How Bad Is American Health Care...Really?

Quote:

Originally posted by J-Swiss

For me personally it sucks out loud. I work full time and have since I was 16 but have no insurance anyway. Like everyone says you can get health care if you really need it. They won't turn you away but they'll also put you in 10's of thousands of dollars in debt with no problem.

The rich and the poor in this country are incredibly well taken care of. If you don't give a shit about your credit or debt you can get all the health care you want. But it's the middle class people who are uninsured like myself who don't want to ruin their credit who carry all the bullshit of the system. I won't go to a doctor for any reason at any time. 2 weeks ago I was in massive pain and everybody I know was trying to drag me to a doctor cause everyone thought I had appendicitis(sp?) and it was gonna burst and kill me or some shit Did I go to the doctor? fuck no cause I'd rather die young with a little cash then old and in debt up to my ears.

I hadn't been to a doctor for 14 years until a few years ago when my finger got cut pretty bad....
[ Link ]

Anyway for 8 fuckin stitches I got a bill totaling $4,698.77. For 8 FUCKING STICHES, a damn antibiotic iv drip, x-rays. In hind sight I should've just super glued my damn finger closed. That's the last time I'll go to any doctor under my own will for anything. Next time I'll be unconscious and someone who loves me will have to drag me there because I just won't go.

In the US if you're middle class and don't have insurance for some reason then you have to choose between physical pain and death or financial pain and death. Personally I'll choose physical every time. Some studies have said that over 60% of all bankruptcies in this country are due to medical bills.

...

Absolutely it happens. If I lose 2 fingers I'll be down 2 fingers. I'm not payin some doctor $50,000 or some shit to put them back on. I mean if 8 stitches on a cut cost me almost $5,000 I can't imagine what it costs to reattach 2 fingers and I damn sure wouldn't go bother to find out. I'd just krazy glue the hell out of it to stop the bleeding and go about my business.

If you're wondering why I keep bringing up krazy glue it's because the male nurse who attended to my finger before the doctor told me in confidence "man, you have no insurance? You could probably just have put some krazy glue on this and it would've closed up. The only problem would be possible infection." The nurse then proceeded to show me his crooked ass pinky where he had once krazy glued a cut similar to mine which he got previous to being a nurse and having insurance. Yes in the US a supposed health care professional will advice you to treat your own wounds with glue bought from an office supply store in order to avoid life destroying bills and ya know just don't worry about that silly infection stuff. And they say we're fuckin civilized.

This post is the one that hit me.

There is no way that 8 stitches cost $4,698.77. JSwiss must have been billed that amount to subsidize someone else's care (or pocketbook). Now, that is real income redistribution in my book. Not fictional, real. PERIOD!

The per capita spending proves its not an efficient system (US$ 7,290 per person). Twice that of Australia, who has better life expectancy and lower infant mortability (the only two stats that are fully comparable).

So, whatever your political views are, doesn't it make sense pragmatically to even consider the tangible merits of things such as a "public option" without the distorted rhetoric of so-called government takeovers, death panels, false hopes of a "tort reform fix"(Its 0.5% of the pie), rationing and so on?

Quote:

Originally posted by rocknthefreeworld

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Nope. You forget that the cause of all of the sub-prime mortgages in the US was government interference. There was a huge government push to increase the number of "affordable" mortgages available to people. The government backed Freddie and Fannie and that played into more people pushing bad mortgages because the government would make them right later if something went wrong. It was the implicit government backing that cause the mortgage crisis which in turn caused the economic downturn.

I disagree. That sounds to me like a simplistic Republican talking point.

I could argue this with you ad nauseum, but it would be really off topic and you probably would still not be convinced. Its a complex matter in any case - one which forced the Bush administration to prescribe more govt intervention to fix a failure in the free market system. These guys weren't liberals - they are let's cut the taxes conservatives.

Quote:

Originally posted by JSly

I'm Canadian. I just don't get it - why Americans are afraid of a "public option"? A non-profit option that competes with big insurance companies to bring the prices down for everyone, including small business employers. Profit of insurers have gone up around 350% in the last few years according to congressional testimony.

Because by instituting a “public option” you’re clear-cutting a forest because a couple trees are sick.

Health insurance providers (along with the pharmaceutical industry, amongst others) are, for all intents and purposes, operating in a monopoly. This is allowed due to legislation that the government has passed that outlaws competition, subsidizes benefits to large employers and corporations and gives the individual little ability to perform the actual market-function of shopping for good coverage, including group bargaining with insurance companies and/or any legal remedy for dropped coverage.

Government intervention is what has caused the problem. Further intervention is not the remedy.

Quote:

Originally posted by JSly

All this business about "government takeovers" seems nonsense to me. In my country, if you go to the doctor (or hospital/clinic) you never meet any government officials because there are none. (I have close family on hospital boards). All decisions are made by doctors and patients - no govt involvement whatsoever.

When people talk about a “government takeover” of healthcare, they’re not insinuating that their local emergency room is suddenly going to be staffed by government bureaucrats. They’re talking about the Pandora’s Box that is opened up by allowing the federal government access to medical records, giving them incentives to legislate lifestyle choices, giving them the ability to dictate payments (more than they already do) to specific sectors of the economy, and generally creating massive conflicts of interest between those being governed and those governing.

Quote:

Originally posted by Jsly

"While some label Canada's system as "socialized medicine," the term is inaccurate. Unlike systems with public delivery, such as the UK, the Canadian system provides public coverage for private delivery. As Princeton University health economist Uwe E. Reinhardt notes, single-payer systems are not "socialized medicine" but "social insurance" systems, because doctors are in the private sector. Similarly, Canadian hospitals are controlled by private boards and/or regional health authorities, rather than being part of government." (Wikipedia,[ Link ]

As WBW Moderator EricLindros notes, whatever label you give to a government funded and administered health-care apparatus does not change the inherent problems and conflicts of interest that arise by such an entity holding such powers.

The problem is further exacerbated when one considers that the government does not have the money to continue to fund the programs currently in place, much less the funds to institute a health-insurance plan for 40,000,000 people.

Quote:

Originally posted by JSly

I just don't get it. Why are so many in the U.S. "afraid" of universal health insurance?

We’re not “afraid” of universal health insurance. I think it’d be great if, somehow, magically, everyone in the world had health insurance and it didn’t cost anyone anything. Unfortunately, I live in the real world.

I assume what most are opposed to is giving the government more authority over the individual, in addition to being philosophically opposed to redistributive policy in general.

Quote:

Originally posted by JSly

Do that mean that "conservatives" are OK with taking tax money to wage pre-emptive wars (label "Culture of Death " and not taking tax money to subsidize health care (label "Culture of Life" )?

No, that do not mean that. Way to group large swaths of people into convenient stereotypes, though.

Quote:

Originally posted by JSly

Would you argue with the proposition that "LIFE, Liberty and the pursuit of Happiness" are self-evident unalienable rights?

I would argue that the proposition that government has any obligation to PROVIDE those things for you.

The government exists to ensure those are not unduly TAKEN from you.

There is a gargantuan difference between positive and negative rights, as positive rights inherently require forcible taking from one party to provide for another, which is against the very essence of liberty.

(BTW, the phrase you quote appears nowhere in the Constitution of the United States…Just throwing that out there since dropping fun, common knowledge facts – such as the “socialized medicine/insurance” you referred to – is somehow apropos here)

Quote:

Originally posted by JSly

If the U.S. govt can use public money for maintaining common-defense, courts of law etc. to protect the liberty of U.S. citizens, why can't it do the same to protect the life of its citizens through health care? Aren't heart attacks, cancer etc. as deadly as potential terrorist attacks?

Are they as deadly? Yes. So are lightning strikes and falls from heights. Does the government have a responsibility to protect me from lightning strikes and falls from heights?

The government can use public money for the courts and a common defense in that those institutions exist to ensure that nobody unduly takes your life, liberty or pursuit of happiness.

Quote:

Originally posted by JSly

If cultural conservatives get riled up against abortion (protecting the unborn), why no such compassion for those who are actually born and for whatever reason unable to afford medical treatment? Or is that "charity"?

Great, more erroneous sweeping generalizations.

I don’t presume to tell a woman what she can or cannot do with her body, just as I don’t expect others to tell me what to do with mine.

Quote:

Originally posted by JSly

The United Nations Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people. Many religions also impose an obligation on their followers to care for those in less favourable circumstances, including the sick. (Article 25 in particular).

Whatever you may think of the U.N., the United States endorsed - actually promoted - that charter. The Universal Declaration was adopted by the General Assembly on 10 December 1948 by a vote of 48 in favor, 0 against, with 8 abstentions (communist nations in the main). Are you stating a view that it should be repealled?

The UDHR is self-contradictory and therefore, as a practical matter, entirely useless as a legal or moral compass. Again, it calls for positive rights, which inherently infringe on the rights of others. How is one to have “security of person“ (Article 3) and be free from servitude and slavery (Article 4), while at the same time being compelled to provide monies, goods or services for others?

I could go on, of course. In addition to the others mentioned, Articles 12 and 17 are also contradictory with articles 22 and 25.

What use is a declaration that is not internally consistent? Which rights are to take precedence over others?

The UDHR was a lovely piece of literature, and its passage a compelling gesture. It is, however, nothing more.

Quote:

Originally posted by JSly

If the argument is essentially economic, why is U.S. devoting 15-16% of its GDP per capita on health care (not covering at least 15% of its population) while other countries spend considerably less? In Canada (my country), its 10% of GDP per capital (and everyone is covered).

First, you’re setting up a false dichotomy, in that the argument against universal health care is either economic or philosophical. It’s both.

Second, I’ll address the GDP issue:
The first problem with using spending as a percentage of GDP is that the United States is generally subsidizing the rest of the world when it comes to healthcare costs. There exists a massive “free rider” issue with regard to the development of new drugs, surgical techniques, medical equipment, etc, between the United States and the rest of the world that is engaged in some sort of socialized/nationalized medicine. They get to reap the benefits of innovation without having to cover the costs associated with the development and implementation of such. This will inherently cause their expenditures as a percentage of GDP to decrease. The second problem with the use of that metric is that it does not take into account the cost of lower GDP growth, which is a natural result of a country having a large government structure, which is necessarily the kind of country that institutes a universal health plan in the first place. Another factor that must be taken into consideration is the relatively unhealthy lifestyles that Americans typically choose to live. Some folks apparently think that a McDonald’s Super Value Meal is one of the basic food groups, and that’s fine for them. I shouldn’t tell them what they ought to be eating. It’s not my place, nor is it yours or anyone else’s. This fact, however, will, without a doubt, increase healthcare costs across the country, as those living unhealthy lifestyles are going to end up consuming more medical resources – again, raising the percentage of GDP spent on healthcare when compared to other nations. Finally, the United States has some of the best end-of-life care in the world. The US life expectancy for people once they hit 60 years of age is one of the highest. Unfortunately, this is also the most costly, by far, period of care. So, while countries that may ration implement cost benefit analyses to increase marginal utility of each healthcare dollar spent have a higher life expectancy at birth, they are surpassed by the US when it comes to end of life care, because as they curtail services, the US continues to provide them. This is quite inefficient, actually, and likely a direct result of the combination of our free-market systems and medicare, but it does account for some of the disparity in spending/GDP numbers.

Add all of those together, and you significantly narrow the gap, if not close it entirely.

Quote:

Originally posted by JSly

If you say, we spend more but have better outcomes, why then did a 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada find that the US ranked last on measures of quality, access, efficiency, equity, and outcomes? (ref:[ Link ]

It should come as no surprise that the only nation without universal healthcare comes in last in the categories of access, equity, and efficiency (with regard to marginal utility). That’s just the nature of allowing some semblance of a free market system.

Now, did you read that before you cited it? Canada comes in last on measures of quality. You might want to re-read that section. The quality section is a combination of “right care,” “coordinated care,” “safe care,” and “patient-centered care.” Now, I can’t imagine what non-patient centered care encompasses – physicians treating the wall instead of the patient, perhaps? -, so I don’t even know how to address that category. The coordinated care measure Canada scores last on, which is surprising, honestly. Countries with a nationalized healthcare system (or at least centrally funded) ought to have a centrally controlled information sharing service, as it makes sense

And there is no “outcomes” category. The reference barely covers outcomes. There is mention made of some metric called “healthy outcomes” which is some amalgam of all of the other categories, including “healthy lives” which I already mentioned as an issue as to why the US healthcare system spends a higher percentage of its GDP on healthcare than these other nations.

Quote:

Originally posted by JSly

Did you know that the Harvard Medical School and the Canadian Institute for Health Information determined that some 31 percent of US health care dollars, or more than $1,000 per person per year, went to health care administrative costs! (ref :[ Link ]

I did not know that. Although, I can’t say I’m a big fan of their methodology, as they’ve taken a lot of leeway in what they consider “administrative costs,” including the administrative costs of hospitals, physician offices, employers and the like. While these may be technically considered administrative costs, I wouldn’t consider a business hiring a “health care benefits consultant” or physicians’ “office expenses that are attributable to administrative work” medical administrative costs any more than I would consider a human resources benefits coordinator a medical administrative cost. They also assume that all clerical work done in a physician’s office is administrative, which is certainly not the case. They further assume that one third of office rents and building costs are administrative in nature.

There are a number of these types of accounting stretches to go along with their numerous broad assumptions and estimates. As a result, I don’t put much credence in that paper.

Now it’s my turn. Did you know that the US department of Health and Human Services says it’s closer to 7%? http://www.cms.hhs.gov/NationalHealthExpendData/downloads/PieChartSourcesExpenditures2007.pdf

Quote:

Originally posted by Jsly

So what is the moral argument based on a modern understanding of human rights?
And what is the financial argument taking into account the actual facts?

The moral argument is that a person is not entitled to the property, work product, or efforts of any other person, and that in providing such universal care this tenet of liberty is violated.

The financial argument is that the naturally equilibrating market forces involved in the provisioning of healthcare have been so grossly distorted by government interference that we have been saddled with an entirely unsustainable model for providing healthcare in the US.

Quote:

Originally posted by JSly

Sorry, I'm totally baffled by these posts.

Of course you are, because you’ve come to the issue with a priori assumptions that cloud your objectivity.

Quote:

Originally posted by Jsly

There is no way that 8 stitches cost $4,698.77. JSwiss must have been billed that amount to subsidize someone else's care (or pocketbook). Now, that is real income redistribution in my book. Not fictional, real. PERIOD!

Swiss was billed that amount because healthcare providers, especially emergency departments – but also hospitals in general, are forced to shift the costs from a large portion of their patients (the elderly) to other paying segments of the population, because they’re prohibited from recouping the actual costs of providing care to the former group. Large private-party insurers do the same thing, but to a much lesser extent, as the laws regarding accepting non-Medicare/Medicaid payments are exceptionally draconian. (For example, if a physician wishes to charge a Medicare/aid patient cash for an expedited and/or alternative treatment that is not specifically covered or offered by Medicare, they are expressly prohibited from such – and if they do accept any cash for such a procedure, they are then prohibited from receiving ANY Medicare/aid funds for a period of two years.)

Quote:

Originally posted by JSly

The per capita spending proves its not an efficient system (US$ 7,290 per person). Twice that of Australia, who has better life expectancy and lower infant mortability (the only two stats that are fully comparable).

Life expectancy is only minimally correlated to healthcare. Much more important are genetics, environment, lifestyle choices, demographics (which is correlated back to genetics), etc. It’s long been conceded that Americans are amongst the unhealthiest people in the developed world due to generally poor lifestyle choices. As such, life expectancy at birth is not a particularly useful metric upon which to base determinations of the efficacy of a national healthcare system.

Additionally, infant mortality rates are likewise correlated to the health of the parents, and thus parents living relatively unhealthy lives lower the life expectancy of their children – not to mention the differences between the ways in which the rates are measured in different countries (which I believe RNTFW already touched on).

Quote:

Originally posted by JSly

Democracy should settle the matter, wouldn't you think?

Not particularly. For the first 100 years of the US democracy decided that slavery was acceptable. Democracy prohibited women from voting in the United States until 1920. Democratic rule refused to accept black people as equal until the 1960s.
Democracy, while better than most other forms of government, is by no means infallible, as an appeal to the majority is nothing more than a civilized form of mob rule.

Quote:

Originally posted by JSly

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I disagree. That sounds to me like a simplistic Republican talking point.

If you would note, I did not place blame on any one party in my statement. Both Democrats and Republicans played that damn game. And both were wrong. Under Clinton, the government started pressuring mortgage companies to give mortgages to people who really were not capable of paying them back. Bush expanded it in some cases and retracted it in others but did nothing to fix the problem. They both owned it by the end. Bush started the BS bailouts and Obama continues them. Both parties were wrong, but none of it can really be blamed on the free market as the market was not free since the government skewed it.

This is directed primarily to Eric - who does (at least) provide a very coherent viewpoint. I disagree with it, but it is clearly thoughtful.

POINT #1

SUMMARY : Government intervention has stifled competition and for all intents and purposes, created a monopoly situation. Further intervention is not the remedy.

RESPONSE: This flies in the face of facts. Opposition to a "public option" in the U.S. by business interests is largely motivated by a fear that such an option would expand competition (without violating anti-trust laws) and cut into corporate profits. Thus, my analysis is directly the opposite of yours.

POINT #2

SUMMARY : A “government takeover” of healthcare, leads to (a) federal government access to medical records, (b) legislating lifestyle choices, (c) redistribution of wealth to specific sectors of the economy, (d) creation of conflict of interest between those being governed and those governing.

RESPONSE: I do not know what the situation is in Australia (I assume you are living there ... I may be wrong), but I've never heard any credible claim of such in my country (Canada). In the our case, we have privacy laws in the first instance. In the second case, I fail to see any evidence of lifestyle bias (e.g. coverage for treatment of lung cancer is the same for smokers and non-smokers). Third, there is redistribution of money between federal and provincial governments in Canada, but not between industrial sectors. I hasten to add that I work directly in this area. In the U.S. the 16th amendment is guiding. In my country, we have a different split in jurisdictional powers. You would have to be more specific with respect to the conflict of interest claim as such a proposition is alien to my/our experience.

POINT #3

SUMMARY : Social insurance" systems lead to a conflict interest situation. The public purse cannot cope with rising Medicare costs and covering the uninsured would exacerbate the fiscal situation even more.

RESPONSE : Not clear whether the claim of a conflict of interest pertains to public versus private sectors, or to the previously mentioned "the governed" versus "the governing". Adjustments to Medicare are required - with or without reform - because of demographic factors (such as the baby boomers reaching retirement age and increased in the aging population). The U.S. is incurring debt (borrowing from China, printing money etc.) for a variety of reasons and public policy is largely a matter of choice. If the U.S. cannot afford to cover the insured, it surely cannot afford to extend the Bush tax cuts or build up archaic missile defense systems in Europe for instance. There is broad discretion available on spending priorities and it's a matter of public choices.

POINT # 4

SUMMARY: Universal health insurance would be great if it didn’t cost anyone anything. I live in the real world and I oppose " giving the government more authority over the individual"

RESPONSE: Universal health insurance has been implemented successfully elsewhere in the real world. This is not theoretical. It can be done.

POINT # 5

SUMMARY: Objection to stereotypes relating to "Culture of Life"

RESPONSE: I did that to stimulate debate. I was responding to the "liberals vs conservatives" stereotypes. Agree that it is best to steer away from those.

POINT #6

SUMMARY: Expression "LIFE, Liberty and the pursuit of Happiness" is not in U.S. constitution. There is a distinction between positive and negative rights.

RESPONSE: Expression is in Declaration of Independence. U.S. constitution is largely an expansion of those core principles.

The libertarian viewpoint holds a distinction between positive and negative rights. In my view, it's a false dichotomy. It's countered by the fact that any right can be made to appear either positive or negative depending on the language used to define it.

POINT #7

SUMMARY: The government can use public money for the courts and a common defense in that those institutions exist to ensure that nobody unduly takes your life, liberty or pursuit of happiness. It doesn't have an obligation to provide for such in a "positive" sense.

RESPONSE: This is political philosophy of course. All I can say is that, in the U.S., no elected governing administration (including Eisenhower, Nixon, Reagan and Bush x2) has followed that course since FDR. Thus, it constitutes a minority opinion.

POINT #8

SUMMARY : Reaction to another stereotype. I don’t presume to tell a woman what she can or cannot do with her body, just as I don’t expect others to tell me what to do with mine.

RESPONSE : If you agree with the right of a "woman to choose" (a enunciation of a positive right from your negative right by the way), such thinking strikes down a slew of popular objections out in the media. I would then presume that if someone CHOOSES to take end-of-life counseling, you could not possibly deny them that choice.

POINT #9

SUMMARY : The UDHR is self-contradictory and therefore, as a practical matter, entirely useless as a legal or moral compass. Again, it calls for positive rights, which inherently infringe on the rights of others. It is not internally consistent

RESPONSE: I guess that why that "lovely piece of literature" was ratified by 48:0. And I guess the abstentions were symbolic as well. International law will always be disregarded by those who hold an " exceptionalism" viewpoint (as was the case with Bush administration). Anyway, my point was that this positive right was widely recognized (irrelevant of whether one agrees with it or not). In other words, it is not an abberation.

POINT #10 (a) and (b)

SUMMARY : First, you’re setting up a false dichotomy, in that the argument against universal health care is either economic or philosophical. It’s both. Second, the United States is generally subsidizing the rest of the world when it comes to healthcare costs with regards to the development of new drugs, surgical techniques, medical equipment, etc

RESPONSE : I agree it's both. And you may be surprised to find I also agree that eliminating the profit motive would decrease the rate of medical innovation and inhibit new technologies from being developed and utilized. No one (in the U.S.) is talking about elimination, but temperance. However, this cuts both ways. The profit motive values money above public benefit, and some argue that it adversely affects the cost and quality of health care.

POINT # 10(c)

SUMMARY: " Another factor that must be taken into consideration is the relatively unhealthy lifestyles that Americans typically choose to live." (In relation to GDP per capita)

RESPONSE : No serious disagreement here. However. I'm not sure lifestyles in Canada differ much, and the GDP per capita is significantly lower.

POINT # 10 (d)

SUMMARY : " The United States has some of the best end-of-life care in the world. The US life expectancy for people once they hit 60 years of age is one of the highest. Unfortunately, this is also the most costly, by far, period of care." Claim that this accounts for some of the disparity in spending/GDP numbers.

RESPONSE: Life expectancy in Canada is marginally better than in the U.S. ( 80.7 years versus 78.1 years according to the OECD). Geriatric care is high in both countries. I can't see how could account for any disparity.

POINT #10 (e)

SUMMARY : " Add all of those together, and you significantly narrow the gap, if not close it entirely."

RESPONSE: Only the spending on R/D would affect it in my estimation. You missed the big one : too many middle-men (middle-persons?) in the U.S. system.

POINT #11 (a)

SUMMARY : "It should come as no surprise that the only nation without universal healthcare comes in last in the categories of access, equity, and efficiency (with regard to marginal utility). That’s just the nature of allowing some semblance of a free market system."

RESPONSE: Ibid. You are effectively conceding the point since all cases are mixed economies

POINT #11 (b)

SUMMARY : Canada comes in last on measures of quality.

RESPONSE : Yes, it does. But not on access, efficiency, equity, and outcomes. The point is not to say that Canada or any one country is "better" across the board. You have to weigh various factors. Such is the nature of the beast.

POINT #12

SUMMARY : Administrative costs. Harvard study places it at about 31% . Government pie chart says 7%. Concerns about methodology.

RESPONSE : Funny how government source places it lower, in lieu of the bias you would expect the other way. I would have to look at what is counted in the 25% for other spending. Don't know for sure. I did see testimony on C-Span that overhead is a significant problem. Since GDP is a measure of "value-added" not straight revenues (i.e. no double counting), I would expect that to have an impact of some kind. I can tell you with confidence, however, that our statistics on capital expenditures and repairs are consistent with the Harvard study.

POINT #13

SUMMARY : " The moral argument is that a person is not entitled to the property, work product, or efforts of any other person, and that in providing such universal care this tenet of liberty is violated." The financial argument is that the naturally equilibrating market forces involved in the provisioning of healthcare have been so grossly distorted by government interference that we have been saddled with an entirely unsustainable model for providing healthcare in the US."

RESPONSE : This is your summation: blame the government for interfering with market forces (I have to paraphrase). Well, you are certainly entitled to that opinion (a positive right of freedom of expression, by the way, that can rephrased as a negative one). I wouldn't hold my breath to see your theory tested. No democrat or republican is likely to implement any kind of retreat.

POINT #14

SUMMARY : " Swiss was billed that amount because healthcare providers, especially emergency departments – but also hospitals in general, are forced to shift the costs from a large portion of their patients (the elderly) to other paying segments of the population, because they’re prohibited from recouping the actual costs of providing care to the former group. etc."

RESPONSE: My point is that redistribution of wealth already occurs. If I grasp your point properly, you attribute this to MEDICARE and the such. The impact on JSwiss (an individual) is that this dumps a cost on him that is not proportional to the treatment received. With Universal Coverage, individuals are not penalized in this way with catastrophic consequences for some. Rather the risk of financial injury is spread across the tax base. Pragmatically, that seems to be a more effective way of doing things, which (granted) increases the burden on a progressive scale.

POINT #15

SUMMARY : "Life expectancy is only minimally correlated to healthcare. Much more important are genetics, environment, lifestyle choices, demographics (which is correlated back to genetics), etc.

RESPONSE : Sorry, but on this one, you cannot be right. First of all you undercut your own argument on GDP (see Point 10d). More importantly, while all the factors you mention are important, life expectancy today is not what it was in past centuries due primarily to advances in medicine and health care. (The only other significant factors are improvements in personal hygiene and public sanitation over time). I'm sorry but that is historical fact.
Demographics enters the picture in another way currently: an aging populus. That puts an increased burden to fund health care for the elderly.

FINAL

SUMMARY : You disagree with the proposition that the matter will settled by democracy, citing slavery and calling it "nothing more than a civilized form of mob rule."

RESPONSE: While I agree that democracy isn't perfect, what is the alternative? Universal Suffrage is, by the way, a positive right assumed by the U.S. constitution. An answer to this one would be most revealing.

___
Now back to the babes (lol)!

Quote:

Originally posted by rocknthefreeworld

...

If you would note, I did not place blame on any one party in my statement. Both Democrats and Republicans played that damn game. And both were wrong. Under Clinton, the government started pressuring mortgage companies to give mortgages to people who really were not capable of paying them back. Bush expanded it in some cases and retracted it in others but did nothing to fix the problem. They both owned it by the end. Bush started the BS bailouts and Obama continues them. Both parties were wrong, but none of it can really be blamed on the free market as the market was not free since the government skewed it.

The key statement here is "none of it can really be blamed on the free market as the market was not free since the government skewed it."

It is quite true that the U.S. is not a pure free market economy (in the Adam Smith sense). That is one without economic intervention and regulation by government except to regulate against force or fraud. With the possible exception of Hong Kong such entities do not exist anymore (if they ever did), and it would take an anarchist revolution to change that.


Neither is it a command economy, where decisions regarding production, distribution, and pricing are a matter of the state. That was the system used in the old U.S.S.R. under communist rule. These are also in decline and expected to die out (e.g. Cuba)

Rather it is a mixed econonomy - one that contains significant economic interventionism by government, while still retaining some characteristics found in a free market. Whether you agree or not, it is fact.

The recent situation has parallels with the Great Depression of the 1930s. There are two competing schools of thought on what happenned: one led by Keynes (which is pro-intervention) and the competing one by Friedman(which is anti-intervention). The Keynesian school of thought prevailed, until laissez-faire economics made a bit of a resurgence under republican presidents (starting with Reagan).

Since Reagan, there has has been less intervention, mainly in the form of deregulation. It increased again under Bush. The result another economic crisis. Coincidence? An administration committed to less intervention realised (much against its will) that disaster would ensue if they did not reverse course, and bailout the banks/financial institutions who had packaged (bundled) bad mortgages in a "free for all" atmosphere that was developing (and still hasn't been really fixed).

Now, if you want to put the blame elsewhere, you are free to do so.

This is a very simplified answer, but at least I've give you a coherent account that actually holds water. You can do what you want with it.

We could go back to Locke and John Stuart Mill, how enlightment thinking influenced the founders etc. but I don't see the point. The topic is "How Bad is American Health Care".

Have a nice weekend.

Quote:

Originally posted by rocknthefreeworld

...

If you would note, I did not place blame on any one party in my statement. Both Democrats and Republicans played that damn game. And both were wrong. Under Clinton, the government started pressuring mortgage companies to give mortgages to people who really were not capable of paying them back. Bush expanded it in some cases and retracted it in others but did nothing to fix the problem. They both owned it by the end. Bush started the BS bailouts and Obama continues them. Both parties were wrong, but none of it can really be blamed on the free market as the market was not free since the government skewed it.

Freddy Mac et al never had a problem when they were government agencies. They were privatized to great fan fare and now they aren't worth a penny.

Privatization as "skewing" ? This stuff can be spun anyway that one wants.

Quote:

Originally posted by 888SPO

...

Freddy Mac et al never had a problem when they were government agencies. They were privatized to great fan fare and now they aren't worth a penny.

Privatization as "skewing" ? This stuff can be spun anyway that one wants.

That is kind of interesting since neither have ever been government agencies. Both have always been stockholder-owned corporations chartered as Government Sponsored Enterprises. They were never privatized and always maintained the same relationship with the federal government that they always had.

Quote:

Originally posted by rocknthefreeworld

...

That is kind of interesting since neither have ever been government agencies. Both have always been stockholder-owned corporations chartered as Government Sponsored Enterprises. They were never privatized and always maintained the same relationship with the federal government that they always had.

I agree. I can't see that argument either.

It is true that in 1968 Fannie Mae was split into a public and a private entity. But then Freddie Mac was created to provide competition to the private arm and to expand the secondary market for mortgages and mortgage backed securities by buying mortgages made by savings and loan associations and other depository institutions. That was almost half a century ago.

The Financial Institutions Reform Recovery and Enforcement Act of 1989, signed into law by a republican president, gave both Freddie Mac and Fannie Mae additional responsibility to support mortgages for low-and moderate-income families. That was in response to the S&L crisis.

But they were always goverment sponsored enterprises (GSEs). These are hybrid forms of a corporation designed to use privately provided capital in pursuit of publicly developed missions. They do not use public money, but while their securities are not explicitly backed by the U.S. government, the market largely perceives them to have an implicit government guarantee. This was and still is reflected in trading patterns. Furthermore, GSEs are exempt from state/local taxes and use of the Federal Reserve as a transfer agent.

So I have to agree with RTF on this one.

The bailout was a test and a consequene of the implicit backing in securities. The Bush43 administration had really little choice : honor that implicit backing or scrap the whole system (started in 1916 by the way before FDR). The latter would have affected upwards of 70% of the residential mortgage loans in the United States.


I disagree with RTF on two points: (a) that he accurately presents the whole story; and (b) that he did not adequately address the issue of WHY the problems occurs: e.g. push to have people who can't afford it to buy homes vs problems with bundling of derivatives vs lack of adequate oversight vs role of the Federal Reserve vs any number of other considerations.

Many people were scratching their heads over this one. RTF just boils it down to the convenient republican talking point of blaming it on Barney Frank and past actions of his committee (even when he wasn't chairing it). It is just not that simple.

Quote:

Originally posted by 888SPO

...

Freddy Mac et al never had a problem when they were government agencies. They were privatized to great fan fare and now they aren't worth a penny.

Privatization as "skewing" ? This stuff can be spun anyway that one wants.

Don't agree (see above).

Furthermore, I think you misunderstand RTFs argument about "skewing". As far I understand it, it is the general philosophy that the government (or public sector) has no right to interfere with free markets (or private sector).
Most libertarians support a limited role by government to prevent fraud and protect individual rights - and that's it.

Going beyond this, it is held that government "intrusion" prevent free markets from operating freely and effectively. And it is held that this is the root cause of almost economic ills including the Great Depression of 1930s (the Federal Reserve should simply have expanded the money supply instead of contracting it; and that mistake caused the crash). A majority of scholars disagree with this but it is argued that the "New Deal" didn't propel the recovery but impeded it. The chief proponent of this theory was Milton Friedman, who received the Nobel Prize in Economics - so its not a "quack" theory. But it is sharpely disputed by most - including the most recent Nobel Laureate in Economics Paul Krugman, and earlier the founder of modern Macro-economics John Maynard Keynes.

In Economics 101, you memorize Friedman with the phrase "markets always work and only markets work".

Quote:

Originally posted by EricLindros

...

... the United States is generally subsidizing the rest of the world when it comes to healthcare costs. There exists a massive “free rider” issue with regard to the development of new drugs, surgical techniques, medical equipment, etc, between the United States and the rest of the world that is engaged in some sort of socialized/nationalized medicine. They get to reap the benefits of innovation without having to cover the costs associated with the development and implementation of such .....

This is quite stimulating ... even though such discussions lead nowhere.

ADDITIONAL RESPONSE:

If I adopt a pure libertarian stance to this, it follows that individuals in one country have the choice of following one path and those in another country have the choice to follow another path. Further, if the one group invests proportionately more in R/D expenditures (i.e. medical research) than others, it doesn't follow necessarily that one country is "subsidizing" the other in this area.

Why?

First of all, if one country exports its medical technology, it recoups all or part of its costs through international trade pricing. If both entities are pure libertarians in their thinking, they would favour free trade, and the principles of supply and demand in international markets.

Second, if there is a free exchange of information between the two, free from "intellectual property" restrictions, then it is an inevitable outcome that one country will benefit from the differential. Thus, in a pure (and entirely theoretical) example of libertarian principles an uneven outcome will inevitably result from uneven choices between two groups of individuals. (Different choice, different outcomes)

Of course, the scenario is totally hypothetical, but it refutes the central tenet of your argument on purely logical grounds. And it rests on "a priori" assumptions and not consistent with pure empiricism. (ref Kant vs Locke)

Looking at the real world in contrast, you can argue that government subsidies, differential taxation, incentives for capital formation, trade barriers, differences in the level of social intervention in the marketplace etc. ALSO contribute to the difference, but how would you quantify such "skewing" effect?

Ever notice international comparisons on R&D expenditures are hard to come by? It is hard even just to quantify the number of articles published from the MEDLINE database (biomedical research) produced in each country, and certainly no one can quantify their quality. Same thing for "technology transfer".

International trade in medical devices and pharmaceuticals is a bit more approachable (due to the near universal application of the Harmonized System classification of goods). But the bottom line is that discrepancy you call "subsidization" has resulted in higher profit margins for U.S. firms - consequence of supply and demand.

Ever wonder why drug prices are lower in Canada? It is not because our government inserts what you would call of a "positive right". Rather, drug prices in the U.S. are kept artificially high to line pockets its pharmaceutical firms - i.e. skewing the supply and demand curve. A better case could be made that U.S. individuals (consumers) are subsidizing the profits of large corporations.

Looking at this solely on a individualistic basis, I/we would indirectly "profit" from this situation because of decisions you make .... and therefore I should argue you should keep your system intact.

Of course, what you do is up to you, not me. I'm not going to "deny your right" to have it your way, am I?

Quote:

Originally posted by EricLindros

...

I did not know that. Although, I can’t say I’m a big fan of their methodology, as they’ve taken a lot of leeway in what they consider “administrative costs,” including the administrative costs of hospitals, physician offices, employers and the like. While these may be technically considered administrative costs, I wouldn’t consider a business hiring a “health care benefits consultant” or physicians’ “office expenses that are attributable to administrative work” medical administrative costs any more than I would consider a human resources benefits coordinator a medical administrative cost. They also assume that all clerical work done in a physician’s office is administrative, which is certainly not the case. They further assume that one third of office rents and building costs are administrative in nature.

There are a number of these types of accounting stretches to go along with their numerous broad assumptions and estimates. As a result, I don’t put much credence in that paper.

Now it’s my turn. Did you know that the US department of Health and Human Services says it’s closer to 7%? .....

I looked at this a bit more.

The 7% in administrative cost you cite pertains to mainly Medicare and Medicaid, and its methodology understates the costs somewhat because it conveniently excludes a few factors. The higher number I cite pertains to the entire system.

That difference was actually cited as a reason for expanding Medicare to apply to everyone .... Funny, how the public sector component has a lower overhead cost than the private one, heh? There's been fudging by liberals as well as the numbers are not strictlty comparable. So the 3:1 claim would be overstated; its really closer to the 2:1 according to less-biased analysts.


Let me throw in a few more citations ... and I'm sure this is far from exhaustive:

------

"It’s instructive to follow the health care dollar as it wends its way from employers toward the doctors and nurses and hospitals that actually provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums — anywhere from 10 to 25 percent — for their administrative costs, marketing, and profits. The remainder is then passed along a veritable gauntlet of satellite businesses that feed on the health care industry, including brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies, information management firms, and so on and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing, and profits. I would estimate that no more than 50 cents of the health care dollar actually reaches the providers — who themselves face high overhead costs in dealing with multiple insurers."

Marcia Angell, M. D. (Senior Lecturer, Department of Social Medicine, Harvard Medical School and Former Editor-in-Chief, New England Journal of Medicine)
Introduction of National Health Insurance Act
February 4, 2003
Washington D.C.

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"A study by researchers at Harvard Medical School and Public Citizen to be published in Friday’s International Journal of Health Services finds that health care bureaucracy last year cost the United States $399.4 billion. The study estimates that national health insurance (NHI) could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.
The study was based on the most comprehensive analysis to date of health administration spending, including data on the administrative costs of health insurers, employers’ health benefit programs, hospitals, nursing homes, home care agencies, physicians and other practitioners in the United States and Canada. The authors found that bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada. They also found that administration has grown far faster in the United States than in Canada"

Press Release, Physicians for a National Health Program , Jan. 14, 2004

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(OF COURSE, ANYTHING OUT OF HARVARD WILL BE PREJUDGED AND DERIDED BY SOME)

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"By international standards, the U.S. approach to financing health care is extremely complex. Research suggests that a sizable fraction of higher U.S. health spending, not explainable by higher GDP per capita, can be traced to the higher administrative overhead required by such a complex system.16 To quote economist Henry Aaron on this point: "Like many other observers, I look at the U.S. health care system and see an administrative monstrosity, a truly bizarre mélange of thousands of payers with payment systems that differ for no socially beneficial reason, as well as staggeringly complex public system with mind-boggling administered prices and other rules expressing distinctions that can only be regarded as weird."

Aaron’s comment was part of his response to a recent paper by Steffie Woolhandler, Terry Campbell, and David Himmelstein, who find that administrative costs for insurers, employers, and the providers of health care in the U.S. health system (not even including the time costs patients bear in choosing health insurance and claiming reimbursement) were "at least" $294.3 billion in 1999, or about 24 percent of total U.S. health spending.

Aaron’s remarks may leave the impression that public insurance programs are the chief culprits in this "administrative monstrosity." However, as Commonwealth Fund president Karen Davis observed in her recent testimony before Congress, administrative expenses for private insurance in the United States are two-and-one-half times as high as those for public programs. "

U.S. Health Care Spending In An International Context . Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, Health Affairs, 23, no. 3 (2004):

http://content.healthaffairs.org/cgi/content/full/23/3/10

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"The system burdens health care practitioners and institutions with too many regulations and forms. A financial officer at one hospital reports that her staff has to handle some 3,200 different types of accounts receivable. The head of the major city hospital in Dallas says he needs 300 people to handle what, at a comparable hospital under the Canadian system, can be dispatched by three people."

White House task force on health care reform, 1994

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I couldn't find a on-point rebuttal to this at the CATO Institure. But they critize the Senate Banking proposal on other grounds see http://www.cato.org/pub_display.php?pub_id=10622

I'm not impressed by the Baucus Bill either - a mandate without a guarantee that competition will drive prices down seems a bit unfair to me. Its a half-baked idea in my view and now really "bipartisan".

I'm sure the must be a counter-argument somewhere to the admin cost issue - I just haven't seen any evidence of it.

So, I've been hearing things about that American health reform thing passing..

..So umm...how about that.

Quote:

Originally posted by Honda_X

So, I've been hearing things about that American health reform thing passing..

..So umm...how about that.

I was wondering about the same.

It passed our House of Representatives. Needs to go through our Senate now. Senate is worse than the House. Only 100 Senators and they all think they are Gods gift. 435 members of the House, so many of the crazy folks on both sides get lost in the crowd. Senate will be a total freak show.

Oh..well then.

TO THE FUTURE!

Dr.Brown...gun it to 88 and lets see how this fucker turns out.

*whoosh to the future*

----- cool future adventures ------

*whooosh back to present*

Wow, everything turned out great. America even converted to the metric system. It's like a real life modern country now. Well done, America.


(Note: Trips to the future I experience maybe be LSD influenced hallucinations...)

Quote:

Originally posted by mrdorkbutt

It passed our House of Representatives.

Yep, barely ... 220 - 215.

Voting yes - 219 democrats, 1 republican

Voting no - 176 republicans, 39 democrats

Democrats say they won with a bipartisan vote, with 1 republican, a congressman from New Orleans, joining them. I would say the real bipartisan vote was the no vote, with 39 dems voting with republicans.

I guess all the polls I have seen, showing the majority of Americans not liking this bill, didn't seem to matter to most of the Dems.

Seems like a pretty good time to bump this back to the top, with all the time and effort spent on healthcare being pretty much all for naught now.

So how bad is American Health Care? Well, I guess that's still up for debate, but the fact that Massachusetts, where Democrats outnumber Republican 3 1/2 to 1, voted for a Republican that campaigned on his ability to kill the current heathcare bill says just about all that needs to be said about how America feels about full-blown government run healthcare.

Maybe next time America..

ah man, you'd think by this point there'd be heathcare for all citizen (and even non citizens), i'm not american so my opinion is as good as pissing next to the fire but we've got it here i don't mind paying the medicare levy and in general healthcare is pretty good all round. All private really does here is help you jump the queue abit mind you smaller country so maybe alittle different.