Burning stupid and hypocrisy

A single question, my zealot of the “truth”. So to which vaccine company you work for?????

http://www.anovaordemmundial.com/

Obviously this new troll has not bothered to read the information provided at the top left of this page. Since when did vaccine companies need surgeons? Nor has he read much of this blog when he pulls the lame “Pharma Shill Gambit”.

Wow…

Gingrich says the current healthcare reform bill is a framework on which all sorts of things we don’t yet know about can be hung from, possibly at the government’s whim and that we shouldn’t trust the government.

And Maddow thinks he’s talking about killing Grandma or something?

Sarah Palin were talking about Dr. Emanuel’s theory/proposal “complete lives system” coupled with Obama’s earlier statement about panels deciding what coverage/care could or would be offered under the new system and wondering if the mandate to pay doctors for giving living will advice was a part of that progress.

I have no idea what Rush was talking about, but the legalzoom ad he read said zilch about “living” wills, unless you assume all wills are living since we can’t write them after we’re dead.

(I have not paid any attention directly to Rush since he called Chelsea Clinton a dog and don’t intend to start now. I think he’s a despicable person.)

Sometimes I think people can search the area between the lines so hard they hallucinate about lines that aren’t actually there.

Yes, the stupid, it burns. Why not let the folks who want to die, die? Stop intubating 95 year olds when they have a laundry list of diseases that will never be cured? Seems the folks who have the most opinion have never worked in a hospital.

You might have a point with Rush, less so with Newt Gingrich, but you’re off the ranch with Sarah Palin, I’m afraid. She made a frikkin’ proclamation as Governor of the State of Alaska encouraging people to prepare living wills, fer cryin’ out loud! How is that not using the power of the government to encourage living wills? True, it’s not legislation, but come on.

No, Dr. D, the smear campaign about “death panels” is one of the most despicable lies I’ve ever seen in my life watching politics. It’s so transparently false and so cynically calculated that it embarrasses me that I used to consider myself a Republican. (Well, an independent who voted Republican most of the time.) It’s stuff like this that drove me from the Republican Party.

Oh, come on. The Republicans are talking out of both sides of their mouths. They had no problem with encouraging living wills in Medicare legislation because they were in power then and it was their bill. The whole “health care reform = slippery slope to Hitler’s T-4 euthanasia program” is such an incredible load of bollocks that it deserves nothing but contempt and ridicule. Yet the press actually takes this loony conspiracy mongering of the tinfoil hat brigade seriously and treats it with far more respect than it deserves.

I went to the PDF of the Republican bill you referenced. As best I can tell it’s quite a different animal from the provision in HR 3200, which seems to take things to a new level in several ways, one of which is that it makes the EOL counseling a performance measure. (See this post):
http://doctorrw.blogspot.com/2009/08/end-of-life-counseling-issue-needs.html

HR 3200 also gives a great deal of discretionary power to a health benefits advisory board which, I’ll say again, in this particular administration, is bent toward rationing against elderly.

Again, no one on the right that I know of is opposing the pure notion of living wills or health care planning. But when you consider the implications of the current bill and the policy agenda behind it, slippery slope and unintended consequence arguments become relevant.

But I wish the Republicans hadn’t hyped the issue so. All they really needed to do was grab the link to Zeek Emanuel’s recent Lancet article and circulate it around. Great primary source material and, as you said, res ipsa loquitur.

Hi all,

I thought these words nicely captured the problem with HR3200 and may explain why some of us are feeling uneasy about the bill:

“It is complexity for complexity’s sake. When one parses out all the legalese, cross-references, and unnessessarily tortuous syntax, one is often (if not in each and every case) left with nothing concrete. To a great extent, the meanings of large sections of HR 3200 are not merely difficult to ascertain, but are fundamentally indeterminate. It has no definite meaning. It is designed for ambiguity.

This is legislation designed to create a legal framework under which huge cadres of unelected, politically-appointed policy mavens and bureaucrats will determine – by publishing hundreds of thousands of pages of regulations, rules, and guidelines – what our new healthcare system will look like. And until those regulations and guidelines are actually created – and this “creation” will be a never-ending process rather than an act – anybody claiming to know the precise nature of our new healthcare system under HR 3200 is engaging in one of the following: lying, projecting one’s own wishful thinking, or extrapolating on the perceived behaviors and beliefs of those who (one surmises) will finally get to make up all the rules.

So nobody voting for HR 3200 will possibly be able to say with any degree of certainty what they are voting for, or what, precisely, a healthcare system will look like that comes from this bill.

This is what makes the debate so difficult. On one side, we have politicians telling us all will be well. We will finally insure 47 million Americans currently without insurance; we will reduce the cost of healthcare without affecting quality; we will not raise taxes to do so; those happy with the insurance they have now can keep it. And the actual language of HR 3200 (at least arguably) may not explicitly contradict any of these claims.

On the other side, we have politicians arguing the opposite on all these points. And HR 3200 seems quite consistent with their predicted outcomes as well.

The fact that the language of HR 3200 is completely consistent with either of these interpretations reduces the debate to a aeries of “Uh-huhs” vs. “Huh- uhs.” The ultimate meaning of HR 3200, by design, is completely open, and finally, will only be determined by armies of commissions, regulators and bureaucrats once it becomes law.”

Link to article: http://covertrationingblog.com/uncategorized/james-madison-sarah-palin-and-hr-3200

After getting a headache reading a lot about healthcare reform, I found that this idea succinctly summarizes the problem with the bill. Do others feel the same way, or are there holes in this argument I am looking for?

David,
Your’e right on the money, as is the Dr. Rich post to which you link.

Orac,
Yes, it must be said that Zeek Emanuel is opposed to euthanasia. No, he doesn’t want to kill gramma. But the Lancet paper and other of his writings make it clear he’s for age based discrimination. When the resources fall short he wants to deny gramma basic care because she’s old. We’re not gonna kill gramma but it’s her duty to die. That’s the philosophical bent of the folks Obama has surrounded himself with. That, combined with the inscrutable language of HR 3200, is cause for concern.

Jeezus, Leggett, talk about reading in a lot of things that aren’t there.

I have neither the time nor the inclination to go through all these point by point, but let’s just take one right now:
“Page 29: Admission that your health care will be rationed!”

No, you twit. Page 29 sets limitations on how much you would have to pay. It sets limits on how much personal contribution you have to make towards healthcare costs!

Page 30 refers to the how they’ll set up the panels to decide what benefits different plans will cover. You’ll have a choice of plans. It is absolutely no different than what you get from any insurance company, and there is certainly no reference to a lack of appeals process.

The whole bit on pp.427+ about end-of-life care very specifically refers back to use of the plan set by the individual in question during consultation.

And so on.
As far as I can tell, ALL of this is just a reading comprehension fail on your part.

Rush Limbaugh is telling us that the government will let people “loop out”?

This from a gentleman who got himself addicted to prescription pain killers?

http://www.cnn.com/2003/SHOWBIZ/10/10/rush.limbaugh/

Those who are railing so loudly against the very concept of rationing healthcare services have apparently never been involved in a triage situation, where the patient load far overshadows the available care-giver resources. I’d take it one step further, and suggest they might benefit from a stint in a major city’s trauma center. Those who require immediate treatment – and have the best chance for survival – get treated first. Those with a slim chance of survival or a meaningful quality of life fall somewhat lower on the list. While it’s easy to sit back and pass judgment on the decision-makers, the truth is that when actually faced with such difficult choices, we have to shift from an emotional to a more pragmatic approach. And believe me, anyone who has been in the position of choosing who gets saved has to deal with their own conflict, and doesn’t need (or deserve) to be condemned.

Rationing is an unfortunate but unavoidable reality until such time as the ratio of healthcare providers to patients improves. When the ER no longer serves as primary care facility for a significant portion of the population, genuine emergencies will be dealt with much more efficiently, healthcare costs will be more likely to decrease, and that rationing everybody is so concerned about will diminish, as well.

If all concerned were more focused upon actually improving the situation than in earning cheap political brownie points… never mind. Might as well say that if grasshoppers carried .45s, mockingbirds wouldn’t mess with them.

Your points are well taken, Orac. Yes we do ration. The difference from other health systems is we don’t ration explicitly. Many are saying we should get over our dread of the R word and start being explicit in our rationing. Would that make it more fair or just inch us down some slippery slope? I don’t know.

And yes, we have age based discrimination. There’s a difference between the type of discrimination we have now, though, and Zeek Emanuel’s discrimination. His is largely utilitarian value based (can we justify health care for an elderly demented patient who’s just a mouth to feed and water but has no value to society) whereas ours is primarily medically based (could gramma tolerate chemo, etc.), and the only values we now respect in such decisions are the values of the patient (would gramma want to live like that?).

So there’s a difference.

Obama’s policy wonks miscalculated. They failed to realize that there’s a uniquely American value that holds the worth of the individual above the good of the commons. Like it or not that’s entrenched in our culture and it’s what’s driving all the town halls, You Tubes and fishy emails.

Robert W. Donnell,

Please read RevRon’s excellent post at #24, and take note that the title of Dr. Emanuel’s article in the Lancet is “Principles for allocation of scarce medical interventions”(emphasis mine). Also, do you really have a complaint about Dr. Emanuel’s conclusions, or are you just upset at the fact that there are situations where care has to be rationed? If the latter, then I wholeheartedly agree. This world leaves much to be desired.

Dr. RW,

With all due respect, have you actually read the whole paper? Seriously. If you did you would know what Dr. Emanuel was talking about. Here’s the abstract:

llocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems.

Here’s the first paragraph:

In health care, as elsewhere, scarcity is the mother of allocation.1 Although the extent is debated,[2] and [3] the scarcity of many specific interventions—including beds in intensive care units,4 organs, and vaccines during pandemic influenza5—is widely acknowledged. For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary.6

Another excerpt:

Some people wrongly suggest that allocation can be based purely on scientific or clinical facts, often using the term “medical need”.[13] and [14] There are no value-free medical criteria for allocation.[15] and [16] Although biomedical facts determine a person’s post-transplant prognosis or the dose of vaccine that would confer immunity, responding to these facts requires ethical, value-based judgments.

It’s a bioethics paper, and it’s primarily about triage for truly scarce medical resources, like organs for transplant, vaccines in some countries, etc. All of these are examples in which various criteria that have used age as one of the major factors, among other things. It is not per se a paper about nationalized health care or rationing under such a system.

Personally, I find the rants of “no rationing” to be naive at best and disingenuous at worst, because rationing is taking place, and right now it is pretty much arbitrary, based more on cost, the flip of the coin (do you have decent insurance?), and other factors, including what part of the country you happen to live in. The difference is that Emanuel’s proposed system, whether you object to it or not, is not arbitrary. It is based on bioethical principles with broad agreement, and he goes into painstaking detail to discuss them. You might object to how those principles are integrated into his proposed system, but, honestly, it’s far less arbitrary than the system we have now, and, unlike the current arbitrary hodge-podge, it has at least some bioethical basis behind it.

Incidentally can I just say here that Rush Limbaugh, apart from having a very silly name that sounds like it should be a sexually transmitted disease, is, as we British are apt to say, an ignorant wanker.

Also, Limbaugh was not only addicted to Oxycontin, but like the chicken~sh*t he is, had his MAID go out and score for him!
JTD

The national health care debate, oops did I say debate? sorry I meant national health care scare could best be summed up by watching the film Dr. Strangelove or How I Learned to Stop Worrying and Love the Bomb.

Brig. General Jack Ripper – Its all about Precicious bodily fluids and flourodated water. “They look a lot like our soldiers general?” “Those commies are clever bastards!”

Oric,

I am sure, if I show up in a hospital with a heart attack the same time there has been a terrorist attack or another Hurricane Katrina. During triage I am not going to come first. My first cousin’s mother-in-law died in Baton Rouge from an untreated infection just after Katrina. I do not want the decision to be made, to let me go because we have spent the money for the year, or I am not going to live long anyway so that is a good place to save. Especially so that on the next bed down we can save the 17-year-old gang banger who has been shot over a drug deal that has gone bad.

Here is what Wikipedia has to say about the British system. http://en.wikipedia.org/wiki/Criticism_of_the_National_Health_Service

I am a 67-year-old male who has had bypass surgery. I am concerned about any system that leads to some type of NICE. I say this from the somewhat selfish point of view that after paying for Medicare for some forty plus years, I am now told that I mush accept less care so that we can give more care to those who have not for whatever reason paid their share.
http://en.wikipedia.org/wiki/NICE

It does seem to me a bit much, asking those of us who have paid in, not to want what they have paid for. It would be easy to fix the high cost of medical care in the US by just dropping medicaid. Wham there goes 320 billion that the uncaring taxpayers are now paying for all the poor who do not pay taxes. I am tired, that after years of working like a dog. I am being told that I am greedy and selfish for wanting the 45 to 50 percent who pay no federal income tax to pay something. If I hear that they pay SSA etcetera and that is a large part of their income. I am going to scream. (7.5% $20,000 =$1,500
7.5% $100,000 =$7,500) It is the same rate for everyone. Where is my tax break here?

Now there are things that the government ought to do to improve care and reduce cost. The law that prevents Medicare from negotiating with drug companies is an abomination. I would go one step further and tell the drug companies that they can charge all the markets will bear. As long as they charge the same to any first world country. I am tired of paying the total cost of drug research so that Canada and Europe can get the new drugs cheaper.

We could also lower the cost of Medicaid by insisting that any Medicaid/ welfare recipient was on birth control before they received their check/payment. I say this because I cannot figure a way out for a 17-year-old girl without any education and three kids. I also limited my fertility to the number of children I could afford to raise.

I want the US Government to first fix all the problems, they have with their current program’s VA, Indian, Medicaid and Medicare before I am willing to intrust them to increase the scope of these programs. I doubt it even then, because that would still leave the worst problem of National Healthcare System. If the government both runs and oversees the health care system, there is the inherent conflict of interest between the two functions. I want the government to be and impartial judge of any problems I have with private healthcare. I do not want there to be nowhere to go if and when I have a problem. See above NICE for everyone who thinks it cannot happen here.

Robin Levett,

Two minuets research on the internet says different. I have not done extensive research but if I am wrong I would like to see the research. Please send me some sources.

http://www.americablog.com/2009/07/advair-costs-13-price-in-europe.html

http://www.highbeam.com/doc/1P2-7826688.html

http://www.manhattan-institute.org/html/miarticle.htm?id=3240

thanks John

Robin Levett,

Two minuets research on the internet says different. I have not done extensive research but if I am wrong I would like to see the research. Please send me some sources.

A quoit from the Chicago Sun Times URL below.

“Late last month, when European health ministers were being advised of the importance of drug pricing freedom, the House approved a bill on drug reimportation by a whopping margin, 243-186. Reimportation would allow Americans to purchase pharmaceuticals from nations like Canada where governments fix drug prices. In other words, it’s a back door for introducing price controls. ”It’s about money, the money that the pharmaceutical companies are making on the backs of the American people,” Rep. Dan Burton (R-Ind.) explains.

Actually, it’s about research and development. And here’s the connection between Europe’s decision and Congress’ folly. Pharmaceutical innovation is pinned on profitability. While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States. And even European firms such as GlaxoSmithKline have moved essential work across the Atlantic, to American shores. No wonder the EU is reconsidering their regiment of price controls.”

http://www.manhattan-institute.org/html/miarticle.htm?id=3240

http://www.americablog.com/2009/07/advair-costs-13-price-in-europe.html

http://www.highbeam.com/doc/1P2-7826688.html

http://www.manhattan-institute.org/html/miarticle.htm?id=3240

http://www.house.gov/cummings/pdf/intl.pdf

Robin, “NHS access is therefore controlled by medical priority rather than price mechanism,” IF it were only true url below quoit.

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs — including Sutent, which costs about $50,000 — that would help terminally ill kidney-cancer patients. After last year’s ruling, Peter Littlejohns, NICE’s clinical and public health director, noted that “there is a limited pot of money,” that the drugs were of “marginal benefit at quite often an extreme cost,” and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: “When treatments are very expensive, we have to use them where they give the most benefit to patients.”

http://online.wsj.com/article/SB124692973435303415.html

See also in Canada.

http://www.vancouversun.com/story_print.html?id=1878506&sponsor

As I said before, I am a sixty seven year old cardiac patient. Because I am a 67 year’s old, I am somewhat cynical about government promises. You may be willing to trust some faceless bureaucrat with your life, without any recourse. I would prefer not to do so. Maybe it is because I spent twenty four years of my life as one and understand what goes on when you are forced to match expenditures with your budget. We are going to save 50 billion a year from Medicare without any cuts. If you believe that I some water front property for sale about 100 miles south of Mobile. I started paying in to Medicare when it was passed

A brief history of Medicare. http://seniorjournal.com/NEWS/2000%20Files/Aug%2000/FTR-08-04-00MedCarHistry.htm

July 30, 1965 Medicare and its companion program Medicaid, (which
insures indigent recipients), are signed into law by
President Lyndon Johnson as part of his “Great Society.”

Ex-president Truman is the first to enroll in Medicare.

Medicare Part B premium is $3 per month.

1972 Disabled persons under age 65 and those with end-stage
renal disease become eligible for coverage. This is strange for a program for seniors maybe it should have been part of Medicaid.

Services expand to include some chiropractic services,
speech therapy and physical therapy.

Payments to HMOs are authorized.

Supplemental Security Income (SSI) program is established
for the elderly and disabled poor. SSI recipients are
automatically eligible for Medicaid. I wonder why there are problems with the trust fund.

1982 Hospice benefits are added on a temporary basis.

1983 Change from “reasonable cost” to prospective payment
system based on diagnosis-related groups for hospital
inpatient services begins.

Most federal civilian employees become covered.

1984 Remaining federal employees, including President, members
of Congress and federal judiciary become covered.

1986 Hospice benefits become permanent.

1988 Major overhaul of Medicare benefits is enacted aimed at
providing coverage for catastrophic illness and
prescription drugs.

Coverage is added for routine mammography.

1989 Catastrophic coverage and prescription drug coverage are
repealed. The cost were so high that seniors revolted.

Coverage is added for pap smears.

1992 Physician services payments are based on fee schedule.

1997 Medicare+Choice is enacted under the Balanced Budget Act.
Some provisions prove to be so financially restrictive
when regulations are unveiled that Congress is forced to
revisit the issue in 1999. I wonder how many people died?

1999 Congress “refines” Medicare+Choice and relaxes some
Medicare funding restrictions under the Balanced Budget
Refinement Act of 1999.

2000 Medicare+Choice Final Rule takes effect.

Prospective payment systems for outpatient services and
home health agencies take effect.

Medicare Part B premium is $45.40 per month.

Thanks John

@John G Leggett:

I’ve just submitted a longish post with a number of links which is being held in moderation. The bottom line is that you shouldn’t believe all you read on right-wing sites. Reality has a well-known liberal bias.

@John G Leggett:

Shorter version: Sutent is approved for kidney cancer; Pfizer hasn’t yet demonstrated efficacy (over current treatments) for Sutent in other cancers.

I know, by the way, that there is a trial in Wales on use of Sutent in advanced breast cancer.

Robin, I never said that there are not problems with health care in the US. I even gave what I still think are two ways that cost could be reduced. I have a third that at first glance looks crazy. Triple the pay of primary care physicians. I pay my internist $1500 up front each year. For this he limits his practice to 600 hundred patients instead of the more standard two thousand patients. The statics I have read say. “What does all of this mean for patients? Patients in MDVIP affiliated practices are admitted to the hospital at dramatically lower rates than non-MDVIP patients.”
http://mdvip.com/NewCorpWebSite/ValueInPrevention/HealthcareStatistics.aspx

This makes sense to me, during the spring of 2007 I had bronchitis twice and pneumonia once. I saw my doctor the same day. I came down with symptoms. If as frequently happened before I joined. I was told that the first appointment was in a week. How much more likely would it have been for me to have made it into a hospital?
I by the way already have a healthcare power of attorney and a living will. I do not need or want to waist my time on government forced counseling.

I said in one of my previous posts that one other way that healthcare costs could be greatly reduced. Is to, mandate that every welfare recipient is on birth control with either a patch or month long shot administered before they receive their check. I would be willing to pay them a thousand dollar bonus. If they become permanently sterilized. I had a vasectomy thirty years ago. So I am only saying do what I do. It is none of my business how many children anyone who does not get my money to support themselfs has. It does become my business when I am asked to support them.

I guess this is another right wing blog.
http://www.nytimes.com/2009/08/21/health/policy/21seniors.html?_r=3&hpw

Another right wing blog.
http://www.reuters.com/article/newsOne/idUSTRE57K4XE20090821

How much health care are we going to get if the country is bankrupt. Germany 1920’s, Greece 1940,s, Argentina 1970’s. You do know what the correct name for income transfer is. It is called armed robbery. Taking property from someone to give it to another. That is what Robin Hood was a highwayman after all.

@Robin Levett #49:

First I think we ought to take this off the blog. I am enjoying this discussion so here is my email [email protected] I will be on the road to Friday so donot expect and anser before that.

Neither Reuters nor the NYT are a right wing blog – but th fact that your health system is in deep trouble is hardly news; and what relevance their criticisms of Obama’s plans have to your claims that the US contribute more to drug R&D through higher prices I have no idea.

Robin my brother wrote me this maybe you can anser his questions.

I continue to be perplexed by all of this. Just What Part of America’s Health Care services (the best in the world) is broken? We all complain about having to pay so much money for our health needs. There are catastrophic consequences that can result if we can’t afford proper care – but what are we trying to address. I am not sure that the problem has been sufficiently defined. What is so unlikable about the private health care initiatives that are out there?
Are there not enough physicians? The answer could be Open up new schools to enable more aspirants to become physicians.
Are there not enough nurses? Ditto.
Is it the number of people who are under-insured (anywhere from 5 to 40 million people depending upon the study)?
Should there be required insurance for everyone here? Why? Is this an entitlement? How will it help? What problem does it cure? Who should provide the insurance? Why? How?
Are those not insured being denied medical services? If so, when? How? Why? What circumstances? (This can be addressed I would think in a number of ways)
Is it that there aren’t sufficient venues for treatment?
Is it that drugs are too expensive? The government already has a prescription subsidy program of some sort – does it need to be more robust?
Is it that there aren’t enough physicians in rural areas?
Is it that there is too much need in urban areas, such that the urban systems are over-stretched beyond capacity?
If we are going to throw lots of money at this problem, how do we direct it to be most efficiently spent (not by Democrats)?
I have been paying into Medicare for about thirty (30) years and am yet to draw the first penny from its resources. How can Medicare be a model for how best to efficiently run an insurance program when it has been pre-funded for a number of years and still operates on negative margins?
Everywhere you look these days there are “Doc in a Boxes.” Does the Government need to set up their own “Doc in a Boxes” to treat those who are being turned away (?) by existing medical services (if any are?)
Should emergency rooms be the first treatment area for all uninsured? [They are quite expensive]
My head just hurts from all of this stuff, but I’m not ready to be put out to pasture or planted in the pasture just yet.

UK 1948. Do you have any idea what the UK’s economic position was after WWII? We’d just gone through 6 years of war, had the centres bombed out of half our cities and massive damage to our capital; we’d been gouged to the hilt by US arms manufacturers, and had a national debt well over twice our GDP – we only finished paying off the WWII debt recently.

I did not mention UK, if you have paid of your WWII debt you are in much better shape than the US we have not paid of our WWI debt much less our WWII debt.

The figures show however that the NHS costs less per head than your system; in fact, our entire spending on healthcare, government and private – per head – is less than your government spends on healthcare. The question is how can you afford your current healthcare system if you go bankrupt. You already have 45 million with no coverage at all (outside the emergency room).

You are making my point why would we want to increase spending power to anyone who is doing such a poor job of spending currently. We also get better healthcare. I am really uncaring when it come to people who are illegal entering the country some 10 to 20 million depending on who reports. I do not much want to pay for the 9 million who make over $75,000 a year.

http://www.cnsnews.com/Public/Content/article.aspx?RsrcID=51443

I do not need or want to waist my time on government forced counseling.

You don’t even know what’s in the bill, do you? Free clue; the provisions for end of life counselling in the bill mandate its availability, not its uptake.

Start reading at page 439. While the language is obscure. It is not the only thing we have to go on. Read

http://www.washingtontimes.com/news/2009/aug/26/the-government-death-book/

I take it that you’re not a Christian then; or if you are, you’re one of those that believe that the sacred texts stop at Leviticus and only restart with Revelation.

Where does it say in the bible that there are any benefits to anyone who surrenders their property when some one points a gun at them? I ascribe to the Jewish view on charity. Charity given anonymously if the best.

This is the liberal canard that conservatives do not care. The facts show different conservatives on average give about twice as much as liberals. If even half of the liberals gave as much blood as I have over the last fifty years. It would eliminate all the blood shortages in the US.

Even if you’re not; how is it I can read your words, since surely someone with your views shouldn’t freeload on the taxpayer’s dime – or take advantage of the technological benefits available in an advanced society – by using the Internet? I presume you stay at home – you wouldn’t freeload on the taxpayer dime by using publicly funded roads, would you? (etc etc etc).

I object to your statement about freeloading. I have paid more than my share of taxes for the common good. It is being asked over and over again to pay someone else’s that I object to. I do not know how it is in the UK but in the US around half the people pay no federal income tax. We taxpayers are spending around 320 billion dollars a year, for the federal medicaid program for the poor and illegals who pay nothing.

Posted by: Robin Levett

I’m always slightly stumped when faced with a claim like “There is one great advantage that private healthcare rationing has compared with government rationing: competition”. Are people really that dumb?

Competition between companies basically amounts to who can make the greatest profit, this is normally achieved by working very hard to take the largest possible sum of money from the customer while giving them the smallest possible return. How the hell do people fail to understand this? This is why peoples health care decisions are dictated by insurance company employees whose christmas bonus depends on them denying as many claims as they can possibly get away with.

Markets are useful to society for driving things such as technological innovation, but we should never lose sight of the fact that they are selfish by their very nature.

This is a curious post by Ramel. Most people who think that markets and profits don’t work in health argue that market mechanisms can’t operate because of certain “market failure” conditions– say, adverse selection or moral hazard in insurance, or asymmetrical information between providers and patients. But it sounds like you’re questioning the efficacy of markets, competition and profits.

“Competition between companies basically amounts to who can make the
greatest profit,…”

So far so good.

“this is normally achieved by working very hard to take the largest possible sum of money from the customer while giving them the smallest possible return.”

Um, no. As you note, companies compete with each other, not with the consumer. In a functioning market, they compete for profit by competing for market share– to the advantage of the consumer– by offering (a) a better product/service, or (b) a more cost-efficient deal on roughly the same product/service. Excessive profits are competed away; firms strive to increase output to cost (input), driving innovation and capital investment.

It is where there is NO competition that firms lack the incentive to innovate, or to keep prices reasonably related to costs– since where else can consumers turn? This happens with monopolies and with price-fixing cartels. A reestablishment to market freedom– the entry of competitors looking to explode these fiefdoms by offering consumers a better alternative– restores the impetus to efficiency.

“Markets are useful to society for driving things such as technological innovation….”

How do you think this works? The profit motive! In an economy based on voluntary exchange, the only way to get money is to offer someone something they value in return. Having to compete with other providers impels you do your best to offer good value. In a functioning market dollars are “certificates of performance.” They’re also purchasing power– so your power in the market as both supplier and consumer will be enabled by performance.

You are not the first person in history to question a system based on something as “selfish” as the profit motive. A little thing called the 20th century provided a number of global experiments with alternatives. It turns out that that the market and its pricing function comprise an irreplaceable discovery process for determining how resources can be allocated efficiently AND when you disconnect rewards from achievement (e.g., by banning profits or controlling prices) you pretty quickly erode the economic performance of a population. Also consider the “expertocracies” that try to replace markets in allocating resources turn out to be poor substitutes for the emergent order that results from the interaction of millions of free buyers and sellers. Plus, consider that the bureaucrats that policy textbooks depict as disinterested, objective and omniscient agents ALSO turn out to be human beings with fallible perspectives, facing their own political incentive structures, and make the WRONG decisions for their OWN self motives.

“It should also be kept in mind that the management of the company is
almost always much better paid than the rank-and-file employees.”

It’s also worth pointing out that under competitive conditions, any firm that devotes too little of its budget on capital investment, r&d or recruiting and maintaining a skilled workforce will lose out to firms who take care of such expenditures with an eye to improving their own productivity and increasing their market share. Blowing your budget on upper management salaries or even excessive shareholder dividends is no strategy for the firm’s success. (It can, of course, profit a few here-and-gone administrators; but the bankruptcies, acquisitions and liquidations that befall the firms will, ultimately, provide the incentive for industries to restructure misaligned executive incentives.)

“…but we should never lose sight of the fact that [profits] are selfish by their very nature.”

The premium that economists place on results rather than intentions tends to irritate moral philosophers. Perhaps moral philosophers should renounce any good or service that is made available to them from any motive apart from altruism or principle.

Again, we can discuss elsewhere the reasons why markets may or may not function in the context of health care, or sectors of it. But it’s nonsensical to imply that they can’t because health care is too important to be left to the profit motive. Food, clothing and shelter are overwhelmingly provided by the market (while experiments with government management of food provision around the world are an unhappy tale indeed– cf. Mao’s Great Leap Forward, Lenin’s War Communism, etc.). We don’t lament providers profiting from our hunger, nakedness and need for shelter. If they can profit from our illness while providing what we want– the best treatment possible– I for one will begrudge them nothing.

Thanks for the response.

I refer to what goes on between two or more suppliers in a market as “competing.” What goes on between supplier and consumer I’d call “bargaining” or driving a bargain. I assume that, as a consumer, you strive to get the best value for your money– in your terms, to get the most product/service as possible while surrendering as little money as possible. The supplier is doing the inverse. But, in a market context with no coercive regulation, each of you can walk away from the deal if you deem the terms unsatisfactory. Relatively few things that I find myself wanting or needing don’t have at least remotely acceptable substitutes that I can procure elsewhere; and in a competitive market there are other suppliers of roughly the same or similar good or service looking for my business.

Again, in a functioning market, competition erodes excessive profits and discovers a true price. As a consumer I may start out wanting an HDTV for, oh, $35. I will quickly discover that no one can cover their costs and earn a motivating profit by offering one at that price. A firm that makes them might prefer to charge me $12,000 for one. They will quickly discover that in doing so they have ceded the market to suppliers willing to price at or near what turns out to be the equilibrium price.

As to monopolies: There is a good deal of literature on the subject, much of which suggests that even markets with only a few major suppliers tend to remain competitive; cartels are tough to maintain—–the temptation to break ranks and reap increased market share (lower unit price more than compensated by increased volume of units sold, good for shareholders) tends happily to be too strong. But I think a bigger point is the role that government often plays in making a field less competitive. In the 1950s and 1960s big businesses in the U.S. tended to be very happy with the heavily regulated business environment in the wake of the “Treaty of Detroit.” It turned out that regulations stipulating elaborate labor benefits, production schedules, etc. (including airline, trucking etc. regulation) worked to protect large established businesses from competitive entries that couldn’t afford these transaction costs. Big firms were more secure, shareholders got modest but largely guaranteed returns, workers felt all but invulnerable—and consumers paid the freight.

As to ads and marketing: When products are essentially similar, ads can make a big difference by successfully depicting a given product as hipper, sexier, and more stylish. But ads also convey substantive information about product differences, and particularly in major purchases consumers care about such things more than some social critics would have us think. Anyway, marketing is seduction, not coercion, and seduction is typically a mixture of substance and style. Where substance leaves off, marketers discover that style—a certain image, say—is part of what people want. That’s an aspect of taking freedom seriously.

As to innovation: Many important new goods enter the market at a high price. During the time these spend as “luxury goods” the wealthy are in effect paying the cost of further development to achieve more cost-efficient manufacture, allowing the good to be priced down to the mass market. In capitalism the payoff is a mass market, which is why, say, Mr. Ford wound up so much wealthier than Messrs. Rolls and Royce. I think it was Joseph Schumpeter who said that while royal women had had silk stockings for centuries, the achievement of capitalism was to make them affordable to factory girls.

This post isn’t about health care financing as such. Let me hasten to say that I don’t relish any more than you do the thought of somebody suffering acutely or even dying because they can’t afford treatment that exists and that many others can easily afford. Like you, I want the most/best health care to be accessible to the most people. From my acquaintance with the subject thus far I am less sanguine about achieving that goal through centralized government management, and suspect that a well-designed marketplace—supplemented with demand-side vouchers for low income people—will wind up better performing the needed combination of tasks: Controlling costs, driving innovation, broadening access. But again, this is for another, less general post.

Finally, as to collectivist societies I never said anything about violence, oppression, human rights violations, etc. I realize all socialist/collectivist/social-democrat systems are not totalitarian Communism—although giving sufficient power to centralized government to “manage” the economy rather than leaving it largely to free exchange can bite a society in the ass down the road. My remarks were about the relative efficiency of free vs. controlled economies in general. Again, I am happy to address what seem to me the trade-offs between the approaches to health care taken by the US and by various other developed countries (which as you know differ considerably among themselves, though almost all have more government control than the US) in a dedicated post or posts. But I’ll end here by saying that one thing I’ve come to appreciate about competitive market settings is that, where they function, they tend to make the performance of their participants efficient by tracking reward to achievement far more acutely than occurs in bureaucratic settings, where signals to change policy (and authorization to do so) tends to be glacially slow, and where individual performance is camouflaged by bureaucratic mass and often difficult to access by incentive structures beyond doing the minimum and keeping your head down.