Monday, June 22, 2009

The Health of America, Part 11

Discussing healthcare reform last week, Assistant Village Idiot observed:
What other similar countries spend and what they get for it is interesting and partially relevant, but never even a close match. We have a different legal climate.
All true, but foreign healthcare policy trends can help predict how America might fare under Obama-care. And this June 18th Daily Mail (U.K.) article is a bad sign:
Gipsies and travellers should be given priority in NHS [National Health Service] hospitals and GP surgeries, doctors have been told.

They will be fast-tracked for doctors, nurses and even some dentist appointments above all other patients.

GPs have also been told to see any travellers who simply walk in without an appointment, even if all consultation times for the day are full.

They will also be given longer consultations than other patients. Five or ten minutes is the average but travellers will be given 20 minutes and allowed to bring relatives into the consulting rooms.

Staff will be given 'mandatory cultural awareness' training so they can fully understand what it is like to be a traveller or gipsy.

It raises the prospect that other patients will suffer worse healthcare and have to wait even longer to see their GP.
Marathon Pundit wisely warns:
There's a lesson here for Americans. Our population is more diverse, and we have countless affirmative action laws in place. A decade or two from now, someone from a less-healthy ethnic group might be seen ahead of you while you wait...wait...and wait for a doctor.
Which could generate additional medical malpractice lawsuits--another aspect of America's "different legal climate" already upping our healthcare costs.

Speculation?--sure. Yet perfectly plausible, should we increase the government's role in healthcare. Another reason to insist, as Virginia Postrel argues, that the Administration fix Medicare first:
Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems, why not start with Medicare? Let's see what "better management" looks like applied to Medicare before we roll it out to the rest of the country.
(via Doug Ross)


suek said...

Re: medical malpractice lawsuits...

If the Feds are the single source of health care payments, will you be _permitted_ to sue?

I wonder...

OBloodyHell said...

probably not.

copithorne said...

We have countless affirmative action laws in place? What do you have in mind?

Medicare works pretty well. It's definitely cost efficient and it does have the authority to negotiate advantageous reimbursement rates.

The VA system is another example of a government run health care system that is now creating the best outcomes at the lowest costs.

Anonymous said...

Friends of the U.S. Chamber - Protect choice and private health care. Agree with the U.S. Chamber of Commerce that having competitive market forces is the best way to meet the growing needs of the American people? Support the Chamber’s efforts by signing the health care petition. Go to

suek said...

Does anyone know of any private sources that are alternatives to Medicare and/or Medicaid?

OBloodyHell said...

Petition from CC:

Here's a more direct link

That takes you directly to the petition.


P.S. for those of you who don't know how to apply links:

format is

[a href="http://inserturlhere"]Applicable Text[/a]

Replace the "[]" with "<>" in the above example

This, FYI, is close to an internet/blogging standard.

If the comment engine supports links, that's usually how they are formatted (and if that does not work, try it with actual "[]" in place of the brokets "<>", that's the most common, though unusual, variant)


Carl said...

could copithorne be the only one who doesn't know Medicare's a mess with out-of-control costs?

suek said...

I don't have any links, but I think I've read that the VA care system is considered pretty deficient as well.

I still want to know if there are Medicare/Medicaid alternatives, and if not, why not.

I suspect we all know why - and if the government gets into "alternative" insurance, there would soon be no "alternatives" left in the private market, and we'd have a single payer program, no matter what O says.

It's only the first step out of the airplane that is a matter of choice. After that, the results are inevitable.

copithorne said...

Medicare is a very popular program. Senior Citizens like it. Doctors don't find it unusually onerous. Providing medical care to senior citizens is very expensive and getting more so. But you couldn't replace Medicare with private insurance. It would be a lot more expensive if you did.

If you guys want to run against Medicare, be my guest. If you've got ideas for making it less expensive, please describe. One thing we could have done is to empower the government to negotiate reimbursement rates from pharma companies for Medicare Part D. We could have saved a lot of money that way.

Here's a great study of the VA system that documents how the VA system provides the best outcomes at some of the best efficiency:

Finally, I gather that "countless affirmative action laws" cannot be substantiated. Where did that sense of victimization come from, if not from the outside world?

suek said...

>>Where did that sense of victimization come from>>

It came from those who have been pushing for "diversity". Divide and conquer.

make mine freedom

Note the date. Predates "diversity"


suek said...

socialised medicine in practice

Assistant Village Idiot said...

copithorne - generalise much?

No, I guess there are no affirmative action requirement in America. I go to all that training every year and keep track of racial statistics for nonexistent people.

Carl said...


Doctors "don't find [Medicare] unusually onerous"? False--doctors are "opting out."

Medicare "works pretty well. It's definitely cost efficient"? False--Medicare runs out of money in 2017, and would require enormous tax increases by mid-century.

copithorne said...

The thesis here is that government doesn't work: look at Medicare!

My response is, Medicare works far better than any non-government solution. Doctors opt out because their reimbursement rates are low. Are you suggesting we raise reimbursement rates while cutting costs? The reimbursement rates are low to save costs. That's a feature, not a bug.

Do you have a private solution you prefer to insuring retirees? Please describe.

Yes, if we don't fix the healthcare system, Medicare will become increasingly expensive. It is expensive to provide medical care to senior citizens. If you've got solutions, please advise. But complaining is useless.

And please, run against Medicare.

AVI, sarcasm is not conversational. I was told there are "countless affirmative action laws in place." I asked for an example. No one answered. It is hard for to tell if you are providing me an answer. Are you saying that you believe that your diversity trainings are mandated by law? Every private company of size has diversity trainings. Are you telling me that your procedure to record the ethnicity of your clients constitutes affirmative action? I don't understand. But again, with sarcasm I have to impute your meaning because you have reached a point of agitation where you can't express it directly.

suek said...

>>The VA system is another example of a government run health care system that is now creating the best outcomes at the lowest costs.>>

Or not.

suek said...

>>Medicare works far better than any non-government solution.>>

What non-government solutions? Could you suggest any for comparison?

copithorne said...

What would happen without Medicare? How would senior citizens get private insurance? I dunno, I asked you. I can't think of a good solution.

Some people would be able to negotiate retiree benefits from their companies. That would be a huge hit to corporate balance sheets. We just saw GM struggle with a fraction of that obligation.

Can you imagine senior citizens trying to go out and buy insurance themselves? With preexisting conditions? Not in today's America. I might guess that maybe one in three senior citizens would be able to get and afford private insurance. That's probably high.

As far as I can see you would be talking about at least half of senior citizens without medical care. Or doing whatever emergency room patch they can do. Or going bankrupt. It would be a cascade of catastrophes.

Thanks for the article on the VA system. I read it. When we rationalize the health care system there will always be pressures about how much to pay and how to strike a balance between cost and quality.

OBloodyHell said...

> I can't think of a good solution.

That's because you lack any semblance of a brain. That doesn't mean others don't, even to the point of grasping that you just put up a strawman argument. Duh.

Who, praytell, said to "get rid" of it? "Reform"<>"Eliminate".

And yes, its costs are spiraling out of control. Partly because more and more things are getting covered by it. It's no longer just "basic services".

> I asked for an example. No one answered.

Why should we do for you what a simple web search will do? Funny how you never, ever can be bothered to supply links for your "info" (read: "made-up BS"), but you expect us to do so...

But how's this:
... the data show that the odds favoring black over white applicants with the same background and academic credentials were 442 to 1. For Hispanic applicants, the odds radio was about 90 to 1. Looking purely at race and state residency (a key factor in public university admissions), said Roger Clegg, president of the center, "a white resident of Nebraska in 2007 was more than 20 times less likely to be admitted than an African American applicant from out of state.”

And this:
you [now having more than 50 employees] are now a "federal contractor" under the affirmative action laws. Many banks and financial institutions do not realize they are a federal contractor with affirmative action obligations until the Office of Federal Contract Compliance Programs ("OFCCP") sends them an EO-Survey or notice of a compliance check.

Both found with one search, and about 3-5 minutes reading.

Too tough for you?

Perhaps this explains why you make things up.

copithorne said...

The fair question is if you were to take all the Medicare money and cut checks to seniors and told them to go buy insurance, could they do it. I haven't seen data covering this. I would expect a large number could not buy insurance at any price due to preexisting conditions. I expect the rest would be paying quite a bit more than they received. By that measure, government administration of Medicare is a success.

Bloody Hell, you didn't identify a law governing University of Nebraska admissions policies. Most universities try to achieve diversity because they perceive it to be intstrumental to a good education. That's not a matter of law, but of administrative practice. I would expect that decisions governing University of Nebraska's admissions policies would be made at the same level that decisions are made at a private university.

The second link identified an legal obligation to track the ethnicity, gender and veterans status of employees and applicants. Large companies also have to have a written plan about how they are going to make opportunities available to people of different minorities, genders and service status. Seems like a good law to me. Not onerous at all.

There may also be a law about government contracts favoring purchases from minority owned business. I'm not sure if that is still around. Local towns may also have laws to try and have their police and fire departments integrated.

To me, this stuff seems beyond trivial, but it touches a nerve with the crew here so that it seems 'countless.'

suek said...

>>I would expect a large number could not buy insurance at any price due to preexisting conditions.>>

And so...they'd not get treatment and die. At present, they _get_ treatment - and die.

>>Most universities try to achieve diversity because they perceive it to be instrumental to a good education.>>

Pray tell, how does the make-up of the student body contribute to a good education? Do they present cultural instruction?

>>Large companies also have to have a written plan about how they are going to make opportunities available to people of different minorities, genders and service status.>>

And why would that be? Since a company has a single goal, and that is to produce a profit, why does it matter what the makeup of its employees is?

>> Seems like a good law to me.>>

Why is that?

>>Not onerous at all.>>

You obviously aren't responsible for the bean counting required in order to a) prove compliance with government regulations and b) to prevent lawsuits based on possible discrimination.

Why don't we enforce % regulations on the NBA? Have you considered the number of blacks on the Lakers team for example, and compared it to the % of blacks in the population? I figure they're entitled to 1 black player. Obviously there's discrimination against whites in the sport. Why doesn't someone in government investigate _that_?

Carl said...

copithorne asks:

>The fair question is if you were to take all the Medicare money and cut checks to seniors and told them to go buy insurance, could they do it[?]

They could if we eliminated the tax deduction for employer-sponsored health insurance (in a revenue neutral fashion, by reducing income tax), so forcing private insurers to compete at the individual policy level.

suek said...

Another link worth checking out:

questions about the health plan

suek said...

Looks like the problem of insurance for seniors is a problem with or without the health care plan...

senior's care

suek said...

Well well. Looky here.

birth certificate may finally be looked at

(And OBH, I think I finally have that linky code memorized! I've been working at it!)

Carl said...

In addition to the recommendation above, I would eliminate Medicare to concentrate on Medicaid (or, what would be the same thing, means-test Medicare benefits).