Health care

[Fairweather]

Awww, come on, Jay! There's, um, there's not gonna be any rationing, um, ok, yea, and, and, it's gonna be FREE!!!!

[olyclimber]

Free your mind, your ass will follow

[JayB]

So - the argument isn't that the state hasn't/won't use the "the state's paying for the ill effects of (insert unpopular behavior that sane adults choose to do to themselves here), the state has the right to outlaw it" rationale if given the chance.

 

It's that the fact that you're willing to exchange whatever liberties the state deems necessary to restrict in the name of cost-containment in exchange for whatever security you expect a third party rationing mechanism run by a state monopoly to provide.

 

Or "Hey, I'm cool with the state outlawing stuff in exchange for single payer."

 

Might as well be clear about it.

 

How about "I'm cool with allowing any possible infringements on our liberty like (get ready for this bombshell) mandatory seat belt laws (shivers) to work their way through the normal legislative process that you and yours are so keen to remind us is the best system in human history like any other laws rather than satisfying any and all theoretical potential ideological boogymen that you can toss out while people are dying because they can't afford healthcare". That's what I meant.

 

Or..."Hey, I'm cool with the state outlawing stuff in exchange for single payer." Got it.

 

People die because of the rationing imposed by single-payer systems as well - which a quick look at the comparative survival stats for various cancers will readily show.

 

The mortality and morbidity stemming from inferior trauma care, inadequate diagnostic capabilities, delayed treatment, etc are just as real as the deaths from the lack of health insurance. Ditto for the people who have and will die as a consequence of the drugs and other medical innovations that haven't and won't be developed as a result of price controls imposed by various governments - even though they're impossible to determine. How about people who can't afford coverage because the mandates that legislatures have imposed make even the least expensive coverage vastly more expensive than it would be otherwise?

 

If your goal is simply to insure that everyone has coverage, it'd be much cheaper to simply give anyone who couldn't afford private insurance (A) or wasn't already covered by an existing government program (B) already - (care to venture what percentage of the uninsured are left after controlling for A and B) - income indexed subsidies and tax credits to purchase high deductible plans and fund their HSA's to some threshold of the deductible.

 

Or you can pretend that the only mechanism for doing so is via nationalization/single-payer.

 

 

[olyclimber]

it seems like people die no matter what system we embrace. don't you have a perfect final solution for all of us jay?

[JayB]

Awww, come on, Jay! There's, um, there's not gonna be any rationing, um, ok, yea, and, and, it's gonna be FREE!!!!

 

Friedman pretty well summed it up. "If you think healthcare's expensive now, just wait until it's free."

 

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It's also worth pondering precisely how much good getting an insurance policy does for you when price controls restrict the supply of primary physicians at the same time that demand for their services increases. Particularly when you have to get a PCP's referral for diagnostics, specialist visits, etc. How come there's a shortage of PCP's? Couldn't have anything to do with government price control schemes, could it?

 

The next well-intentioned development in the devolution of medical care was the mechanism by which medical fees were set, a system called Resource-Based Relative Value Scale (RBRVS). This was the invention of Professor William Hsiao, an actuary at the Harvard School of Public Health. RBRVS attempted to price every item in medical care based on the resources required to create it. Procedures or devices that were expensive to make were priced higher. Physicians who required more training and preparation were paid more. What a dream for insurance companies—pricing without negotiation. In any industry but medicine, this would be called "price fixing" and probably be illegal. Instead, RBRVS was immediately adopted by Medicare in 1988. It has been a fixture in insurance reimbursement ever since.

 

Unfortunately, there was a problem with RBRVS—it killed primary care. Just as bad, it caused a natural migration to more and more expensive treatments. The primary-care doctors didn't have expensive procedures, and they didn't spend as many years in training as the specialists. In the RBRVS world, they were nearly worthless. In real markets, prices are determined by what customers value and are willing to pay: Too high a price, no sale. In health care, if it is expensive to produce, we pay more. If you want to understand why American medical care is dominated by specialists doing expensive procedures, you need look no further than this. Despite growing mountains of data showing that medical systems dominated by primary-care physicians produce better health outcomes at lower cost, we persist with an insurance system programmed to annihilate primary care and encourage expensive procedures.

 

Good summary of the effects of third party payment/rationing on healthcare...

 

 

The primary physician shortage is already a reality in MA. The state had a problem before they implemented their strategies to cover everyone, but it's become considerably worse since then. Guess what happens when people are sick and worried and either can't find a doctor, or can't see them in less than six weeks?

 

[JayB]

it seems like people die no matter what system we embrace. don't you have a perfect final solution for all of us jay?

 

Yes.

[prole]

Or..."Hey, I'm cool with the state outlawing stuff in exchange for single payer." Got it.

First they came and took away our right to be swindled out of our money and or addicted by snake oil salesmen selling alcohol and opium as medicine.

Then they came and took our right to drive without a seatbelt while committing other traffic violations.

Then they took our freedom to be poisoned by cigarette smokers in public places.

Then they took away our Olestra.

Then they took away our liberty to kill a motorcyclist with our cars when it might have been preventable (in some states).

 

Ohhhh, the horror! Anyway Jay, I wasn't aware that any single payer proposals involved outlawing anything. I think any such drastic steps would go through proper legislative processes under public scrutiny and that the Republic, having been through the Civil War, etc., can probably accommodate some debate on any of the terrifying dystopian healthcare fantasies you can dream up as they come up. Maybe you (and Fairweather) can point out for us some of the activities that have been outlawed in any of the modern liberal democracies with robust public healthcare systems for their citizens? You know, so we can be ready for them as they emerge.

 

 

[j_b]

Financing single-payer national health insurance:

 

Myths and facts

 

Myth: Employers fund the majority of health care in the U.S. Fact: Private business funds less than 20 percent of total health spending. (Government employees have taxpayer-funded coverage through the FEHBP program and employer payments for private insurance receive a substantial tax subsidy).

 

Myth: The U.S. has a privately financed health care system. Fact: 60 percent of health spending is financed by taxpayers. (Estimates that are lower exclude two large sources of taxpayer-funded care: health insurance for government employees and tax subsidies to employers to provide coverage.)

 

Myth: Covering the uninsured is unaffordable. Fact: 31 percent of current health spending is squandered on administrative tasks related to our fragmented payment system with hundreds of different health plans rather than invested in patient care. Over $350 billion – about half of the money currently wasted on overhead and bureaucracy – could besaved with simplified single-payer administration, enough to cover all the 46 million uninsured. Covering the uninsured is affordable; keeping the current private insurance system intact is not.

 

Myth: National health insurance would require large new taxes. Fact: No increase in total health spending is needed to finance single payer. The increase in taxes required to finance national health insurance would be fully offset by a reduction in out-of-pocket costs and premiums.

 

Myth: Making people more “cost conscious” is the best way to control health costs. Fact: The U.S. has the highest health care costs even though Americans pay the highest out-of-pocket costs of any nation.

 

Myth: Rising numbers of elderly Americans will bankrupt the single payer. Fact: Europe and Japan already have a larger proportion of elderly people than America faces with the aging of the baby boomers. Germany and Japan have adopted single-payer programs for long-term care coverage precisely because of single payer’s greater potential for efficiency and cost containment.

 

Myth: Rising numbers of obese Americans will bankrupt the single payer. Fact: The proportion of health spending dedicated to caring for the obese is not rising faster than their share of the population. The best way to address the issues of obesity, smoking and other public health epidemics is through public health measures.

 

Myth: U.S. health spending is higher than other nations because we get more and higher quality care. Fact: Americans get less of most kinds of care (doctor, hospital, surgery, etc.) than the citizens of other industrialized nations, and our care is lower quality by several measures.

 

http://www.pnhp.org/single_payer_resources/Myths-and-Facts-on-single-payer.pdf

 

 

[j_b]

1. Who are the "pushers for suicidal behavior," what qualifies as such, who makes that decision, and what additional powers would you like to give the government in order to prohibit/criminalize it?

 

2. Better by what definition? Spare me another iteration of life-expectancy/infant-mortality argument.

 

Spare me your usual crapola JayB. Who decides that greenhouse gas emissions should be reduced? Who decides that PCB, asbestos, … should be used only in a very controlled environment? Who decides that the content of cigarettes should be carefully monitored? Who decides that plywood, sheetrock, foams shouldn’t de-gass noxious chemicals in our living and working spaces? Etc … You see, the regulatory agencies, the experts already exist and make decisions all the time so there is no need to present yourself as the perpetual defender of freedom when, in fact, you act as a defender of the right of corporations to run our lives with as little regulation as possible so that they can maximize profits at our expense.

 

[glassgowkiss]

I see the future...... I see a pig running.......

 

 

Like I've already told you, GGK; I have no interest in your chubby, squealing wife.

it's not my wife, it's your mom, btw tell her i'm busy

[j_b]

3. What part of the state deciding who's too old to bother treating, who's too ill to continue tying to save, how injuries get diagnosed, which injuries get treated, how they get treated, and when, which chemo options are too costly, how much money gets allocated for surgical services, etc don't constitute rationing? I heard about all of the above on a case-by-case basis for months in a country that supposedly has no rationing.

 

 

Rationing will be a fixture of any system, the only question is who makes the calls when the time comes to make choices that involve various tradeoffs. The only real question is whether its better to allocate the same pool of resources in a way that leaves the vast majority of those decisions in the hands of individuals or third party payers. If we're left with only a choice between the latter, it's worth asking whether a cash-strapped state monopoly that's immune from liability or a competitive insurance market that has to answer to both the state and the consumers is more likely to have the means and motive to enforce the more stringent rationing.

 

I find it rather ironic that you expend all this energy viz rationing of healthcare in nations that have much better healthcare than we do for ALL of their citizens when healthcare is currently rationed for 1/6th of all Americans insofar they don’t have any, and for another 1/5th because of useless health insurance coverage. Who decided that healthcare should be run for profit squandering 1/3 of every healthcare dollar on marketing, underwriting, billing, overhead, obscene CEO’s paychecks and bonuses while leaving 1/3rd of Americans without adequate health coverage?

 

[j_b]

Awww, come on, Jay! There's, um, there's not gonna be any rationing, um, ok, yea, and, and, it's gonna be FREE!!!!

 

Nobody said it was going to be free, jackass. Single payer healthcare is much cheaper than for profit healthcare (we pay twice as much as other nations for an inferior outcome) and everybody has access to healthcare, i.e. no rationing.

[j_b]

The rationing of healthcare:

 

Make that 22,000 uninsured deaths

 

Uninsured and Dying Because of It:

 

By Stan Dorn

Urban Institute

January 2008

 

The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm—namely, greater risk of death—and seeks to illustrate its general order of magnitude.

 

In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.

 

Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.

 

More broadly, these estimates should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise “body counts.” The true number of deaths resulting from uninsurance may be somewhat higher or lower than the estimates in this paper, but that number is surely significant.

http://www.pnhp.org/news/2008/january/make_that_22000_uni.php

[JayB]

1. Who are the "pushers for suicidal behavior," what qualifies as such, who makes that decision, and what additional powers would you like to give the government in order to prohibit/criminalize it?

 

2. Better by what definition? Spare me another iteration of life-expectancy/infant-mortality argument.

 

Spare me your usual crapola JayB. Who decides that greenhouse gas emissions should be reduced? Who decides that PCB, asbestos, … should be used only in a very controlled environment? Who decides that the content of cigarettes should be carefully monitored? Who decides that plywood, sheetrock, foams shouldn’t de-gass noxious chemicals in our living and working spaces? Etc … You see, the regulatory agencies, the experts already exist and make decisions all the time so there is no need to present yourself as the perpetual defender of freedom when, in fact, you act as a defender of the right of corporations to run our lives with as little regulation as possible so that they can maximize profits at our expense.

 

What does any of the above have to do with outlawing risky behaviors where the adverse consequences are limited to the sane adults who willingly engage them on their own or with other consenting adults?

 

Regulations that specify a set of standards that a given industry, profession, etc have to abide by are something else entirely, kemosabe.

 

[prole]

What does any of the above have to do with outlawing risky behaviors where the adverse consequences are limited to the sane adults who willingly engage them on their own or with other consenting adults?

 

Regulations that specify a set of standards that a given industry, profession, etc have to abide by are something else entirely, kemosabe.

 

You're of course referring to behaviors like prostitution and drug use that have been outlawed in countries with strong public healthcare systems, right?

 

 

I hate to bring any sense of irony into this Jay, but if actually existing history is any guide (you know, as opposed to your dystopian fantasies or theo-rhetorical nonsense about "motives"), when it comes to regulating social behavior, Americans have far more fear from the puritanical halfwits and corporatists that make up your own political party.

[j_b]

1. Who are the "pushers for suicidal behavior," what qualifies as such, who makes that decision, and what additional powers would you like to give the government in order to prohibit/criminalize it?

 

2. Better by what definition? Spare me another iteration of life-expectancy/infant-mortality argument.

 

Spare me your usual crapola JayB. Who decides that greenhouse gas emissions should be reduced? Who decides that PCB, asbestos, … should be used only in a very controlled environment? Who decides that the content of cigarettes should be carefully monitored? Who decides that plywood, sheetrock, foams shouldn’t de-gass noxious chemicals in our living and working spaces? Etc … You see, the regulatory agencies, the experts already exist and make decisions all the time so there is no need to present yourself as the perpetual defender of freedom when, in fact, you act as a defender of the right of corporations to run our lives with as little regulation as possible so that they can maximize profits at our expense.

 

What does any of the above have to do with outlawing risky behaviors where the adverse consequences are limited to the sane adults who willingly engage them on their own or with other consenting adults?

 

Regulations that specify a set of standards that a given industry, profession, etc have to abide by are something else entirely, kemosabe.

 

I have never discussed outlawing risky behavior, and I don't intend to. I said "regulating the pushers for risky behavior" like in regulating industries that put taxpayer subsidized sugar in all processed food. Do you have reading comprehension problems or is your eagerness to spew your propaganda about progressives and their policies getting the better of you?

 

But if I understand well, your moto is to fantasize about the rationing of public healthcare while you remain completely silent on the current for profit healthcare that effectively rations healthcare for 1/3 of all americans (and withholds it entirely for 1/6 of all americans), AND you also like to fantasize about public healthcare excluding from coverage illnesses resulting from risky behaviors while you remain completely silent on for profit healthcare that excludes most preexisting conditions. To be perfectly candid, your rhetoric doesn't pass a basic honesty smell test.

[j_b]

Published on Thursday, July 2, 2009 by Consortium News

Who Sits at the Health-Reform Table?

by Tom Klammer

 

President Obama held a town hall on Health Care Reform last week, broadcast nationwide on ABC with Charlie Gibson and Diane Sawyer. Once again, even though a majority of the public and now even a majority of doctors in the US favor a single-payer system, single payer was still off the table.

 

The president of the AMA, which opposes single payer, nowadays representing about a 19 percent minority of doctors, was prominently on display.

 

Ron Williams, CEO of Aetna, the health insurance company that in the 1850’s provided insurance to slave holders for their slaves, was part of the discussion too. In 2007, Ron Williams received $19,924,027.00 in total compensation as CEO of that health insurance company.

 

But the part of the healthcare problem that caught my eye was a woman in a bright yellow jacket, seated on the front row in the East Room of the White House. "Dr. Gail Wilensky, who ran Medicare in the Bush Administration," gushed ABC's Diane Sawyer by way of introduction.

 

Wilensky (the Dr. in front of her name is for a PhD in economics, not a degree in medicine) got to ask the last question in the prime-time portion of the show, right before the late-night news. She tossed out some big numbers and asked "What do we do in ways that CBO will count so that we can actually get everybody covered?"

 

It is worth noting here that CBO, the Congressional Budget Office, has 'scored' other plans, but not single payer. If the single payer numbers were run by CBO, she might have the answer to her question.

 

Wilensky was also present at one of the Senate Finance Committee hearings in May where the Committee Chairman, Senator Max Baucus, joked about needing more police as he had single payer advocates arrested for vocalizing their wish to be included in the debate.

 

At www.singlepayeraction.org , I read that "Baucus held three days of health care hearings and heard from 41 witnesses — not one of which was a single-payer advocate," and that, "Earlier this month, Baucus said that he will use the power of his office to seek to have the criminal charges against the Baucus 13 dismissed," and that as of June 25, "Prosecutors said this week they have not heard from Baucus or his office about the matter."

 

Doctors, nurses, other advocates are kept away from the table and face criminal charges. Wilensky and Aetna are at the table and get invited to the White House.

 

more: http://www.commondreams.org/view/2009/07/02-5