Trumpcare

[dawei]

I heard an interview with him and his statements were very informative. What has not been brought to the attention is the inflated salaries/bonuses of insurance CEO's and how they get to decide what procedure one receives or not. Corporate bottom line is the driving interest.

 

I agree with Trunk's comment about the complexity and there are too many layers that so-called 'competition' is going to restore order.    I raised some issues earlier but no comments so I'm not going to repeat them.

 

There are too many driving interests and I wish the US would see that not everything works by competition for the betterment of the public.   In most cases and industries it does live up to its reputation but to think 'one size fits all' is something nobody would agree with but that seems to be the argument here.

 

Like: Why does USPS lose money every year when other mail delivery carriers make money?   So competition creates some to make money and others not to... cuz they are just stupid regarding how to work within competition.

 

We need to drive costs down and competition alone won't do something like States lowering their property tax on hospitals for the good of their residence (Oops... just repeated a past statement).   

 

It is too complex not too complex to solve... other countries have done it and we do need to look at what works or might work here. 

[MooNiNite]

You're pivoting to the opposite now...  My comments are in regards to the new proposal but your's is in regards to current one.   I'm not talking the current/past.

 

 

Please.... you can't really believe that... competition is going to solve this? 

 

I think there are some in the repeal/replace that do believe this and they are going to face a harsh reality if they hang their hat on that.     

 

Competition in the market place is the only thing that forces companies to have low prices and drive themselves to make better products. 

If you were always on top, you would get stagnated. It is true for all things. 

[MooNiNite]

Thanks for the graph!  All 4 of the countries listed have health care majorly publicly funded (with some mix of public and private funding).  That is, *NONE* of them have free-market health care.  So, your comment is disproved by your own graph! 

 

Then explain how these countries governments interact with their healthcare providers. Surely the government doesn't simply provide all the healthcare, the governments are somehow working with the healthcare providers in a fair manner that is promoting competition in the market. 

Edited March 15, 2017 by MooNiNite

[dawei]

What we need is a medical/health care system that takes care of all. Basing this system on a neoliberal ideology of competition is a moot point and will never serve all persons equally. Physicians don't need to make 500k to millions a year, which makes money the priority, as opposed to upholding the Hippocratic Oath and serving those in need. Train physicians to practice real medicine, not pharmaceutical pill pushing. Opioids and anti-biotics are the worst forms of medical abuse. Also, stop the pharmaceutical ads for drugs every five minutes on TV! Self diagnosis only presents more problems.

 

 

How much do physicians need to make?

 

 

I think this is a very interesting point on both sides.   

 

Anyone who was/is in the military and was at a base that had its own hospital will maybe observe as I did.  

1. They were paid according to rank (maybe that is why they ultimately left the military  ),

2. On the flip side, folks used it much more than they needed to.

3. There were no clinics, just the hospital to come get all your care needs meet.

4. etc.

 

Obviously, costs are contained in ways that don't really work in a free-for-all, competitive market... so I have thought about this for quite a long time, given that I also have seen state controlled stuff very similar in china.

 

When do we realize that competition is not the answer to something but cost contained methods that simply are done for the people's needs.

 

I'm not really suggesting this must be done for healthcare but this is what I meant earlier about thinking one size (competition) fits all (solves all needs)...

[MooNiNite]

The majority of physicians arn't making the money. They are pawns in the game too. 

I know plumbers that make more than doctors. 

[dawei]

Competition in the market place is the only thing that forces companies to have low prices and drive themselves to make better products. 

If you were always on top, you would get stagnated. It is true for all things. 

 

Explain how malpractice insurance is going to lower in your scenario?  As long a people can sue for $ billions of dollars without a ceiling, there is a cost without any possible containment.  It trickles down to the provider and then on to the consumer.   That is just one example.

 

In FL, I used to go to a doctor who had a big sign on his door that the reason his rates were lower was because he put up his own money to fall in the exception of needing malpractice insurance and he hoped that the patients understood this (ie: Don't sue me... let's work on this together).

 

There are cost containment issues that don't care about competition. 

[MooNiNite]

Explain how malpractice insurance is going to lower in your scenario?  As long a people can sue for $ billions of dollars without a ceiling, there is a cost without any possible containment.  It trickles down to the provider and then on to the consumer.   That is just one example.

 

In FL, I used to go to a doctor who had a big sign on his door that the reason his rates were lower was because he put up his own money to fall in the exception of needing malpractice insurance and he hoped that the patients understood this (ie: Don't sue me... let's work on this together).

 

There are cost containment issues that don't care about competition. 

 

Malpractice insurance is so high because it costs so much to treat any additional illness they might contract/receive during treatment.  Therefor the cost of malpractice insurance will lower in tandem with everything else. 

[ralis]

I think this is a very interesting point on both sides.   

 

Anyone who was/is in the military and was at a base that had its own hospital will maybe observe as I did.  

1. They were paid according to rank (maybe that is why they ultimately left the military  ),

2. On the flip side, folks used it much more than they needed to.

3. There were no clinics, just the hospital to come get all your care needs meet.

4. etc.

 

Obviously, costs are contained in ways that don't really work in a free-for-all, competitive market... so I have thought about this for quite a long time, given that I also have seen state controlled stuff very similar in china.

 

When do we realize that competition is not the answer to something but cost contained methods that simply are done for the people's needs.

 

I'm not really suggesting this must be done for healthcare but this is what I meant earlier about thinking one size (competition) fits all (solves all needs)...

 

 

When I was in the military (1970-1975 I was hospitalized with a fever of 104.5 which for an adult, is serious. The fever lasted 3.5 days and the doctors were incompetent in that they offered no diagnosis except 'viral syndrome'. Offered no treatment protocols and criticized me for drinking water. WTF! All I could do was drink as much water as I could which finally broke the fever. I was beginning to be a bit delirious i.e, visual hallucinations which scared me. If it wasn't for my wits and daily yoga practice, I might not have made it.

Edited March 15, 2017 by ralis

[cold]

Based upon information published December 2010 Major Maryland hospitals (USA Major Hospital)s:

 

Federal Government 1

 

Proprietary (for profit) 2

 

Non profit private 29

 

Non profit other 9

 

Non profit church 6

 

The vast majority would not be paying property taxes.

 

Not that it amounts to a hill of beans.

 

Nor will this, but some enlightened hospitals have found paying nurses and other health care providers to visit and provide both preventive and routine care to the uninsured members of the public who regularly avail them selves of their services in the ER have better utilization of there limited resources and an improved bottom line!

Edited March 15, 2017 by cold

[ralis]

This thread is revealing in that as a species we are divided by myriad problems and working together is not a very strong point. Many of which are based on money and more money.

Edited March 15, 2017 by ralis

[cold]

or simply greed

[MooNiNite]

So lets just give more money to the government, seems to be working...right?

 

It doesn't actually matter how much we give the government, because the government can spend money it doesn't even have. 

[MooNiNite]

"This thread is revealing in that as a species we are divided by myriad problems and working together is not a very strong point. Many of which are based on money and more money."

 

Well most Americans are brought up with the idea of "making it" or making the most amount of money possible.

It is well established in our very public education system. 

[Brian]

Public and not private. I stand by my statement that your belief is based on Social Darwinism and you can't refute that. Further, ER's are clogged with patients with conditions that preventative care would have alleviated and a little prevention with doctor visits would alleviate much of the burden place on the system. But, your legalistic argument that there is no universal right is quite disturbing.

So...

 

Since you simply ignore simple and direct questions, let's explore the idea of a universal right to healthcare and we'll see if you choose to jump in.

 

First, what is "a right?" Well, "a right" might be a legal right or a natural right. A legal right is something a society's law says the law cannot deprive one of because the law says so. A natural right, on the other hand, is something which is innate -- or, as the Declaration of Independence says (notice, BTW, that it is not "the Declaration of Collectivism"):

 

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

 

Since we are talking about US law, US society, US healthcare, etc., I think this is a reasonable starting point.

 

Notice that these are not things which the government gives but things which the government is to protect -- they are not to be granted by a benevolent civil authority but to be guarded against infringement upon. This is a critical distinction. If you (the nonspecific reader of this post) doesn't understand the significance of this distinction, or the distinction itself, please stop RIGHT HERE and ask me for clarification before reading another sentence!

 

Seriously.

 

OK, so I am able to walk. I don't need the government to grant me the right to walk, I just need to government to not prevent me from walking. I am able to speak. I don't need the government to grant me the right to speak, I just need the government to not prevent me from speaking. I empower my government, further, to protect my right to speak, to keep others from preventing me from speaking. I don't empower the government to prevent others from exercising their right to speak, either, nor do I empower the government to empress my thoughts upon others by forcing them to accept as true or even as valuable the words that I choose to speak -- only that they vouchsafe my unalienable right to do so just as they protect others from me infringing upon their right to speak.

 

A right is not granted by a government but protected from the government, and protected by the government on behalf of the individual. Protection of natural rights, then, is the counter to the divine right of kings or, in a more common incarnation, counter to mob rule -- the liberty and sovereignty of the individual is paramount.

 

Do I have "a right" to chocolate milkshakes? Well, the Declaration of Independence (and the Constitution of the United States as well as The Bill of Rights which followed) make it clear understood that I have the right to pursue chocolate milkshakes -- if that's what makes me happy -- but I am not entitled to them.

 

Do I have a right to Flintstones chewable vitamins? Nope. I may choose to pursue them, if I wish, but I can't go to Bayer HQ and demand they provide me with them. Why not? I mean, if they make me happy, surely I have a right to them, right? No. Flintstones vitamins are the product of someone else's labor and I have no claim on that.

 

This leads directly to the fallacy of "the right to universal healthcare," you see. I don't have universal healthcare[/i]. "Universal healthcare" is not something innately mine which is to be protected but, instead, is the product of someone else's labor. I am not entitled to someone else's labor. Period. Full-stop. We have a word for the taking of someone else's labor -- several of them, actually, depending on the situation. If it is an after the fact "taking" then it is called "theft." If, on the other hand, we take current or future labor for a limited duration or with some imposed compensation, it might be called "indentured servitude." If we simply compel someone to surrender their labor for our benefit on an on-going basis then it is called "slavery."

 

The imagined "right to universal healthcare" is, therefore, either theft or indentured servitude or slavery. Doesn't matter whether you think it is a nice idea or would benefit the collective or would help to assuage your conscience for not volunteering your own labor to benefit your fellow man (and/or woman and/or child) or not. You are not entitled to someone else's labor, regardless of whether you are going to pay them with (another) someone else's money or not. Democrats in the US felt, during the late 18^th & early 19^th Centuries that rice & cotton plantations in the South were critical to the success of their society and they maintained that they had a right to someone else's labor to fill that need. Didn't make it so.

 

Now, setting that aside for a moment (although there really needn't be any continuation of the discussion at that point) what about the ramifications to doing it anyhow?

 

First, there's the cascade effect of taking someone's labor. If the government takes it upon itself to provide "universal healthcare as a right" then that means it has to be "free." You cannot say some classes of people have the right to universal healthcare and others who have money don't have that right, can you? At that point, it is a "special privilege" rather than a "right." That means the entire healthcare system must be completely free. Doctors must work for free, nurses must work for free, laundry workers in the hospitals must work for free, the people who work in sheet factories which supply sheets to the hospitals must work for free, etc., etc. But wait! There's more...

 

Doctors and nurses and laundry workers and sheet factory workers need to eat, right? So their food must be provided for free, too. And their clothes. And their shelter. And their entertainment. Etc. Etc.

 

"Now hold on!" you say? "We wouldn't have this whole 'for free' infrastructure -- that would be silly! We'll pay them with 'government money!'"

 

So... Where ya gonna get that "government money"??? Gonna take it from people against their will? At best, that's theft. Indentured servitude or slavery become increasingly likely as costs begin to spiral out of control (we can explore why that will happen later, if your wish...)

 

Oh, but you are going to design this all very carefully so that it is efficient and unobtrusive, right? Perhaps you will rein in costs by controlling things like how much a physician "needs to make" or how much the CEO of a pharmaceutical company gets paid? Or how much a pill costs? Or who is allowed to get which treatments? Maybe you'll do away with the pharmaceutical company all together and "the government" will decide who gets which treatments based on things like their value to society?

 

 

Hmmm...

 

Do we really need to continue?

[Brian]

You narrative is absolutely bogus! Totalitarianism and treating people like animals? That is preposterous! All I said is that we are all part of a complex system of life in which the individual does not exist in a vacuum. Even the Buddhist's teach that.

 

Get angry all you want, but when you claim there is no right to healthcare, that is a divisive issue.

Is that all you said??? Really?!?

 

Show me where the Buddhists say that the government should use force to compel people to surrender their labor to provide goods & services to others. Point to that in the Buddhist canon and I'll consider taking you seriously.

[Brian]

I think this is a very interesting point on both sides.   

 

Anyone who was/is in the military and was at a base that had its own hospital will maybe observe as I did.  

1. They were paid according to rank (maybe that is why they ultimately left the military  ),

2. On the flip side, folks used it much more than they needed to.

3. There were no clinics, just the hospital to come get all your care needs meet.

4. etc.

 

Obviously, costs are contained in ways that don't really work in a free-for-all, competitive market... so I have thought about this for quite a long time, given that I also have seen state controlled stuff very similar in china.

 

When do we realize that competition is not the answer to something but cost contained methods that simply are done for the people's needs.

 

I'm not really suggesting this must be done for healthcare but this is what I meant earlier about thinking one size (competition) fits all (solves all needs)...

I disagree. It is, in fact, obvious from history AND from purely logical analysis that it is only the free exchange of energy in an open & competitive environment which can foster innovation, creativity and genuine efficiency. Every time freedom is suppressed, the motivations for innovation, creativity & efficiency are also suppressed. A free people can choose those things on which they agree to pool their energies but cannot be compelled to do so or they are no longer free (and the death spiral begins...)

[Brian]

Just throwing this out...

 

Some say health care works best when allowed to work according to the free market with minimal (or no) government involvment; others say the government needs to preside over a program of "universal health care." Personally, I`m undecided.

 

I think it would be informative if Bums advocating for one position or the other would throw out examples from other countries that follow their proposed system with success.

 

Free-market advocates: Is there a country you can point to that follows a free-market health care system with success?  In what sense is it sucessful?

 

Government-program health advocates: Is there a country with a health care system overseen by a government that you can point that succeeds?  In what sense is it successful?

I like this idea, Luke, but would suggest a minor modification -- the healthcare systems presented should have demonstrated this success in a sustained fashion over a period of at least a century with no substantial changes in structure.

[ralis]

Is that all you said??? Really?!?

 

Show me where the Buddhists say that the government should use force to compel people to surrender their labor to provide goods & services to others. Point to that in the Buddhist canon and I'll consider taking you seriously.

 

You really don't understand what I said. I stated that we are part of a complex system of life with no separate individuals which does not deny that individuals exist. That is all. No separation is what Buddhism teaches and nowhere did I say anything regarding forced labor or anything to that effect.

 

Why not go out and do tonglen practice and discover as to what your place in this system is. The question is, can you handle the practice? If done correctly and a real connection, it can be most disturbing.

 

I am going for a walk outside to enjoy the fresh air and light.

Edited March 15, 2017 by ralis

[Brian]

You really don't understand what I said. I stated that we are part of a complex system of life with no separate individuals. That is all. No separation is what Buddhism teaches and nowhere did I say anything regarding forced labor or anything to that effect.

 

I am going for a walk outside to enjoy the fresh air and light.

Then there's no need for the government to get involved in any of it, right? I mean, if we aren't individuals then there are no individuals to be governed and hence no need for government in the first place. For that matter, there are no individuals in need of healthcare nor individuals to be protected from predations (like forced labor at the nonexistent hands of a totalitarian oligarchical collectivist state). Of course, you can't go for a walk outside because you don't exist as a separate individual but I certainly wouldn't let that stop you.

 

<grin>

[liminal_luke]

I like this idea, Luke, but would suggest a minor modification -- the healthcare systems presented should have demonstrated this success in a sustained fashion over a period of at least a century with no substantial changes in structure.

 

That`s a pretty tough hurdle, I imagine.  A century with no substantial changes in structure?  I`m not sure there`s such an animal.  But OK, sure...all other things being equal, the longer a system has successfully worked, the better.

 

I like your earlier explanation of rights.  It`s tempting to think of universal health care as a right, but I don`t want the government to start outlawing my unhealthy choices.  Few people would argue that Mexico has an ideal government, but one of the things I like about living down here is that there are less rules -- and also a greater assumption of personal responsibility.  Wanna drive without a seatbelt?  No problem.  Forgot your bike helmet?  Ditto.  But don`t expect great healthcare if you get into an accident. 

 

Lots of people from the United States are afraid to visit Mexico.  My experience is that it is indeed dangerous here, but it`s not the drug cartels you have to watch out for.  The real danger is the potholes in the sidewalks.  If you`re not watching where you going it`s easy to fall and twist an ankle or worse.  And you can forget about sueing.  Mexicans would laugh you out of court; you`ve got eyes don`t ya?  

Edited March 15, 2017 by liminal_luke

[Brian]

You narrative is absolutely bogus! Totalitarianism and treating people like animals? That is preposterous! All I said is that we are all part of a complex system of life in which the individual does not exist in a vacuum. Even the Buddhist's teach that.

 

Get angry all you want, but when you claim there is no right to healthcare, that is a divisive issue.

BTW, you mistake amusement for anger. Curious.

[MooNiNite]

hmm, wonder why... they didnt corner the market did they?

 

"The cost for two EpiPens ranges from less than $100 in France to just over $200 in Germany. In New York City, a two-pack retails for $615 to $650, according to prescription drug-price tracker GoodRx. The product cost only $57 a shot when Mylan took over sales in 2007."

 

The government gets in the ways and says, "only this company can produce this!". Because of heavy influence (a product of rich capitalists). Soon later, every aspect of healthcare is controlled and run by select companies and people (those that have influenced our democracy), and everything costs a shit ton for the people, because they have no choice. 

 

Why do they have no choice? Because the government destroyed the free market. 

 

Obama's idea of universal health care, was an honest and good one, UNTIL he started giving special privileges and contracts to specific companies. 

Edited March 15, 2017 by MooNiNite

[Brian]

That`s a pretty tough hurdle, I imagine.  A century with no substantial changes in structure?  I`m not sure there`s such an animal.  But OK, sure...all other things being equal, the longer a system has successfully worked, the better.

 

I like your earlier explanation of rights.  It`s tempting to think of universal health care as a right, but I don`t want the government to start outlawing my unhealthy choices.  Few people would argue that Mexico has an ideal government, but one of the things I like about living down here is that there are less rules -- and also a greater assumption of personal responsibility.  Wanna drive without a seatbelt?  No problem.  Forgot your bike helmet?  Ditto.  But don`t expect great healthcare if you get into an accident. 

 

Lots of people from the United States are afraid to visit Mexico.  My experience is that it is indeed dangerous here, but it`s not the drug cartels you have to watch out for.  The real danger is the potholes in the sidewalks.  If you`re not watching where you going it`s easy to fall and twist an ankle or worse.  And you can forget about sueing.  Mexicans would laugh you out of court; you`ve got eyes don`t ya?

"The first thing we do, let's kill all the lawyers" - (Henry VI, Act IV, Scene II)

 

I think killing them might be a bit extreme but I certainly understand the sentiment. I think attorneys taking over the government (particularly elitist "Ivy League" attorneys such as Woodrow Wilson maintained should be the only people running the show) is a major part of the problem in the US and it is widespread and manipulated ignorance of the law which motivates me to post about US law so much here.

[MooNiNite]

""Those who cannot remember the past are condemned to repeat it," declared philosopher George Santayana.  The U.S. “health care cost crisis” didn’t start until 1965.  The government increased demand with the passage of Medicare and Medicaid while restricting the supply of doctors and hospitals.  Health care prices responded at twice the rate of inflation (Figure 1).  Now, the U.S. is repeating the same mistakes with the unveiling of Obamacare (a.k.a. “Medicare and Medicaid for the middle class”)."

 

 

"Both have claimed "physician supply can create its own demand," which means increasing the supply of doctors and hospitals will just motivate them to convince "ignorant" consumers to order more unnecessary and expensive health care.   During the 1970s, Frank Sloan, a Vanderbilt University health care economist, explained the success of the most influential pro-regulation health care economist, Uwe Reinhardt: "His theories are highly regarded because he is so clearly understood.  Unfortunately the evidence for them is not good; it is not bad either, it is just not there.  And it would be a shame to see federal policy set on such a poor, unscientific basis." Since the early 1900s, medical special interests have been lobbying politicians to reduce competition.  By the 1980s, the U.S. was restricting the supply of physicians, hospitals, insurance and pharmaceuticals, while subsidizing demand.  Since then, the U.S. has been trying to control high costs by moving toward something perhaps best described by the House Budget Committee: “In too many areas of the economy - especially energy, housing, finance, and health care – free enterprise has given way to government control in “partnership” with a few large or politically well-connected companies”  (Ryan 2012).  The following are past major laws and other policies implemented by the Federal and state governments that have interfered with the health care marketplace (HHS 2013):"

 

 

 

Figure 2:  Health Care Spending in U.S. by Sector from 1960 to 2005  (Source: US Census 2013) Spending on prescription drugs didn’t accelerate until after pharmaceutical monopolies were strengthened in 1984.  Spending has increased even less for administrative, net cost of private health insurance and nursing home care, and not much at all for dental, structures, equipment, public health, other personal and professional care, home health care, research, non-prescription drugs and durable medical equipment. Since the 1980s, the government has used its buyer monopoly power, through its Medicare and Medicaid programs, to effectively set price and quality controls (e.g., underpayments) on physicians and hospitals (Stagg-Elliot 2012).  For the same purpose, the Federal and state governments promoted the concentration of private insurance into buyer monopolies (e.g., HMOs). 

 

 

https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive

Edited March 15, 2017 by MooNiNite

[Brian]

When I was in the military (1970-1975 I was hospitalized with a fever of 104.5 which for an adult, is serious. The fever lasted 3.5 days and the doctors were incompetent in that they offered no diagnosis except 'viral syndrome'. Offered no treatment protocols and criticized me for drinking water. WTF! All I could do was drink as much water as I could which finally broke the fever. I was beginning to be a bit delirious i.e, visual hallucinations which scared me. If it wasn't for my wits and daily yoga practice, I might not have made it.

What an outstanding argument against letting the government take over the healthcare system!