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Health Care do we have the makings of... posted by: simplicissimus 16:53 8.10.10 a very special "tentfort death panel"? i think so. and given the fact that -- at least for a bit longer -- i do not have a spouse, if i should go vegetative before such time that a woman will have the legal right to put words in my (unopened) mouth i request that the plug be pulled immediately. hell, half the time i feel like installing a plug *immediately* so i can beg someone to pull it immediately. kidding, kidding. sort of. did i just announce something? no i did not. ps: hb loves guys who kidnap girls and make them pull bong hits. do we have the makings of... posted by: simplicissimus 16:53 8.10.10 a very special "tentfort death panel"? i think so. and given the fact that -- at least for a bit longer -- i do not have a spouse, if i should go vegetative before that time i request that the plug be pulled immediately. hell, half the time i feel like installing a plug *immediately* so i can beg someone to pull it immediately. kidding, kidding. sort of. did i just announce something? no i did not. ps: hb loves guys who kidnap girls and make them pull bong hits. and for the record... posted by: horsebeater 16:07 8.9.10 ... simpli is a partisan ninny parental instructions posted by: horsebeater 16:06 8.9.10 back from vacation, so just picking this up. I have not asked my parents these kinds of questions in detail, but I have asked them generally what their wishes are. My mom (arguably creepily answering for both of them) said that we should "pull the plug." I'm planning on exercising discretion, but I'll do it within the understanding that if it's a close call, I should err on the "more likely to die" side of things and not on the "go ahead and intervene" side. A sticky aspect of this is that their choice is shaded by their religious beliefs, which I don't share, so I can foresee scenarios where it is complicating. Like, they are unconscious and it is conceivable that they could awaken some day and the question of whether an invasive procedures should be done comes up. What do you do there? I have brought it up with my spouse, but she generally has just not answered the question. Since she's 4 years younger and healthier than I am, I figure there's about a 10% chance of her dying before me, so I figure it won't come up. On the other hand, I would like to take this opportunity to let it be known, as I have done with my spouse and siblings, that all you fuckers should all keep me alive as LONG as fucking possible. If worst comes to worst, freeze my ass like Ted Williams. I am too fucking important to humanity to expire before all resuscitative potentialities have been fully explored. silly rabbit posted by: simplicissimus 14:44 8.9.10 ...i'm not sure what they're called in lacrosse. but the rest of the country knows those things as "death panels". i'm almost positive that the willingness of the government to reimburse health care providers for services like this was the "proof" of the death panels that the republicans used to such great effect. Advance Directives posted by: isidorus 07:00 8.5.10 The Aug 2 2010 New Yorker includes a long article by Gawande about dying, hospice care and the purpose of medicine at the end of life. http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande It's a tough read at times but one part that got my attention was about La Crosse Wisconsin, where life expectancies are longer than average and end-of-life costs are lower. They claim this is due to a local effort to get anyone admitted to a facility to answer questions about end of life care: 1. Do you want to be resuscitated if your heart stops? 2. Do you want aggressive treatments such as intubation and mechanical ventilation? 3. Do you want antibiotics? 4. Do you want tube or intravenous feeding if you can’t eat on your own? My parents are in their early sixties, healthy. We haven't discussed these questions. I am curious whether the rest of the fort with 'rents still around has done so. Or maybe even with your wives, where applicable. If so how did it go? Wait, I'm confused. posted by: spacehippie 01:25 3.22.10 I thought we already had a national referendum on health care, and health care lost. Isn't that why we elected Scott Brown? Maybe THAT'S why all these people are saying this is unconstitutional... as of 9:45 posted by: simplicissimus 22:49 3.21.10 ...the united states has joined the rest of the world in offering some form of near-guaranteed health care coverage for its citizens. perfect? not even close. a step in the right direction? from just about every reputable source out there: yes. the politics of the issue are way more interesting than anything else. and i can't help but think the republicans over-played their hand in the whole affair. they won july, august, september, october, november, december, january, and february. and they are going to win november 2010. but i gotta say: by so publically and vehemently deeming that this was going to be the "waterloo" of the socialist-marxist-kenyan-nazi-terrorist president -- and by losing anyway -- they gained very little and made obama a hell of a lot more popular with the base then he was in the fall. obama's numbers aren't that great right now. but he's living to fight another day. and the republicans are going to have to come up with something better when we move on to immigration, education, and reforming wall street. and -- despite all the sound and fury now -- there's very little place for obama to go from here but up. It's not that anyone's done anything wrong posted by: simplicissimus 15:18 1.22.10 It's simply that we're spending way too much. 6% yearly increases are basically madness and -- what people don't seem to realize -- end up having a huge impact of people's pay. As costs rise, premiums rise, and employers put all the earnings gains that could be out there into health care premiums. Eventually, we'll all going to be working for free simply in order to get health insurance. I kid, I kid. In any event, it sure feels like we've jumped off a 20 story building and because we're now at floor 6 or 7 and still alive it's somehow proof that we're going to be ok. No need to rehash it, but the only way you're going to bend the cost curve is if you somehow either (a) let old people die more easily (and I would humanely, after the monthly horror stories my dad tells); or (b) provide less in the way of high end services that are likely unncessary. Both things are politically impossible, but financially required. And the insurance companies / doctors are not going to be the ones to say it. Why would they? They're doing just fine, and will be regardless of whether we're paying 6% or 10% or 15% or 25% of our incomes for their product. I'm a little baffled as to what we've done wrong. posted by: horsebeater 12:41 1.22.10 You link to a chart that shows we spend a lot of money and links that to life expectancy. Cam and I say we aren't really convinced by a chart like that. You respond as if we said we love U.S. health care and everything about it. Look, on whether we are 15th or 37th, see my previous posts. I think we are #1 or #2 or damn close to it. When it comes to HALE, isn't the far-and-away most likely explanation that we have a vast middle and upper class that gets kept alive a long time with serious diseases, when in other countries the services aren't quite as good and they die a little sooner (i.e., we keep the terry schiavos of the world alive a lot longer than anyone else)? And you even somewhat concede this. And I absolutely agree that costs are a big problem and should be controlled better, and I would love to see legislation that did that. But Obamacare, whatever its benefits, was not that legislation. Obamacare was going to to very little to "bend the cost curve" and while it would have helped the poor, on balance, it would have hurt the upper and middle classes (via injecting more demand into an already stressed system, through a cadallac tax or high earner tax or both, etc). i'm confused posted by: simplicissimus 15:43 1.20.10 Even if you don't like life expectantcy... 1) What about HALE (the percentage of years people live in good health)? Same as with life expectantcy, the US is last among industrial countries. http://www.conferenceboard.ca/HCP/Details/health/life-expectancy.aspx#quality 2) What about "Mortality Amenable to Health Care"? Same as with life expectantcy, the US is last among industrial countries. http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/Jan/Measuring-the-Health-of-Nations--Updating-an-Earlier-Analysis.aspx 3) Etc. Etc. --- Now, I get the argument that... a) we may not be 37th in the world, but actually 15th! http://online.wsj.com/article/SB125608054324397621.html b) and if you have a lot of money, this is the place to get health care (though that also seems to be slipping). BUT THIS IS WHAT I DON'T UNDERSTAND: We'15th or 37th or somewhere not close to the top, but were spending the most, and the costs are increasingly like crazy: In 2000, we were no. 1 at $4600 per capita (Switzerland was no. 2 at $3200) to a world average of $2000. In 2007, we were no. 1 at $6100 per capital (Luxembourg was no. 2 at 51 and a few euro countries were @$4000) I mean, maybe I'm missing something, but a 33% increase in 7 years (where wages and inflation were nearly flat-lined) is pretty disturbing, no? How about the fact that it's going up 6% a year (with wages and inflation near flatline)? What am I missing, HB? Forget what should be done: just explain to me why the idea of 6% yearly increases in cost (which is what is eating up people's salaries, let alone wage increases) is not something that won't eventually cause some serious economic and financial problems? Maybe I'm blind, but I think a 6% increase status quo is a pretty damn awful situation. amen to camdolphin. count us both blind, i guess posted by: horsebeater 12:54 1.20.10 You're right about everything... posted by: camdolphin 13:29 1.19.10 except the chart. Life expectancy just doesn't seem like the best measure of healthcare. We're fat smokers who don't eat fish or exercise so we don't live so long. Hard to blame Blue Cross for that. I think you'd see the same results with some other indicator, though; like childhood mortality rates. i'm usually not one to fall too hard for charts. posted by: simplicissimus 13:08 1.19.10 but this one is astounding: http://andrewsullivan.theatlantic.com/.a/6a00d83451c45669e2012876efdd68970c-800wi if this doesn't convince you the system is broken (and broken in ways that the health care bill probably doesn't fix), you're blind. and i will say that the biggest casualty in all of this is going to be our country. whether right or wrong, at this point it's now pretty much clear that the minority party is going to use the filibuster with greater and greater frequency. i mean in 2016, when president palin (i kid, i kid) unveals her signature program and senator brown (i kid, but not so much) is the republican majority leader trying to get it through, the dems will simply filibuster it so that it never passes. and on and on and on it will go. and in that sense, no sane political party will ever want to get to 60. because at 60 you'll have all the power but it will be impossible to do anything so you'll take all the blame, too. every once in a while, i fear greatly for our political process. not because one thing or another must (or must not) pass, but because we're clearly entering a period where all the minority party has to do is oppose, oppose, oppose and watch the president suffer. because after this, there isn't going to be a sane politician from either party that will cross the aisle on anything big. the political payoff for the party (and therefore the pressure on the politician) to oppose everything and anything that the other party's president wants is just too great. this is the problem.... posted by: simplicissimus 20:14 12.21.09 nobody is sickened unless they're on the losing side: http://www.foxnews.com/story/0,2933,49837,00.html i'm not calling out hb, i'm just saying that everyone's radar is up and running whenever the "other team's" congress passes the "other team's" bill. mccain deserves great credit on this issue, but he's one of a very few. i'd include coburn on that list, too. --- i guess all i'm saying is that this is how shit gets done, and it's problematic that nobody cares unless it's the "other team" doing it. 2010 will see the republicans trumpeting it (which is incredible, given 2002-2006). and then 2012 or 2016 or 2018 will see the dems do the same (which will be no less incredible). and on and on it will go. anyone that isn't sickened... posted by: horsebeater 15:47 12.21.09 ... just isn't paying attention: http://www.nytimes.com/2009/12/21/health/policy/21healthcare.html?_r=1&ref=todayspaper the stimulus was pork-fest #1. Now we have pork-fest #2. i gotta say.... posted by: simplicissimus 18:01 11.24.09 the reviews i've read of this bill -- across party lines -- are better than i would have thought. the latest: http://politics.theatlantic.com/2009/11/obama_and_the_atlantic.php we'll see what happens in the final version -- but it seems pretty clear that obama is not going to be clintoned here, it's actually going to pass. in any event, when non-partisan MIT economics guys say its not going to add any money to the deficit and is doing "everything" feasible to "bend the cost curve" (which is the only reason it's worth trying because otherwise it's all irrelevant) ... well, it could be a lot worse. posted by: horsebeater 12:47 11.20.09 my (7) is to limit the property tax exemption for "non-profit hospitals" to the amount of charity care that they give. the cleveland clinic now owns approximately 50% of the fucking land in the city of cleveland, and it's just starving the schools. having them pay nothing makes little sense, unless they really are giving back as much as they say that they are. hospitals may not be businesses, but are they 100% not businesses? aren't they 50% businesses at least? So how about they pay 50% of the property taxes that the rest of us pay, instead of using the extra cash to make sure staff doctors get 250K a year instead of 230K. i really wasn't being snarky. posted by: simplicissimus 16:45 11.18.09 naturally, the majority of this stuff is politically radioactive. (1)(b) and (c) seem particularly sane (maybe lower amounts, though), except there isn't a politician alive who would propose it. (2) and (3) are brilliant, except the doctors would go apeshit. to me, these two are the keys to the castle. my brother in law was with a group that owned mri facilities or something and the amount of money they made from those things was ridiculous. i'll just put it this way: their OFFICE MANAGER (who was fired and arrested for embezzling) MADE $250,000 A YEAR. 10 doctors, a single office, and they paid her $250,000. i swear i considered leaving law and volunteering to run it for them. if that ain't a sign that they were bringing in way too much cash, i don't know what is. (4) would, i think, be an easy "give" for the left, though i have to say what i've read about tort reform's impact on health care costs has not been encouraging (ie, doctors pay insurance companies who then pay judgments ... surprise, suprise, insurance companies aren't exactly keep to "give back" some of the found money, as negligible as it is) (5) i don't know enough about (6) this price differential has been explained to me as a gigantic ruse. sorta akin to the "these knifes are worth $300 but we'll give them to you for $30!" commercial. since everybody knows they aren't getting paid by uninsured folks, it really is just a hypothethical jack-up so (a) the 30% they do get paid is higher then the 30% they'd get paid if the amounts were lower; and (b) to inflate the amount of "charity care" figures for hospitals; and (c) the allow hospitals to monkey with their bottom lines (think sports teams losing money). holy shit, simpli... posted by: horsebeater 16:09 11.18.09 ... the idea that the public option will save costs, when congress just this week overrode the "automatic" deductions that doctors were supposed to have imposed upon them (thus costing medicare $350 million) is the first red herring. But the flip side, that conservatives have no alternative ideas, is crazy. Let me say at the outset that many conservatives have been attacking health care from the right and the left. you can cry "unfair" about this, but which was made possible by obama setting out his principles and then not living up to them (i.e., "no one that has insurance will have their insurance changed" and "we will not add any money to the deficit"). So some of the senior-bashing was politically fair in my view (because Obama really was going to change their insurance) but was also republicans attacking obama's proposals essentially from the left, which is a weird thing. but there are TONS of conservative ideas how there. ... read the atlantic article, for starters. c'mon, man. off the top of my head: (1) do things to generally make consumers more price sensitive, like: (a) eliminate the tax deduction for employer-sponsored health insurance and replace with individual tax credits so consumers are paying for their own insurance. if consumers are paying themselves, they'll make better choices. (b) more radically, outlaw any insurance that pays more than 80% of a cost until you get to $5,000 in non-insured annual expenses (i.e., your health bills exceed $25,000). all of a sudden, people would ask doctors what things cost. This really is the magic bullet to health care. I have watched myself "go along" with 3-4 tests in the last 5 years that I was sure were bullshit (ohhh.. you had a mole that I want to remove and check for cancer, even though I'm 99% sure it's fine). Everyone does this and it just runs up the costs. (c) even more radically, outlaw any insurnace that covers ANY of your first $10,000 or $25,000 in annual costs. (2) Fix the ethical laws governing doctors so that they can't refer people to testing facilities that they own. Read the New Yorker article on McAllen, TX; there are all kinds of loopholes here. (3) create a new class of health professionals. in canada, for simple stuff you can just go to a pharmacy, get diagnosed in 5 minutes and walk out with your meds. there's no reason we can't add 2 years to pharmacy school here. think of the millions of walgreens and rite-aids on every corner. You'd solve the preventative care issue (that I think is bunk, but campdolphin would be happy) too by making things super-accessible. practically, this means using federal power to remove the state medical board monopolies that have served to protect doctors at all costs by not letting any treatments be performed by anyone other than an MD or DO with 11 years of post-high school education. (4) Tort reform. I'm not an ultra-conservative on this. The tort system has its place and conservatives go too far. But reasonable federal caps on liability would help malpractice insurance. or just taking malpractice out of the tort system and creating something else could save a ton of money. (5) Break down state barriers. Remove the bizarre restriction that insurance companies cannot operate and pool people across state lines. This is weird and just adds to admin costs for having 50 blue cross/blue shield organizations instead of one. (6) Use the antitrust laws to get rid of the ridiculous practice of charging uninsured people 2 or 3 times what the insured pay. Getting the ultrasound bill for $250 (and then seeing Aetna negotiates the discount down to $82, of which I pay $20). What is that? Why do you basically have to pay twice as much if not insured? we may have had a more robust public option... posted by: simplicissimus 13:43 11.18.09 except all that death panel talk scared the shit out of the blue dogs. i mean this is what i don't get: if the only idea that anyone (right or left) has to reign in -- let alone cut -- health care costs while keeping us away from single payer is a stong public option ... why isn't everyone supporting it? maybe i'm not reading everything i can be, or missing a big right-leaning idea, but ... if we agree there's a healt care problem and agree it needs to be fixed, what are the other plans out there that don't involve single payer or public option? robert reich's open letter to harry reid posted by: horsebeater 09:56 11.18.09 which states the obvious, which is that the house health care bill completely and totally fails to cut costs. http://wallstreetpit.com/12097-an-open-letter-to-harry-reid-on-controlling-health-care-costs while we're waiting for the final bill... posted by: simplicissimus 17:10 10.20.09 let's keep something in mind: the status quo on health insurance for those that have it sucks, too. http://voices.washingtonpost.com/ezra-klein/2009/06/blogging_the_cea_health_care_r_1.html reich's take is very interesting... posted by: horsebeater 14:04 10.20.09 ... basically calling this a special interest bill ... by paying off the doctors, the drug companies and the insurance companies and not harming them, the only constituency left to pay for the bill is the taxpayers, and this bill does it on the backs of people with insurance (i.e., the middle and upper income classes). come on... posted by: simplicissimus 11:11 10.20.09 can't you just wait until there's a really shitty final bill before you justifiably crucify it? robert reich... posted by: horsebeater 18:14 10.19.09 ... here again, arguing that the middle class gets killed by this health care plan: http://www.huffingtonpost.com/robert-reich/lessons-from-letterman-in_b_325557.html (the rich gets killed too, but the middle class gets it almost as bad, and they can afford it less) a few thoughts on the dem health care bill posted by: horsebeater 18:09 10.19.09 (because talking about the public option is so July 2009): (1) i find it exceedingly sad that the administration has chosen lies as the way to explain the financing. having taxes kick in now and having benefits kick in 5 years from now and then claiming it is "cost neutral" because 10 years of taxes paid for 5 years of benefits ... that's just sad. in year 11, it plainly isn't paying for itself. (2) i find it quite sad that one of the central tenets that obama laid out there, that no one with health insurance now would see a change, has been completely scrapped. Baucus is plainly going to make "cadallac plans" more expensive. If I were a union member, I would be flipping out too. (3) i think the # 1 effect of the bill is that companies with "cadallac" health insurance are going to chip away at what is covered (higher deductibles, co-pays, etc.) in order to stay under the level at which the insurance companies will be taxed. So that coverage will be worse. This will, in effect, simply be a transfer from a system where the insurance pays 90-95% of the costs to a system where insurance will pay 80% or so of the costs. you'll have to pay more out of pocket. (4) because baucus funds his uninsured coverage with the cadallac health plans, but because the cadallac health plans are going to reduce coverage, then most of the alleged tax revenues will never materialize, and the plan will be majorly in the red. (5) I would love to see if the forced medicare/medicaid reductions ever pan out. the fact that obama is calling for another set of $250 payments to seniors because they aren't getting a social security increase this year (they got a 5.8% increase (!) last year) strongly suggests to me that he doesn't take COLAs and automatic reductions very seriously. if those don't pan out, there's another huge hole in the budget. so that's about 50% of the financing that's completely smoke and mirrors. ******** you could honestly debate the merits of the health care proposals and say "yes... this is basically a tax on people with good jobs and good health care proposals, and we're basically authorizing the insurance companies to get a bit nastier with you to keep costs down." I'd appreciate that debate, understanding what it is costing to obtain the real benefit of 25-30 million more people with insurance. What we get now is a bunch of BS regarding how all this will be funded, which is sad. simpli... posted by: horsebeater 17:56 10.19.09 i completely agree with you. it is one or the other, and i absolutely think the problem is going to be # 1, which is what you think. but if a different person on the right wants to argue that the problem might be # 2, then that's fair as well. all i'm saying is that the dems argued that she made up all this death panel stuff, and reich at least had discussed something similar publicly, so it's not insane for her to say that she's concerned about it. this is what confuses me... posted by: simplicissimus 16:50 10.19.09 as far as i can tell, there are two -- opposing -- reasons to be against the public option: (1) it will be so generous it will inflict the double whammy of (a) driving private insurers out of business; and (b) growing more and more expensive. this is the classic conservative "no such thing as a free lunch" line of reasoning. or (2) it will be so super-efficient that grandmas all over the country are going to put to death to save money. this is the palin "death panel" line of reasoning. --- but what i don't understand is: which one is it? or more honestly, how on earth can it be no. 2? i mean if it's a public option, and you can choose it from a variety of plans, why on earth would anyone choose it if it's so horrible and will result in your untimely demise? it sure seems to me that no. 1 is way, way, way, way more likely to be a problem. the CBO has had some fairly pro-public option opinions out there. and when you combine that with the idea that people can choose, well, it seems to be a pretty good bet. --- i just don't get statements like hb's ("when a dem politico as high up the food chain as reich says 'we're going to let you die,' sarah palin isn't necessarily crazy.") this is what private insurers do all the time. and, frankly, if we're ever going to get this thing under control, it's going to have to happen a lot more. especially for those receiving "end of life" care. there is no easy way to answer how this should be accomplished. but when the republicans turned a provision that doctors could be reimbursed for *discussing* end of life care options into "they're going to kill grandma" (when such conversations appear to be an easy way to lower health care expenses when they are normally insanely high and serve no real purpose ... http://www.dailyfinance.com/2009/07/03/reform-health-care-now-end-of-life-costs-are-too-high/) well, i'm not optimistic that it's politically possible. and i guess that's the rub. the second a single person (who would be refused care by a private insurer) is refused care by the government, well it'll be 24-hour-a-day news on all the cable channels. which is really depressing, because until people realize that spending $100,000 to give you an extra last 6 weeks of life is pointless, i'm not sure how this nut is going to get cracked. robert reich telling the dirty truths about health care posted by: horsebeater 09:46 10.15.09 http://www.youtube.com/watch?v=IT7Y0TOBuG4&feature=player_embedded# I might even be able to get behind a plan like this. (but note that when a dem politico as high up the food chain as reich says "we're going to let you die," sarah palin isn't necessarily crazy) has the fever broken? posted by: simplicissimus 21:17 10.7.09 strangley, it seems all the hoopla this summer, which reached way more than a fevered pitch, has somehow resulted in ... stronger support for a health care bill (?!?) it looks to be 50/50, but it ain't near the bloodbath it was a month ago: http://health.usnews.com/articles/health/healthday/2009/10/07/health-highlights-oct-7--2009.html also, you've got moderate, elder statesmen (bob dole, being the most prominent) who are sounding way more open to some sort of bill: http://www.huffingtonpost.com/2009/10/07/bob-dole-health-care-will_n_312837.html looks like a trial balloon to me. not that the republicans are anything close to rolling over, but that something's up. in any event, it's hard to sell the idea as socialism, fascism, marxism, etc. with guys like dole giving some cover for it. in other words, i think the fullscale war is over and now there'll be a shitload of negotiating behind the scenes for the republicans to get the best bill. and what could that be? what could be even better for those pushing the public option than the "trigger"? we have a winner: a public option that states must "opt in" to. tactically, this is fucking brilliant. 70% of the country's population (california, washington, colorado, minnesota, wisconsin, illinois, michigan, pennsylvania, new york, new jersey, massachusetts, maryland) will get it for sure. another 15% (virginia, florida and ohio) may get it. and the remaining 15% (texas, every one of those square states west of the mississippi, the deep south, and the border states won't. in other words, the issue is now not whether we need the public option, but whether each and ever member of congress wants to prevent PEOPLE WHO WANT IT from getting it. this allows blue dogs to vote for it without any blood on their hands. and it makes it much, much harder for republicans to block it. and it should be enough to -- at the very least -- get votes from the snowe, collins, leiberman, and voinovich (making it at least somewhat bipartisan. i gotta say, this cuts the gordian knot (politically and procedurally) even better than a trigger. i like it. this backs up what my pops tells me... posted by: simplicissimus 20:03 9.14.09 doctors favor (at the very least) a public option. http://voices.washingtonpost.com/ezra-klein/2009/09/doctors_support_the_public_opt.html i'll be honest -- reading about this study is the first time i've felt entirely comfortable with the idea of a public otion, especially if it's a trigger. doubly so given the fact that the poll has a built in bias - the government pays doctors less than private insurance, so doctors are actually supporting something that could hurt them financially. now, i could be wrong about that last point, but i'm pretty sure that's right. The "public trigger" posted by: simplicissimus 12:39 9.4.09 snowe's proposal to extend medicaid to families within 133% of poverty line and that the public option kicks in whenever "affordable" health insurance is not available to 95% of a state's residents. there's a lot to like about this idea in theory: the private insurers compete more and are forced to rein in costs and profits. the left and right hate it: which means somebody is on to something good. there's a lot to not like about this idea in practice: something similar was tried with Medicare Part D (for prescription drugs) and it never kicked in -- however, i'm not sure why that was. also, there are so many games one could play with numbers that i wonder if it won't be easy for private insurers to comply without really changing anything. that said: at heart, i like this at first glance. the federal government holds a gun to the insurers' heads, saying that they better find a way to make this shit affordable. if what i suspect is right is right -- that insurance companies in competition and with the fear of losing the whole shooting match, could go a long way to doing just that without the world ending -- than this is absolutely good enough. what i don't get, for the life of me, is why this wasn't front and center sooner. it ain't perfect, but it sure as hell -- in theory -- addresses a lot of the left's concerns without being all that objectionable to the right. neither likes it, like i said: which can only mean it's a sensible idea. That's absolutely right, HB posted by: camdolphin 11:26 9.2.09 Pre-natal care is one area, though, where we get the best bang for our money because of the high potential for life-long disabilities. Basically, no prenatal care = low birth weight = extremely high cost of care + hidden cost of treating the retard through school and beyond. So I'm happy to pay for crazy new moms' 6th ultrasound. I couldn't find jack to support my $1 saves $10 argument, and couldn't get access to articles that were helpful. Here's an old one, though, that says prenatal care is cost-effective: http://findarticles.com/p/articles/mi_m0795/is_n4_v15/ai_15868838/ And you subsidize poor people through medicaid, and my parents (i.e. old people) through medicare. Thanks. I guess my real frustration is that aren't these costs of preventative care at the margins? We pay more for them, they help a select few, drain some resources, but nothing like the resources my mom would someday drain if she hadn't always promised to put her head in the oven. Routine tests add up, but I would guess they're a lot of fixed costs being overbilled. In the scheme of things, not the real problem. My lifetime of healthcare will probably be dwarfed by my demand that HB junior pay for my 3 months on an iron lung in 2060. prenatal care posted by: horsebeater 12:22 9.1.09 thinking about this further, isn't there probably some portion of the population that has way too little prenatal care and some portion of the population that has way too much (i.e., the basic problem with health care generally)? I would be willing to subsidize the poor (oops, actually I already do: it's called Medicare) if we could find a way to make it all more cost effective. "I submit that longer wait times indicate a well run system" posted by: horsebeater 12:12 9.1.09 might be my favorite line of the year, spacehippie. I would be willing to buy a bumpersticker if you're inclined to print some up. Preventative Medicine (like pre-natal care) saving Cash posted by: horsebeater 12:08 9.1.09 I can't wait for the Dems to start hating the CBO. They loved it for 8 years, but that time may be coming to an end. CBO's conclusions on preventitive care are here: http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf Money quote from the first paragraph: Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall A Krauthammer article on this: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/13/AR2009081302898.html ************* CAMDOLPHIN: Does this mean you're wrong on prenatal care? Maybe or maybe not. But I don't think it is obvious that spending a dollar on prenatal care saves $10 down the road. When you've had 5 ultrasounds, I really doubt that the 6th is cost-effective. I read this up until the part about comparing routine health care with gas posted by: camdolphin 10:17 9.1.09 That's bat shit crazy. I mean, he throws in prenatal care as something that people can plan for. At the same time he makes the economic argument about how people are incentivized to act in their economic best interest, meaning people will find the way to have the cheapest prenatal care so they can have the high-end crib and isn't it a pain to go to the doctor every week. But every dollar spent on prenatal care saves ten (and probably a lot more) at the other end. That's why most insurance plans waive even the co-pay for prenatal care. If this guy really spent a year talking to doctors he would know that one of the absolute biggest nightmares is a pregnant woman showing up to give birth with no history of prenatal care. The real difference is that if you don't buy gas you can't use your car, so then you use public transit, which is relatively cheap for the government to provide (b/c it also provides benefits in terms of reduced pollution and congestion). When you don't get routine preventative care you run the risk of serious problems that sap our resources and provide no public benefit - and can either bankrupt a person or force the government to pay for the expensive stuff. (The flaw here is that I'm not sure how cost-effective routine care is - physicals are pretty ineffective, but having that lump checked out early could really save a lot later). Sure we'd rather have people look out for themselves. But it seems to me that spending on the catastrophic stuff dwarfs everything else, which is causing this problem, so we shouldn't be talking about reducing what actually might prevent some of the catastrophic stuff. the atlantic article is good stuff. posted by: simplicissimus 22:22 8.31.09 i mean, there's a couple flaws. car insurance works because most people -- especially early in life -- have a car they beat to death. don't get 10,000 mile checkups, aren't religious about oil changes, etc. and their car gets run into the ground and they think, "Shit, next car I have I'm going to be anal as hell about oil changes, 10,000 mile tune-ups, car-washes, you name it. the same can't be said for one's body. there are rarely second chances, so once you fuck up you're not only *not* fucking up grandpa's car that's been passed from sibling-to-sibling, you don't have the chance to make good with your first "real" car that comes right about the time you have your first job. also, the setting of the catastrophic "floor" would be rife with problems. shit, doctors would be incentivized to offer patients (think workers comp "doctors") just enough care to have it covered by the government. if the floor was 50k, i reckon a shit load of procedures or events that cost 30k or 40k would all of the sudden cost 51k ... the incentives sure work that way. on top of that, can you imagine the political fallout when grandmas all over the country were dropping dead when their money ran out? i mean, i don't think it's a *bad* idea, but there isn't a politician in this country who would back a plan that up front say, "if you don't have the cash, you don't live". all of that said, it's a great read. seeing as how single payer and the public option are D-E-A-D dead, this is shit worth thinking about. and, for the record, if republican politicians talked this way, i could easily find myself voting for them. i get that fear tactics are a tried-and-true s.o.p. for both sides of the aisle, but the shit they're peddling is so bizarre that i wouldn't trust any of them to make a single decision of any of it. i know it's a broken record, but where the fuck is thinking right? this atlantic article gives... posted by: horsebeater 18:14 8.31.09 ... basically the libertarian approach to health care (although the author goes to pains to describe his bona fides as a dem). if you don't understand what the "thinking right" wants out of health care, you should read this: http://www.theatlantic.com/doc/200909/health-care there's not much new here, but it gets all the arguments in one place. it ends up proposing a mandatory catastrophic health care regime of the type that simpli seems to reference above. the most interesting part of this is the argument on how "if you need gas, or new tires, do you expect your car insurance to pay for it? then why do we expect health insurnance to pay for run of the mill stuff?" and if car insurance paid for gas, you can bet that old people would (a) have one less thing to talk about but (b) would no longer make 12 mile treks to buy gas that costs 8 cents less per gallon. interesting to me to see the tentfort debate... posted by: horsebeater 18:07 8.31.09 ... basically recounted on the big stage. (does this mean we are original or that the parties get their talking points ingrained in our heads before we even know it? don't answer that...) http://www.slate.com/id/2226793/ A few more "6 things" responses posted by: spacehippie 01:01 8.24.09 2) Since when does just having drug companies working here make our system better? And wouldn't paying the highest prescription drug prices in the world, while having those companies working here qualify as "pissing away" an advantage? 3) You're missing the point regarding wait times. All the statistics that people toss out about wait times and satisfaction with insurance providers aren't really measures of the effectiveness of a health care system as a whole, they're measure of customer service - an important distinction to make. I read the fucking link, man, and I didn't see any mention of someone receiving inferior care because they had to wait a little longer to get to see the doctor. In fact, I submit that longer wait times indicate a well-run system, in which cases are properly triaged so that folks that can't wait to see someone are moved to the front of the line, and those that can wait do. I also had a feeling you would latch on to the line about wait times being caused by Massachusets' health care system. The next time you offer up a half-baked theory "surmised" in a USA Today article as "proof" of anything, you owe me 20 pushups. 5) We're not just talking about the "kooks" on the right. The level of bullshit that is coming out of the establishment of the Republican party, while not at the level of painting Hitler moustaches on Obama's face, is not insignificant. And much of it gets picked up and repeated ad nauseum on the internets and in main stream media outlets. It's a brilliant tactic, actually. When health care reform proponents have to continually talk about what reform is NOT, they are less able to talk about what it IS. I would have liked to think that Obama would have had the savvy to get around that tactic, but he hasn't proven up to the task just yet. 6) My wife is a physician in one of those publicy-funded hospitals, and sees first-hand what these folks have to go through on a daily basis and how it affects their overall health and quality of life. Believe me, the situation is a lot more tragic than you care to think it is. My wife is not a political person by any stretch of the imagination, and she doesn't get riled up easily. Lately, she is literally losing sleep over the direction the health care debate is heading in this country. i think that article nails it probably more than anything... posted by: simplicissimus 17:13 8.21.09 i have had the pleasure of offering my (unofficial) council to an orthopedic surgeon who is severing his relationship with his former partners. and i can say this: you would not believe how much fucking money these guys make. they owned, and had stakes in, numerous buildings, clinics, and god knows what else that was brining them 50, 70, 90 grand (a piece) per year. on top of the mid-six figures they are making. on top of the free car leases, gas fill-ups, and god knows what else that were partnership expenses. it's insane. how insane? they were paying their office manager $250,000+ a year to run a business of 8-10 doctors. she didn't work more than 40 a week. she basically was a head secretary. but they were so fucking rich it didn't really matter to them that they were paying her 5 times what the open market would pay her. (and she sucked by the way). and you should hear dr. simpli rage about this topic (along with how we *wanted* terry schiavo to die). anyhow, hb's former point is well taken: there is a slippery slope with any government program. it can become an overstuffed monstrosity and not only crowd out private insurers, but do NOTHING to control costs to boot. however, that said, the sensible plan would be something like "Castrophic public option"? Or some sort of "Indexed public option" that would provide a base level of insurance or insurance for truly catastrophic things? I'm not sure this is right, but the point is there is probably a way -- it's just one that would be unacceptable to one of the main constituentcies of the major parties. gawande new yorker article posted by: horsebeater 16:44 8.21.09 i missed this during my string of 300 hour billable months, but it's a fascinating examination of why McAllen, TX's medical care costs more than double the national average one lesson to take out of this is that greedy doctors (likely GOP voters) are to blame. but another might be that insurance companies should be given MORE power to deny procedures, which I can't imagine will be particularly popular with the public. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all lots more to say... posted by: simplicissimus 15:27 8.21.09 but this is perhaps the real looming threat to americans' health: http://www.foodgeekery.com/reviews/double-down-with-kfc/ i can just see hb now, proudly declaring he will get in the car right now, drive to kfc, and eat two of them: not because he wants to, but because nobody else can. my secretary just walked into my office said she had a headache and is going home... posted by: horsebeater 15:05 8.21.09 ... and then said "what is that demonstration going on out there [by the free stamp?] they probably want us to pay for their health care because they don't have jobs. y'know, whatever health care package they are trying to sell us, you know within 5 years it is GOING TO DEVOLVE INTO SOCIALIZED MEDICINE. It's just a trick. OK, I'm going home. Have a good weekend." This is an Obama voter. regarding whether the right's argument is incoherent posted by: horsebeater 14:31 8.21.09 "The right can't come out and say what it means: that all the horror stories about socialized medicine (of any kind, in any country) are only relevant here if there's a public option and it's SO EFFECTIVE it will kill private insurance. You know how that will happen? Because the public option will be cheaper and as good (or better) than private insurance. If there's a public option and it sucks, none of this talk about the health care end times makes any fucking sense." This is a strong point simpli makes, and is correct if that were the end of the story, but what makes the opposition coherent to those on the right is that we don't believe that the public option will remain unsubsidized. If it loses money, it will be propped up, a la the post office, a la freddie mac and fannie mae, a la the pbgc, etc., etc. no "quasi-governmental" agency is ever, ever, ever allowed to fail. hell, even the GOP doesn't let them fail. so the question is then, will the public option price itself so that it loses money and has to be subsidized? the answer to that is "of course it will." the health agency will be staffed by people who think it is their mission in life to deliver health insurance to as many people as possible, and not by anyone who gives a fuck about the bottom line. so a soft, reliable annual subsidy (like the post offices) will become the norm. and then, surprise!, the subsidized health insurance will drive out normal private insurers, whether or not the subsidized is actually better. on getting check-ups.... posted by: horsebeater 12:01 8.21.09 .... simpli, i'm 100% the opposite of you. i don't think i've ever gotten the follow-up appointment. i always think to myself "well... how will i know if i'm away for work/or on vacation/or whatever 6 months from now." so i never make the appointment. then i call (like i did last week), and hear that the first appointment i can get is in 6 weeks and i get fucking annoyed and don't make the appointment still and then i tell my wife how I can't stand fucking doctors and their shitty customer service. simpli's dad wants to kill terry schiavo!!!! posted by: horsebeater 11:56 8.21.09 i knew there was something suspect about him from the moment i met him interesting article from wapo posted by: horsebeater 11:56 8.21.09 http://www.washingtonpost.com/wp-dyn/content/article/2009/08/18/AR2009081803449_pf.html (it appears to be from someone on the left, but I can't really tell) and it at least in part answers the 2-3% administrative cost question I was having so much trouble with. 6 things: a response posted by: simplicissimus 00:27 8.21.09 On (1) and (2), I sincerely believe you guys are talking past each other a bit. Both of these statements are true: A. The best care in the world is found in the US. B. Americans do not enjoy the same access to quality health care as other citizens in other countries. At some point, this is just another left-right argument regarding whether a base level of X resource should be available to all at the possible expense of a higher level of X resource being available to some. There is more than enough data to back either point: the question is one of priorities, and that ain't ever going to be resolved. It's complicated in my opinion by the fact that the US provides an overwhelming amount of new drugs/new procedures, etc. that the rest of the world basically gets subsidized. And if you fuck with that structure, you are potentially fucking with medical advancement. (3) I don't buy the "wait time" argument re: preventative care. The wait time at my dentist could be 5 months and 29 days or it could be 1 day -- it makes no difference to me: everytime I go, I get a date 6 months in advance for my next appointment. This is far from a convincing argument when it comes to preventative care. Additionally -- READ THE FUCKING LINKS, MAN (I kid, I kid because I love) -- the wait times were for 5 *specialties*, not for seeing a primary care physician. I get the point about Massachusetts (oh, Romney, what did you do?), but the USA Today article is about what you expect from USA Today - pretty poorly written and sort of non-sense: what does wait time for specialists have to do with not enough primary care physicians (which is likely true, but...)? As a side note, and, this is crucial, why the fuck are we talking about Canada (or, in case it comes up Britain)? Britain is a pure single payer -- the government runs health care - employing doctors, nurses, etc. Canada's health care providers are self-employed, but all bills are paid by the government. Neither of these things are remotely close to what the dems are proposing -- the closest the plan is likely to get is to Switzerland. http://www.nytimes.com/2009/08/17/opinion/17krugman.html (4) I get that the right really dislikes the idea of government. I get the the left really likes the idea of government. I could write some screed -- and started to -- about how their are good people attempting (and succeeding) at achieving good things in government. But that's not going to convince anyone of anything. Suffice to say that the right's insistence that Bush should be lauded because his *government apparatus* was so capable and effective at keeping us safe from another terrorist attack, while at the same time thinking government is incapable of doing anything ... well, it burns. And it makes no god-damned sense. I'll take one or the other, but how the hell -- and the number of examples I could cite are endless -- can government be so powerful and effective and so bumbling and awful? (5) No argument here. I'm not sure how he got here, but Bushian is dead solid right. (6) Sigh. This really goes back to (1) and (2). I watch this and think it's unacceptable. It doesn't make me a better or more moral or more saintly person. It's informed by my world view, and that ain't going to change. http://www.youtube.com/watch?v=t9JmEHsCv4c ----- I am now pretty sure of one thing, though: both sides' arguments are incoherent. The right can't come out and say what it means: that all the horror stories about socialized medicine (of any kind, in any country) are only relevant here if there's a public option and it's SO EFFECTIVE it will kill private insurance. You know how that will happen? Because the public option will be cheaper and as good (or better) than private insurance. If there's a public option and it sucks, none of this talk about the health care end times makes any fucking sense. The left can't come out and say what it means: the glorious benefits of the publi option will by definition result in canadian-style health care - the government will crowd out the private insurers and they will shrivel up and die. Isn't this the point of both sides' current positions? I know there are nuances but am I missing something? The right may claim that a public option will allow many employers to shovel their workers onto the government plan. The left may claim that private insurance will always be available to those willing to pay for it. But there are a shit load of things between A and Z such that either argument relies on a lot of guesswork, a long time's worth of changes, etc. And I'm sorry, hb, I've looked again and again and again - Medicare is a pretty good program and those numbers (re: administrative costs and dollars spent on healthcare and overall costs) are right. --- Talk to any doctor -- or at least my pop, who has concerns about the dems' plan and thinks the republicans' failure to acknowledge a crisis that is just going to get larger -- and they'll tell you: we cut off the end of life care, the millions it costs to keep somebody on a ventilator, let alone other life-support measures for a span of 2 months (his estimate) and things would be pretty much work out for everyone just fine. and -- according to him -- until this country realizes that spending a huge percentage of health care costs of people that are never, ever, ever going to leave the hospital again (during their 2-3 months of miserable and often unconscious "life"), the ballooning costs really not going away. 6 things... posted by: horsebeater 18:18 8.20.09 ... (1) Because most people with health insurance in this country tend to have pretty good health insurance (we have little tolerance for shitty insurance), and because most of the middle class is covered, the argument that we have a good health system for the super-rich and a lousy one for the middle class is the knee jerk lib reaction to everything (we're screwing the middle class) and is pretty obviously wrong if you give it any thought, spacehippie. Various members of my very middle class extended family regularly make the 1-hour trek into the Cleveland Clinic and get very good care there. The idea that if you were middle class with insurance and got sick with a disease and would want to live anywhere but the U.S.... I'm just not buying it. (2) If the U.S. plainly has the best research institutions in the world (through our university system), and has the most important drug companies in the world working here, and has a bigger GDP than almost anyone else, and we spend a higher % of GDP on health care, why would ANYONE challenge the fact that our health care system is the best? You would have to believe that we piss away a TON of advantages we get from the above to believe we're not the best. I'm just not seeing it. (3) Everyone likes to say "preventative care / preventative care / preventative care." But if there is one thing that stops people from doing the annual check-up, it's not being able to get a convenient appointment. and countries with socialized medicine do poorly in that regard. Spacehippie: re your USA Today link. They note that Boston has DOUBLE the wait time of everyone else, and they surmise it is due to the 2006 bill they passed requiring everyone to get health insurance. So you've basically proven the point that health care reform is going to cause longer wait times. And the brush aside argument ("If someone needed to be seen quickly in Canada, I'm sure they would be..."). Whatever. Read the fucking links, man. (4) If the government can't pass out $600 stimulus checks in less than 4 months and can't get cash for clunkers checks to car dealers, why do we think it's competent enough to run healthcare? And I'm not buying the Medicare argument. There's something badly fucked up about those numbers. (5) The fact that the entire left has turned to "let's go after some of the kooks on the right" instead of actually explaining the fucking health care plan on the table is just sad. Does ANYONE understand what the plan on the table is anymore? the failure of leadership is, shall I say, Bush-esque. The GOP made the argument that you were voting for Obama in the voting booth, but you were getting President Pelosi. I didn't fully believe that argument in 2008, but I gotta say it's a lot more true than I ever thought it was going to be. (6) At the end of the day, I always remember that we don't really have 40 million people without access to health care. What we have is 40 million people that have to go to free clinics or public-owned hospitals or emergency rooms for healthcare. In Cuyahoga county, a family of 4 gets free or significantly subsidized care if they earn under $88K/year That's less than ideal, but it's not the tragedy some try to portray it as. republicans loved "death panels" in 2003... posted by: simplicissimus 01:40 8.14.09 ...or at least they didn't signify the onset of nazism, fascism, and the end of the republic. http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/ this isn't surprising. and it's all one big game, i know. there's hypocrisy enough to go around (the dems are perfectly capable of scaring the hell out of senior citizens for political advantage when it comes to something that wasn't going to effect them, like, say, privitization of social security). but -- still -- you'd think the dems, not a time reporter, would be prepared for this kind of nonsense. sigh posted by: simplicissimus 11:07 8.11.09 like everyone else, the entire subject of health care at this point brings me a feeling of fear and dread. especially the shots of the crazy bitters at these town halls just going nuts for no apparent reason. but this -- this -- is just too good: investors business daily's editorial page cites steven hawking as the type of sick person who would "never have a chance" of living if he was under the british health care system. all fine and good, save for the fact that hawking was BORN and LIVES in england. http://voices.washingtonpost.com/ezra-klein/2009/08/how_stehpen_hawking_proves_tha.html (and i won't even get into sarah palin's son trig, whom she claims would be killed under obama's health care plan. in addition to being total nonsense, one has to wonder and just what sort of financial / health care fantasy land palin thinks that a normal middle class family with a down syndrome kid lives in, but whatever ...) links in parentheses posted by: publius 09:46 7.17.09 you can do it, just make sure to put a space between the end of the url and paren...it's a little glitch that i've never motivated to fix.... A quote from "Sicko" posted by: spacehippie 23:01 7.16.09 Yes, I realize I'm treading back into Coulter-esque territory here, but the quote is not from Michael Moore, and I just like it. An employee of a health insurance company who's job it was to find any possible way for his company not to pay a claim after a procedure had been approved said something along the lines of (and I'm paraphrasing), "This country's system does not 'let people slip through the cracks'. It creates the cracks, makes them bigger, and then sweeps the people into them." Still not buying it. posted by: spacehippie 22:52 7.16.09 First off, I need to stop putting my URL's in parentheses, tentfort apparently no likey: http://www.who.int/whosis/en/index.html From there, I clicked on the "Mortality and burden of disease" link, created a table with all of the different indicators, downloaded the data as a .csv file, and then opened that file with Excel. That allowed me to sort each column relating to the particular indicator to obtain each country's rank. Regarding some of your other points: -If there was a surgeon or procedure that was only available in Canada/Norway/wherever, you bet your sweet bippy I would get myself there. Not necessarily because they have a better system as a whole, but because it would be the best choice for my particular situation. And that's the same case with the Canadian MP you mention - he didn't come to the US because our "health care" was the best in the world, or even better than Canada's, he came for a particular procedure. -Wait times - Please, this ain't McDonalds we're talking about. If someone needed to be seen quickly in Canada, I'm pretty sure they would be. And it's not like we're all that great here: http://www.usatoday.com/news/health/2009-06-03-waittimes_N.htm?csp=34 -Moms delivering in the US - Transferring patients to other hospitals is nothing new. It happens all the time, for any number of reasons, and it takes place everywhere. These women were transferred less than two hundred miles. People are transferred within the US over far greater distances. The fact that the transfer happened across an international border is not even newsworthy, let alone a condemnation of the entire Canadian system. -Wealthy Arabs - it's not like the US has a lock on medical tourism. If that's going to be your metric, then the edge should go to Singapore, who saw 410,000 people travel there in 2006 alone, solely for their health care. Including many Americans, for whom "the biggest motivation is the cost savings for high quality health care, as patients can receive US standard health care from JCIaccredited health care facilities and internationally known doctors at a fifth of the price back home or less." Plus, your super-rich Arab example begs the question, for whom is our health care the best? While I might agree with the assertion that it's the best for upper class/rich folks, there's no way that it's the best for the middle class. Those are the folks that aren't rich enough to afford the stuff that the sheiks and their chartered planes can, but they're not poor enough to get any kind of assistance. For most people, including the middle class, the best health care focuses on basic, affordable/free, PREVENTATIVE care, which our system does not. ---- In the end, this discussion could go on and on, with each of us briging up examples as to why we think the US system is the best, or why that's not the case. The issue has gotten so complex that even the WHO, who are probably far more equipped to make that judgement than any of us, stopped ranking countries because of the complexity of the task. The last time they did that was in 2000. I'd say for your claim (somewhat supported by simpli) that we have the best health care for any significant portion of our population to hold any water, you'd expect to see the US in the top 10, or even top 25 on the WHO's list: http://www.photius.com/rankings/healthranks.html We come in at 37th, with the usual suspects from the other lists ahead of us. Moreover, if you dig a little deeper - http://www.photius.com/rankings/world_health_systems.html - when it comes to "level of health", we rank 72nd. Still think we've got the best health care? Fine. I sure don't. There is of course, one list where we rank near the top: http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html (A slightly different illustration of the costs from the per capita perspective, but the same results. And I don't think it's just us being genetically inferior and eating shitty foods that's causing this.) average health care waiting times in canada posted by: horsebeater 16:46 7.16.09 http://www.waittimealliance.ca/June2009/Report-card-June2009_e.pdf Check out page 7. If you get cancer, you only have to wait 45 days for the radiation therapy. ack! and, mrbuckles... posted by: horsebeater 16:37 7.16.09 .... if the arabs aren't going to norway/england/sweden, the asymmetric argument does work on some level. buckle me this posted by: horsebeater 16:34 7.16.09 Canadian Liberal MP travels to US for healthcare: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070914/belinda_Stronach_070914/20070914?hub=TopStories In 2007, 5 Canadian women in a month were sent to Seattle to give birth because Canada couldn't handle it: http://www.komonews.com/news/10216201.html I could go on... boom.... posted by: simplicissimus 16:01 7.16.09 this is very, very bad (or good, depending on what you think): http://blogs.abcnews.com/thenote/2009/07/cbo-sees-no-federal-cost-savings-in-dem-health-plans.html as discussed below... posted by: simplicissimus 13:51 7.16.09 http://www.google.com/search?sourceid=gmail&rls=gm&q=france%20health%20care%20system so much to say on this... posted by: simplicissimus 13:44 7.16.09 i think spacehippie/hb are demonstrating what is ultimately the real philosophical dividing line between right and left. which is pretty funny. neither side is disputing the facts. one says (correctly) we have the best healthcare for a large number of people and the other says (correctly) we have pretty poor health care for all people. -- though i have to add that we're paying 50% more than anywhere else per capita, so i'm not sure we're getting such a great bargain even if it is the best -- so the only question left is this: is it possible (and let's not talk in theory, let's recognize the political process for what it is) that a public option could exist without impacting those who are happy with their current insurance? i'm not sure -- at all -- the answer is yes. a public option is either going to suck or it's going to be good. if it sucks it's probably a wash. but if it's good, it is going to grow bigger and bigger and bigger. which means it's going to exert more and more competitive pressure on the private insurers to match what it does. however, at a certain point it could easily create a situation where private insurance is just not feasible. and, boom, we have de facto national health care. which, by definition, will be worse for many americans than what they have now (and a lot better for many americans than what they have now). now, i'm pretty sure that france has a "blended" system, but i'm not positive. so maybe the next step is to see if this mix exists elsewhere and what the situation looks like. The asymmetric argument posted by: mrbuckles 13:42 7.16.09 You can't say "who would go to canada/norway/england" and then follow it up with "arabs come here". Either make the point that Canadians, Norwegians and Brits are filling up the lobby of the Cleveland Clinic, or concede that the degrees between our health care and theirs isn't enough (in either direction) to warrant the trip. also... posted by: horsebeater 12:49 7.16.09 ... link to WHO site is broken. if you are middle class or upper class or rich... posted by: horsebeater 12:48 7.16.09 ... and you're not in the bottom quartile, we have the best health care in the world. our system lets some fall through the cracks (and our system lets a lot of people voluntarily choose to dangle themselves over the cracks if they see fit, increasing the risk that they fall through). so we're not going to top the charts on 27 measures of mortality relating to pregnant ladies in the current system. ******** but who on the fort, given insurance and a diagnosis of any disease, would even think "well... I better get myself to [canada/norway/england/insert country here] because they have the best care." On the flip side, arab countries practically have a fucking regular charter flight from the arabian peninsula to the cleveland clinic. you want top notch care, you come here. Best health care in the world? posted by: spacehippie 02:29 7.16.09 In the US? Really? How can there NOT be a serious question about that? First, you need to define how you determine our health care to be "the best". While it's true that life expectancy doesn't completely measure the quality of health care, it certainly is a factor in determining it. And the fact that the US sits at #45, regardless of other factors, does not speak highly of our system. (Way to cherry pick Puerto Rico, by the way. I'd say you could make a significant argument that most countries ahead of the US on that list have better health care than us. You also left out the fact that nearly all of those countries have universal health care, but we can get to that later...) This pattern shows up over and over, especially in mortatlity rates, which are a very good measure of health care. I downloaded stats for every country in the World Health Organization's database (http://www.who.int/research/en/). Here's how the US ranks in the following areas: -Adult mortality rate (dying between 15 to 60 years): 43rd -Infant mortality: 39th -Maternal mortality: 35th -Neonatal mortality: 34th -Under 5 mortality: 29th -Years of life lost to communicable diseases: 41st Again and again, the same countries come in on top of the US, almost all of them with some form of universal health care. I don't know how you can look at these figures and claim that we have the best health care. I'll agree that some of the greatest advances in medical research, technologies, and surgical procedures in the world are discovered/produced here, but that's not a complete measure of health care either. I should add that most of those advances have been taxpayer-funded, too. But here's the bigger point - even if you want to say the US has the best health care by whatever metric you choose, it doesn't mean jack to the 15 or so percent of our population that has no access to it. As far as they're concerned, our health care resembles Swaziland more than it does Andorra. there's tons of stuff.... posted by: simplicissimus 16:56 7.15.09 (and i've spent way too much time trying to get a fully-credible link) here's the 2003 NE Journal of MEdicine study that started it all is here (I'm not sure where Krugman got his Medicare/Advantage numbers but they are identical to these findings ... I think): http://www.pnhp.org/publications/nejmadmin.pdf (Krugman, however, points out that another 6 cents/dollar goes toward profit, which is how he got to 17%) there seems to be a burgeoning cottage industry among stat heads supporting / debunking these numbers (or, actually, whether they mean what they seem to mean). i'm willing to accept that the difference may not be 17% to 3%, but given what i've read (and the potter video, which is the first link i posted) thus far, i think it's a pretty solid claim that there's a huge gap between private/government administrative expenses. well.... posted by: publius 16:34 7.15.09 i'm not a huge krugman fan, but comparing a guy who won the nobel prize in economics to a woman who's main achievement is.....well....being ann coulter.... that's a touch silly... the per capita argument has never swayed me... posted by: horsebeater 16:11 7.15.09 The U.S. has the best health care in the world. I don't think there can be a serious question about that, really. Certainly health services can impact life expectancy, but I believe that people live longer in denmark and other countries is because of a combination of health care along with genetics, cultural eating habits, etc. http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy Check the above link out. Do you think Puerto Rico has better health care than the continental U.S.? It has a better life expectancy. ******** i'll start believing krugman links when you start believing ann coulter links. you have anything from someone other than krugman? more facts... posted by: simplicissimus 11:40 7.15.09 i'm really not staking a position here. i've moved more to the right (well, the center) as a result of my job. not because my governing philosophy has changed, but because i realize how much vigilence is required when it comes to bright shiny ideas from the government. that said, here are the "administrative cost" numbers (the amount of cents per dollar that go to overhead/profit) from krugman, who wisely compare Medicare to "Medicare Advantage", which is set up for private insurance companies to provide Medicare services: Medicare: 98 cents on the dollar for health care (2% for administrative costs) Medicare Advantage: 83 cents on the dollar for health care (@17% for administrative costs and profit) http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/ These numbers (as he points out) refute the argument that Medicare has all sorts of administrative costs taken care of by the DOJ or Congress, etc. because Medicare/Medicare Advantage are the exact same thing - the exact same population getting the exact same treatment in the exact same manner. The only difference is who is covering it. Additionally, here is a per capita health care spending breakdown ... and recognize that all of these countries have better life expectency and infant mortality numbers: United States: $5711 Denmark: $2743 France: $3048 Germany: $2983 Italy: $2314 Japan: $2249 United Kingdom: $2317 And yet we're paying double for it. doesn't this statement you make posted by: horsebeater 10:40 7.15.09 "the fact that i'm probably more comfortable with a government bureaucrat in charge of health care decisions (a gross exaggeration of the right, but one i'll run with) than i am with a for-profit bureaucrat doing the same. one is a bureaucrat will no skin in the game, the other is a bureaucrat who has a personal stake in denying as much care as is possible." doesn't this mean that you're admitting that public insurance will cover more (and spend more) than private? ****** the real problem with the "public option" is that the feds are going to subsidize it in some form. if it covers more, everyone is going to then choose it. Employers will choose it to get the subsidy; employees because it is gold plated. And you end up with de facto single payer. george will from a month ago: http://www.washingtonpost.com/wp-dyn/content/article/2009/06/19/AR2009061902334.html ****** so what's wrong with single payor? If you believe the 95-97% medicare / 80% private insurance figures are correct, hell, maybe it's ok. But those numbers are a joke. But there is no fucking way in hell I buy those numbers. ultimately, single payer is going to be more expensive for the exact reason simpli notes in what I quote above. no one will be minding the store and trying to get doctors to not just order every test in the book. (that's not a value judgment on whether a more expensive single-payer is better or worse than the current system) ****** I've said forever (and sullivan notes this) that the # 1 way to make health insurance more affordable is and has always been to create a middle class of health professional between doctor and nurse. The sacrifices people make to become doctors personally scared me away (after thinking I was pre-med and taking my mcats, at the end of my junior year i realized i didn't want to kiss my 20's goodbye and didn't bother applying to med schools) and it scared away my sister (who dropped out of med school after her first quarter). once doctors get through all that shit at age 30 or 31 or 32 or 33, they want to get paid for their sacrifice. I've never understood why someone couldn't take a 6 year BA/Masters course (instead of 4 years at college) and be expert at all kinds of basic doctor shit. a pretty good summary of questions/issues... posted by: simplicissimus 00:01 7.15.09 http://andrewsullivan.theatlantic.com/the_daily_dish/2009/07/sundry-thoughts-on-health-care.html as far as i can tell, the big objections to "public option" are as follows: (1) it is unwise and unwarranted to give the government more power and authority over americans through a "public option". this is generally based upon the idea that government programs are bloated and wasteful or that the government will ultimately end of abusing the power; (2) the public option is going to really fuck with the free market system and is merely the first step toward a situation where the government has complete control over health care. (3) whatever the "public option" provides is going to become the industry standard, which would result in all sorts of market inefficiencies and could possibly result in a lot of unintended consequences. i think these are all legitimate concerns. however, if it is true (based on medicare) that a government program would likely provide more at lower cost (because somewhere between 95 and 97 cents of every dollar would go toward health care, while private insurance is somewhere around 80 cents of every dollar towards health care), it's easy to see why a public option is an attractive thing. additional factors in my opinion are: the fact that there is no real free market when it comes to health care. you get what your company gives you and that's that. surely a company is free to choose its plan, but the number of americans who are free to choose jobs on the basis of health care plans is very, very small. the number of people who simply can't leave their jobs for another, let alone strike out on their own, because health care is prohibitively expensive. the amount of money companies are spending on health care when compared with basically the rest of the developed world, which is nearly universally provided government care of some sort. the fact that i'm probably more comfortable with a government bureaucrat in charge of health care decisions (a gross exaggeration of the right, but one i'll run with) than i am with a for-profit bureaucrat doing the same. one is a bureaucrat will no skin in the game, the other is a bureaucrat who has a personal stake in denying as much care as is possible. ---- and i'll add a personal story. some of you know that a buddy of mine's wife committed suicide last month. a terrible, terrible story. i'm just now learning what a struggle it was for them -- both free lance creative types -- to get care for her mental health. i won't go into details, but it was an ugly situation. i can't blame it for her ultimate death, but i can say that at the very least it really, really made their lives difficult. and that really sucks. ---- i suppose the ultimate question is where the money is going to come from. it's hard to imagine -- given the amount of money americans currently spend on health care (just look at your premiums and consider how much your employer is kicking in) that there's a way that's damn close to cost-neutral to do this thing. and if that's the case, free market be damned, i just can't see why making health insurance available to everyone if they want/need it, is such a terrible idea. ...how has this not been discussed posted by: simplicissimus 21:25 7.11.09 probably the last place anyone wants to start, but check out this bill moyers piece -- it's @40 minutes -- with the former head of public relations for CIGNA. i have been a fence-sitter on the single payor thing, and remain so. but this is some serious food for thought: http://www.pbs.org/moyers/journal/07102009/watch2.html as for the bigger issue right now -- the "public option" (where people had the choice to join a government health insurance pool) -- it's really interesting. here is some pro- and con- discussion of the public option. check it out. http://www.prospect.org/cs/articles?article=the_public_option_and_the_hope_of_health_care_reform http://online.wsj.com/article/SB124528251402125409.html http://online.wsj.com/article/SB124709618142215031.html it does seem to me that the issue is one of the dems' beautiful charts and graphs versus the republicans' horror stories about pork and government spending. and the funny thing is, both may be right.