[blackshoe]

[quote name='Cthulhu D' timestamp='1384331539' post='764387']
INow, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious.
/quote]
Was a recent new item about a guy who passed out in his bathroom. Ambulance took him to some hospital that didn't recognize his insurance. He woke up several days later and the hospital presented him with a bill for $150,000.

"Dunces" and "ignoramuses" are pejorative. Ignorance, at least, is fixable. Stupid isn't, but that doesn't mean we should hold the stupid in contempt — they can't help being stupid.

And 'there can be no free market in health care' does not lead to the conclusion that the President ought to run the health care system — he's already demonstrated he's not competent to do so.

[ArtK78]

The fact that there is no free market in the health care system means that the health care system should be regulated.

It does not mean that the President runs the health care system. Anyone making that argument (or trying to make points by responding to it) is being ingenuous (I could use a stronger term, but they know who they are).

[Winstonm]

HighLow21, on 2013-November-13, 00:49, said:

Given that revenue began falling due to a long-term debt cycle decline (read: depression or deleveraging), one of the worst possible actions that could have been taken would have been to cut spending. All that would have done is further exacerbate the depression.

Actually, cutting taxes in that scenario is also one of the worst possible ideas, but Republicans still seem to dig it.

See:
http://dealbook.nyti...d-cartoon/?_r=5

Here in the U.S., the two things that can be counted on from the political far right: reasonable ideas (Adam Smith) will be bastardized to fit a small government agenda (i.e., Reaganomics), while ideas that cannot be co-opted into small-government bumper stickers (John Keynes) will be demonized, (i.e., current tea party outcries over debt and spending).

It is the binary thinking process that underlies the ultra-conservative mindset that, IMO, must be overcome before any real progress can be made. I would think that anyone over the age of 10 could see that "free market good/government bad" is a silly, fantasy-based model that has no basis in reality.

Thus far,this is what the "market good" approach has wrought:

Quote

While the US spends more on healthcare than any other developed nation, it also has one of the lowest life expectancies: People living in the US die sooner, get sicker and sustain more injuries than those in other high-income countries.

Compared to 16 other affluent nations, the US has the highest mortality rate, according to a new report titled “US Health in International Perspectives: Shorter Lives, Poorer Health.

[Zelandakh]

What is the comparison after factoring out things that are beyond the scope of the direct healthcare system, such as diet, stress, gun use and violent crime, Winston?

[Winstonm]

Zelandakh, on 2013-November-13, 09:19, said:

What is the comparison after factoring out things that are beyond the scope of the direct healthcare system, such as diet, stress, gun use and violent crime, Winston?

Actually, I don't think that really matters all that much as the ideological conflict crosses all boundaries of discussion - whether discussing the negative effects of tobacco or acid rain or climate change or U.S. healthcare, there is a group of people dedicated to the ideology that government activity is bad and free markets are the ideal solution to every human problem.

If one reads all the threads, the dissenting point of view of taking any action is almost always a small government mindset.

[Zelandakh]

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

[Winstonm]

Zelandakh, on 2013-November-13, 12:05, said:

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

That's why I posted the link to the article - the article is clear that the high mortality rate is not simply poor healthcare but a combination of problems of a type that seems to stem from small-government viewpoints - less regulation is better that leads to no or poor insurance, no gun control, inequality of wealth, etc.

IMO the problem is not simply healthcare but the worldview heralded by Ronald Reagan and his followers.

[kenberg]

For me, it really is not a matter of big gov versus little gov. I don't much trust ideology whether if comes from the left or the right.

Here is my general view:

If I were to choose solely on self-interest, I would say leave things as they are (or rather as they were). it's a mess, but it's a mess I can cope with. Change is not always the same as improvement.

So to the extent that I support the ACA, and I do support it and hope it works, it's because I think that health care for many is really in a shambles. I think there is a limit on my obligations to me fellow man, but the current situation, for a fairly rich country, is an embarrassment.

Now what I want for my support, basically my bottom line demand, is that it be done competently. Maybe that will still happen, I hope so, but we are off to a truly bad start. The Pres signed the ACA into law some three plus years ago, it is widely regarded as his signature accomplishment. I hoped for a better launch. What on Earth were they thinking?

My primary reaction to the way it has gone is one of great sadness. I don't believe that history will judge the Obama presidency favorably.

[ArtK78]

Winstonm, on 2013-November-13, 12:17, said:

That's why I posted the link to the article - the article is clear that the high mortality rate is not simply poor healthcare but a combination of problems of a type that seems to stem from small-government viewpoints - less regulation is better that leads to no or poor insurance, no gun control, inequality of wealth, etc.

IMO the problem is not simply healthcare but the worldview heralded by Ronald Reagan and his followers.

I wholeheartedly agree with this opinion. Ever since "The Great Communicator" served as President, it seems that the mainstream Republican Party has treated his ideas as Gospel (literally, not figuratively) and Reagan as the second coming of the Messiah. The Tea Party represents the fundamentalist sect of the mainstream Republican Party.

[hrothgar]

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.
What have to I gotten? Nada.

I'm a dues paying member of the New World Order.
I want some consideration for my support.

The day you can't trust the Bavarian Illuminati is a sad day indeed.

[HighLow21]

hrothgar, on 2013-November-13, 16:12, said:

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.
What have to I gotten? Nada.

I'm a dues paying member of the New World Order.
I want some consideration for my support.

The day you can't trust the Bavarian Illuminati is a sad day indeed.

I have to remember the phrase "Bavarian Illuminati" for my next social gathering.

-T

[ArtK78]

kenberg, on 2013-November-13, 15:08, said:

For me, it really is not a matter of big gov versus little gov. I don't much trust ideology whether if comes from the left or the right.

Here is my general view:

If I were to choose solely on self-interest, I would say leave things as they are (or rather as they were). it's a mess, but it's a mess I can cope with. Change is not always the same as improvement.

So to the extent that I support the ACA, and I do support it and hope it works, it's because I think that health care for many is really in a shambles. I think there is a limit on my obligations to me fellow man, but the current situation, for a fairly rich country, is an embarrassment.

Now what I want for my support, basically my bottom line demand, is that it be done competently. Maybe that will still happen, I hope so, but we are off to a truly bad start. The Pres signed the ACA into law some three plus years ago, it is widely regarded as his signature accomplishment. I hoped for a better launch. What on Earth were they thinking?

My primary reaction to the way it has gone is one of great sadness. I don't believe that history will judge the Obama presidency favorably.

I disagree.

In time, these hiccoughs will fade from memory, and if the ACA performs as I expect it to in the fullness of time, it will be viewed in the same manner as Medicare and Social Security.

Remember, universal health coverage was a goal of the Clinton administration, and Clinton could not pull it off (one of the few things he could not pull off). Obama succeeded where Clinton failed, and this has earned him vilification from the right. In time, all that will remain will be universal health coverage, and that will be how history will judge the Obama presidency.

[kenberg]

The BBO Forum is a never ending prompt toward knowledge. I looked it up:

The Illuminati (plural of Latin illuminatus, "enlightened") is a name given to several groups, both real and fictitious. Historically the name refers to the Bavarian Illuminati, an Enlightenment-era secret society founded on May 1, 1776 to oppose superstition, prejudice, religious influence over public life, abuses of state power, and to support women's education and gender equality. The Illuminati were outlawed along with other secret societies by the Bavarian government leadership with the encouragement of the Roman Catholic Church, and permanently disbanded in 1785.^[1] In the several years following, the group was vilified by conservative and religious critics who claimed they had regrouped and were responsible for the French Revolution.

I didn't know half this stuff! (Or, any of it, actually, but don't blab.)

[Cthulhu D]

Zelandakh, on 2013-November-13, 12:05, said:

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

Part of it depends how you measure: You can do population health with control for socio economic status, you can do patient satisfaction, and you can do quality of care. Looking at the UK vs the US.

Current evidence suggests that the quality of care in the NHS is of approximately equal quality to the care delivered by the US system (to people who present at GPs etc and have full medical records - so this is giving the US a 'free pass' on the uninsured who present at ERs). There are varying strengths and weaknesses, the NHS is vastly superior at managing chronic illnesses, US cancer treatment tends to be better, both are amazingly awful at treating alcoholism, but overall the quality is about the same. On patient satisfaction, of those that are admitted to hospital or have long term prescriptions the NHS vastly out scores the US (but, but, bizarrely, not with those who just go to the GP and don't have significant medication, though, imho, asking people who don't go to hospital how statisfied with the hospital system they are is dumb, I don't work for the WHO). Population health is less clear cut, and trying to draw conclusions there is difficult. They seem to indicate that the NHS is better, but honestly this is hard to tell.

Of course, while these measures are close (except patient satisfaction where the UK is leaps and bounds ahead), the UK total healthcare spending per capita (including private health insurance and spending) is like a third of US healthcare spending. Which to me suggests the US is getting a bum deal.

blackshoe, on 2013-November-13, 07:22, said:

Cthulhu D, on 2013-November-13, 02:32, said:

INow, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious.

Was a recent new item about a guy who passed out in his bathroom. Ambulance took him to some hospital that didn't recognize his insurance. He woke up several days later and the hospital presented him with a bill for $150,000.

"Dunces" and "ignoramuses" are pejorative. Ignorance, at least, is fixable. Stupid isn't, but that doesn't mean we should hold the stupid in contempt — they can't help being stupid.

And 'there can be no free market in health care' does not lead to the conclusion that the President ought to run the health care system — he's already demonstrated he's not competent to do so.

Amusingly this is something Adam Smith got wrong - he thought that could never happened because of basic human decency hahaha. Anyway, this is a market failure and the only solution in the case of market failures is government intervention. It has been shown time and time again that in the case of healthcare the most efficient and effective form is a single payer system ala the French, Canada or the NHS. Pick how much you want to pay and go with that.

[mycroft]

hrothgar, on 2013-November-13, 16:12, said:

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.
What have I gotten? Nada.

Just a reminder to all the parents out there. Let’s talk about safety when taking your children out to play in the Scrub Lands and the Sand Wastes. You need to give them plenty of water, make sure there’s a shade tree in the area, and keep an eye on the helicopter colours. Are the unmarked helicopters circling the area black? Probably World Government. Not a good area for play that day. Are they blue? That’s the Sheriff’s Secret Police. They’ll keep a good eye on your kids, and hardly ever take one. Are they painted with complex murals depicting birds of prey diving? No one knows what those helicopters are, or what they want. Do not play in the area. Return to your home, and lock the doors until a Sheriff’s Secret Policeman leaves a carnation on your porch to indicate that the danger has passed. Cover your ears to blot out the screams.

-- Welcome to Night Vale, Ep. 1

[blackshoe]

ArtK78, on 2013-November-13, 08:04, said:

The fact that there is no free market in the health care system means that the health care system should be regulated.

It does not mean that the President runs the health care system. Anyone making that argument (or trying to make points by responding to it) is being ingenuous (I could use a stronger term, but they know who they are).

This so calls for a snarky reply!

[hrothgar]

Quote

The White House on Thursday will announce a plan for allowing insurance companies to continue offering existing individual insurance policies even if they fall short of the coverage standards set by the 2010 health-care law, a Democratic official briefed on the plan said.

....The plan, which the official said could be implemented without passing legislation, would allow insurance companies to extend "substandard'' plans in 2014 only if they are already in existence. Unlike the House bill, the administration plan wouldn't allow insurance companies to offer such plans to new customers.

This has already been characterized as "Put up or shut up"

[mike777]

The President just changed the law, not sure he has that power but that is what we have.

Again if you want to nationalize health care industry at the very least define it and measure it. I note no other country has nationalized the health care industry despite people saying so. The UK and Canada does not run with just a single payer.

If I understand Winston's point if we take away the profit motive and put the economic and political power over the health care system in a few powerful hands it will be more productive, innovative, and efficient. But at least define that system and how we are going to measure it. Inote even if we expand medicare that does not cover or eliminate the for profit sector or even cover much of the system.

Side note, Winston we have much more regulation than 30 years ago, much more, not less. Whatever the faults of market based health care it is not a lack of regulation.
In any event I still stick with my prediction that millions and millions will benefit from ACA.

[blackshoe]

Cthulhu D, on 2013-November-13, 17:35, said:

the only solution in the case of market failures is government intervention.

I'm not at all sure this generalization is true. Government intervention seems to be the "go to" solution, for a lot of people, for many, if not most, if not all, ills. Seems to me they're operating with blinders on.

To be fair, so are the people who insist that government can never be even part of the solution to a problem.

I've said that I prefer a free market solution. Others insist "that doesn't work". How do they know, since it's never been tried? Let the government do it? I'm sorry, I don't trust governments. Well, local ones are usually okay, or can be made so. But anything as big and powerful as a national government ought to be looked at warily, at least. "Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master. Never for a moment should it be left to irresponsible action" -- a statement originally attributed, as far as anyone can tell, to "the first President of the United States", and thus to George Washington, although there's no concrete evidence that he said it. But the first President of the United States was not George Washington, it was John Hanson of Maryland, who served as President from November 5, 1781 to November 3, 1782, the President being limited to a one year term in any three year period by the Articles of Confederation. There doesn't seem to be any evidence that Hanson said it either, but no matter - it is, in my opinion, a good thing for all of us to keep in mind.

[Cthulhu D]

blackshoe, on 2013-November-14, 16:29, said:

I'm not at all sure this generalization is true. Government intervention seems to be the "go to" solution, for a lot of people, for many, if not most, if not all, ills. Seems to me they're operating with blinders on.

To be fair, so are the people who insist that government can never be even part of the solution to a problem.

I've said that I prefer a free market solution. Others insist "that doesn't work". How do they know, since it's never been tried? Let the government do it? I'm sorry, I don't trust governments.

The conditions for a free market are well known. By definition it includes the ability to make rational decisions to select between a range of competing products (you know.. some sort of market). How do you make rational decisions when you are unconscious?

Please tell me how you propose to resolve this critical issue in free market delivery of healthcare - patient decision making while the patient is unconscious. I look forward to it. Then we can talk about how head injuries impair rational decision making!

blackshoe, on 2013-November-14, 10:23, said:

This so calls for a snarky reply!

Why? It's dumb. Once you've accepted that government intervention is a necessity, we can discuss what the most effective form of intervention is. I submit it's the type of intervention that results in the highest quality of care delivered with the least number of public dollars. How do you do that? Well, you implement the NHS, which delivers coverage to the entirety of the UK population for roughly the same amount per capita the US pays for Medicare and Medicaid. All the single payer systems have the lowest costs, lowest cost born by the public sector and thus the taxpayer. The hybrid solutions - like Australia's Medicare and the US solution just result in additional public AND private expense and no benefits at all.