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SFTor
Guest
Oscar, are you really recommending “entrepreneurial” coronary bypasses?
Respectfully,
Tor
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Respectfully,
Tor
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Oscarthecat
Guest
Follow the link to the previous discussion on this topic.
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SFTor
Guest
Oscar, please steer me towards some hard data on the efficiency of Medical Savings Accounts in the real world. Some states or countries where the system is in use would be nice.
Please also give me your latest numbers on the per-capita or per-household savings rate in the United States.
Respectfully,
Tor
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Oscarthecat
Guest
I look forward to anything new you may have to discuss that hasn’t already been addressed in previous posts.
Until then, I encourage you to read previous posts.
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SFTor
Guest
Oscar, I understand if you are getting tired of this debate. That’s understandable. You accuse me of bringing nothing new to the discussion, and perhaps I don’t. I find that you need to hear that your contributions are invariably theoretical, ideological, or largely untested in the real world.
You insist in advancing these theoretical constructs as real solutions to an issue of major importance to the basic viability of the country. I for one am arguing against this approach, as I can’t see that ideologically based experiments have any place in this arena. It’s too important for that, and pragmatic solutions must take precedence. I find that your foremost motive is to avoid “socialism” and government tyranny of the patient population. I look to countries with public health care and see no tyranny.
I also sense a great deal of animosity and a rather dismissive attitude towards government in general. Whether this is warranted or not is beside the question. It is however a strange and unfortunate attitude in any citizen of a democracy. This country depends on involved citizens, and the engagement needs to be focused on improving the quality of government. It is in the end meant to be the expression of the shared values of all Americans.
We have data on two potential systems today: the American system, which is mostly private, and the systems of all the other industrialized nations, which are mostly public. The verdict is in as regards the effectiveness of these systems on a society-wide level. The public system works better according to data from the OECD and WHO, on two major parameters: cost and outcomes. This is not up for discussion, although it does not mean that the public systems are not facing significant challenges as well.
This is why I believe the only solution we have today is to adopt the system that, simply put, works better. We don’t have anything else. Maybe your suggestions could work, and maybe this could be determined in small-scale experiments in different states or communities, but to deploy such solutions on a countrywide scale belongs in an imaginary world. No responsible government can take that risk with its country’s ability to care for the sick and injured, and with the general health of its population.
We can also take the discussion to the next level, to questions of social responsibility and altruism. Again the notion of sharing the burden for health care seems superior to me, as opposed to a system where wealth determines access.
Perhaps it is a quaint notion in this country that we should participate in the care of an increasingly sick and aging population. Perhaps it is outmoded, but some may remember that these are the people who spent their lives building the communities and the wealth we enjoy today, and protected our freedom. We may disagree on this, but the final word is with ordinary Americans, who will decide whether this is a society that shares its burdens, or leaves behind the ones who no longer have, or never had, the earning power to receive the medical care they need when they need it most. This is happening today, and this country has not yet made a definitive move either way.
So let me just say this: this is an issue that goes to the wallet and the heart of America. I will trust that most Americans will in the end see that their interest lies towards inclusiveness and shared responsibility. If not I think the sickness of the country is worse than we realize.
Respectfully,
Tor
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onetimeposter
Guest
**Everyone in Canada. **
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SFTor
Guest
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stevegravy
Guest
From SFTor
"also sense a great deal of animosity and a rather dismissive attitude towards government in general. Whether this is warranted or not is beside the question. It is however a strange and unfortunate attitude in any citizen of a democracy. This country depends on involved citizens, and the engagement needs to be focused on improving the quality of government. It is in the end meant to be the expression of the shared values of all Americans.
We have data on two potential systems today: the American system, which is mostly private, and the systems of all the other industrialized nations, which are mostly public. The verdict is in as regards the effectiveness of these systems on a society-wide level. The public system works better according to data from the OECD and WHO, on two major parameters: cost and outcomes. This is not up for discussion, although it does not mean that the public systems are not facing significant challenges as well.
This is why I believe the only solution we have today is to adopt the system that, simply put, works better. We don’t have anything else. Maybe your suggestions could work, and maybe this could be determined in small-scale experiments in different states or communities, but to deploy such solutions on a countrywide scale belongs in an imaginary world. No responsible government can take that risk with its country’s ability to care for the sick and injured, and with the general health of its population.
We can also take the discussion to the next level, to questions of social responsibility and altruism. Again the notion of sharing the burden for health care seems superior to me, as opposed to a system where wealth determines access.
Perhaps it is a quaint notion in this country that we should participate in the care of an increasingly sick and aging population. Perhaps it is outmoded, but some may remember that these are the people who spent their lives building the communities and the wealth we enjoy today, and protected our freedom. We may disagree on this, but the final word is with ordinary Americans, who will decide whether this is a society that shares its burdens, or leaves behind the ones who no longer have, or never had, the earning power to receive the medical care they need when they need it most. This is happening today, and this country has not yet made a definitive move either way.
So let me just say this: this is an issue that goes to the wallet and the heart of America. I will trust that most Americans will in the end see that their interest lies towards inclusiveness and shared responsibility. If not I think the sickness of the country is worse than we realize.
Respectfully,
Tor"
I say every perk and privilege that all the members of the senate and congress receive every single American also gets. They…the lying, thieving, debased, abusers of the public treasury, those skunks in congress must be forced to live with the same stinking government mismanaged health care system that will be forced on the rest of us. If we end up with a two tiered plan one for them and one for everyone else then it is a sham and hypocrisy to advocate any kind of Universal any thing. …. If those rats get away with having a special system for themselves then I say just go ahead and impose slavery or what ever they do in China because at least there they do it without the base alloy of hypocrisy. If you don’t think my concerns are real then lets ask the question, why doesn’t the railroad workers and most state and municipal employees have to pay into social security.
"also sense a great deal of animosity and a rather dismissive attitude towards government in general. Whether this is warranted or not is beside the question. It is however a strange and unfortunate attitude in any citizen of a democracy. This country depends on involved citizens, and the engagement needs to be focused on improving the quality of government. It is in the end meant to be the expression of the shared values of all Americans.
We have data on two potential systems today: the American system, which is mostly private, and the systems of all the other industrialized nations, which are mostly public. The verdict is in as regards the effectiveness of these systems on a society-wide level. The public system works better according to data from the OECD and WHO, on two major parameters: cost and outcomes. This is not up for discussion, although it does not mean that the public systems are not facing significant challenges as well.
This is why I believe the only solution we have today is to adopt the system that, simply put, works better. We don’t have anything else. Maybe your suggestions could work, and maybe this could be determined in small-scale experiments in different states or communities, but to deploy such solutions on a countrywide scale belongs in an imaginary world. No responsible government can take that risk with its country’s ability to care for the sick and injured, and with the general health of its population.
We can also take the discussion to the next level, to questions of social responsibility and altruism. Again the notion of sharing the burden for health care seems superior to me, as opposed to a system where wealth determines access.
Perhaps it is a quaint notion in this country that we should participate in the care of an increasingly sick and aging population. Perhaps it is outmoded, but some may remember that these are the people who spent their lives building the communities and the wealth we enjoy today, and protected our freedom. We may disagree on this, but the final word is with ordinary Americans, who will decide whether this is a society that shares its burdens, or leaves behind the ones who no longer have, or never had, the earning power to receive the medical care they need when they need it most. This is happening today, and this country has not yet made a definitive move either way.
So let me just say this: this is an issue that goes to the wallet and the heart of America. I will trust that most Americans will in the end see that their interest lies towards inclusiveness and shared responsibility. If not I think the sickness of the country is worse than we realize.
Respectfully,
Tor"
I say every perk and privilege that all the members of the senate and congress receive every single American also gets. They…the lying, thieving, debased, abusers of the public treasury, those skunks in congress must be forced to live with the same stinking government mismanaged health care system that will be forced on the rest of us. If we end up with a two tiered plan one for them and one for everyone else then it is a sham and hypocrisy to advocate any kind of Universal any thing. …. If those rats get away with having a special system for themselves then I say just go ahead and impose slavery or what ever they do in China because at least there they do it without the base alloy of hypocrisy. If you don’t think my concerns are real then lets ask the question, why doesn’t the railroad workers and most state and municipal employees have to pay into social security.
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cynic
Guest
What motivation would a government run insurance scheme have to not pay? It’s easy to see why a private insurance company would try and get away with it - increased profit and share price.
Most people accept socialism as government control of the means of production, with the abolition of private property etc. To use it as a casual insult in the debated is boring and childish.
O
onetimeposter
Guest
Canada is as capitalistic as the U.S., yet we have UHC…and were healthy. We have a minority conservative government in power…contrary to what some people choose to believe…we are not a socialist state.
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jman507
Guest
What motivation would the government run insurance scheme have to not pay? It’s fiscal policy is very important to the economy. It can sink the value of the currency, and encourage inflation. While there may be a profit motive to drive business, likewise when it comes to government there can always be problems due to waste and some degree of cronyism. Also very important is economically an entity can only run so long in a condition where it spends more than than the incoming revenue, before it starts to break down. Eventually the US can only take on so many liabilities before they either have to default on them, or cut out other important spending.
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SFTor
Guest
Here is the difference as far as I see it: health care will no longer be a profit center, but a cost center.
You will pay more taxes, but will no longer have to pay health insurance.
The public agency (known by some as Medicare 2.0) will pay independent physicians and medical groups. With the pressure on cost in our health care system there will be very strong incentives to look for savings.
The main ones that I can see is savings on administration (demonstrable today), bargaining on drug prices (demonstrable today), greater use of social medicine and preventive care (possible and feasible), less use of end stage and futile care (ditto), and greater use of hospice care for end stage patients (ditto.)
Will it work? Yes, if we build a strong public federal agency or state agencies run by competent people—they exist. Administrators will be answerable to Congress and state governments. Presumably denial of care will be difficult to do if the whole purpose of the agency is to provide it, and is mandated to do so by law.
It is not a small task, but this country has taken on bigger challenges in the past.
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SFTor
Guest
Sounds like an excellent idea. I’m all for it. It would certainly help keep politicians honest.
Best,
Tor
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cynic
Guest
who says a government run scheme wouldn’t be able to at least break even? They could have the same policies as private providers to limit abuse, however they wouldn’t actively seek to deny claims, or push the price up just for the sake of profit.
J
jman507
Guest
So basically what you are saying as you become older more expensive options are going to be off the table. Unfortunately it may be hard for a large bueraucracy to tell the difference between individual cases. Less money will allowed to be spent on more expensive procedures, but more will be sunk in preventive medicine. There will probably be more laws aimed at what seem to be causes of health problems such as types of food.
Chances are even if denial of care will be presumably explicitly less, it will be perceived to be implicitly more, because of the difference between consideration of care available before and after the new system is in place. (Granted it will take a while before the effects of the transition may be felt. Part of that may also be unwarranted due to the nature of the increasing demand on care.)
Then with Congressional oversight which has a great track record of being more reactionary, causing problems due to its tendency to care more about the short term, than the long term. They’ll come up with a policy that seems to solve the problem, then later on have to deal with the unintended consequences from it.
Innovation could be slowed. Even though research money will come through the NIH, much of the end stage development will have to come through private entities. Their consumers will be more cash strapped. As they say you can have your goods and services fast, cheap, or with good quality, but you cannot have all three.
Also you may have once the “greying” of the industrialized nations becomes more and more of a fiscal problem, you may have once again another burgeoning private insurance market for the rich. Since many of the members of Congress are also rich, I’m sure they’ll do just fine, and may also have a conflict of interest to break down a “second tier” of insurance.
That “greying” of the industrilized world, not only encompases medical care, but also any pension programs. On top of that, there is also the problem of energy prices. Now if we can have a breakthrough that greatly reduces the amount of cost of energy, we may have to settle for slower growth of the economy. Which leads to problems of what do you cut out?
So will it work, of course it will work. The only way for it to not work if for no money to go into the system, or no one to accept the money as payment. Is it the best policy, well, nominally the “best” policy is irrelevant. The “best policy” depends upon what you think is the best policy due to your ideological philosophy of what the best policy would do. Then in actuality, how close that policy is to your aims for the policy.
As far as the Americans facing bigger challenges, what exactly was that? To create a huge bureaucracy that will ensure great health care to the masses, seems to me, to be an impossible task. It depends upon you think “great” means. As they say, you cannot please everyone all the time.
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SFTor
Guest
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DL82
Guest
One of the big oversights in all these debates about public vs private healthcare is the assumption that private healthcare is somehow customer-run and value-neutral. It is not.
Why are some people so scared of trusting their government (whether Federal or State) who they elected, and who are accountable to the electorate, but quite happy to trust private companies who are only accountable to their share-holders for the profits they make!
If the choice were between health-insurance co-operatives run at local level where people agreed to share their wealth with one another as any had need, and government healthcare, sure, there would be an argument against getting government bureaucracy involved. This isn’t about that, it’s about huge companies with expensive bureaucracies, who exist not to help people get healthcare but to help their shareholders to get rich.
Every time you go to see a doctor in America, you’re paying for two doctors, one to examine you and tell you what treatment you need, the other to examine that doctor’s paper-work and tell you what treatment you don’t need! This is an enormous waste of resources. With a universal healthcare programme, the government can trust the doctor who examines you to decide what treatment you need. There is no incentive for government to waste money on the kinds of claims assessment common to American private healthcare.
Trust me, universal healthcare works pretty well here in the UK.
Another advantage of universal healthcare is it provides a check on the cost of private healthcare. For example, a few years back I needed a scan for something which was worrying me. The scan would have taken 3 weeks in a free hospital, which wouldn’t have been a problem, except that I was really stressed at the time, and am very anxious about some aspects of my health, so I went to get it done privately. It cost £200, which was quite reasonable, and that’s without insurance! If it had cost £2000, I would have waited 3 weeks instead, because I had the choice between a premium service and something else. Because Americans don’t have the choice of something else, the scan could cost $10,000, because you either pay it or don’t get anything. That’s not a fair free market, that’s a price-fixing monopoly! Our free market for healthcare in the UK, perversely, works far more fairly than America’s, precisely because we have a non-market alternative.
Why are some people so scared of trusting their government (whether Federal or State) who they elected, and who are accountable to the electorate, but quite happy to trust private companies who are only accountable to their share-holders for the profits they make!
If the choice were between health-insurance co-operatives run at local level where people agreed to share their wealth with one another as any had need, and government healthcare, sure, there would be an argument against getting government bureaucracy involved. This isn’t about that, it’s about huge companies with expensive bureaucracies, who exist not to help people get healthcare but to help their shareholders to get rich.
Every time you go to see a doctor in America, you’re paying for two doctors, one to examine you and tell you what treatment you need, the other to examine that doctor’s paper-work and tell you what treatment you don’t need! This is an enormous waste of resources. With a universal healthcare programme, the government can trust the doctor who examines you to decide what treatment you need. There is no incentive for government to waste money on the kinds of claims assessment common to American private healthcare.
Trust me, universal healthcare works pretty well here in the UK.
Another advantage of universal healthcare is it provides a check on the cost of private healthcare. For example, a few years back I needed a scan for something which was worrying me. The scan would have taken 3 weeks in a free hospital, which wouldn’t have been a problem, except that I was really stressed at the time, and am very anxious about some aspects of my health, so I went to get it done privately. It cost £200, which was quite reasonable, and that’s without insurance! If it had cost £2000, I would have waited 3 weeks instead, because I had the choice between a premium service and something else. Because Americans don’t have the choice of something else, the scan could cost $10,000, because you either pay it or don’t get anything. That’s not a fair free market, that’s a price-fixing monopoly! Our free market for healthcare in the UK, perversely, works far more fairly than America’s, precisely because we have a non-market alternative.
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BamaRider
Guest
Ask the folks in Katrina Land what happens when you trust the govt.
It was Wal Mart and its vast, efficently run network supply and distribution that rushed aid into the area, weeks ahead of the govt.
I trust myself and my BCBS insurance to take care of my health needs, ahead of *any *govt agency. But I’m talking to a person that trusts the people that run Social Security to run his healthcare, so I dunno if I can get through or not.
P
pathia
Guest
It’s nice that you can get a BCBS plan, I wish I could. Some of us just can’t, we’re completely uninsurable in the free market. Why should I have to crawl on my knees and beg for money to get healthcare, when the all-mighty free market just outright FAILS me. I have/used to have the income to afford a policy, but they just don’t cover me, period.I trust myself and my BCBS insurance to take care of my health needs, ahead of *any *govt agency. But I’m talking to a person that trusts the people that run Social Security to run his healthcare, so I dunno if I can get through or not.
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Oscarthecat
Guest
You’ve mentioned “begging” a number of times, so I think it is worth noting that in all my years working for and with privately funded social services agencies, I never once saw anyone crawl on their knees or beg to receive services. For that matter, I don’t ever remember even thinking about having someone do that.
In fact, I don’t think that I’ve ever even heard anyone working for a social services program say “you know what, I think that it would be a good idea if we made these folks crawl on their knees and beg for money before we help them.” They don’t even joke about it.
Typically, we would just ask them to fill out a little paperwork (most of which was for the purpose of complying with arbitrary government regulations), talk to them about what they need, and see what we could do to help them. Of course, there were those cases where the individual’s needs were so immediate that we just skipped all of that gave them what they needed right away- even though we usually got in trouble with the government bureaucrats when we did that.
I find it insulting that you consistently characterize people working for social services agencies the way you do. The people working at these places are generally there because they genuinely want to help people- they certainly aren’t there for the pay, the benefits, or the hours.
In fact, in my experience, the ones who “burn out” because of the low pay and long hours typically leave private social services agencies to go work for government programs because of the better pay, shorter hours, and lower standards. Of course, I’m not saying that’s universally true of all government employees working in social services, I’m just talking about my experience-
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