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senna
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Health Care the world over
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Nov 2 08:54 UTC 2000 |
Health care has, understandably, been on the front of my mind lately. I'm
becoming overwhelmed by the sheer cost of the care given to people like my
Dad. We are extremely fortunate to possess splendid health care coverage,
something we haven't always had the benifit of. They're taking a fair hit,
because current and future expenses promise to be tremendous.
The world's state of health care is clearly unsustainable; A proper system
giving quality coverage to everybody would quickly cripple the world's
economy without other reforms. Clearly, things need to be done. I continue
to become more and more convinced that health care reform is inextricable from
serious welfare reform, and vice versa. Both deal mostly with the fates of
less fortunate individuals (note how that PC term is steadily gaining momentum
as a slur) who lack good jobs and health insurance. The United States
possesses a less thorough system than most other economically strong
countries, and the results are mixed. Health care for the uninsured is
clearly inadequate in this country, but health care for the universally
covered in many other countries isn't much to shout about, either.
It is unlikely that my Dad would have even received an MRI by now in Canada,
meaning he'd still be completely crippled with pain and without a diagnosis.
Canada wrote itself a huge debt in funding its system, and related problems
have become so widespread that politics are taking a dramatic right turn.
Republican standards such as tax cuts and spending reduction, previously
unheard of north of the border, are now popular battle cries.
I haven't really decided where to stand on the issue, yet. It seems that
comprehensive universal health care and welfare would be impossible for an
economy without ouside help or seriously increased production from those being
assisted. Or, alternatively, widespread automation. The few simply cannot
support the many.
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| 45 responses total. |
bdh3
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response 1 of 45:
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Nov 2 11:48 UTC 2000 |
Welcome to the abyss.
It used to be 'doctors' used to dispense 'health care' as and how they
saw fit. Adhering to an 'oath' that they took which was basically 'do
no harm' (hard to figure with blind 'placebo' esperimental medical stuff
despite the 'scientific' reasoned justification.) With the
consolidation of 'health care providers' prompted by the clintonistas'
'national health care plan' the control of health care fell into the
hands of not those most knowlegable but those looking at the 'profit' or
the 'business plan'. The 'docs' not longer are in control, and quite
rightly from a 'profit/loss' perspective no medical care at all is
warranted from such a view. Sick people should die and get off the
program. Only healthy people should be allowed 'health care'.
"The few simply cannot support the many"? What are you? Some kind of
tax protester? Some kind of 'commie'? Where did *you* get the right
to hold the view that six or ten or twelve people shouldn't work and
have money taken out of their pockets to support one old fart living
down in Ft. Lauterdale in an ocean view condo? What right do you have
to say how your tax money collected by the state before you cash the
check is to be spended. How dare you. Of course the 'few' can support
'the many' so long as the 'few' haven't a clue and it is treason to
point out otherwise and there are all sorts of new laws defining
'treason' coming down on the books. How dare you suggest that 'social
security' is a government sponsored 'ponzi scheme'. How dare you
suggest that it is nothing less than a government and 'constitutional
right' that every non-american has the same right to have a lot of money
as any other citizen. To be 'rich' is a constituional right and a world
right. It is sinful that people can get rich in the USSA when others in
the 'third world' don't have color cable TV and watch _Seinfeld_ and
can't afford the NYC rent controlled condo that they live in. Its clear
that if 10 people are laboring clearing a bridge over a river to get
food that 1000 times as many ought to get the benefit there of. One
ought to be able to freely wave a hand over a bushel of corn and have it
changed into gold given the communal effort to do so.
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jazz
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response 2 of 45:
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Nov 2 14:20 UTC 2000 |
Please recall that insurance-assisted costs are "funny money" and do
not represent actual costs. But then again, what wouldn't you pay for your
life?
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keesan
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response 3 of 45:
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Nov 2 18:58 UTC 2000 |
I think somewhere around one third of the cost of health insurance is for the
paperwork (paid to agents, and the people who fill out the forms, etc.). One
local hospital was giving a discount to people without insurance. - less work
for them.
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senna
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response 4 of 45:
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Nov 2 19:29 UTC 2000 |
The idea of rationing health care frightens me, but it seems way too popular
these days.
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drew
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response 5 of 45:
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Nov 2 22:15 UTC 2000 |
Re #1:
Yeah. Turn all of our food into gold. Uh huh.
Re #4:
Rationing health care is popular in about the same sense that the 'Laws
of Thermodynamics' are 'popular'. Ie, they're not. This is something that's
coming down the pike whether we like it or not, irregardless of how the
politicians juggle the money and the 401Ks and the medical savings accounts.
#0 hinted at the only thing that can get us out of the mess: increased
productivity via widespread automation. But no one in this debate is pushing
for it one iota, least of all the politicians. In fact, widespread automation
is often resisted by those very people who everyone is uptight about not being
able to make ends meet or have a decent retirement.
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senna
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response 6 of 45:
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Nov 3 00:31 UTC 2000 |
Put them to work for the health care system.
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mdw
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response 7 of 45:
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Nov 3 01:20 UTC 2000 |
The figure I heard was about 50% of health-care costs go to
non-health-care expenses - bureaucracy and paperwork, including the
incredible maze of clerks in both the hospitals and insurance companies
who shuffle paperwork back and forth. Each hospital and each insurance
company has its own way of handling things, which is one reason why it's
all so expensive.
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gelinas
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response 8 of 45:
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Nov 3 03:07 UTC 2000 |
The idea behind insurance is that not *everyone* will need a particular
benefit. With health care, sooner or later *all* of us need the best
there is. So there is no "risk" to "share"; we all have to pay for
everything we want/need.
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richard
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response 9 of 45:
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Nov 3 16:24 UTC 2000 |
Senna, this is why you should vote for Al Gore. There is a big difference
between Bush, who basically wants a tax cut above all else, and Gore who
sees that it is more important to address issues like health care. Polls
show 86% of those for whom health care is the number one issue this year
will vote for Gore.
Gore wants to extend the Children's Health Insurance Program (CHIP) to
cover parents. He proposes letting americans aged 55-65 get a 25 percent
tax credit to buy into Medicare. And also offer a 25 percent tax credit
to small businesses so they can cover health care premium costs for their
employees.
Gore wants to divert the interest savings from the reduction of the
national debt to keep Medicare solvent until at least 2030. He also
would allow expansion of Medicare to further cover the rising costs of
prescription drugs.
Gore supports the Patients Bill of Rights, which if passed would ensure
that patients critical health needs/decisions would not be made by
insurance companies and HMO's.
Bush is opposed to these things. Bush just wants a tax cut. So ask
yourself Senna, which president would better protect your dad's longterm
health care needs?
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senna
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response 10 of 45:
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Nov 3 18:53 UTC 2000 |
Richard, you mindless party-line bootlicking moron, this has nothing to do
with the presidential election. Frankly, neither candidate would adequately
deal with the system. This is a discussion of how health care is, and where
it should go, not who you should vote for. You should know better than to
try to use your cattle-hearded reasoning to convince me to vote for the party
you worship. And to answer your question, Bush would. That's neither here
nor there, however.
What I'd like to know is how there are so many uninsured people in this
country. Are they not eligible for government programs, or simply not
enrolled? What sort of coverage do these programs provide, anyway?
That first sentence was fun to write. Harmless, but fun.
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drew
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response 11 of 45:
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Nov 3 22:17 UTC 2000 |
Joe's comment in #8 is a good addition to my point. Not everyone is going
to file a fire damage claim, so fire insurance can be relatively cheap. Just
about everyone is going to goto the hospital sooner or later, in ever
increasingly vain attempts to continue living, and rack up ever increasing
hospital costs. So there is no non-claiming population to spread the costs
out to. This makes the insurance, one way or another, as expensive as just
paying cash for the treatments as you get them.
Stipulated that Gore means well with his health care ideas: the basic
theme of these ideas is giving money to people for their health care costs.
If the government really wants to do this, giving/spending money is a trivial
task. What is *not* trivial is ensuring that there will be hospital beds,
MRI equipment, medicines, and assorted medical personnel in adequate
quantities to treat all these people when they show up in the ER with their
gold-plated insurance cards and|or stacks of $1000 bills.
The latter task is what's needed of real health care reform; and I've yet
to hear a proposal from *any* politician - including Gore *and* Nader - and
Bush for that matter - to impliment it.
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richard
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response 12 of 45:
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Nov 3 22:41 UTC 2000 |
senna, but WHY would Bush as president better serve your dad's
health care needs? he wouldnt reign in HMO's, he wouldnt reign
in high insurance costs.
the election is four days away, and the future of how health care
will be dealt with for many years to come is on the ballot
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russ
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response 13 of 45:
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Nov 4 06:46 UTC 2000 |
Where should health care go? Excellent question.
I'll take the position most likely to give richard a stroke and
say that we should be going exactly backwards from where we have
been heading in the last 35 years. To be brief, we should be
scaling back Medicare and the FDA and removing the deductibility
of health insurance.
Why? It's complicated, but it can be summed up as politics and a
tragedy of the commons. Subsidies are inherently bad; whenever
something is too cheap people consume too much of it, and whenever
discretionary costs are pooled everyone demands the most and the
best even if they'd be fine with less. Because there are no taxes
on health insurance, people demand more of it than they'd otherwise
want. Because the FDA has a mission which is aimed at perfection
rather than making rational tradeoffs (a drug which might cause
cancer 10 years down the road is a great deal for someone dying of
an infection or heart attack today), it costs too much to get drugs
approved and only the most profitable make the cut.
The influence of subsidies on supply costs is also pernicious. The
cost of Medicare was rising several percentage points above inflation
for years and years. It was really popular, because nobody had any
incentive to avoid treatments; not the patient, whose bills were
paid, and not the care establishment, which was paid for work done.
It took almost no time at all for Medicare spending to outstrip the
most generous estimates of its proponents. The only one doing poorly
was the taxpayer, whose taxes kept getting increased to cover these
skyrocketing costs. Medicare is heading for bankruptcy again, so
we can expect another tax hike soon. (Scaling the system back to
stay within its means doesn't seem to be an option.)
So what's our current system costing us? Around 14% of GNP, and
a lot of options:
- We can't make our own cost/benefit/risk tradeoffs on drugs, because
anything that hasn't gone through very costly tests isn't available.
(If I recall correctly, many thousands of Americans died because
beta blockers, which were available in Britain, were hung up in the
approval process here.) What has made it through the approval process
is very expensive until patents expire; the costs have to be recovered.
- We can't make our own decisions about coverage, because the price
of treatments is jacked up by the demand-push inflation to the point
where you have to be part of a subsidized buying pool to get more
than high-deductible catastrophic-care coverage. You can only pick
from the pools you can get into, which might be three if you're
lucky (your professional society, your employer, your spouse's employer).
- Because of the behavior of small pools, your choices may be constrained
or even eliminated because one other person's expensive illness pushes
the premiums beyind your reach. Entire companies have dropped coverage
because of events like this.
- We can't decide to opt out and spend our money elsewhere, because so much
of the money comes out of our pockets as taxes that we are participants
whether we want to be or not. This eliminates our ability to influence
the system via individual choice.
- Because the system is so politicized, we can only get the choices we
can force through the legislatures instead of what a free market would
offer.
The senior lobby is one of the strongest, if not the strongest, in
Washington. Someone has got to stand up to them and tell them, "It
is not within the power of government to make you live forever. You
retirees already have a lower poverty rate than the struggling young
families trying to raise your grandchildren while paying your Social
Security benefits and your Medicare. It's time for you to stop
demanding Cadillacs and settle for Chevys. It's also time for a
special tax on age-restricted communities so that you pay your fair
share of school costs and the child-care expenses that your children
incur because you're not around to help the way families once were."
(How'm I doing on the Apoplecto-Meter?)
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richard
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response 14 of 45:
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Nov 4 07:24 UTC 2000 |
a special tax on age restricted communities?!?!?! russ would make a
popular candidate, he wants to raise taxes on senior citizens and cut
taxes on everyone else.
russ, you fail to see the purpose of government. Its the idea of
community, that we dont advance ourselves as a people if we leave the
poor, the sick, the elderly, the disabled behind.
We are headed to a major healthcare crisis, because the numbers of
senior citizens are going to skyrocket. People are livinglonger, and the
baby boom generation is getting older. So we have older people living on
fixed incomes who cant afford drugs and whose insurance companies wont
cover them.
We cant ignore this impending crisis. The human cost would be too great.
The role of government is to be the protector...give me your tired, your
poor, your huddled masses...we cant become a world where dignity is only
available to those who have themoney to afford it.
Russ, from the sounds of your last post, you seem to be of the opinion
that we should line up all the helpless old people and march them into gas
chambers, before you'd consent to raising your taxes. Thats a selfish
attitude...you act as if you live in this world by yourself, that you are
the only person who matters, and you could care less about anyone else.
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senna
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response 15 of 45:
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Nov 4 08:53 UTC 2000 |
Richard, your last paragraph is absurd, and you know it. It is mindless
acrimony like that that makes politics in this country so ineffectual.
Instead of working from where russ stands (coddling the elderly is heniously
expensive and improperly throwing the money in the wrong direction, and
additionally somewhat inneffectual) and instead throwing meaningless
accusations of gas chambers and selfishness. Why talk at all? Let's just
accuse everyone of being a nazi right at the start and get it over with.
No, I don't really agree with what Russ says, but he's reasoning a point, and
you have to listen to that. It is *tremendously* expensive to care for the
ailing (and increasing) elderly. The solution is going to be difficult to
find. Simply feeding money into a program that doesn't work effectively isn't
going to do it. It's like putting a braindead patient on a ventilator.
UAW workers don't have to worry about automation supporting health care,
because they have excellent coverage. Great. I'd prefer that coverage not
to be removed.
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cmcgee
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response 16 of 45:
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Nov 4 09:05 UTC 2000 |
Richard, the "tragedy of the commons" is precisely what happens when you act
as if you live in this world by yourself, that you are
the only person who matters, and you could care less about anyone else.
Russ is painting a picture of what has happened when people (especially
seniors) behave in just that way. The tragedy of the commons happens when
you can externalize the cost of your choices. His description of the current
health care system demonstrates exactly that point.
Every citizen is not going to be able to have the very best care. Given that
health care must be bounded by some constraints, Russ is point out where the
current economic constraints actually drive the system into irrational
outcomes.
And, by the way, those who live in age-restricted communities, and those
seniors who vote against school taxes because they don't have children in the
school system are about as close to your description of people who could care
less about anyone else as I've ever seen.
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bru
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response 17 of 45:
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Nov 4 17:03 UTC 2000 |
Lord know I want the best health care I can get. I don't want some admin
telling me I cannot have a kidney transplant because the hospital can't afford
to do it.
On the other hand, I think health care costs are out of hand BECAUSE of
insurance. 200,000 for a transplant, figure the doctor should get $50 an hour
and the operation should take 10 hours, so we are loking at $500 for the
doctor. The instrements can oftne be sterilized and used over again, so their
cost can be spread over many patients, say $200. Some insturments annot be
reused, say $100. Anethsteziologist $400. 5 nurses $1000. Facilities over
3 years, $1000. drugs, $100. support staff 4 $200
Actual cost $3500.00
Ad insurance
on teh doctor malpractice
hospital malpractice
nurses malpractice
on the facilities fire, theft, flood, accident, business
on the anestheziologist malparactice
on the builder
on the engineers
suddenly we are up to $20,000 for a $3500 dollar operation.
Noe you might think my figures are a little low, but put in your own and see
how high the insurance bill gets...
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gull
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response 18 of 45:
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Nov 4 21:56 UTC 2000 |
Re #0: One thing that's often missed when people discuss Canada's health
care system is that a major reason it's in crisis is that Canada's economy
isn't very good. Any system they had would be having problems.
I can understand the arguments for eliminating insurance and subsidies, but
I find I can't support them. I don't think *anyone* should be allowed to
die needlessly just because they aren't rich. For someone on minimum wage,
even a broken leg could be lethal if not for government-subsidized emergency
room care.
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danr
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response 19 of 45:
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Nov 5 00:36 UTC 2000 |
re #17: $50/hour for a doctor? Where do you come up with these figures, Bruce?
Hell, I get more than that, and I'm just a website developer. And I sure as
hell don't want a $50/hr doctor operating on me, even if you could find one.
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richard
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response 20 of 45:
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Nov 5 08:21 UTC 2000 |
senna, the health care costs of caring for our elderly are only going to
rise as the elderly population rises...
And we have to pay for it, its our responsibility. And themoney to care for
these folks wont come from corporations, it will come from us. Russ
cant seem to accept that we cant take care of our loved ones without taxes.
We are one of the LEAST taxed countries in the free world, and Russ could
care less. Russ wont take one dollar outof his wallet to help the
people who made our world possible, unless its at gunpoint or he cant
vote against or scream against those who take it.
So, this is a question I want Russ to answer...if the choice is either
raise your taxes or line up all the old people and march theminto the
gas chamber...which would you choose? Is there ANY circumstance in which
you would agree to a tax increase?
.'
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cmcgee
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response 21 of 45:
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Nov 5 16:56 UTC 2000 |
Richard: a lot of people that you are lining up for the gas chamber have 2,
3, 4 or more times as much income as I do. Why should my taxes go up so they
can keep their disposable income higher? I'm in favor of needs-based social
support, but not government benefits that accrue to you simply because of your
age.
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senna
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response 22 of 45:
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Nov 6 05:49 UTC 2000 |
At least you haven't mentioned presidential candidates in that response,
richard. And yes, I know the costs for the elderly are going up.
The Canadian economy's difficulties are sizably subject to the health care
system. It has racked up huge debts, forcing gigantic taxes which overshadow
everything in Canada. Even reasonably successful people can lose upwards of
75% of their income before sales tax up there. Little wonder it's hard to
keep things afloat, particularly when so much up there is dependent on
American money.
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russ
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response 23 of 45:
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Nov 8 04:57 UTC 2000 |
(responding to Sunday's download, since I couldn't get on Monday)
Judging from the reaction, I think #13 scored about 8 out of a
possible 10 on the Apoplecto-meter. Not bad, eh?
Addressing the rest of #14:
Yes, a special tax on age-restricted communities. Remember, they
aren't paying school taxes! They aren't paying their fair share of
the cost of educating the nurse's aides who will be spooning their
gruel and wiping their butts when they're in nursing homes, let alone
the doctors and med techs and drug chemists who'll keep them alive
for all those extra years. Plus, the no-children villages attract
a wealthier clientele. Why SHOULDN'T they be paying extra?
I don't give a damn about being popular. I'm here to speak truth as
I see it, not to kowtow for a pat on the head and a handout of kibble.
You're right, we are heading into a hell of a crisis. What's causing
it? We're LETTING PEOPLE RETIRE TOO SOON. Notice that we ALSO have
a labor shortage and a huge under-funding problem with the national
retirement system. Guess what, raising the retirement age will fix
those too!
Know one more difference between you and I? I don't believe that the
role of government is to pass a huge and escalating bill down through
the generations like a time bomb. This demographic problem should have
been addressed comprehensively in 1983, by paying off the unfunded liability
and moving to a fully-funded system. It wasn't. We've lost 17 years
of very precious time, and we musn't waste any more.
This is one reason why I'm hoping that Bush wins, because he is the
one candidate with a platform that would actually address the
mis-allocation of Social Security surpluses. They are going into the
purchase of government debt (financing deficit spending) when they
should be placed in productive investments outside of political
(e.g. government) control, though subject to strict standards of
fiduciary responsibility. Thousands of pension funds do this all
the time, it's well-understood. It's just the left-wing scare-mongers
who seem to think that the sky would fall if we fixed what's broke.
>from the sounds of your last post, you seem to be of the opinion
>that we should line up all the helpless old people and march them into gas
>chambers, before you'd consent to raising your taxes.
("gas chambers" is a Nazi reference. According to Godwin's law, I win.)
They already raised my taxes. Know what? I didn't get crap for them,
and if something isn't done to fix this problem soon the kids being
born today will be paying 25% or even 30% in Social Security taxes by
the time they're my age. It's time to defuse that time bomb.
Remember, the elderly are THE wealthiest segment of the population.
Why not means-test Social Security? If you cut off the payouts going
to millionaires it would fix a lot of the problem right there!
And this was too funny (absurd false dichotomy) not to mock:
>So, this is a question I want Russ to answer...if the choice is either
>raise your taxes or line up all the old people and march theminto the
>gas chamber...which would you choose?
What? I have to CHOOSE? What did we do 50 years ago before we had
all these fantastic and expensive drugs and treatments and things, did
we march all our elderly into gas chambers? The history books left
that part out! I feel so cheated by my public-school education, not
telling me of these awful shames in my country's past!
Richard, you really and truly are an unthinking parrot for the far left.
If I really gave you a stroke I would almost regret losing you; every
serious discussion needs some comic relief.
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gull
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response 24 of 45:
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Nov 8 15:53 UTC 2000 |
Sure, investing Social Security money in the market appears to make sense
*now*, when it appears to be going up endlessly. What happens when it
inevitably crashes?
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