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03/28/2010

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Jim

The real problems have been and will continue to be in the trenches where the individual patient receives "health care". The system is by nature complex and getting more so for reasons too lengthy to go into here. But because the system, the art, and the technology has gotten so complex and inter-related, most people cannot navigate through it nor do they understand anything about their own bodies and how medical processes work sufficiently to make good decisions about what is necessary or helpul. Pulling back to a rationed or "protocol" type approach will make patient understanding even worse. Citing Medicare as an example of insurance sanity is insane. Medicare is not an insurance scheme. It is a subsidy and a bankrupt one at that, ten times its original estimate in 1965. The bill under discussion is not about health care, or cost. And certainly not about quality. It is about control and the government's desire to have a voting majority dependent on the power elite. Anyone who thinks that their access will improve can imagine caling a provider and getting on a phone tree something like, "If your problem is with your prostate, press 1, if it is your heart, press 2, etc." Good luck!!!!!

Kelly


The data is pretty clear, Americans pay twice as much as everyone else in the world for medical services (see link below).

http://voices.washingtonpost.com/ezra-klein/2009/11/an_interview_with_kaiser_perma_1.html

If we reimbursed medical services on parity with the rest of the world, we would spend 8.5% of GNP, instead of 17, including the private insurance overhead rip-off.

It does not take a genius to see that the problem is not overuse of medical services by Americans, but a completely ineffective system for pricing medical services (unless you are a provider or shareholder in big pharma).

All the freemarket hobbyhorse "medical fixes" are all predicated on demonstrably false premises--overuse of services by whiny Americans or "tort reform" (insurance is 3% of medical spending--if we give doctors complete immunity from suit it would only save 3% of 17% of GNP).

I understand why hacks in Washington oppose real health care reform, and why any real provisions for fixing the mis-pricing of medical services were stripped from the HCR bill (K-street?). But why do right-wing academics, who presumably aren't on the corporate take, insist on publishing public policy proposals based on junk and bunk?

Rodrigo

>>But why do right-wing academics, who presumably aren't on the corporate take, insist on publishing public policy proposals based on junk and bunk?<<

Too much emphasis on modeling and simplifying and theorizing, and not enough on appreciating the real complexities of the health care markets. And too much exposure to unqualified free-market dogma, with all respect to the learned academics at the Chicago school.

Rodrigo

America has the highest infrastructure and technology to patient ratios across almost every category. Yet America lags on almost every health metric and spends twice as much (in terms of % GDP) as most of the OECD nations on health care. America spends a higher percentage of its health care dollars on administrative costs than any other OECD nation.

It's hard to argue against the data. If our "free-market" system is great the proof should be in the pudding.


K

Three links for you Dr. Becker.

Cost Containment
http://www.nytimes.com/2010/03/10/business/economy/10leonhardt.html

Selling Across State Lines
http://www.cbo.gov/doc.cfm?index=6639&type=0
http://www.pbs.org/wgbh/pages/frontline/shows/credit/more/rise.html

Jack

K. The Times is on the right track. We spend about $6500 per person for a patchwork delivery system we all know is far from what it could and should be.

Let's see what we MIGHT whack out of it:

Insurance company overhead is 30% or so plus the friction of a blizzard of paperwork to comply with over 1000 different contracts. Surely with one or a few contracts gatekeeping of what's covered can be reduced to 10%. Savings? At least 20% of $6500 Bam! $1300 right off the top.

Next? Often overlooked in these disussions is our spending on drugs:

"The United States has the largest pharmaceutical industry in the world. In 2007, its pharmaceutical revenue totaled at US $315 billion."

Ahh, a bit over $1,000 per person. We know that Canada and others pay less than half what most in the US pay, and that our VA which is "allowed" to price shop and use generics when it's practical also pays half the going rate. How about "allowing" Medicare D the same shopping privilege as the VA? Let's say we pruned them back 25% and let the rest of the world chip in to make up their advertising and R&D costs for a per person savings of $250?

Well we're down to $5,000 each. While we all appreciate the high technical skills of hospitals, surgeons, MRI and CAT scans they're all done in other advanced nations at far lower costs and in a natioln of flat wages for most, there is NO system in which we can pay for soaring costs in one sector. So cost cutters unite! Be it improvements in efficiency and higher usage rates for scans and other tech, surely we should be able to compress costs in this area 10% and implement methods to restrain the per capita growth.

$5,000 less $500 for a target of $4500 per capita and about 30% less than we spend/waste today. Well, perhaps too optimistic as that amount is only $1,000 higher than what Canada spends per person!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"It's unfair," Mr. MacDonald said. "Millions and millions of people are being excessively charged late fees and bad-check fees and over-the-limit fees and then these 25 percent APRs to make the profits for the industry, so that they can keep the rates lower for people who are rate sensitive, who can in fact shop the system.''

Mr. Kahr, for one, makes no apologies. "If someone is riskier, he should be paying a higher rate,'' he said. "It's more economically sound. It's fairer for riskier people to pay a higher interest rate, higher fees, whatever it is, than less risky people.''

Ha! "fairness" aside, venue shopping for lax usury laws and how that may well turn out if "insurance" companies were prematurely let out from under what little state regulation and commission oversight we have today.

BTW does ANYone here think today's credit card schemes represent a functional market of willing parties coming to equitable terms?

Chris Graves

I believe that this entire discussion, as many of these discussions of public policy slip into, is based on confusing the role of establishing justice in contrast to pursuing the good. I can see how both Professor Becker and Judge Posner consistently conflate these two vital concerns of political philosophy since they both assume some variation of utilitarianism, which John Rawls observed as being the prime source of this mistake.

Classically liberal rights-based justifications for the government are founded on individuals delegating their power to protect their rights to the state which acts on their behalf thereafter to clarify and enforce their rights. Hence, the state is empowered to use violence or the threat of violence to protect the individual and associations of individuals from violations of their rights modeled on the concept of property as a private sphere each individual is entitled to be free to manage according to his own judgement. The demands of justice are centered on protecting these rights and facilitating individuals peacefully and respectfully engaging one other within the bounds of these rights otherwise leaving people free to voluntarily pursue their own conception of the good.

Health is a good that each of us pursues in his own way. In a free society, we are left free to purchase the type of health care that we see as best for ourselves. We are free to purchase health insurance at the level and range of coverage that we desire and can afford. Just as the central government in our Federal system should leave us free to pursue our own relationship with God as we so choose or our various relationships with one another as we so choose within the broad legal constraints of justice, we should be free to pursue our own conception of what constitutes the good as far as our own personal health. Therefore, the health care bill along with other measures that have been taken by the Federal government along these lines are out of order. Health is a matter of the good that should be left to individual discretion or among voluntary organizations that people are free to join or ignore which offer a variety of approaches to pursuing better health.

So, what about the poor and their need for health care? Dealing with poverty and its related problems should not be viewed as a matter of justice. Rather, aid for the poor should be seen as a matter of pursuing the good. How can we best help the poor? John Winthrop, the first governor of Massachusetts Bay Colony, made the point that God has ordained some to be rich and others to be poor, in part, to cultivate a community of mutual aid and complementary support. Those who are entrusted with more have a greater responsibility to aid those in need. Winthrop writes:

"Thirdly, that every man might have need of others, and from hence they might be all knit more nearly together in the bonds of brotherly affection. From hence it appears plainly that no man is made more honorable than another or more wealthy etc., out of any particular and singular respect to himself, but for the glory of his Creator and the common good of the creature, man...There are two rules whereby we are to walk one towards another: Justice and Mercy.... By the first of these laws, man as he was enabled so withal is commanded to love his neighbor as himself. Upon this ground stands all the precepts of the moral law, which concerns our dealings with men. To apply this to the works of mercy, this law requires two things. First, that every man afford his help to another in every want or distress. Secondly, that he perform this out of the same affection which makes him careful of his own goods, according to the words of our Savior (from Matthew 7:12), whatsoever ye would that men should do to you..."

This is the same work that President Reagan famously alluded to in his admonition that the United States be a "City on a Hill" that should inspire the world by our example. Reagan drew from this portion of Winthop's "A Model of Christian Charity":

"For we must consider that we shall be as a city upon a hill. The eyes of all people are upon us. So that if we shall deal falsely with our God in this work we have undertaken... we shall be made a story and a by-word throughout the world."

http://religiousfreedom.lib.virginia.edu/sacred/charity.html

When the Federal government confuses justice with mercy and justice with pursuit of the Good, it degrades and perverts each of these distinct but complementary principles.

Jim

The devil is in the details and unintended consequences of the health-care reform bill. The United States is not France, the United Kingdom, Germany, Switzerland or Sweden. Trying to make the United States, run like those countries will ultimately require some form of compulsion and rationing. Insurance coverage does not equate with access, and I suspect medical care providers in the trenches will find a way maintained their positions and financial status. One of those ways will to become more efficient and automated. The patients are going to love it when they phone a physician or other health care provider and are put into a phone tree, which begins as follows: "if you are calling about your prostate, touch one, if you are calling about your heart, touch two........... if you would like to speak to the medical clerk, touch zero. Please note that there will be an extra charge for any compassion shown by our personnel. We regret that you will not be able to speak to a physician as they are busy seeing a patient every 10 minutes in order to pay the expenses of running this office. Our next available appointment is in three months. If you wish to be seen sooner. Please go to an emergency room. Good luck"

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treebagger

Here's a challenge to the Right, and to those of you who claim to be independent,etc.

Is it possible for you to discuss this issue without mentioning taxes?

You're like HBO host Bill Maher in this regard. He can't go 60 minutes on any topic without talking about legalizing marijuana. You can't discuss anything without talking about taxes.

If you have a point to make about whether or not this law benefits Americans, discuss the merits of the law without invoking the spectre of taxes rising up to destroy us all.

Once you have made your point and we have discussed the impact of the Law on healthcare, then we can more on to discussing the "value" of the bill.

Asel

The health care system in this country is putrid. I'm glad to see you agree to no change along with a large number of dubious associations and lobby organizations.

Rodrigo

Jim,

How exactly do you think the American health system works now?

Rodrigo

A summation of the comments of Chris Graves:

Americans should not use the body empowered and chartered to look after their collective interests to actually look after their collective interests. Acting collectively is unamerican.

Except when corporations act collectively at the expense of individuals who cannot protect themselves because they refuse to act collectively. That is OK because it is capitalism, and capitalism is very American.

Your dangerous and self-limiting rhetoric amounts to exhorting your fellow citizens to deffer on decisions about their health, freedom, and safety to powers that have no incentive to protect any of the three. It shackles people to their circumstances and the mercy of powers greater and more aware by forcing them to turn their eyes down to the reality beneath their feet and within their grasp and blinding them to the greater world around them and what it could be if they thought in terms grander than themselves.

So nuts to you. Every great thing we've ever accomplished we've done as a collaboration, and government is just another form of collaboration. We shouldn't be afraid of government. Government is us.

cardiology emr

Thanks for such a great blog to share with.Congrats on this thoughtful post and the discussion it has generated.I enjoyed reading it and I think other readers might enjoy reading it as well.

Eric Pearson

My name is Eric Pearson, and as a Democratic Party candidate for the U.S. Congress in 2010, I want to thank the below list of the truly courageous and honorable Democrats that voted against the health care bill.

John Adler – New Jersey, 3rd District
Jason Altmire – Pennsylvania, 4th District
Michael Arcuri – New York, 24th District
John Barrow – Georgia, 12th District
Marion Berry – Virginia, 8th District
Dan Boren – Oklaholma, 2nd District
Rick Boucher – Virginia’s 9th District
Bobby Bright – Alabama, 2nd District
Ben Chandler – Kentucky, 6th District
Travis Childers – Mississippi, 1st District
Artur Davis – Alabama, 7th District
Lincoln Davis – Tennessee, 1st District
Chet Edwards – Texas, 17th District
Stephanie Herseth Sandlin – South Dakota, 1st District
Tim Holden – Pennsylvania, 17th District
Larry Kissell – North Carolina, 8th District
Frank Kratovil – Maryland, 1st District
Daniel Lipinski – Illinois, 3rd District
Stephen F. Lynch – Massachusetts, 9th district
Jim Marshall – Georgia, 8th District
Jim Matheson – Utah, 2nd District
Mike McIntyre – North Carolina, 7th District
Michael McMahon – New York, 13th District
Charlie Melancon – Louisiana, 3rd District
Walt Minnick – Idaho, 1st District
Glenn Nye – Virginia, 2nd District
Collin Peterson – Minnesota, 7th District
Mike Ross – Arkansas, 4th District
Heath Shuler – North Carolina, 11th District
Ike Skelton – Missouri, 4th District
Zack Space – Ohio, 18th District
John Tanner – Tennessee, 8th District
Gene Taylor – Texas, 18th District
Harry Teague – New Mexico, 2nd District

Thank you, and God bless America.

Eric Pearson, Democratic Party candidate for US Congress in the 5th district, Tennessee.
Site: http://www.democraticreformparty.com

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