[mike777]

"When those flying pigs take away the troughs and make government unassailable by the special and moneyed interests, then and only then will you stand a chance of the government for, of and by the people that it is supposed to serve and represent"



This is not logical. I think you do not understand the definition of special or moneyed interests or what an interest group is. By definition all interest groups are special and all interest groups have some level of money behind them. By definition if you cut off access or influence to government by interest groups you cut off access of the people they serve.

[blackshoe]

My understanding of the insurance business generally may be flawed, but it is this:

People would wish to undertake risky actions - for example, sailing to the East Indies from England in order to buy spices and other things at a relatively low price there, in the expectation of selling those things for a higher price back in England. The risks involved are many, but just one example is that the ship might sink on the way back, with the loss of all those spices. So people were found who were willing to make a bet with the entrepreneur. The bet worked like this: the entrepreneur put up some cash, in effect betting that his ship would sink. The insurer(s) agreed to pay some larger amount of cash if it did, in effect betting it wouldn't sink.

Carry that on to "health insurance". The insured is betting he's gonna have some medical problem in the future for which he won't be able to pay out of his own pocket. The insurance company is betting he won't. Given people are living longer, while being more sedentary and doing "unhealthy" things like smoking (although granted there's less of that than there used to be) it seems a very bad bet on the part of the insurance companies. So they're trying to "hedge" their bets, and their customers are viewing many of the ways they're doing that as cheating (I agree with them, btw).

It seems to me that given the current state of medical technology, the cost to any nation-sized group of people of complete, universal health care for everyone in the group is always going to far exceed the money available to pay for it. So I'm not sure there's any solution, given the current state of the technology. Certainly, given the paradigm above, insurance is not a viable mechanism. In the long run, the best answer is to improve the technology. Unfortunately, we need a short term answer, particularly those of us (like me) who are reaching the point where we are almost certain to win our side of the bet relatively soon. I don't know what that answer might be, but as I said I don't think the insurance paradigm qualifies.

[kenberg]

Insurance means different things to different people. I insure against catastrophe. I don't have theft insurance on my car. If it is stolen, I won't like it but I will buy another. I have never insured my car against theft. But I do have fire insurance on my home. My home burning down would be a catastrophe.

Now I do have health insurance. Unlike car insurance my employer (even in my retirement) contributes to this plan so economically it makes sense. I also have medicare. And prescription drug insurance. All subsidized. I just went to the pharmacy for some prescribed lotion for my poison ivy. It cost five bucks. To say that I have insured against the catastrophe of having to pay the marked price of fifty buck is a distortion to my way of using words. It's better to say that I contribute to a subsidized health plan that allows me cheap meds and doctor visits when needed/wanted.

Regardless of semantics, the distinction in intent is important as we try to decide what we should do. Do we want to make sure everyone can get prescription medicine at low cost for relatively minor issues? My prescribed lotion at $5 is cheaper than a probably adequate (I am beginning to think maybe better) over the counter lotion. Or are we prepared to say "If you get poison ivy you have our sympathy but buy your own lotion, we are here to help when you have appendicitis"? And what really do we intend to do about someone who will live for maybe three more weeks but we could extend it to perhaps four more weeks if we spend enough cash?

The issue of what we intend to do, what we do not intend to do, what we can afford to do, what we cannot afford to do is real. The discussion seems to mostly be dominated by those who imply that there are no difficult choices that need to be made and those who fantasize about death squads. We can do better.


ALSO:
I could use help on a specific issue. My congressman, Roscoe Bartlett, was asserting yesterday that in England no one over the age of 65 can get into an intensive care unit. The thought that a 66 year old is hit by a truck and left to die because he is too old to go to an ICU is, I presume, another fantasy of the right wing. Could someone direct me to information to learn what British policy is being distorted here? I would like to call him on this, but I need facts with some precision.

[RichMor]

blackshoe, on Aug 27 2009, 09:55 AM, said:

My understanding of the insurance business generally may be flawed, but it is this:

People would wish to undertake risky actions - for example, sailing to the East Indies from England in order to buy spices and other things at a relatively low price there, in the expectation of selling those things for a higher price back in England. The risks involved are many, but just one example is that the ship might sink on the way back, with the loss of all those spices. So people were found who were willing to make a bet with the entrepreneur. The bet worked like this: the entrepreneur put up some cash, in effect betting that his ship would sink. The insurer(s) agreed to pay some larger amount of cash if it did, in effect betting it wouldn't sink.

Carry that on to "health insurance". The insured is betting he's gonna have some medical problem in the future for which he won't be able to pay out of his own pocket. The insurance company is betting he won't. Given people are living longer, while being more sedentary and doing "unhealthy" things like smoking (although granted there's less of that than there used to be) it seems a very bad bet on the part of the insurance companies. So they're trying to "hedge" their bets, and their customers are viewing many of the ways they're doing that as cheating (I agree with them, btw).

It seems to me that given the current state of medical technology, the cost to any nation-sized group of people of complete, universal health care for everyone in the group is always going to far exceed the money available to pay for it. So I'm not sure there's any solution, given the current state of the technology. Certainly, given the paradigm above, insurance is not a viable mechanism. In the long run, the best answer is to improve the technology. Unfortunately, we need a short term answer, particularly those of us (like me) who are reaching the point where we are almost certain to win our side of the bet relatively soon. I don't know what that answer might be, but as I said I don't think the insurance paradigm qualifies.

Good analysis, but I disagree with some basic concepts.

First, the shipping thing. This is classic insurance history stuff, but the origin is simpler. Several ships left England empty, sailed to the East and bought goods. The captains would distribute their goods among the ships for the return voyage. If one or more ships were lost, everybody lost some of thier goods but nobody lost everything (unless all the ships were lost)

So the basic concept of insurance is loss sharing. Everyone accepts a likely small loss in order to avoid a total loss. The original insurance syndicates shared the liability for a shipping loss. Modern insurance organizations still reinsure.

Second, the betting thing. Health insurance is not a large series of binary 'bets' that the insured will or will not require medical treatment any more then life insurance is a bet that the insured will or will not die. Nobody gets out of this world alive.

So I don't agree that insurance companies try to 'hedge' an individual bet. They just try to balance their expected losses (claims) with expected gains (premium plus investement earnings).

RichM

[Al_U_Card]

mike777, on Aug 27 2009, 09:30 AM, said:

This is not logical. By definition if you cut off access or influence  to government by interest groups you cut off access of the people they serve.

Heaven forbid that we should deny the corporate lobbyists their chance to shill for and enrich those that benefit the most at the loss of the VAST majority. That is how oligarchies function. ¢erfs and peasants pay homage and owe fealty to the noble$.

[helene_t]

kenberg, on Aug 27 2009, 04:39 PM, said:

I could use help on a specific issue. My congressman, Roscoe Bartlett, was asserting yesterday that in England no one over the age of 65 can get into an intensive care unit. The thought that a 66 year old is hit by a truck and left to die because he is too old to go to an ICU is, I presume, another fantasy of the right wing. Could someone direct me to information to learn what British policy is being distorted here? I would like to call him on this, but I need facts with some precision.

http://www.angelfire.com/pa/sergeman/issue...ukcarebeds.html

The article is from a journalist of a not-so-serious newspaper, sorry that I couldn't find anything better. It is somewhat vague.

Edit: The source is the newspaper Telegraph, http://www.telegraph.co.uk/news/uknews/334...-care-beds.html

Anyway, it is fair to say that:
- UK has severe shortage of IC beds, only 2.7% of all hospital beds, compared to e.g. 4% in Denmark and 6% in the US.

- The admission of old people (>80 years) is probably much lower than what would be optimal. It is not clear to me what exact age group the figures in the article are about, though. He talks about a high-risk group of patients characterized by a combination of age and other factors.

[mike777]

helene_t, on Aug 27 2009, 03:31 PM, said:

kenberg, on Aug 27 2009, 04:39 PM, said:

I could use help on a specific issue. My congressman, Roscoe Bartlett, was asserting yesterday that in England no one over the age of 65 can get into an intensive care unit. The thought that a 66 year old is hit by a truck and left to die because he is too old to go to an ICU is, I presume, another fantasy of the right wing. Could someone direct me to information to learn what British policy is being distorted here? I would like to call him on this, but I need facts with some precision.

http://www.angelfire.com/pa/sergeman/issue...ukcarebeds.html

The article is from a journalist of a not-so-serious newspaper, sorry that I couldn't find anything better. It is somewhat vague.

Edit: The source is the newspaper Telegraph, http://www.telegraph.co.uk/news/uknews/334...-care-beds.html

Anyway, it is fair to say that:
- UK has severe shortage of IC beds, only 2.7% of all hospital beds, compared to e.g. 4% in Denmark and 6% in the US.

- The admission of old people (>80 years) is probably much lower than what would be optimal. It is not clear to me what exact age group the figures in the article are about, though. He talks about a high-risk group of patients characterized by a combination of age and other factors.

Helene if the UK has a severe shortage of IC beds and they know it, why don't they simply get more? I would think greedy capitalists in America would gladly sell them all they want. I assume money cannot be the issue, the UK controls the printing presses and taxing policy.

[helene_t]

Mike, people are already complaining that they pay too much for health care. It is ridicolously expensive here, appr. one third of what you guys pay.

[kenberg]

Interesting article. It appears that the concern over icu care in Britain is reality based.

[mike777]

helene_t, on Aug 27 2009, 04:19 PM, said:

Mike, people are already complaining that they pay too much for health care. It is ridicolously expensive here, appr. one third of what you guys pay.

Helene I am trying to understand this single payer system that Winston and other posters advocate. I thought the UK loves the single payer system. BTW as far as I can tell Canada does not have a single payer system that covers what we would call basic health care.

If there is a severe shortage of IC beds do not the voters demand a better quality of healthcare, in this case alot more IC beds? If need be the UK can just borrow the money like we do or tax the top 5% and worry about paying it back later.

[mike777]

I would only add the suggestion that there seems to be a real need for effective special interest groups that can lobby the government for more IC BEDS. At the very least I would think corporate IC bed makers in the UK would apply pressure.

[Winstonm]

There are a number of good points brought out in several posts - obviously, this is not a simple problem with simple-minded solutions.

Of what is health care comprised? As Ken mentioned, is it paying less for meds or does it mean insuring against catastrophic loss?

I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe.

As to the ICU beds, I am not so certain how to determine necessity of those beds. I have seen hospitals with not-very-ill people in the ICU beds because they were available (at a huge cost to whoever had to pay the bill.)


The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care.

[nigel_k]

Winstonm, on Aug 27 2009, 07:06 PM, said:

The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care.

Firstly, the political motive (to get elected and stay elected) is even more corrupting than the profit motive. Surely you have been paying enough attention to notice that the interests of politicians are not in your well being either. The difference is that when a corporation screws you over, you are not obliged to keep giving them your money.

Secondly, how do you feel about a corporation supplying the food you eat? Medical care is important, but not as important as food. If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

[hrothgar]

nigel_k, on Aug 28 2009, 03:34 AM, said:

Secondly, how do you feel about a corporation supplying the food you eat? Medical care is important, but not as important as food. If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

Idiotic question/statement

There is a (broadly) competitive market for food here in the United States.
There is nothing resembling a competitive market for health services.

[Winstonm]

Quote

Firstly, the political motive (to get elected and stay elected) is even more corrupting than the profit motive. Surely you have been paying enough attention to notice that the interests of politicians are not in your well being either. The difference is that when a corporation screws you over, you are not obliged to keep giving them your money.

The politicians are owned to a large degree by the corporations - 97% of incumbents are re-elected. Do you think that happens because because their constituents want it to happen or because the corporations donate strongly to their reelection?

Quote

Secondly, how do you feel about a corporation supplying the food you eat?

Fine.

Quote

Medical care is important, but not as important as food.

Tell me that when you have acute appendicitis or a perforated bowel.

Quote

If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

There was no mention of sovietizing - what are you trying to do, promote fear by trying to compare socialized medicine to the U.S.S.R.?
They are not the same. Your argument is invalid - no one but you said that the profit motive was incompatible with the proper provision of essential goods and services.

What I argued was that some aspects of health care should not be classified as essential goods and services but basic human rights.

How Stalin-esque of me, I'm sure.

[mike777]

Again Socialized medicine does mean having the economic and political power in the same pair of hands by definition. That is what socialism means.

Again I do not claim this is what the President is calling for but it does come across as what Winston is calling for.

At the very least Winston comes across as prefering that to what we have now.

If you do not want the economic and political power of health care to be in the same hands then you are calling for something other than socialized medicine, what I do not know.


"There was no mention of sovietizing - what are you trying to do, promote fear by trying to compare socialized medicine to the U.S.S.R.?
They are not the same. Your argument is invalid - no one but you said that the profit motive was incompatible with the proper provision of essential goods and services."




Since you make this claim at the very least back it up, just do not dismiss it by saying it is not the same, please.

[kenberg]

Winstonm, on Aug 27 2009, 07:06 PM, said:

I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe.

As to the ICU beds, I am not so certain how to determine necessity of those beds. I have seen hospitals with not-very-ill people in the ICU beds because they were available (at a huge cost to whoever had to pay the bill.)

ICU: Knowing the exact number of beds needed is asking too much of me, but hardly necessary to contrast the situation here with the situation in Britain as reported in the Telegraph article. In 1977 my father, aged 77, was carried by helicopter from a smaller hospital to one with a respected icu facility. The attempt to save him was ultimately unsiccessful but I believe that a very strong effort was made. I am surprised and dismayed to learn that in Britain there might not have beem space available. I gather the Brits are working on this and I wish them well.

Cost: I believe that there are limits. Individually we can only afford so much, and collectively this is true as well. There is a lot of wastage as we do things now, we should do better, but I think there will always be limits. I don't see the ICU example as determining, it's there not here for one thing, they may well solve the problem for another thing, but it is a reminder that there are costs and therefore limits to what we might wish to do.I favor having an adequate supply of ICU beds. I favor doing many things. I favor paying for the choices we make. I accept being taxed. I do not believe, in health or in any area, that we will not have to choose. This thing we do, this other thing we do not.

[mike777]

"I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe."


I do think this is your main point and you make it clearly.


But we come back full circle to other threads:
1) There is an unlimited demand for health care
2) There is a limited supply of health care.
3) We must ration health care.


You clearly prefer the government to make these political and economic decisions and not free capital markets via the pricing mechanism.


This decision, security vs loss of freedom is never an easy one.

Increased security provided by a central government making both the economic and political decisions always comes at some cost.


That is what elections are for and the people have voted.


"I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable."

Side note, All countries deny health care on the basis that they cannot afford it. Europe and Canada certainly deny health care on this basis. See Helene's post.



"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."

http://online.wsj.co...3435303415.html

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."

[PassedOut]

Certainly there are always going to be limits on what health care costs are covered, and some hard questions will have to be answered. That's true now and will be true in the future. Better to get those questions on the table instead of sweeping them under the rug.

We need to know reliably what is covered and what is not, and that the coverage will not disappear when folks need it. No doubt companies will offer supplemental policies to cover the rest, including extreme end-of-life measures for those who wish to pay for them.

[Winstonm]

Thanks for a reasoned reply, Mike. Although I understand your point I believe you are not making a valid comparison. It appears to me you are comparing reasonable access to health care with unreasonable expenses of limited value.

It is much different not getting a needed bowel resection for a perforated bowel than being denied access to a cancer drug with limited benefits to the terminally ill. In the first case, you will surely die without the procedure; in the second case, you will surely die with or without the medication.

I don't think you should use case two to prove the reason why case one should have a profit motive.

Quote

1) There is an unlimited demand for health care
2) There is a limited supply of health care.
3) We must ration health care.

This does not equate - I don't agree with either premise, but even accepting those premises does not bring about your conclusion in #3. The economic answer would be #3: health care becomes more costly, followed by #4: health care costs decline over time as supply catches up to demand.

That is how a true and free market would work - but all we see are rising health care costs. It is therefore obvious to even the most ardent Phil Gramm fanatic that the current system is NOT a free market system.

It is crony capitalism with supply held tightly in a few hands.

Quote

That is what elections are for and the people have voted.

If you truly believe this then I have to say you are IMO grossly naive. I would strongly urge you to read today's Salon.com article by Glen Greenwald about the changing thoughts on Democratic centrists.

While I may be overly cynical, Greenwald seems to hit a nice, reasoned balance with an explanation of reality.