[kenberg]

Winstonm, on 2012-March-29, 16:16, said:

Oklahoma is my home state, and it is in the running for the most stupid state in the union, I'd put it about 4th in that contest behind Mississippi, Texas, and Louisianna.

I don't know about Viagra, but OK did have a law that a woman was forced to listen to the sound of the heartbeat of the fetus prior to an abortion - and it was struck down just in the past two days.

I have known women who have regretted having an abortion, and, to be a little personal, I am adopted because my 20 year old unwed mother did not get an abortion. All that being true, it is impossible to understand why a bunch of men, and here the gender is really relevant, think that they get to dictate to women on this matter. A nd this law comes from people who think that the state is too intrusive in people's lives.

My home state is Minnesota. The attitude there was that the only reason that "Thou shalt not meddle in another person's business": was not part of the Ten Commandments was that God thought it was too obvious to waste tablet space on.

[PassedOut]

Winstonm, on 2012-March-29, 16:16, said:

Oklahoma is my home state, and it is in the running for the most stupid state in the union, I'd put it about 4th in that contest behind Mississippi, Texas, and Louisianna.

I don't know about Viagra, but OK did have a law that a woman was forced to listen to the sound of the heartbeat of the fetus prior to an abortion - and it was struck down just in the past two days.

Vagina enters stage left -- or is it right?

Quote

Oklahoma state. Sen. Constance Johnson in early February introduced a handwritten amendment to the Health and Human Services Committee which read, "Any action in which a man ejaculates or otherwise deposits semen anywhere but in a woman's vagina shall be interpreted and construed as an action against an unborn child."

"I asked myself, 'Is there another word for ejaculation or vagina?' I couldn't think of any," she said, her drawl thick. "I wasn't trying to be funny. As ludicrous as I thought my proposal was, I was dead serious. If it's good for the goose, it's good for the gander."

Johnson has worked in the Oklahoma Senate for 32 years, first as a longtime staffer before she became an elected member in 2005. As a staffer, she drafted the bill in the late 1990s to mandate coverage of Viagra, she said.

"They passed that thing so quick. It was the fastest bill I've ever seen go through the legislature," Johnson said.

[kenberg]

PassedOut, on 2012-March-29, 16:22, said:

I thought that the church flap was about birth control pills (not okay) versus Viagra (okay), but maybe condoms were included. Just never heard of that before.

I don't have a problem with folks buying insurance for foolish stuff, so long as they're paying the premiums for what they get. I do have a problem with free-riders getting emergency care (or Viagra, condoms, etc.) paid for by their more responsible neighbors.

Are your flu shots really free, or do you mean that you have no co-pay? If really free, does the state pick up the tab, or is it some charity?

"Free" is always a matter of context. My health is holding up but still I am 73 and I seem to see a doctor from time to time. After he does whatever he does, he says "Have you had your flu shot"". If the answer is no, I can get one on the same co-pay. But actually, I think I can, even did at one time, just go in and get one w/o a co-pay. It wouldn't be crazy on the theory that flu shots cost less than treating flu. They have called to nag me about the shingles shot, I just procrastinate. I think that there will be a token payment for that since it will not be in their office. No medical reason, just procrastination. Unless I procrastinate long enough, then maybe it will be free.

Of course I pay for medicare and I pay for a supplemental health plan. After which I seem to pay very little. I'm too healthy to have extensive data on this. Bottom line, if my personal well-being is the criterion, I'm fine with the way things are.

Times change.

When I was very young with a young wife and a young baby I put the diapers in a plastic bag, the bag in a box, the box on the handlebars of my bike and took them to a laundermat. No car, no washing machine. Yes, it was a challenge in Minnesota in January. I imagine there are young people now in approximately that position. I think it would be nice if when the child got sick, they could take the child to a doctor. I don't think one has to be a rabid liberal to agree with this.

[Winstonm]

mike777, on 2012-March-29, 16:17, said:

Of course insurance and even the actual medical decisions are just a part of the whole health care system.


You have the whole medical equipment and supply parts as well as drug companies.

You have real estate, location, staffing, education, equipment and many many other moving parts to the whole health care system. Asset allocation decisions need to be made as too what research or what equipment or training will be funded and which will not be.

I do understand that many posters feel the central govt will do a better job making all of these complex decisions than the marketplace.

That is alot of economic power combined with political power put in a very few hands inside the Beltway.

Mike,

I think you are making a strawman argument. Single payer is about paying. Medicare is a form of single payer - is medicare a commie demon eating Adam Smith's children?

The idea of single payer is to eliminate much of the 20% overhead cost of the present system.

Speaking, of marketplaces, what do you propose to be the correct profit margin for repairing a heart valve?

[luke warm]

Winstonm, on 2012-March-29, 16:16, said:

Oklahoma is my home state, and it is in the running for the most stupid state in the union, I'd put it about 4th in that contest behind Mississippi, Texas, and Louisianna.

you should leave and go to a smarter state... (by the way, it's spelled Louisiana)

[Winstonm]

Quote

(by the way, it's spelled Louisiana)

Not here.

[Winstonm]

mike777, on 2012-March-29, 16:17, said:

Of course insurance and even the actual medical decisions are just a part of the whole health care system.


You have the whole medical equipment and supply parts as well as drug companies.

You have real estate, location, staffing, education, equipment and many many other moving parts to the whole health care system. Asset allocation decisions need to be made as too what research or what equipment or training will be funded and which will not be.

I do understand that many posters feel the central govt will do a better job making all of these complex decisions than the marketplace.

That is alot of economic power combined with political power put in a very few hands inside the Beltway.

The key element in this debate is the motivation to offer services. With a market-based approach, the motivation is simply profit, with competition as the regulator. The question to answer in my mind is whether or not healthcare should be driven by such a motivation or whether it should be considered more of a public service, like electricity or telephones.

Public service/ public good goals are not addressed adequately by the marketplace, and I would venture to say that under a total capitalistic free-market system the U.S. would still not have telephone or electric services in many rural areas - it was only the compulsion of federal mandate that forced Bell to extend services to all - while we could still be facing the prospect of small pox without government mandated vaccination programs.

The free market does a great job in some aspects - but it is not a one-size-fits-all cureall for every decision.

[blackshoe]

Winstonm, on 2012-March-30, 07:30, said:

The free market does a great job in some aspects - but it is not a one-size-fits-all cureall for every decision.

Neither is Big Government.

The cost of providing telephone service in rural areas would eventually have fallen to the point where Bell (or somebody) would have found it economical to provide the service. In the actual circumstances, that might have taken a while, but that's because government intervention slows down progress. Had there been no intervention (including no government-sanctioned monopoly) I have no doubt it would have taken considerably less time.

[hrothgar]

Winstonm, on 2012-March-30, 07:30, said:

With a market-based approach, the motivation is simply profit, with competition as the regulator. The question to answer in my mind is whether or not healthcare should be driven by such a motivation or whether it should be considered more of a public service, like electricity or telephones.

I think that the whole "profit" issue is an un-necessary distractor.

All companies are profit motivated. The fact that health care companies are should not be held against them.

If you want to critique health care companies, do so as follows:

The notion of a perfectly competitive market depends on a variety of factors. Some of the most important are:

Large numbers of buyers and sellers. By definition, markets that are dominated by monopolieis and monopsonies aren't competitive.
Perfect information. If the search cost for information is too high, people can't make informed decisions
Perfectly ration actors. (I sure as hell don't like the idea of my parents trying to decide between various insurance plans)
The ability of firms to freely enter / exit the market

NONE of these holds true for the health care market

[PassedOut]

Santorum needs to get a teleprompter.

[Winstonm]

Quote

I think that the whole "profit" issue is an un-necessary distractor.

All companies are profit motivated. The fact that health care companies are should not be held against them.

Maybe I didn't make the distinction fine enough - or maybe I am simply wrong - but it seems to me that using a business model (where maximizing profits is the goal) is not the same thing as a non-profit that makes a profit.

I am not naive enough to think that non-profit organizations are lilly white, but I would suggest that the non-profit model would make for a more harmoneus healthcare system.

[mike777]

Winston just said the system is a strawman.....

single payer is about the system or it is not.....


the system is not just about medical decisions...it is about thousands and thousands of daily decisions most not medical.


clearly you think a few the central govt can make these decisions best.....that is the dicussion....not what you seem to think it is.


Yet we see Medicare is a complete mess and we see Europe in decline. Clearly you think medicare is not in decline or europe.

ALets put it this way if you think Europe and medicare is great...then that closes the discussion.

YOU ARE RIGHT.

[hrothgar]

mike777, on 2012-March-30, 23:59, said:

Lets put it this way if you think Europe and medicare is great...then that closes the discussion.

Its relatively easy for something to be

"Significantly better than what we have in the US"

but not

"Great"

In all seriousness, the sheer inefficiency of the current US health care system is one of the few things that gives me hope wrt long term budgets.

We're SO bad at this that there are a lot of cost savings to be wrung out of the system when we finally go to single payer.

With this said and done, I occasionally wonder whether we're going to conclude that Logan's Run was onto something, even if they were a bit aggressive regarding the timing of it all...

[Winstonm]

Quote

clearly you think a few the central govt can make these decisions best.....that is the dicussion....not what you seem to think it is

One of us is wrong, and I am not clear who it is. It certainly could be me, but the only physician I have ever met and talked to who practiced in Canada (a U.S. citizen who left) told me the Canadian single payer is much better than the U.S. system because it puts the physicians in charge of heatlcare decision-making instead of using the fee-for-service arrangment of the U.S.

While it is accurate that eventually in single payer it is a government employee who determines payouts, personally I would rather entrust that decision to a group of government physicians than to the board of directors of Enron.

I think it is disingenuous to try to simplify this debate into one that paints a bleak picture that compares universal healthcare to handfull of uniformed cold fish in a dank, gray celler in Communist East Germany, doling out aspirins, while presenting the insurance-based business model as Uncle-Sam-style Democracy that cures cancer and wears a White Hat - haven't we finally outgrown those kids of nonsensical exaggerations?

The administrative costs of providing healthcare in the U.S. at present runs around 20%, while Medicare, a single-payer system, has overhead costs of 3% - yet some would argue that abandoning the present bloated healthcare delivery system would be equivalent to surrendering of American values.

If that argument is true, then America, her values, and her healthcare delivery system all need to change.

[PassedOut]

hrothgar, on 2012-March-31, 06:35, said:

In all seriousness, the sheer inefficiency of the current US health care system is one of the few things that gives me hope wrt long term budgets.

We're SO bad at this that there are a lot of cost savings to be wrung out of the system when we finally go to single payer.

No disinterested business person can reasonably dispute these points. The high-level metrics shout disaster, and any examination of the US health care operation confirms it. And Richard has also pointed out some of the basic reasons why the market cannot correct this on its own. Government intervention is necessary and inevitable.

Nobody thinks that the 2010 health reform is perfect. Far from it. But, under the political circumstances, it was the only way to begin giving our government the tools it needs to fix the problems that the market cannot. Lots more must be done, but we now have a start. Obama got the (former) republican notion of health care reform passed by a democratic congress, and all hell broke loose. Maybe the democratic notion of health care reform will fare better in the future. But so long as the US congress is bought and paid for by rich corporations as it is today, we're not going to get there.

As to Scalia's idea that free-riders should simply be left to suffer and die without care -- an idea that seems to have great appeal among today's republicans -- that is simply not acceptable. Not only would that be a nasty business in itself, but it is beneficial to the country to prevent the development of pockets of untreated disease. And it is much more productive to have a healthy workforce.

[Cthulhu D]

Healthcare can not function as a market in the adam smith sense. Hrothgar has already pointed out the factors needed for a functioning marketplace.

If you are bleeding out in an ER, you cannot solicit quotes from a number of surgeons, consult reviews to determine which one is the most effective, do some research on if the proposed surgery plan is most effect etc, because you are literally dying.

Also, it's hilarious than anyone can use phrases like 'European healthcare' - FYI, Spain and Finland are, you know, different countries, with a vastly different standard of delivered care. Also, Medicare US style is so rampantly poorly designed that it would make a greek Beaurcrat blush.

Quote

ALets put it this way if you think Europe and medicare is great...then that closes the discussion.

So in summary this doesn't mean anything. It's like me saying 'So if you think the moon and a mars bar are round, then that closes the discussion' it's just a non sequitur.

If the objective is to deliver the best healthcare outcomes for a given cost, the US can pick if it wants to be more like:

England and Wales
Canada
France

Those three models represent the triangle of healthcare cost control, outcomes and client satisfaction. Then if you're really good you can hope to deliver as effectively as Finland. Note that if the US could get it's costs down to English levels you can save a grand two grand per person per year. $3 $6 billion a year should focus the mind somewhat.

Edit: Fixed my numbers.

[PassedOut]

Cthulhu D, on 2012-April-01, 18:58, said:

Note that if the US could get it's costs down to English levels you can save a grand per person per year.

It's interesting to note that the US health care free-riders -- whose "rights" the republicans are fighting to establish -- cost the average family here about a grand per year.

[kenberg]

Cthulhu D, on 2012-April-01, 18:58, said:

Those three models represent the triangle of healthcare cost control, outcomes and client satisfaction. Then if you're really good you can hope to deliver as effectively as Finland. Note that if the US could get it's costs down to English levels you can save a grand two grand per person per year. $3 $6 billion a year should focus the mind somewhat.

Edit: Fixed my numbers.

Wouldn't that be 600 billion? 300 million times 2 thousand? But I take your point.

The late Art Buchwald once suggested using military aircraft as a unit of currency to help us keep the numbers straight. For example one could declare "I am not voting for a public health program that would cost two fighters and a wing".

[y66]

kenberg, on 2012-April-02, 05:57, said:

Wouldn't that be 600 billion? 300 million times 2 thousand? But I take your point.

The late Art Buchwald once suggested using military aircraft as a unit of currency to help us keep the numbers straight. For example one could declare "I am not voting for a public health program that would cost two fighters and a wing".

I miss that guy.

[y66]

What is ALEC? Scary.