Here is a debate I am having with my roomate, ENTP. Enjoy
Saul,
You made some claims against UK health care in our last discussion. While I think the UK system is not without flaws, neither are the US or other systems. However, I suggested\believed the UK is much cheaper per person and so I looked it up to be sure (6719 vs 2815 by one study and another one with a closer margin but still around twice as much).
http://www.guardian.co.uk/
http://www.liberalconspiracy.<...are-facts/
http://www.commonwealthfund.
http://www.joepaduda.com/
You can also note the comparisons of nurses\doctors\hospital beds\life expectancy and UK also comes out ahead according to this study. Doesn't seem to be this horrible system one would believe if they only listened to the right wing media machine. It actually seems to even be better. You can note how they have constantly attacked the NHS as an organized campaign sometimes with humorous & amazingly hypocritical bravado(
http://www.practicalethi...e-nhs.html)
Here is US rank in the world:
http://en.wikipedia.org/wiki/<...br>GDP.png
You need to be more careful when getting information from conservative sources these days. I remember awhile back when you posted something from Bloomberg on Facebook (
http://www.bloomberg.com/) which I was able to immediately thoroughly debunk while also pointing out the lack of credibility of the author.
http://www.huffingtonpost.com/...15012.html
http://www.factcheck.org/2009/...rs-orders/
http://www.huffingtonpost.com/...65547.html
You have sometimes criticized me for reading some liberal websites but you will never catch me posting or citing some study, poll or fact that is questionable. I always verify controversial stuff. And as a matter of fact, as soon as I read this article you posted awhile back I immediately sensed it was bs.
On another note, here is an article on French health care. A hybrid system many think is one of the best including WHO who ranked it #1 based on their criteria.
http://healthcare-economist.
My response
Jason,
Before I begin I want you to know that I respect your opinions and believe you are very intelligent. No. I think you are brilliant. I'm
glad I worked on this and did not party tonight.
We both want happiness for our fellow man and differ on how best the
state should serve that end.
I really would like to see your opinions on the reforms at the very end.
France:
I'm going to study the french model and come back you. Noting that
france is rated 1#. After living in france I tell you the french know
how to live. Their socialist system is great living. I'm not joking,
I almost did not come back to the US. If i didn't have a girlfriend
at the time I may not have.
England:
What I was criticizing was real. What I want is better service at
lower prices so the poor can afford medical treatment. I never stated
that socialized medicine was horable. I never stated that people will
go without. Let me clarify: with universal health care a single payer
system. innovation will be delayed for many reasons; government
organizations are insulated from competition, there is less of a drive
for improvement because there is no threat of being supplanted by
others. I'm not saying there will be NO improvement. There will be
marginal improvement but there is no incentive for radical change and
ideas. I think it was you who said that large corporations are guilty
of not taking risk (risk as defined as trying to do things better with
out having all data), i think that holds especially true for large
government beurcracies . Also consumers have a lower incentive to
watch their consumption as they do not pay costs in direct proportion.
(i like high deductable plans with HSA accounts) I can be a fat jesus
loving freak because Saul and Jason will pay for it. I will also study
the NIH better too.
Bloomberg Article:
Let me get back to this when I have more time.
English system v American system
Jason, After reflection and reading the data you are right. The
english system is better. We are comparing quisi-socialist system to a
socialist system
With the act of 86 we are half there. 1/2 of
emergency room visits are indigent. Every one over 65 qualifies for
medicare, 50m people qualify for medicaid and as of now 30m people in
the US are on welfare or food stamps.
Problems with cost
APX 40 years ago American medical spending was estimated at 5 percent
of national income; today it is calculated at some 16.5-18& percent
and rising continually.
Here are some reasons that people throw out there for why the cost of
medical care is high but I disagree:
a) present generation of Americans, which enjoys a level of income and
living standard higher than that of its forebears, is more mindful of
health and wholesome living and, therefore, is spending a larger share
of income on health care.
b) present generations of Americans care less about health - as
evidenced by ever growing number of Americans who are overweight or
even obese, and use drugs and alcohol; which may breed physical
disorders and afflictions and finally acquire medical attention.
c) the endless stream of medical innovations responsible for rapidly
rising health-care costs, such as new drugs and delicate tools for
microsurgery. (jason we both know that most technical innovations
lower the costs of production)
http://www.npr.org/templates/<...>112522353
d) a massive expansion of medical insurance which pays doctors and
hospital bills. They blame insurance companies for the actual cost of
medicine.
e) Medical malpractice: I think this is a problem but not as much as
people make it out to be.
Their argument is that doctors drive up expenses always ordering needless
testing for CYA. So when people go in to the hospital for head ache a
doctor will order an MRI which costs 1,000 dollars (person pays
deductible +20) and thus costs go up. So there are less law suits
because doctors are UBER careful. And they don't complain about it
because they own the MRI machine. I am sympathetic to the defensive
medicine argument but not to much.
BECAUSE of the costs 50,000,000 Americans... and I am one of them dont
have health insurance. This is also a major problem.
So far we are in agreement.
When I talk to my father, who started practicing medicine in the late
70s he and others will tell you that expensive health-care costs are
the inevitable consequence of a 1965 social security amendment which
spawned Medicare and Medicaid.
These are welfare programs that cover most people aged 65 and older as
well as all needy individuals. Medicare pays 41 million elderly and
disabled person and medicaid serves 50,000,000 poor beneficiaries and
is responsible for 20% of average state total spending
http://www.texaspolicy.com/kh.pdf
I agree that like any welfare program it has done good. It has
increased quality of living for countless people. But like all
policies there are cause and effect. I agree with you that in order
to have smart policy we must look at the ramifications of our policy
and see the negative with the positives.
Medicare and Medicaid are political footballs and like all entrenched
subsides will always be well defended by people who receive benefit
from them. How many Politicians talk about medicare and medicaid
reform or social security reform other then raising taxes and boosting
spending?
As costs have gone up for these programs many have proposed
a) to reduce the cost-of living increases in benefits
b) others plan to increase the wage subject to payroll taxation. In
2005 the benefit-politicians raised the maximum earnings subject to
Social Security tax exactions to $90,000 with the tax rate at 12.4
percent, borne equally by employer and employee. In 2006 they raised
the maximum to $94,200;
2008: 12.4% of earnings up to 102,000 + 1.45% on all earnings
2009: 12.4% of earnings up to 106,800 +1.45 on all earnings
(jason this is on top of federal income tax, state income tax,
real-estate tax and sales tax)
In 2003 Republicans and Democrats voted for prescription drug coverage
for Medicare - (
http://en.wikipedia.org/wiki/<...zation_Act)
Now a 10 year cost of $1.2 trillion as it was advertised it would only
cost $450 billion - talk about Bush administration deception haha
So as you can see the government is heavily invested and regulates
healthcare. This is not a free market. There are few areas that are
not regulated by state and federal governments in regards to health;
from adopting and distribution of drugs drugs, medical equipment,
mandatory treatment of poor and indigents hospitals, IT, insurance,
welfare, licensing of doctors and nurses:
http://useconomy.about.com/od/...>htm
http://www.hhs.gov/policies/index.html
Other reasons why Health Costs are high:
1) No free market competition. Doctors have their fees set by
insurance companies and Medicare, so they can’t advertise low prices.
Nor can they advertise higher prices but better service.
2. Bureaucratic medical billing- extra labor-extra cost
3. Malpractice insurance - not the huge expense republicans make it
out to be but it is there, because of the CYA and Defensive Medicine
4. Drug Company Advertising they spend more money advertising vs. R&D
(i haven't found a solution for this yet) Or maybe there isn't one b/c
distribution is important.
5. The Emergency Medical Treatment and Active Labor Act of 1986: All
medical facilities are required, under severe penalty for
noncompliance, to provide emergency care regardless of ability to pay.
It’s an unfunded mandate. With this law we sealed the deal on
socialized medicine but did it non efficiently.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
-because of this act we already have half assed socialized medicine.
I think the argument is; "it would be better to have full blown with
full care then the fucked ups shit we have now" - More than half of
all emergency room care in the U.S. now goes uncompensated. Hospitals
write off such care as charity or bad debt for tax purposes.
6. Nurses or sub-doctors need to have more power. Doctors are
expensive - why can't a Nurse with a bachelor's degree handle simple
cases???
End of life care: I am all for death panel's
why take 100,000s of
thousands of dollars so grandma lives an other 6 weeks in pain.
Agreement with you.
Free Market Examples:
Lasik eye surgery: Open competition, prices and service advertised!
Laser eye surgery has the highest patient satisfaction ratings of any
surgery, it has been performed more than 3 million times in the past
decade, it is new, it is high-tech, it has gotten better over time
and... laser eye surgery has fallen in price. In 1998 the average
price of laser eye surgery was about $2200 per eye. Today the average
price is $1350, that's a decline of 38 percent in nominal terms and
slightly more than that after taking into account inflation.
Abortion: Jason, abortion isn't covered by insurance. Therefore
doctors have to compete with open competition for service and price.
This article from the national abortion federation talks about the
costs. from $350 to 1,000 for ones with complications. That is cheap
for a medical procedure.
http://www.prochoice.org/
As you know I am a big fan of states innovating and experimenting with
solutions. One reason why I don't like federal control is that it
pre-supposes you can have all available information and have all
available results of that policy and one policy for all communities.
Here is an interesting article from a prof at harvard about the
Massachusetts healthcare system. If you read only one thing that I
post please read this:
What I like:
What i would like to see more personal control and true reform. You
can't have smart solutions if you won't even think about rational
options. free market solutions I have seen that people are not even
thinking about:
1. Eliminate (over time) all licensing requirements for medical schools,
hospitals, pharmacies, and medical doctors and other health-care
personnel. Their supply would almost instantly increase, prices would
fall, and a greater variety of health-care services would appear on
the market. Competing voluntary accreditation agencies would take the
place of compulsory government licensing — if health-care providers
believe that such accreditation would enhance their own reputation,
and that their consumers care about reputation, and are willing to pay
for it. Because consumers would no longer be duped into believing
that there is such a thing as a "national standard" of health care,
they would increase their search costs and make more discriminating
health-care choices.
2. (I'd like to see this over the next 20 years, but NOT NOW) Eliminate
all government restrictions on the production and sale of
pharmaceutical products and medical devices. This means no more Food
and Drug Administration, which presently hinders innovation and
increases costs. Costs and prices would fall, and a wider variety of
better products would reach the market sooner. The market would force
consumers to act in accordance with their own — rather than the
government's — risk assessment. And competing drug and device
manufacturers and sellers, to safeguard against product liability
suits as much as to attract customers, would provide increasingly
better product descriptions and guarantees.
3. Deregulate the health-insurance industry. Private enterprise can offer
insurance against events over whose outcome the insured possesses no
control. One cannot insure oneself against suicide or bankruptcy, for
example, because it is in one's own hands to bring these events about.
Because a person's health, or lack of it, lies increasingly within his
own control, many, if not most health risks, are actually uninsurable.
"Insurance" against risks whose likelihood an individual can
systematically influence falls within that person's own
responsibility. All insurance, moreover, involves the pooling of
individual risks. It implies that insurers pay more to some and less
to others. But no one knows in advance, and with certainty, who the
"winners" and "losers" will be. "Winners" and "losers" are distributed
randomly, and the resulting income redistribution is unsystematic. If
"winners" or "losers" could be systematically predicted, "losers"
would not want to pool their risk with "winners," but with other
"losers," because this would lower their insurance costs. I would not
want to pool my personal accident risks with those of professional
football players, for instance, but exclusively with those of people
in circumstances similar to my own, at lower costs.
4 Because of legal restrictions on the health insurers' right of
refusal — to exclude any individual risk as uninsurable — the present
health-insurance system is only partly concerned with insurance. The
industry cannot discriminate freely among different groups' risks. As
a result, health insurers cover a multitude of uninsurable risks,
alongside, and pooled with, genuine insurance risks. They do not
discriminate among various groups of people which pose significantly
different insurance risks. The industry thus runs a system of income
redistribution — benefiting irresponsible actors and high-risk groups
at the expense of responsible individuals and low-risk groups.
Accordingly, the industry's prices are high and ballooning. To
deregulate the industry means to restore it to unrestricted freedom of
contract: to allow a health insurer to offer any contract whatsoever,
to include or exclude any risk, and to discriminate among any groups
of individuals. Uninsurable risks would lose coverage, the variety of
insurance policies for the remaining coverage would increase, and
price differentials would reflect genuine insurance risks. On average,
prices would drastically fall. And the reform would restore individual
responsibility in health care.
Please let me know what you think about the purposed solutions.