BBO Discussion Forums: Luke Warm was right, I was wrong - BBO Discussion Forums

 PassedOut, on 2012-July-11, 09:18, said:

some, yes

Quote

to have universal healthcare, some things have to be agreed to... first, there can be absolutely no competition... there would have to be one insurance company, period.. second, the group must be as large as possible, meaning no opt outs, meaning participation is req'd... third, health care providers must be forced to accept the rate tables as established by, supposedly, the gov't...

will it work? if i were dictator, yes... i do not believe it can work in this country at this time, because the political will cannot be mustered by politicians of both parties in sufficient numbers to pass it (and don't fool yourself, plenty of democrats would abandon that ship, it wouldn't just be republicans - our politicians' #1 priority is staying in power)...

having said all that, i'm definitely against it in the form of the ACA... it does not do what it says it would do, and it does not do it far more expensively than rumored... before i'm accused of making the good the enemy of the best, read the above paragraph... the best is all there is, there is no "good"

one other thing, to put some elderly minds at ease... yes there will be "death squads," although they won't be named that... if someone has already outlived the actuarial tables, there is no reason to put him anywhere near the top of the list for a new heart/kidney/liver/cornea, etc... if someone has a chronic condition, and especially if treatment for that condition is expensive, and most especially if that person is elderly, well (paraphrasing spock) "the good of the many outweigh the good of the few"... if you want it to work, and if you don't want it to bankrupt the country, something like that has to be implemented

 luke warm, on 2012-July-11, 15:40, said:

I certainly agree with this. But I don't think that the political difficulty of achieving universal healthcare in the US today means that it is not the best approach.

And I agree that both democrats and republicans are in the pockets of their large contributors, which is why I'm an independent voter. (I was once a republican, but a lunatic fringe has all but taken over the party, so that's no longer a possibility for me.)

 PassedOut, on 2012-July-10, 15:42, said:

The concerns are 2:
1) quality will suffer, innovation will suffer
2) we cant afford it.


I use the word concerns rather than arguments against it.

I think proponents of universal healthcare just need to do a better job overcoming these concerns.

To put it another way if universal healthcare leads to better quality/innovation at the same or lowercost people will be less scared of it.

When proponents point to Europe or WHO result studies, people dont trust the results/studies.

Of course the present system is not working either.

The question of "best" seems to provoke a question: Best for whom?

In general, I think one big problem here is that there are several desirable feature and it is unlikely that any one approach optimizes all of them

 kenberg, on 2012-July-11, 18:23, said:

yep, that's almost always the question... also, imo mike's two concerns are legitimate, accurate and unavoidable...

Here are some of my thoughts:

Personal level: I am reasonably content. I think that there are quite a few MDs out there who I would not want taking care of me, but I seem to be able to cope. I just changed opthamologists, and I am hunting for a good dermatologist for an annoying but not particularly severe skin issue. I have good insurance. In particular, I go to the doc that I choose, no referral needed.

Nationally: We have to figure out what to do about those who have no means to pay for care. I seriously doubt we can afford to do everything for everyone, but currently there seems to be a rather strong element of randomness. As I understand it, and I do not much understand it, children in poverty situations are eligible for some fairly decent care if their parents can get their act together enough to access it. Adults without a job, or with a low paying job w/o insurance, are more or less screwed. My desired program would lie somewhere between "You're on your own, buddy" and "Whatever you need, we provide".

Those seeking political support would be well-advised to make note of my fair satisfaction, for my own needs, with the status quo.. Big changes can make things better, or they can make things worse. If I am to support change, I have to be convinced that the change will not adversely affect my own situation. I suspect I am far from the only person holding this view.

Here is a piece from Kathleen Sibelius.
http://www.washingto...ry.html?ilink=1

Here is an amusing mathematical challenge. From the article:

"Between 2000 and 2009, the average family premium more than doubled, from $6,438 to $13,375, an annual increase of 8.1 percent. "
Challenge: Where did the 8.1 come from?

 kenberg, on 2012-July-12, 05:08, said:

under the ACA? yes, that's true... what's even more confusing is, a lot of those folks *support* the ACA, mainly because they support obama... of course a lot of older folks support romney, not knowing for sure where he stands on ssa and medicare... ayn rand is right once again... we'd all probably be better off is we acted, and voted, according to our own selfish needs... the trick is figuring out just what's actually in our own interests without some politician having to tell us

 barmar, on 2012-June-30, 13:58, said:

On what rational basis? It's pretty clear cut: Idiots on motorcycles without helmets costs society a lot of money. Whatever marginal utility idiots get for not wearing motorcycle helmets is far, far outweighed by the loss from injuries. It's theft. It would be a completely different situation if we didn't live in a world where the paramedics will pick the dude up and treat him regardless of his helmet wearing status or otherwise, but we don't (which is good), so helmets should be mandatory.

Quote

Both of these points are objectively wrong. Consider the NHS: It is both massively cheaper than US healthcare and just as effective (when considered as an entire system)! But the NHS is kinda shitty so let's move somewhere colder. The Finns have a healthcare system that is massively cheaper and more effective! What's not to love?

Quote

I guess everyone has a right to an opinion, but this one is factually incorrect. See: Finland.

Quote

Check out patient satisfaction rates in one of the cuddly european countries. Like Finland! They have less waiting times, they do a better job, less people die and you'd save a fat chunk of cash. Exactly what do you possibly want from a healthcare system that isn't getting done here? Cheaper, more effective and more satisfying!

Amusingly I worked out if you could have the high levels of public sector efficiency (hahaha) associated with a country like the UK, for what the US government pays out in Medicare, Medicaid etc you could deliver NHS quality universal healthcare for your entire country.

The conclusion I draw is that Americans are somehow intrinsically masochistic and are willing to fight to the death to protect their right to be overcharged for bad service. I honestly cannot understand what the rationale here is. Does America just not like money, or the idea of a healthy population or something?

Seriously, people are defending their right to pay extra so poor people die of preventable illnesses. It is literally madness.

 luke warm, on 2012-July-12, 15:34, said:

Or, perhaps, because they are less screwed than they were before the ACA: Consumer Reports: Update on health-care reform

Quote

 Cthulhu D, on 2012-July-12, 18:15, said:

Unfortunely you do not quote me in full and simply avoided my point.

Advocates keep making the same mistake over and over again, you either dont quote studies or you quote studies that simply are thought to be faulty for many reasons.

Pointing to Europe which seems to be going broke and lacking in innovation will not carry the argument.

To put it another way, you may be right but your arguments are not believed by many for many reasons.

Telling Americans we should be much more like Europe is not overcoming peoples concerns.
Saying America should be like Finland a tiny, tiny country is not overcoming peoples concerns.

Finland has a population under 6 Million.

 Cthulhu D, on 2012-July-12, 18:15, said:

Your logic is flawed.

If "America should be like Europe" were a true statement, our ancestors would not have revolted against George III.

 mike777, on 2012-July-12, 20:23, said:

I am happy to provide some studies, there are approximately a billion. However, to facilitate this process, we first need to define the principles that you want to see in understanding what makes a healthcare system 'effective' - as a starting point I would suggest

A) Cost per capita
B) Patient Satisfaction (for people admitted to hospital or present at an ER, measuring the satisfaction of people who don't use the healthcare system's satisfaction with it is a pointless exercise in futility).
C) Some measure of quality. This is the most difficult to measure so I would like your thoughts. If it's population health measures I need you to understand that the drivers of this are diet and smoking rates which mask the small differences in outcomes between the healthcare systems. If it's delivery of WHO recommended care, I will note that no study has been performed other than a single one which says there is no difference between the NHS and the USA.

Please note: No country in the OECD has as large a population as the USA. If smaller countries are not legitimate examples, there is no evidence that can pursade you.

If you have some other set of preferred principles please suggest them. It is impossible to proceed until it is clear what factors would satisfy you prior to gathering information.

 blackshoe, on 2012-July-12, 20:43, said:

Which step?

A. Not wearing helmets increases medical costs
B. Not wearing helmets is unauthorized in my country
C. At-least 40% of medical costs of motorcycle accidents are covered by the public or written off as loses by care providers regardless of jurisdiction
D. The remaining 40% or more is covered directly or indirectly by taxpayers and healthcare users (US numbers, higher in oz).
E. If costs are covered by taxpayers that results in increased tax burden
F. If costs are covered by care providers they amortise the loss over other patients, resulting in increased costs for healthcare users
G. I am a taxpayer and healthcare user
H. Therefore I pay for the medical care of people who have motorcycle accidents without a helmet
I. Non consensual re-purposing of funds is 'embezzlement'
J. Embezzlement is colloquially known as theft.
K. As this re-purposing of my funds is unauthorized (by the accident haver), they are committing theft.

 blackshoe, on 2012-July-12, 20:44, said:

This is insane. I presume you are going to stop pasteurising milk? Just because colonial imperialism is bad, all products of Europe ever are bad? Amazing.

Of course, people are really defending this system, so I guess things are beyond help?

Quote

 mike777, on 2012-July-12, 20:23, said:

Try Germany then. It has a universal healthcare system that is massively cheaper than America, at least as effective and insurance-based with (some) competition and choice in the insurance market. I do not know of them personally but I understand France and Japan use similar models. Altogether this might represent a large enough sample, no?

However, one thing is clear. A universal healthcare system involves some people paying more than they currently do for little gain. Those people are likely to be the richest and most influential (call them Group 1). There would almost certainly be another sizeable chunk who will pay more than they do now but get back in return as much or more in terms of healthcare value. This is the group that Group 1 will be working very hard to convince they are worse off, even when they are in truth better off. Phrases such as "Don't let the government decide what you should do with your money" and the like will be heard. It is essentially the opinion of this second group that will decide whether America can ever move to a universal healthcare system. At present it looks sadly like the efforts of Group 1 are still winning the argument despite the obvious overall gains to be had from moving America away from the current model.

A question to Luke - why would poor people not support the ACA when the alternative is the old system? Sure, many of them may not immediately gain directly from the legislation but it is one step closer and for Americans to finally provide some kind of safety net for the poor it may well take such a halfway-house compromise to provide a stepping stone. One thing that must be 100% certain for any poor but clever/educated American is that they will surely never be worse off under Obama than Romney.

@Cthulhu: try this logic:-

1. I understand that wearing helmets is a good idea.
2. Therefore I wear a helmet and encourage everyone to do likewise
3. I believe fundamentally that the government should never have the right to require me to do something that does not threaten another individual directly.
4. Therefore I am vehemently opposed to any government legislation making the wearing of helmets mandatory.

By your logic, smoking and drinking alcohol should also be illegal. Both cost society money. Similarly for many dangerous activities such as handgliding. For that matter, chip pans are a major cost due to the fires and injuries they cause. Perhaps we should ban those while we are at it?

What's insane is complaining that society is paying for peoples' idiocy, and then complaining again when society tries to make an idiot pay when he refused treatment and told the paramedics he couldn't afford it.

As for "being like Europe", I was speaking in terms of politics - in particular for this thread the politics of health care. The other crap you brought up is a nice red herring, but that's all it is.

The flaw in your logic is that you need to examine why "idiots on motorcycles without helmets cost society a lot of money". Either society takes on responsibility for these (and presumably for all) idiots, or it does not. If people, idiots or otherwise, are (as they should be imo) responsible for their own actions, then the solution to "society's" problem seems obvious.

It is not the case that in a free society the answer to every problem is more government regulation. Of course, if you want to posit an unfree society, where the government is paramount and freedom is a myth, that's a different story.

 Zelandakh, on 2012-July-13, 03:24, said:

the "old" system is, go to the ER, get whatever treatment you need, go home, pay nothing... the new system (except in extreme poverty cases) is, receive an income based subsidy, pay your premium... as you know, paying something costs more than paying nothing... i just think the ACA is still being confused w/ universal healthcare

 luke warm, on 2012-July-13, 04:05, said:

Sounds just like the NHS. So the American system is free treatment for all - who'd have thunk it.

 Zelandakh, on 2012-July-13, 04:15, said:

Makes you wonder why anyone bothers with insurance at all. Evidently medical care in the US was, before the ACA, a free-luncher's paradise.

 blackshoe, on 2012-July-13, 03:30, said:

So to use a true to life example, my grandmother had a stroke literally 3 weeks ago. She had it at her hairdressers. She attempted to refuse treatment because she was 'fine' despite being in the process of having a stroke as she was delusional, so the paramedics said 'hahah no you are having a stroke' and took her to ER against her will, thus saving her from permanent disability because she got treatment within 10 minutes of the stroke beginning (partly due to luck). As a result she made a full recovery, despite having a stroke at the age of 94(!).

Are you saying that the paramedics should have left her at her hairdresser because she attempted to refuse treatment? Despite being obviously irrational? If you seriously believe that there is no point in further discussion.

This is why the model is broken. The paramedics CANNOT check your insurance details prior to treatment. Say you left your card at home, do they just let you bleed out? You're seriously okay with that If you present at ER with major trauma (say... gunshot), do you want the ER to confirm you have insurance prior to treating you? What happens if you do have insurance and die in the mean time?

Similarly it is unworkable to not to coersively take you when you've obviously suffered head trauma - people who are concussed do not make rational decisions. They cannot not take someone who is obviously not in full command of their mental faculties.

Reality is, ERs must treat patients who present with emergency conditions immediately. Nothing else is a workable model. Under this model costs are socialised, just they can be socalised upfront or in your bills. Once you get over this hurdle, it is obvious that you are paying for the dudes motorcycle accident and as a result the guy should be forced to wear a helmet, no question.

 mike777, on 2012-July-12, 20:23, said:

Mike,

This sounds like Mancur Olson - could it be?

Olson contended that size of group mattered, that in large groups there was no choice for group betterment unless it was accompanied by a personal benefit.

In the U.S., I think the reason is more simple: a tiny, tiny minority has the ability to block and halt any change to the status quo they deem harmful to their cause. Note, this is not a single group acting in concert, but splinter groups within a bigger group of super-wealthy who act in their own interests to keep the status quo. It may be A,B,C who oppose universal healthcare and act to keep it off the table, while it may be X,Y,Z who oppose changes to energy profits by opposing global warming.

Regardless, the U.S. is no longer a representative-Republic, and because of that I fully expect the U.S. to continue to follow the path of other lumbering giants who could not or would not evolve.