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I was reading a debate on healthcare in the recent Newsweek. The prominent Democrat supported some sort of national healthcare while the prominent Republican supported more of a free market approach. Most people will probably take sides based on their assumptions about government efficiency versus market efficiency.

An old joke that works as its own punch line goes "I'm from the government and I'm here to help." Most people in this country reflexively believe the government will screw up anything it touches. There's plenty of evidence for that view.

But I wonder if government can be more efficient than the free market in specific situations, specifically in situations where the service is more about software than headcount, and where nothing needs to be invented.

Imagine a situation where you are deciding if a particular service should be handled by the government or by a hypothetical free market dominated by three players. The government's incentive is to provide the service as cheaply as it can. Any company's incentive is to transfer the greatest amount of money from consumers to stockholders. And to do that in a competitive industry you usually end up with what I call confusopolies. A confusopoly is a situation in which companies pretend to compete on price, service, and features but in fact they are just trying to confuse customers so no one can do comparison shopping.

Cell phone companies are the best example of confusopolies. The average consumer finds it impossible to decipher which carrier has the best deal, so carriers don't have normal market pressure to lower prices. It's a virtual cartel without the illegal part.

The advantage of a free market system is innovation. The market has an incentive to try new things. Governments prefer to avoid risks. If you need innovation, you want the free market.

In the case of national healthcare insurance, I ask myself these questions:
  1. Is it more about software than headcount?
  2. How important is innovation?
  3. Is the free market for this service a natural confusopoly?


Before you call me a socialist, I don't have an informed opinion on national healthcare. But I also don't have an automatic bias in favor of a free market that gave us Enron, WorldCom, Madoff, derivatives, and mortgages to hobos. I think you have to look at the specifics.

 
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May 24, 2009
has anyone every found a real free market. the only people who still talk about it spend too much time on the fox news. read what adem smith really said, not what liers say he said.
 
 
May 24, 2009
the thing is that before the r's opened war on it the government was a lot more efficienet. and after the r's have worked over the free market it worse than the gov. the post office had mail 2 times a day and stamps did not fall off.
 
 
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May 15, 2009
I'm somewhat flexible on the topic. Right now it seems the free market healthcare system, with all its faults, is better than the government's best ideas, but if someone intelligent can figure out something better I definately have an open mind.

The three questions:
"Is it more about software than headcount?"
- Yes and no. The biggest problem is no one can decide what healthcare plan to program into the software. We need some very smart people for that - smarter than those I've seen working on it now. Get that squared away and it could work.

"How important is innovation?"
-On the delivery of healthcare, not much; to the medical industry overall, it's extremely important. If the incentive to continue searching for medical breakthroughs and implementing them into the larger system is there, then it could work.

"Is the free market for this service a natural confusopoly?"
Yep - you betcha.
 
 
May 15, 2009
Think of it lke this:

House Democrats have finally started to come around to thinking like a Huckabee Republican.

There's some truth in this. In the 60's and 70's, Demacrats were truly "Tax and Spend". They felt that the problem of poverty could be solved by giving poor people money. The Republicans said, "That won't work". They were right.

Since Clinton, Democrats have learned that the government cannot solve all problems simply by throwing money at it. It's tempting to say that they've forgotten this lesson by looking at the current budget, but several things need to be kept in mind:
1) The problem with the economy right now IS a lack of money - capital lending by the banks. Throwing money at the problem IS the logical solution. (No, I don't like it, either. But it does appear to be right. And working).
2) The "throw money at the problem" was first proposed by Republicans (esp. Pres. Bush). We're still in the continuation from the old guard to the new. Much of the budget overages were already in place before the election.
We can't really judge anything until at least Q3 2009.

-----

That being said, I do have issues with the "Force everyone to have insurance" rule.

The government grants me the priviledge to drive a car on the roads they built. They require those roads to be safe, and so insist that (a) I know how to operate the car (pass a test), and (b) can pay for any mistakes I make while using their roads.
If I violate their rules, they can take away my privileges.

The government does NOT grant me my health, however. Therefore, they cannot mandate that I take care of it, nor can they take it away if I don't.
The only thing that they CAN do is insist that I pay for keeping my health, and not burden them with it (since it isn't theirs to begin with).
But that leads to "dying in the ER waiting room" scenario, that we all agreed was "insane".

So, another way of looking at it - the House Democrats are on the path to being "insane".
 
 
May 14, 2009
Michael, I can't even imagine how depressed you must be by this coincidence. My condolences. Don't do anything rash.

Webster
 
 
May 14, 2009
Michael, I wouldn't normally say this in public, out of fear of deeply offending my American cousins, but I think my view of government would more akin to your view if I lived in the US.

Don't get me wrong, Canadians, like people all over the world, thoroughly enjoy politician/government bashing. In fact, Canadians are notoriously brutal in the sport. But still ... something seems to have gone very wrong with the US political system over past 30 years or so. Maybe it's imaginary, but it seems to me that the Watergate era represented something of a turning point.

Anyway, your current political system is the same system that produced many great leaders and important social/economic progress, so I suspect you are just going through a run of bad luck with your politicians. But that is small consolation if the unlucky streak happens to coincide with your adult lifetime, no doubt about that.

It was many years ago, so I don't recall the name of the spot where we were fishing ... but I'm sure it will come to me.

Webster

PS ... don't tell anyone I told you this, but Sarnia is a really bad sample of Canada. ;-)
 
 
May 14, 2009
Michael, I agree that lunch would be a much better forum. But alas, as much as I have fond memories of fly fishing in your beautiful part of the world, I have no plans to visit Arkansas in the foreseeable future. However, if you are ever plan to visit Vancouver ... let me know.

I don't want to belabour this debate, and I am definitely not wanting to offend or frustrate you, but let me say this about where we started and where we seem to have ended.

I dropped into this thread fairly late. It's an interesting topic, but I had nothing to contribute ... until I noticed two things:

First, several manifestly false statements about the Canadian health care system. Right or wrong, I decided to call "nonsense" on those statements. I used capital letters for emphasis and to distinguish my text from the quoted text. I suspect this is where you gained the feeling that I was SHOUTING. Fair enough. Later, at your prompting, I explained why I was in a credible position to call "nonsense" on those particular fabrications.

Second, I noticed something that I often notice in these pages. The debate was heavily polarized at the ideological level. Right or wrong, I decided to share my views on why this sort of ideological polarization has contributed a to lack of progress in reforming the American health care system. I used the word "ideologue" to describe those who hold rigid positions at either extreme. I described opinions on the legitimate role government as the pivot point for those ideological battles. At one extreme you have an ideology that sees government as the source of all good, at the other extreme you have an ideology that sees government as the source of all evil.

Michael, everything you are saying, from beginning to end, reinforces the view that you do not trust government and would balk at any health care reform that further involved government. That's fine, but that also means your array of acceptable solutions are highly limited by your idiology. And it also means that you are very likely to see any solution that involves government in a meaningful way as "creeping socialism".

Throughout the exchange of the past few days, I have been doing my best to explain why this sort of ideological impasse is just that ... an impasse.

I don't see government as inherently good or inherently bad, and, like most Canadians, I have no problem with "our" government administering programs for the general good of the population -- if that is our will. Without exception, government is not involved in administering such things unless it has been demonstrated (to the voters) that the private sector is unable or unwilling to handle the matter fairly and efficiently. Times change, and if experience proves that a government agency (a ferry service, for instance) is less efficient than the private sector, it is not uncommon to see such things "privatized".

The vast majority of Canadians don't see the role of government in administering such things as health care as "socialism", nor, as you will see in the Wikipedia article that I shared, does it fit the proper definition of the word. Rather, Canadians see such things as the normal functioning of our parliamentary democracy -- with the common expectation that our elected representatives, regardless of political party idiology, will manifest a social conscience -- sometimes known as the call for "a just society".

So there you have it. We live in different worlds and we have different world views. Nothing wrong with that. But alas, I fear that 'never the Shania Twain shall meet". ;-)

Webster

 
 
May 14, 2009
OK, now for my analysis (opinion) of Sentient's Plan:

1) The cost.
Employer-paid insurance rates are already high, and that's part of the problem. And that's for coverage for the following demographic:
- Relatively young (at least, not geriatric, with the associated extra care)
- Relatively healthy (if they are too sick to get to work, they lose their job, and thus their insurance)
- Relatively affluent (poverty and illness seem to go hand in hand, and employment tends to reduce poverty)
- Are not Excluded (preexisting conditions, lifestyle risks, etc.)

If you include the old and the chronically ill, the rates will go up. Way, way up.

But, the argument goes, there will be some savings gained from the following:
- Indigent care costs won't have to be "passed on" to those who can pay.
- some young folk, just starting out, opt of of the insurance system, figuring that they're healthy and so don't need it. Their premiums and lack of services improve the lot for the rest of us.

Fair enough. There will be benefits. But, IMHO, these do offset some, but not all, of the cost increase.

My reasoning:
For the sake of arguement, let's define Medicare as an insurance co. Under Sentient's Plan, it will just have a different owner that the Gov't. With that, assuming that there is no other changes to the overall system, the Gov't will pay in "premiums" what is currently pays out in "reimbursements" for the same population (which, by my Q4, does not seem to change). No advantage there, unless overall premiums drop. We'll see....

Let's assume for a moment that under the current system, the "insurance companies" pay for both their insurees and the indigent, but are only getting premiums from their insurees. Under the Plan, they will pay out the same, but have premiums from the indigent (or the Gov't). So far, so good. More income, same outgo means that the average premium should go down. Sounds like we're on the right track here....

But, we are also adding people who, because they were un- or under-insured, forwent (forgoed?) getting treatment. Did this lead to more severe (& indigent) illness later, or were they simply not taxing an already over-burdened system? There will be more herrings (red and otherwise) on this, much noise, but the truth is: No One Knows. Not even the insurance cos. And yet, they have to make a finanical decision based on it. Any guesses how the coin they'll flip will land?


But by far the biggest factor why I think the premiums would go higher is the loss of bargaining power, by both the healthcare providers and the insurance companies.

Under the current system, the insurance companies can play hardball with the hospitals, "We have 1 million subsribers. If you don't accept our lower terms, you won't be "Preferrred", and our 1 miillion will use someone else." This keeps down costs.

Also, under the current system, the hospital can say, "We can't stay in business at your rates. Drop us from your lists". This keeps the rates in line with reality.

Under the Plan, since people can freely choose their medical provider, they'll tend towards getting Cadillac care. And the insurance co. will have no choice but to pay for it. Add in the currently untreated, and by the law of supply and demand, the day-to-day costs MUST rise.

Since insurance cos are forced to take people for whom everything is covered, there is just no incentive, as I'm understanding Sentient's Plan, to reduce cost. If I've missed something, let me know, but I'm not seeing it in the premises.



2) Medical Care, and its Quality.

One thing that was touched on was the hard-line (cold-hearted?) approach that the ER would be allowed to take. While I do personally find it reprehensible, there is a sound principle at its core. Namely: "we will not impose our value system on someone else." For example, I wouldn't require a doctor to perform an abortion if its against his religious belief. And I wouldn't require that a restaurant give its food to the hungry, nor a hotel with empty rooms those to the homeless. But since in emergency situations, confusion can abound, and time is critical, no, an ER should not be allowed to refuse care. Ever.

But what of non-emergency situations? Chemo today or tomorrow doesn't make that much difference (usually). The big complaint in these comments about the Canadian system was the long wait for care. We have that now, too, BTW. If today I call my GP for a physical, his next opening isn't for 6-8 weeks. My dentist books 6 months in advance, so if I miss an appt, the only opening I can get is to be on the waiting list and hope for a cancellation. But adding more people to the same amount of services will, by the laws of physics, cause delays.

But that's another codfish (I'm tired of herring). What Sentient's Plan has done is to give desperately ill people the ability to keep hounding the health system until they are satisfied, or give up (or die). Let's take Scott and his dysphonia as an example: How many doctors did he see before he found the ONE on the planet that could cure him? I seem to remember him saying at least 5. Fortunately, as everyone knows, Scott is infinitely rich, and could afford to do so. Now multiply that event times the number of people with similar "incurable" illnesses/maladies/discomforts, each with the unlimited resources of their insurance co. behind them, who by law must pay every single one of those doctors, both MD and Witch.

The good news is that we will get the absolute best care on the planet. For as long as the insurance companies stay in business at any rate. And if you can get an appointment with that ONE guy.


==========================

All this being said. there's much Sentient's Plan has going for it. The principles are sound:
- Everyone is covered; everyone pays (or has a benefactor pay for them).
- Simple is better than complicated (no "Confusopoly").
- Competition reduces cost. (the biggest drawback to the "single payer"/Gov't healthcare idea.)

It's the "Everything is covered" that causes the train-wreck. But to not cover everything means that every now and again, someone will discovered they have what they are not covered for, and it will destroy their finances, and perhaps their families and lives. "There but for the Grace of God, go I". No, I don't want it to happen to me, or to anyone I know. But doctors learn that you can't fix everything, and I think that this is one of those things.

I think that the "Sidebar" comment to Q8 ("Sidebar: Could some insurance company gain more customers by covering non-traditional treatments?") hints at the solution:

Insurance companies decide what to cover, and what not to. Consumers choose which plan covers their needs best.
- Want Cadillac care? Here's your plan and your bill.
- Want Alternative therapy? We've got a plan (and a cost) for you, too.

This solution also controls the Gov't cost for the poor. The "no deductible" plan would only provide wellness (at x visits/year) and catastrophic (life-threatening) care. No alternative techniques, no mental (I know they may be more likely to need it, but it's expensive and not always effective).

The hard part is Chronic care and Prescriptions. They need to be limited to make the plan affordable, but it's not ethical to decide on someone's health based solely on money. And here's where I get stuck.

==========

That's the big problem with the debate - it's not possible to be both ethical and responsible. The problem is, very few are willing to be honest that THIS is the major obstacle of the problem. The only logically correct solution is the politically incorrect one. Choose ethics ("cover everything"), and you'll be attacked for fiscal irresponsibility. Choose responsibility, and you'll be attacked for denying coverage to one or more sympathetic groups (seniors, the poor, etc).

I keep coming back to what I said in my first post. The problem isn't with the system, but with people's EXPECTATIONS of the system.
- They want to do as they please (pick their doctor/alternative treatment) and don't want to pay (too much) for it.
- They want the doctor to be a god, and cure them quickly, with minimal rehab, and completely.
- And being a god, the doctor is not allowed any mistakes. Any.

The last means that if a doctor doesn't have enough info to be able to defend his diagnosis in court against an ignorant jury and a biased "expert opinion", he needs more info, and thus more and more tests, until the counter diagnoses are eliminated.

To offer a guess, what makes the Canadian and European systems more "successful" (a qualified success, for agruments sake) isn't any virtue that they possess, but the culture of those countires and their expectations of what is possible.

The US has a very strong feeling of "entitlement", and I'm not just talking about Social Security and welfare, here. We feel entitled that every product that we buy is 100% safe, and if it isn't, we are entitled to a retrospective replacement, even if the manufacturer was just as ignorant of the design flaw as we were when we bought it. And that's 100% 99.995% is not good enough. If an injury occurs because some aspect of the design didn't account for an unlikely use in a particular way to increase a chance of failure, the product must be recalled. Get served coffee that is "dangerously hot" (above the "expected" hot-ness), and collect $50,000.

Changing the culture of a nation is tough, and momentum does not favor making the necessary change. So torte reform will also have to be at the heart of the healthcare reform.

=====

I wish I had the answer. I wish Sentient had the answer. But I just don't think that this is it. A valiant effort, and one worth exploring more. But it still doesn't solve the Fundimental Flaws.

 
 
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May 14, 2009
Well, Sentient, I think we may have finally plumbed the depth of why our line of discussion will not lead to anywhere in particular.

You have admitted that you can't trust a Canadian to expose the difference between truthful and false claims about the Canadian health care system. I, for instance, know the difference between an isolated health care horror story/outlier and complete fabrication/nonsense (see my earlier) -- but of course that knowledge is useless to you if you do not believe that I know the difference -- or you believe that I am not telling the truth because I am attempting to "sell" you something.

And you have admitted that you do not trust your elected officials to fairly distinguish truth from falsehood under the same heading -- and, by inference, you do not trust the academic community -- nor anyone else -- to tell you the truth about other national health care distribution systems.

So yes, that level of self-confessed cynicism pretty well obliges you to come up with your own, independent, self-verified solution.

The only problem I can see with that is this:

If you manage to come up with a good solution independently, who would you trust to implement it and keep it running efficiently? Keeping in mind that there is NO solution that does not require the active participation and support of your elected representatives at the State and Federal level.

Webster

 
 
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May 14, 2009
I hesitate to raise the cliche about 'reinventing the wheel", but I think most would agree that developing a comprehensive understanding of health care delivery systems employed by other industrialized nations would be a good first step to finding ways to improve the US system -- particularly since America is the only industrialized nation whose health care system does not provide "universal access" -- and this is the principal point of criticism/weakness of the current US health care system.

This being seen as logical, possibly you will understand why I objected to dismissive and ill informed references to the systems employed in other nations -- particularly that of your immediate neighbour to the north.

Wikipedia is a fairly good and reliable source of information on this sort of topic. For instance, see http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

What follows is simply a snippet from this particular Wiki link ....

"The governments of both nations are closely involved in health care. The central structural difference between the two is in health insurance.

In Canada, the federal government is committed to providing funding support to its provincial governments for health care expenditures as long as the province in question abides by accessibility guarantees as set out in the Canada Health Act, which explicitly prohibits billing end users for procedures that are covered by Medicare.

While some label Canada's system as "socialized medicine," the term is inaccurate. Unlike systems with public delivery, such as the UK, the Canadian system provides public coverage for private delivery.

As Princeton University health economist Uwe E. Reinhardt notes, single-payer systems are not "socialized medicine" but "social insurance" systems, because doctors are in the private sector.

Similarly, Canadian hospitals are controlled by private boards and/or regional health authorities, rather than being part of government."

Webster

 
 
May 14, 2009
@Sentient:

I'm familiar enough with databases to know that what is needed is indeed technically possible. I only used the "benevelant god manager" to stiffle any criticism of their existence. Whether one db or two is irrelevent, for they will share many properties:
- They will be keyed on the same fields (Patient_ID, Biometric_Info)
- They will have many shared fields (DOB, Addr)
- They will need have audit trails, logging each time a record was viewed, and by whom
- This requires the need for security, yet the records willl also be accessable to a large number of people, many of very low rank. The MedDB, by any med tech or LVN; the InsDB by any clerk in any office in any insurer.
- There will be a "Bill of Rights" to allow the patient to, for example, access the audit trail on the patients records, so that, for example, Angelina Jolie can know who to sue when her sonogram gets posted on the web.

And getting stakeholder buy-in will be a non-trival task. Consider the following:
- Each DB will need a key field; a "national ID number" if you will. Oh me, oh my, Big Brother is Watching. Ogga-booga.
- The InsDB contains biometric info, so that the hospital can treat you in the ER without ID. It is mandated that everyone have insurance, therefore everyone will have their biometric data in the database. Can Law Enforcement access it? The plus side is that they could find your killer this way. The bad side is, they can find you if you commit a crime.
- The MedDB could contain DNA info. Again, could LEOs access it? Again, there's a benefit: Police find blood on a crime scene - they know that you're the one who's injured, and can make a more effective search. Also, if a crime is committed, and you are tagged as a "1-in-a-billion" match, you might be able to query the DB to find the other 6 people on the planet that also match, and who DID commit the crime you are accused of.

Lots of ethical questions. Add in topics like "illegal aliens", "identity theft" and you can see that President Obama will finish his second term before the DBs are in place. And they are the foundation to the rest of the plan.

I've finished my critique of your Plan, but I want to mull it over a bit. I'll post it at lunchtime.
 
 
May 13, 2009
@ Sentient:

Thanks for the replies. I almost see what you see. I try to do this with everyone, but sometimes the noise on comments board make it hard. But you showed that (unlike some regular posters (who didn't quite get voted off the island)) you are willing to discuss, and not just spout platitudes (again, Webster's main complaint).

Just a few more points: I want to clear up in my mind: No need to quote the whole text, the number is sufficient (I wish we had better control of our text on this site. Just to be able to BOLD the text would be nice.):


Q7) How will the Coverage be tracked?
Currently I carry my insurance card in my wallet. If I'm mugged (and why I'm winding up in the hospital), I have no ID, no proof of insurance. Under the current rules, the hospital takes care of me first, and gets my insurance info after the fact. In your system, could I be turned away or denied treatment, just because someone took my card? Or do you envision (as the President perhaps does) of a national database with both insurance info and medical history, with my biometric data for the ER MD & RN to ID me? If so, this should be in place first, before your reforms start. Again, we'll ignore the red-herring / sideshow / distracting noises of Privacy, hacking, security, validity of info. Assume a perfect database, maintained by a benevelant god, if that's where you're heading.


Q8) You say "Everything is covered including ...., chiropractic,.... and many natural or non-traditional remedies". The word "many" instead of "all" implies (to me) that someone, somewhere, is deciding what does and does not have to be included.
>> True statement?<<


There are some crackpots out there, with pretty wild techniques. Some even dangerous.

My guess:
Covered: Chiroproctic, Accupuncture
Not covered: Crystal Therapy, Christian Scientist Priests (providing prayer only)
What about: Reiki? Aromatherapy? Acai? Penis enlargment?


I think I'll leave this post with "penis enlargement". Seems appropriate for a Scott Adams blog. Look forward to your reply.

 
 
May 13, 2009
@Aardwizz

I truly admire the sincere effort you are putting into having a calm and reasoned discussion on the differences of opinion evident in this exchange.

However, on the subject of whether a 'reformed' American health care system should allow the uninsured to curl up and die in the emergency room waiting room, I have to agree with your original assessment. That is an "insane" concept. Truly scary. But thank you for bringing it to the surface.

Webster
 
 
May 13, 2009
RE: "ERs can refuse the non-covered":

I can see several solutions:
1) For tourists, etc. In my youth, there were machines in airports that allowed you to buy life insurance in the event the plane went down. A quick policy, with a short time duration for a small price. A similar kiosk could be set up at the Customs terminals.

2) Even though "required" to have insurance, some drivers (and no doubt some sick people) will not. They could be forced to buy insurance (i.e., assigned to an insurer), and be required to pay ??THREE YEARS?? in back premiums. (number subject to law and number of abusers), in ADDITION to any other fines / prison terms / that being in violation of the law would incur.
 
 
May 13, 2009
Q6) Like the mandated Auto insurance, I can choose one of several plans. For simplicity's sake, let's make it 3:
Plan A - Low deductible, high premium.
Plan B - High deductible, low premium.
Plan C - Medium deductible, medium premium.

Q6A) - Would a heath insurance co be allowed to make the same offering to its clients', provided they followed all the rest of the rules of (a) no exclusions and (b) same rate for the plan?
Q6b) - If the Gov't is paying or helping pay for someone to be a plan, does it get a say in which plan (i.e., low premium) is picked, or does it just pay for "basic coverage", and if the client wants to go with the "better" plan (low deductible) he pays the difference out-of-pocket?
 
 
May 13, 2009
@Sentient:

Before I critique/criticize your plan, I want to make sure I understand it first. (Something that I wish the more partisan members of Congress practiced.
http://news.yahoo.com/s/ap/20090513/ap_on_go_pr_wh/us_health_overhaul )

Your basic premises are clear, simple and straightforward.


Q1) By your execution plan, you envision the US Gov't getting out of the INSURANCE business, but may (if I'm following you right) still be in the Insurance PAYING business. That is, they may, as required, pay the insurance premiums for certain (groups of) individuals, but they will no longer reimburse medical practitioners for providing care.
>> Is this an accurate statement ?? <<

Q2) In order to ensure that Everyone has insurance, the government will create rules that effectively mean that no resident of the US can be denied insurance. The specific rules may be subject to debate, but the principle is that no one can be denied. Nor can someone be "forced" out by the moral equivalent of a Poll Tax - any plan an insurance company has, will have the same rate for everyone in that plan.
>> Is this an accurate statement ?? <<

Q3) All health care providers must accept payment from all insurance companies. This is a logical consequence of your rule that all insurance companies must allow the patient to pick any practitioner.
>> Do you agree with this assessment? <<

Q4) The Government will pay all or part of the premiums for the following groups of people that they have committed to pay for in the past:
- Veterans (disabled and not)
- Retirees (who will not have employers to help with the cost)
- Federal Workers (the Gov't sets the example to employers by buying its employees insurance)
- The Disabled (those who cannot work)
- The "Poor" (who cannot otherwise afford it). The term "poor" may need better definition, and I would expect much side-show arguments on this provision. But by your plan, the poor's payments are made by the Gov't.
>> Do you agree with the concept and the list. Did I include or miss someone?

Q5) I did not follow how the states would get involved in this. It seems like you are looking for private insurers to be the sole payer of all medical expenses. Or is Q4 to be administered by the States, but payed for by (contributions from) the Fed? I live in one State, but work in another (State taxes are a PITA). Which State's rules/money would affect me? Please clarify this relationship.


 
 
May 13, 2009
@Sentient asked ... "How, exactly, do you *know* that the two *specific* incidents spoken of by Carpe Geekem are "fabricated", "lies" and "distortions", "utter nonsense"?"

I know because I live in Canada and use the health care system. As do my family, friends, neighbours and employees. And my brother is a specialist with a very successful 25 year practice. He doesn't drive a Lada, by the way.

Webster
 
 
May 13, 2009
@ Sentinel:

I look forward to hearing your plan. I'm especially interested to see if it matches the expectation that the public has for health care that I put in my last post:
* Everyone is included (i.e., "I'm included", no mater who *I* is).
* All care is covered. And that includes:
- - - Problems that I brought upon myself
- - - Problems for someone for whom, if born in a different era, or if they didn't have unlimited resources, would be dead.
- - - "Alternative" treatment (no matter how "unscientific" - after all, "I know someone for whom this worked....")
- - - Bonus points for covering mental problems
* The cost is low and/or non-existent (or at least hidden) to
- - - me ("me, my familyu and my heirs shouldn't be bankrupted" by an act of God)
- - - my employer ("Insurance is what makes US uncompetetive in the global marketplace"
- - - the government ("my taxes are already too high")

Good luck. This is perscription for "Something for nothing". Seems impossible to me, but that how the debate is currently framed. (NOTE: I don't agree with all of the arguments above; they are just the most common in the debate. Any solution should find a way to silence the debaters if it can't satisfy them.).

====

Per Webster, let's agree to drop the use of the word "Socialism" and it's variations. Even if it may be an apt description, the word is too emotionally charged to lend itself to calm discourse. The Nazis were Socialists.

I accept that you are libertarian in principle, and prefer a smaller, non-intrusive government. I have similar leanings, but recognize that a larger government agency IS the best solution. I am NOT saying that this is true in this case, but am open to the possibility that it MAY be. If you cannot agree with that, then the discourse may be over, except where you can show me why it is not the best solution. But I'll admit to being prejudiced against you, because of your admitted closed-mindedness.

Just to show you that all government programs aren't evil, I present one example - the much-maligned post office.
This morning, I went to the end of my driveway and put a piece of paper in a box conveniently located there. For a whopping 44 cents, that paper will be in my sister's hands, 2000 !$%*! away, the day after tomorrow. No other entity could do this for this little. Yes, sometime letters get lost. But I've had more misdirected luggage in my life than misdirected mail.

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RE: Your comments:
I accept your definition of rationing. It matches what I said.
I used the phrase "red herring" in the same context that Webster used it when using the word "Socialism" - that the phrase itself carries with it such an emotional charge that reason can be lost.
Red = seeing red (i.e., acting without reason).
Herring = Bait. cf. "Red baiting"

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Yes, the pharmacist agreed to the insurance co. price. So why then did he submit the $151 amount? If the McDonald's counterperson asked me for $5 for a $2.99 Big Mac, I could have her fired, and rightly so, even if she agreed that it was only $2.99.
My point was, someone is out of money on the transaction, just as merchants lose profit when you pay by credit card instead of cash. Agreeing to pay AMEX 4% is "part of the cost of doing business", and worth the extra traffic that accepting that card brings. Some don't think so, and so don't accept them.
In a Universal plan, especially one that will prevent abuse, SOMEONE is going to set a price for a service. The questions are: (a) Who? (b) How? and (c) Will it be "enough"?

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I've also heard what you say (slowness, at least) about Medicare, but don't know much more about it. I'm intending to stick only to what I know in these discussions. I know nothing about the Canadian Healthcare system, so cannot comment.

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You are correct, the government does have to run (in the long run) at a zero-sum. My point was that the FEEs for a service are not the sole part of the budget. The rest is "hidden" in the form of general taxes. That's part of the debate, an part of the "low or non-existent" cost bullet point above. In theory, we could create a system that has low out-of-pocket costs, but results in high taxes. Or we could have a higher out-of-pocket cost, with lower taxes. Or have low out-of-pocket, and low taxes, but then lower the services rendered (do we need to do an MRI when someone comes in with a sprained ankle, just because the sprain MAY result in a life-threatening embolism?)

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I look forward to your post.
 
 
May 13, 2009
@Aardwizz

"What's wrong?"

The Canadian and American health care systems are more alike than different -- they are BOTH "insurance" models.

The American insurance model is not working to the satisfaction of tens of millions of Americans because the private, for profit insurance model is unable to accommodate [unless obliged by government (the people) to do so] the concept of fair and affordable universal access.

"How to fix it?"

The US government (the people) must find a way to alter the American health care insurance model in a fashion that obliges it to accommodate the concept of fair and affordable universal access. The Canadian system represents one way of doing that. There are many other examples of workable solutions around the world. Pick one ... and go for it.

Webster


 
 
May 13, 2009
@Sentient

I will make one last effort to assist you with your reading comprehension issues.

You asked me: "Do you really, truly believe that characterizing the Canadian system as socialistic is spreading lies and distortions"

No, I really, truly don't give a damn what your definition of socialism includes. Senator Joe McCarthy accused Canada of being a communist country. Canadians are still chuckling over that.

By the way, Uncle Joe was a "red baiter", not a "red herring". I mention this because it is the meaning of of the phrase "red herring" that you seem to be struggling with.

Anyway, if you re-read my comments, you may notice that the 'distortions and lies" referred to the following nonsense spouted by Carpe Deekem ....

-------------------------------------------------------------------------------------------------------------------------------------------------------

"The Canadian health care system didn't permit her to switch doctor ...

His average wait to see a specialist is A YEAR AND HALF, and in the interim he receives no treatment of any kind, because only a specialist is allowed to treat him ...

The Canadian health care system, like all similar systems, pays specialists too little for it to be worth their while to train in a specialty, leading to horrible shortages of specialists and insane wait times."

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Webster

 
 
 
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