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Thank you, Terry, for your views, which I fully share. We are living in a world run by magicians whose aims are to increase profits, no matter how and only individual efforts to search truth behind each trick can help. Not an easy task, but worth making the effort.
Posted by Maria on Mar 5, 2008 at 12:51 PM
Regarding the paragraph near the end of the article about health care, I’ve often wondered whether it’s truly feasible to promise full health support for 300M people. I’m not claiming expertise, but when I read figures related to this issue, it hits me as counterintuitive. The author’s view that the best solution is to remove the profit element and simply make health care a state-guaranteed “right” gives me pause, because the mathematics implied by that solution do not seem realistic. If they are, I would want to see hard figures. I say this because it seems as though the demand for health services never plateaus, but only continues to increase, beyond the ability of any revenue source to pay for it all. The erroneous but (I think) likely public perception that state-sponsored health care is “free” sets up an incentive to use those services liberally. An analogy is the excessive use of the 9-1-1 emergency number. I have a good buddy who is a fireman-medic, and he’s been called out hundreds of times to deal with situations that are not at all emergencies. The cost of one medic team’s run to his city government (not a profit-oriented enterprise) in terms of man-hours of salary and benefits, equipment usage, etc etc, is in the thousands of dollars. Someone is going to pay, and pay big, whether profit is the agenda or not.
Having said that, my wife’s family was nearly ruined by her father’s cancer treatments in 1989. And he had insurance! However, the cap had been reached, and it was not the best coverage in any case.
He died anyway, though the debt lived on, for years afterward. It was only his death that prevented bankruptcy; the treatments and hospital care costs were hair-raising. One of those instances you’ve all heard about, in which the most exorbitant treatments are devoted to extending the life of a gravely ill loved one for only a few months.
The author does have a point in general terms about the nature of the questions that are asked in connection to societal problems, and whether they’re in effect a form of trickery. The questions may even imply sincere but still misleading mistakes of understanding, not necessarily cynical exploitation of people’s fear of illness and premature death. But the simplicity of her suggested solution to the health care crisis, to just get profit out of the mix and pay for health care with tax revenues, may itself be misleading, due to the problem of ever-increasing demand in such a populous country.
How, or whether, the problem can be feasibly repaired, is something I do not pretend to know. I suppose if there were a transformation in our attitudes about sickness, death, and the use of publicly provided resources, it could perhaps come true, but I don’t see much to make me have faith in that happening.
If we had been able to soak up a lot of state resources to make my father-in-law well, or at least to not have to pay and pay for years after he was dead, I suppose we would have.
Posted by Kuya on Mar 6, 2008 at 1:25 AM
Healthcare is expensive, no doubt about it, but it’s not helped by having it provided by companies whose legal obligation is to deny it to you as much as they are legally able. Their fiscal obligation is to their shareholders, not to the patient. Additionally, if you examine the structure of the current US healthcare, it is almost entirely curative, not preventative, because they have no incentive to keep you healthy when you may at any time switch to another healthcare provider. Their treatments are measured against short-term actuarial tables, and so typically inexpensive short term preventative treatments are forgone because there’s no upside for them (unless it’s demanded by law).
Also, as opposed to the standard arguments against it, there are few differences between waits for critical care in the US vs Canada. For elective treatment, there are certainly longer waits (and when you’re one of those people whose ‘elective’ treatment gets shoved back, this is an argument for a mixed model). There are some shortages that I cannot fathom, such as extremely long wait times for NMR or other imaging scans. Altho these machines are fairly expensive, they are not stratospherically expensive (cost of a used, trailer-mounted imaging machine is order of $200K - our univ just sold one. At such prices, it’s no wonder that private imaging clinics are springing up across Canada.
However, having a permanent single payer system via Govt is hardly more expensive than having the same heathcare offered via a for-profit system because they’re FOR PROFIT. They make more $ when they deny you coverage. On the other hand, while there is plenty of room for mismanagement via shady contracts, inefficiency, slow movement to adopt the latest technical advances, there are also some advantages to having this pachydermic approach - one payment system, one paper trail, a system that turns over every few years for another political party to rake out the accumulated slime and (hopefully) let the sunshine in. And the slowness has its own advantages - not quite so fast to buy into the latest drug from a pharma industry also very keen to sell you a brand new drug to address the shame of “advancing cuticular decrepitude”.
And let’s also include the larger picture - the US is now spending not just /more/ than the rest of the world combined on weaponry and intelligence but /much/ more than the rest of the world combined. About $.5 trillion/year (from what we can see - that which is not black).
(Interesting factoid - $500B in $1 bills is the approximate weight of the Knock Nevis supertanker - the largest ship ever built.)
$500B/y could go a long way to helping pay that healthcare bill; not to mention that you already are supposed to be paying for your healthcare - that $ would go to th esingle-payer gov’t agency to disburse for your healthcare. Yet another tax? Yes, but one that should be less than the alternative, more responsible for long term care, and theoretically less likely to deny you coverage, especially on catastrophic care. Then again, this is the same gov’t that took us to war on false pretenses, leaving us with a $3T bill. YMMV.
Canada also has a parliamentary system with (it seems) much better responsiveness to its constituents. Or at least, if you elect a fool, he has to stand before the House and be shown as one on a regular basis.
Forgive me, for it seems I rant on…
Best
h
Posted by hjmangalam on Mar 17, 2008 at 10:04 PM
Page 1 of 1 pages
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Reader Comments
Thank you, Terry, for your views, which I fully share. We are living in a world run by magicians whose aims are to increase profits, no matter how and only individual efforts to search truth behind each trick can help. Not an easy task, but worth making the effort.
Regarding the paragraph near the end of the article about health care, I’ve often wondered whether it’s truly feasible to promise full health support for 300M people. I’m not claiming expertise, but when I read figures related to this issue, it hits me as counterintuitive. The author’s view that the best solution is to remove the profit element and simply make health care a state-guaranteed “right” gives me pause, because the mathematics implied by that solution do not seem realistic. If they are, I would want to see hard figures. I say this because it seems as though the demand for health services never plateaus, but only continues to increase, beyond the ability of any revenue source to pay for it all. The erroneous but (I think) likely public perception that state-sponsored health care is “free” sets up an incentive to use those services liberally. An analogy is the excessive use of the 9-1-1 emergency number. I have a good buddy who is a fireman-medic, and he’s been called out hundreds of times to deal with situations that are not at all emergencies. The cost of one medic team’s run to his city government (not a profit-oriented enterprise) in terms of man-hours of salary and benefits, equipment usage, etc etc, is in the thousands of dollars. Someone is going to pay, and pay big, whether profit is the agenda or not.
Having said that, my wife’s family was nearly ruined by her father’s cancer treatments in 1989. And he had insurance! However, the cap had been reached, and it was not the best coverage in any case.
He died anyway, though the debt lived on, for years afterward. It was only his death that prevented bankruptcy; the treatments and hospital care costs were hair-raising. One of those instances you’ve all heard about, in which the most exorbitant treatments are devoted to extending the life of a gravely ill loved one for only a few months.
The author does have a point in general terms about the nature of the questions that are asked in connection to societal problems, and whether they’re in effect a form of trickery. The questions may even imply sincere but still misleading mistakes of understanding, not necessarily cynical exploitation of people’s fear of illness and premature death. But the simplicity of her suggested solution to the health care crisis, to just get profit out of the mix and pay for health care with tax revenues, may itself be misleading, due to the problem of ever-increasing demand in such a populous country.
How, or whether, the problem can be feasibly repaired, is something I do not pretend to know. I suppose if there were a transformation in our attitudes about sickness, death, and the use of publicly provided resources, it could perhaps come true, but I don’t see much to make me have faith in that happening.
If we had been able to soak up a lot of state resources to make my father-in-law well, or at least to not have to pay and pay for years after he was dead, I suppose we would have.
Healthcare is expensive, no doubt about it, but it’s not helped by having it provided by companies whose legal obligation is to deny it to you as much as they are legally able. Their fiscal obligation is to their shareholders, not to the patient. Additionally, if you examine the structure of the current US healthcare, it is almost entirely curative, not preventative, because they have no incentive to keep you healthy when you may at any time switch to another healthcare provider. Their treatments are measured against short-term actuarial tables, and so typically inexpensive short term preventative treatments are forgone because there’s no upside for them (unless it’s demanded by law).
Also, as opposed to the standard arguments against it, there are few differences between waits for critical care in the US vs Canada. For elective treatment, there are certainly longer waits (and when you’re one of those people whose ‘elective’ treatment gets shoved back, this is an argument for a mixed model). There are some shortages that I cannot fathom, such as extremely long wait times for NMR or other imaging scans. Altho these machines are fairly expensive, they are not stratospherically expensive (cost of a used, trailer-mounted imaging machine is order of $200K - our univ just sold one. At such prices, it’s no wonder that private imaging clinics are springing up across Canada.
However, having a permanent single payer system via Govt is hardly more expensive than having the same heathcare offered via a for-profit system because they’re FOR PROFIT. They make more $ when they deny you coverage. On the other hand, while there is plenty of room for mismanagement via shady contracts, inefficiency, slow movement to adopt the latest technical advances, there are also some advantages to having this pachydermic approach - one payment system, one paper trail, a system that turns over every few years for another political party to rake out the accumulated slime and (hopefully) let the sunshine in. And the slowness has its own advantages - not quite so fast to buy into the latest drug from a pharma industry also very keen to sell you a brand new drug to address the shame of “advancing cuticular decrepitude”.
And let’s also include the larger picture - the US is now spending not just /more/ than the rest of the world combined on weaponry and intelligence but /much/ more than the rest of the world combined. About $.5 trillion/year (from what we can see - that which is not black).
(Interesting factoid - $500B in $1 bills is the approximate weight of the Knock Nevis supertanker - the largest ship ever built.)
$500B/y could go a long way to helping pay that healthcare bill; not to mention that you already are supposed to be paying for your healthcare - that $ would go to th esingle-payer gov’t agency to disburse for your healthcare. Yet another tax? Yes, but one that should be less than the alternative, more responsible for long term care, and theoretically less likely to deny you coverage, especially on catastrophic care. Then again, this is the same gov’t that took us to war on false pretenses, leaving us with a $3T bill. YMMV.
Canada also has a parliamentary system with (it seems) much better responsiveness to its constituents. Or at least, if you elect a fool, he has to stand before the House and be shown as one on a regular basis.
Forgive me, for it seems I rant on…
Best
h
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