Saturday, April 18, 2009

Now We Know Why Americans Complain About Healthcare

Discussion continues: here

Last year, "Michelle Obama received a salary of $62,709 from the University of Chicago Hospitals, where she was an executive." But Ms Obama didn't work at the hospital last year; instead, she campaigned with her husband.

Don't bother trying to get her old job--it was eliminated early this year.

(via Doug Ross, Sweetness & Light)

29 comments:

Thai said...

Likely an "unspoken" political payoff similar in a reverse kind of way to what Rod Blagojevich asked for with his wife?



Anyway, I have another question for you on health care.


How do you reconcile a concept like "freedom of choice" with a concept like as "insurance".

For the very idea behind "insurance" is you pool your money together with others and if you need their assistance, the other people pay for you.

For I hear an awful lot about "freedom of choice" in the health care, but tend to actually see this is a kind of schizophrenic cover for "freedom to spend other people's money".

How do you reconcile this conflicting ideas on this blog?

For my own personal view of a conservative is that they simply rightfully recognize that people are not free to do whatever they want when it comes to asking others for help.

Yet O'Bloody Hell's notion that people are "free to chose" when they are spending other people's money fails to take this into account.

Is a conservative someone who says you can do whatever you want and someone else will pay for it? (We'll call this a Type A conservative)

Or is a conservative someone who says you can do whatever you want but you must also personally accept the consequences of those decisions if people don't want to pay for them? (We'll call this a Type B conservative- e.g. really a Libertarian)


For in the first example, a Type A conservative would have helped O'BloodyHell out when he needed health care assistance (as long as he was playing by the rules).

In the second instance a Libertarian conservative would have let him die.

Which of these two schizophrenic versions of conservatism does this blog represent?
Your blog's title "NO OIL FOR PACIFISTS" suggests you are a Type A conservative.

Am I making sense?

Regards

OBloodyHell said...

> For the very idea behind "insurance" is you pool your money together with others

> Am I making sense?

No, Thai, you're a friggin' moron. Nothing new there.

You CHOOSE to pool your money with others. If you think it's a bad deal, you don't do it. Once you've committed to the system, you have to follow the rules for opting out, if you later decide it's not a good bet for you.

It's called a contract, and there is nothing in conservative OR libertarian philosophy which rejects the idea.

As long as you enter into it of your own free will -- no one is actually holding a gun against your head making you sign.

What part of that isn't "free choice" to you?

That seems rather incredibly DUH even for you -- but hey go figure... we clearly still haven't found the bottom of your intellectual talents, despite using a bathyscaphe.



As far as insurance goes, I've always been a very healthy sort of guy. So, for the majority of my life, I haven't had any insurance, choosing to bet the other side of that risk. And about 99% of the time I've won.

But
a) My choice. I don't *demand* charity. I'll take it, but I don't expect it. There's a vast difference there.

b) I'm getting old enough to seriously consider the other side of the bet. And anyone else doesn't like that, they are free to refuse to bet, and thus jack up the amount I have to pay into the betting pool.

c) Frankly, like Social Security's best-claim for existence -- if I was required by law to maintain some minimum level of health insurance (i.e., or if a percentage of my income was to be automatically deducted and put into a 401k plan), I wouldn't have a major problem with that -- because that wouldn't be a giant Ponzi scheme like SS is, or like Health Insurance is sure to become. And one can argue reasonably for certain societal issues occurring without some required level of coverage.

P.S.

> Your blog's title "NO OIL FOR PACIFISTS" suggests you are a Type A conservative.

This comment suggests you are a capital-A Asshole, in addition to the previously-demonstrated capital-M Moron, the Capital-J Jackass, and the capital-B Butthead. I think there's a capital-D something in there, too, but I forget...

You know, you're well on your way through the whole alphabet. Too bad you haven't yet managed to learn it after 15+ years of voc-ed.

Are we surprised? Nawwww...

Thai said...

... Wherever you go today, there does always seems to be a "lighter" version of the product. Only sometimes you really want at least a few calories.

For yet again OBloodyHell, you clearly illustrate you have only a rudimentary understanding of the issue as well as little idea of what I am talking about.

A rather consistently nasty ability to insult people to overcome this your obvious knowledge base fools no one.


Most types of insurance have the opportunity to throw people out for "abuse". Use you homeowner plan in any kind of "abusive" way and you can be sure they will not sign you up again next time around. Further, the lack of ability to resign you homeowners insurance will be used as a red flag by other insurance carriers who are likely to avoid also signing you up. So when your home has issues next time, you won't have insurance.

The reality is you still need to play by the rules even why you purchase insurance.

Try doing the same if you are an health insurance plan? (e.g dropping an "abusive" patient or and "abusive" doctor). Though you don't have insurance so it makes sense you don't know about abusing it- you just stiff (abuse) others in the name of your bizarro "conservative freedom of choice" theology where once the charity is given as you say (and 50% of it came from the government) you .

Just try forcing an abusive patient out of their health insurance if you are a health insurance company.
Why do you think Prudential pulled out of the health insurance market all together?

And what happens to the abusive patient IF they were forced out?

Your alphabet slurs do not answer my point at all- actually they don't eve address it.

Carl, can I talk to the real thing? Junior is getting rather annoying.

Thai said...

Carl, Sell.

Oh, and OBloodyHell, If what you saw as "charity" was really an accident, e.g. they really thought you needed it but it turns out they were wrong and you didn't, I am sure quite sure they wouldn't mind you paying them back at even this late date.

Carl said...

Thai:

Mostly, I find your questions confusing. I agree with most of OBH's answers, without endorsing his style. In the most abstract sense, insurance is a contract between willing buyer and willing seller. It's logical that insurers (of any sort) have opt-out clauses: if you hold nightly firework parties at home, it's going to be difficult to get homeowner's insurance.

Health insurance has three characteristics that some (but not all) other types of insurance have. First, in contrast to vehicle insurance, there vastly fewer externalities. There are government mandates for auto insurance -- which pre-dated no-fault -- because a driver can injure another person or damage another person's property. Second, there is a substantial tax-funded health-care safety net covering those without private health insurance (including Medicare, Medicaid and hospital obligations to treat indigent patients). Third, Americans have come to view health insurance somehow differently from, say, car insurance--as something that funds virtually the entire cost of healthcare, rather than the "catastrophic" approach Congress backed out of years ago. And we know what happens when a "good" is free--compare the problem we have with government-provided flood plain insurance which, in the worst cases, funds re-creating a house that has no business being there after each hurricane, at our expense, of course.

I don't profess to understand your Type A/B conservative distinction. It ignores the outline of conservative principles I previously provided you, especially regarding pragmatism. Under your approach, Type B's aren't conservatives at all, and thus I'm not a Type B.

OBH can answer for himself, but this four-year old quote from my first healthcare post might short-cut your inquiry:

"Americans are rich enough to aid the poor to provide a safety net. That net includes both governmental programs like Medicaid/Medicare as well as charitable assistance."

I fail to see what's "schizophrenic" about this.

Thai said...

Carl, thanks for the response

Re: "Americans are rich enough to aid the poor to provide a safety net. That net includes both governmental programs like Medicaid/Medicare as well as charitable assistance."

It is a shame I did not read this quote a long time ago- I obviously couldn't agree more. My point is no one should lose sight of this issue.



Re: Schizophrenia. There is a dichotomy between OBH's points and yours, even if you do not clearly see it. To the extent readers like me see you as one voice, it causes a schizophrenia to your message on health care.


Re: principles of conservatism. I actually never saw this posting. When I read your comment regarding "choice" (although I see how you could take an abortion interpretation from such a loaded word, I actually NEVER ONCE thought of abortion), I jut stopped reading your blog as I decided you guys were a bunch of crackpots since "choice" was not the first thing I personally would define as ALWAYS compatible with "No Oil for Pacifists". But let's move on as I sense this would be a complex conversation and likely lead to much agreement on your 6 principle.

FYI- you are what I grossly oversimplified as a "Type A" conservative. Your use of the term "constraints on choice" (nothing to do with abortion) tells me this. And FWIW we actually share many similar views in those 6 principles (I think I am probably what you would call a Moynihan liberal, at least as I read your post).

... In fact the great paradox of liberals vs. conservatives imho more often has to do with this issue. Both see the needs for constraints on choice. They really tend to argue more over the aesthetics of where that restraint should exist within the system. (If it helps, I tend to look at the world thru the lens of complexity science).

Re OBH: I am sorry about the unpleasant words. I am rather intolerant of someone who is quick to give a simplistic "love it or leave it" and "free choice" answer to what is an incredibly difficult problem when 1. I work in the system and do understand it's problems very well, 2. Pay the taxes which bails out people like OBH when they get into trouble. i.e people like OBH who get "oil" while professing pacifism (to use your blogs title as analogy).

FWIW- the two of you should talk privately, especially about the idea of "constraints on choice". Oddly, liberals would agree with you. Where they would obviously disagree is "where" those constraints should reside. And though I absolutely give OBH kudos for at least having the integrity to admit he gamed the system, the simple fact he did and fails to understand what it means to liberals undermines both his arguments and to some degree yours. It is definitely fuel to fire liberal outrage so to speak.

... And while I might understand a conservative relishing such an idea, I don't think fueling this particular outrage helps your cause one bit. At least my 2 cents.

Regards

OBloodyHell said...

Carl, when Thai can actually make a point without being a dismissively rude DICKHEAD, I'll soften my style. Until then, he can go f*** himself.

Thai said...

OBH- I don't know why I am repsonding at all other than to say I will take the bait.

Coaching point- I suggest you go back and look at the sequence of comments in our initial encounter whenever that was.

OBloodyHell said...

> Coaching point- I suggest you go back and look at the sequence of comments in our initial encounter whenever that was.

Gee, too much work to actually point me to it? Or doesn't it exist because you made it up?

You don't get to claim I owe you an apology without citing causes, asshole.

If I'm rude to someone it's virtually always because they're

1) being remarkably stupid in their claims in the first place -- and I do mean excessively remarkably. As in claiming the sky is red, or that there is NO reputable evidence against AGW.

I'll accept the belief in AGW as a defective, but not inherently stupid, starting point -- but if you don't grasp that there ARE valid arguments against it -- even if you disagree with them completely -- then you either haven't done your homework, or you're too stupid to understand them -- in either case, you're too ignorant and stupid to be expressing an opinion on the matter. In other words, STFU and stop showing everyone what a fool you are. The faster you learn that the better off everyone will be.

Everyone has a right to an opinion. They also have a responsibility to recognize when it lacks any value... (yeah, go ahead and be mindlessly insulting here, like I'm betting *you* want to be...)

2) Not actually making either refutative points or potentially refutable claims. This is the typical libtard position. Just blathering on about how "it's so obvious" that libtard position 'x' is right... and usually demonstrating that they can't explain WHY it's right for even a single consistent thread of support.

3) Not bothering to cite any sources but just bloviating on how things are "obviously supposed" to be. That sounds like "2" but reinforces the need to provide a source or two for some of the less obvious claims, esp. if they can't be easily found with a wiki or google search.

4) citing random libtard/Democratic "talking points" without actual justification (see "1") in support of them. This sort of rolls up 1,2,3 into one big ball of goo, but also says that said idiot can't even come up with their own thoughts -- they can only parrot Memes of Ignorance when taught them by others. To paraphrase that: "I have no thinking ability of my own. I only low in response to my herd brethren"

Example:
"Bush Lied!!"
Simply put -- "Oh, just shut the f*** up". With that claim it's blatantly clear that you're a complete moron, right out of the gate, utterly incapable of rubbing two memes together to make an idea. Two friggin' words and you've demonstrated a single-digit Wisdom Quotient.

5) Ignoring previously disabused claims to attempt to re-assert some disproven concept. If someone's taken the time to disprove your ideas, you either need to deal with why that disproof is incorrect, or stop using it in this venue (and, to be intellectually honest, to stop using it at all).

===================
In short, even if I disagree with you, if you are making the attempt to reason and make points, I'll usually give you the benefit of the doubt and be polite -- even when you're being rather dense.
===================

This is why, if you review my interactions with bobn, my responses vary considerably. When he's making a valid effort to talk/argue his points, I speak politely to him and treat him seriously. When he's bloviating on a subject and repeating previously disproved mantras, I deservedly smack him down like the idiot he's being. I don't think bobn's an idiot. But he often plays one on the internet.

And, in a recent case, I DID treat your comments seriously, and DID politely refute them, you were a completely rude PoS.

And that's the difference.

I get rude when (like, bobn) someone attempts to re-claim a point which I/we've already shown is inherently defective.

I get rude when someone attempts to assert blatantly stupid "facts" when I know they should know better (again, using bobn as an example, when he attempts to claim OFHEO under Bush should have done something to rein in the GSEs when I know for a fact that I've already shown him that they inarguably DID attempt to do exactly that, but got shot down in the oversight committee... by Democrats).

Example -- if you make the claim that Bush is an idiot. OK, I'll usually give you that -- once -- followed by an explanation of why you're wrong, including pointing you to the spectacularly excellent disproof of said meme from Bill Whittle, over on Eject Eject Eject. Now, having put the facts before you -- if you attempt to re-assert the claim again -- then *yeah*, I'm going to insult YOU at that point as an idiot because you haven't learned jack shit. You've demonstrated that you're not debating, you're bloviating. If your claim is that *I'm* wrong, then you damned well better make a case for it. Because I guarantee you I've made a valid, worthwhile case for that idea being in error.

In short, if you're wasting everyone's time by...
a) Not learning anything at all
b) Not paying any attention to demonstrated flaws in your claims
c) Making everyone re-hash stuff that's already been covered in detail, and recently...then, in my opinion, you're the one being rude, and don't deserve politeness.

Now, Thai, go ahead and point me to where you deserved politeness but I was rude to you -- so I can show you where you violated the above principles. If I can't, *then* I'll apologize.

But I'll lay odds it's an entirely correct statement that if I insulted you, it's because you were being rude to everyone here.

And if you can't do that, you need to STFU.

As AVI has said of me -- I don't suffer fools. I've got better things to do than to waste my time arguing with someone who cannot learn jack shit, and cannot prove a point to save their own lives (and thus are unable to correct me in any error *I* may be making, even IF they happened to stumble blindly across one such).

I sometimes choose to refute the points of a libtard idiot just because they haven't been covered recently, and that allows any newbie viewer to see where the flaws are -- plus it also causes me to review my own case in the face of the universe of ever new information -- and that's one reason I'm fairly sure of my stance on a lot of things -- they're reviewed on a regular basis not just by me but by others.

But when a point has been recently dealt with, I'm just going to call you a friggin' idiot if you've made no valid effort to refute said point, but ignored the disproof and gone on with it as though it remained valid.

When you do that, you show you aren't even attempting to argue or debate, and disrespecting everyone around you.

You're not even attempting to argue -- you're just bloviating.


Hell, Thai, go look at my first comment in this thread. Even when I insulted you, I still took the time to explain why you were stupid.

Not so much because I expected you to figure it out, but although it was insulting, I wasn't out to make it ad hominem.

And someone else might be able to figure out those things you refuse to figure out for yourself, insisting that we do the thinking for you.

Game. Set. Match.

'nuff said.

Carl said...

OBH:

Can we have a moratorium on the words "d*ckh**d" and "*ssh*le"?

Thai:

I concur with OBH in that I can't understand your argument. What are you saying about healthcare policy (or conservatism)? You've neither set forth any sort of syllogism nor pointed to particular points made here with which you disagree.

Thai said...

I keep saying that I think this "choice" issue is an illusion (nothing to do with abortion). For no matter what we do "There will be restraints on choice".

We look at our health care system and say it is the best because we have freedom of choice to make our own health care decisions. Yet the reality is these decisions are making us spend more and more money in the system today.

We have the best health care system in the world because we spend the most money of anyone in the world- not because we have choice, not because of American exceptionalism.

Only we have a little problem. We are borrowing as a society in order to pay for it.

In order to "fix" this problem, a traditionally conservative solution would be to allowing freedom of choice to achieve better "value conscious decisions" (e.g. demand restraint).

But it is also fair to say that a traditionally liberal approach of centralized controlling (e.g. supply restraint) would also fix the problem (I understand you would not like this choice).

But arguing which is better when you are talking an economy from 18% GDP to (say) 12% (which still wouldn't cover our current deficit spending), is miss the much larger picture that we will be spending WAY less money either way.

It is kind of like worrying about whether a bridge you will drive your family across is built with labor paid hourly or labor paid using some kind of wage-productivity model, when the bigger issue is the road was built with 1/3 less money (something was cut from the costs).

IN health care, it has to mean 1/3 less care- period.

Someone is going to have to get rationed.

So there will be restraints on choice. And whether these restraints come from people own personal choices or from a central authority, they will come.

And when they come, the result is some people will end up losing as a result.

Of course, some people will end up winning (as is always true when bubbles pop).

To get so passionate about these nuances on "restraints on choice" seems to miss the bigger issue.

And as I am sure you are aware, were heath care rationed according to a "more equitably centralized liberal approach", it would be the northeast liberal states that would suffer the most (Boston and Long Island would go through a massive recession whereas Utah would see a huge gain, etc...)

The politics of this whole thing is fascinating in its complexity.

OBloodyHell said...
This comment has been removed by the author.
OBloodyHell said...

> Yet the reality is these decisions are making us spend more and more money in the system today.

No, they aren't. We CHOOSE to spend more. There's no Health Authority out there holding a gun to anyone's head and "making" anyone spend more. The level of medical attention -- and the level of technology applied to it -- is VASTLY more than we've spent in the past.

And we do make that choice as much because we can as because we want to. People want to be active longer in their lives, so they actually GET knee-joint replacements in their 80s (Yes, *80s* -- I know someone who did exactly that), something unheard of at any age a mere 50 years ago.

That ain't cheap -- not to develop the ability, nor to implement it.

> We are borrowing as a society in order to pay for it.

What's this "we" shit, kemosabe?

Socialized healthcare, which you appear to be a proponent of, is the only way as "a society" we're likely to wind up borrowing to pay for health care.

Individuals in our current system, if they choose to do so, are not encumbered by the health care decisions of others. So there's no "society" going into debt to do this.

Not yet.



> Someone is going to have to get rationed.

Ah, so you figured that part out, eh?

So, which way shall it be rationed -- by cost -- meaning that one might obtain charitable assistance, from a vast array of possible organizations, to pay for it -- or by bureacratic fiat -- meaning some lone bureacrat somewhere who has no interest in your problems gets to decide?

"In a competitive society, most things can be had for a price -- though it is often a cruelly high price we have to pay... The alternative is...the favor of the mighty."
-- economist Friedrich Hayek --

> And whether these restraints come from people's own personal choices or from a central authority, they will come.

As the above indicates, there is a considerable difference between being dependent on the willing charity obtained from one of a vast array of individuals and organizations and the charitable inclinations of a bureaucrat who could care less about you and your damned problems (You and your silly problem is making her late for lunch!!)

Statistically, it seems incredibly obvious that you're a lot better off spreading any dependence on charitable inclinations around.

Remi said...

Mostly, I find your questions confusing. I agree with most of OBH's answers, without endorsing his style. In the most abstract sense, insurance is a contract between willing buyer and willing seller. It's logical that insurers (of any sort) have opt-out clauses: if you hold nightly firework parties at home, it's going to be difficult to get homeowner's insurance.

Thai said...

Re: "We are borrowing as a society in order to pay for it.

What's this "we" shit, kemosabe?"

You really are getting tiresome...

Ok, we will go back to econ 101.

So when you "stiffed" the hospital (or somehow thought the doctors and nurses were simply giving you charity care out of the goodness of their heart), who actually paid the hospital, doctors and nurses for the care they provided you?

For I promise those doctors and nurses and drug companies didn't work for free. I employ almost 100 of them (and I provide lots and lots and lots of indigent care, on both a personal and organizational basis, so on this topic I am intimately aware of the details).


If you would, please post a comment thread for the rest of your readers that describes precisely where the money to pay for your health care came from (I mean the care you received when you stiffed my colleagues).

Please draw for the rest of us to see a "follow the money trail" so to speak. And please continue in this diagram (e.g. only stop) when you really come to the end.

Saying "somebody went to work and paid taxes" or "somebody went to work and paid private insurance or somebody took their own money and paid the doctor and hospital" is most certainly no the end of that money trail, so please keep going until you come to the end it and let us know where all that money originated from?


Do you even see the endless "circular loops" in economics like the rest of us or not?

Thai said...

Re: "meaning that one might obtain charitable assistance, from a vast array of possible organizations, to pay for it".

The key word in this statement is might.

For they also might not

Thai said...

And OBH Re: "Socialized health care, which you appear to be a proponent of, is the only way as "a society" we're likely to wind up borrowing to pay for health care."

Please read a little more.

You seem to make mental silos out of our country's money in ways that are meaningless to anyone but yourself (although I am in no way suggesting by this statement that anyone steal or tax you in the same way that you steal from everyone else when it comes to getting health care).

For we are most definitely borrowing as individuals, as a society, as private businesses, as private households, as local as city and as a federal government.

We are all most definitely borrowing (and now we are also printing money- Bush's Fed did it and now Obama's Fed is doing it).

... Although I would agree with you if you are saying we could keep spending the money in health care IF we took it from somewhere else (like roads or military or education or retirements, etc...).

Or you are saying we could reduce the health care portion "just a little"- say stop giving it to those charity cases who also stiff doctors when they can really pay (kind of a "no oil for pacifists" approach)

... and then we get the rest from everywhere else.

Or I guess we could continue to borrow AND print?

Is that the preferred OBH solution to our problem???

OBloodyHell said...

> So when you "stiffed" the hospital (or somehow thought the doctors and nurses were simply giving you charity care out of the goodness of their heart), who actually paid the hospital, doctors and nurses for the care they provided you?

WHAT CARE ARE YOU TALKING ABOUT? Stop "inventing" straw arguments, Thai.

> The key word in this statement is might.
> For they also might not

Correct.

And JUST as applicable is the notion that they MIGHT get help from a disinterested and harried bureaucrat, or they MIGHT NOT.

Which one of those options do you want to stake your needs on, Thai?Possible charitable intentions from a thousand random individuals... or ONE probably surly, arrogant bureaucrat?

YOU bet on the bureaucrat. Me, I prefer my chances with the group.

> Please read a little more.

OK, here's a pie chart of the actual value of a pie chart with no sources, no information, no diddly squat to explain itself, just random numbers apportioned out:

O

I think mine reads more clearly.

> For we are most definitely borrowing as individuals, as a society, as private businesses, as private households, as local as city and as a federal government.

And this directly applies to your claim that we are doing it for health care *alone* ---- HOW? Are you now attempting to conflate and equate all debts and all expenditures as completely fungible? That's just flat-out ludicrous.

Further, there is a whole host of causes for this borrowing you speak of, and at least one huge chunk is government policies.

...Or don't you think that socializing RISK, as well as LOSS, is strongly encouraging to people to go into debt in order to finance things?

I mean, when the government spends like there's no tomorrow, and when one of the uses for this spending is to eliminate any risk or loss to individuals, groups, and organizations from failed decisions, what the heck do YOU think is the likely result?"Well, Bill, if you borrow US$10,000, and put it into this portfolio, you'll probably get $75,000 back. If it fails, then the government will give you $25,000 back. You win either way!"

Gee, I can't imagine why everyone thinks that's a good deal for them... (don't argue with ME about the long-term issues with it!)

> (and now we are also printing money- Bush's Fed did it and now Obama's Fed is doing it).

They've been doing that for ages. I don't believe a fraction of a percentage of the lot actually grasps how much wealth there is in the economy (nor do you, nor to I -- but I do grasp the fact and nature of said ignorance), so the numbers are all woefully untrustworthy all around.

We are in an IP and Services Economy, and I have yet to see any sign of an economist who Actually Gets That, much less fully grasps the vast and serious distinctions between Real Property and Intellectual Property, which are both "property" in the sense that H2O is "water"... but one is Ice and the other is Steam... the underlying behavior -- economic for property, physiochemical for H2O, is radically different. RP is a phase-change away from IP. And no one has a clue about reliably defining and measuring the value of IP at this point. Not on an individual level or on a widespread social level.

So how much actual worth is there IN our society? God knows. I guarantee you no human does.

> Or you are saying we could reduce the health care portion "just a little"- say stop giving it to those charity cases who also stiff doctors when they can really pay

And if you actually READ anything I've said, then you'd grasp that I certainly don't have a problem with the notion of requiring a certain percentage of one's income be allocated to the procurement of insurance. YOU pick the policy, YOU pick the coverage (with certain mandated minimums). This is pretty much the standard for the Auto Industry, and can work just as well for the Healthcare industry (and, to head off your objections at the pass, yes, I'm aware of the issues of Uninsured Motorists. And there are ways to structure the system to eliminate those to a minumum for both Auto AND Health, though neither is implemented to do such at this time).

The same thing should be the rule for pension/social security -- A portion of one's income directed into a fund, akin to a 401k, which includes a mimimal part you own but have limited control over (you can always put in more, and do whatever you want with that part).

And all of these place the supervision of both the funding and the services into the hands of the individual most capable of grasping it and assigning the importance to it that it needs... the consumer.

Which is precisely where it belongs.

> Is that the preferred OBH solution to our problem???

I'm sorry, what possible absurd twisting of ANYTHING I've EVER said ANYWHERE would lead you to think *I* -support- this sort of crap?

I think the whole system is far, far out of control, is in a totally messed up positive feedback loop, and is going to shatter itself at some point in the cycle of wild oscillations.

Yet another reason I object to gun control. It ain't gonna be pretty.

But how is "socializing" the whole mess going to improve on things?

How is putting control over all this stuff into the hands of blatant economic illiterates and two-bit thieving political whores going to "fix" anything at all? It's certainly done WONDERS for Social Security, hasn't it?

If anyone BUT the government set up a giant friggin' PONZI scheme to handle peoples' investments, they'd either be in jail, or headed there.

But noooo, "Let's give the Fed MORE money to screw things up with," says Thai... "They've done SO well with the money we've given them so far. Just look at the massive success that Hawaii has had just with health care for children"

In short, Thai --

1) You need to lay out what you actually stand for and support. So far, I notice that you've been "interestingly" careful to not actually specify this.

2) You need to actually argue how you expect to
a) PAY for that
b) CONTROL those expenses in the face of widespread perversion attempts by various individuals and organizations.

I'm sure one can come up with more, but I'll be impressed if you even come up with either of those.

Thai said...

OBH- Your responses are too long and you seem to be having a conversation with yourself. Further you are not reading me closely and frequently contradict your own interpretations of my statements.

I will say again: "I keep saying that I think this "choice" issue is an illusion (nothing to do with abortion). For no matter what we do "There will be restraints on choice".

Repeat: "illusion".

Re: my opinion on socialized vs. private health care. I am 100% agnostic. Either is wonderful/sucks. The argument is a Tweedle Dumb vs. Tweedle Dee.

That you can't see this? I only suggest you open your mind.

Re: taking advantage of your peers. or as you say "Possible charitable intentions from a thousand random individuals... or ONE probably surly, arrogant bureaucrat?"

This statement seems to miss the asymmetric"risk" issues inherent in most of health care- classically illustrated by the example of the uninsured motorcycle driver who sustains a head injury in a crash while not wearing a helmet.

If his epidural hematoma is evacuated, he will live with full recover. If it is not, he will die.

The surgery and subsequent care costs way more than all but the richest of people can afford.

The patient is now in an emergency department. What does society do? What would you do?

Your notions of private charity certainly works IF you only need a small assistance or you actually can get 1000 people to make small contributions to your needs. But if you cannot, you are in trouble.

Carl said...

Thai:

I agree that spending on entitlements (including Medicare and Medicaid) is increasing too rapidly. That, of course, doesn't suggest that increased government intervention in healthcare would control costs (though I understand you're not necessarily advocating that). Yet I agree with OBH that Americans are spending more on healthcare because we can and choose to. (I'll be posting a chart soon on that.) So, we're not necessarily in the "emergency department": the higher spending might be desired (and I expect it to decline somewhat in the current recession).

I also agree that rationing exists under all healthcare systems. But if we're going to have rationing, shouldn't it be explicit, i.e., based on the price system?

Beyond that, I'm still confused about your recommended policy solution. Could you restate?

BTW, I've been toying with the notion of advocating elimination of Medicare, with the funding transferred to Medicaid--the theory being we should support healthcare for those who can't afford it, instead of essentially all the elderly. (Essentially the same thing as means-testing Medicare.) But I haven't researched the point yet.

Thai said...

Carl, obviously not being in your head and unwilling to read all your prior posts, I THINK the problem you MAY be having is you seem to be confusing the idea of Medicare and Medicaid (our current "socialized system") with socialized medicine in general (a very generic term that can mean many different things).

I assume the idea of the military providing care to its soldiers does not equally freak you out?

Medicare is not a program designed with rationing in mind at all. Think of it as a money bag with gold coins and a few holes. The more you "whack it", the more money comes out. So people just whack and whack away- "why stop?

Indeed, the idea of a politician publicly professing open rationing in health care (Medicare) is like touching "the third rail of politics" to the power of 10.
And any attempt at rationing leads "some selfish" voters to call their representatives who immediately squelch the rationing.

I think the term is "fragging"?

... And moving the poor to Medicaid would do nothing to change behaviors for the group of citizens who do not understand any of these issues and have little to lose in the first place.

I think that if you understood how Medicaid works (it just pays less for the same services but otherwise has no rationing) you would see it as a bad deal.

If Medicaid doesn't pay enough to let any doctor see you, they just go to the ED and the system is "sabotaged" so to speak.

The key is to get people to use care when they REALLY need it and not use it when they don't. And they don't know when they really need it. They need to be enrolled in a comprehensive system that otherwise has significant "restraints on choice".

Personally I prefer the idea of just opening the VA to everyone (take the money from Medicare and Medicaid and do it).

Lock the ED's down. Or open VA clinics in EDs with liberal protections for care providers when patient's are mistriaged/misdirected to the clinics when they should have been seen in the EDs.

Eventually people will get the message.

And if you have something which is non-emergent, you will be made to wait if you "break the rules" so to speak.

If you don;t like it, you can always go out and buy your own.


But as Medicare must ration, the current covert aspect of American rationing creates a most insidious system that fewer and fewer people trust.

Sure rationing is ugly, but it could be made a whole lot less ugly if it were a lot fairer.

The blog I keep referring you to, Dr Rich's Covert Rationing blog has been trying to tell everyone just that.

Their basic message is: get it out in the open, it is what it is.

-Amen

Rich, like me, like many other health care providers, is highly offended at the covert aspect of health care rationing.

We watch soldiers die for this country defending its freedoms, police officers getting shot protecting us (I have seen this many times) but you and I, average citizens, are not expected to give up a few days/weeks/months of life when the cost of extending those days becomes so extreme it literally crowds out decent education for those soldier's and police officer's kids?

What has happened to us as a collective?

Our grandparents knew this intuitively. They made these sacrifices for our parents, for us. But now look at the level of public discourse...

Now everyone gets 3 MRI's (if they are rich enough), when the data is clear they don't even need one and they really aren't even paying for it in the first place (except they are) as it was "someone else's money" (i.e. private insurance).

And a hard working trucker who is just acting stupidly doesn't end up taking blood pressure pills he thought were too expensive at $4/month out of pocket (people can be really really stupid) so he strokes at 45 when he would have had another 5-10+ years of good quality life on this planet if he had simply taken them because someone gave them to him.

I would have no trouble applying such rule to myself/my family. I don't want to die early, but I also know I should lose a few pounds and yet I don't (if you get my drift).

If we are going to ration (as we already are and indeed must), covert rationing seems far far more dangerous.

Covert rationing is far less likely to solve our national health care Tragedy of the commons.

Do you not see the similarity of your title: "no oil for pacifists" with the "The covert rationing blog"?

You are saying the same thing as Rich, only you are talking about military service, he is talking about health care.

I cannot see for the life of me why conservatives do not promote someone like Dr Rich as their spokesperson. He is the most intelligent voice on this subject I have heard in quite some time (though he is wordy).

But instead a faction of your party has gotten your conservatives so obfuscated on this absurd issue of "choice" (which you don't really believe anyway) and "socialism" (as if there were really a difference) you are forgetting your own core values.

Stop kidding yourself.

OBH has so bought this "freedom of choice/private" BS he thinks he can avoid being indebted to "the mighty" (as if we were 9 year olds).

Common, we are all indebted to "the mighty" (and I am not religious).

That is why you say "No oil for pacifists".

FWIW- I have no trouble with benign paternalism. I do it all the time. In fact I am ethically bound to do so and would lose my license rightfully if I did not.

Were I poor and ill informed about health care issues, knowing what I know today, I would prefer a group of people who are looking out for me and see a broader picture than I do make the decisions for me. That a conflict of interest can arise is just part of the price of living on this planet.

The UK's NHS NICE is probably the fairest health care system on the planet. I would think conservatives would love it. Brits can always "top up" if they want.

You bash poorer British outcomes on things like cancer because of socialism. I say it has nothing to do with socialism. Britain simply spend less than us on health care on both a $/person AND %/GNP basis.

It is simply a sad fact of life-
"It is better to be rich than to be poor".

Thai said...

Carl,

While I couldn't agree more with your statement "if you think health care is expensive now, wait till it's free", I think you are being very disingenuous if you equate this same statement with the socialized/private medicine debate.

The truth is Americans have some of the lowest out of pocket expenses in the world right now.

Claiming this would be worse under a "socialized system" is disingenuous (if not downright dishonest) to say the least.

Remember, it is against the law for Medicare to ration. Repeat, against the law.

This is the American people doing very stupid things. It has nothing to do with socialism/private systems.

If conservatives keep framing the debate this way, in the end, they will lose whatever it was they really wanted when they kept pushing for a private system as their preferred method of "restraints on choice".

Because make no mistake, "restraint on choice" is coming.

Regards

Carl said...

Thai:

I'm still not sure I understand your policy recommendations, with I think inconsistent. On the one hand, you complain when OBH tries to fit you into the "socialized medicine" box, yet you suggest "just opening the VA to everyone (take the money from Medicare and Medicaid and do it)," which is about the most frightening form of American socialized medicine I could imagine. You stress the importance of rationing, yet claim that Medicare "is not a program designed with rationing in mind at all." Yes, Medicare theoretically outlaws rationing, but this ignores the reality of the bureaucratic top-down cost control and drug/procedures exclusions that are themselves the "covert" rationing you claim to oppose. And your various statements seem strangely disconnected from the Obama Administration's actual proposals, which would move away from reliance on private insurance without any realistic hope of controlling costs.

But what is most confusing is your conclusion that the "U.K.'s NHS NICE is probably the fairest health care system on the planet." Two points:

1) As coach Mora might say, "Fairness? You're talking about fairness? Are you kidding me?" The three goals of any medical policy are high quality of care, minimizing costs, and broad accessibility (similar to fairness). But, as Arnold Kling reminds:

"Any health care system must reflect a compromise of preferences. We cannot have health care that is both accessible and affordable while insulating consumers from the cost."

America already has high quality care that is broadly available. I'd put fairness at third priority, and rely on private insurance, yet sever the link between employment and health insurance in order further to broaden availability (upping fairness and relying on competition between insurers to reduce healthcare costs). Obama wants to increase availability--fairness--which, inevitably will end up increasing costs and government debt, which you claim to oppose. So why are you emphasizing fairness at the expense of cost control? And wouldn't my proposal better achieve your goals?

2) Britain's National Health Service is a disaster, a lesson of what to avoid, not imitate. It might be "fair"--but only in the sense of providing bad healthcare to all. (I'll be posting more on this next week.) Sort of like Cuba.

Conclusion: Your pronouncements are both unhelpfully theoretical and inconsistent.

Thai said...

Carl, fair confusion.

You asked me for a policy suggestion, I gave you one. I recognize this could be done other ways and I am not wedded to any particular one but I think the idea that needs national agreement is "basic" + "top up".

So I can see why you are confused with my suggestion.

It is only my opinion but it seems to me if you are going to make a change, change it where there is a "problem". And imo, the problem centers around those with few resources getting desirable care.

I think many people might get agreement that the "cost-value" proposition for many of these Americans is not ideal.

I am not suggesting the VA be the only part of America's health care system.

What I am suggesting is we open the VA up to everyone and move SOME % of the money from Medicare and Medicaid (I would eliminate both) to this new universal entity and eliminate what you see as the straw man issue of universal coverage.

This program would be the "basic" most Americans who currently complain would complain about.

After that theses Americans could "top up" so to speak.

And I would give the rest back to taxpayers to decide how they want to spend their money.

So IF we spend 18% GDP on health care now and 1/2 of this is public funding, the easiest thing is to create a universal entity funded with around 9% GDP (under a VA admin renamed whatever we want to call it) and let Americans have the rest back in Tax refunds.

The money in this system would go to a basic plan. And whether the basic plan is like the NHS's NICE and uses explicit rationing like NICE or some other approach to contain costs, I am not wed (though I think NICE is fair).

The other 9% Americans could do with as they chose.

Of course, I am only suggesting we use the VA because the system is already in place.

We could just as readily subcontract to a single or number of private entities to distribute care as a VA would but there are logistical issues with this approach... I kind of think the difference is Tweedledum vs. Tweedledee.

So again, I am not wedded to the idea of a single government entity like the VA taking over. I just think it would work to deliver a "basic" + "top up" approach and the system is already in place.

Our VA does ration care today (unlike Medicare/Medicaid... though I will say the geographic variation in VA spending is almost equal to Medicare's variation which is alarming).

Imo, "restraint on choice" is what we need.

I also understand we could just as readily solve the "basic" + "top up" approach with lots of individual private plans + subsidized basic ones that have strong rationing controls built into them, but this would be a monumental mindset change for most Americans and I do not see how you will get Americans to change their mind/behavior in a reasonable time frame.

Further, I would loath to defend these plans in court. And even if they did ultimately hold up, they would be incredibly expensive to defend as insurers tried to enforce rationing in them. We already undermined HMO's attempts at rationing. I am unsure why we would not do it again to these new rationed plans.

So again, it is just my opinion, but the biggest problem with escalating health care is from people who see it as free (just look at the difference in spending from the uninsured with chronic illnesses vs. insured with with similar chronic illnesses).

It is the behavior of these people that I see as needing restraining the most.

I do feel that not all parts of our system are in trouble, but if you don't have a "basic" plan, I think this will be dealing with this straw man issue forever.

Of course I readily admit that once you do get a "basic", there will be endless new battles on how much to fund it and who controls the rationing decisions and the unfairness that some have more than others.

So you could argue everything is equal.

And again, I am not so much personally interested in how you feel the NHS is a disaster (I have seen its problems first hand as I worked for a few months in it) UNLESS you adjust your criticisms to reflect "price".

I still feel you can't buy a Rolls Royce for the price of a Hyundai- period. Which has always been my main point.

If you have "price normalized" value data showing the NHS still does terribly across the board (again, it is always a composite picture), then I am truly interested in seeing the data.

Regards

Thai said...

"So you could argue everything is equal"

Sorry, I meant to say "So you could argue that since it is always going to be unequal, why even bother fixing something that changes nothing in the end".

And to this I would have to agree and say I have no answer other than to say it might quell the noise down for a little while anyway.

;-)

Regards

Carl said...

I have no confidence that any top-down government solution would be effective or efficient. The solution I outlined above--based on increasing competition among private insurers--would ration effectively (cost control) and could work.

Thai said...

I completely respect this point of view or article of "faith" as you so put it.

What I am a little confused by is how you see increased competition amongst private insurers resolving a rationing issue when it seems to me it is more a legal issue than anything else.

I agree with all the links you have given. What I cannot see is how you connect the dots to a system which puts "restraint on choice".

The legal preventions around overt rationing in both health care delivery are quite strong. American's cognitive dissonance around this issue is bizarre to say the least.

How would you resolve this problem?

Insurers tried and failed already.

Carl said...

Editorial from Monday's Washington Post:

"Of the many possible issues that could snarl health-care reform, one of the biggest is whether the measure should include a government-run health plan to compete with private insurers. The public plan has become an unfortunate litmus test for both sides. The opposition to a public plan option is understandable; conservatives, health insurers, health-care providers and others see it as a slippery step down the slope to a single-payer system because, they contend, the government's built-in advantages will allow it to unfairly squash competitors.

For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform -- changes that would expand coverage and help control costs -- without a public option."

Thai said...

Fair enough if I get your drift. I too am certainly in the public-private debate is a little bizarre camp so I may be a prisoner of my own logic.

Yet I read in none of your "solutions" a way out of the issue of how private organizations can overtly ration in ways consumers can chose (but also be held accountable too) and maintain these contracts once patients decide to "renegotiate" by taking them to court.

Hospital's obviously cannot simply "pull the plug" in our current system against their will so to speak.

Similarly I fail to see how one can control the behavior of physicians with their current "professional standard" protections built into the current system with the current private health insurance model.

Address these issues in a way that holds private citizens and medical practitioners accountable and you will solve the issue imo.

Do you have a link which addresses this?