect barrel.

My experience so far has been the best is usually (though not always) when government keeps their noses out of <insert topic here>.

And, responding to Harry, I have to quibble about the quality of medical care here. Rich people from all over the world come here for treatment. Ours is the best (allowing for a sluggish FDA that often seems to cater to big pharma more than to those whom they supposedly serve). It's just out of reach of the poorer people. But the stuff American medicine can do is quite amazing.

It is my understanding that in places like England those who can afford it still go to their own doctors because they get better care. You'll never remove the advantage the rich have in terms of living standards and care.

1poorguy
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I can almost guarantee you it is more than $500 per person, per year.

Just as a point of reference, I pay more than that per month. It's a benefit of my wife's job that I'm able to get it that cheap.

I guess the bright side is that we spend enough on insurance that we actually get to deduct medical costs on income taxes.


David
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(allowing for a sluggish FDA that often seems to cater to big pharma more than to those whom they supposedly serve).

This statment makes no sense. Big Pharma wants the FDA to be faster at approving drugs, not more sluggish. In being "sluggish", the FDA is frustrating big pharma.

It's when things are rushed that you can accuse them of catering to the pharma industry.


David
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While I think everyone should have health insurance, I am not too keen on forcing someone into a system, which I feel garnishing wages does.

You're already paying for it. Why shouldn't you get the benefits?

In the U.S., the per-capita expense for health care runs over $6,000/year. About half of that is from the government. The other half is through private insurance or expense.

The rest of the industrialized nations of the world spend between $2900 - $3500/person/year, and cover all their citizens.

Is it ironic that the most authoritarian arm of the government -- the U.S. military -- has socialized health care for all of its members?

Finally, do we even want insurance? Why? Why not just health care? If everyone is to have insurance, insurance adds no benefit to the equation at all: certainly not to the insured, who are regularly denied coverage their health-care professionals think appropriate, nor to the health-care providers, who have to jump through different hoops (and expense) for (nearly) every insurer. Getting rid of the insurers alone could lop nearly 30% off the cost of health care.

rj
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Finally, do we even want insurance? Why? Why not just health care? If everyone is to have insurance, insurance adds no benefit to the equation at all: certainly not to the insured, who are regularly denied coverage their health-care professionals think appropriate, nor to the health-care providers, who have to jump through different hoops (and expense) for (nearly) every insurer. Getting rid of the insurers alone could lop nearly 30% off the cost of health care.

rj
---------------------


Exactly.
And probably more than 30%

AM
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1poorguy wrote:

Excellent question. I have no answer at this time. I'll have to check my pay stubs and get back to you (like most folks, mine is through my employer...I have some withheld every pay check).

Check your pay stub for 'social security tax' and 'medicare tax' and/or FICA. You'll find you're paying more than 6%, unless you make a lot more money than I do. And you should double the amount you see -- your employer pays an equal amount directly to the government (that never shows up on your paycheck -- but if you're self employed, you pay double).

So the way I see it I pay for a lot of other people's health care and insurance, but still have to pay $20k/year to have health insurance for my family.

Worse yet, if I choose to 'go naked' and forego insurance, hospitals and the like will overcharge me by at least 5x (according to friends who work at insurance companies). Because there are no laws to prevent such scams and no meaningful competition, and because the default rates on payment are so high.

rj
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Big Pharma wants the FDA to be faster at approving drugs, not more sluggish. In being "sluggish", the FDA is frustrating big pharma.

You are, of course, correct. I've known folks that shoot down to Mexico to get medicines they can't get here (less so now than several years ago when they were going for viagra and -I think- AZT and some others). I was referring to keeping foreign drugs out. But perhaps that isn't as big a problem.

1poorguy
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I can't afford another $2K in taxes (including MIL, I have four people under my roof).

Can you afford more than two million in medical expenses if one of your kids gets cancer?

No. But my inability to afford that is completely irrelevant to my inability to afford the other. I can't afford either. Give me something else.

1poorguy

$2K? I can afford it if my insurance bill went away. But I don't advocate that. I would prefer Universal Health Insurance to a nationalized health plan. And I agree with Hillary to take money be\y gaarnishment (read taxes) if they don't want to pay.

UHI: First paid by employers. Most, at least many do this already. A healthy employee is a better employee. Second, if no employer insurance, the individual. Take their money at gun point, as the Libertarians say. Third, if they truly can't afford insurance, the gummit pays. How much would that cost? Less than we currently pay for indigent health care via emergency room visits, I betcha.

cliff
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xcellent question. I have no answer at this time. I'll have to check my pay stubs and get back to you (like most folks, mine is through my employer...I have some withheld every pay check).

Your pay stubs aren't going to tell the tale. That will only show you your contributory portion. There is a large portion, I guarantee a sizeably larger portion which your employer pays. Obviously any system isn't going to require your employer to pay a full share, and you to pay another full share on top of that to duplicate the same coverage.

We may not be able to go through every pay stub in America, and the books of every company large and small, but we have some fairly crude tools which can get us close: the total cost of health care. The total number of citizens covered. Divide. Now you have a "cost per citizen" figure which is relevant today. Now normalize that across all citizens and see what it buys.

Talk to the hospitals and doctors' offices. See what they guesstimate they pay for administration. Look at what similar government programs pay for administration: Social Security. Medicare. Medicaid. Veterans Health. We have several different models on several different levels, operating in similar environments. Surely one of them, or an average of them is going to give us some indication of what to expect.

Opponents are positioning this as "expensive." Well of course, because if they ever said "Hey, this might even be cheaper" the game would be over. The opponents, of course, are those who are making huge profits out of the inefficiency of the current game and want to keep it that way. What else would you expect?
 
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Your pay stubs aren't going to tell the tale. That will only show you your contributory portion. There is a large portion, I guarantee a sizeably larger portion which your employer pays. Obviously any system isn't going to require your employer to pay a full share, and you to pay another full share on top of that to duplicate the same coverage.


if you get yourself unemployed and go COBRA, you find out.

if you know someone in payroll/HR/personnel, you can ask, "what would i have to pay for COBRA?"

Talk to the hospitals and doctors' offices. See what they guesstimate they pay for administration. Look at what similar government programs pay for administration: Social Security. Medicare. Medicaid. Veterans Health. We have several different models on several different levels, operating in similar environments.

my cousin the doctor 'retired' because the cost of "dealing with Insurance" was too great.

said he researched it and found Medicare/VA around 3-5% overhead, private ins. 10-45%


..FWIW


Opponents are positioning this as "expensive." Well of course, because if they ever said "Hey, this might even be cheaper" the game would be over.

worth repeating.



=
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For me, FICA is by far the largest "garnishment" from my wages.


I have never considered it as such. I just feel if someone does not want to be covered....why they wouldn't I don't know. But if they don't want the insurance, why force it on them?

Charlie
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Dear AM,

I'm sorry to make you repeat. Did not know I was creating a problem. I'm sorry though, saying we just do it is not a good enough answer. You are right when it comes to the lobbying interests. They are very powerful, and I am afraid there is no one strong enough to lead on this.

My apologies. I will not mention it again.

Charlie
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$2K? I can afford it if my insurance bill went away.

Actually, I should rephrase. I can afford it on occasion. Regularly would be a problem. If my (and 1poorlady's - she's covered on her own plan because it was cheaper for us) payments went away we probably could afford it (I pulled out my stubs). Whether or not "they" (whoever oversees this) could afford to give us the same level of coverage we have now is another question.

I would prefer Universal Health Insurance to a nationalized health plan.

If I understand the distinction you are making, then I would agree that UHI is preferable to nationalized health.

And I agree with Hillary to take money be\y gaarnishment (read taxes) if they don't want to pay.

Not sure I do. If someone wants to opt-out, why not? Then if they have a problem they are on their own. They either can afford it, or they bleed to death. Their choice, their problem. Sorta like helmet laws on motorcycles...I don't agree with them. If Gary Busey wants to ride without a helmet, fine. However, I think the insurance company should have the right to write into their policies that if you aren't wearing a helmet then you're not covered. It's a personal choice thing.

It seems your vision is somewhat different. You see the gummit as enforcer: you WILL have insurance. Not provider. That certainly would reduce the bureaucracy.

One concern I have throughout this whole thing is that we still are addressing bits and pieces of the problem. Maybe not even that, but rather symptoms of the problem. As another poster pointed out earlier, whacky billings, pharmas courting MD's, malpractice (both the bad doc side, and the litigation side), etc., all contribute to making our system unaffordable. Those need to be addressed as part of any proposed action, or you really aren't fixing anything, IMO.

1poorguy
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I have never considered it as such. I just feel if someone does not want to be covered....why they wouldn't I don't know. But if they don't want the insurance, why force it on them?

Charlie

Because when they show up, crawling on their bloody knees at the emergency care place, we can't tell them to just go somewhere else to die.

cliff
... yeah, yeah, yeah. Prolly Greeked about ten times.
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I related previously the anecdote of a hospital billing process of which I have first-hand knowledge. To recap, the bill was for $34000 (1 night in the hospital, plus the actual procedure that was done). When the insurance company got it they invoked a "contractual discount" and the bill dropped to about $3K (as I recall), they paid their percentage of that leaving the patient with a ~$500 bill. So were did that $34K come from, and how (if that was a reasonable billing) could they possibly accept 1/10th that amount later? Had there been no insurance would the $34K have been billed? Would they expect payment from the average working family? This to me seems to be a huge disconnect. Why bill $34K if you know you're only getting 1/10th that? Why not just bill that much (in which case most folks could afford it if they had to)?

I think this is one of the biggest problems with our healthcare system...Out of control costs that nobody seems accountable for. My biggest fear about a universal healthcare system is that my quality of care will go down and my costs will go up as in I'll pay more in additional taxes than I pay for my health insurance.

I don't really agree with Hillary's plan to garnish wages and force people into a system, but if people choose not to have insurance under a "mandatory" plan, then they shouldn't receive care if they can't pay for it out of pocket. It isn't fair for them not to pay when everyone else is and then show up and expect free coverage.
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Because when they show up, crawling on their bloody knees at the emergency care place, we can't tell them to just go somewhere else to die.


Why not? They made their choice. If they'd rather have that big screen TV than proper insurance, they suffer if something goes wrong. I have more sympathy for someone with no choice than someone who makes a dumb one.

1poorguy
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Why not? They made their choice. If they'd rather have that big screen TV than proper insurance, they suffer if something goes wrong. I have more sympathy for someone with no choice than someone who makes a dumb one.

1poorguy


But, then, we are Nice Guys.

cliff
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I have never considered it as such. I just feel if someone does not want to be covered....why they wouldn't I don't know. But if they don't want the insurance, why force it on them?

Charlie

Because when they show up, crawling on their bloody knees at the emergency care place, we can't tell them to just go somewhere else to die.



you not greeked ...i almost was...

woulda said --

because if they get sick or hurt, their choices are go to ER and cost every one more, go to Dr and stiff her on the bill, die in a gutter and stink up the place
And
.... if you're working from 'insurance' model[*], 'young & healthy' in the pool brings down the costs for everyone ( and young+healthy 'give' now and 'receive' later )


-b

[*] whole nother issue . ..whether 'insurance' model is the best ..but sort of is what we have
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And
.... if you're working from 'insurance' model[*], 'young & healthy' in the pool brings down the costs for everyone ( and young+healthy 'give' now and 'receive' later )

True that. I see the insurance lobby as a huge impediment to progress in this area. Being as they own most of Congress, hard to get by them. So we co-opt them. But with roolz: They have to accept all comers at the same price. (Can be age adjusted?) This is not so different from what they do with big corporations now.

Besides, if we get the insurers involved, they will act to control hospital and other "health providers" costs. AMA would likely resist mightily, but I'd rather fight them than the insurors. Shoot, maybe they could even open up the admissions to med school! The present system has the effect of limiting the law of supply and demand by strangling the supply part (Physicians) while letting the demand increase.

I also remember seeing big buildings in Germany with the word INSURANCE proudly displayed. There would still be competition within the insurance world. They would control the cost side. (Germany has UHI.)

Only issue would be to keep the insurance companies from cutting off the demand side by denying treatment whenever it was cheaper to let the patient die than to treat.

cliff
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True that. I see the insurance lobby as a huge impediment to progress in this area. Being as they own most of Congress, hard to get by them. So we co-opt them. But with roolz: They have to accept all comers at the same price. (Can be age adjusted?) This is not so different from what they do with big corporations now.


yup.
...... one of the things 'we' (we who are in favor of some sort of Universal care, not you and me (i?)) are arguing about -- Insurance companies..what to do with them? drag 'em out back and shoot them? work with them? co-opt them? regulate them?

30 yrs ago, might have said, 'treat 'em like public utilities'



Besides, if we get the insurers involved, they will act to control hospital and other "health providers" costs. AMA would likely resist mightily, but I'd rather fight them than the insurors. Shoot, maybe they could even open up the admissions to med school! The present system has the effect of limiting the law of supply and demand by strangling the supply part (Physicians) while letting the demand increase.


i'm not so sure about that.

that they'd control costs or that the current system inappropriately decreases supply ..
tricky line between not enough doctors and enough, but too many incompetent ones.
( actually, the insurance business has negative effect on supply --doctors spend time with red-tape that could have been spent with patients )


=
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<<If someone wants to opt-out, why not? Then if they have a problem they are on their own. They either can afford it, or they bleed to death. Their choice, their problem.>>


It all depends on whether you view it as a national issue, or strictly an individual one.

If you never drive, you still have to pay for roads.

If you are a pacifist, you still have to pay for the military.

If you have no kids and went to private school, you still have to pay for public school.

The question is: why do we think of health care differently than these other issues? We are not unique in doing so, but we are unusual in that regard.

I think it's simply because of habit. We didn't have national health care, so we grew to think of it as a strictly individual matter. Just like if we had grown up without public schools, we'd probably think "Well, everyone should get to opt out if they don't want to go to school."

-chris
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jp: tricky line between not enough doctors and enough, but too many incompetent ones.

I betcha they reject many highly qualified applicants for med school every year, because of artificial limits. I know alchook would disagree, but he's wrong.

cliff
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Had there been no insurance would the $34K have been billed? Would they expect payment from the average working family? This to me seems to be a huge disconnect. Why bill $34K if you know you're only getting 1/10th that? Why not just bill that much (in which case most folks could afford it if they had to)?

Yes, they would have billed you that much. And they also would have been willing to negotiate and take as much as they thought they could get from you.

But you've identified the main issue with healthcarec costs...there really is no "market" here because no one knows what they're spending until it's too late. Markets can't possibly be efficient if both the producer and the consumer don't have the information to make rational choices.
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jp: tricky line between not enough doctors and enough, but too many incompetent ones.
--------
I betcha they reject many highly qualified applicants for med school every year, because of artificial limits. I know alchook would disagree, but he's wrong.



i think my cousin would also disagree .... key word being 'artificial' ...

(he was one of those --rejected though qualified, went two yrs to Mexico, transfered taking slot of someone who washed out)

... there's only so many cadavers ... and every med student needs 12 or 14 of their own ..no?



=
...... i'll ask my Dr. next time i see her. (since it wasn't that long ago she couldn't get into med school for 'rude limits'
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But you've identified the main issue with healthcarec costs...there really is no "market" here because no one knows what they're spending until it's too late. Markets can't possibly be efficient if both the producer and the consumer don't have the information to make rational choices.


i agree there's no Market ... consumer lacks info and can be limited in choice

not clear what info the producer lacks



=
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Clinton and Barack Obama could well be the difference
between achieving universal health coverage and falling far short.

http://www.nytimes.com/2008/02/04/opinion/04krugman.html?th&emc=th

-----------


But...but...but.... I'm FOR Universal Healthcare.



But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.


contra 'this' ......someone argued on PA today that because of 'mandates', Clinton's HC plan would kill her in the general election[*].

kind of a tricky situation .. Clinton has a better plan (according to Krugman ..and Jack Nicholson), but it can and will be used by Reps to defeat her; Obama has a weaker plan that will be even weaker when/if implemented.



=j
[*] and her position on Iraq ..but i also wonder about that
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Whether or not "they" (whoever oversees this) could afford to give us the same level of coverage we have now is another question.

My older kids have had ACCESS cards in the past. (That's PA's version of medical assistance.) Best insurance we've ever had in most respects. Free meds, no co-pays, it was very rare that the dr we preferred was not covered.

Our current insurance, through Jeff's work, sucks. The plan we had when he first started there was ever so slightly better, but was $250 every two weeks out of his check. Now it's only $100, but the co-pays are much higher, except for meds. It's a better trade-off. I did the math when we first switched and determined we could all spend 3 nights in the hospital (the biggest co-pay increase) and break even. Our dental and vision might as well be nonexistent.

It seems your vision is somewhat different. You see the gummit as enforcer: you WILL have insurance. Not provider. That certainly would reduce the bureaucracy.

I'm on the fence about this issue because I'd like to see how it works in real life. You equated it to helmet laws. Why not just equate it with car insurance? If I don't have car insurance, I get in trouble. I believe this varies by state, and I think in PA's it may just be a fine if I get pulled over.

Part of the problem is that people don't pay their medical bills - especially hospital bills. In the world of government health insurance, how do you force people to pay their hospital bills if they aren't covered? I don't think that denying treatment is the right answer. If someone comes into the ER having a heart attack, the doctors shouldn't check for valid insurance before saving his life. How do you make him pay later? For people who really can't afford insurance who would be covered for free anyway, maybe there could be a 3 month period of paying back bills. (PA has this.) Some poor people who qualify now don't have it simply because it's a PITA to get it. Paperwork, standing in line, being looked down on, etc. The paperwork can especially be intimidating.

My dad had a stroke a couple years ago about a week before his health insurance for his new job kicked in. And just for added kicks, he lives in AR, but he had the stroke in PA. My dad was working at Walmart - not the best paying job in the world. After the stroke he tried to work, but eventually had to stop. Even though his wife isn't going to pay one dime of his medical bills, her income was counted for every type of possible assistance for paying the bill. He was in the hospital for almost 2 weeks, most of that in a special unit. It wasn't called an ICU, but it was similar to that, I guess. He's a little too young for SS, but he qualified for SSDI, but only after being denied several times because he went back to work after the stroke, proving he could work. (Except that it proved that he tried, not that he could.) He can't get veteran's assistance because he was drafted but sent to Germany instead of Vietnam. From what I understood from the 230 people I spoke with, serving in Vietnam would have made a difference.

He filled out paperwork for the hospital (with my mother's help, no less) and was able to explain that he wanted to pay the bill but couldn't afford the whole thing. They forgave 80%, I think. The dr had already agreed to reduce his expenses considerably. So the bill was still way more than he could afford, but it was much less than it had been. He went from part-time Walmart income to no income to SSDI, and he has been paying his bill. He didn't buy Christmas presents for his kids or grand-kids this year (not that we care) because he's paying this bill. He's actually almost done paying the bill. Almost all of his money is going to this bill. To be honest, my sister and I told him to send the hospital $5 or $20 or $100 a month for the rest of his life. That's more than a lot of people (dare I say most people) would do with a hospital bill like that! But my dad doesn't believe in not paying his bills, and since his health isn't great he has to get it paid as quickly as possible. It bothers him. It doesn't bother most people.

With SSDI, medicare kicks in after 24 months after onset of disability. So, people getting disability from SSA - which is also based on quarters worked - have to wait 2 years to get medicare!

My point to this long story is that without forcing everyone to be covered, how do you make people pay a bill like the one my dad faced? You can't garnish his wages. I guess you could reduce his SSDI, but you couldn't even do that until he qualified. I don't know when Medicare kicked in for my dad. It should have in October if they go by the stroke date as the onset date. Up until then, he still had to pay all of his regular dr bills out of pocket. He required blood work for monitoring his meds after the stroke every week or something like that. All of that was out of pocket.

Rebecca
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But, then, we are Nice Guys.

:-)


(Sometimes it's nicer to let someone fall and learn from their mistakes than to hold their hand and coddle them.)

1poorguy
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I have never considered it as such. I just feel if someone does not want to be covered....why they wouldn't I don't know. But if they don't want the insurance, why force it on them?

Charlie

--------------


Because you will end up paying their bills if they don't.
It's just as simple as that, Charlie. How many people can you afford to pay for?

AM
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Dear AM,

I'm sorry to make you repeat. Did not know I was creating a problem. I'm sorry though, saying we just do it is not a good enough answer. You are right when it comes to the lobbying interests. They are very powerful, and I am afraid there is no one strong enough to lead on this.

My apologies. I will not mention it again.

Charlie

----------------------


Dear Charlie (MY dear Charlie),
You are not creating a problem.
But saying "just do it" actually IS a good enough answer.
Every single task I've ever done requires first one step then the next.
One foot in front of the other. Tenacity. And it all boils down to "just do it."

Want a new or better job? Go look for one and don't stop until you get it.

Want to write a book? Sit down at the computer and begin typing.

Want to paint your living room? Buy the paint and a brush, roll up your sleeves, and start painting.

We, the people, CAN "just do it".
It is SO simple that maybe that is the problem.

First, we say NO to congress-things that take money from insurance and drug companies. Next, we say NO to those same insurance and drug companies. Then, we look at each other and say, "Hello fellow citizen! Let's insure ourselves and save boo-coo bucks in the process -- AND save each other from certain bankruptcy and loss of everything we've ever worked to achieve in the event of a catastrophic illness."

Then, we "just do it."

It would be so easy to "just do it."

The problem is the vast amount of brain-washing that has taken place over the years such that people immediately think - "Government! Socialism!" And they fold their hands and turn their backs and hope that no catastrophic illness ever strikes their own families or themselves. After all, we are invincible, aren't we? Can't happen to us! Happens only to other people. People who don't plan or have insurance.

Our current libertarian-nonsense-speaker thinks I told a "sob story" when I told of the family who lost everything when their baby got sick - even though they had really good insurance. He can't afford $2K in taxes. So he says. I say, "Bull dookey." Big, fat, black, steaming piles of "Bull Dookey." He doesn't know what he's talking about.

It really happens. People really do lose everything because of health problems in this country. People in France do not. People in England do not. People in Germany do not. People in Canada do not.

The United States doesn't HAVE to be this backwards. Or this heartless. The irony is that they are being heartless to themselves in the long run. Because chances are that one day someone in their family will need expensive care. Care that they cannot pay for -- even with good insurance (since the insurance companies put caps on their coverage as though after the cap is reached you suddenly become non-human and not worth saving).

We don't HAVE to be the backwards.
We CAN "just do it."

The problem is that we somehow fail to understand how easy it would be -- and how much better off we would all be -- if we DID "just do it."

We have a mean-spiritedness in us in this country. We hate to see others get something we don't think they deserve. We look down on the less fortunate as people who never tried very hard - even though we don't really know their circumstances. We would rather suffer ourselves than reach a hand down to the guy below us on the luck-ladder if that reaching is going to cost us a buck or two.

We CAN "just do it."
It's so easy.
But we won't.
We won't until our own system (if you can call it a "system") all but collapses and people begin dying in the streets. We won't because we are mean-spirited, greedy SOBs that don't really care at all about anybody but ourselves. We won't because somebody once whispered the word "Socialism" into our jaundiced ear. We won't because the word "taxes" is involved and we have been taught to hate that word and translate it as "theft." So, in our ignorance and pettiness, we will deny ourselves the security of knowing that we cannot ever fall below a certain level due to unforseen circumstances of illnesses that play no favorites among the rich or poor.

And this is why we are among the most stupid of nations - populated by the most stupid of people. A pox on the whole lot of us. Without insurance.

AM
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I don't think I've ever been so torn in a political primary election.
Usually I know which candidate I want. This time, I want them both.


I understand the dilemma. But. Clinton just has too much baggage, whether you want to believe it is her fault or not, and will rally the ultra right wing-nuts against her. McCain would have an easier time beating Clinton than Obama.

We MUST get the fascists out of the WH. Since Clinton is even a slightly greater risk, we MUST go for Obama.

I'd take either of them in a heartbeat over the current train wreck. Of course, I'd choose a toaster over Bush, but we fortunately don't have to go that far this election.
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My point to this long story is that without forcing everyone to be covered, how do you make people pay a bill like the one my dad faced?

Rebecca,

You would have to have a system where if you opt-out then you are on your own. If you can't pay, you don't get treated. If such a system existed I'm sure your dad would have signed-up (I suspect almost everyone would). Had he not, he would not have been treated and not had to worry about any bills. That sounds harsh, but that would be the only way to make the system fair and still preserve people's right to choose. We all have to live with our choices.

Healthcare is not a right. It is a service, like any other. If you can't pay, you don't get. Insurance initially helped this situation (i.e. most of us could not get routine medical stuff without it), but I agree with everyone else that now it is part of the problem. I differ only in the presumption that government is the solution.

Why not just equate it with car insurance? If I don't have car insurance, I get in trouble. I believe this varies by state, and I think in PA's it may just be a fine if I get pulled over.

I could, but car insurance generally is mandated in such a way as to protect OTHERS, not you. AZ had the law for a while that you had to carry PL and PD. Those cover everyone except you. The helmet laws are all about you and only you. That's why I chose them.

But my dad doesn't believe in not paying his bills,...

I like him already! I'm the same way. I don't like being in debt, and do my best to clear debt as quickly as feasible. I hope he's doing better, by the way.

1poorguy (noting that if they can forgive 80% and remain in operation, then the billing system clearly is messed up)
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I think it's simply because of habit. We didn't have national health care, so we grew to think of it as a strictly individual matter.

Been thinkin' about your comment. There may be something to that, but I think there's also a lot of simple distrust of the government. We don't trust them to do it right, we don't trust them to take care of us, we don't trust that some special interest isn't going to twist things to their favor (through influence peddling). I've read op-ed pieces that claimed that distrust of authority is almost an American tradition. I'm thinking that might be a larger factor. And the examples we see of government management of things doesn't instill a lot of confidence (especially after the past 7-8 years!). Trusting something as important as our health to such an entity probably scares the bajeezus out of many/most folks.

1poorguy
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1poorguy says

And, responding to Harry, I have to quibble about the quality of medical care here. Rich people from all over the world come here for treatment. Ours is the best (allowing for a sluggish FDA that often seems to cater to big pharma more than to those whom they supposedly serve). It's just out of reach of the poorer people. But the stuff American medicine can do is quite amazing.

They can do the same things in India or Brazil, for a lot less money. Haven't you heard about medical tourism? And when my mother was sick and poor, she moved to Canada for the medical care, which was excellent.
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For most people, the one-payor system will be a replacement, not an addition. Savings come from the dramatic drop in administrative costs and other things which the private market has. Indeed, for some people it will likely be cheaper, not more expensive. Surely you don't think you are going to keep the same level of coverage (and cost) while another, more comprehensive (and paid for a different way) comes about, do you?

Goofy,

All of the Universal Healthcare have promised a lot of things:

Affordability
Universal coverage
Better care
Low waiting times
etc.

However, consider the history of SS:
We were promised the SSN would not be used as a national ID number Promise broken!
We were promised the revenues would not be used to finance current spending. Promise broken!
We were promised excess revenues would be saved for future needs. Promise broken!
We were promised that SS withholding wouldn't rise. Promise broken!
We were initially promised that only those who paid into the system could benefit from it. Promise broken!

Once a "Universal" benefit is put in place, it'll be impossible to remove. After it's in place the voters ability to control the system will be removed. It'll all be controlled through a buracracy and we'll have no ability to appeal decisions in a timely manner.

Even with the best of intentions and design as currently envisioned, you can assured that the system will slowly mutate and degrade over the decades.

Eventually we will get wait times like those experienced in the UK.

Eventually the healthcare will be rationed by how long we can wait for treatment.

Eventually the quality of the system will degrade after the reward for excellence is removed.

Is our current system broken? Absolutely.
Should something be done to fix it? Absolutely.
Is Universal Healthcare the answer? Absolutely NOT!
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I was referring to keeping foreign drugs out. But perhaps that isn't as big a problem.


I personally don't have a problem with this. After all, part of their job is to make sure that when a person gets a drug, he is getting what is intended. If drugs are shipped directly from out of country, the FDA has no way whatsoever to control this. So allowing foreign drugs in would be a violation of their duty.


David
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For me, FICA is by far the largest "garnishment" from my wages.


I have never considered it as such. I just feel if someone does not want to be covered....why they wouldn't I don't know. But if they don't want the insurance, why force it on them?



But why isn't forcing of SS a "garnishment"? It's not something that you can opt out of, unless you go work for the government. So it's every bit as much of a garnishment as anything else; no matter what, you don't get to choose how you spend the money.



David
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I am not too keen on forcing someone into a system, which I feel garnishing wages does.

You're against Social Security?

How about roads, are you against those too?

Goofy
(not particularly happy about being "forced" into a war in Iraq, either.)


You are using Social Security and the roads to support an arguement on universal healthcare. I don't know about you but I ain't banking on Social Security funding my senior years. The roads,..., potholes, have you heard of them? Bridges to nowhere, need any more reminders?

The entity that brought you the Postal Service, the Department of Education, the Department of Defense, the Congress of the United States bringing us healthcare, I'd rather take my chances on the open market, at least it'll be my choice if I go to a witch doctor.

my 2 cents,
Ed
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(I've lost track of the conversation, but heard a funny thought on this subject.)

Tax people based on their weight.
Why not, we tax their cigs, might as well tax their weight and give discounts on milage walked/run.

Yep. All solved.
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You would have to have a system where if you opt-out then you are on your own. If you can't pay, you don't get treated. If such a system existed I'm sure your dad would have signed-up (I suspect almost everyone would). Had he not, he would not have been treated and not had to worry about any bills. That sounds harsh, but that would be the only way to make the system fair and still preserve people's right to choose. We all have to live with our choices.

I'm sure my dad would sign up if at all possible. Honestly, his situation sucks because for income qualifications his wife's income counts even though it's HER money and he has no say.

The other issue (maybe I addressed it in a post other than the one you are responding to) is people who cannot afford it and would be subsidized 100% by the govt, but don't sign up. The reasons for this would vary, but paperwork could be a really big deal. As could transportation to the sign-up place, lack of internet access, not understanding what it available, etc. I would have no problems with them being treated and then HELPED to set up the insurance which could then be retroactive by 3 months.

If I come into the ER with my head spilt open, are you really going to ask for my insurance card? Or are you going to treat me? It seems obvious to me that I would be treated. If I go for an ear infection, then I suppose I could be turned away unless I had insurance or cash (under a GHI system). But after the doctors have stitched my brain together, and then find out that I do not have insurance, how do they force me to pay? I see that as a problem for not making it mandatory.

In my dad's case, he did not have insurance. He would have if he'd waited a week to have his stroke. Should they have kicked him out of the hospital? They had no way of knowing that they'd ever see one cent of the money he owed. In his case, he is paying the agreed upon amount after they forgave a significant portion. If they had insisted on the full amount he would literally be paying for it to the grave OR it would be so overwhelming that maybe he wouldn't pay it. Not because he wouldn't want to, but if you're living on nothing and have a 6 figure medical bill, that would be insurmountable. It would be easier (for some) to ignore the bill than to see it never be paid down far enough to look like the end might be in sight.

I don't have answers. Just questions.

Rebecca
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1poorguy wrote:

You would have to have a system where if you opt-out then you are on your own. If you can't pay, you don't get treated. If such a system existed I'm sure your dad would have signed-up (I suspect almost everyone would). Had he not, he would not have been treated and not had to worry about any bills. That sounds harsh, but that would be the only way to make the system fair and still preserve people's right to choose. We all have to live with our choices.

1poorguy, you are presuming that people have that choice, and that they make rational choices. These presumptions are highly suspect in this case -- many people don't have the money up front to pay, making that 'choice' vacuous.

Secondly, another large -- and highly important -- class does not have that choice: children. They comprise the largest group of the uninsured, and those that benefit most from each healthcare $.

Thirdly, the main point of voluntary vs. involuntary is that (if you'd read the Krugman article) the economics mean that if the program is voluntary, the costs are tripled for those who participate. Like many things, when you try to do something on the cheap, it's substantially more expensive all around.

I think this should be the lesson that the 'no tax' crowd should most learn (but certainly won't): you can only push down on taxes so much before those costs pop up other places. When those costs do pop up, they'll be substantially greater.

As a conspicuous example, it's a lot cheaper to fix a bridge than to replace it after it has collapsed. Even when you don't count the costs of routing around the old bridge while the replacement is built.

This is at least as true of health care. And is substantially more true (the ratios are even more egregiously lopsided) when it comes to public health.

rj
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If I come into the ER with my head spilt open, are you really going to ask for my insurance card? Or are you going to treat me? It seems obvious to me that I would be treated. If I go for an ear infection, then I suppose I could be turned away unless I had insurance or cash (under a GHI system).

********

In college I had a job as the nighttime ER check-in clerk at a big central urban hospital two nights a week. I was the guy with the clipboard asking exasperating questions: name?, address?, next of kin?, health insurance status?, SS#?, and "what seems to be the problem?" of people having heart attacks, allergic reactions, bleeding from gashes in their abdomens that they were holding shut with blood soaked rags, drifting in and out of consciousness or babbling incoherently (drugs? fever dementia? psychotic break?) while their boyfriend looked on in barely contained fear and rage, gunshot wounds (1971 -- not many) with the victims shrieking in fear and pain while I doggedly tried to extract the data needed to admit them. Some nights were calm and I could study, plan physics lab work, etc. Other nights all hell broke loose, and I would stay extra hours to help cope with the load -- typically an uptick in gang warfare. One night I was trying to get my data from a guy who literally had a stiletto knife stuck into his brain through the right temple.

One reason you want Universal Healthcare is that when you need medical attention, you want trained committed nurses and doctors taking care of you who don't give a damn about what you signed, how stupid you were when you bought your motorcycle without a helmet, or whether you chose to pay your health insurance bill when faced with the choice between it and eating. And you certainly don't want an exhausted college sophmore, like me, deciding your fate.

Almost all individual health care is Public Health care: if you are sick with communicable diseases then you are a danger to everyone, if you are disabled or die prematurely, you leave your dependents on the public tab, etc.

It is a mistake to think of health care as an individual acquisition, something that individuals can chose to have or not have. Health care is in fact a pubic good largely paid for already with public funds (research, education, hospitals, emergency personnel, and tax deductions for corporate and private health bills, charities, etc.) It makes sense to acknowledge this, and use taxes or FICA like fees to kick in the last dollars required to access the system.

I am a firm believer in markets and individual choice where they can work well. With regard to health care, the use of markets is a miserable failure. Another poster pointed out that when you need medical treatment you have neither the time nor the emotional capacity to make an informed and quality choice. Trying to use markets for health care is best thought of as superstition based on distorted and irrational quasi-religious beliefs about markets.

Certain goods are much cheaper and better when acquired publicly than privately that it is usually stupid to provide them in some other way: urban water supplies, fire protection, police protection, and public health protection.

A completely separate issue, and one that must be faced regardless of the organization of medical insurance, is that we are fast acquiring sufficient medical knowledge and technology to make it possible to use all the GDP for health care -- which would be insane. We need to enter into a Moral and Ethical Debate about what should be provided and paid for as a Public Good for All, and what should be left as optional and, in fact, as a luxury for the very wealthy or crazy to fall prey to, if they wish to pursue the vain and demeaning dream of eternal life and youthful beauty.

Sorry for the length. I do seem to be ranting these days.

david flyerboy
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Super post!

I would only take exception with the following:

It is a mistake to think of health care as an individual acquisition, something that individuals can chose to have or not have. I am a firm believer in markets and individual choice where they can work well. With regard to health care, the use of markets is a miserable failure. When you need medical treatment you have neither the time nor the emotional capacity to make an informed and quality choice. Trying to use markets for health care is best thought of as superstition based on distorted and irrational quasi-religious beliefs about markets.

The individual acquisition of insurance would normally be done long before the health crisis is upon you, when everything is still cool and calm.

If you find yourself in the hospital because you did something that violated the insurance contract, like motorcycling without a helmet, then yes the hospital should still fix you (if they can) right away - but you should bear the cost, not society.

Markets need to be regulated but US health care is far more expensive than elsewhere because the markets are not open. They are owned by the AMA and the drug dealers (sorry, the pharmaceutical industry).
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These presumptions are highly suspect in this case -- many people don't have the money up front to pay, making that 'choice' vacuous.

If by that you mean they have no choice but to sign up for the hypothetical NHI we're discussing, that's not entirely true. They can choose not to receive care if/when they need it. That would be a foolish choice, but it is a choice. And there are those that would choose it.

...children. They comprise the largest group of the uninsured, and those that benefit most from each healthcare $.

A most-excellent point. Not one I have heard. We do tend to overlook them, don't we. If we had NHI, and if it was voluntary, we'd probably need some mandatory provisions for children. I could argue that if the parents choose against it, and their children can't get care as a result, that it's just Darwin in action. But I won't because, as you say, the children have no choice. Thanks for giving me something substantial to think about.

Thirdly, the main point of voluntary vs. involuntary is that (if you'd read the Krugman article) the economics mean that if the program is voluntary, the costs are tripled for those who participate.

Actually, I did read it. I don't think my one caveat registered with you. Krugman assumed that those who didn't participate would drive up costs when they got sick and needed care. If it is voluntary, then you cannot give the opt-outers care or he is correct about the problem of increased costs for the opt-in-ers. Those that opt-out are simply out of luck. That would be the only way a voluntary system could work. Making it mandatory, of course, by-passes the problem. But the cost of that is loss of yet another freedom/choice. For many that is worth it, for many others it isn't.

Also a very valid point about health maintenance. It is always better to keep yourself healthy. The bridge analogy is very good there. Of course, even with NHI there are many people who won't (for whatever reason) go to the doctor. Or are you proposing that they MUST go every year whether they like it or not? I doubt you are, but don't want to assume too much. That would help keep costs down (i.e. catching problems before they become catastrophic), but civil libertarians would be all over it. Where do we draw the line on what we mandate, and why do we draw it there and not further one direction or the other?

1poorguy
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Almost all individual health care is Public Health care: if you are sick with communicable diseases then you are a danger to everyone, if you are disabled or die prematurely, you leave your dependents on the public tab, etc.

It is a mistake to think of health care as an individual acquisition, something that individuals can chose to have or not have. Health care is in fact a pubic good largely paid for already with public funds (research, education, hospitals, emergency personnel, and tax deductions for corporate and private health bills, charities, etc.) It makes sense to acknowledge this, and use taxes or FICA like fees to kick in the last dollars required to access the system.


i sometimes think the great divide in American discourse is "Cowboys v Commies"

the Cowboys believe (the myth) that we're all rugged individuals who can take care of ourselves .. and anyone who can't take care of theirowndamnself --bleep 'em

the Commies believe (the myth) that we're a community ..all in This together ..have to watch out for each other ..take care of each other.

*i* think we're too big and diverse to be a community. *i* don't feel much in common with some random person in Indiana (Utah, Idaho or Tennessee maybe) ..feel i have nearly as much in common with some random person in Baja California ..more in common with someone in British Columbia.
( in one of life's little coincidences, it was exactly 40yrs ago next month i first noticed this )

thanks to the internetwebtubes, i do have friends in Ohio and Vermont and Kentucky and other strange states .. but also in BC, Australia, Amsterdam, and Turkey (!!)

.... but now i'm ranting ....


=
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When you need medical treatment you have neither the time nor the emotional capacity to make an informed and quality choice.

I agree with the OP as well, with a few comments about an individual's ability to control his own health expenditures:

1) Since individual insurance is governed in most cases by your employer, you don't really have the kind of wide choice at low switching costs that favors free market solutions.

2) You may not correctly anticipate what you will need when you are sick. Maybe it turns out you need a specific medicine that's very expensive and not covered by your plan but is covered by some other plans...there's really no way any of us can anticipate all those kinds of possibilities. This lack of insight into what you will really need makes it hard to be a good individual consumer of health insurance.

3) You do make some decisions that have large financial implications when you are sick. Say you're in the hospital gravely ill and the doctor tells you you need an MRI...do you ask for a cost benenefit analysis of MRI versus CT versus Ultrasound? Do you question all of your doctor's decisions/recommendations if that will result in a lower bill to you?

Anyway I don't think we really disagree on most of this, I just wanted to point out that there are serious problems with looking at purchasing health care like we look at purchasing other goods/services, that make it less suitable to a purely free market solution.

Cheers,

Hubris
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Also a very valid point about health maintenance. It is always better to keep yourself healthy. The bridge analogy is very good there. Of course, even with NHI there are many people who won't (for whatever reason) go to the doctor. Or are you proposing that they MUST go every year whether they like it or not? I doubt you are, but don't want to assume too much. That would help keep costs down (i.e. catching problems before they become catastrophic), but civil libertarians would be all over it. Where do we draw the line on what we mandate, and why do we draw it there and not further one direction or the other?

A misunderstanding here: I was not talking about health maintenance, I was talking about public health. flyerboys also addressed this well with his next post.

When someone comes in with pneumonic fever (aerosol transmissible bubonic plague), do you want the hospital sending him home because he hasn't paid up his insurance? How about scarlet fever/strep throat? TB? Pertussis (whooping cough)?

Dealing with these sorts of things in epidemic is insanely more expensive than simple routine health care. IMO, this alone is worth the price of universal health care. We want the first-line health care professionals to be holding the line on public health issues: epidemics, MRSA/antibiotic resistance, &c. That is very much harder to do well in privatized medicine. (Yes, the U.S. does not do this very well. Things like follow-up rates on TB treatment are lower than many 3rd world countries.)

Whether you -- or they -- like it or not, some people must go to the doctor every so often and can be -- and sometimes are -- ordered by the courts to do so. Neither I nor you want people with communicable multi-drug resistant TB walking around on the streets, nor another Typhoid Mary out working in delicatessens. A large part of public health is ensuring that these people are being treated and are taking steps to avoid infecting others. This was settled by the courts long ago, before the age of antibiotics, when epidemics of smallpox, diptheria, flu, yellow fever, typoid, &c were commonplace. (Alas, enforcing those orders is another matter...)

Of course, health maintenance is another issue, and another one the U.S. does poorly. If this discussion didn't mention early on the observation that the U.S. is last in industrialized countries in preventable causes of death, it should have.

rj
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One reason you want Universal Healthcare is that when you need medical attention, you want trained committed nurses and doctors taking care of you who don't give a damn about what you signed, how stupid you were when you bought your motorcycle without a helmet, or whether you chose to pay your health insurance bill when faced with the choice between it and eating. And you certainly don't want an exhausted college sophmore, like me, deciding your fate.

On the contrary, "an ounce of prevention is worth a pound of cure." So you DO want a national health care system in which serious incentives are provided for prevention. Such as wearing a motorcycle helmet. Or perhaps banning motorcycles entirely. Rational health care requires that one's trained/committed doctors and nurses intervene to ensure that the patient is receiving good nutrition, exercise, etc.

Almost all individual health care is Public Health care: if you are sick with communicable diseases then you are a danger to everyone, if you are disabled or die prematurely, you leave your dependents on the public tab, etc.

Since the public has an interest in everyone's private health concerns, then there really should be no objection should the government, as part of a universal health care plan, impose requirements/restrictions as to diet; exercise; consumption of tobacco/alcohol; engaging in unsafe sex; etc. Everything one does has a potential impact on one's health and hence upon health care costs. Therefore the public has the right to regulate any private activities which may have a health care impact.


It is a mistake to think of health care as an individual acquisition, something that individuals can chose to have or not have. Health care is in fact a pubic good largely paid for already with public funds (research, education, hospitals, emergency personnel, and tax deductions for corporate and private health bills, charities, etc.) It makes sense to acknowledge this, and use taxes or FICA like fees to kick in the last dollars required to access the system.

If this is something you believe and we wish to be somewhat logically consistent, then the most efficient thing we could do to improve public health is to immediately ban the sale and use of any tobacco products. This single action will reduce health care costs by hundreds of billions per year.

I am a firm believer in markets and individual choice where they can work well. With regard to health care, the use of markets is a miserable failure.

This is actually incorrect, but irrelevant. Universal health care is not sought because the markets do not work, but rather, because they do work. Rationing of health care currently occurs approximately in proportion to how much wealth the individual has to spend on health care. That means the market is working as it should. People with less money get less health care. People with more money get more and better health care. That is precisely how a market system should operate.

The effect of a universal health care system would be to subsidize various behaviors which are not the most beneficial to healthy living because the costs of the unhealthy living are spread out beyond those actually engaging in the risky behaviors. Therefore, as part of such a system, the government must step in and directly regulate individual behavior, because the market will not be available to do so.



Another poster pointed out that when you need medical treatment you have neither the time nor the emotional capacity to make an informed and quality choice.

If this is really what you think the problem is, then universal health care will not solve it. If people are incapable of making rational health care choices even when forced to pay for those choices directly, there is no hope that they will be able to make rational health care choices if they do not have to pay for them directly. However your belief is entirely consistent with the notion that one way or another the government will have to step in and regulate individual behavior. Again that really has nothing to do with insurance companies, markets, etc. The government, if it wanted to do so, could ban all use and sale of tobacco products without modifying the health care system at all. It could directly regulate clearly harmful behavior. But it chooses not to.


Trying to use markets for health care is best thought of as superstition based on distorted and irrational quasi-religious beliefs about markets.

Actually even with a single provider/government system, you will still have a market. Except it will be governed by a monopoly provider. Generally speaking markets which are governed by monopolies are not the most economically efficient.



Certain goods are much cheaper and better when acquired publicly than privately that it is usually stupid to provide them in some other way: urban water supplies, fire protection, police protection, and public health protection.

Of course you could say the same thing for any industry, good, or service which you consider sufficiently important, and nationalize everything. It's not too hard to extend your analogy to the nationalization of, say, oil companies.

Your notion seems to be based on the idea that people are stupid and are incapable of making individualized health care decisions, that somehow, Hillary care can do it better for them. I don't think people are all that stupid.



A completely separate issue, and one that must be faced regardless of the organization of medical insurance, is that we are fast acquiring sufficient medical knowledge and technology to make it possible to use all the GDP for health care -- which would be insane.

Actually, and apparently because you are not a very "market oriented" person, you have the relationship backwards: as medical knowledge and technology increases, the relative proportion of GDP devoted to health care in relation to value of the health care received will decline, not rise. In the same way that developments in agriculture over the past hundred years have allowed us to produce much more food (as a nation) at much less cost and with much less manpower.

Think about it this way: If they ever develop a "cancer-curing pill", don't you think health care costs for cancer treatment will dramatically decline? When arthroscopic surgery techniques were developed, the costs of various forms of orthopedic surgery were greatly reduced. And so on, there are numerous examples.


We need to enter into a Moral and Ethical Debate about what should be provided and paid for as a Public Good for All, and what should be left as optional and, in fact, as a luxury for the very wealthy or crazy to fall prey to, if they wish to pursue the vain and demeaning dream of eternal life and youthful beauty.

Yes we do need to enter into a moral and ethical debate, but it should not be about how much we can get out of such a system. Rather, it should be about on how far we can or should go on restrictions on individual behavior which if uninhibited result in increased health care costs. Such as drugging, drinking, tobacco use, overeating, and unsafe sexual practices. If the American public wants a government run health care system, then they need to be willing to have the government regulate their personal habits.

Sorry for the length. I do seem to be ranting these days.
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Babble: The individual acquisition of insurance would normally be done long before the health crisis is upon you, when everything is still cool and calm.

If you find yourself in the hospital because you did something that violated the insurance contract, like motorcycling without a helmet, then yes the hospital should still fix you (if they can) right away - but you should bear the cost, not society.


How do you address the issue of people who cannot buy insurance at any price? They want insurance, but the insurors will not issue policies. How about insurors who cancel policies if there is a claim?

Markets need to be regulated but US health care is far more expensive than elsewhere because the markets are not open. They are owned by the AMA and the drug dealers (sorry, the pharmaceutical industry).

Well, at least you got that much right. But add the insurance companies to your list.

cliff
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Markets need to be regulated but US health care is far more expensive than elsewhere because the markets are not open. They are owned by the AMA and the drug dealers (sorry, the pharmaceutical industry).
-=-=-==-
Well, at least you got that much right. But add the insurance companies to your list.



one of the cool things about the current 'system' ..depending on POV,
you cans blame da AMA and drug-dealers ...
or you can blame the Ins.corps and the AMA ..
or the drug-dealers and the Lawyers ..
or Ins.corps and the patients ..


or any combination thereofat


=
...... did i forget anyone?
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Markets need to be regulated but US health care is far more expensive than elsewhere because the markets are not open. They are owned by the AMA and the drug dealers (sorry, the pharmaceutical industry).

I think you're vastly overestimating the influence of the AMA. Their influence has been waning for some time: PhRMA and the Medical Insurance industries have had vastly more influence for several years now. The AMA simply is not throwing money at the gov't at more than a few percent of the rates that PhRMA and UHC et. al. are.

rj
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Markets need to be regulated but US health care is far more expensive than elsewhere because the markets are not open. They are owned by the AMA and the drug dealers (sorry, the pharmaceutical industry).

I think you're vastly overestimating the influence of the AMA. Their influence has been waning for some time: PhRMA and the Medical Insurance industries have had vastly more influence for several years now. The AMA simply is not throwing money at the gov't at more than a few percent of the rates that PhRMA and UHC et. al. are.

rj

----------------------------


I was thinking about all this last night and it occurred to me that those people who are so opposed to national, universal health-care (a single-payer system) would never be so stubborn in other areas.

For example. If they had two ways of buying some kind of investment vehicle (let's say bonds just for the example...but you could call it doplegers or rafpigens or whatever you want to call it) and the ways were:

1. They could buy these vehicles directly from the government that guarantees payment of all interest every month does not charge a purchase fee...

or

2. They could buy these vehicles from a third-party (let's call this an insurance company) that has the power to deny interest for any month they decide to deny it...AND they charge a 20 to 30% purchase fee...

From which one of these entities would they purchase their investment vehicle?

Health care is not any different. Insurance companies, after you have paid about a 20 to 30% fee just to own the policy -- can (and do) deny coverage whenever they feel like it. You have to go through agony to get them to change their minds. Agony that is just too much for the elderly and the really sick (for two groups) to contend with.

The government, on the other hand, taxes all citizens for universal healthcare. But there is no "purchase fee" because the middle man has been eliminated. And the government does not arbitrarily deny coverage.

Universal healthcare could be so simple and such a life-saver for us all. The government could spell out what is covered and what is not. All catastrophic illnesses would be covered. All basic preventive care would be covered.

Botox treatments, of course, would not be covered. Elective surgery would not be covered. This would all be spelled out up front. Then, if people wished, they could buy insurance to cover what the government does not cover.

But with universal healthcare, no one would ever have to worry about receiving a mind-shattering hospital bill or pharmaceutical bill. They would never even see a bill at all.

When AngelSpouse had to have surgery (holes drilled in his skull) to drain the blood that had accumulated between the brain itself and the skull.... he spent several days in intensive care and about two days in a regular hospital room. The bill was large, but we had insurance through his work. Even so, it took TWO YEARS to get all the problems with that bill resolved. We were nervous wrecks (at a time when we should have been resting and taking care of ourselves) due to the bill.

I simply can't understand why anyone would object to having the same healthcare they currently have -- same doctors, same hospitals, etc. -- but paying less to get it. Even taxed for it, they would pay less.

Only a really bad investor would choose to buy from another source.

AM
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As a conspicuous example, it's a lot cheaper to fix a bridge than to replace it after it has collapsed. Even when you don't count the costs of routing around the old bridge while the replacement is built.

This is at least as true of health care. And is substantially more true (the ratios are even more egregiously lopsided) when it comes to public health.

rj


Are you implying that preventive health care will save us money? If so, are you basing this merely on analogies or on research?

You might want to at least consider other possibilities.

"Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday."

http://www.wftv.com/health/15220387/detail.html?treets=orlc&tml=orlc_health&ts=T&tmi=orlc_health_1_11150202052008

"In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.

“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts."


http://www.nytimes.com/2007/08/08/business/08leonhardt.html?_r=1&oref=slogin

"Second, does preventive care save money? Careful studies show that, in general, preventive medicine raises rather than lowers overall health care costs. Preventive medicine is "economical" only when special at-risk groups are targeted. Giving preventive services to the entire population usually costs more than any savings from the early detection of disease."

http://www.ncpa.org/w/w26.html

"The benefits of prevention are primarily improved health for consumers, rather than reduced health spending."

http://calhealthreform.org/content/view/42/
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You might want to at least consider other possibilities.

Sure. And we can save end-of-life money on Social Security and medical care by killing workers in steel mills by getting rid of OSHA regulations, and coal miners by getting rid of mine safety, and lots of people by getting rid of food inspection, but that's not a very compelling argument for doing any such things.
 
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A completely separate issue, and one that must be faced regardless of the organization of medical insurance, is that we are fast acquiring sufficient medical knowledge and technology to make it possible to use all the GDP for health care -- which would be insane. We need to enter into a Moral and Ethical Debate about what should be provided and paid for as a Public Good for All, and what should be left as optional and, in fact, as a luxury for the very wealthy or crazy to fall prey to, if they wish to pursue the vain and demeaning dream of eternal life and youthful beauty.

All indications are that this is what is breaking the bank. Along with defensive medicine & the tort system essentially requiring the use of all those gizmos.
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A completely separate issue, and one that must be faced regardless of the organization of medical insurance, is that we are fast acquiring sufficient medical knowledge and technology to make it possible to use all the GDP for health care -- which would be insane. We need to enter into a Moral and Ethical Debate about what should be provided and paid for as a Public Good for All, and what should be left as optional and, in fact, as a luxury for the very wealthy or crazy to fall prey to, if they wish to pursue the vain and demeaning dream of eternal life and youthful beauty.

david flyerboy

**** ****


All indications are that this is what is breaking the bank. Along with defensive medicine & the tort system essentially requiring the use of all those gizmos.

eaglehaslanded


**** ****


Yes! Thanks, eagle, for underlining this.

And it is very interesting to me that Europe, with universal health care, while also struggling with this, is in much better shape than the U.S. My guess is that in the U.S. we developed the habit of equating "Do everything possible, I don't care how much it costs!" with being loving and caring and self-sacrificing, when it fact it is often being cruel and ridiculous. In Europe, possibly because universal health care allows people to trust the medicos to be genuinely caring, people are far less likely to go for crazy useless expensive stuff.

david flyerboy
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Are you implying that preventive health care will save us money? If so, are you basing this merely on analogies or on research?

You might want to at least consider other possibilities.


I'm probably considerably more aware of these "other possibilities" than you are. It has been known for a while that having smokers stop smoking costs society dollars -- non-smokers live longer and as a result cost more to take care of.

However, if we want to do health care on the cheap, shouldn't we just euthanize babies at birth? That would certainly be a great deal more cost-effective than raising them, with all the checkups, vaccinations, and so on that children invariably require, to say nothing of the usual broken bones and occasional medical disasters they suffer.

Once you get past the absurd comparisons, it turns out that preventive medicine does improve the quality and length of life substantially. And it turns out that paying for childrens' health care provides substantial returns on their ability to produce income later in life as well. As patients get older, the cost/benefit ratio to society decreases. However, we already pay for retirees' health care. Why shouldn't we cover everyone?

Ignoring costs is dumb. But pretending that everything in life is only dollars and cents is even dumber. (Many of us also find it personally reprehensible.)

Right now, however, it's also apparent that we are spending our health care dollars very poorly. U.S. citizens are spending nearly twice the health care moneys of any other country, and getting poorer health care for it than any other industrialized society on the planet.

rj
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I'm probably considerably more aware of these "other possibilities" than you are.

I highly doubt it.
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In Europe, possibly because universal health care allows people to trust the medicos to be genuinely caring, people are far less likely to go for crazy useless expensive stuff.

I don't believe this for a second. When your mother/father/wife/husband/child is dying, you want the docs to pull out all the stops, no matter what.

You especially want it if it is paid by insurance and you never see the bill. Why this would be different under a universal payor system where you still never see the bill is a legitimate question. I don't claim to know the answer.

If someone has a link to a cogent, less-than-boooklength explanation for the phenomenon, I would appreciate receiving it.

Personally, I would like to see an analysis of costs broken down by "regular", "end-of-life", and "exceptionally expensive" or something like that, and then compared country by country.

I'm going to go out on a limb here an speculate that government programs have "just so much money" and therefore cover a certain, but limited range of maladies, and beyond that, I don't know. It isn't that they don't have expensive equipment; I read that Japan has more MRI and catscan equipment (per capita) than we do, by far. And it can't be that government healthcare automatically means rationing and long lines, because the experience in Germany and England and France is quite the opposite.

Dunno.

I have one personal story which I try not to conflate into "THIS IS THE REASON WHY..." and it goes like this: In the 1980's, Mrs. Goofy worked in PR for one of Pittsburgh's big hospitals. It was just the time when heart-transplants started, and it was a whirlwind of national and international press, of operations, and of the procurement of equipment to enable the processes. About the same time Magnetic Resonance Imaging came to be developed, and the first machines were ghastly expensive, sort of like flat-panel screens when they first came out.

Mrs. Goofy's hospital bought one of these newfangled MRI machines and didn't have all that much use for it, but there were four large hospitals, all within a block or two, and they would ship patients over if the need arose. Even with four hospitals using it, the machine wasn't fully utilized, but soon the other three - ALL THREE - hospitals bought their own. It was a "marketing" decision, because which hospital administrator wants to tell people "We don't have the latest equipment; you have to go to Presby for that"?

So rather than one MRI being half utilized, we had four being barely utilized each - and the hospitals were happy because they got to brag about their swell new equipment and didn't have to send patients out for this new (and effective) test.

Obviously over time the use stats on the machines crept up, and eventually, I'm sure, might have eventually justified having more than one, or perhaps several, but "the market", unhinged from monetary realities, made a decision which it passed on to other "customers" in the form of higher hospital bills for other entirely unrelated medical issues.

Is that a big and continuing cause? I dunno. But it's a story I've kept in my craw for almost 30 years, and I still wonder about it.

Anyway, a better analysis than my one anecdotal story would be appreciated, if someone has one to give.
 
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rmhj: I'm probably considerably more aware of these "other possibilities" than you are.

MadCapitalist: I highly doubt it.

Good on ya mate. It's a democracy, when it's not a solipsism.

For all your cites, you failed to cite anything relating to the VA. Their system and history is particularly relevant to this particular argument. And they traditionally have provided among the best and most cost-effective care in the country.

rj
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{{I think this should be the lesson that the 'no tax' crowd should most learn (but certainly won't): you can only push down on taxes so much before those costs pop up other places. When those costs do pop up, they'll be substantially greater.

As a conspicuous example, it's a lot cheaper to fix a bridge than to replace it after it has collapsed. Even when you don't count the costs of routing around the old bridge while the replacement is built.

This is at least as true of health care. And is substantially more true (the ratios are even more egregiously lopsided) when it comes to public health.}}


While that is possible true for bridges, it is not true for government spending on individuals. There have been studies, including one that came out just this week, that healthy individuals who live longer are bigger drains on public resources than are unhealthy individuals. When you claim otherwise, you are simply making s*** up. While there may be a moral or religious motivation for government provided health care, there is not an economic one.


c
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You might want to at least consider other possibilities.

Sure. And we can save end-of-life money on Social Security and medical care by killing workers in steel mills by getting rid of OSHA regulations, and coal miners by getting rid of mine safety, and lots of people by getting rid of food inspection, but that's not a very compelling argument for doing any such things.


You never did respond to my response that contradicts your claim that mine safety laws led to an immediate downward trend in mine deaths:

http://boards.fool.com/Message.asp?mid=26232681
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For all your cites, you failed to cite anything relating to the VA. Their system and history is particularly relevant to this particular argument. And they traditionally have provided among the best and most cost-effective care in the country.

rj


Here ya go:

http://boards.fool.com/Message.asp?mid=25270004
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Goofyhoofy: I'm going to go out on a limb here an speculate that government programs have "just so much money" and therefore cover a certain, but limited range of maladies, and beyond that, I don't know. It isn't that they don't have expensive equipment; I read that Japan has more MRI and catscan equipment (per capita) than we do, by far. And it can't be that government healthcare automatically means rationing and long lines, because the experience in Germany and England and France is quite the opposite.

Ironically enough, that's exactly how things work in this country. If you have a heart attack, UHC will give your hospital $50k. They justify it in lots of ways and break it all out fancily, but it comes down to the fact that UHC will reimburse $50k in costs for treating a heart attack.

Your story about MRI scanners matches my own experiences. The same was also true of CAT scanners when they came out. And many other devices. I agree that it's very wasteful, and think it's one of the conspicuous disadvantages of "the market". Health care spending in this country is incredibly distorted. IMO, many of our routine healthcare dollars go to support exotic and underutilized infrastructure.

goofyhoofy: I don't believe this for a second. When your mother/father/wife/husband/child is dying, you want the docs to pull out all the stops, no matter what.

You especially want it if it is paid by insurance and you never see the bill. Why this would be different under a universal payor system where you still never see the bill is a legitimate question. I don't claim to know the answer.


I'm not so sure I believe this. I know many anecdotes to the contrary: the people who most want all the stops pulled out seem to most often be relatives who barely knew or paid attention to the person while s/he was alive and healthy, and suddenly want everything made right. Often over the objections of the patient and/or his close friends and intimates.

Or for another instance, a lady who was diagnosed with breast cancer, and refused to have it treated because her vanity wouldn't allow her a mastectomy and she didn't want to deal with chemo. But after the cancer had metastasized and was seriously affecting her, then she wanted all the stops pulled out.

rj
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However, if we want to do health care on the cheap, shouldn't we just euthanize babies at birth? That would certainly be a great deal more cost-effective than raising them, with all the checkups, vaccinations, and so on that children invariably require, to say nothing of the usual broken bones and occasional medical disasters they suffer.


Indeed, we don't have to wait for the actual birth, we can euthanize them beforehand.
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rmhj: For all your cites, you failed to cite anything relating to the VA. Their system and history is particularly relevant to this particular argument. And they traditionally have provided among the best and most cost-effective care in the country.

MadCapitalist:

Here ya go:

http://boards.fool.com/Message.asp?mid=25270004


Cool. You do realize that these snippets don't particularly support your position? Most systems, when systematically starved for money, will do a poor job when confronted with huge surges in demand, especially when not provided additional funds to handle the surges?

I will concede that this tends to be a general problem with public financing.

rj
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While that is possible true for bridges, it is not true for government spending on individuals. There have been studies, including one that came out just this week, that healthy individuals who live longer are bigger drains on public resources than are unhealthy individuals. When you claim otherwise, you are simply making s*** up. While there may be a moral or religious motivation for government provided health care, there is not an economic one.


c


I wonder what such studies are really measuring. Apparently, raw costs only, but not benefits accrued to persons and to society by being healthy.

Taken to its logical extreme, such a study implies that it would be economically advantageous to society never to treat anyone with a serious or debilitating injury or illness, but rather, let them suffer and perish.

That obviously is nonsense on its face. The only way one can reach such a conclusion is to assume there is no net value gained--either economically speaking or hedonically speaking--to an individual or to society from being healthy.

If I had to guess, I would have to assume the author of such a study was pimping for some interest group that had a vested interest in denying medical treatment to seriously ill people.
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That obviously is nonsense on its face. The only way one can reach such a conclusion is to assume there is no net value gained--either economically speaking or hedonically speaking--to an individual or to society from being healthy.

If I had to guess, I would have to assume the author of such a study was pimping for some interest group that had a vested interest in denying medical treatment to seriously ill people.


I don't know why this is, but it seems commonplace among a large crowd.

It may be a consequence of worshipping capitalism, and a concomitant desire to cast everything in micro-economic terms. (At least in my own experiences, this seems likely.)

Many questions, however, are fundamentally macro-economic questions: e.g., is a minimum wage good or bad? What's the "best" value? Micro-economics provides an answer to this particular question, but the question is fundamentally different than the same question asked of a macro-economist.

The former is all about minimizing costs; the latter about maximizing returns.

rj
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You never did respond to my response that contradicts your claim that mine safety laws led to an immediate downward trend in mine deaths:

http://boards.fool.com/Message.asp?mid=26232681


Sorry, easy enough to do.

Between the 1890s and 1930 coal production increased significantly. (It fell during the Depression, of course.) You would hardly expect to double production without some attendant increase in mine accidents, would you?

I note that it took several iterations of mine safety laws to get mine owners to pay attention. Some did at the beginning, some did not. More laws were passed. There was some more compliance. More laws were passed. This wasn't a "magic bullet", by any means.

At any rate:

1869 The Pennsylvania Department of Mines is established.
1870 Industry records that close to 15 fatalities per million tons of coal occur. This fact, in conjunction with the Avondale mine disaster bring about the nation's first stringent mine safety laws.
late 1880s Bill Mitchell gains the trust and support of the various divergent local miner 'social' groups into what will become the UMWA (United Mine Workers of America.)
...
1900 The historical total fatality count in anthracite mines tops 13,000 men, women and children.
1914 Employment at anthracite mines reaches a maximum of 180,000 workers.
1917 Anthracite coal production peaks at over 100 million tons.
1931 With stringent laws in place and state mine inspections, the number of fatalities per million tons of coal drops to 6.5.

http://www.msha.gov/District/Dist_01/History/history.htm

Between the years 1897 and 1904 coal production increased by nearly 125% and the need for a Department of Mines was warranted. In July of 1905 the West Virginia Department of Mines was created. The law also increased the number of inspectors to seven.
http://www.wvminesafety.org/History.htm

There is no doubt that there are many factors at play. One obvious one is increasing productivity, including the increased use of mechanical advantage in mining. Another is surface strip mining which is less dangerous (to individuals, while more dangerous to the environment). Yet another is the increased (or decreased, depending) use of other mining techniques, such as long-wall mining or retreat mining.

Twenty-two coal mine workers died in 2005. However, more than three times that many (68) died 20 years before (1985) and more than 10 times 2005's figure died in 1965 (259 deaths). Go back to 1955, fifty years before, and you will find that 420 miners died that year. Seventy years before (1935), 1,242 miners died.

Of course, there are more than four times fewer people working in mines now than there were back then.

http://www.poynter.org/column.asp?id=2&aid=94595

Four times fewer people working in mines, and yet with higher production. With four times more people working in mines we might have expected the number of fatalities to be 88 back in 1935, but it was actually 1,242. Quite a difference, eh? Perhaps that's a coincidence, year after year, with an ever escalating trend over the past century.

But I don't think so. I think "regulation" has had a LOT to do with it. I'm sure you don't and can find some mystical theory somewhere to explain it.
 
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Here ya go:

http://boards.fool.com/Message.asp?mid=25270004


Cool. You do realize that these snippets don't particularly support your position? Most systems, when systematically starved for money, will do a poor job when confronted with huge surges in demand, especially when not provided additional funds to handle the surges?

I will concede that this tends to be a general problem with public financing.

rj


It *does* support my position that VA hospitals as well as socialized medicine or universal health care in general is not all it is cracked up to be by liberals. If you are going to promote government intervention in health care, you can at least acknowledge the *very* significant shortcomings of doing so.

As Milton Friedman and Thomas Sowell point out, liberals tend to compare the *actual* operation of the free market with an *ideal* operation of the government.
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When your mother/father/wife/husband/child is dying, you want the docs to pull out all the stops, no matter what.

I think a lot of it comes down to societal expectations and culture. In America we are all about the individual, so in medicine we have the idea that we should have any treatment/care that provides us any incremental benefit, almost without regard to the cost. In Europe or Asia, there seems to be more of a societal attitude resulting in people being willing to forego care because of the drain it would have on society. Of course this is all anecdotal too, and may just reflect the people I've met, but it seems to make sense...

I think this is part of what makes it so hard to get meaningful health care reform in this country. Clearly, we have to make tough decisions and end up effectively "rationing" care. But we've evolved a system where we ration by accident, being unwilling to make politically hard choices up front.

So rather than one MRI being half utilized, we had four being barely utilized each - and the hospitals were happy because they got to brag about their swell new equipment and didn't have to send patients out for this new (and effective) test.

It's even worse than that because the marginal cost of doing another scan during the working day is insignificant compared to the fixed costs of the magnet, so every hospital has an enormous financial incentive to run their MRI machines as close to full capacity as possible. So you end up doing a whole bunch of unnecessary scans.
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It may be a consequence of worshipping capitalism, and a concomitant desire to cast everything in micro-economic terms.

Largely I think it' the effect of simple minded people believing the "market is perfect" nostrum because they had a book which mentioned "supply and demand" and didn't bother delving into the fact that there are many more externalities to the market than just those two.

Then you take Reagan's "government isn't the answer, government is the problem" soundbite, coming on the heels of the turbulent 60's and malaise filled 70's, and you have an entire generation which dismisses the efforts - and effects - that government has provided across the decades.

Ask them how the military did from, say, 1941 to 1945 and they'll tell you "Great!". Ask them about the GI Bill and they'll nod their head about how terrific it was for them, or their brother. Talk about the pride in the Space Race and how we beat the Russkies to the Moon and they'll laugh "Yeah, we showed them."

Ask if they want to go back to the Sugar Trust and Standard Oil and the Steel Trust and they'll wrinkle their nose and say "I' suppose not." Tell them AT&T brought order out of a chaotic phone system and they'll look at you like you're from another planet, but it's true. Ask if they think Rural Electrification was a good idea and they won't have any idea, but might agree how it's OK to have let the suburbs have electricity, too.

Ask if they like the Interstate Highway System, or 9-1-1 service, or FDIC insurance and they'll nod vigorously, and then turn around and tell you again "Government can't do anything right."

And no amount of logic seems able to penetrate. Their mind has been made up, no sense trying to change it with facts.
 
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Between the 1890s and 1930 coal production increased significantly. (It fell during the Depression, of course.) You would hardly expect to double production without some attendant increase in mine accidents, would you?

I don't know. It's a possibility, but it certainly isn't a conclusion that I would jump to without more information.

But I don't think so. I think "regulation" has had a LOT to do with it. I'm sure you don't and can find some mystical theory somewhere to explain it.

You *always* think regulation has a LOT to do with anything positive, and then you discount or completely ignore the negative.

Safety tends to increase even without government intervention, something that you pretend doesn't happen. The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.
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For all your cites, you failed to cite anything relating to the VA. Their system and history is particularly relevant to this particular argument. And they traditionally have provided among the best and most cost-effective care in the country.

Really? Am I mis-remembering something here? I seem to recall a couple of years ago a HUGE scandal involving VA hospitals. They were run-down, poorly equipped, stuff (like plumbing) didn't work, vets were being stacked up on gurneys and in wheelchairs in hallways. I forget all the details now, but I remember there was an outcry about how shoddily we were treating our vets.

If I'm even close in my memory here, then the VA is probably not a great example for you to use.

1poorguy
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Really? Am I mis-remembering something here? I seem to recall a couple of years ago a HUGE scandal involving VA hospitals. They were run-down, poorly equipped, stuff (like plumbing) didn't work, vets were being stacked up on gurneys and in wheelchairs in hallways. I forget all the details now, but I remember there was an outcry about how shoddily we were treating our vets.

If I'm even close in my memory here, then the VA is probably not a great example for you to use.


No, but you're looking at only one side of the equation. The VA has done very good work on a relatively small budget. Their budget has been starved for some time, and their demographic has been aging for some time, adding to the strain. Now pile on the tens of thousands of new patients, egregiously wounded, w/o additional funding, plus crony-driven outsourcing and bad things happen.

They are also, traditionally at least, highly cost-benefit driven. Our congressmen, who get VA treatment as one of their perks, still seem quite content.

The lesson to be taken from this should be that it is possible to have good government managed healthcare. The second lesson is also that with sufficient load, insufficient funding, and corruption at the top, any system can be screwed up thoroughly.

rj
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The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.

Except, of course, the testimony of people in the mining industry, workers in the mining industry, and the people charged with evaluating safety in the mining industry.

Statistical correlations with mine safety laws and a dramatic decrease in mining accidents, stories from mine owners who acknowledge having spent more on mine safety as a result of safety regulations, and, did I mention, statistical correlations with mine safety laws and a dramatic decrease in mining accidents.

But other than that, right.
 
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...so every hospital has an enormous financial incentive to run their MRI machines as close to full capacity as possible. So you end up doing a whole bunch of unnecessary scans.

disclaimer: not an MD

I'm not sure this is so. It seems getting an MRI is more difficult than getting a CAT scan (which is more difficult than getting a normal X-ray). It is my understanding that MRI's give much better resolution than any of the other methods I just named. So doctors prefer it if they can get it. If the hospitals (and medical imaging firms) really want to keep it humming 24/7, I would think it wouldn't be that hard. Plus, as an added bonus, there are no known side effects from magnetic resonance (unlike the radiation of x-rays), making it safer. Far from unnecessary, I'd say they are preferable to the alternatives.

1poorguy (saw 1poorlady's MRI...it was seriously cool to be able to "pan" through the body and see everything; yes, she's fine, for those interested)
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The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.

Speaking as a person who looks at data a lot, I would have to disagree. You could say he hasn't proven it. I'd agree with that. But the correlation in the data is strong and compelling. Without some counter-evidence or other explanations for the correlation I would say his case is fairly solid.

1poorguy
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The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.

Except, of course, the testimony of people in the mining industry, workers in the mining industry, and the people charged with evaluating safety in the mining industry.

Statistical correlations with mine safety laws and a dramatic decrease in mining accidents, stories from mine owners who acknowledge having spent more on mine safety as a result of safety regulations, and, did I mention, statistical correlations with mine safety laws and a dramatic decrease in mining accidents.

But other than that, right.


You haven't supplied sufficient information before and after the mine safety laws to make any compelling case one way or the other.

What was the historical employment? The rate of accidents or deaths relative to employment? Productivity?

What statistical correlations can be derived from such a dearth of data before the mine safety laws?
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Ask if they like the Interstate Highway System, or 9-1-1 service, or FDIC insurance and they'll nod vigorously, and then turn around and tell you again "Government can't do anything right."

And no amount of logic seems able to penetrate. Their mind has been made up, no sense trying to change it with facts.


This is ironic. You can't possibly deny that government intervention has had *significant* negative consequences in a huge number of cases if you look at the facts.

The government occasionally does more benefit than harm, but politicians are *notoriously* bad at predicting when this will be the case. The law of unintended consequences is a powerful one, and yet they try to ignore it completely. Our politicians are woefully ignorant of economics and human behavior.

It is absolutely inconceivable to me how you can so completely ignore the costs of government intervention.
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Far from unnecessary, I'd say they are preferable to the alternatives.

MRI's are very cool imaging tools and their use is going up for legitimate reasons. My point was that there is an enormous financial incentive to use machines you've already bought and hired staff for, and that this will factor into decision making. The judgement calls may tend to swing toward the scan...does this patient with a headache or that patient with back pain need an MRI? Of course you have insurance "utilization review" to make sure you can't just scan people at random, but the incentive is there nevertheless.
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Safety tends to increase even without government intervention, something that you pretend doesn't happen.

Actually, it usually doesn't. Safety didn't change in the mines until there were significant accidents and legislation followed.

Safety didn't increase in Henry Ford's plants until the unions came in (abetted by laws which allowed the formation of unions). Indeed, the first issues for the unions weren't "wages and benefits", they were safety and working conditions. Ford famously doubled the wages of his workers because he was suffering 400% annual turnover, and on an automated line everything moves at the pace of the slowest station. Doubling the wages he reduced the turnover by half, but the real cause for his exceptionally unhappy workers was safety and speed-up.

Are there areas in which safety increased without government intervention? Sure. It happens when there is an economic payoff with the addition of safety. Unfortunately, there is often an economic disincentive to add those costs, which is why it requires regulation to create a level playing field among all participants, so one does not gain advantage by cutting corners.

The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.

Nothing will ever be compelling to you. You have the singular ability to filter out any facts which are contrary to your position and then claim nobody has provided you with any facts. When presented with statistical analyses you repeat "correlation doesn't prove causation", which while occasionally true, is one of the legs of the scientific method, and is used across the world in exactly that way.
 
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Safety tends to increase even without government intervention, something that you pretend doesn't happen.

Actually, it usually doesn't.


Yes, it does. As just one example, look at cars. They have numerous safety innovations that aren't required by law. Sellers and employers have incentives to be safe. Even if you make an argument that safety laws are necessary when an economy is not developed, there simply is no case for it when the economy is developed and provides a lot of competition.

Safety didn't change in the mines until there were significant accidents and legislation followed.

You just explained how the output was increasing and so it should have been expected that accidents would increase.

You really aren't making a very good case.

The fact is that you still haven't provided any compelling evidence that it was a result of the mine safety laws.

Nothing will ever be compelling to you. You have the singular ability to filter out any facts which are contrary to your position and then claim nobody has provided you with any facts. When presented with statistical analyses you repeat "correlation doesn't prove causation", which while occasionally true, is one of the legs of the scientific method, and is used across the world in exactly that way.


In this situation, I doubt there is compelling evidence available. It was too long ago and data is hard to come by. However, if you find more complete evidence that actually makes a compelling case, I'll be happy to look at it.
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Yes, it does. As just one example, look at cars. They have numerous safety innovations that aren't required by law. Sellers and employers have incentives to be safe. Even if you make an argument that safety laws are necessary when an economy is not developed, there simply is no case for it when the economy is developed and provides a lot of competition.

Here you are simply wrong, and/or are cherry picking.

The single greatest advance in automobile safety was the seat belt. Usage did not take off until after legislation forced their presence in cars (1965 I think -- they were an option prior to that that most did not choose), and further laws that required buzzers and warnings (and one year wouldn't allow you to start your car), plus now in many states laws requiring passengers to wear them, and requiring child safety seats.

NHTSA also does safety testing and rating; this also ensures that consumers are informed regarding the crash safety of cars. NHTSA has also promulgated many standards relating to safety, and has made substantial efforts towards commonizing traffic laws in the different states (often with a very heavy hand). NHTSA also keeps accident statistics, and this has also done an enormous amount to improve automobile safety -- product liability suits have been a substantial impetus for manufacturers to improve safety.

A great deal of the progess this country has seen in automobile safety would not have happened without government regulation.

rj
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A great deal of the progess this country has seen in automobile safety would not have happened without government regulation.

rj


Thanks rj. This is almost as insane as having to make the case for evolution over creationism.

Madcapitalist, you make real contributions here, but often you do seem to have a religious, rather than fact-based, position against government.

david fb
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P.S.: other gov't standards for automobile safety:
Auto tire standards
Headlight standards
Safety glass/windshield standards
brake light and turn signal standards
airbag standards
crashworthiness standards
door latch safety standards
rollover safety standards
child car-seat safety standards
head restraint standards

off the top of my head. Google turns up:


http://www.access.gpo.gov/nara/cfr/waisidx_01/49cfr571_01.html

which lists many, many more.

rj
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Yes, it does. As just one example, look at cars. They have numerous safety innovations that aren't required by law. Sellers and employers have incentives to be safe. Even if you make an argument that safety laws are necessary when an economy is not developed, there simply is no case for it when the economy is developed and provides a lot of competition.

Here you are simply wrong, and/or are cherry picking.

The single greatest advance in automobile safety was the seat belt. Usage did not take off until after legislation forced their presence in cars (1965 I think -- they were an option prior to that that most did not choose), and further laws that required buzzers and warnings (and one year wouldn't allow you to start your car), plus now in many states laws requiring passengers to wear them, and requiring child safety seats.


I never said that the government can't accelerate the introduction of safety precautions. My argument is that safety *does* improve through the free market. Competition for employees and customers guarantees it.

Look at the lead scare from products from China. Do you really think the behavior of companies that provide these dangerous products that people are shunning will not change without government intervention?

Goofyhoofy is basically trying to argue that the answer to this question is a resounding Yes, as ludicrous as it is.
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The law of unintended consequences is a powerful one, and yet they try to ignore it completely.
Projecting? How about all those negative unintended consequences of unregulated capitalism?
--Alan
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Do you really think the behavior of companies that provide these dangerous products that people are shunning will not change without government intervention?

People are shunning them because they violate the federal lead paint standard. I'm on the FTC recall notice list, I see these all the time. If it didn't violate the federal standard (and if it wasn't being tested to assure compliance), no one would even know about it. China's response may turn out to be an example of free market, but only because of our regulations here. Otherwise they'd just ignore it.

Bad example, MC. I agree with the other poster: sometimes you have some sharp insights, but this time you're off-base. Or at least this example does not appear to support your position very well.

1poorguy
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Do you really think the behavior of companies that provide these dangerous products that people are shunning will not change without government intervention?

People are shunning them because they violate the federal lead paint standard.


I'm talking about customers. They stop buying the toys because they don't want their children to get lead poisoning, not because of the Federal lead paint standard.
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The law of unintended consequences is a powerful one, and yet they try to ignore it completely.

Projecting? How about all those negative unintended consequences of unregulated capitalism?
--Alan


I have never in my life claimed that free markets are perfect. I have only claimed that government intervention is usually worse.

This is what I don't understand about liberals. They go to great lengths to point out the flaws of the free market, but they will completely ignore the innumerable flaws of government intervention. Just once I would like to hear a liberal acknowledge that there are trade-offs associated with government intervention and give a thorough explanation of these trade-offs. Unfortunately they invariably give far too little thought to the negatives of government intervention, and instead we are told about the magical free lunch we can expect from government intervention.
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I never said that the government can't accelerate the introduction of safety precautions. My argument is that safety *does* improve through the free market. Competition for employees and customers guarantees it.

There's been no argument -- just the blind assertion. I and goofyhoofy believe you are wrong: safety _may_ improve, but only when the public is knowledgeable about the issue and the costs are not substantial.

Look at the lead scare from products from China. Do you really think the behavior of companies that provide these dangerous products that people are shunning will not change without government intervention?

No. China will prosecute a few people, it will blow over, and our government will continue to do nothing. This is not a failure of regulation -- there are already laws against this. This is a failure of corruption and inadequate inspection.

History consistently shows that when it is advantageous to do so, companies will ignore the law. This is simple pragmatism, and its truth is borne out in many, many incidents from U.S. and world history.

Look at the lead scare from products from China. Do you really think the behavior of companies that provide these dangerous products that people are shunning will not change without government intervention?

Goofyhoofy is basically trying to argue that the answer to this question is a resounding Yes, as ludicrous as it is.


I think you and I have differing standards of ludicrous. I think there will be (has been) a big blow-up. And once it fades from public view, it will happen all over again. Again, this was not a failure of legislation per se, this was a failure of inspection (and/or corruption). Companies are strongly motivated to minimize costs: they do this with remarkable consistency whenever they can get away with it, even when it involves breaking the law.

rj
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The law of unintended consequences is a powerful one, and yet they try to ignore it completely.

Projecting? How about all those negative unintended consequences of unregulated capitalism?

--Alan

I have never in my life claimed that free markets are perfect. I have only claimed that government intervention is usually worse.

This is what I don't understand about liberals. They go to great lengths to point out the flaws of the free market, but they will completely ignore the innumerable flaws of government intervention. Just once I would like to hear a liberal acknowledge that there are trade-offs associated with government intervention and give a thorough explanation of these trade-offs. Unfortunately they invariably give far too little thought to the negatives of government intervention, and instead we are told about the magical free lunch we can expect from government intervention.


--MadCapitalist

Wow. Talk about projection! Alan nailed this on the head, and then you go and put this one through the uprights.

rj
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Wow. Talk about projection! Alan nailed this on the head, and then you go and put this one through the uprights.

rj


This makes no sense.
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No. China will prosecute a few people, it will blow over, and our government will continue to do nothing. This is not a failure of regulation -- there are already laws against this. This is a failure of corruption and inadequate inspection.

Only to a liberal can a failure of government regulation not be a failure of government regulation.
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rj: Here you are simply wrong, and/or are cherry picking.

The single greatest advance in automobile safety was the seat belt. Usage did not take off until after legislation forced their presence in cars (1965 I think -- they were an option prior to that that most did not choose), and further laws that required buzzers and warnings (and one year wouldn't allow you to start your car), plus now in many states laws requiring passengers to wear them, and requiring child safety seats.

rj (and others): You are talking with a known troll. One who delights in obfuscation, then taunts you that you didn't provide a rational discussion. It's an easy game to play, and as long as you let him dictate the discussion, he wins. "You Liberals can't even have a civil debate." (They love the word debate. It dignifies thier spew.)

cliff
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Madcapitalist, you make real contributions here, but often you do seem to have a religious, rather than fact-based, position against government.

david fb

He does? When? Where? By spewing his right-wing crap and calling it data?

I scoff.

cliff
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I scoff.

cliff
=b


..... so rare that one has the opportunity to .actually. Scoff
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cliff: "He does? When? Where? By spewing his right-wing crap and calling it data?"

I had the same questions.
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For example. If they had two ways of buying some kind of investment vehicle (let's say bonds just for the example...but you could call it doplegers or rafpigens or whatever you want to call it) and the ways were:

1. They could buy these vehicles directly from the government that guarantees payment of all interest every month does not charge a purchase fee...

or

2. They could buy these vehicles from a third-party (let's call this an insurance company) that has the power to deny interest for any month they decide to deny it...AND they charge a 20 to 30% purchase fee...

From which one of these entities would they purchase their investment vehicle?


but for most people, those aren't the 'choices'.

for most, there's (3) my employer buys it (free and FREE to ME!) and don't know whether/what will be paid ('interest' wise) until it's needed.

tell them the system -might- change and they run and hide under the bed.
tell them it **might** cost them more and they squeal like the proverbial Bat

tell them it will be Good for other people, and they go, "bleep 'em"


..tying this to another thread -- we're seeing SOME movement towards UHC because actual people are feeling insecure in their jobs ..lose your job and you're kind of uninsured



=
...... part of the problem is the 'insurance' model .. at best, insurance is a gamble that something will bad will happen, more costly than premiums and insurance with 'fix' things.
(at worst, it's a scam) But eventually ..Everyone gets sick
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rmhj: No. China will prosecute a few people, it will blow over, and our government will continue to do nothing. This is not a failure of regulation -- there are already laws against this. This is a failure of corruption and inadequate inspection.

MadCapitalist: Only to a liberal can a failure of government regulation not be a failure of government regulation.

There's a substantial and obvious difference between bad and inappropriate legislation and good and appropriate legislation. Most falls somewhere inbetween, existing in the real world as it does.

Only reactionary and libertarian nutcases claim that they're the same.

Goodbye, troll.

rj
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cliff: "He does? When? Where? By spewing his right-wing crap and calling it data?"

I had the same questions.

-----------------


Who are ya'll talking to?
My p-box is overflowing these days...

AM
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..tying this to another thread -- we're seeing SOME movement towards UHC because actual people are feeling insecure in their jobs ..lose your job and you're kind of uninsured

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And some employers no longer provide healthcare - so it wouldn't matter if you had a job or not. You're toast.

AM
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"This is ironic."

Indeed it is. Many of your posts are quite ironic.

"You can't possibly deny that government intervention has had *significant* negative consequences in a huge number of cases if you look at the facts."

Who has denied that government intervention has had negative consequences?

"The law of unintended consequences is a powerful one"

A lesson you should learn.

"and yet they try to ignore it completely."

Where are they trying to ignore it completely? Stop making crap up.

"It is absolutely inconceivable to me how you can so completely ignore the costs of government intervention."

Not anymore inconceivable than how you constantly ignore stuff that doesn't fit you preconceived notions.
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"I have never in my life claimed that free markets are perfect. I have only claimed that government intervention is usually worse."

Ok.

"This is what I don't understand about liberals."

That you consider Alan to be "a liberal" provides yet more evidence that there are lots of things you do not understand.

"They go to great lengths to point out the flaws of the free market, but they will completely ignore the innumerable flaws of government intervention."

Who completely ignores the innumerable flaws of government intervention? Nobody. You are making stuff up again because you cannot deal with their real words and arguments.

Furthermore, flip the sides and then look at yourself in the mirror. You are describing yourself.

"Just once I would like to hear a liberal acknowledge that there are trade-offs associated with government intervention and give a thorough explanation of these trade-offs. "

You mean besides all of those posts about universal health care, mine safety regulation, product safety regulation, etc.?

Besides, why hold them to a different standard than you hold yourself?

"Unfortunately they invariably give far too little thought to the negatives of government intervention, and instead we are told about the magical free lunch we can expect from government intervention."

No, they disagree with you with the weightings of the negatives and the positives of government intervention vs. free markets.

That you describe their argument as a "magical free lunch" exposes just how little you really know about the issues involved. You don't even understand them so you make stuff up to attack instead. It is kind of sad and pathetic behavior.
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How do you address the issue of people who cannot buy insurance at any price?

If you have a grave pre-existing condition that would likely lose money for the insurer, therefore no insurer will take you - then yes there needs to be a government safety net program to help you out. Most places already take care of people who show up at the hospital door with empty pockets, through indigent health care programs.

But thats a different issue from insuring the larger population who are not gravely ill or indigent. Different strokes for different folks.
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<<Most places already take care of people who show up at the hospital door with empty pockets, through indigent health care programs.>>


No, they don't. If the patient is truly without resources, they foist the bill off on state welfare. If the patient has any savings or enough income, the hospitals hammer them for every red cent they can squeeze out of them. If you can "afford" that $50 Valium and that $6,000 CT-scan then you are damn sure gonna pay it - they might negotiate it down (or might not) but you're gonna pay for it.

In other words, if you can't get insurance and you have to go to the hospital, you had better be broke because, otherwise, the hospital will make sure that you wind up broke anyway.

-chris
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Madcapitalist, you make real contributions here, but often you do seem to have a religious, rather than fact-based, position against government.

david fb


*****************

He does? When? Where? By spewing his right-wing crap and calling it data?

I scoff.

cliff


**************

Thanks Cliff.

I don't know if I'll ever get used to the trolls that stomp into this garden. After reading your post I went back and looked, and yeap, he's a mess of a troll.

Scoff away!! I should have gone to bed

david flyerboy
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In other words, if you can't get insurance and you have to go to the hospital, you had better be broke because, otherwise, the hospital will make sure that you wind up broke anyway.

-chris

-----------------------


They will even take your home.

AM
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Babble: If you have a grave pre-existing condition that would likely lose money for the insurer, therefore no insurer will take you - then yes there needs to be a government safety net program to help you out.

I was thinking of my wife. When I retired, she went out to get private insurance. Was turned down flat by more than one insurance company. Why? She had a D&C to remove a benign cyst a few months before. The cyst was benign! They still turned her down. A year later, after two "clean" Pap smears, she was able to get insurance, at a 25% surcharge. $3500 deductible. She will likely never us up the deductible (I hope), so the Insurance Co. just laps up the gravy.

cliff
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if you can't get insurance and you have to go to the hospital, you had better be broke because, otherwise, the hospital will make sure that you wind up broke anyway.

Either way, whether thru the state or thru the county or thru an insurer, the person gets health care.

The fact that they go broke in the process, is a different issue. Would you rather be poor, or dead?

We need to reduce the costs of health care by 50% by breaking the vampire cartels that suck their blood from this business.

But if you walk into a hospital needing urgent care, one way or another you will get it.
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Safety tends to increase even without government intervention...

That's a bold statement. Except for maybe the odd magnate feeling a bit bad and easing up until his thankless scions take over, it has *never* happened without intervention, or the direct threat of it.

Apparently Capitalianity is a religion too, where fictions are accepted "on faith".
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But why isn't forcing of SS a "garnishment"? It's not something that you can opt out of, unless you go work for the government.

You can't opt out of it as a government employee anymore, unless you are still on the old system. I have to pay a lot for SS that I probably won't ever get back.

Also, let me say something about VA care as a model for govt health care. I think the VA is great for our veterans, but there are a number of services that have to be contracted out to the private sector. If there was no private sector, that would be a problem.

I would like for the private sector to be able to work out some sort of reasonable catastrophic insurance for those that don't have it, and some sort of reasonable outpatient care. I think it's already getting there (4 dollar generic drugs at walmart, primary care clinics in CVS). What the government needs to do is encourage this, instead of discourage it. THAT would help the majority of people with their most pressing needs, without making people pay for another giant government system.
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I seem to recall a couple of years ago a HUGE scandal involving VA hospitals. They were run-down, poorly equipped, stuff (like plumbing) didn't work, vets were being stacked up on gurneys and in wheelchairs in hallways. I forget all the details now, but I remember there was an outcry about how shoddily we were treating our vets

That was NOT the VA. It was Walter Reed Army Hospital, which is run by DOD not VHA. But still government, if that helps!
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