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07/26/2009

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Anonymous

I'm sure that in the last sentence of the fourth paragraph you meant to write $100 billion and $900 billion.

Also, here's a link to the McKinsey report:

http://www.mckinsey.com/mgi/publications/US_healthcare/

Anonymous

Right on! I am a voluntarily uninsured adult American. If Obama wanted to help me maintain my health, he might consider putting in some racquetball courts around here. As it is, I can't afford to participate in either Medicare or Obamacare, which promise to tax me but not to cover me when I am sojourning for six months every year overseas.

Anonymous

Dear Judge Posner,
May I gently suggest that, in this and other of your recent writings, there is a danger of your concentrating so much on explaining the comparative economics that you seem to ignore the often more important personal liberty aspects. And I say this as an economist and lawyer who has great admiration and appreciation for your contributions to law and economics.
In your discussions of health care policy as well as other issues such as the environment and government spending, please keep much in the forefront the importance of personal choice and the many benefits to freedom of personal over governmental allocations and spending.

Anonymous

Medicare works. I have never heard anyone say that Medicare is like getting healthcare from the DWV. Lower the eligibility so more people can use Medicare. Taking something that works, making it better, and expanding it to serve more people is simple and easy to grasp.

Anonymous

I would be interested in hearing what the previous commenter means when s/he writes that "medicare works." It seems to me that it reimburses doctors poorly while at the same time engendering massive amounts of fraud and waste. As an example: An ailing member of my family just got a hospital bed and wheelchair delivered to our home at Medicare's expense -- both of which were brand new and very good quality. She used them for approximately two weeks, then entered home hospice care. Due to redundancies in the system (and a lack of oversight by Medicare) the hospice program ordered an entirely different bed and wheelchair for her, again on Medicare's tab, and paid for a pickup man to drive upwards of 100 miles each way to pick up the nearly brand-new equipment (I'm not sure if it'll be used again or dumped). This kind of idiocy makes me very nervous to consider expanding Medicare without evaluating its waste -- not from doctors, who weren't personally responsible for demanding that she get another bed, but from the government bureaucracy that requires and then reimburses such stupid expenditures.

Anonymous

President Obama is addressing the nation this evening on this topic. Our healthcare system should be revamped only after very careful analysis of implementation, consequences, and procedures. Many in Canada have vigorously encouraged the US to NOT adopt their healthcare programs. Let us act prudently and wisely. Amen.

Anonymous

An erlier commentator remarked: "there is a danger of your concentrating so much on explaining the comparative economics that you seem to ignore the often more important personal liberty aspects." Yet personal liberty presupposes income: If you can't pay, you can't choose. The issue of economic inequality is an issue of unequal liberty. Making health care affordable for the poor in one way or another enhances economic liberty. There is no point in arguing for free choice for people who cannot afford to choose.

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Anonymous

I take issue with the comment stating that many Canadians feel the US should not adopt the Canadian single payer health insurance scheme. It seems to me that if the Canadian health system is so bad, the Canadian electorate would scrap it. Is any Canadian political party suggesting this? The answer, of course, is negative. It would be electoral suicide. The same goes for any British, Dutch, German, Swiss, French,or Japanese political party. The whole world is familiar with our health system due to America's cultural reach, and the whole world knows that our health system stinks. The only people who don't know it are Joe the Plumber and other members of the Republican base.

Anonymous

http://www.youtube.com/watch?v=3EPd2i4Jshs

Anonymous

"If you can't pay, you can't choose. The issue of economic inequality is an issue of unequal liberty. Making health care affordable for the poor in one way or another enhances economic liberty. There is no point in arguing for free choice for people who cannot afford to choose."

Many people choose not to pay for health insurance and choose to buy something else instead. Then, when something goes wrong, they choose to visit the hospital emergency room which has a mandate to treat anyone who shows up, without regard to ability to pay. That's one of the things that increases the cost of insurance/Medicare for everyone.

My understanding of the currently proposed plans is that they will force people to purchase insurance who are now choosing not to, so we will end up with less rather than more liberty.


David Drake

Anonymous

"The whole world is familiar with our health system due to America's cultural reach, and the whole world knows that our health system stinks."

So why do many people from other countries who can afford it come here for treatment?

Anonymous

There is nothing inconsistent with "many Canadians feel the U.S. should not adopt the Canadian system" and no Canadian political party's proposing to scrap the Canadian system.
Would very many people in the U.S. propose that any other country adopt our public school system? Would any political party urge abandoning it?


"The whole world is familiar with our health system due to America's cultural reach, and the whole world knows that our health system stinks."

So why do many people from other countries who can afford it come here for treatment? You confuse the quality of services provided--which are world class--with the system of paying for them, which, for historic reasons, is not.


David Drake

Anonymous

I agree with Judge Posner.

We can't afford for everyone to get all the healthcare they want. For the few who can, that's great. We also are not going to cut even more people out of the healthcare system. It's wrong and long-term disastrous. I love our country and capitalism and personal freedom, but platitudes about personal choice or isolated clever analyses of individual items are not going to save our country. Rising health care costs are squeezing our standard of living and will bankrupt our country.

Anonymous

if there is anything which needs the supply side thinking, its healthcare.

invest more into building facilities and training doctors from taxpayer money.

then everyone can have all the heathcare they want.

Anonymous

Callahan from the Hastings institute for ethics states logically that the only way to set up a national health care system is to admit and accept the necessity to ration care on the front end and of course our politicians are to slimy to do that. So we will get a higher cost lower access poorer quality system. I talk to many physicians of every specialty every day and it is they who will provide care or not provide care depending on the system finally passed. The AMA does not represent physicians so what ever they say doesn't reflect what physicians are thinking.

Anonymous

Becker encourages skepticism toward the policy-maker's agenda. Posner responds by encouraging skepticism of Becker's conclusion -- that is, by encouraging skepticism of skepticism.

No study will definitively explain why the US spends more than other countries on health care, but Preston and Hu offer the plausible hypothesis that lifestyle choices matter. And no study will resolve how much of our extra expenditures are worthwhile, but Becker marshals an argument that much of it might be.

If similar hypotheses are even partly right, then the proposals now before Congress may not help and might hurt. Legislative humility may be too much to hope for, but legislative caution isn't.

Anonymous

Both of these posts mix together some very complicated issues. As I am sure that both Mr. Posner and Mr. Becker are aware "outcomes research" which was largely developed by John Wennberg of Dartmouth University shows some very serious problems with American healthcare. We underfinance public health which is both very inexpensive and the only part of the healthcare system which can be definitely shown to increase life expectancy. We underfund prenatal care,and have millions of citizens who have diabetes and heart disease without being aware of it. The reason for this is simple: public health is a public good which makes it difficult for private business to profit from it.

At the same time American physicians are often pressured to do unnecessary operations on their patients in order to keep their jobs. Dr. Wennberg's first major study was on the number of hysterectomies performed in various parts of the U.S..At that time 70% of American women were undergoing the procedure. In Boston the figure was over 90% in Nebraska only 20%. It turns out that sometimes less is more. Doing fewer hysterectomies in a population can improve life expectancy and save women much unnecessary pain. This problem of physicians performing too many operations has since been shown to be the case with many other procedures.

As an attorney investigating health care cases in the Detroit area I was appalled by the number of times patients' families were lied to by hospital staff in order to convince them to agree to operations on family members. This is essentially a problem of asymmetric information. Physicians, having lost their independent professional status, need to meet monthly billing quotas in order to keep their jobs. Patients have no way of knowing what procedures are really necessary. Consequently profitable procedures like hysterectomies and electro-shock therapy are overperformed.

President Obama may not have the answers for our healthcare system but it is clear that reform is needed.

Anonymous

Both of these posts mix together some very complicated issues. As I am sure that both Mr. Posner and Mr. Becker are aware "outcomes research" which was largely developed by John Wennberg of Dartmouth University shows some very serious problems with American healthcare. We underfinance public health which is both very inexpensive and the only part of the healthcare system which can be definitely shown to increase life expectancy. We underfund prenatal care,and have millions of citizens who have diabetes and heart disease without being aware of it. The reason for this is simple: public health is a public good which makes it difficult for private business to profit from it.

At the same time American physicians are often pressured to do unnecessary operations on their patients in order to keep their jobs. Dr. Wennberg's first major study was on the number of hysterectomies performed in various parts of the U.S..At that time 70% of American women were undergoing the procedure. In Boston the figure was over 90% in Nebraska only 20%. It turns out that sometimes less is more. Doing fewer hysterectomies in a population can improve life expectancy and save women much unnecessary pain. This problem of physicians performing too many operations has since been shown to be the case with many other procedures.

As an attorney investigating health care cases in the Detroit area I was appalled by the number of times patients' families were lied to by hospital staff in order to convince them to agree to operations on family members. This is essentially a problem of asymmetric information. Physicians, having lost their independent professional status, need to meet monthly billing quotas in order to keep their jobs. Patients have no way of knowing what procedures are really necessary. Consequently profitable procedures like hysterectomies and electro-shock therapy are overperformed.

President Obama may not have the answers for our healthcare system but it is clear that reform is needed.

Anonymous

Both of these posts mix together some very complicated issues. As I am sure that both Mr. Posner and Mr. Becker are aware "outcomes research" which was largely developed by John Wennberg of Dartmouth University shows some very serious problems with American healthcare. We underfinance public health which is both very inexpensive and the only part of the healthcare system which can be definitely shown to increase life expectancy. We underfund prenatal care,and have millions of citizens who have diabetes and heart disease without being aware of it. The reason for this is simple: public health is a public good which makes it difficult for private business to profit from it.

At the same time American physicians are often pressured to do unnecessary operations on their patients in order to keep their jobs. Dr. Wennberg's first major study was on the number of hysterectomies performed in various parts of the U.S..At that time 70% of American women were undergoing the procedure. In Boston the figure was over 90% in Nebraska only 20%. It turns out that sometimes less is more. Doing fewer hysterectomies in a population can improve life expectancy and save women much unnecessary pain. This problem of physicians performing too many operations has since been shown to be the case with many other procedures.

As an attorney investigating health care cases in the Detroit area I was appalled by the number of times patients' families were lied to by hospital staff in order to convince them to agree to operations on family members. This is essentially a problem of asymmetric information. Physicians, having lost their independent professional status, need to meet monthly billing quotas in order to keep their jobs. Patients have no way of knowing what procedures are really necessary. Consequently profitable procedures like hysterectomies and electro-shock therapy are overperformed.

President Obama may not have the answers for our healthcare system but it is clear that reform is needed.

Anonymous

"My understanding of the currently proposed plans is that they will force people to purchase insurance who are now choosing not to, so we will end up with less rather than more liberty."

Not quite so, if the system becomes cheaper that way (as has been argued by proponents). Then more resources will be available for other purposes, enlarging the scope of liberty, so to speak. So in the end all boils down to an efficiency argument.

The liberty of those who don't insure and are treated with the taxpayer's money reduce the scope of liberty of those who subsidize them. It is a forced subsidy, and it strikes me as strange to defend that for the sake of liberty.

The tenor of the commentator seems to prohibit subsidies for treating the uninsured. This is a valid alternative to mandatory insurance, perhaps the only one, although I doubt that many would favor it.

The status quo is not defensible, even with an appeal to liberty.

Anonymous

One question? "What good is Free Choice and Liberty when one is sick or injured and can't get Medical Care"? Should we return to the the "good ol days" where the medical wisdom of the day was, save one bullet for yourself?

As for Canadian Med. Care, perhaps the following anecdote will put the whole medical thing in a new light:

I was talking to friend of mine who is Canadian and lives in Canada about our health care debate currently going on. His Comment, "Thank God I'm Canadian and live in Canada. At least I know if I get sick or injured I can get Medical Care when and where I need it; whether I'm employed or not. Unlike you confused and "wacked out" Americans."

Anonymous

"The fact that so many Americans eat badly, don't exercise, drink (or "text") when they drive, and otherwise endanger their life and health, implies, since one can eat well, drive sober, and exercise, etc., at relatively low cost, that people don't value small improvements in quality and quantity of life very much--unless the improvements are paid for by someone else!"

It seems like this is the problemn with the current health care system, and a reason we should move off of the lush benefit program popularly associated with government and union employees and towards high-deductible insurance plans where the consumer bears most of the costs.

Anonymous

First off, please keep comments to fewer words than the actual post. God.

Secondly, when the government forces healthcare or mandates insurance for everyone (as they do here in Massachusetts), then it also becomes in the government's interest to monitor the health of Americans. If my tax dollars will foot the bill when you go to the hospital, then I would want the government to ensure that you live a healthy life to lower costs. Is that the world we really want? Close McDonalds because it is unhealthy. Monitor people's sexual partners to ensure they are not participating in high risk behavior.

If we can devise a system that provides SOME necessary/essential healthcare to indigent Americans and ensure emergency care and anything beyond that is up to the consumer, which could probably be achieved without spending a dime more than we already do by cutting spending in other areas of healthcare. It just makes no sense to mandate that everyone have or have access to health insurance. I don't want the government telling me what I can smoke, eat or drink or who I can sleep with or what dangerous activities I can participate in - I dont' think Obamacare goes that far, but how close to socialized healthcare do we need to inch before it becomes the state's interest to determine how people behave? More so than they do already that is.

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