The Observation Deck

[quote="Jim O'Bryan"]
What I am getting at is that countries like England, France, Germany seem to have taken
this part of life out of their day to day lives very nicely, without bankrupting their economy.
The British plan seems like a very good plan with emphasis placed on prevention, that has
proven to decrease costs across the board.

WB It is interesting that, among themselves, the British, for example, are very critical of their health care system, but when an outsider, such as an American, is critical of their system, they become very defensive and support it. I guess that is human nature.


I think when you take a long term view of the social support networks, including healthcare, you find that the generous programs do not last. The oil runs out, or the economy falters, and they back off their generous programs and try to find something they can afford. I would prefer to avoid a situation where we give everyone health care, then find out we can't afford it, and start cutting back until only the politicians and their friends are covered.

But I'm certainly willing to look at any program and see if it, or part of it, will work for us. My objection now is that my party is running around like Chicken Little saying we have to enact a program right now because the sky is falling. We need to get a full and open discussion, not a series of sound bites, and as part of that, we should repair what is already broken. I'm waiting for an answer on why dental care has no problem, while medical care is so broken, and no one seems to have the answer.

[quote="Jim O'Bryan"]
As for one plan, it is theoretically a good idea, make it basic health care allowing all of those
that want better care or selective surgery pay for it.

As David Anderson pointed out, it would be a great stimulus package for the business
incubator in America called "small business." Last week I started looking at health care
for all of the Observer papers, and we are having trouble putting together a real program
that can be managed by the companies we are talking to. It would be a patch quilt of
three different programs. One for health care, one to cover the gaps in that and another
for "major medical" moments. Now as I look over the propaganda put out on the pro
single payer side, they claim, these companies have a 30%-45% management rate for
these plans. As opposed to the 3% for the VA, and 3.5% of Medicare. Could it be that the
government can do some things better like the post office, and the VA plan?

WB If you will recall, despite government subsidies and restrictions on what could be delivered by private services, companies like UPS and FedEx came very close to driving the post office out of business. It was only when the post office drastically changed their operations that the hemorrhaqing stopped, and they are still far from being a self-supporting enterprise. Citing the post office as an example of how things can be done better by the government is probably not an argument you want to advance, unless you are looking for laughs.

[quote="Jim O'Bryan"]
If innovation was the number of reason for expense. Medicine would cost the same on
both sides of the borders. I am not saying it is not one of the reasons, but the biggest
reason in the USA is the lobbying, to keep the machine going strong.

WB I don't know if you have an understanding of how manufacturing works. I'll phrase this in fictional and small numbers so we can both handle it. Assume a company does some research and comes up with a new product. The research costs $1000. Actual cost of the production of the product is $1, and the company thinks it can sell about 100 of the items. So what price to they set on the product? Probably a little over $102, of which $1 will cover manufacturing, $100 will pay them back for the research costs, and the balance a profit to pay shareholders a dividend so they will invest in the company. I ignore advertising costs as I think they are indefensible; physicians, not consumers, should be deciding whether to use a certain drug.

Now, another country's health care program approaches the company and offers to buy a lot of the product, but only if they can get it for $3 a dose. Will the company take that deal? Certainly, because it costs them only $1 to manufacture, so they have a profit of $2, more than they profit on a domestic sale.

That's precisely the reason you can get US drugs in Canada for far less than in the US. The cost of research is being paid by us, but not by the Canadians. That's especially galling when you realize that a lot of the research is paid for by our government, so we are actually paying for it twice! I won't argue that that is fair to us, but it makes sense to the companies that make the drugs. I used to think that we should just slap a hefty tax on such overseas sales to recover at least the cost of the research that our government had paid, but I'm not sure that is a practical, or legal, solution. I suspect that, faced with higher costs because of the tax, the Canadians would just choose to buy a very similar drug from some other country. So I don't have a solution. But at the same time, I think an understanding of this will show that your argument that lower drug prices overseas means there have not been a lot of increases attendant to the advances in medications is in error.

[quote="Jim O'Bryan"]
But them, I am one of the ignorant masses that do not understand how what a positive
impact bankruptcy is on a family of four.

WB
I hope I didn't say it was a positive experience, but only that it is not the fatal experience that you seemed to believe. And I would certainly like to see some evidence supporting your statment that people lose most of their assets in undergoing personal bankruptcy, but I suspect I won't.

I have nothing against ignorance, we are all born ignorant and that is a condition we can improve. But making arguments about something about which you know you are ignorant is not ignorance.

What kills me is the socialism fears. All private insurance is socialized. You join a group, put your money into a pool and get your benefits when you need it. It's speading the wealth alright, just within a given company. People who want the status quo only want to share their benefits with the people they work with, not every American. Memememememememememememememe. I got it. You can't have it. That's the attitude of many of today's Americans.

Insurance is sharing of risk. We buy an insurance policy knowing that not all of us will collect immediately, and those who do collect are compensated by the premiums payed by all, and from investment income, or possibly co-insurance.

One dictionary describes socialism as:
1. Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy.
2. The stage in Marxist-Leninist theory intermediate between capitalism and communism, in which collective ownership of the economy under the dictatorship of the proletariat has not yet been successfully achieved.

So the medical insurance I have seen is not socialism because the insurance companies do not own the hospitals and equipment and personnel who provide the medical care. An HMO comes close to socialism, but falls short, in my opinion, as they do not come close to cornering the market, and as socialists march down the road toward communism, they always seem to seek a monopoly, and fear competition.

So a question hovering over this subject is whether we want to try to create a society where we all receive the same treatment, work the same hours, live in identical houses, and don't drive identical cars because the politicians controlling our existence think we don't need cars. We've enjoyed extraordinary prosperity, and I think our allowing our people economic freedom has been a major factor in that. An effect of allowing this freedom, however, is that some people will fail. But if you guarantee everyone equal income and care, you remove any incentive for people to work harder, or longer, or to put a lot of effort into their education, and that will cause prosperity to disappear, as it did, in most cases, in the Communist countries.

Even in those societies, they never achieved true economic equality. The privileged political class had cars and drivers, and nicer housing, and better food, while the so-called equal masses had poor housing, no cars, poor food, and endured frequent shortages of virtually everything, even toilet paper.

The idea that we can provide the same services to everyone as the rich get is a fool's quest. The rich will always be able to get better care; if necessary, they will just pack up and go to Thailand for their cosmetic surgeries, while the rest of us will do without.

None of the universal health care advocates is willing to face the reality of rationing, but care has always been rationed, and the only way to stop that is to stop innovation. In my lifetime, people whose kidneys failed just died. Then someone invented the dialysis machine, but it was expensive and rare, so the reality was that some people got dialysis, while some didn't, and died. Now the machine is commonplace and everyone can get dialysis, even those without insurance. (This machine, of course, probably contributed to the increase in cost of medical care.) So as new equipment and techniques is developed, some people will get treatment, and some won't. There will be effective rationing.

I think the so-called death panels are a creation of people who are opposed to having the government control health care. I don't understand the right-to-lifers, but this concept certainly gets them exercised. I guess if you feel that life is sacred and runs from conception to death, you think allowing abortion is just the camel's nose under the tent, and the idea of artificially ending life is not far behind. So the idea of death panels is a clever political ploy to get the right to lifers active in opposing universal health care.

I think the proponents of universal health care, controlled and substantially funded by the governmet, close their eyes to the realities of rationing, despite mountains of evidence that the level of care constantly varies, and that care is rationed.

Medicaid is a federal program, but they dump a lot of the financial responsibility on the states. The net result is that coverage varied between the states; some cover certain procedures, others don't. So if you are unlucky enough to live in a poor state, or one that would rather pave roads than pay for heart transplants, you aren't going to get a heart transplant if you are on Medicaid. And you can be very certain that every state is looking at things like this very carefully now, as they all are in financial distress.

The Canadian universal plan that people argue works so well is actually funded substantially by the Provinces (analogous to our States), and it is common that every year the province runs out of money, and health coverage is reduced or deferred.

Lets say that here, you have a 90 year old man and a 23 year old man, both close to death and needing a heart transplant, but you have only one donor heart. Who gets it? I would rather have that decision made by physicians and ethicists, than by some government bureaucrat. But if we buy into universal health care, the government will almost certainly demand to make the decision itself, and the case will to to a bureaucrat who will take a year to make a decision, while the donor heart rots and both patients die. If you think I am wildly exaggerating, read some articles about how long it takes the VA to make decisions on disability claims.

I'm not arguing that our current system is perfect, or even good. I am saying that competition is essential if we hope to get costs under control, and a good first step would be to fix Medicare and Medicaid, since the insurance industry seems to follow their lead. And I think we have to take a hard look at rationing of care. Just to pick a subject that is not emotionally laden, should we be paying for Viagra for a ninety-year-old man?

And a step they could take easily now would be to look at drug company advertising. Our government gives the drug companies huge sums to support research. The companies spend huge sums on advertising. We should levy a tax on their advertising of 200 percent of the cost, up until we have recouped double the amount we gave them for research. A law like that would free up a lot of TV time, and lower the cost of drugs, and free up a lot of physician's time as they wouldn't have people coming in with symptoms they saw on TV

That is a very well-thought out post, Will. I do ask this question, though: are Medicare and Medicaid socialism? By your definitions of socialism, they are not. But some argue that they are. What am I to think?

How about this scenario, which I have not heard. The feds set the rules for a public option, and then goes out and offers implementation of the program out to the highest bidder. Kind of like public privitization. In this situation, the public is compensated according to the market. My guess is insurance companies, fearing a public option might eventually drive them out of business, would line up to run this thing. This option could limit private sector job losses and would also mute the argument that the government will screw up something that the private sector could run better.

In education in this country there has been billions of dollars spent since on the 1960s on reforms trying to diminish the racial/income achievement gap. That gap is bigger now than it was in the 1980s. A reason for the failure of the reforms includes the fact that the government implemented them nationwide with little to no accountability instead of implementing them in small groups with accountability and feedback on what works and what doesn't work. Billions of dollars in an attempt to help the poorest but none of the efforts show real success. The gap is bigger.

We should learn from this. I want every person in the country (in the world really) to have health insurance and access to proper medical care. But this plan needs improvement. Rushing it will be another disaster. Healthy Start is available to every single child in need of health care and it is so good it includes full dental and eye. Many of the kids not covered are simply the result of the parent not getting them on the program. Small businesses should not be forced to provide ridiculously priced health insurance to every worker to the point of going out of business. Then the economy would lose the business and each employer/employee would be out of work and benefits.

In this recession who is still making billions of dollars? The drug companies. Let's start working in that area. Let's make laws where the drug companies don't wine and dine doctors to prescribe their medicine at high costs. You think the scandal in our county with the Metro head being wined and dined for contracts is scandalous (it is) bu this goes on daily with our drug companies and doctors. There is a reason the drug companies have paid millions lobbying and getting what they want.

There is much reform needed in this country. But nothing rushed can be worthwhile. Both republicans and democrats want reform and there needs to be more dicussion to fix the problems. And there has to be a way to start in smaller sections than the whole nation. We have waited decades to get this on the table, now that it is it has to be done right or the consequences will be much more distrastrous than what is going on now.

The longer we go the more diluted it becomes, in the meantime people are dying.

We have a system that works, it's called Medicare and it should be available for everyone. No one should have to die from treatable illnesses and diseases in our country. It's ridiculous.

Hate long waits at the ER? Think it's ridiculous that people go there with bad colds? If you can't see a doctor because you have no health care you go to the ER?

Do you think you aren't paying for that?


Is it fair that what decides if you live or die is if you have money? What does it say about us?

A society is judged by how they treat the least of their members.

Justify that one.

I am sick of this posturing, theorizing, intellectualizations and sheer greed. Get over it. Support the efforts to get it done or know that we have your number and will remember the contents of your character.

Well said Sharon.

It's frustrating for those of us in the middle of this chaos. I spoke with a friend of mine the other day who is in nearly the same position as me and he is as ticked.

I know a lot of people are happy with their coverage and that is great. I am happy with the coverage of the rest of my family. But I sit without any hope of ever get healthcare coverage and my credit is getting ruined by hospital bills that I'll have a hard time ever paying. My parents have gone bankrupt because of their medical bills and they have a few more years until they can get medicare.

Something has to be done, I love my country but my friends in other countries are appalled by my situation. We are an embarrassment when it comes to the way people's healthcare is handled. Flame me if you want but I dare any of you to come walk in my shoes and you'll understand the plight of the uninsurable within seconds.

Stop the whining, stop the scare tactic, stop the posturing and do something already.