Healthcare & rationing

[TallDave]

Equally, if renewables are subsidised versus carbon fuels with a cash-neutral carbon tax, the new technologies developed can be sold.

Not equally, because no one buys those unless you force them to. They're less efficient and that means everyone is poorer. Again, this is the basic broken windows fallacy.

Let's say you passed a law saying everything now needs to be painted purple to ward off space aliens who will otherwise attack in 100 years. This is great for makers of purple paint but bad for everyone else.

I don't buy the bottom-line cost. Healthcare is pretty basic, and governments give up plans in adversity easier than people give up health. The issue is that the US health system uses lots of resources. People cannot choose "cheap, efficient, slightly worse" healthcare if they want to.

Sure they can (without even moving to those other countries that mandate worse care). In fact, I myself do exactly that. Go on, ask me how. The answer will shock and amaze you.

There are too many monopolistic issues in the system.

The government has largely created those issues. The biggest problem is the employer-provided insurance tax incentive, which virtually eliminates the market for private insurance, and the second-biggest is mandates, which ensure people cannot choose what to avoid insuring against. I do agree that the cartelization of the AMA is a problem.

So saying "the inefficiency is Ok, because people can choose it or not" is not fair.

Fair or not, adding more gov't will not improve efficiency. If government could do things better, we'd all be speaking Russian by now.

[TallDave]

I know I'm going to get flamed for saying this, but I think the argument for 'free markets' in healthcare is a bit delusional.For a free market to lead to the optimal outcome there has to be some elasticity of demand. I would argue that there is none for life saving procedures and medicines,

It's true the marginal value of a life-saving treatment is essentially infinite, at least if you're an heirless selfish atheist. But a doctor can't just charge you an infinite amount (or everything you own). This is partly because insurance companies force them to match costs to prices.

OTOH, there isn't an infinite supply of procedures to buy. There's only the ones that might save you.

I also agree there is a problem with selling an insurance policy that covers everything, no matter how expensive. This is why we need a real private insurance market with better-defined benefits so people can choose.

It's all more reactionary smoke and mirrors to protect the fat insurance companies' profits. Business as usual in Washington.

Insurance companies don't make any profit on policies; the actuaries try to make the policy cost what it's priced at. They make profit by investing the float.

The chicken littles in the forum, and on the right, would have you believe that implementing public healthcare will suddenly make it impossible to receive additional care outside the system.

This is actually true in most socialized countries, including Britain, France, most of Canada. But it's also true most people are shut out of that system and have to suffer the six month waits and rationed care (esp. for marginal diagnostics, where cost effectiveness is low). Do we really want to adopt a system under which the difference in care for the elite is much greater than now?

and Japanese life expectancy is among the highest in the world.

The correlation between quality of care and LE is not significant enough to show up in the small LE differences between modern Westernized nations; lifestyle is much more important. Also, Japan's LE/IM statistics are known to be flawed anyway because of how they account for stillbirths (esp. those of girls).

[TallDave]

Great Moments In Socialized Health Care

After weeks of excruciating pain, Mark Wattson was understandably relieved to have his appendix taken out.
Doctors told him the operation was a success and he was sent home.
But only a month later the 35-year-old collapsed in agony and had to be taken back to Great Western Hospital in Swindon by ambulance.
To his shock, surgeons from the same team told him that not only was his appendix still inside him, but it had ruptured - a potentially fatal complication.
In a second operation it was finally removed, leaving Mr Wattson fearing another organ might have been taken out during the first procedure.
The blunder has left Mr Wattson jobless, as bosses at the shop where he worked did not believe his story and sacked him.

[Skipjack]

Things like these do happen anywhere. This has nothing to do with socialized healthcare or not, but with overworked doctors in clinics.
Like any other work environment accidents to happen. Ever worked on construction? If so, you sure know what I mean.

[Skipjack]

Talldave, have you actually lived in a system with socialized healthcare? Where do you get your information from? Some of the stuff you are saying sounds like bullshit to me. At least where I live this does not happen.

[vankirkc]

Great Moments In Socialized Health Care

After weeks of excruciating pain, Mark Wattson was understandably relieved to have his appendix taken out.
Doctors told him the operation was a success and he was sent home.
But only a month later the 35-year-old collapsed in agony and had to be taken back to Great Western Hospital in Swindon by ambulance.
To his shock, surgeons from the same team told him that not only was his appendix still inside him, but it had ruptured - a potentially fatal complication.
In a second operation it was finally removed, leaving Mr Wattson fearing another organ might have been taken out during the first procedure.
The blunder has left Mr Wattson jobless, as bosses at the shop where he worked did not believe his story and sacked him.

Okay, so there are horror stories in socialized countries. So what? Are you saying that the grand U.S. system doesn't have any tragic cases like this? I can remember reading stories about doctors carving their initials into patients, nurses administering incorrect medicines and dosages, and surgeries being performed on the wrong organs of the wrong people even in the U.S. Bad stuff happens everywhere in the world, the U.S. is no exception.

What you don't mention there is that Mr. Watson and his dependents didn't subsequently lose their healthcare as a result of his medical problems, his 'insurer' didn't weasel out of paying his bill by declaring that his condition predated his policy, even if he didn't know he had it, and as a consequence he didn't end up with crippling debt from shouldering the cost on his own. Count these as additional hazards this guy would have faced had he been in the U.S., over and above what is mentioned in that article.

All the arguments that are laid out against controlled healthcare expenses are nonsense. The true beneficiaries of the current system are the insurer, who gets to take your money without being obliged to provide you with the service you are paying for, and the health care product or service provider who is free to fleece you when you cannot shop around.

Furthermore, you dismiss life expectancy as a measure of success or failure of a healthcare system. What yardstick are we to use to compare these systems? The cost picture is clear, U.S. is by far the most expensive per capita in the entire world. How do you propose to objectively measure the value of the healthcare service, per capita, and compare with with alternative systems that exist in the real world. I daresay life expectancy is the only possibility.

[TallDave]

Well, for starters in the U.S. you wouldn't wait six weeks to have your appendix taken out. And our rate of hospital infections is considerably lower.

But sure, this is one anecdote, and you can probably find a similar stories in the U.S. somewhere.

But the historical evidence says you're going to get more of this the more government is involved. Price controls lead to shortages. Lack of profit motive leads to poor service and stagnant innovation.

[KitemanSA]

There is no New Socialist Man. Neither is Libertarian Man on the horizon.

I'd be somewhat interested in seeing your definition of "Libertarian Man", since mine is pretty much what most Americans are now. Remember, Johansen's third law says that "Like most toxic substances, government programs are subject to the J-Curve". So the KNOWLEDGABLE Libertarian Man recognizes that a LITTLE government is benefitial but is ever vigilent against excess dosage. Sound ALMOST like you. Hmmm. MS = closet LM?

[TallDave]

Talldave, have you actually lived in a system with socialized healthcare? Where do you get your information from? Some of the stuff you are saying sounds like bullshit to me. At least where I live this does not happen.

I've provided numerous links. Which socialized country do you live in that has similar #s for organ transplants per capita, specialist treatment wait times, and MRIs per capita?

All the arguments that are laid out against controlled healthcare expenses are nonsense. The true beneficiaries of the current system are the insurer, who gets to take your money without being obliged to provide you with the service you are paying for, and the health care product or service provider who is free to fleece you when you cannot shop around.

This is just mind-bogglingly disconnected from reality. Insurers are obligated by law to cover you for the things you've contracted for. You can shop around for treatments, but you have no incentive to do so because of how government has screwed up the market. And your solution is... more government control?

[vankirkc]

This is just mind-bogglingly disconnected from reality.

Actually, I think your arguments are mind-bogglingly disconnected from reality.

I live in a country with one of these systems. I have personal experience with socialized medicine and I have never experienced anything like the dramatic shortages, wait times or poor quality that you're claiming are endemic in the system.

If you are so keen to pay 3x more for your healtchare than I do, that's fair enough. You can go to private doctors and hospitals that are outside the system here as well, if you're prepared to pay for it..which clearly you are. The difference is that you want to force your lifestyle choice...and its associated additional expense...onto everyone else.

You have such bizarre opinions. On the one hand you argue that any expense associated with controls on carbon emmissions are going to cost lives, and on the other it's just fine and dandy to spend 3x more on healthcare costs so you don't have to wait in line for a few minutes to see a dr. Weird.

[TallDave]

I have personal experience with socialized medicine and I have never experienced anything like the dramatic shortages, wait times or poor quality that you're claiming are endemic in the system.

The plural of anecdote is not data. If you don't mind that you're 10x less likely to get an MRI and are likely to wait much longer for specialized care, then enjoy your health care. You're getting less than what Americans on welfare (Medicaid) get. But hey, lots of people are happy with fans instead of air conditioning.

You have such bizarre opinions.

Sorry, I have facts. It's pretty clearly you who are out of touch with reality.

e.g. Organ transplants
http://en.wikipedia.org/wiki/Organ_tran ... emographic 2x as many transplants per capita

On the one hand you argue that any expense associated with controls on carbon emmissions are going to cost lives, and on the other it's just fine and dandy to spend 3x more on healthcare costs so you don't have to wait in line for a few minutes to see a dr.

Yes, it's strange I want to spend money on saving lives rather than chasing nonexistent problems. Truly weird. How did our country end with these skewed priorities? Must be that ineffable "individual choice" thing at work.

[MSimon]

There is no New Socialist Man. Neither is Libertarian Man on the horizon.

I'd be somewhat interested in seeing your definition of "Libertarian Man", since mine is pretty much what most Americans are now. Remember, Johansen's third law says that "Like most toxic substances, government programs are subject to the J-Curve". So the KNOWLEDGABLE Libertarian Man recognizes that a LITTLE government is benefitial but is ever vigilent against excess dosage. Sound ALMOST like you. Hmmm. MS = closet LM? :o

I was thinking of Libertarian Man as some one who decides everything based on rational calculation. I used to be one of those. Now a days I'm libertarian man. i.e. I think that a bit of socialism is a good thing. It has been a feature of government for 1,000s of years. There must be some value in bread and circuses (it keeps those on the bottom fed and occupied - which prevents revolts - and revolts are bad for business).

I liked the system set up in the science fiction book Child of Fortune

http://www.amazon.com/gp/product/076530 ... 0765301555

A very minimal and uncomfortable safety net. But it can't be too good or too comfortable since that sets up a bad incentive system. And "do gooders" always feel that those on the bottom don't get enough - forgetting that the march of civilization and profit has raised the lot of those on the bottom tremendously. You just have to be patient.

What it comes down to is that many have gotten the idea the Buddha had. Too much suffering. However, unlike the Buddha, many have decided to make others ("the rich" being a prime target) relieve the suffering not realizing that such efforts retard the advance of civilization (or technology advances if you prefer) - which is our best hope to raise the lot of all people.

[TallDave]

Furthermore, you dismiss life expectancy as a measure of success or failure of a healthcare system. What yardstick are we to use to compare these systems?

I don't dismiss them, actuaries do.

What are good measures? Cancer survival rates. Availablity of MRIs, other diagnostics and specialist care.

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

Or how about R&D?

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

[KitemanSA]

3. Put a cap on non-quantifiable damages.

I disagree there. I think tort reform should instead focus on penalizing those that bring frivolous suits such as with the English rule system

While I agree with the fact that there is way too much money currently being wasted on lawsuits and malpractice insurance, I also think the threat of a huge punitive lawsuit needs to be there because otherwise there are going to be some cases where it would be cheaper for an offender to be sued and lose than to address the problem. Sure, there will be cases where excessive punitive damages are awarded but the court needs to have the power to match the penalty to the offense. Anyway, excessive punitive damages that can be appealed.

Maui,
You are mixing two issues here, both lawsuit related. The first relates to compensatory damages and the second relates to punitive damages. MSimon seems to believe that there should be a cap on non-quantifiable compensatory damages. I happen to agree with him and think that cap should be zero. Compensatory damages should be limited to real, demonstrable expenses. If you have pain or suffering, get it worked on til it is fixed and get compensatory damages for the real, demonstrable costs. If you and the doctor you are suing agree out of court to other arangements, fine, but the court system should only award compensation for real demonstrable damages. I am willing to compromise to the extent of a fairly low cap, but remember Johansen's third law.

You responded with a desire to allow big awards to "punish" doctors. This is the punitive damages issue. Please excuse the aside, but it is actually germain.
Suppose Bill Gates or Warren Buffet or the Queen of England or some other Obsenely Rich Person were to pick up a gun and in plain view of many people kill an individual. That ORP then confesses and is found guilty and sentanced to the worst sentance you permit in your vision of what is just. Do you in ANY way think it acceptable for that ORP to hire a poor person to serve their sentance for them?
If you do, we can't truly communicate because your sense of justice is just too different from mine. If NOT, then why in the world do you think it is ok for doctors to insure themselve against PUNITIVE damages? Punitive damages are supposed to punish THAT DOCTOR for doing something morally WRONG! I am not talking about making a mistake or being a bit inattentive on infrequent ocassion. For punitive damages, it has to be something morally repugnant, tantamount to criminal activity. If found guilty, that doctor should pay, not the poor insurance premium payer. Punitive damages should NEVER be insurable. While this perversion of justice continues, NO fiddling at the edges can reform such a fundamentally broken system.

O'Bama and the demoblicans don't want reform. They want to subsidize a fundamentally broken system. The repocrats want to polish it up a bit.

Sigh!

[vankirkc]

I have personal experience with socialized medicine and I have never experienced anything like the dramatic shortages, wait times or poor quality that you're claiming are endemic in the system.

The plural of anecdote is not data. If you don't mind that you're 10x less likely to get an MRI and are likely to wait much longer for specialized care, then enjoy your health care. You're getting less than what Americans on welfare (Medicaid) get.

You lead this exchange with a single anecdote, and held it out as evidence of the horrors of socialized medicine. I've been in this system, and using it, for twenty years. My son had Leukemia, and a transplant by the way, and survived. I've had surgery, and my family has had various other issues. And in this long experience, and intimate long term participation in the healthcare system, I haven't seen any evidence of the horrible scenarios you are mentioning. I hold that out as evidence countering your claims. You can choose to ignore it if you like, but it's a fact.

Sorry, I have facts. It's pretty clearly you who are out of touch with reality.

e.g. Organ transplants
http://en.wikipedia.org/wiki/Organ_tran ... emographic

Okay, how about posting these facts? Cost per capita for U.S. healthcare versus those of socialized countries, and life expectancy in U.S. versus those socialized countries. I think that's a more meaningful measure than organ transplant statistics.

Yes, it's strange I want to spend my money on saving lives rather than chasing nonexistent problems. Truly weird. How did our country end with these skewed priorities? Must be that ineffable "individual choice" thing at work.

No it is weird because you're paying 3x more for the same service than you could be. That means you can only save 1/3rd of the people. There's no other way to look at it I'm afraid. It's weird because the central premise that money = lives seems to only count for carbon controls.

I don't get the last dig there. Not sure what you're trying to say.