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On July 18 2009 06:07 TanGeng wrote:
The main source of problems that may arise in your hypothetical is in the geographical monopoly of the hospital and not insurance. Exorbitant charges by the hospital would have to be countered by a some kind of community demonstration, building a new hospital in the area, and directing all marginal emergency cases to more distant emergency rooms.
So let me get this straight:
The problem - hospital is too expensive
The cause - insurance company has negotiated monopoly of service with this hospital, reduced fees are "negotiable" but still probably exorbitant
The solutions -
- community demonstrations (lol like that would do anything)
- building a new hospital (you call this an efficient market? Hospitals cost millions and millions of dollars to build)
- diverting people to further away hospitals (again, waste of resources, lots and lots of time and money is wasted by having coordinators and probably lawyers representing different organizations arguing about just how this would be accomplished, what constitutes "marginal", etc.)
Wouldn't it be a lot easier to have a system where no one ever gets screwed over by geographic profit-seeking monopolies to begin with?
And yes, if an insurance company lobbies medical providers to sign exclusive arrangements, the problem is with the insurance company as well. And if there are no laws to stop them from doing that, that is exactly what would happen.
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On July 18 2009 06:35 TanGeng wrote:
Apollo program and its counter part in USSR Sputnik were both huge wastes of money. They had no practical use. (It was certainly inspiring!) Manned-spacecraft was not very useful. It's still not all that useful. Most useful technology in space are all unmanned - communication satellites, spy satellites, and extraterrestrial telescopes. Development of technologies like the LEM and many other devices related to manned-space craft are still technological dead-ends with respect to useful applications earth-side.
Why didn't private companies then develop nuclear fission or the internet?
You say manned spacecraft was not very useful as if we will never make them again. Someday, it will be profitable to send people into space (see Virgin Galactic). The barriers to enter that market will be much lower thanks to the research into heavy-lift rockets, ground control organization, orbital mechanics, composites, the physiology of space travel, orbital assembly, etc. that were done by these "wasteful" programs.
Future manned space entrepeneurs will not have to do any of that work because it's already out there as a model to follow, making it more likely for companies to enter the market without needing immense R&D capital that only the largest of companies (and governments!) could afford up front.
Currently, there are space faring ventures being launched with private capital. Total capitalization of each of these ventures is 30 times smaller than what NASA will spend in one single year, and they expect to be profitable - rather than a 20 billion dollar sinkhole every single year.
Pets.com "expected" to be profitable. Webvan "expected" to be profitable. If they didn't "expect" to be profitable they wouldn't get venture capital and wouldn't exist. They "expect" to be profitable because all of the research and development of rocketry as we know it was already developed by not-for-profit institutions over the last few decades, and their failure rate is still extremely high.
I work for a privately held for-profit company. Because we're not accountable to shareholders, we're able to invest money on higher-risk ventures that shareholders would never approve, and since we're not legally obligated to maximize quarterly profits, we don't need to see a return on investment as quickly. We have many very profitable programs that would have never been developed if we were a publicly held company because having a sound long-term plan was more important than instant results.
Government is inefficient. I've seen it first hand. But sometimes it's extremely harmful and destructive. I could live with its inefficiency, if government would merely refrain from doing anything destructive.
The whole point of government is to offer services and research that are not profitable to operate (such as basic research into the hard sciences) or represent a conflict of interest if they were to be operated in a for-profit manner (for example, for-profit prisons encourages the companies that run them to lobby for stricter and less reasonable laws because prisoners are profitable).
As for the faults in free society: Charity, altruism, and sense of community is really strong. Much of what is unprofitable and avoided by for-profit ventures will be covered by charities and through the kindness of neighbors. Beyond that, activities beneficial to society but unprofitable usually suffer from an incomplete or incorrect model for coordinating effort and resources from those willing to do the work and those that will eventually benefit. Develop the correct business model to do do these activities and it will get done.
If an insurance company drops coverage on someone who needs major (read: expensive) surgery because they had an outstanding $7 bill a decade ago, "charity, altruism, and a sense of community" might get their lawn mowed, it won't get them a six-figure hospital bill
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The only way oligopolistic and monopolistic organizations come about is due to government regulations that allow larger organizations to crush smaller ones, thereby negating smaller organizations advantages (i.e. less bureaucracy) and allowing for a few large corporations to seize control. This is false.
The entire history of this phenomenon says the opposite: from robber barons to viking greenland, from the guild system to country clear cutting, consolodation always occurs in the long run. Standard Oil wasn't the result of 'too much regulation'.
Apollo program and its counter part in USSR Sputnik were both huge wastes of money. They had no practical use. (It was certainly inspiring!) Manned-spacecraft was not very useful. It's still not all that useful. Most useful technology in space are all unmanned - communication satellites, spy satellites, and extraterrestrial telescopes. Development of technologies like the LEM and many other devices related to manned-space craft are still technological dead-ends with respect to useful applications earth-side. NASA's current quote is that every dollar spent on space R&D has produced 10 dollars in the american economy via the private use of the new composite, robotics, etc technology they produced.
So maybe the technologies eventually do dead end, but the process of centralizing R&D and operating at such a large scale clearly add net value.
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On July 18 2009 07:27 L wrote:
The entire history of this phenomenon says the opposite: from robber barons to viking greenland, from the guild system to country clear cutting, consolodation always occurs in the long run. Standard Oil wasn't the result of 'too much regulation'.
Guilds use force and government force to crush free trade.
Robber barons used information denial in order to quickly consolidate their gains. Information is now much more widely available and thus the likes of rapid consolidation are unlikely to happen again.
Viking Greenland I would not consider to be a private business.
Consolidation does not naturally occur in the long run. Entropy yayyyyyy~~~
Consolidation only occurs when the means to do so exist, i.e. the use of force. The use of force these days is primarily through government.
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PHYSICAL force is consolodated via government because otherwise you get non process driven usage, which happens when gangs enter the market, which they do, did, and will do again. Guilds essentially were the result of private enterprises restricting access to training, materials, supply lines, etc. Guild-form private enterprise still exists in the form of professional orders, and have dropped the bulk of their anti-competitive practices because governments normally legislate them into existence, or regulate their operation directly.
Other forces, such as the ones used by standard oil (go look them up) led to the rapid consolidation and aquisition of nearly 90% of the market share in a number of key areas. When the government tried to prevent him from doing so, he split up his company and organized them via a trust so that he could get around the legislation. Anti trust legislation isn't about trusting the company: it was about using a shell trust to circumvent governments trying to regulate the industry and was introduced specifically to break up THAT company, because it controlled pretty much every level of oil production. It wasn't them using force, it was them undercutting, refusing rail access to other companies (because they also controlled most of the rail lines, and most of the steel plants used to make the engines and tracks), and preferentially giving lower oil rates to compliant companies. This cute experiment resulted in John D. Rockefeller becoming the world's richest man ever, with a current inflation adjusted wealth of 320 billion or so.
But that's the government's fault, right? In the sense that the government prevented gangs from killing him and looting his property, yes. In the sense that regulation itself caused the incident? No. It was his circumvention of legislation that caused it. It is a prima facie example of THE PRECISE OPPOSITE of what you're claiming.
Viking greenland was a collection of privately owned farms which over the span of 500 years or so consolidated as bad winters forced small farms under and forced their owners into vassalage to the larger farm owners. It is nearly a perfect analogy to large companies being better able to weather cyclical downturns and presents a worrisome challenge when companies can create 'bad winters' by a number of anti-competitive tactics.
Your assertion that the GOVERNMENT made monopolies form instead of monopolies being the end-preference to anyone in a certain market is ridiculous.The government itself can be seen as the end result of a monopoly on physical force, the existence of which everywhere across the world besides native new guinea (and even then there there are analogous forces) is a pretty obvious example of the centralizing and consolidating effect of cornering the market.
Lol, i seriously can't believe this is even a point of contention.
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No he's right see here I found proof:
As you can see from this image, in 1984, AT&T voluntarily split itself up so all the smallest companies could compete to provide the best service (the free market *always* acts in the best interest of the customer).
Over the next two decades, the evil inefficient government got madder and madder. All these little companies with all of their efficiencies were making the big bloated cumbersome government look bad! One by one, the government in its jealousy forced these companies back together.
Consolidation happened because the government used force - as we saw already, this is the information age so therefore mergers and monopolies are less likely to happen.
Now Ma Bell (originally called that because of how caring and benevolent the company was) has almost completely re-consolidated. Customers have less choice than ever when it comes to telecommunications. There are only three companies left (the picture is out of date, BellSouth is part of AT&T as of 2006). How much longer will it be before the government's use of force consolidates them back to one?
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On July 18 2009 09:37 L wrote:
Other forces, such as the ones used by standard oil (go look them up) led to the rapid consolidation and aquisition of nearly 90% of the market share in a number of key areas. When the government tried to prevent him from doing so, he split up his company and organized them via a trust so that he could get around the legislation. Anti trust legislation isn't about trusting the company: it was about using a shell trust to circumvent governments trying to regulate the industry and was introduced specifically to break up THAT company, because it controlled pretty much every level of oil production. It wasn't them using force, it was them undercutting, refusing rail access to other companies (because they also controlled most of the rail lines, and most of the steel plants used to make the engines and tracks), and preferentially giving lower oil rates to compliant companies. This cute experiment resulted in John D. Rockefeller becoming the world's richest man ever, with a current inflation adjusted wealth of 320 billion or so.
Which is why vertical integration of the healthcare industry from insurance to hospital to doctor to equipment to drug is simply inevitable if left to its own devices.
The whole point of Standard Oil is that if they were ripping you off and you wanted to go into the market to offer a better alternative, economics of scale simply forced you right back out of the market because the barriers to entry were too high. Whether it's a single company that does this or a collection of large companies working together to some degree is irrelevant because the effect on the would-be competitor is similarly disastrous.
The same thing happened with the electronics industry in the US. Large Japanese manufacturers were able to collude and undercut domestic makers. With their larger capital reserves and less obligation to quarterly earnings they were able to take massive hits up front that US companies simply could not do. Once the american companies were forced to shutter, the Japanese manufacturers promptly raised their prices, free of competition.
For industries that are doing well such as healthcare and energy, the idea of "competition" is simply a dog and pony show. They only have to put on enough of a facade of "fighting for higher efficiency and lower prices" and decades of indoctrination causes lower and middle class americans to earnestly believe them. They all know that if any of them lowered their prices, they would all lower their prices to stay in business, and overall profits in the industry would decrease since their goods are relatively inelastic. It's all a gentleman's game to them.
If the healthcare industry were to reach the point that in order to beat Cigna you would have to either outbid them for exclusivity agreements or build your own hospital it would be beyond impossible for a new player to enter the market and the industry players would be free to charge whatever they wanted.
This is not two kids with lemonade stands having a price war or any other glorified notions of unrestrained capitalism, this is pepsico undercutting the kid with the lemonade stand out of the business before he even sees a dime.
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+ Show Spoiler +On July 18 2009 09:42 zeppelin wrote:No he's right see here I found proof: As you can see from this image, in 1984, AT&T voluntarily split itself up so all the smallest companies could compete to provide the best service (the free market *always* acts in the best interest of the customer). Over the next two decades, the evil inefficient government got madder and madder. All these little companies with all of their efficiencies were making the big bloated cumbersome government look bad! One by one, the government in its jealousy forced these companies back together. Consolidation happened because the government used force - as we saw already, this is the information age so therefore mergers and monopolies are less likely to happen. Now Ma Bell (originally called that because of how caring and benevolent the company was) has almost completely re-consolidated. Customers have less choice than ever when it comes to telecommunications. There are only three companies left (the picture is out of date, BellSouth is part of AT&T as of 2006). How much longer will it be before the government's use of force consolidates them back to one?
Just a heads up for anyone reading this post: it is all hilarious sarcasm.
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Sorry for the delay in response as I've just recently come down with a cold. But anyhow...
TanGeng wrote:
Hey, Syntax do have statistics for miscarriages/stillborn. I've talked with doctors in obstetrics and they talk about babies more than 10 weeks premature, babies under one pound, etc. being counted as live births before being rushed into the NICU. Nowhere else in the world would that ever happen. Most countries would write the fetus off as dead and move on.
The CDC doesn't agree that the differences in counting infant mortality are significant, why should anybody else?
The CDC wrote:
International comparisons of infant mortality can be affected by differences in reporting of fetal and infant deaths. However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking.
TanGeng continues:
These are of course macro statistics and not controlled for any genetic factors. Moltke's already addressing the other half of the problem which is racial disparity. And from what I have gathered, most of the difference in infant mortality rates is prenatal care and daily nutrition rather than hospitals and their obstetrics departments. Of course, I'm arriving at that conclusion with a some bias towards my medical acquaintances.
Except that you're not showing that there is any significant disparity between the US and other comparable countries with regards to these statistics. Plenty of other nations have to deal with exactly the same problems as the US yet they still perform better in this metric.
Caller wrote:
There is a limited extent of feedback in government. While elections certainly are a form of feedback, it is limited in three ways: a) a large amount of the population cannot participate b) point of views may be biased because of government subsidies to certain groups and c) this does not really effect unelected bureaucrats. The programs that many people complain about are in the hands of these bureaucrats. One example that has been beaten to death is the DMV.
Nevertheless, we see that socialised medicine does in fact work in countries that implement it since they achieve better outcomes for lower cost. Of course there can be limitations, but limitations also exist with free market. The question isn't over which of the two is perfect, but which of the two is an improvement over the other.
Show nested quote +My usage of the expression fair market was to try to cover the market situation described by gchan where the government does interfere to prevent corporations from engaging in anti-competitive practices. I avoided using the expression "free market" because he was clearly describing a need for some government inference. No, this was a clear attempt to "No True Scotsman," the very thing you accuse me of numerous times below.
Seriously, WTF? How on earth is this a No True Scotsman? You and I both know that a market regulated to prevent anti-competitive practices does not operate in the same way as a market with no regulation whatsoever. Nevertheless, if you want to describe either as being free market, then that's fine by me since the traits of for-profit, unequal access to preventative care, service duplication and exorbitant marketing budgets are typical to both.
You're going a bit too far here.
You outright claimed that there wasn't necessarily a connection between quality of health and healthcare services when the mechanism between the two is very clear. You know you were trying to be deceptive here; you're just butt-hurt that you were caught out on it.
What I meant to say was that there are clearly other reasons why quality of health is much higher in some nations than others-Japan, for instance, has the longest expected life longevity, a significant amount of which is documented to be responsible by a combination to their diet (both the type and the quantity) as well as their culture.
Yet these factors are documented. We can clearly see that Japan has a significantly lower obesity rate, etc. All you've done so far is perform some special pleading that the US is somehow different without providing a shred of credible evidence to support this claim at all. You even go so far as to admit that you don't have any real evidence to support this position.
When we look at the data for the rest of the world and compare it to the US, we notice that the US spends enormously more money than virtually all developed nations with socialised medicine and achieves worse outcomes. It's not just some nations in the world, but virtually all. Does that not look fishy to you? Does this not make you ask how this possibly could be? Does that not cause you to actually examine the healthcare system itself and see what it might be doing to cause this to happen?
Because there have been no studies done comparing the healthcare rates of the minorities in France, I cannot agree or disagree with this point.
[...]
That's not quite accurate. While they are both not homogeneous ethnically, Canada socioeconomically is fairly homogeneous.
Evidence that this actually has a significant impact?
Actually, it would probably be better to look at urbanisation rates and see how much merit your claims have.
For 2005
US: 80.8%
Canada: 80.1%
Australia: 88.2%
Sweden: 84.3%
Finland: 62.4% (!!!)
France: 76.7%
While there is a clear difference between US and Australia (although its closing), are you honestly trying to suggest that a difference of 7.4% in urbanisation will result in a more than 50% increase in healthcare spending (relative to GDP) and an almost one third increase in infant mortality?
Anyhow, we're just going to go back and forth on this issue since you're always going to look for an exception. The point that I'm trying to make is that you've failed to show how any one of these issues shows a significant impact to account for the massive discrepancy between the US and the rest of the world.
And actually, since you're harping on minorities it would be interesting to look at the US and its infant mortality rates for minorities. We can see that infant mortality for Non-Hispanic African Americans is 13.63 per 1000 live births for 2005. This is absolutely appalling especially in light of the huge discrepancy between this rate and the rest of the US.
If you actually read what I said, I said that there are bound to be changes in other areas that may not be directly interpreted as cost but nonetheless uses time. Using your own words, you're decreasing cost in one place only to see it appear somewhere else!
Except I'm actually pointing out where these extra costs come from with a big neon saying "They're over here!" pointing directly to them. All you're doing here is trying to claim that there are extra costs but you put no effort into illustrating what those costs actually are. You cannot make vague claims to their existence without substantiating those claims using evidence.
Nothing has shown any consideration of the differences and nonetheless concluded that a socialized system will do as well as it has in other countries, either.
No, the conclusion is that it will be a significant improvement to public health in the US and that systems of socialised medicine are superior to the US model. All the credible evidence posted in this thread supports that conclusion. Do you have a single shred of evidence to support your position? If not, then why should we feel inclined to believe it?
Show nested quote +Now you're just nitpicking. Here's a revolutionary idea: Why not pay the doctors that work in less attractive regions more money? This is not remarkably difficult for a government... a) Where is the money coming from? b) If it works so well, why doesn't the government do this whenever they want to get an industry in a certain area? They do? But it raises costs? Oh...
Don't pretend that private industry doesn't have to contend with exactly the same problem (with the added burden of needing to remain profitable). And as has been demonstrated clearly in this thread, when you improve access to preventative care, you reduce costs in emergency care and that gives you a net savings overall.
No, you're missing the point that education costs are going to be sky high and we have a much larger delay in the US than overseas in medical school costs. I acknowledge that remote areas will likely suffer in terms of doctors, but I disagree that it would not become profitable for remote regions and doctors.
But you do acknowledge that if a region was unprofitable or barely profitable then there is simply no way the free market can cope and provide healthcare to the region?
Show nested quote +You're full of shit. Doctors have to pay exorbitant education fees in the UK which operates with the NHS. They're not super-rich like US doctors but its a far-cry from "uneconomical". Tuition for a BM (the degree for a UK doctor to be order to practice) is 3225 pounds, or about 6500$ per annum. Tuition for a MD is about 50,000$ per annum for four years, not to mention a varying 4k-50k undergraduate degree.
Sorry. I'll concede this as a bad example as I didn't realise that the level of government subsidy in the UK. Australia is a far better example since they see fees on a similar level as the US (though the government is still covering part of the tuition from what I've understood).
Great. So? Just because one industry is gouging you, doesn't mean that another isn't. This is just a red-herring.
Looking at the rate of premium increase versus wage and inflation increases, we can see that over the years between 2002 and 2007, wages have increased 19% overall, inflation 17% and insurance premiums? A whopping 78%! In 2004 alone premiums rose 11.2%. In 2003 it was 13,9%!!! They're fucking you! And it's not a sweet, gentle love making. They're getting a cucumber, wrapping it with barbed wire and shoving it up your arse.
Sideways.
With no lube.
Show nested quote +This is indeed true. Plenty of private corporations do sponsor university research. This, however, does not detract from my point that R&D would dry up without obscene profits. So without obscene profits, R&D would dry up? What?
Sorry, typo. "This, however, does not detract from my that R&D wouldn't dry up without obscene profits."
Show nested quote +Evidence that it's the government's responsibility rather than the fact that it's simply more profitable to focus on long-term drugs over cures? http://www.law.umaryland.edu/marshall/crsreports/crsdocuments/RL3075601102005.pdfWhile it's not apparent, a reading of the article gives one an understanding that the act that resulted in combination of increases in generic drugs along with the patent incentive for further R&D leads to a rather obvious conclusion: the kind of drugs that we get today-chronic, money-making drugs-were due to the combination of incentives that were aforementioned.
I'm sorry, I'm not drawing the same conclusions and I'm not seeing them in the report either. The report does cite a study to claim that patent law surrounding the pharmaceutical industry in the US does impede market forces in the cost of drugs and the number of innovations, but I can't see anything there to suggest that the types of drugs being developed is significantly influenced by this.
Furthermore, I would like to add that in 2006, the largest selling drug in the world was Lipitor which is purely a lifestyle drug. The market incentive for developing such a drug is clear, but none of the development cycle was addressed to curing the problem (high cholesterol intake in a typical American diet), nor is the drug the best solution to the problem. There is simply no way the patent law can be changed to foster development away from such lifestyle drugs and direct it towards more feasible long-tem solutions. The development of lifestyle drugs by the pharmaceutical industry is in no way related to the structuring of US patent law. These drugs are clearly very profitable to pharmaceuticals, so take a guess where they will focus their R&D efforts.
Show nested quote +No true Scotsman once again. This is the practical result of introducing free market conditions to healthcare. Pretending that it doesn't fit your preconceived notion of being a free market--despite clearly operating far more freely than socialised healthcare systems--is at its very heart a No True Scotsman. One may also accuse you of a No True Scotsman here, seeing as how the current market-which is far more socialized than what is accepted to be a free-market-yet you perceive it to be a free-market, hence the No True Scotsman.
Bwahahaha! Are you honestly arguing that the US medical system is less free market based than socialised medicine implemented in other countries?
Response bias.
Okay, now you're just acting like a broken record. The study specifically states that they took response bias into account and didn't find it to be significant. The passage I quoted shows that very clearly. Restating your accusation does not make an argument. Can you actually show that there is significant response bias in the study?
Show nested quote +Are you honestly so thick that you can't figure that out for yourself? Here, let me hold your hand and walk you through it:
People are not bankrupted due to medical problems in single payer systems due to the fact that:
a)Everybody has coverage.
b)Nobody is dumped by the insurance.
c)They do not engage in recission.
d)There are no caps.
e)Decisions over treatment are made by your doctor and require no approval from insurance industry bureaucrats.
f)There are minimal to no co-pays whatsoever.
g)You don't have your premiums jacked up if the insurer considers you a higher risk (by getting ill, for instance).
I challenge you to find any bankruptcy statistics that show that under a socialised healthcare system, there is a significant number of people that are bankrupted due to medical expenses.
(Hint: These statistics don't exist because virtually no one is bankrupted due to medical expenses under socialised medicine.)
The study specifically points out that people that lost their coverage rarely lost it by choice. Its a fact that the insurance companies dump you. Their methods can vary from case to case, but they do find a way. No, you're dodging my point here. You made the point that: regardless of whether or not they had healthcare insurance, people went bankrupt. My response was: because insurance companies don't cover some things (as would the universal plan), they would be forced to pay the uninsured rate for something, which is always very high compared to the insured rate. This would be enough in cases to force bankruptcy, regardless of whether or not they had insurance.
I most certainly am not dodging your point. I explained how under a single-payer system, the practices which US health insurance companies use simply do not happen. Your perspective on how a single payer system works is just flat-out wrong and also illustrates that you've no experience dealing with insurance and how they gouge you for using your insurance or try to fuck you over with legal fine print. You're trying to magic up some "things" that would not be covered by by a universal plan. Well, what are those "things"? Because I've never seen a single case where socialised healthcare has not covered treatment that has been deemed medically necessary by a qualified doctor. And I'm not seeing statistics on patients in the US bankrupting themselves to pay for medical treatment which they don't need.
The point I'm particularly trying to hammer home, which you seem to completely miss, is that insurance companies in the US are systematically disenrolling people when they begin to see them as a burden. This is done in the name of profit. You have market forces driving them to act this way. You have the former VP of CIGNA admitting that to you in the interview I posted earlier. Does he literally need to slap you in the face with the evidence before you decide to take notice of it?
From the interview...
BILL MOYERS: That they're spending more money for medical claims.
WENDELL POTTER: Yeah.
BILL MOYERS: And less money on profits?
WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.
BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?
WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.
But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.
And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.
They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.
It's spelled out very plainly here: if you need to start utilising your insurance, the insurance company is going to start looking for ways to get rid of you. This does not happen under a single-payer system. Ever. Do you comprehend this?
Then you have the issue of co-pays:
Also from the interview...
BILL MOYERS: What did you see?
WENDELL POTTER: Well, I was beginning to question what I was doing as the industry shifted from selling primarily managed care plans, to what they refer to as consumer-driven plans. And they're really plans that have very high deductibles, meaning that they're shifting a lot of the cost off health care from employers and insurers, insurance companies, to individuals. And a lot of people can't even afford to make their co-payments when they go get care, as a result of this. But it really took a trip back home to Tennessee for me to see exactly what is happening to so many Americans.
This is a large source of your medically insured bankruptcies.
Then you have caps, which means that if your medical costs exceed your coverage level (which can easily happen if you have poor and cannot afford adequate coverage) then all your expenses which exceed the cap are coming out of your own pocket.
You have the wonderful practice of rescission. I'm sure it's a wonderful feeling to think you have coverage and then have the rug pulled out from under you after having been judged to have a pre-existing condition (a term which simply doesn't exist under a single-payer system). Pre-existing illnesses also really suck if you lose coverage temporarily for one reason or another (e.g. lost your job and can't afford COBRA).
These are all avenues for people to be bankrupted and still have health insurance during onset.
Caller wrote:
You then say, why don't people with single-payer plans go bankrupt. The answer is that the government forces everybody to have insurance. While this certainly prevents people from being charged the uninsured rate, it does so at a cost-namely, reduced supply.
Ignoring the fallacies in your argument which I've already addressed, I would like to ask you a simple question:
Do you consider it acceptable for people to be bankrupted over necessary medical treatment?
A better alternative would be to wonder, why the hell is the uninsured rate so high compared to the insured rate.
That's pretty simple: insurance companies have more clout than individuals so they can negotiate better fees.
Show nested quote +The costs are reduced because access has been improved (bringing more focus to preventative care) and through risk pooling (the whole fucking point behind insurance). You seem to be ignoring my point and going back to the typical "greed, GREED, GREEEED" line that I hear all the time. While it's true, it's also ignoring my point.
Now you're just lying. There are no "uncovered things" under a single-payer insurance as I've illustrated. The source of the bankruptcies for those covered by insurance is cause primarily by the practices of the insurance companies, not over medically unneccessary treatment.
Show nested quote +This is straying from the topic of the thread, but the point was to highlight the process of issuing credit to those unable/unlikely to pay it back and then packaging that debt and playing pass-the-parcel with a ticking time-bomb, and this is something we see from free markets operating in the real world. But anyway, back to the thread. Scotsman.
I disagree with that entirely, but I'm not going to continue along this because it's not so relevant to the topic.
Show nested quote +If this were true, we'd see this problem occur in real life in places that don't charge for simple check-ups. Fact is, it doesn't. While it's true that you will see some people go to the doctor more frequently for trivial matters, you won't see that much change that it creates a serious problem in the healthcare system.
But don't let something like real evidence get in the way of your worldview. Charge for ER vs. Charge for Check-up. What gives?
Seriously, WTF? The NHS in the UK is free for most doctor services. Can you honestly demonstrate that this is happening in real life? Are people honestly going to the doctor as much as possible?
Show nested quote +Notice the fact that the serious problems arose after the private industry took over? Blaming the government here is like blaming a knife manufacturer for someone being stabbed. Not quite-the thing was that these organizations were simply not feasible at all without government aid. Rather than blaming a knife manufacturer, the government's role here is more like dumping fertilizer and letting weeds grow.
Nonsense. And here we get into the issue of the No True Scotsman. What makes your argument a Scotsman is the fact that you do not provide a mechanism for how the government is responsible rather than the free market. You try to claim that the businesses would not have been initially feasible without government support because the industry was supported initially, but you've done nothing to show that the medical industry would not have arisen without government support. Furthermore, the end result is clearly an effect after market forces started to dominate. To use your analogy, the weeds only started to grow after the government stopped tending to the garden so diligently, so what really is at fault?
Show nested quote +This is just pure sophistry on your behalf. The evidence overwhelmingly supports public healthcare and you've not provided a single shred of credible evidence that shows otherwise. The evidence is mostly showing healthcare vs. current situation, which is obvious. It doesn't show healthcare vs. other alternatives like complete privatization. And I have provided evidence.
Yes, it does. I've clearly shown how free market mechanisms resulted in the mess that we see today and call the US healthcare system.
No, Ad Hominem is attacking them for being Democrats or w/e. I'm attacking them because they are writing about a subject which they are not as known for as opposed to other journals.
Right. You did not criticise the methods. You didn't criticise their numbers. You didn't in any shape or form approach the study and the conclusions it reached. You dismissed it because its not an economics journal despite the fact that it was assessing healthcare overhead costs.
I also love how you ignore that one of the writers has an M.H.A. and another an M.P.H.
I also think its funny that you use this argument, seeing as how you call me dishonest and an ignorant idiot multiple times.
Okay, it's clear that you don't understand how Ad Hominem is a fallacy. An Ad Hominem is an argument provided without any supporting evidence, just insults, which is what makes it a fallacy. I'm clearly justifying my position. Just because I take the time to comment on your own habits (and pointing out how you're either lying or being stupid) doesn't in any way form a fallacy in my arguments. If I just said that you're a lying moron and left it at that, then I would be conducting an Ad Hominem. Saying that you're a lying moron and demonstrating how that's so is not. Here, let me demonstrate this in the next section:
Wait times is beaten to death, but also increased deficits (France's healthcare system runs at quite a large deficit) as well as taxes.
Here you're either intentionally being thick or lying. Now if I left my argument at that, I would be conducting an Ad Hominem. But let's break it down further, shall we?
I've already addressed the issue of wait times in this thread. The comparison between Canada is just outright dishonesty which has never been addressed.
The WHO data makes all healthcare expenditure very clear. We know where all the costs towards healthcare are going in both private and public spending across a whole host of nations. We can see clearly from that data that the healthcare costs in all countries that implement socialised medicine are all substantially less than the Us expenditure as a function of GDP. So can you detail what exactly these additional costs are and how socialised medicine is responsible for them given that Canada spends less overall on healthcare than the US. Given that Canadian overhead is one third of the US, we can begin to actually understand why the Canadians are paying less.
Show nested quote +Can't access your link for some unknown reason. Nevertheless, the Canadian system achieves much better health outcomes with fewer doctors. Could it be that they're being... *gasp* ...more efficient? Is a doctor more efficient because he works in a rich community than one who works in a poor community?
If the outcomes for the people in the poorer community are better than those in the richer, then yes, he is being more efficient. Especially if you consider that the rich are spending more relative to wealth as compared to the poor.
My point was government interference causes problems. But yes, this is true in some ways.
Okay, this is quite fine. Sometimes government interference can cause problem. But it's an enormous (and fallacious) leap of logic to go from government interference can cause problem to all government interference causes problems, since one is a claim of existence and the other is a claim of universality.
http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf
Try getting Adobe Acrobat Reader, its a pdf.
Okay, seems to be working now. Not sure what caused it to be blocked earlier.
Oh, I see, you're contending that the US pharmaceutical industry spent more on R&D. Actually, the report you linked to agrees with the PLOS study since they're both citing the same PhRMA statistics. The difference between number is that PLOS seems to be only looking at US domestic spending on R&D (since its only looking at US marketing).
What I find shocking though is that the US marketing budget still outstrips total worldwide R&D performed by these companies by about 45%. But considering they also employ an enormous army of about 100,000 salesmen, I realise the pure insanity of what's going on.
Caller continues...
I agree with you about the insanity of the marketing, though. But it's a result of the patent process and the loss to generics.
Evidence of the mechanism because I honestly can't see how they have any incentive to do so given that they've found that aggressive campaigns do increase their profits and market share. If we compare the US to other countries for 2000 in terms of relative R&D spending, we find...
The study wrote:
The US is clearly not a world leader in this respect. There are a number of countries which operate with more tightly regulated pharmaceutical industries and socialised medicine but still spend similar amounts (or more) on pharmaceutical R&D.
I also saw something that you wrote earlier which I don't agree with...
Caller wrote earlier...
By implementing a fat tax, one essentially legitimizes fat like cigarettes. Essentially, it's like "Oh, I can just pay a tax and thus its ok for me to be fat." So sure, you get some money, but it doesn't improve health-in fact, it would discourage health, and also reduce demand in the health and gym industries.
Don't believe me? Freakonomics has a similar actual study, where economists tried to penalize parents whom were late to pick up their kids. By adding a fee, however, more parents came later to get their kids-the replacement of the huge social pressure with a moderate fiscal pressure essentially legitimized their bad behavior.
When extra taxation was levied on cigarettes in 1982-83, the tobacco industry felt the effects of it.
From an internal Philip Morris memo:
You may recall from the article I sent you that Jeffrey Harris of MIT calculated . . . the 1982-1983 round of price increases caused two million adults to quit smoking and prevented 600,000 teenagers from starting to smoke.hose teenagers are now 18-21 years old, and since about 70 percent of 18-20 year-olds and 35 percent of older smokers smoke a [Philip Morris] brand, this means that 700,000 of those adult quitters had been [Philip Morris] smokers, and 420,000 of those non-starters would have been [Philip Morris] smokers. Thus, if Harris is right, we were hit disproportionately hard. We don't need this to happen again.
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Sanya12364 Posts
On July 18 2009 06:44 zeppelin wrote:Show nested quote +On July 18 2009 06:07 TanGeng wrote:
The main source of problems that may arise in your hypothetical is in the geographical monopoly of the hospital and not insurance. Exorbitant charges by the hospital would have to be countered by a some kind of community demonstration, building a new hospital in the area, and directing all marginal emergency cases to more distant emergency rooms.
So let me get this straight: The problem - hospital is too expensive The cause - insurance company has negotiated monopoly of service with this hospital, reduced fees are "negotiable" but still probably exorbitant The solutions - - community demonstrations (lol like that would do anything) - building a new hospital (you call this an efficient market? Hospitals cost millions and millions of dollars to build) - diverting people to further away hospitals (again, waste of resources, lots and lots of time and money is wasted by having coordinators and probably lawyers representing different organizations arguing about just how this would be accomplished, what constitutes "marginal", etc.) Wouldn't it be a lot easier to have a system where no one ever gets screwed over by geographic profit-seeking monopolies to begin with? And yes, if an insurance company lobbies medical providers to sign exclusive arrangements, the problem is with the insurance company as well. And if there are no laws to stop them from doing that, that is exactly what would happen.
Wow quite obstinate. But, the only problem in your scenario is the geographical monopoly of the hospital. If management at the hospital think they can overprice their service like that or overcharge a large segment of the market like that, someone will see an opportunity and provide them competition by building a new hospital.
Second hospital in the area, geographical monopoly gone, problem solved. In fact, if the original hospital built up ill-will in the community, people would rather visit the new hospital even in face of higher prices just to spite the original hospital.
What you lack is an understanding of free market responses and how important good public relations is for business operations. As a business, you have to satisfy a large majority of your customers and avoid any PR messes. It all gets reflected in their bottom line.
The solutions -
- community demonstrations (lol like that would do anything)
- building a new hospital (you call this an efficient market? Hospitals cost millions and millions of dollars to build)
- diverting people to further away hospitals (again, waste of resources, lots and lots of time and money is wasted by having coordinators and probably lawyers representing different organizations arguing about just how this would be accomplished, what constitutes "marginal", etc.)
- community demonstrations is all about negative PR and showing demand for a new hospital - clearly a lot of people have to be behind it - meaning there has to be a lot of people not covered by Aetna in the area - or there's no point. If Aetna has over 90% of the market share and 90% of the population is covered, then both Aetna and the hospital must be satisfying its customers well enough that a monopoly would NOT be an injustice.
- building a new hospital - If there is sufficient demand for a new hospital build one. It's not like millions and millions of dollars is a big deal if you have a 1000 patients a day. Just do the math - million and millions of dollars is NOT a lot of money. If it's just emergency room that's a problem, build a new ER that can handle most ER cases and have the ER facility transfer patients when they don't t have the equipment.
- diverting people to further away hospital - is a waste of resources - but no less a waste of resources than overpaying for ordinary emergency room service. Just think in dollar terms for the consumer. If they are conscious and can make the decision to go to further hospital let them. In case of serious injuries and unconscious patients, they'll have to bite the bullet. However, just diverting a lot of emergency care patients away from a hospital will really hurt the bottom line for the hospital. People should be allow to not do business with merchants that are excessively greedy. That way their greed will come back to bite them.
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What it comes down to is this: no fact based arguments support the current system, beyond those that posit health care as a justifiably for-profit market sector. It's a shame there is no meaningful debate on this in our government. We simply have republicans throwing out nonsense scare words like CANADA and SOCIALISM, democrats who are just barely liberal enough to not count as republicans but by no means liberal, and a president who is so determined to appear bipartisan he refuses to do anything at all the right way (Guantanamo, carbon emissions regulations) or honor campaign commitments (gay marriage, abortion). Sigh.
Seriously, it's time to move to Canada.
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United States22883 Posts
On July 22 2009 02:10 Louder wrote:
We simply have republicans throwing out nonsense scare words like CANADA
Holy fuck that's terrifying. Just think, YOUR hometown could be the next Montreal.
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Sanya12364 Posts
On July 18 2009 06:52 zeppelin wrote:Show nested quote +On July 18 2009 06:35 TanGeng wrote:
Apollo program and its counter part in USSR Sputnik were both huge wastes of money. They had no practical use. (It was certainly inspiring!) Manned-spacecraft was not very useful. It's still not all that useful. Most useful technology in space are all unmanned - communication satellites, spy satellites, and extraterrestrial telescopes. Development of technologies like the LEM and many other devices related to manned-space craft are still technological dead-ends with respect to useful applications earth-side.
Why didn't private companies then develop nuclear fission or the internet? You say manned spacecraft was not very useful as if we will never make them again. Someday, it will be profitable to send people into space (see Virgin Galactic). The barriers to enter that market will be much lower thanks to the research into heavy-lift rockets, ground control organization, orbital mechanics, composites, the physiology of space travel, orbital assembly, etc. that were done by these "wasteful" programs. Future manned space entrepeneurs will not have to do any of that work because it's already out there as a model to follow, making it more likely for companies to enter the market without needing immense R&D capital that only the largest of companies (and governments!) could afford up front. Show nested quote +
Currently, there are space faring ventures being launched with private capital. Total capitalization of each of these ventures is 30 times smaller than what NASA will spend in one single year, and they expect to be profitable - rather than a 20 billion dollar sinkhole every single year.
Pets.com "expected" to be profitable. Webvan "expected" to be profitable. If they didn't "expect" to be profitable they wouldn't get venture capital and wouldn't exist. They "expect" to be profitable because all of the research and development of rocketry as we know it was already developed by not-for-profit institutions over the last few decades, and their failure rate is still extremely high. I work for a privately held for-profit company. Because we're not accountable to shareholders, we're able to invest money on higher-risk ventures that shareholders would never approve, and since we're not legally obligated to maximize quarterly profits, we don't need to see a return on investment as quickly. We have many very profitable programs that would have never been developed if we were a publicly held company because having a sound long-term plan was more important than instant results.
It is not a problem of whether or not it will ever be useful. It's a matter of getting your priorities straight. A family doesn't invest in shiny brand new cars when it has trouble putting food on the table. Whether or not that technology has any use in the future is immaterial. It hasn't shown any benefit at this moment. Meanwhile things like medicine, education, and other social priorities have been forgone for the mistimed adventure into space.
Private companies can invest long term in whatever R&D type project they want to. They're putting up their own money. Just don't complain when they reap profits if and when they are successful. Intel is famous for piggy-backing on the R&D developments of IBM during the 80's. Well it turns out Intel is really profitable because it was consumers and manufacturing oriented, while IBM loved to play with exciting new gadgets. Over time IBM failed and Intel prospered.
During the last two decades, Intel's taken over the bleeding edge semiconductor development. They're still profitable and now dominates the market. It's thanks to its smart R&D model that has immediate relevance to the market place. It's not like IBM's old model or the government's ivory tower model for researching "interesting scientific toys." This is an example of having your priorities straight.
Government is inefficient. I've seen it first hand. But sometimes it's extremely harmful and destructive. I could live with its inefficiency, if government would merely refrain from doing anything destructive.
At its core, government provides a framework for valuable services to society: governance, cooperative projects, and charity. However, there is a tendency for government to be monolithic in its pursuit of all three services and in the process confuse its goals, priorities, and rationals.
Charity is directly connected to the benevolent spirit of the public, but once tether to taxation, that connection is largely severed and what was originally charity becomes an entitlement.
Cooperative projects involves the key stakeholders - people owning land in question, business that stand to gain, consumers who would like to see new services provided, and other land owners who might see some sort of pollution result from the project. Project costs are divided asymmetrically among the stakeholders. Once cooperative projects are funded by the general public, neutral and usually indifferent decision-makers are introduced into the project, and costs of the project is foisted on an ambiguous body of people called the public. Pork barrel spending and log-rolling tactics are extremely common in such an environment.
Governance, the enforcement of justice and peace, is hindered by placing their agents inside government bureaucracy. Enforcers in government do not get immediate feedback for their performance in upholding justice and peace. Instead, their feedback is forced through the bureaucracy of the central government, the provincial government, and then local government. Sometimes, the only feedback is through a very much delayed election process. The layers and layers of government is extremely destructive to society. By hindering feedback from public, perversions of justice and peace becomes more and more likely.
But the greatest danger in government, is a confusion of three services. It is extremely dangerous for government to confuse charity with justice and peace and force its members to be patrons for others. It is extremely dangerous for government to confuse cooperative projects with justice and peace and make exception to its own laws to the benefit of the few (eminent domain is extremely problematic). It would be an immediate improvement if government were to split into three independent entities each responsible for one of governance, cooperative projects, and charity.
On July 18 2009 06:52 zeppelin wrote:
If an insurance company drops coverage on someone who needs major (read: expensive) surgery because they had an outstanding $7 bill a decade ago, "charity, altruism, and a sense of community" might get their lawn mowed, it won't get them a six-figure hospital bill
The health care system doesn't work. You're only pointing out the symptoms. Throwing a band-aid on it won't solve the internal rot. The idea that health care should be provided through by a third party payer is truly idiotic and disastrous. You're very much fixated on certain examples of failures in the system. I don't like any part of it.
But if being unable to pay for surgery is pervasive across much of society, all I can say is that said major expensive surgery is a luxury and elective - even if it is lifesaving. Under the current model, insurance agency should drop it from its core coverage plan and stop abusing technicalities in its contracts. The focus of the health care debates should not be over expensive catastrophic procedures but rather improving access for everyday care.
I'm in favor of the high deductible plans that are being developed recently. It has real promise in the long run, since it will provide incentive for cost savings initiatives on everyday care. But I'm still not that optimistic, because there are a lot more regulations that stand in the way of providing good care at a low cost.
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Sanya12364 Posts
On July 22 2009 02:10 Louder wrote:
What it comes down to is this: no fact based arguments support the current system, beyond those that posit health care as a justifiably for-profit market sector. It's a shame there is no meaningful debate on this in our government. We simply have republicans throwing out nonsense scare words like CANADA and SOCIALISM, democrats who are just barely liberal enough to not count as republicans but by no means liberal, and a president who is so determined to appear bipartisan he refuses to do anything at all the right way (Guantanamo, carbon emissions regulations) or honor campaign commitments (gay marriage, abortion). Sigh.
Seriously, it's time to move to Canada.
How do you propose to ration the production and consumption of health care if not by price and by for-profit providers?
There are serious questions:
Who decides which kind of medical care is necessary or effective?
Who decides who gets the medical care?
Who will provide the care?
Who will quality control the medical care being provided?
What are the long term trends for demand and supply under such a system?
What are the long term trends for the development of better technology under such a system?
There's no meaningful debate in the government because the GOVERNMENT CONSISTS ENTIRELY OF IDIOTS! And that's on both sides of the debate.
For the current system, the answers are:
Who decides which kind of medical care is necessary or effective?
The insurance agencies and in a way the doctors, consumers, and the government, but mainly the insurance agency through "coding" practices. WTF
Medicaid and Medicare for those eligible.
Who decides who gets the medical care?
Everyone must be treated in the ER. Otherwise it has to be paid for by the patient or paid by through Medicare, Medicaid, or by a charity.
Who will provide the care?
Doctors and nurses who have to be certified. The process is largely overseen by the AMA.
Who will quality control the medical care being provided?
By patients who judge the doctor's competency and track record. Patients who can sue for malpractice in expensive litigation suits where expert witnesses must be hired to support the case.
What are the long term trends for demand and supply under such a system?
Restricted supply of doctors by the AMA. Demand is expected to skyrocket as population gets older. Technology is improving to allow doctors to handle more patients, but supply is still too low.
What are the long term trends for the development of better technology under such a system?
R&D done by universities and by for-profit companies that usually have partnerships with said universities. For-profit companies will responsive to market opportunities for profit, while the university system subsidizes more exploratory research. New technology is developed every year, but are usually very expensive in the first years of availability.
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http://this.org/magazine/2009/04/28/your-money-or-your-life/comment-page-1/
I'm always curious as to how people can argue economics about the health and well being of others. It simply amazes me how your constitution provides for free speech, rights of protection (among others) which have done a great deal of bad along with a great deal of good and yet it doesn't provide a standard for the health and welfare of its citizens which, as far as I can tell, only really has the capacity to do good.
Personally I see a pure private health care system as a lesser form of black mail; as if you can't pay, your level of health decreases. And its defiantly debatable if doctors in the private system are more efferent than those in the public.
Here in New Zealand:
ACC expenditure = $3 billion
Population of NZ = 4.3 million
Cost/person = $700 for every man, woman and child in the country
http://www.acc.co.nz/about-acc/overview-of-acc/introduction-to-acc/ABA00004
I'm not sure if those figures appear high to you or if they don't, but the result is alot more wide reaching than that; there are laws which provide a "no fault" compensation to accident victims (in or out of work), and the right to sue is removed. However those reasons alone don't attribute as to why the US pays so much and we pay so little.
I was talking to a 6th year Med student who's flatting with me; and he told me about what a doctor who was teaching him ethics at the time had said to him. He said that there is a direct link between the rising cost in health care and the rising frequency of use of insurance. Unsurprisingly, when people find out that the insurance company is paying, both parties don't mind if the price gets jacked up. A sort of 'Well If it isn't you, and it isn't me...' mentality develops. Now this, in turn, leads to insurance companies raising their rates for an insurance policy... And it becomes self perpetuating. Now from an ethical stand point it's a difficult question... Because the people who can't now afford to pay for the insurance they had in the past are partly to blame for the price increase...
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