Real Changes in US Healthcare (Euro members please share your opinions)
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rob_gould
Well-known member
DaveP said:
I think this is the thing that baffles me the most about US politics in general, and especially with the health care debate.
The staunchest adversaries to Obama's health plans, the far right wing Tea Party, are the ones who are quickest to quote and claim Christian values when it suits them.
There's lots to delve into with the above statement, and I don't plan to go anywhere near any of that as it is so divisive.
But, what I do struggle with is the hypocrisy (I can't think of a lighter / nicer term) of the fact that as I understand it Republican values are meant to have christian commitments at their heart, but these people seem to be utterly unwilling to be a good neighbour, never mind a good samaritan when it comes to sharing their means with their fellow man who might be suffering.
Be nasty, or be nice! You have to pick one...
There are plenty of each kind of person in the world, but this very right wing ' but we have God on our side' attitude very much seems like having your cake and eating it to me. Compassion and greed are mutually exclusive as far as I am concerned.
Anyone Stateside please correct me - as I say, this is just my uninformed impression of things...
Gold said:
Perhaps you can explain how it disagrees? My understanding the Hippo oath means the Dr will act in the best interest of the patient to the best of his ability. Denying the patient an unnecessary test that he or she asked for merely because they saw it on TV or whatever, is still operating in the patient's best interest because it is saving him and us all money. Certainly not doing any harm, if the DRs judgement that the test is not needed can be trusted.
While I didn't paraphrase the entire article, the example given was that the patient wanted some test because a relative just had one. In a world with zero cost consideration the DR is inclined to give the patient anything and everything they ask for that won't actually harm them. If they patient wants to spend their own money, test away.
There is an active debate in the medical community about the true benefit of of some cancer testing. Again I won't repeat the full arguments for and against, only to state that there is an active debate, and it not just about cost. False positives and some very slow advancing cancers. like some variants of prostate cancer are not worth the stress the tests generate.
What exactly did you see as a conflict?
JR
the real deal said:
and more modern versions http://nktiuro.tripod.com/hippocra.htm
JohnRoberts said:
Maybe I misunderstood you. I thought you were saying it should be up to the patient to decide whether they want a test if they can pay for it. The hippocratic oath says "do no harm". By allowing the patient to make that decision they take on all the risks of an unnecessary medical procedure.
Which healthcare debate are you talking about? Some sound bites you get on the Beeb?rob_gould said:
There are many valid disagreements, and even more false characterizations of both sides positions.
say amen, brother,.. :
: are you serious? Then why bring it up?
Actually statistical research doesn't show much difference in charitable giving based on political affiliation, Despite a popular argument by Brooks that says conservatives are actually more charitable. Close inspection shows Brooks screed doesn't hold water, but there is higher charitable giving by religious vs secular members of both political suasions.
I would note that supporting government giving is not the same as personal charity, since the government is giving away OPM typically taken from taxpayers or borrowed.
It's nice to be nice... I used to know a (huge) bar bouncer who always said that, just before giving you that choice about how to behave.
If there was a god, he or she could just heal everybody and be done with it. I have little respect for either political extreme, and equally derogatory characterizations can be made about the far left.
We are a centrist nation and need to get back to centrist policy. When you're in the the left ditch, stop turning left.
Always glad to try... but I suspect opinions will still vary.
JR
Gold said:
Sorry if I wasn't clear, it seems I have been making the same argument here for a couple years.
Doctors need to make medical decisions and offer viable options "but" the patient needs to be involved in the cost consequence of these decisions.
The classic example is use of a generic drug vs a name brand drug. How many people spending their own money want to pay several times more for the same equivalent medicine?
=======
OK I'll save you all the time of searching for the flaw in either my argument, or the other side's. Is there enough money in the world, to give everybody in the world unlimited "cost no object" health care from cradle to grave including all extraordinary end of life procedures, and every experimental cancer treatment that comes down the road?
My view point is hell no, not by a long shot. So how do we decide how to match the limited resources, to the much too large to service demand? I plan to die when I run out money, which is why i should be working more and posting here less. Of course if you think we can get all the money we need by taxing a few millionaires, then I understand your position.
We will not determine that, here and now, and what I think doesn't really matter. (even though it does to me) IMO THE MOST IMPORTANT THING, no matter which approach we end up with is that we reduce the cost of health care delivery. The government approach to reducing healthcare costs, is typically to just cut what they budget to pay for it, and expect it to magically work out, "see that's what the legislation says". They balanced obamacare by not funding medicare. the shortfall was added back in the recent house version of the "jobs" legislation that obama is threatening to veto, but it's a little more complicated than that (damn politicians).
The only way I know to stimulate innovation and invention in healthcare to improve results and reduce costs, is by getting more not less free market forces involved.
This is a technical website, (mostly) talking about technical stuff... maybe we could focus on the technical aspects of healthcare,,, not whether I'm a religious wingnut, or a hypocrite, and admittedly economics which a lot os my arguments are based on is not a science as much as another belief system, steered by experience.
I think theres a lot of potential for computers and expert systems to improve outcomes once we get all records in a standardized format and single database, but what would I know?.
JR
PS: Another example of the government trying to make something happen by legislative fiat, when reality is not so accommodating, is the legislation to promote cellulosic ethanol. (remember that?). The government (bush) set up huge support incentives, and even mandates about how much the big oil companies must use, or pay penalties. The ugly truth is the cellulosic industry can't deliver but a small fraction of amount legislated, so we have the oil companies paying fines because they aren't using cellulosic ethanol, they can't find... ate least they could buy sugar cane ethanol from Brazil. Of course guess who pays for all this nonsense....... yup, you and me... Government is not smarter than the citizens, certainly not our government.
living sounds
Well-known member
JohnRoberts said:
Charity has a lot do with tax returns. Also, a recent study in the US has shown that people falling on hard times become significantly less religious and stay that way. Based on this one might deduce that those who are well off simply can give more (and have more of a tax incentive) and are also simply more religous because of their financial well-being.
But it's a distraction anyway, there should be no need for charity in a well organized system. In the case of Africa there is a growing number of voices claiming all the foreign aid is actually harmfull to economic development, and what would really be needed is fair access to the global market...
We've heard here much debate on how to save US Healthcare. Some solutions are obvious and others more dubious. I'm not sure we are qualified to pronounce on the effectiveness of these measures. But for ANY of these measures to even get to the starting line, someone in power must want the final result; lower cost to the nation and a fairer deal for the poor.
Both the US and Oz will vote next year. If something is important to us, we need to vote in governments who also think it important. It is now very clear what the various parties in both countries consider important and what they will sacrifice on the altar of political expediency. Just see what each politician does, what he votes for now.
I'm not sure why their souls and loyalties have been laid so open these last few years. Perhaps I'm just beginning to see. Or perhaps the issues have become more important.
Adam Smith's "Wealth of Nations" is the foundation of all modern economic theory. But in his time, he was more famous for "The Theory of Moral Sentiments".
Here he suggests that the person who cannot empathise, who does not sympathise with the poor and disadvantaged, is also incapable of morality.
Like all classic texts, both are often misquoted by those who have not read the originals, to support their own agenda. eg Baroness Thatcher.
The originals are astounding in their relevance to modern times. eg Smith discusses what should be the province of government and what should be left to the free market. Both deal with far more and in a more sophisticated manner than what the proponents of laissez-faire imply.
While the unwashed masses (us) may not be experts on how to solve US Healthcare, we SHOULD be experts in figuring out who wants to do this.
May both the US & Oz vote in moral & competent leaders as opposed to politicians.
Both the US and Oz will vote next year. If something is important to us, we need to vote in governments who also think it important. It is now very clear what the various parties in both countries consider important and what they will sacrifice on the altar of political expediency. Just see what each politician does, what he votes for now.
I'm not sure why their souls and loyalties have been laid so open these last few years. Perhaps I'm just beginning to see. Or perhaps the issues have become more important.
Adam Smith's "Wealth of Nations" is the foundation of all modern economic theory. But in his time, he was more famous for "The Theory of Moral Sentiments".
Here he suggests that the person who cannot empathise, who does not sympathise with the poor and disadvantaged, is also incapable of morality.
Like all classic texts, both are often misquoted by those who have not read the originals, to support their own agenda. eg Baroness Thatcher.
The originals are astounding in their relevance to modern times. eg Smith discusses what should be the province of government and what should be left to the free market. Both deal with far more and in a more sophisticated manner than what the proponents of laissez-faire imply.
While the unwashed masses (us) may not be experts on how to solve US Healthcare, we SHOULD be experts in figuring out who wants to do this.
May both the US & Oz vote in moral & competent leaders as opposed to politicians.
All details aside for a moment in view of big picture -
If UK, Germany, Thailand, Canada and any other non US country can support a system that provides quality affordable healthcare to it's citizens then so can the US IMO.
If we need a plan to follow, that's how many other countries to look to for a model? It's not like another workable system doesn't exist - we're not looking at treading into totally uncharted territory here.
How about examining the reasons why the US may not be able or willing to adopt UHC as practiced elsewhere. Are they all practical and rational?
**Getting tangled in the minutiae of short term fallouts and obstacles would be a distraction IMO, and does not give sound reason to why UHC as practiced outside US will not work in the long term stateside. But I suspect we will have to endure.
Empirical trumps theoretical IMHO. Nothing to really do but speculate until the US makes a commitment to adopt a new system.
If UK, Germany, Thailand, Canada and any other non US country can support a system that provides quality affordable healthcare to it's citizens then so can the US IMO.
If we need a plan to follow, that's how many other countries to look to for a model? It's not like another workable system doesn't exist - we're not looking at treading into totally uncharted territory here.
How about examining the reasons why the US may not be able or willing to adopt UHC as practiced elsewhere. Are they all practical and rational?
**Getting tangled in the minutiae of short term fallouts and obstacles would be a distraction IMO, and does not give sound reason to why UHC as practiced outside US will not work in the long term stateside. But I suspect we will have to endure.
Empirical trumps theoretical IMHO. Nothing to really do but speculate until the US makes a commitment to adopt a new system.
Kingston
Well-known member
JohnRoberts said:
Here's a great example of how Finland is even today improving on this aspect of patient/doctor relationship through legislation. It is currently mandatory by law for the pharmacy's to offer the cheapest alternative to brand name drug if there is one available. The most important detail: this applies to all prescription medicine and they must do this on all customer transactions. It was implemented only several years back even I bumped into this already and thought it was pretty cool.
Critics will now say "but it stifles innovation and competition". It doesn't, because it only applies to medicine where patents have expired - at least in this country! Implementing this law actually caused the most severe diplomatic dispute between Finland and US for decades. It was worse than when we were criticising US/Irak situation. Just goes to show the core level thinking differences we have in implementing health care policies. There were several massive US big pharmas threatening with financial embargoes. Note, not the United States Government, but actual corporations. They simply used the government as a puppet, the courier of the message. I guess they are not used to not being able to dictate their own policies.
I also find that having to involve patients in the cost consequences of treatments is a major systems failure. Sure, the doctor is still able to make the right decisions for the patient, but in reality he is now severely handicapped. The cost factor should be eliminated entirely from doctor/patient relationship. Enter socialist health care, and unlimited wallet for the doctor to dig in for the right treatments. When I say unlimited I mean we actually happily raise taxes before even thinking about damaging this system. Well, in reality it means some small schools will be shut down and outback libraries closed, perhaps a strike organised by the union of nurses who's pays just got cut, but that's roughly how it works. The aforementioned issues stem from county level financial problems when implementing expensive health care policies, but that's the subject of another discussion. Health care is still considered "sacred".
I don't see this ever happening in the US system, in fact even a thought of that probably causes your average republican nightmares. Let alone struggling out of the death grip of big insurance and big pharma.
Law has been passed and is being implemented, with more than few rough edges due to incomplete design.ricardo said:
The poster boy for political expediency is illegal immigration which keeps getting ignored. The administration has reduced immigration mainly with a soft economy.
There has been an awakening among grass roots voters that this is their country to take back. I won't pretend to link all the different high profile political movements together, but it is remarkable to even see public demonstrations in russia against Putin's attempt to finesse term limits there.
I am not very familiar with Oz's gov't but suspect it may have a few similar issues with big business having undue influence. I have heard suggestions (here) from one of the current candidates suggesting term limits as a remedy for the political class becoming too entrenched, but this has already been tried in california, and the result is shifting more power to the unelected political bureaucracy, so not really addressing the problem. These unelected power brokers are the problem.
I haven't read his theory of moral sentiments but I did recently read Wealth of nations and it is a long, and very data intense read, while IMO well worth slogging through. The best analysis of comparative governments I've read (so far) was the Federalist Papers which looked at many of the classic forms of government (while it predates the progressive and socialist movements of the last few centuries). While there is no shortage of suggestions for what is wrong with the US, I find it useful to understand how our government was intended to work, and try to get back to that model, not the crony capitalism we have now with little discernible difference between the two parties.
I will venture to suggest that everybody wants to see healthcare more efficient and more effective. We clearly differ about what is the best path to that end. I am not a big fan of increasing government management and direct government intervention.
Unfortunately the system rarely offers truly great choices, so we usually vote for a lesser evil. The competing campaigns count on this and offer us a long list of evils to turn voters away from wither side. No wonder election turn out is lower here than in some countries where people actually risk their lives to vote. Sad and embarrassing, but if you don't vote you have little right to complain.
JR
Here is a fundamental point of disagreement.. The taxpayer's wallet is not unlimited, digging deeper and deeper into the public wallets, reduces private business activity, reduces growth, and can actually shrink the economy. Raising taxes further to make up for the falling revenue, can shrink the economy even more in a spiral downward. This is an old argument and we will have to agree to disagree since either side can not be easily proved.Kingston said:
I have been researching this for the last few years and almost every socialized health care system in the western world is hit by the same demographic bomb of aging population that reduces tax revenue when they retire and increasing late life heath care costs as we have. I have watched as many nations try to deal with this double pronged problem of increasing costs and declining revenues.
I don't see an easy answer for this, and am suspicious of all who pretend it is trivial.
I don't see what this imaginary slight has to do with the topic, but if it makes you feel better to say it, enjoy. I won't even pretend to care what other nations think about our current politicians. The work to fix it is here, with us, the vote is held here so it's our job to throw the bums out.
JR
the details do matter... IMOlassoharp said:
yup
where have you been as we inspected these sundry systems for the last few years, at least I have and have posted here about them.
Last I checked the law of the land (unless the supreme court overturns it) is headed that way. And only parts of the law are being inspected for constitutionality. (note: I saw a recent argument for why Kagan should recuse herself, when FOI revealed documentation that she was indeed aware of legal strategy in the writing of the legislation. this is mainly political machinations as people expect her to support the legislation.
Empirical is all about the details (minutiae). Not only must we inspect the other systems, but also look at the pressures and trends they are battling or we are just jumping into the same sinking ship. This isn't quite as simple as many would have us believe. Of course we can all hope I'm wrong.
JR
I've been watching this thread with interest as someone who has (unfortunately / fortunately???) had cause to interact quite deeply with the Britsh system (NHS and private) and US health care systems. I've avoided posting for fear that this thread would delve into the usual political position taking, and I would be drawn into a debate I don't particularly have time for.
However there area couple of things that I think need to be mentioned which appear to have not been.
1 The US requires Tort reform to be able to reliably reform health care for less cost.
2 A nationalised health system does not require that everyone receives all care for everything for free (as JR points out there isn't enough money for this to be the case). Any rudimentary study of the NHS will show that the system was conceived, and hopefully still operates largely such that care is given to those most in need and financed by all according to their means. More trivial matters can be taken care of privately for more prompt service if one is able to afford it or has private insurance.
However there area couple of things that I think need to be mentioned which appear to have not been.
1 The US requires Tort reform to be able to reliably reform health care for less cost.
2 A nationalised health system does not require that everyone receives all care for everything for free (as JR points out there isn't enough money for this to be the case). Any rudimentary study of the NHS will show that the system was conceived, and hopefully still operates largely such that care is given to those most in need and financed by all according to their means. More trivial matters can be taken care of privately for more prompt service if one is able to afford it or has private insurance.
+1... tort reform was a key proposal from the minority side of the aisle that only got lip service from the majority, (IIRC Obama said at the time that he would order a study by executive order, yawn), but tort reform was pretty much missing from the final legislation. At the risk of stating the obvious, lawyers are a special interest group with great influence on the party in power when this legislation was written and signed.Strongroom said:
I have been posting in this subject for a few years so this has come up before. It was also mentioned again in the editorial I linked to for Ricardo the other day when he asked for alternatives in this thread.
from the link said:
As long as the government does not crowd out all private activity in the category. I expect we will end up with some hybrid, just like most other western systems are not pure all-public, zero-private. I am still hopeful that a Walmart/Walgreen type private business is allowed to attempt a cost effective chain approach to medical clinics. They have already been instrumental IMO in reducing prescription costs due to price competition. So far I know their past efforts to expand the medical services they can offer have been blocked by the medical establishment that doesn't want to upset the current balance of power. So far the government involvement looks like they are just re-arranging the deck chairs (still mostly single payer just with a different new boss same as the old boss), not actually changing course.
I want to pay for my own healthcare, just a fair price with effective management. Right now i can buy parts and PCBs far more effectively than healthcare, which is the much larger business so should be more efficient not less. I don't see us moving in that direction, but I hope I'm wrong.
JR
PS: I apologize for posting so much in this thread that is literally asking for input from Euro members. I obviously have strong opinions about this and have invested a lot of time into researching this subject over the last few years. I hope my comments do not discourage any posts. I am trying to be nice but factual, as factual as I can be with squishy subjects like economics, and predicting the future that can't be completely fact based.
Obama's health care undertaking was due years ago. People should be a little more appreciative towards all the regulations concerning health care that have been inaugurated so far. I fail to understand how anybody can't get the bigger picture on this matter?
Egregious health care abusers have been a part of our welfare system with our without obamacare. I've honestly expected more change from the democratic party but it is hard to judge considering the mess they were pushed in, left by the Bush administration.
I'm sensitive to premature judging and we def. haven't gotten far enough to second for any alternative available.
Egregious health care abusers have been a part of our welfare system with our without obamacare. I've honestly expected more change from the democratic party but it is hard to judge considering the mess they were pushed in, left by the Bush administration.
I'm sensitive to premature judging and we def. haven't gotten far enough to second for any alternative available.
travis
Well-known member
This is a difficult discussion because everyone has their own interests in mind (me included). Right now I own a small buisness and pay for health care out of pocket with a 7,000 deductable. A little over a year ago I refused surgery on a badly broken wrist because I knew there was no way I could pay for it.
To put things in perspective, how strange would it be if you could not call the police when someone was breaking into your home or threatening you? That is sort of how I see our health care system right now.
I am not concerned with the threat of socialism.....there are many non-socialist countries funtioning very well with equal access health care. What I see is democracy being taken advantage of hardened into a caste system.
To put things in perspective, how strange would it be if you could not call the police when someone was breaking into your home or threatening you? That is sort of how I see our health care system right now.
I am not concerned with the threat of socialism.....there are many non-socialist countries funtioning very well with equal access health care. What I see is democracy being taken advantage of hardened into a caste system.
John, I didn't want to comment on the proposals in the link but tort reform was one of the obvious YES points.JohnRoberts said:
Who were these minority Representatives? We need to know who the Good Guys are. Oz is going the way of the US with law suits starting at $1M and going up. There was talk of Tort reform at our last elections that sunk out of sight as soon as the results were in.
ricardo said:
The minority at the time the health care legislation was drafted were the republicans. I would never in a million years call them the "good guys" while in this case their proposals were less biased in favor of traditional democratic interest groups (lawyers, unions, etc) than what we got. For something as important as this, the legislation should have represented viewpoints from both sides of the aisle, and as much of the population as possible, not rhamed down the throats of roughly one half, by the other 53%.
Nobody denies that health care was broken, I (we) disagree primarily about how to fix it. The problem before was a lack of economic discipline caused by an oligopoly** of large insurance companies with limited competition in their state regulator carved up markets. Replacing that with a government monopoly will not return discipline to the system. Government run, and cost effective solution, do not occur side by side in the same sentence ever, (except perhaps for this one time). A more practical solution would be to open up health insurance to competition across state lines (like car insurance) so competition could be increased not decreased. Of course big insurance hid behind the same commerce clause that may tangle up the obama care mandate.
Once more for the bleachers, I hope I'm wrong. We need change, just change I can believe in too... not what I see so far. In hindsight the republicans were not likely to fix this alone, as their special interest group is business (who seems happy to crony up with either party). I just wish the democrats, weren't so typically left of center with their solution. We are not a left of center nation so they are not really trying to please the actual majority, just their much smaller base.
I can see how people not paying attention to the details could like the vague something for nothing appeal of this, but life is never quite that simple. There are always costs and consequences from any action.
JR
**oligopoly =a monopoly but made up of a small number of sellers who control a market jointly, not just one seller. Kind of like a cartel but less formal and open about what they are doing.
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