Talk-Polywell.org

Okay, here's where I stand. I am definitely for healthcare for all. I don't care as much how it happens, but it seems silly to me that we, for example, find it perfectly acceptable to mandate car insurance, but not health insurance. Just as uninsured motorists will have accidents , uninsured people will have health problems and just as with car accidents the cost will end up falling on others, so it does with healthcare-- whether its the cost that gets built into what the hospitals and doctors charge, aid programs funded by government, creditors that don't get paid due to bankruptcy or even just the tax breaks those paying for healthcare out of pocket.

Anyway, that's not my point, and neither is it my point that I don't agree with implementing a program without a plan to pay every penny of it. I was pissed at the way Bush let the debt get out of control, and I'm even more pissed at that way Obama doesn't even pretend to care about the budget disaster (or just blames his planned contribution to the debt on Bush)

My point really is is what the heck is up with all the hoopla about rationing care for the terminally ill? Hello-- that, is one of the primary jobs of insurance. Not that anyone should "trust" either the government or private industry to make the right decisions when it comes to rationing, but someone has to do it-- why would the government (which would constantly be under scrutiny from anxious representatives in re-election campaigns) be any more cold-hearted with these decisions that private industry whose primary motivation is making a profit? And if all GOPer's really believe that public insurance would be evil, we certainly wouldn't have to worry about private insurance going out of business, would we?

I also don't get the idea that the GOP doesn't think healthcare is a "right" that everyone should be entitled to, yet at the same time apparently believe that if someone does pay for insurance (no matter how cheap the plan) they are suddenly entitled to every medical weapon in humankind's arsenal no matter how dire an individuals situation or how unlikely the procedure is to help.

Neither do I get the idea that it is a crime to look at the health systems of countries which have a much higher satisfaction rate and much lower cost for clues on how we might be able to lower our own healthcare costs (each person in the U.S pays almost twice what Canadians pay and almost 3 times what the British pay). It seems like everyone has an opinion about what would lower healthcare costs... but looking at a system that actually *does* have lower costs seems to me the only real evidence of what actually works.

I suppose the simple truth is that the health debate is suddenly all about politics and not about a sincere discussion or debate on how to fix healthcare. I'm pissed at the GOP for selling politics of fear (again), but also disappointed because I really believed in Obama's promise of a post-partisanship era. Whether or not the lack of bi-partisanship is his fault or not, he has utterly failed on that promise. And while that doesn't by any stretch condemn his presidency to failure, I think there's no getting back "post-partisanship" for him. Once its gone its gone.

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With an insurance company you have a contract.

The government has sovereign immunity.

Do you understand the difference?

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And let us not forget that about 40% of doctors will not accept Medicare patients. If the number is the same under "universal care" will there be enough doctors to take care of 47 million new enrollees?

If Medicare is going broke what exactly will save "universal care" from the same fate?

http://powerandcontrol.blogspot.com/200 ... broke.html

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And then there are the incentives:

If the government decides and old fart's care is not worthwhile it saves twice. Social Security and medical bills.

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Let us look at Medical Insurance Cos. If they do not treat their covered population well they lose business.

If government does not treat its covered population well it profits.

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Medicare loses 30% of its income to fraud. Insurance cos about 1%. So where does the 30% profit the insurance cos get go to? Executives for sure. But also to pension funds and 401 (K) accounts.

The deal is that there are a lot of interconnections the geniuses trying to run our economy are not taking into account. Hayek explains the problem in "The Road To Serfdom". I just happen to have a link:

http://www.amazon.com/gp/product/022632 ... 0226320553

No one should be talking economics without having studied the information problem.

A simple example should suffice: If passing on the merits of Polywell would you prefer a board of 12 randomly selected lawyers or 12 randomly selected engineers?

MSimon wrote:With an insurance company you have a contract.

The government has sovereign immunity.

Do you understand the difference?

Yet the GOP's idea of healthcare reform is to make it illegal for patients to sue. How, then, is the end result any different?

Anyway, I don't think its impossible to sue government insurance. For example, and another.

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And let us not forget that about 40% of doctors will not accept Medicare patients. If the number is the same under "universal care" will there be enough doctors to take care of 47 million new enrollees?

Are you sure this isn't pointing out one of the problems with our healthcare system? Namely that doctors and hospitals are currently able to ask for too much money from private health insurance? Could there possibly be a relationship between the fact that doctors are paid more that twice as much here as in Britain and the fact that we pay more that twice as much here for healthcare? In the scenario you are alluding to, if doctors have to decide between a pay cut and being jobless, don't you think they'd choose the paycut?

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If Medicare is going broke what exactly will save "universal care" from the same fate?

http://powerandcontrol.blogspot.com/200 ... broke.html

Agreed. In any action we take on healthcare, we need plenty of scrutiny to ensure everything is being properly budgeted and paid for. But just because it may be tough to get the economics of a public option right doesn't mean that the status quo is any better.

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And then there are the incentives:

If the government decides and old fart's care is not worthwhile it saves twice. Social Security and medical bills.

I think this argument is complete garbage. These are completely different departments with completely different budgets. Congress is the only body with authority over both. This isn't like an insurance company where there can be a couple closed door meetings no one ever knows about-- you'd need collusion between a significant percentage of representatives as well as the CBO, etc.

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Let us look at Medical Insurance Cos. If they do not treat their covered population well they lose business.

If government does not treat its covered population well it profits.

If you make certain assumptions on how a public option would work, maybe. I admit, I don't know that details of what is being debated, but, for example, the Post Office doesn't profit when it loses customers. I agree, we shouldn't have a public option funded in a way that creates conflicts of interest. But that has nothing to do with whether there should be a public option in general.


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Medicare loses 30% of its income to fraud. Insurance cos about 1%. So where does the 30% profit the insurance cos get go to? Executives for sure. But also to pension funds and 401 (K) accounts.

Ironically, this goes against your earlier argument. Looks like public health tends to try to "save" too many rather than too few, eh? Doesn't look like they are really that worried about finding people they can kill to save $, does it?

From what I have read, yes, Medicare needs to spend more to combat fraud. But similar to my above argument, just because there are many potential problems with does not mean they all have to be part of any incarnation of a public option that is created. Let's look at what Medicare does wrong, what Britain's NHS system does wrong, etc and learn from them.

Heck, like I said in my first post, its not that I'm even set that there has to be a public option-- I just think one way or another we should all be required to have health insurance.

You've brought up many reasonable arguments here. What inspired me to post in the first place is this baloney about how a public option is going to execute the elderly (and somehow ignore that private insurance already makes these same decistions).

Maui wrote:Okay, here's where I stand. I am definitely for healthcare for all. I don't care as much how it happens, but it seems silly to me that we, for example, find it perfectly acceptable to mandate car insurance, but not health insurance.

There is one small distinction. Car insurance is in fact insurance. You are required to have some before you enhazard others by driving in order to make the OTHERS whole if you mess up. Health "insurance" is not in fact insurance. It is a pre-paid medical plan. It does not pay for others that you make sick. It pays for YOUR trips to YOUR doctor. Some folk are in to "alternative" health care. Would you require them to pre-pay for a health plan they will never use? Seems a tad heartless to me.

Yet the GOP's idea of healthcare reform is to make it illegal for patients to sue. How, then, is the end result any different?

It is a difficult problem. Medical work is mostly art with a bit of science. People expect a doctor's judgment to be better than an aerospace engineer's with no justification. The malpractice premiums in some places and some specialties is clearly excessive.

OTOH how much is suffering worth? You measure it in lost income. You supply pain relievers to cover the rest.

How much is the life of a baby worth? Depends on the sales ability of the lawyer and the product he has to sell.

And this is not to leave out the fact that there are true disaster doctors running loose. Part of the problem is the cost of medical school. No doctor can afford to drop back to being a nurse and pay the bills.

As I said. A difficult question.

Ironically, this goes against your earlier argument. Looks like public health tends to try to "save" too many rather than too few, eh? Doesn't look like they are really that worried about finding people they can kill to save $, does it?

Not really. It is that they are just now running out of money. Now that could be fixed - for a while - if government unstrangled the productive economy. But folks who think in terms of - government run - are not going to be sympathetic to business.

“The problem with socialism is that you eventually, run out of other people’s money.” – Margaret Thatcher

KitemanSA wrote:

Maui wrote:I don't care as much how it happens, but it seems silly to me that we, for example, find it perfectly acceptable to mandate car insurance, but not health insurance.

There is one small distinction. Car insurance is in fact insurance. You are required to have some before you enhazard others by driving in order to make the OTHERS whole if you mess up. Health "insurance" is not in fact insurance. It is a pre-paid medical plan. It does not pay for others that you make sick. It pays for YOUR trips to YOUR doctor.

Health savings accounts are pre-paid health plans. Car insurance is so others don't have to pay when something horrible happens. So is health insurance.

I do grant you there is a significant difference between the two, but you really touched on my larger point-- it is already the case that we are largely paying for the healthcare of those that weren't insured. Just as with auto-insurance, it seems a better system to ensure everyone is contributing up-front and systematically for the "just-in-case", rather that have all parties whose money is involved deal with the aftermath.

Some folk are in to "alternative" health care. Would you require them to pre-pay for a health plan they will never use? Seems a tad heartless to me.

Alternative medicine costs money too. If it's cheaper, their insurance should be too. I'm not advocating one universal public option everyone is required to take. I'm just saying I think the eventual goal certainly needs to be that health insurance is not optional (okay, except in the case, as is with auto-insurance, that you have a certain amount of $ put away that is explicitly marked as health-savings account $).

MSimon wrote:It is a difficult problem. Medical work is mostly art with a bit of science. People expect a doctor's judgment to be better than an aerospace engineer's with no justification. The malpractice premiums in some places and some specialties is clearly excessive.

I second all of that.

Part of the problem is the cost of medical school. No doctor can afford to drop back to being a nurse and pay the bills.

Yeah, we'll fix rising education costs just as soon as we fix rising healthcare costs.

Maui wrote:Yeah, we'll fix rising education costs just as soon as we fix rising healthcare costs.

Interesting insight earlier this month by a metahistorian netfriend of mine:

- Second, America has been widely deceived as to the desirability and necessity of a college education. This started after WWII with the GI Bill and shows no signs of stopping, again because of the class pretensions of middle Americans (and the interests of the universities and their administrators). The immediate result of this is that millions of people with no particularly great intellectual aptitude go to college, accumulate high levels of debt, and graduate to find themselves non-competitive in a market where everyone else has a baccalaureate as well. The more remote results have included the grotesque lowering of educational standards to accommodate the demand for degrees; I suspect that there has been an evisceration of the intellectual elite as well, the handful of real scholars that remain having turned inward while most of their nominal colleagues produce "scholarship" like a commodity.

I wait for the realization on the part of some enterprising populist politician that the higher "education" industry (and the student loan debt crisis) are ripe for vilification in a way not seen since the attack on monastic property circa 1517. That and a direct assault on the pretensions of the judiciary are ripe low hanging fruit for whomever decides to play Marius this time around.

Currently about 10% of Canada's GDP goes to health care to 16% US. Longevity and infant mortality compare reasonably. US trade delegates have been known to complain this is an unfair economic advantage. As MSimon mentioned in another thread, the US has to get its costs under control.

That said, the two medical systems operate in different legal and cultural frameworks and I don't know if it would be possible to transplant the Canadian system into the US.

The AMA did a study that showed both health care systems produce the same results because in American doctors have to practise defensive medicine, and have to carry more liability insurance. Lawsuits are discouraged by the legal system here.

Also, the government taxes the heck out of Canadians, and we don't mind. I once talked to a Hong Kong millionaire, who told me he paid about 3% taxes in Hong Kong to nearly 50% in Vancouver. He also told me he preferred doing business in Vancouver because all the essential services provided by the government here, he ended up paying more for privately in Hong Kong.

Many of you may have probably seen this table. I find it crystal clear. If I were a US citizen, I would put the ideological private-public debate aside (more or less as suggested by CHoff) and focus on the main issue: what do we get for our money and where do the $7290 go? In other words, who is profiting from the crime?
Lawyers? I do not really know but I had a chat with a nice old man in California two weeks ago who told me the worst problem in the US education system was that it produced more lawyers than engineers. Is it true?
Just a detail by the way: health costs per capita or as a percent of GDP are better comparizon indicators than as a percent of government revenue, because the government sphere varies a lot from a country to another.

As MSimon mentioned in another thread, the US has to get its costs under control.

I'm not so sure I said that.

I like the American system. People pay for the kind and quality of health care they want.

BTW the Canadian system has a shortage of doctors and long waiting lists relative to the USA. You get what you pay for. Or in the case of government plans what is forced on you.

The one adjustment I'd like to see is portability of insurance across State lines. To do that without raising costs medical insurance would need to be untaxable if bought by individuals. i.e. decouple insurance from employment.

If the government option is so good there are two things I'd like to see.

1. Fixing of Medicare and Medicaid. First.
2. Congress Critters be forced to join any plan they enact.

http://powerandcontrol.blogspot.com/200 ... ctors.html

SASKATOON — The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.

Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.

"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."

The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred.

Wait Times in Massachusetts:

http://powerandcontrol.blogspot.com/200 ... times.html

The real relevant chart across nations is medical expenditure vs per capita income.

You might find that as per capita income rises so does the willingness to spend on medical care. We know this is true for environmental spending.

So Americans - with higher per capita incomes than Euros - might very well wish to spend that extra money on medical care.

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What is broken in the American system is government programs. They cut costs by not paying full price for services rendered. It is one reason 40% of doctors will not take new Medicare patients.

This causes cost shifting - the privately insured pay for the underfunded government programs. The insured are also forced to pay for the uninsured. With Medicaid there is no reason for anyone in America to be uninsured.

Roughly 60% of all Americans are satisfied with the health care system as it is.

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The American system pays for most of the medical innovation in the world. Even at the cost of higher prices for Americans I don't want that to stop.

MSimon wrote: If the government option is so good there are two things I'd like to see.

1. Fixing of Medicare and Medicaid. First.
2. Congress Critters be forced to join any plan they enact.

Fixing Medicare is not the problem. It is part of the system that people want replaced/fixed/fiddled with.

I've felt that there was a simple path to public health care that would work safely. The US Government runs a nationwide complete health care system. It is called the VA. Fix the VA. Expand it by buying failing hospitals and clinics. Fix their failing culture. Expand the enrollment beyond veterans to include those in medicare and medicaid. Expand the enrollment to people who wish to buy into the system. This kills many birds with one stone. This may take a while, but could be done reasonably and safely within 8 years and every step is a positive one that all can agree on.

If our government can't fix the VA and turn it into a world class system, how do you suppose that they are going to be able to do it to the MUCH larger regular health care industry?

I honestly believe that this is a viable option.